Difference between revisions of "Basti"

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{{#seo:
 
{{#seo:
 
|title=Basti(therapeutic enema)
 
|title=Basti(therapeutic enema)
 
|titlemode=append
 
|titlemode=append
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|keywords=Basti, Basti meaning, Basti defination, Basti in ayurveda, uttar basti,basti Indication, Niruaha, Anuvasana, Charak samhita,carakasamhitaonline, Indian System of Medicine, enema
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|keywords=Basti, Basti meaning, Basti definition, Basti in ayurveda, uttar basti, basti Indication, Niruaha, Anuvasana, Charak samhita, carakasamhitaonline, Indian System of Medicine, enema, therapeutic enema, benefits of basti, benefits of enema, decoction enema, unctuous enema, panchakarma
 
|description='basti' is applied to indicate therapeutic enema among panchakarma
 
|description='basti' is applied to indicate therapeutic enema among panchakarma
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|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg
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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
 
|image_alt=carak samhita
 
|image_alt=carak samhita
 
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|type=article
 
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<p style='text-align:justify;'>The word ‘basti’ denotes therapeutic procedure of enema. It is one of the five purification procedures ([[panchakarma]]). Basti also spelled as vasti, literally means bladder or an injection-syringe made of bladder or injection itself.<ref>Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Vasti, Page 933</ref> In anatomical perspective, the urinary bladder is called as basti. In ancient times, the bladder of animals (mainly goat or buffalo) was used to administer enema therapy, hence the therapy is knows as ‘basti’. [A.S.Sutra Sthana 28/2]<ref name= Sangraha> Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.</ref> It is the best treatment for disorders of [[vata dosha]]. [Cha.Sa. [[Sutra Sthana]] 25/40]. Due to the primary importance of [[vata dosha]] in causing diseases, basti is considered as the chief treatment among [[panchakarma]]. [Su.Sa.Chikitsa Sthana 35/3]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>
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<br/>
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In therapeutic management, it denotes medicated enema with decoction, oils or any other fluid either in rectum or urethra or vagina. The term ‘uttara basti’ is used for enema given through anterior orifice like urethra or vagina. In unction therapy, local therapeutic procedures like keeping warm oils or medicated substance on affected body part are used. These procedures are termed after name of affected part as suffix to the word ‘basti’. E.g. ‘janu basti’ means keeping warm medicated substance on knee joint; ‘kati basti’ means keeping it on the lumbar region. Most commonly, the term ‘basti’ indicates per rectal enema. Hence this article focuses on therapeutic enema given per rectum.
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</p>
 
{{Infobox
 
{{Infobox
  
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|label2 = Authors
 
|label2 = Authors
−
|data2 = Aneesh E.G., Deole Y.S.
+
|data2 = Aneesh E.G., [[Yogesh Deole|Deole Y.S.]]
  
 
|label3 = Reviewed by  
 
|label3 = Reviewed by  
−
|data3 = Basisht G.
+
|data3 = [[Gopal Basisht|Basisht G.]]
  
 
|label4 = Affiliations
 
|label4 = Affiliations
−
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar  
+
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar  
  
 
|label5 = Correspondence email:
 
|label5 = Correspondence email:
 
|data5 = carakasamhita@gmail.com
 
|data5 = carakasamhita@gmail.com
  
−
|label6 = Date of first publication:
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|label6 = Publisher
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|data6 = December 12, 2020
+
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
−
|label7 = DOI
+
 
−
|data7 =  Under process
+
|label7 = Date of first publication:
 +
|data7 = December 12, 2020
 +
 
 +
|label8 = DOI
 +
|data8 =  [https://doi.org/10.47468/CSNE.2020.e01.s09.034 10.47468/CSNE.2020.e01.s09.034]
 
}}
 
}}
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<div style='text-align:justify;'>
 
−
The word ‘basti’ denotes therapeutic procedure of enema. It is one of the five purification procedures ([[panchakarma]]). Basti also spelled as vasti, literally means bladder or an injection-syringe made of bladder or injection itself.<ref>Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Vasti, Page 933</ref> In anatomical perspective, the urinary bladder is called as basti. In ancient times, the bladder of animals (mainly goat or buffalo) was used to administer enema therapy, hence the therapy is knows as ‘basti’. [A.S.Sutra Sthana 28/2]<ref name= Sangraha> Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.</ref> It is the best treatment for disorders of [[vata dosha]]. [Cha.Sa. [[Sutra Sthana]] 25/40]. Due to the primary importance of [[vata dosha]] in causing diseases, basti is considered as the chief treatment among [[panchakarma]]. [Su.Sa.Chikitsa Sthana 35/3]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>
 
−
 
−
In therapeutic management, it denotes medicated enema with decoction, oils or any other fluid either in rectum or urethra or vagina. The term ‘uttarabasti’ is used for enema given through anterior orifice like urethra or vagina. In unction therapy, local therapeutic procedures like keeping warm oils or medicated substance on affected body part are used. These procedures are termed after name of affected part as suffix to the word ‘basti’. E.g. ‘janubasti’ means keeping warm medicated substance on knee joint; ‘katibasti’ means keeping it on the lumbar region. Most commonly, the term ‘basti’ indicates per rectal enema. Hence this article focuses on therapeutic enema given per rectum.
 
  
 
==Etymology and derivation==
 
==Etymology and derivation==
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+
<div style='text-align:justify;'>
 
The word ‘basti’ is derived from the root ‘vas’ with suffix ‘tich’. ‘Vas’ is having the following meanings  
 
The word ‘basti’ is derived from the root ‘vas’ with suffix ‘tich’. ‘Vas’ is having the following meanings  
 
*to reside or to stay or to dwell
 
*to reside or to stay or to dwell
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===On the basis of procedure===  
 
===On the basis of procedure===  
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#Enema with decoctions (Niruhabasti)
+
#Enema with decoctions (Niruha basti)
−
#Enema with unctuous substances (Anuvasanabasti)
+
#Enema with unctuous substances (Anuvasana basti)
 
#Enema through urethral or vaginal route (Uttarabasti)[Cha.Sa.[[Siddhi Sthana]] 10/8]
 
#Enema through urethral or vaginal route (Uttarabasti)[Cha.Sa.[[Siddhi Sthana]] 10/8]
  
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The basti can be broadly classified into internal and external based on the site of administration
 
The basti can be broadly classified into internal and external based on the site of administration
  
−
====Internal====
+
==== Internal ====
−
#Administered into colon through anal route (Pakvashayagatabasti)
+
 
−
#Administered into uterus through vagina (Garbhashayagatabasti)
+
#Administered into colon through anal route (pakvashayagata basti)
−
#Administered into urinary bladder through urethra (Mutrashayagatabasti)
+
#Administered into uterus through vagina (garbhashayagata basti)
−
#Administered over wounds for cleaning purpose (Vranabasti) [Su.Sa.Chikitsa Sthana 35/11]<ref name=Susruta/>
+
#Administered into urinary bladder through urethra (mutrashayagata basti)
 +
#Administered over wounds for cleaning purpose (vrana basti) [Su.Sa.Chikitsa Sthana 35/11]<ref name=Susruta/>
  
−
====External====
+
==== External====
  
−
Medicated oils are retained over particular body part for a specific duration. E.g. Medicated oil retained over knee (janubasti), medicated oil retained over lumbar region (katibasti) etc.
+
Medicated oils are retained over particular body part for a specific duration. E.g. Medicated oil retained over knee (janu basti), medicated oil retained over lumbar region (kati basti) etc.
  
 
===On the basis of pharmaco-therapeutic action===
 
===On the basis of pharmaco-therapeutic action===
  
 
The enema therapy is classified based onthe pharmaco-therapeutic activity of its ingredients.  
 
The enema therapy is classified based onthe pharmaco-therapeutic activity of its ingredients.  
−
#[[Dosha]] aggravating enema (Utkleshanabasti)
+
#[[Dosha]] aggravating enema (utkleshana basti)
−
#[[Dosha]] purificatory enema (Shodhanabasti)
+
#[[Dosha]] purificatory enema (shodhana basti)
−
#[[Dosha]] pacifying enema (Shamanabasti)[Sha.Uttarardha.6/17-19]<ref name= Shargadara> Sharangadhara. Sharangadhara Samhita. Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Chaukhambha orientalia;2016.</ref>
+
#[[Dosha]] pacifying enema (shamana basti)[Sha.Uttarardha.6/17-19]<ref name= Shargadara> Sharangadhara. Sharangadhara Samhita. Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Chaukhambha orientalia;2016.</ref>
  
 
===On the basis of number of basti===
 
===On the basis of number of basti===
  
 
The enema therapy is classified based on specific schedule and sequential sessions based on the severity of pathogens ([[dosha]] and [[dushya]]).  
 
The enema therapy is classified based on specific schedule and sequential sessions based on the severity of pathogens ([[dosha]] and [[dushya]]).  
−
#Karma basti: Total 30 basti sessions with 12 decoction (niruha) and 18 unctuous (anuvasanabasti)
+
#Karma basti: Total 30 basti sessions with 12 decoction (niruha) and 18 unctuous (anuvasana basti)
−
#Kala basti: Total 16 basti sessions with 06 decoction (niruha) and 10 unctuous (anuvasanabasti)
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#Kala basti: Total 16 basti sessions with 06 decoction (niruha) and 10 unctuous (anuvasana basti)
−
#Yoga basti: Total 8 basti sessions with 3 decoction (niruha) and 5 unctuous (anuvasanabasti)[Cha.Sa.[[Siddhi Sthana]] 1/47-49]
+
#Yoga basti: Total 8 basti sessions with 3 decoction (niruha) and 5 unctuous (anuvasana basti)[Cha.Sa.[[Siddhi Sthana]] 1/47-49]
  
 
===On the basis of total quantity===
 
===On the basis of total quantity===
  
−
Some enemas are known by their total quantity of ingredients. The measurement ‘prasruta’ (one prasruta = 96 ml) is used to calculate proportion of ingredients and total quantity of enema.  The maximum allowable dosage of decoction enema is 1152ml (12 prasruta). The dosage 1 prasruta is considered as 96 ml as per Ayurvedic Formulary of India. Posology varies from person to person according to Ayurveda. Here ‘prasruta’ is defined as the dosage of liquid in the patient's hollowed palm. [Gayadasa on Su.Sa.Chikitsa Sthana 35/7]<ref name=Susruta/> In a study conducted on 100 participants, one prasruta of Madhutailikabasti (a type of decoction enema) is standardized as 26.4ml.<ref>Singh Nita S. An open clinical trial to assess samyak nirooha lakshana of maadhutailika vasti administered with standardized aaturahastapramaana in kat’eegraha [MD Dissertation]. Kottakkkal: Kerala University of Health Sciences; 2015.</ref>
+
Some enemas are known by their total quantity of ingredients. The measurement ‘prasruta’ (one prasruta = 96 ml) is used to calculate proportion of ingredients and total quantity of enema.  The maximum allowable dosage of decoction enema is 1152ml (12 prasruta). The dosage 1 prasruta is considered as 96 ml as per Ayurvedic Formulary of India. Posology varies from person to person according to Ayurveda. Here ‘prasruta’ is defined as the dosage of liquid in the patient's hollowed palm. [Gayadasa on Su.Sa.Chikitsa Sthana 35/7]<ref name=Susruta/> In a study conducted on 100 participants, one prasruta of Madhutailika basti (a type of decoction enema) is standardized as 26.4ml.<ref>Singh Nita S. An open clinical trial to assess samyak nirooha lakshana of maadhutailika vasti administered with standardized aaturahastapramaana in kat’eegraha [MD Dissertation]. Kottakkkal: Kerala University of Health Sciences; 2015.</ref>
  
 
A few examples are as follows:
 
A few examples are as follows:
−
*Twelve prasruta (1152 ml) termed as ‘Dwadasaprasrutikabasti’
+
*Twelve prasruta (1152 ml) termed as ‘Dwadasaprasrutika basti’
−
*Nine prasruta (864ml )termed as ‘Navaprasrutabasti/padahinabasti’
+
*Nine prasruta (864ml )termed as ‘Navaprasruta basti/padahina basti’
−
*Five prasruta (480 ml) termed as ‘Pachaprasrutikabasti’
+
*Five prasruta (480 ml) termed as ‘Pachaprasrutika basti’
  
 
===Based on the chief ingredient===
 
===Based on the chief ingredient===
  
 
Some enemas are known by their chief ingredient. A few examples are as follows:  
 
Some enemas are known by their chief ingredient. A few examples are as follows:  
−
*Enema with equal quantity of honey and oil is termed as ‘Madhutailikabasti’
+
*Enema with equal quantity of honey and oil is termed as ‘Madhutailika basti’
−
*Presence of alkali in enema is termed as ‘Ksharabasti’
+
*Presence of alkali in enema is termed as ‘Kshara basti’
−
*Milk used as main ingredient in enema is termed as ‘Kshirabasti’
+
*Milk used as main ingredient in enema is termed as ‘Kshira basti’
  
−
==Niruhabasti (enema with decoction)==
+
==Niruha basti (enema with decoction)==
  
−
The medicated enema with decoction of herbs as main ingredient is called ‘niruhabasti’. It is also known as ‘kashayabasti’. The word ‘niruha’ indicates its extensive therapeutic potency. As it stabilizes (sthapana) the [[dosha]], it is also known as ‘asthapanabasti’. [A.S.Sutra Sthana 28/6]<ref name=Sangraha/>
+
The medicated enema with decoction of herbs as main ingredient is called ‘niruha basti’. It is also known as ‘kashaya basti’. The word ‘niruha’ indicates its extensive therapeutic potency. As it stabilizes (sthapana) the [[dosha]], it is also known as ‘asthapana basti’. [A.S.Sutra Sthana 28/6]<ref name=Sangraha/>
  
 
===Indications===
 
===Indications===
  
−
Based on [[dosha]]
 
 
*Aggravated conditions of [[vata dosha]]
 
*Aggravated conditions of [[vata dosha]]
 
*Aggravation of [[vata]] associated with other [[dosha]][A.H.Sutra Sthana 19/1]<ref name= Hridaya > Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>
 
*Aggravation of [[vata]] associated with other [[dosha]][A.H.Sutra Sthana 19/1]<ref name= Hridaya > Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>
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===Contraindications===
 
===Contraindications===
 
   
 
   
−
Niruha enema is contraindicated in following conditions:
+
Niruha basti is contraindicated in following conditions:
 +
 
 
*Extremely weak and debilitated patients[Cha.Sa.[[Siddhi Sthana]] 1/37]
 
*Extremely weak and debilitated patients[Cha.Sa.[[Siddhi Sthana]] 1/37]
 
*Immediately after any other purificatory procedure like therapeutic emesis or purgation [Cha.Sa.[[Siddhi Sthana]] 1/37]
 
*Immediately after any other purificatory procedure like therapeutic emesis or purgation [Cha.Sa.[[Siddhi Sthana]] 1/37]
 
*Breathing difficulty, cough, skin diseases (kushtha), diabetes (madhumeha) etc.[Cha.Sa.[[Siddhi Sthana]] 2/14]
 
*Breathing difficulty, cough, skin diseases (kushtha), diabetes (madhumeha) etc.[Cha.Sa.[[Siddhi Sthana]] 2/14]
  
−
===Ingredients of niruha enema formulation===
+
===Ingredients of niruha basti formulation===
  
−
The predominant content of niruhabasti is a decoction of herbs. It also contains honey, rock salt, unctuous substance (usually oil or ghee) and medicinal paste (kalka). In some conditions, cow’s urine, fermented liquid preparation out of grains (danyamla), meat soup, milk etc. are used instead of decoction.
+
The predominant content of niruha basti is a decoction of herbs. It also contains honey, rock salt, unctuous substance (usually oil or ghee) and medicinal paste (kalka). In some conditions, cow’s urine, fermented liquid preparation out of grains (dhanyamla), meat soup, milk etc. are used instead of decoction.
  
 
===Quantity of ingredients===
 
===Quantity of ingredients===
  
−
The general dosage of ingredients for 1152ml (dvadashaprasruta) basti are as follows. While preparation, the ingredients are mixed in the specific sequence and quantity as given below:  
+
The general dosage of ingredients for 1152 ml (dvadasha prasruta) basti are as follows. While preparation, the ingredients are mixed in the specific sequence and quantity as given below:  
 
#Honey:  192 ml (2 prasruta)
 
#Honey:  192 ml (2 prasruta)
−
#Rock salt (saindhava): 12gram (1 karsha)
+
#Rock salt (saindhava): 12 gram (1 karsha)
 
#Oil/ghee/unctuous substance (sneha): 288 ml (3 prasruta)
 
#Oil/ghee/unctuous substance (sneha): 288 ml (3 prasruta)
 
#Medicinal paste (kalka): 96 gram (1 prasruta)
 
#Medicinal paste (kalka): 96 gram (1 prasruta)
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The proportion of unctuous substance and honey changes based on the predominance of [[dosha]] in diseases. It is as shown below in table 1.
 
The proportion of unctuous substance and honey changes based on the predominance of [[dosha]] in diseases. It is as shown below in table 1.
 +
 
{| class="wikitable"
 
{| class="wikitable"
 
|+ Table 1: [[Dosha]] specific proportion in basti formulation  
 
|+ Table 1: [[Dosha]] specific proportion in basti formulation  
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!  !! [[Vata dosha]] !! [[Pitta]] [[dosha]] !![[Kapha]] [[dosha]]
 
!  !! [[Vata dosha]] !! [[Pitta]] [[dosha]] !![[Kapha]] [[dosha]]
 
|-
 
|-
−
| | Honey  || 144ml (3 pala) || 192ml (4 pala) ||288ml (6 pala)
+
| | Honey  || 144 ml (3 pala) || 192 ml (4 pala) ||288 ml (6 pala)
 
|-
 
|-
−
| | Unctuous Substance || 288ml (6 pala) || 192ml (4 pala)  || 144ml (3 pala)
+
| | Unctuous Substance || 288 ml (6 pala) || 192 ml (4 pala)  || 144 ml (3 pala)
 
|-
 
|-
 
|}
 
|}
 
[Cha.Sa.[[Siddhi Sthana]] 3/30]
 
[Cha.Sa.[[Siddhi Sthana]] 3/30]
  
−
===Dose of niruhabasti in different age groups===
+
===Dose of niruha basti in different age groups===
  
 
The dose of basti formulation changes as per the age. It is shown in table 2.  
 
The dose of basti formulation changes as per the age. It is shown in table 2.  
 +
 
{| class="wikitable"
 
{| class="wikitable"
 
|+ Table 2: Age specific dosage of basti formulation   
 
|+ Table 2: Age specific dosage of basti formulation   
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! Age  !! Dosage of basti  
 
! Age  !! Dosage of basti  
 
|-
 
|-
−
| | 1 year || 48ml (½ prasruta)
+
| | 1 year || 48 ml (½ prasruta)
 
|-
 
|-
−
| |Increase the dosage by 48ml (½ prasruta) each year till 12 years
+
| |Increase the dosage by 48 ml (½ prasruta) each year till 12 years
 
|-
 
|-
−
| | 12 year || 576ml (6 prasruta)
+
| | 12 year || 576 ml (6 prasruta)
 
|-
 
|-
−
| |Increase the dosage by 96ml (1 prasruta) each year till 18 years
+
| |Increase the dosage by 96 ml (1 prasruta) each year till 18 years
 
|-
 
|-
−
| | 18 year and above until age 70 || 1152ml (12 prasruta)
+
| | 18 year and above until age 70 || 1152 ml (12 prasruta)
 
|-
 
|-
−
| | Above 70 year ||960ml (10 prasruta)  
+
| | Above 70 year ||960 ml (10 prasruta)  
 
|-
 
|-
 
|}
 
|}
 
[Cha.Sa.[[Siddhi Sthana]] 3/31-32]
 
[Cha.Sa.[[Siddhi Sthana]] 3/31-32]
  
−
===Method of preparation of decoction enema===
+
=== Method of preparation of niruha basti (decoction enema) ===
  
 
The decoction enema is a combination of many ingredients as mentioned above. These ingredients should be mixed in a specific sequence to formulate homogenous mixture and achieve maximum therapeutic efficacy. The sequence of mixing of decoction enema is as follows.  
 
The decoction enema is a combination of many ingredients as mentioned above. These ingredients should be mixed in a specific sequence to formulate homogenous mixture and achieve maximum therapeutic efficacy. The sequence of mixing of decoction enema is as follows.  
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===Therapeutic procedure of administration===
 
===Therapeutic procedure of administration===
 
    
 
    
−
The procedure of niruhabasti is done as a daily session of administration of enema. Procedure of a single session is described as below:  
+
The procedure of niruha basti is done as a daily session of administration of enema. Procedure of a single session is described as below:  
−
*Pre therapeutic (Purvakarma)
 
−
*Therapeutic (Pradhanakarma)
 
−
*Post therapeutic (Pashchatkarma)
 
  
−
====Pre therapeutic (purvakarma)====
+
*Pre therapeutic procedure (purva karma)
 +
*Therapeutic procedure (pradhana karma)
 +
*Post therapeutic procedure (pashchat karma)
 +
 
 +
====Pre therapeutic procedure (purva karma)====
  
 
On the day of administration, patient is advised to pass natural urges and should not be hungry. [Cha.Sa.[[Siddhi Sthana]] 3/17] Local massage with oil and sudation is done over abdomen, low back, gluteal region and thighs of the patient. The enema mixture is prepared and filled into the basti apparatus (basti yantra). In current clinical practices, two types of basti apparatus are used to administer decoction enema.  
 
On the day of administration, patient is advised to pass natural urges and should not be hungry. [Cha.Sa.[[Siddhi Sthana]] 3/17] Local massage with oil and sudation is done over abdomen, low back, gluteal region and thighs of the patient. The enema mixture is prepared and filled into the basti apparatus (basti yantra). In current clinical practices, two types of basti apparatus are used to administer decoction enema.  
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The enema formulation is filled in the basti bag or enema pot. Then the medicine is passed through catheter to remove air bubbles.
 
The enema formulation is filled in the basti bag or enema pot. Then the medicine is passed through catheter to remove air bubbles.
  
−
====Therapeutic (pradhanakarma)====
+
====Therapeutic procedure (pradhana karma)====
 
   
 
   
 
Patient is advised to lie in left lateral position with left leg extended and flex the right leg at knee and hip. The anal orifice and the basti nozzle or catheter are lubricated with oil. Then the basti nozzle or catheter is inserted slowly and gently through the anal canal.  
 
Patient is advised to lie in left lateral position with left leg extended and flex the right leg at knee and hip. The anal orifice and the basti nozzle or catheter are lubricated with oil. Then the basti nozzle or catheter is inserted slowly and gently through the anal canal.  
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In the enema pot method, the filled enema pot is kept at a certain height to allow passage of enema medicine. The flow and pressure can be regulated with a knob on the tube.
 
In the enema pot method, the filled enema pot is kept at a certain height to allow passage of enema medicine. The flow and pressure can be regulated with a knob on the tube.
 
   
 
   
−
After all enema medicine is in the rectum, the patient is advised to lie in supine position till he feels the urge for defecation. When the patient feels the urge, it shall pass. The time duration the administration of medicine and its evacuation is called as retention enema. The decoction enema is expected to come out within 48 minutes after administration. In a study, the retention time of enema with alkali (ksharabasti) in maximum number of participants (60%) is reported to be 5 minutes.<ref name=Thanki>Thanki K, Bhatt N, Shukla VD. Effect of kshara basti and nirgundi ghana vati on amavata (rheumatoid arthritis). Ayu. 2012 Jan;33(1):50-3. doi: 10.4103/0974-8520.100310. PMID: 23049184; PMCID: PMC3456864.</ref>  
+
After all enema medicine is in the rectum, the patient is advised to lie in supine position till he feels the urge for defecation. When the patient feels the urge, it shall pass. The time duration the administration of medicine and its evacuation is called as retention enema. The decoction enema is expected to come out within 48 minutes after administration. In a study, the retention time of enema with alkali (kshara basti) in maximum number of participants (60%) is reported to be 5 minutes.<ref name=Thanki>Thanki K, Bhatt N, Shukla VD. Effect of kshara basti and nirgundi ghana vati on amavata (rheumatoid arthritis). Ayu. 2012 Jan;33(1):50-3. doi: 10.4103/0974-8520.100310. PMID: 23049184; PMCID: PMC3456864.</ref>  
  
−
====Post therapeutic (pashchatkarma)====
+
====Post therapeutic procedure (pashchat karma)====
  
 
After the evacuation of bowels patient is advised to take hot water bath and light to digest diet based on dominance of [[dosha]] as shown below. [Cha.Sa.[[Siddhi Sthana]] 3/27]
 
After the evacuation of bowels patient is advised to take hot water bath and light to digest diet based on dominance of [[dosha]] as shown below. [Cha.Sa.[[Siddhi Sthana]] 3/27]
Line 218: Line 227:
 
The assessment of therapeutic effect is based on observation of clinical features.  
 
The assessment of therapeutic effect is based on observation of clinical features.  
  
−
====Clinical features of optimal niruhabasti====
+
==== Clinical features of optimal niruha basti====
  
−
Sequential elimination of stool, [[pitta]], [[kapha]] and [[vata]], increased appetite, lightness in body, increase of strength and attainment of normalcy, passage of frothy and whitish mucous in stool are considered as features of optimal administration of niruhabasti. [Cha.Sa.[[Siddhi Sthana]] 1/41] [Ka.Sa.Khila Sthana 8/75-77]<ref name=Kashyapa>Vrddhajivaka, Kasyapa Samhita. Edited by Tewari P V, Reprint edition. Varanasi: Chaukhambha visvabharati; 2008</ref>
+
Sequential elimination of stool, [[pitta]], [[kapha]] and [[vata]], increased appetite, lightness in body, increase of strength and attainment of normalcy, passage of frothy and whitish mucous in stool are considered as features of optimal administration of niruha basti. [Cha.Sa.[[Siddhi Sthana]] 1/41] [Ka.Sa.Khila Sthana 8/75-77]<ref name=Kashyapa>Vrddhajivaka, Kasyapa Samhita. Edited by Tewari P V, Reprint edition. Varanasi: Chaukhambha visvabharati; 2008</ref>
  
−
====Clinical features of inadequately administered niruhabasti====
+
==== Clinical features of inadequately administered niruha basti====
  
−
Headache, pain in cardiac region, anus, urinary bladder and genital organs; edema, coryza, griping pain and nausea; retention of flatus and urine and dyspnea are features of inadequate administration of niruhabasti. [Cha.Sa.[[Siddhi Sthana]] 1/42-43]
+
Headache, pain in cardiac region, anus, urinary bladder and genital organs; edema, coryza, griping pain and nausea; retention of flatus and urine and dyspnea are features of inadequate administration of niruha basti. [Cha.Sa.[[Siddhi Sthana]] 1/42-43]
  
−
====Clinical features of excessively administered niruhabasti====
+
====Clinical features of excessively administered niruha basti====
  
−
Aggravation of [[vatadosha]] due to diminution of [[kapha]] and [[pitta]] [[dosha]], numbness, bodyache, mental fatigue, tremor, insomnia, debility, black outs, insanity and hiccups are features of excess administration of niruhabasti. [Cha.Sa.[[Siddhi Sthana]] 1/19-20]
+
Aggravation of [[vata dosha]] due to diminution of [[kapha]] and [[pitta]] [[dosha]], numbness, bodyache, mental fatigue, tremor, insomnia, debility, black outs, insanity and hiccups are features of excess administration of niruha basti. [Cha.Sa.[[Siddhi Sthana]] 1/19-20]
  
−
The features of inadequate and excess administration of niruhabasti are treated with specific protocols.  
+
The features of inadequate and excess administration of niruha basti are treated with specific protocols.
  
−
==Anuvasanabasti (enema with unctuous substance)==
+
== Anuvasana basti (enema with unctuous substance) ==
 
   
 
   
−
Anuvasanabasti is a type of medicated enema with unctuous substances like oils, ghee etc. It is also called as ‘snehabasti’. The term ‘anuvasana’ means that can be followed daily. Hence the unctuous enema can be administered daily (anu divasa) without any complications. [Su.Sa.Chikitsa Sthana 35/18] Unlike niruhabasti, this enema formulation contains unctuous substances only. Medicated oils are widely used in this therapy to produce unctuousness in the body. [A.S. Sutra Sthana 28/7]<ref name=Sangraha/>
+
Anuvasana basti is a type of medicated enema with unctuous substances like oils, ghee etc. It is also called as ‘sneha basti’. The term ‘anuvasana’ means that can be followed daily. Hence the unctuous enema can be administered daily (anu divasa) without any complications. [Su.Sa.Chikitsa Sthana 35/18]<ref name=Susruta/> Unlike niruha basti, this enema formulation contains unctuous substances only. Medicated oils are widely used in this therapy to produce unctuousness in the body. [A.S. Sutra Sthana 28/7]<ref name=Sangraha/>
  
 
===Types (based on the dose)===
 
===Types (based on the dose)===
−
#Sneha basti: Dose of oil is ¼th of the total dose of niruhabasti i.e. maximum upto 288ml.[Su.Sa.Chikitsa Sthana 37/4]<ref name=Susruta/>
+
 
−
#Anuvasanabasti: Dose of oil is ½ of snehabasti i.e. 144ml. [Su.Sa.Chikitsa Sthana 35/18]<ref name=Susruta/>
+
#Sneha basti: Dose of oil is ¼th of the total dose of niruha basti i.e. maximum upto 288ml.[Su.Sa.Chikitsa Sthana 37/4]<ref name=Susruta/>
−
#Matrabasti: Dose of oil is ¼th of snehabasti i.e. 72ml
+
#Anuvasana basti: Dose of oil is ½ of snehabasti i.e. 144ml. [Su.Sa.Chikitsa Sthana 35/18]<ref name=Susruta/>
 +
#Matra basti: Dose of oil is ¼th of sneha basti i.e. 72ml
  
 
===Indications===
 
===Indications===
  
−
Anuvasanabasti is indicated in following conditions:  
+
Anuvasana basti is indicated in following conditions:  
 
*In cases of depletion of [[kapha]] and [[pitta]] [[dosha]] [Cha.Sa.[[Chikitsa Sthana]] 3/172]
 
*In cases of depletion of [[kapha]] and [[pitta]] [[dosha]] [Cha.Sa.[[Chikitsa Sthana]] 3/172]
−
*Conditions due to aggravation of [[vatadosha]] [Cha.Sa.[[Siddhi Sthana]] 2/19]
+
*Conditions due to aggravation of [[vata dosha]] [Cha.Sa.[[Siddhi Sthana]] 2/19]
 
*If there is excess dryness and obstruction in the bowel due to feces [Cha.Sa.[[Chikitsa Sthana]] 3/173]
 
*If there is excess dryness and obstruction in the bowel due to feces [Cha.Sa.[[Chikitsa Sthana]] 3/173]
 
*In case of the increased power of digestion or hypermetabolism [Cha.Sa.[[Chikitsa Sthana]] 3/172]
 
*In case of the increased power of digestion or hypermetabolism [Cha.Sa.[[Chikitsa Sthana]] 3/172]
Line 251: Line 261:
 
===Contraindications===
 
===Contraindications===
  
−
Unctuous enema is contraindicated in diseases where purification is indicated like skin diseases (kushtha), obstinate urinary diseases including diabetes (prameha), obesity (sthaulya)[Cha.Sa.[[Siddhi Sthana]] 1/36]; the diseases with ama (undigested state) like acute fever, anemia, rhinitis etc. It shall not be given to patients on empty stomach and those who have low digestive capacity. [Cha.Sa.[[Siddhi Sthana]] 2/18]
+
Unctuous enema is contraindicated in diseases where purification is indicated like skin diseases ([[kushtha]]), obstinate urinary diseases including diabetes ([[prameha]]), obesity ([[sthaulya]])[Cha.Sa.[[Siddhi Sthana]] 1/36]; the diseases with [[ama]] (undigested state) like acute fever, anemia, rhinitis etc. It shall not be given to patients on empty stomach and those who have low digestive capacity. [Cha.Sa.[[Siddhi Sthana]] 2/18]
  
 
===Dosage===
 
===Dosage===
 +
 
*Maximum dose:288ml (6 pala)
 
*Maximum dose:288ml (6 pala)
 
*Medium dose :144ml (3 pala)
 
*Medium dose :144ml (3 pala)
Line 260: Line 271:
 
===Procedure of administration===
 
===Procedure of administration===
  
−
====Pre therapeutic procedure (purvakarma)====
+
====Pre therapeutic procedure (purva karma)====
  
 
Unctuous enema is administered immediately after meals. [Su.Sa.Chikitsa Sthana 37/54]<ref name=Susruta/>  On the day of enema, the patient should take little quantity of food, ¼ part less than his regular diet quantity. The patient is advised to walk for few steps and to pass the natural urges if any. [Su.Sa.Chikitsa Sthana 37/57-58]<ref name=Susruta/> The lukewarm medicated oil or ghee is filled in the enema syringe attached with catheter. In some conditions, fine powders of Anethum sowa (shatapushpa) and rock salt are added to oil. [Su.Sa.Chikitsa Sthana 37/63]<ref name=Susruta/>  
 
Unctuous enema is administered immediately after meals. [Su.Sa.Chikitsa Sthana 37/54]<ref name=Susruta/>  On the day of enema, the patient should take little quantity of food, ¼ part less than his regular diet quantity. The patient is advised to walk for few steps and to pass the natural urges if any. [Su.Sa.Chikitsa Sthana 37/57-58]<ref name=Susruta/> The lukewarm medicated oil or ghee is filled in the enema syringe attached with catheter. In some conditions, fine powders of Anethum sowa (shatapushpa) and rock salt are added to oil. [Su.Sa.Chikitsa Sthana 37/63]<ref name=Susruta/>  
  
−
====Therapeutic procedure (pradhanakarma)====
+
====Therapeutic procedure (pradhana karma)====
 
   
 
   
−
The procedure of administration of enema in anuvasanabasti is same as mentioned above in context of of niruhabasti. Enema syringe is used instead of enema pot.
+
The procedure of administration of enema in anuvasana basti is same as mentioned above in context of of niruha basti. Enema syringe is used instead of enema pot.
 
   
 
   
−
====Post therapeutic procedure (pashchatkarma)====
+
====Post therapeutic procedure (pashchat karma)====
  
−
After administration of enema, patient is advised to lie down with well stretched body parts for 1-2 minutes(100 matra). Mild strokes over the gluteal region are given. Then both lower limbs are lifted slowly for three times to prevent the immediate evacuation of the medicine. [Cha.Sa.[[Siddhi Sthana]] 3/28] [Su.Sa.ChikitsaSthana 37/60-62]<ref name=Susruta/> Patting  is done over palms and soles followed by gentle massage over calf and painful body parts in upward direction for 1 – 2minutes (100 matra).[A.S.Sutra Sthana 28/31]<ref name=Sangraha/> The maximum retention time of medicine is about 9 hours. [Cha.Sa.[[Siddhi Sthana]] 1/46] In a study, the retention time for anuvasanabasti is reported as 3 to 6 hours in maximum (62.22%) participants.<ref name=Thanki/>
+
After administration of enema, patient is advised to lie down with well stretched body parts for 1-2 minutes(100 matra). Mild strokes over the gluteal region are given. Then both lower limbs are lifted slowly for three times to prevent the immediate evacuation of the medicine. [Cha.Sa.[[Siddhi Sthana]] 3/28] [Su.Sa.Chikitsa Sthana 37/60-62]<ref name=Susruta/> Patting  is done over palms and soles followed by gentle massage over calf and painful body parts in upward direction for 1 – 2minutes (100 matra).[A.S.Sutra Sthana 28/31]<ref name=Sangraha/> The maximum retention time of medicine is about 9 hours. [Cha.Sa.[[Siddhi Sthana]] 1/46] In a study, the retention time for anuvasana basti is reported as 3 to 6 hours in maximum (62.22%) participants.<ref name=Thanki/>
  
 
===Assessment of therapeutic efficacy===
 
===Assessment of therapeutic efficacy===
Line 276: Line 287:
 
The assessment of therapeutic efficacy is done on the basis of clinical features observed in patient.
 
The assessment of therapeutic efficacy is done on the basis of clinical features observed in patient.
  
−
====Clinical features of optimal administration of anuvasanabasti (unctuous enema)====
+
====Clinical features of optimal administration of anuvasana basti (unctuous enema)====
  
−
Unobstructed expulsion of fecal matter mixed with oil, feeling of lightness in the abdomen, clarity in sense organs, improved quality of body tissues like blood etc., sleep and proper manifestation of natural urges are observed after optimal administration of basti. [Cha.Sa.[[Siddhi Sthana]] 1/44] The features are similar to that of oral intake of unctuous substances (snehapana). [A.H. Sutra Sthana 19/53]<ref name=Hridaya/> Proper movement/functioning of [[vatadosha]] and improved digestion are also observed in optimal anuvasanabasti.  
+
Unobstructed expulsion of fecal matter mixed with oil, feeling of lightness in the abdomen, clarity in sense organs, improved quality of body tissues like blood etc., sleep and proper manifestation of natural urges are observed after optimal administration of basti. [Cha.Sa.[[Siddhi Sthana]] 1/44] The features are similar to that of oral intake of unctuous substances (snehapana). [A.H. Sutra Sthana 19/53]<ref name=Hridaya/> Proper movement/functioning of [[vata dosha]] and improved digestion are also observed in optimal anuvasana basti.
  
−
====Inadequate administration of anuvasanabasti====
+
====Inadequate administration of anuvasana basti====
  
−
Obstruction in the functioning of [[vatadosha]] like obstruction in passage of stool, urine and flatus; pain in lower parts of body, abdomen, arms, back and sides of chest; dryness and roughness of body are observed due to inadequate administration of anuvasanabasti. [Cha.Sa.[[Siddhi Sthana]] 1/45]
+
Obstruction in the functioning of [[vata dosha]] like obstruction in passage of stool, urine and flatus; pain in lower parts of body, abdomen, arms, back and sides of chest; dryness and roughness of body are observed due to inadequate administration of anuvasana basti. [Cha.Sa.[[Siddhi Sthana]] 1/45]
  
−
====Excessive administration of anuvasanabasti====
+
====Excessive administration of anuvasana basti====
  
−
Excessively administration of anuvasanabasti causes nausea, unconsciousness, mental fatigue, exhaustion, fainting and griping pain. [Cha.Sa.[[Siddhi Sthana]] 1/46] Anemia and discharge through nose, mouth and anus are also observed. [A.H. Sutra Sthana 19/53]<ref name=Hridaya/>
+
Excessively administration of anuvasana basti causes nausea, unconsciousness, mental fatigue, exhaustion, fainting and griping pain. [Cha.Sa.[[Siddhi Sthana]] 1/46] Anemia and discharge through nose, mouth and anus are also observed. [A.H. Sutra Sthana 19/53]<ref name=Hridaya/>
  
−
===Number of anuvasanabasti based on [[dosha]] vitiation===
+
===Number of anuvasana basti based on [[dosha]] vitiation===
 
   
 
   
−
General indications for administration of anuvasanabasti based on [[dosha]] vitiation is as below.   
+
General indications for administration of anuvasana basti based on [[dosha]] vitiation is as below.   
 
{| class="wikitable"
 
{| class="wikitable"
−
|+ Table 4: Number of anuvasanabasti based on [[dosha]]  
+
|+ Table 4: Number of anuvasana basti based on [[dosha]]  
 
|-
 
|-
−
! [[Dosha]] involved  !! Number of anuvasanabasti sessions
+
! [[Dosha]] involved  !! Number of anuvasana basti sessions
 
|-
 
|-
 
| | [[Vata]] vitiation || 9 -11
 
| | [[Vata]] vitiation || 9 -11
Line 321: Line 332:
 
#Bodyache
 
#Bodyache
 
#Tearing pain in anus
 
#Tearing pain in anus
−
#Rectal discharge
+
#Rectal discharge [Cha.Sa.[[Siddhi Sthana]] 7/5]
  
−
The major complications during unctuous enema are  caused due to obstruction of unctuous medication by [[vata]], [[pitta]], [[kapha]] or fecal matter. The obstruction may also happen due to excessive food intake prior to unctuous enema. If unctuous enema is performed in empty stomach it may also leads to complications.  
+
The major complications during unctuous enema are  caused due to obstruction of unctuous medication by [[vata]], [[pitta]], [[kapha]] or fecal matter. The obstruction may also happen due to excessive food intake prior to unctuous enema. If unctuous enema is performed in empty stomach it may also lead to complications.[Cha.Sa.[[Siddhi Sthana]] 4/25]
  
 
==Safety precautions==
 
==Safety precautions==
 
   
 
   
 
===Precautions at the time of selection of patient and drug/medication===
 
===Precautions at the time of selection of patient and drug/medication===
 +
 
An improper selection of drug or patient may lead to complications. The highly potent drug to a delicate person or a less potent drug to a strong person will lead to complications. A proper knowledge about the patient’s nature of gut and digestive capacity is necessary. Educate the patient properly about the whole procedure, so that complete co-operation from patient’s side can be assured.
 
An improper selection of drug or patient may lead to complications. The highly potent drug to a delicate person or a less potent drug to a strong person will lead to complications. A proper knowledge about the patient’s nature of gut and digestive capacity is necessary. Educate the patient properly about the whole procedure, so that complete co-operation from patient’s side can be assured.
  
 
===Precautions at the time of administration===
 
===Precautions at the time of administration===
−
Practically most complications are observed by the improper administration of enema. Enema must be administered by a well trained physician. The patient should not be too much hungry at the time of administration of decoction enema. At the same time proper digestion is also required. Special care must be taken if the patient is having associated complaints like diabetes. After basti administration never allow the patient to withhold the urge. It is better to advice the patient not to close the toilet door from inside as fainting might happen during defecation. Advice the patient to take hot water bath followed by intake of moderate amount of food immedietly after passing the bowels.       
+
 
 +
Practically most complications are observed by the improper administration of enema. Enema must be administered by a well trained physician. The patient should not be too much hungry at the time of administration of decoction enema. At the same time proper digestion is also required. Special care must be taken if the patient is having associated complaints like diabetes. After basti administration never allow the patient to withhold the urge. It is better to advice the patient not to close the toilet door from inside as fainting might happen during defecation. Advice the patient to take hot water bath followed by intake of moderate amount of food immediately after passing the bowels.       
  
 
==Importance in preservation of health and prevention==
 
==Importance in preservation of health and prevention==
  
−
Basti provides nourishment and strength to the body. It helps to protect the health and improves longevity. [Su.Sa.Chikitsa Sthana35/4]<ref name=Susruta/> For the protection of vital structures in the body (marma), basti is considered as the best treatment. [Cha.Sa.[[Siddhi Sthana]] 9/7] The eighteen schedules of unctuous enema involving 18 sessions in each schedule gives maximum strength like an elephant and increases the longevity. [Su.Sa.[[Chikitsa Sthana]] 37/76]<ref name=Susruta/> Basti is administered in healthy individuals during pre-rainy and rainy season for management of naturally aggravated [[vatadosha]] and prevent its disorders to preserve health. [Cha.Sa.Sutra Sthana 7/ ref]  
+
Basti provides nourishment and strength to the body. It helps to protect the health and improves longevity. [Su.Sa.Chikitsa Sthana35/4]<ref name=Susruta/> For the protection of vital structures in the body (marma), basti is considered as the best treatment. [Cha.Sa.[[Siddhi Sthana]] 9/7] The eighteen schedules of unctuous enema involving 18 sessions in each schedule gives maximum strength like an elephant and increases the longevity. [Su.Sa.Chikitsa Sthana 37/76]<ref name=Susruta/> Basti is administered in healthy individuals during pre-rainy and rainy season for management of naturally aggravated [[vata dosha]] and prevent its disorders to preserve health. [Cha.Sa.[[Sutra Sthana]] 7]
  
 
==Importance in management of disease==
 
==Importance in management of disease==
  
−
Basti is the best treatment for aggravated [[vatadosha]]. [Cah.Sa.[[Siddhi Sthana]] 1/39] It can effectively manage the diseases due to associated [[dosha]]s like [[pitta]] and [[kapha]].[Su.Sa.Chikitsa Sthana 35/6]<ref name=Susruta/> It is considered as the major treatment in gouty arthritis (vatarakta), [Cha.Sa.[[Chikitsa Sthana 29/88]], abdominal lumps (gulma)[Cha.Sa.[[Chikitsa Sthana]] 5/100] etc. diseases. Basti shows its generalized action on all body parts.[Cha.Sa.[[Siddhi Sthana]] 7/64] The advantage of therapeutic enema over other purification procedures is that it can be administered in the most vulnerable age groups like old aged persons and young children.[Cha.Sa.[[Siddhi Sthana]]11/36] Basti is considered as half of the entire treatment or as the complete treatment itself in a given treatment protocol.[Cha.Sa.[[Siddhi Sthana]] 1/38-39]
+
Basti is the best treatment for aggravated [[vata dosha]]. [Cah.Sa.[[Siddhi Sthana]] 1/39] It can effectively manage the diseases due to associated [[dosha]]s like [[pitta]] and [[kapha]].[Su.Sa.Chikitsa Sthana 35/6]<ref name=Susruta/> It is considered as the major treatment in gouty arthritis (vatarakta), [Cha.Sa.[[Chikitsa Sthana 29/88]], abdominal lumps (gulma)[Cha.Sa.[[Chikitsa Sthana]] 5/100] etc. diseases. Basti shows its generalized action on all body parts.[Cha.Sa.[[Siddhi Sthana]] 7/64] The advantage of therapeutic enema over other purification procedures is that it can be administered in the most vulnerable age groups like old aged persons and young children.[Cha.Sa.[[Siddhi Sthana]]11/36] Basti is considered as half of the entire treatment or as the complete treatment itself in a given treatment protocol.[Cha.Sa.[[Siddhi Sthana]] 1/38-39]
  
 
==Mode of action==
 
==Mode of action==
Line 347: Line 360:
 
==Current researches==
 
==Current researches==
  
−
The rectal route of drug administration is an alternate route of drug delivery. Certain studies suggest that rectal route is more efficient than the intravenous route as it partially bypasses the first pass metabolism of liver.<ref name=KadusPA>Kadus PA, Vedpathak SM. Anuvasan Basti in escalating dose is an alternative for Snehapana before Vamana and Virechana: Trends from a pilot study. J Ayurveda Integr Med 2014;5:246-50.</ref>
+
The rectal route of drug administration is an alternate route of drug delivery. Certain studies suggest that rectal route is more efficient than the intravenous route as it partially bypasses the first pass metabolism of liver.<ref name=KadusPA>Kadus PA, Vedpathak SM. Anuvasana Basti in escalating dose is an alternative for Snehapana before Vamana and Virechana: Trends from a pilot study. J Ayurveda Integr Med 2014;5:246-50.</ref>
  
−
A study showed that basti medicine reaches upto ileo-caecal junction<ref name=Juneja>Juneja Yashwant M, Thakar A. B. Standardization of procedure of administration of Basti w.s.r to Kshinashukra (oligozoospermia), MD Dissertation, IPGT& RA. Jamnagar: Gujarat Ayurved University; 2010</ref> however the active principles of formulation may extend their action to systemic levels. In an experimental study, the presence of active principle of a drug used in medicated enema is found in the systemic circulation. Gallic acid, a marker compound of Triphala (a compound containing Terminalia chebula, Terminalia belerica and Emblica officinalis), is observed in serum after administration of basti with triphala. Moreover, the concentration of gallic acid in serum is more, when the basti is added with catalytic adjuvant (prakshepakadravya). The concentration and rate of absorption depends on property of constituents in basti. The adjuvants might have irritant property, which cause mild inflammation in the colon. This inflammation alters the capillary permeability, which may enhance drug absorption.<ref name=SwapnilSApharma>Swapnil SA, BK Ashok, Anup B Thakar et al. An experimental study to evaluate the pharmacokinetic aspect of Lekhana Basti (Emaciating/ Desiccating Medicated Enema).  Anc Sci Life. 2011 Oct;31(2):38-43.</ref>
+
A study showed that basti medicine reaches up to ileo-caecal junction<ref name=Juneja>Juneja Yashwant M, Thakar A. B. Standardization of procedure of administration of Basti w.s.r to Kshinashukra (oligozoospermia), MD Dissertation, IPGT& RA. Jamnagar: Gujarat Ayurved University; 2010</ref> however the active principles of formulation may extend their action to systemic levels. In an experimental study, the presence of active principle of a drug used in medicated enema is found in the systemic circulation. Gallic acid, a marker compound of Triphala (a compound containing Terminalia chebula, Terminalia belerica and Emblica officinalis), is observed in serum after administration of basti with triphala. Moreover, the concentration of gallic acid in serum is more, when the basti is added with catalytic adjuvant (prakshepakadravya). The concentration and rate of absorption depends on property of constituents in basti. The adjuvants might have irritant property, which cause mild inflammation in the colon. This inflammation alters the capillary permeability, which may enhance drug absorption.<ref name=SwapnilSApharma>Swapnil SA, BK Ashok, Anup B Thakar et al. An experimental study to evaluate the pharmacokinetic aspect of Lekhana Basti (Emaciating/ Desiccating Medicated Enema).  Anc Sci Life. 2011 Oct;31(2):38-43.</ref>
  
−
The efficacy of a treatment procedure highly depends upon the standard operative method. The method of administration of basti is very important. Basti administered through enema instrument (bastiyantra) by exerting uniform manual pressure shows that the contents reach upto ileo-caecal junction and more concentration of contents seen in the proximal colon. On the other hand, basti administered using enema-can which uses atmospheric pressure, also shows the same extent of reaching ileo-cecal junction, however the concentration of contents is less in proximal colon. Proximal colon has significant role in colonic motility and absorption. The interstitial cells of Cajal in sub-mucosal surface (ICC) of the circular muscle, are present only in the proximal colon. Loss of ICC correlates with loss of pace maker activity, defects in propagation, reduction in neurotransmission etc. Short chain fatty acids (SCFA) which play a major role in maintaining the colonic health are chiefly synthesized in proximal colon. Butyrate, one of the SCFA, promotes the absorption of water and electrolytes from the proximal colon. More concentration of basti medicine at proximal colon may stimulate the ICC thereby stimulating the propagation, neurotransmission etc. It may also facilitate greater absorption of water and electrolytes along with other active principles.<ref name=Manohar>Manohar SG, Ashwinikumar AR, Nitin MK. Basti: Does the equipment and method of administration matter? J Ayurveda Integr Med. 2013 Jan;4(1):9-12. doi: 10.4103/0975-9476.109543.</ref>
+
The efficacy of a treatment procedure highly depends upon the standard operative method. The method of administration of basti is very important. Basti administered through enema instrument (basti yantra) by exerting uniform manual pressure shows that the contents reach upto ileo-caecal junction and more concentration of contents seen in the proximal colon. On the other hand, basti administered using enema-can which uses atmospheric pressure, also shows the same extent of reaching ileo-cecal junction, however the concentration of contents is less in proximal colon. Proximal colon has significant role in colonic motility and absorption. The interstitial cells of Cajal in sub-mucosal surface (ICC) of the circular muscle, are present only in the proximal colon. Loss of ICC correlates with loss of pace maker activity, defects in propagation, reduction in neurotransmission etc. Short chain fatty acids (SCFA) which play a major role in maintaining the colonic health are chiefly synthesized in proximal colon. Butyrate, one of the SCFA, promotes the absorption of water and electrolytes from the proximal colon. More concentration of basti medicine at proximal colon may stimulate the ICC thereby stimulating the propagation, neurotransmission etc. It may also facilitate greater absorption of water and electrolytes along with other active principles.<ref name=Manohar>Manohar SG, Ashwinikumar AR, Nitin MK. Basti: Does the equipment and method of administration matter? J Ayurveda Integr Med. 2013 Jan;4(1):9-12. doi: 10.4103/0975-9476.109543.</ref>
  
 
===Therapeutic efficacy of basti===
 
===Therapeutic efficacy of basti===
  
−
Enema intended for removal of morbidity (lekhanabasti) is found effective in hyperlipidemia by reducing the serum cholesterol, serum LDL, serum apolipoprotein B. Significant reduction in weight, body mass index (BMI), body fat percentage and skin fold thickness were also reported.<ref name=Swapnilhyper>Swapnil SA, Anup B Thakar et al. Assessment of Lekhana Basti in the management of hyperlipidemia. Ayu. 2013 Oct;34(4):339-45. doi: 10.4103/0974-8520.127683.</ref> The hypersensitivity or hyper responsiveness of hypothalamo-pituitary adrenal (HPA) axis is the main reason for endocrine malfunction in human obesity. Serum cortisol levels are found to be decreased in obese patients after basti treatment. This suggests normalizing of HPA axis through basti. Medicated enema shows immuno-modulatory effect by regulating pro-inflammatory cytokines, immunoglobulins and functional properties of T-cells.<ref name=Urmila>Urmila T, Shubhada C et al. Immunological & metabolic responses to a therapeutic course of Basti in obesity. Indian J Med Res. 2015 Jul;142(1):53-62. doi: 10.4103/0971-5916.162099.</ref>
+
Enema intended for removal of morbidity (lekhana basti) is found effective in hyperlipidemia by reducing the serum cholesterol, serum LDL, serum apolipoprotein B. Significant reduction in weight, body mass index (BMI), body fat percentage and skin fold thickness were also reported.<ref name=Swapnilhyper>Swapnil SA, Anup B Thakar et al. Assessment of Lekhana Basti in the management of hyperlipidemia. Ayu. 2013 Oct;34(4):339-45. doi: 10.4103/0974-8520.127683.</ref> The hypersensitivity or hyper responsiveness of hypothalamo-pituitary adrenal (HPA) axis is the main reason for endocrine malfunction in human obesity. Serum cortisol levels are found to be decreased in obese patients after basti treatment. This suggests normalizing of HPA axis through basti. Medicated enema shows immuno-modulatory effect by regulating pro-inflammatory cytokines, immunoglobulins and functional properties of T-cells.<ref name=Urmila>Urmila T, Shubhada C et al. Immunological & metabolic responses to a therapeutic course of Basti in obesity. Indian J Med Res. 2015 Jul;142(1):53-62. doi: 10.4103/0971-5916.162099.</ref>
  
−
A study reported that low dose medicated oil enema (matrabasti) is effective in reducing the signs and symptoms of osteoarthritis. There was significant reduction in pain and swelling in joints and reduction in pain during joint movements.<ref name=Mayuri>Mayuri RS, Charmi SM et al. A Clinical study of Matra Vasti and an ayurvedic indigenous compound drug in the management of Sandhigatavata (Osteoarthritis). Ayu. 2010 Apr;31(2):210-7. doi: 10.4103/0974-8520.72399.</ref>  Erandamuladiyapanabasti is found effective in reducing the pain, stiffness and tenderness related with lumbar spondylosis and improving the quality of life.<ref name=Damayanthie>Damayanthie Fernando, Anup B Thakar, VD Shukla. Clinical efficacy of Eranda Muladi Yapana Basti in the management of Kati Graha (Lumbar spondylosis). Ayu. 2013 Jan;34(1):36-41. doi: 10.4103/0974-8520.115444.</ref>   
+
A study reported that low dose medicated oil enema (matra basti) is effective in reducing the signs and symptoms of osteoarthritis. There was significant reduction in pain and swelling in joints and reduction in pain during joint movements.<ref name=Mayuri>Mayuri RS, Charmi SM et al. A Clinical study of Matra Vasti and an ayurvedic indigenous compound drug in the management of Sandhigatavata (Osteoarthritis). Ayu. 2010 Apr;31(2):210-7. doi: 10.4103/0974-8520.72399.</ref>  Erandamuladi yapana basti is found effective in reducing the pain, stiffness and tenderness related with lumbar spondylosis and improving the quality of life.<ref name=Damayanthie>Damayanthie Fernando, Anup B Thakar, VD Shukla. Clinical efficacy of Eranda Muladi Yapana Basti in the management of Kati Graha (Lumbar spondylosis). Ayu. 2013 Jan;34(1):36-41. doi: 10.4103/0974-8520.115444.</ref>   
  
−
Panchamooladikaalabasti is reported to be effective in reducing the symptoms of rheumatoid arthritis (amavata) especially  pain, stiffness, swelling and tenderness in the joints. It is also found effective in reducing the generalized symptoms like heaviness of body, fatigue, feverishness and anorexia. Basti acts over the prime seat of [[vatadosha]] i.e. large intestine (pakvashaya) and controls it. The alkali present in the ksharabasti improves digestion and removes the accumulated toxins (ama).<ref name=BariaR>Baria R, Joshi N, Pandya D. Clinical efficacy of Panchamuladi Kaala Basti (enema) in the management of Amavata (Rheumatoid Arthritis). Ayu. 2011 Jan;32(1):90-4. doi: 10.4103/0974-8520.85737. PMID: 22131764; PMCID: PMC3215425.</ref>  
+
Panchamooladikaala basti is reported to be effective in reducing the symptoms of rheumatoid arthritis (amavata) especially  pain, stiffness, swelling and tenderness in the joints. It is also found effective in reducing the generalized symptoms like heaviness of body, fatigue, feverishness and anorexia. Basti acts over the prime seat of [[vata dosha]] i.e. large intestine (pakvashaya) and controls it. The alkali present in the kshara basti improves digestion and removes the accumulated toxins (ama).<ref name=BariaR>Baria R, Joshi N, Pandya D. Clinical efficacy of Panchamuladi Kaala Basti (enema) in the management of Amavata (Rheumatoid Arthritis). Ayu. 2011 Jan;32(1):90-4. doi: 10.4103/0974-8520.85737. PMID: 22131764; PMCID: PMC3215425.</ref>  
  
−
Unctuous enema in minimum dose (matrabasti) is found effective in 12 cases of anovulation. Ovulation occurred in the maximum number of participants (63.64%) and increased follicular size is also reported after matrabasti. Basti shows its action on Enteric Nervous System (ENS). The endogenous opioids especially beta endorphins may get stimulated. This may affect the GnRH secretion and there by regularize hypothalamo pituitary ovarian (HPO) axis. HPO axis regulates the ovarian cycle and ovulation. By the action over ENS, basti may also stimulate CNS and thereby stimulates pituitary. This results in the secretion of FSH and LH which plays an important role in ovulation.  More studies are needed to study the effect of basti on specific pathways.<ref>Donga KR, Donga SB, Dei LP. Role of Nasya and Matra Basti with Narayana Taila on anovulatory factor. Ayu. 2013 Jan;34(1):81-5. doi: 10.4103/0974-8520.115453. PMID: 24049410; PMCID: PMC3764886.</ref>  
+
Unctuous enema in minimum dose (matra basti) is found effective in 12 cases of anovulation. Ovulation occurred in the maximum number of participants (63.64%) and increased follicular size is also reported after matra basti. Basti shows its action on Enteric Nervous System (ENS). The endogenous opioids especially beta endorphins may get stimulated. This may affect the GnRH secretion and there by regularize hypothalamo pituitary ovarian (HPO) axis. HPO axis regulates the ovarian cycle and ovulation. By the action over ENS, basti may also stimulate CNS and thereby stimulates pituitary. This results in the secretion of FSH and LH which plays an important role in ovulation.<ref>Donga KR, Donga SB, Dei LP. Role of Nasya and Matra Basti with Narayana Taila on anovulatory factor. Ayu. 2013 Jan;34(1):81-5. doi: 10.4103/0974-8520.115453. PMID: 24049410; PMCID: PMC3764886.</ref> More studies are needed to study the effect of basti on specific pathways.
  
 
==List of theses done==
 
==List of theses done==
−
#Savjani Rekha T (2001): A clinical study on the management of sthaulya by panchatikta and lekhanabasti, Department of Kayachikitsa, IPGT&RA  Jamnagar
+
 
 +
#Savjani Rekha T (2001): A clinical study on the management of sthaulya by panchatikta and lekhana basti, Department of Kayachikitsa, IPGT&RA  Jamnagar
 
#Bhatted Santosh (2002): A comparative study of the role of vajeekarana drugs administered orally and by basti in the management of klaibya with reference to erectile dysfunction. Department of Kayachikitsa, IPGT&RA  Jamnagar
 
#Bhatted Santosh (2002): A comparative study of the role of vajeekarana drugs administered orally and by basti in the management of klaibya with reference to erectile dysfunction. Department of Kayachikitsa, IPGT&RA  Jamnagar
−
#Mangalasseri Prakash (2002): A clinical study of shukragatavata w.s.r to premature ejaculation & its management with Akarakarbhati yoga yapanabasti, Department of Kayachikitsa, IPGT&RA  Jamnagar
+
#Mangalasseri Prakash (2002): A clinical study of shukragatavata w.s.r to premature ejaculation & its management with Akarakarbhati yoga yapana basti, Department of Kayachikitsa, IPGT&RA  Jamnagar
 
#Varma S P (2002): Study of Vaitarana-Basti in the management of Kati-shoola. Department of Kayachikitsa, IPGT&RA  Jamnagar
 
#Varma S P (2002): Study of Vaitarana-Basti in the management of Kati-shoola. Department of Kayachikitsa, IPGT&RA  Jamnagar
 
#Pawar Anand M (2003): A comparative study on the role of basti therapy and pramehaghna drugs in the management of madhumeha (Diabetes mellitus). Department of Kayachikitsa, IPGT&RA  Jamnagar
 
#Pawar Anand M (2003): A comparative study on the role of basti therapy and pramehaghna drugs in the management of madhumeha (Diabetes mellitus). Department of Kayachikitsa, IPGT&RA  Jamnagar
Line 373: Line 387:
 
#Bhatkoti Mayank (2005): A comparative clinical study of vaitaranabasti and virechana karma in the management of amavata. Department of Kayachikitsa, IPGT&RA  Jamnagar
 
#Bhatkoti Mayank (2005): A comparative clinical study of vaitaranabasti and virechana karma in the management of amavata. Department of Kayachikitsa, IPGT&RA  Jamnagar
 
#Tejal Khunt (2005) :Comparitive study on the Virechana Karma and Lekhana Basti in the management of Sthaulya. Department of Kayachikitsa, IPGT&RA  Jamnagar
 
#Tejal Khunt (2005) :Comparitive study on the Virechana Karma and Lekhana Basti in the management of Sthaulya. Department of Kayachikitsa, IPGT&RA  Jamnagar
−
#Anamika Kumari (2006): A comparative study on the effect of some indigenous compound drug and matrabasti in the management of Gridhrasi (Sciatica). Department of Kayachikitsa, IPGT&RA  Jamnagar
+
#Anamika Kumari (2006): A comparative study on the effect of some indigenous compound drug and matra basti in the management of Gridhrasi (Sciatica). Department of Kayachikitsa, IPGT&RA  Jamnagar
−
#Mayuri Shah (2006): A comparative study of matrabasti and some indigenous compound drug in the management of sandhigatavata (osteoarthritis). Department of Kayachikitsa, IPGT&RA  Jamnagar
+
#Mayuri Shah (2006): A comparative study of matra basti and some indigenous compound drug in the management of sandhigatavata (osteoarthritis). Department of Kayachikitsa, IPGT&RA  Jamnagar
−
#Sanjay Gupta (2006): A clinical effect of Baladiyapanabasti and vajikarana yoga in the management of sukradushti w.s.r to oligoasthenozoospermia. Department of Kayachikitsa, IPGT&RA  Jamnagar
+
#Sanjay Gupta (2006): A clinical effect of Baladiyapana basti and vajikarana yoga in the management of sukradushti w.s.r to oligoasthenozoospermia. Department of Kayachikitsa, IPGT&RA  Jamnagar
−
#Gajanan Kulkarni (2007): A comparative study of role of yapanabasti and karma basti in the management of Pakshagata (CVA). Department of Panchakarma, IPGT&RA  Jamnagar
+
#Gajanan Kulkarni (2007): A comparative study of role of yapana basti and karma basti in the management of Pakshagata (CVA). Department of Panchakarma, IPGT&RA  Jamnagar
−
#Vinay Chaudary (2007): A clinical study of standardization of Yapanabasti in the management of Kampavata. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Vinay Chaudary (2007): A clinical study of standardization of Yapana basti in the management of Kampavata. Department of Panchakarma, IPGT&RA  Jamnagar
−
#Jayadip Kumar P Shah (2008): Effect of Tiktakshirabasti and patrapind sweda in the management of cervical spondylosis (Asthigatavata). Department of Panchakarma, IPGT&RA  Jamnagar
+
#Jayadip Kumar P Shah (2008): Effect of Tiktakshira basti and patrapind sweda in the management of cervical spondylosis (Asthigatavata). Department of Panchakarma, IPGT&RA  Jamnagar
 
#Vimal M Vekaria (2008): Comparative study of Virechana karma and kala basti in the management of Pakshaghata. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Vimal M Vekaria (2008): Comparative study of Virechana karma and kala basti in the management of Pakshaghata. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Geeta Jatav (2008): A Comparative Study on the effect Of VidarikandadiVati and KshirabalaTaila Basti in the management of Karshya in Children. Department of Kaumarabrithya, IPGT&RA  Jamnagar
 
#Geeta Jatav (2008): A Comparative Study on the effect Of VidarikandadiVati and KshirabalaTaila Basti in the management of Karshya in Children. Department of Kaumarabrithya, IPGT&RA  Jamnagar
 
#Juneja Yaswant M (2009): Standardization of procedure of administration of basti w.s.r to Kshinashukra (oligozoospermia). Department of Panchakarma, IPGT&RA  Jamnagar
 
#Juneja Yaswant M (2009): Standardization of procedure of administration of basti w.s.r to Kshinashukra (oligozoospermia). Department of Panchakarma, IPGT&RA  Jamnagar
 
#Gohil Jalpa H (2009): A comparative clinical study of Virechana karma and kala basti in management of Amavata. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Gohil Jalpa H (2009): A comparative clinical study of Virechana karma and kala basti in management of Amavata. Department of Panchakarma, IPGT&RA  Jamnagar
−
#Ajay K Gupta (2010): Effect of Majjabasti and AsthiShrinkhala in the management of osteoporosis w.s.r to Asti Majjakshaya A clinical study. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Ajay K Gupta (2010): Effect of Majja basti and AsthiShrinkhala in the management of osteoporosis w.s.r to Asti Majjakshaya A clinical study. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Gyanendra D Shukla (2010): A Comparative Study of efficacy of Virechana and Basti Karma with Shamana therapy in the management of Essential Hypertension. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Gyanendra D Shukla (2010): A Comparative Study of efficacy of Virechana and Basti Karma with Shamana therapy in the management of Essential Hypertension. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Damayanthie Fernando (2011): Assessment of Clinical Efficacy of ErandamuladiYapana Basti and ErandaBijaKshiraPaka in the management of Kati Graha w.s.r. to Lumbar Spondylosis. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Damayanthie Fernando (2011): Assessment of Clinical Efficacy of ErandamuladiYapana Basti and ErandaBijaKshiraPaka in the management of Kati Graha w.s.r. to Lumbar Spondylosis. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Swapnil S Auti (2011): Assessment of Lekhana Basti in management of Hyperlipidaemia (A Randomised Controlled Clinico-Experimental Study). Department of Panchakarma, IPGT&RA  Jamnagar
 
#Swapnil S Auti (2011): Assessment of Lekhana Basti in management of Hyperlipidaemia (A Randomised Controlled Clinico-Experimental Study). Department of Panchakarma, IPGT&RA  Jamnagar
−
#Nikunj M (2012): A comparative study of vrishyabasti and kulinga (Blepharis edulis) after virechana karma in the management of kshinashukra w.s.r to oligozoospermia. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Nikunj M (2012): A comparative study of vrishya basti and kulinga (Blepharis edulis) after virechana karma in the management of kshinashukra w.s.r to oligozoospermia. Department of Panchakarma, IPGT&RA  Jamnagar
−
#Saurabh R Bhuva (2012): A comparative study of matrabasti and brimhanasnehana by asthishrinkhalaghrita in the management of asthi-majjakshaya w.s.r to osteopenia/osteoporosis. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Saurabh R Bhuva (2012): A comparative study of matra basti and brimhanasnehana by asthishrinkhalaghrita in the management of asthi-majjakshaya w.s.r to osteopenia/osteoporosis. Department of Panchakarma, IPGT&RA  Jamnagar
−
#Siddharth Kumar J (2012): Role of matrabasti as chemoprotective adjuvant in the management of cancer. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Siddharth Kumar J (2012): Role of matra basti as chemoprotective adjuvant in the management of cancer. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Hemal Kumar V Dodiya (2013): A comparative clinical study on the effect of Guduchi-Bhadramustadi yoga administered orally and by basti in the management of sthaulya w.s.r to obesity. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Hemal Kumar V Dodiya (2013): A comparative clinical study on the effect of Guduchi-Bhadramustadi yoga administered orally and by basti in the management of sthaulya w.s.r to obesity. Department of Panchakarma, IPGT&RA  Jamnagar
−
#Chughdeepa surrender pal (2014): A comparative study of shwadanshtradibasti and chitrakadighrita management of sandhivata with special reference to osteoarthritis. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Chughdeepa surrender pal (2014): A comparative study of shwadanshtradi basti and chitrakadighrita management of sandhivata with special reference to osteoarthritis. Department of Panchakarma, IPGT&RA  Jamnagar
−
#Jadav Hasmukh Bhavanbhai (2014): Management of premature ejaculation (shukragatavata) with erandamoolbasti and vanarikalpa- A clinical study. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Jadav Hasmukh Bhavanbhai (2014): Management of premature ejaculation (shukragatavata) with erandamool basti and vanarikalpa- A clinical study. Department of Panchakarma, IPGT&RA  Jamnagar
−
#Paikrao Sumedh Narayanrao (2014): A clinical study on siravedha and vaitaranabasti in the management of gridhrasi with special reference to sciatica. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Paikrao Sumedh Narayanrao (2014): A clinical study on siravedha and vaitarana basti in the management of gridhrasi with special reference to sciatica. Department of Panchakarma, IPGT&RA  Jamnagar
−
#Rani Sangeeta Ishwar Singh (2017): A randomized clinical trial on brihatyadiyapanabasti and patrapinda sweda with aadityapakaguggulu in the management of cervical spondylosis w.s.r to asthigatavata. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Rani Sangeeta Ishwar Singh (2017): A randomized clinical trial on brihatyadiyapana basti and patrapinda sweda with aadityapakaguggulu in the management of cervical spondylosis w.s.r to asthigatavata. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Kumar Surendra Ganesh Ram (2017): Comparative efficacy of vajigandhaditailapana and basti in the management of gridhrasi (sciatica) – A randomized clinical trial. Department of Panchakarma, IPGT&RA  Jamnagar
 
#Kumar Surendra Ganesh Ram (2017): Comparative efficacy of vajigandhaditailapana and basti in the management of gridhrasi (sciatica) – A randomized clinical trial. Department of Panchakarma, IPGT&RA  Jamnagar
−
#Ram Poojan Verma (2018): Efficacy of erandamooladiniruhabasti and shunthikwatha with erandataila in the management of katishoola (lumbar spondylosis): A open labeled, Randomised, comparative clinical trial. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Ram Poojan Verma (2018): Efficacy of erandamooladiniruha basti and shunthikwatha with erandataila in the management of katishoola (lumbar spondylosis): A open labeled, Randomised, comparative clinical trial. Department of Panchakarma, IPGT&RA  Jamnagar
−
#Shiho Oikawa (2018): Virechana karma along with vaitaranabasti followed by mahabhallatakaavaleha in the management of amavata wsr to rheumatoid arthritis-A compararive randomized controlled study. Department of Panchakarma, IPGT&RA  Jamnagar
+
#Shiho Oikawa (2018): Virechana karma along with vaitarana basti followed by mahabhallatakaavaleha in the management of amavata wsr to rheumatoid arthritis-A compararive randomized controlled study. Department of Panchakarma, IPGT&RA  Jamnagar
  
 
==More information==
 
==More information==
  
−
[[Bastisutriyam Siddhi]], [[Panchakarmiya Siddhi]], [[Kalpana Siddhi]], [[Snehavyapat Siddhi]], [[Netrabastivyapat Siddhi]], [[Bastivyapat Siddhi]], [[PrasritaYogiyam Siddhi]], [[Phalamatra Siddhi]], [[Uttar Basti Siddhi]], [[Basti Siddhi]]
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[[Bastisutriyam Siddhi]], [[Panchakarmiya Siddhi]], [[Kalpana Siddhi]], [[Snehavyapat Siddhi]], [[Netrabastivyapat Siddhi]], [[Bastivyapat Siddhi]], [[Prasrita Yogiyam Siddhi]], [[Phalamatra Siddhi]], [[Uttar Basti Siddhi]], [[Basti Siddhi]]
  
 
==Abbreviations==
 
==Abbreviations==
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Cha. = Charak, Su. = Sushruta, A. = Ashtanga, S. = Sangraha, Hr. = Hridayam, Sa. = Samhita, Sha. = Sharangadara, Ka. = Kashyapa
 
Cha. = Charak, Su. = Sushruta, A. = Ashtanga, S. = Sangraha, Hr. = Hridayam, Sa. = Samhita, Sha. = Sharangadara, Ka. = Kashyapa
  
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==List of References==
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<big>'''[[Special:ContactMe|Send us your suggestions and feedback on this page.]]'''</big>
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The list of references for Basti in Charak Samhita can be seen[[Media:References_for_word_Basti.pdf| here]]
 
  
 
==Reference==
 
==Reference==
 
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Latest revision as of 09:59, 24 February 2024

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The word ‘basti’ denotes therapeutic procedure of enema. It is one of the five purification procedures (panchakarma). Basti also spelled as vasti, literally means bladder or an injection-syringe made of bladder or injection itself.[1] In anatomical perspective, the urinary bladder is called as basti. In ancient times, the bladder of animals (mainly goat or buffalo) was used to administer enema therapy, hence the therapy is knows as ‘basti’. [A.S.Sutra Sthana 28/2][2] It is the best treatment for disorders of vata dosha. [Cha.Sa. Sutra Sthana 25/40]. Due to the primary importance of vata dosha in causing diseases, basti is considered as the chief treatment among panchakarma. [Su.Sa.Chikitsa Sthana 35/3][3]
In therapeutic management, it denotes medicated enema with decoction, oils or any other fluid either in rectum or urethra or vagina. The term ‘uttara basti’ is used for enema given through anterior orifice like urethra or vagina. In unction therapy, local therapeutic procedures like keeping warm oils or medicated substance on affected body part are used. These procedures are termed after name of affected part as suffix to the word ‘basti’. E.g. ‘janu basti’ means keeping warm medicated substance on knee joint; ‘kati basti’ means keeping it on the lumbar region. Most commonly, the term ‘basti’ indicates per rectal enema. Hence this article focuses on therapeutic enema given per rectum.

Contributors
Section/Chapter/topic Chikitsa / Panchakarma/ Basti
Authors Aneesh E.G., Deole Y.S.
Reviewed by Basisht G.
Affiliations Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar
Correspondence email: carakasamhita@gmail.com
Publisher Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of first publication: December 12, 2020
DOI 10.47468/CSNE.2020.e01.s09.034

Etymology and derivation

The word ‘basti’ is derived from the root ‘vas’ with suffix ‘tich’. ‘Vas’ is having the following meanings

  • to reside or to stay or to dwell
  • to cover
  • to move or motion

Classification

On the basis of procedure

  1. Enema with decoctions (Niruha basti)
  2. Enema with unctuous substances (Anuvasana basti)
  3. Enema through urethral or vaginal route (Uttarabasti)[Cha.Sa.Siddhi Sthana 10/8]

On the basis of site of administration

The basti can be broadly classified into internal and external based on the site of administration

Internal

  1. Administered into colon through anal route (pakvashayagata basti)
  2. Administered into uterus through vagina (garbhashayagata basti)
  3. Administered into urinary bladder through urethra (mutrashayagata basti)
  4. Administered over wounds for cleaning purpose (vrana basti) [Su.Sa.Chikitsa Sthana 35/11][3]

External

Medicated oils are retained over particular body part for a specific duration. E.g. Medicated oil retained over knee (janu basti), medicated oil retained over lumbar region (kati basti) etc.

On the basis of pharmaco-therapeutic action

The enema therapy is classified based onthe pharmaco-therapeutic activity of its ingredients.

  1. Dosha aggravating enema (utkleshana basti)
  2. Dosha purificatory enema (shodhana basti)
  3. Dosha pacifying enema (shamana basti)[Sha.Uttarardha.6/17-19][4]

On the basis of number of basti

The enema therapy is classified based on specific schedule and sequential sessions based on the severity of pathogens (dosha and dushya).

  1. Karma basti: Total 30 basti sessions with 12 decoction (niruha) and 18 unctuous (anuvasana basti)
  2. Kala basti: Total 16 basti sessions with 06 decoction (niruha) and 10 unctuous (anuvasana basti)
  3. Yoga basti: Total 8 basti sessions with 3 decoction (niruha) and 5 unctuous (anuvasana basti)[Cha.Sa.Siddhi Sthana 1/47-49]

On the basis of total quantity

Some enemas are known by their total quantity of ingredients. The measurement ‘prasruta’ (one prasruta = 96 ml) is used to calculate proportion of ingredients and total quantity of enema. The maximum allowable dosage of decoction enema is 1152ml (12 prasruta). The dosage 1 prasruta is considered as 96 ml as per Ayurvedic Formulary of India. Posology varies from person to person according to Ayurveda. Here ‘prasruta’ is defined as the dosage of liquid in the patient's hollowed palm. [Gayadasa on Su.Sa.Chikitsa Sthana 35/7][3] In a study conducted on 100 participants, one prasruta of Madhutailika basti (a type of decoction enema) is standardized as 26.4ml.[5]

A few examples are as follows:

  • Twelve prasruta (1152 ml) termed as ‘Dwadasaprasrutika basti’
  • Nine prasruta (864ml )termed as ‘Navaprasruta basti/padahina basti’
  • Five prasruta (480 ml) termed as ‘Pachaprasrutika basti’

Based on the chief ingredient

Some enemas are known by their chief ingredient. A few examples are as follows:

  • Enema with equal quantity of honey and oil is termed as ‘Madhutailika basti’
  • Presence of alkali in enema is termed as ‘Kshara basti’
  • Milk used as main ingredient in enema is termed as ‘Kshira basti’

Niruha basti (enema with decoction)

The medicated enema with decoction of herbs as main ingredient is called ‘niruha basti’. It is also known as ‘kashaya basti’. The word ‘niruha’ indicates its extensive therapeutic potency. As it stabilizes (sthapana) the dosha, it is also known as ‘asthapana basti’. [A.S.Sutra Sthana 28/6][2]

Indications

  • Aggravated conditions of vata dosha
  • Aggravation of vata associated with other dosha[A.H.Sutra Sthana 19/1][6]
  • Conditions of accumulation of dosha in large intestine (pakwashaya) in a completely metabolized (pakwa) state [Cha.Sa.Chikitsa Sthana 3/171-72]

Contraindications

Niruha basti is contraindicated in following conditions:

  • Extremely weak and debilitated patients[Cha.Sa.Siddhi Sthana 1/37]
  • Immediately after any other purificatory procedure like therapeutic emesis or purgation [Cha.Sa.Siddhi Sthana 1/37]
  • Breathing difficulty, cough, skin diseases (kushtha), diabetes (madhumeha) etc.[Cha.Sa.Siddhi Sthana 2/14]

Ingredients of niruha basti formulation

The predominant content of niruha basti is a decoction of herbs. It also contains honey, rock salt, unctuous substance (usually oil or ghee) and medicinal paste (kalka). In some conditions, cow’s urine, fermented liquid preparation out of grains (dhanyamla), meat soup, milk etc. are used instead of decoction.

Quantity of ingredients

The general dosage of ingredients for 1152 ml (dvadasha prasruta) basti are as follows. While preparation, the ingredients are mixed in the specific sequence and quantity as given below:

  1. Honey: 192 ml (2 prasruta)
  2. Rock salt (saindhava): 12 gram (1 karsha)
  3. Oil/ghee/unctuous substance (sneha): 288 ml (3 prasruta)
  4. Medicinal paste (kalka): 96 gram (1 prasruta)
  5. Decoction (kwatha): 384 ml (4 prasruta) to 480 ml (5 prasruta)*
  6. Additives (aavapadravya): 192 ml (2 prasruta)

[Su.Sa.Chikitsa Sthana 38/37-39][3] *[Cha.Sa.Siddhi Sthana 3/30]

Proportion of unctuous substance and honey based on dosha predominance

The proportion of unctuous substance and honey changes based on the predominance of dosha in diseases. It is as shown below in table 1.

Table 1: Dosha specific proportion in basti formulation
Vata dosha Pitta dosha Kapha dosha
Honey 144 ml (3 pala) 192 ml (4 pala) 288 ml (6 pala)
Unctuous Substance 288 ml (6 pala) 192 ml (4 pala) 144 ml (3 pala)

[Cha.Sa.Siddhi Sthana 3/30]

Dose of niruha basti in different age groups

The dose of basti formulation changes as per the age. It is shown in table 2.

Table 2: Age specific dosage of basti formulation
Age Dosage of basti
1 year 48 ml (½ prasruta)
Increase the dosage by 48 ml (½ prasruta) each year till 12 years
12 year 576 ml (6 prasruta)
Increase the dosage by 96 ml (1 prasruta) each year till 18 years
18 year and above until age 70 1152 ml (12 prasruta)
Above 70 year 960 ml (10 prasruta)

[Cha.Sa.Siddhi Sthana 3/31-32]

Method of preparation of niruha basti (decoction enema)

The decoction enema is a combination of many ingredients as mentioned above. These ingredients should be mixed in a specific sequence to formulate homogenous mixture and achieve maximum therapeutic efficacy. The sequence of mixing of decoction enema is as follows. Honey and rock salt should be mixed first. Then unctuous substance such as oil or ghee is added and mixed. Medicinal paste is added next to it and finally the decoction is added.[Cha.Sa.Siddhi Sthana 3/23] This process acquires the state of emulsion. Honey is a natural emulsifying agent and is preferred for the preparation of basti because of its stability and therapeutic properties.[7]

Therapeutic procedure of administration

The procedure of niruha basti is done as a daily session of administration of enema. Procedure of a single session is described as below:

  • Pre therapeutic procedure (purva karma)
  • Therapeutic procedure (pradhana karma)
  • Post therapeutic procedure (pashchat karma)

Pre therapeutic procedure (purva karma)

On the day of administration, patient is advised to pass natural urges and should not be hungry. [Cha.Sa.Siddhi Sthana 3/17] Local massage with oil and sudation is done over abdomen, low back, gluteal region and thighs of the patient. The enema mixture is prepared and filled into the basti apparatus (basti yantra). In current clinical practices, two types of basti apparatus are used to administer decoction enema.

  1. A basti bag attached with basti nozzle
  2. Transparent plastic enema pot with an attached tube and catheter

The enema formulation is filled in the basti bag or enema pot. Then the medicine is passed through catheter to remove air bubbles.

Therapeutic procedure (pradhana karma)

Patient is advised to lie in left lateral position with left leg extended and flex the right leg at knee and hip. The anal orifice and the basti nozzle or catheter are lubricated with oil. Then the basti nozzle or catheter is inserted slowly and gently through the anal canal.

The basti bag is squeezed in uniform pressure to pass the basti medicine in rectum. It is not emptied totally in order to avoid passage of air through basti apparatus. Then the nozzle is removed slowly. [Cha.Sa.Siddhi Sthana 3/18-20]

In the enema pot method, the filled enema pot is kept at a certain height to allow passage of enema medicine. The flow and pressure can be regulated with a knob on the tube.

After all enema medicine is in the rectum, the patient is advised to lie in supine position till he feels the urge for defecation. When the patient feels the urge, it shall pass. The time duration the administration of medicine and its evacuation is called as retention enema. The decoction enema is expected to come out within 48 minutes after administration. In a study, the retention time of enema with alkali (kshara basti) in maximum number of participants (60%) is reported to be 5 minutes.[8]

Post therapeutic procedure (pashchat karma)

After the evacuation of bowels patient is advised to take hot water bath and light to digest diet based on dominance of dosha as shown below. [Cha.Sa.Siddhi Sthana 3/27]

Table 3: Specific diet as per dosha
Dosha Diet
Vata Meat soup or green gram soup
Pitta Milk
Kapha Soup prepared with cereals (yusha)

[Cha.Sa.Siddhi Sthana 3/34]

Assessment of purification

The assessment of therapeutic effect is based on observation of clinical features.

Clinical features of optimal niruha basti

Sequential elimination of stool, pitta, kapha and vata, increased appetite, lightness in body, increase of strength and attainment of normalcy, passage of frothy and whitish mucous in stool are considered as features of optimal administration of niruha basti. [Cha.Sa.Siddhi Sthana 1/41] [Ka.Sa.Khila Sthana 8/75-77][9]

Clinical features of inadequately administered niruha basti

Headache, pain in cardiac region, anus, urinary bladder and genital organs; edema, coryza, griping pain and nausea; retention of flatus and urine and dyspnea are features of inadequate administration of niruha basti. [Cha.Sa.Siddhi Sthana 1/42-43]

Clinical features of excessively administered niruha basti

Aggravation of vata dosha due to diminution of kapha and pitta dosha, numbness, bodyache, mental fatigue, tremor, insomnia, debility, black outs, insanity and hiccups are features of excess administration of niruha basti. [Cha.Sa.Siddhi Sthana 1/19-20]

The features of inadequate and excess administration of niruha basti are treated with specific protocols.

Anuvasana basti (enema with unctuous substance)

Anuvasana basti is a type of medicated enema with unctuous substances like oils, ghee etc. It is also called as ‘sneha basti’. The term ‘anuvasana’ means that can be followed daily. Hence the unctuous enema can be administered daily (anu divasa) without any complications. [Su.Sa.Chikitsa Sthana 35/18][3] Unlike niruha basti, this enema formulation contains unctuous substances only. Medicated oils are widely used in this therapy to produce unctuousness in the body. [A.S. Sutra Sthana 28/7][2]

Types (based on the dose)

  1. Sneha basti: Dose of oil is ¼th of the total dose of niruha basti i.e. maximum upto 288ml.[Su.Sa.Chikitsa Sthana 37/4][3]
  2. Anuvasana basti: Dose of oil is ½ of snehabasti i.e. 144ml. [Su.Sa.Chikitsa Sthana 35/18][3]
  3. Matra basti: Dose of oil is ¼th of sneha basti i.e. 72ml

Indications

Anuvasana basti is indicated in following conditions:

Contraindications

Unctuous enema is contraindicated in diseases where purification is indicated like skin diseases (kushtha), obstinate urinary diseases including diabetes (prameha), obesity (sthaulya)[Cha.Sa.Siddhi Sthana 1/36]; the diseases with ama (undigested state) like acute fever, anemia, rhinitis etc. It shall not be given to patients on empty stomach and those who have low digestive capacity. [Cha.Sa.Siddhi Sthana 2/18]

Dosage

  • Maximum dose:288ml (6 pala)
  • Medium dose :144ml (3 pala)
  • Minimum dose :72ml (1 ½ pala) [Ka.Sa.Khila Sthana 8/109][9]

Procedure of administration

Pre therapeutic procedure (purva karma)

Unctuous enema is administered immediately after meals. [Su.Sa.Chikitsa Sthana 37/54][3] On the day of enema, the patient should take little quantity of food, ¼ part less than his regular diet quantity. The patient is advised to walk for few steps and to pass the natural urges if any. [Su.Sa.Chikitsa Sthana 37/57-58][3] The lukewarm medicated oil or ghee is filled in the enema syringe attached with catheter. In some conditions, fine powders of Anethum sowa (shatapushpa) and rock salt are added to oil. [Su.Sa.Chikitsa Sthana 37/63][3]

Therapeutic procedure (pradhana karma)

The procedure of administration of enema in anuvasana basti is same as mentioned above in context of of niruha basti. Enema syringe is used instead of enema pot.

Post therapeutic procedure (pashchat karma)

After administration of enema, patient is advised to lie down with well stretched body parts for 1-2 minutes(100 matra). Mild strokes over the gluteal region are given. Then both lower limbs are lifted slowly for three times to prevent the immediate evacuation of the medicine. [Cha.Sa.Siddhi Sthana 3/28] [Su.Sa.Chikitsa Sthana 37/60-62][3] Patting is done over palms and soles followed by gentle massage over calf and painful body parts in upward direction for 1 – 2minutes (100 matra).[A.S.Sutra Sthana 28/31][2] The maximum retention time of medicine is about 9 hours. [Cha.Sa.Siddhi Sthana 1/46] In a study, the retention time for anuvasana basti is reported as 3 to 6 hours in maximum (62.22%) participants.[8]

Assessment of therapeutic efficacy

The assessment of therapeutic efficacy is done on the basis of clinical features observed in patient.

Clinical features of optimal administration of anuvasana basti (unctuous enema)

Unobstructed expulsion of fecal matter mixed with oil, feeling of lightness in the abdomen, clarity in sense organs, improved quality of body tissues like blood etc., sleep and proper manifestation of natural urges are observed after optimal administration of basti. [Cha.Sa.Siddhi Sthana 1/44] The features are similar to that of oral intake of unctuous substances (snehapana). [A.H. Sutra Sthana 19/53][6] Proper movement/functioning of vata dosha and improved digestion are also observed in optimal anuvasana basti.

Inadequate administration of anuvasana basti

Obstruction in the functioning of vata dosha like obstruction in passage of stool, urine and flatus; pain in lower parts of body, abdomen, arms, back and sides of chest; dryness and roughness of body are observed due to inadequate administration of anuvasana basti. [Cha.Sa.Siddhi Sthana 1/45]

Excessive administration of anuvasana basti

Excessively administration of anuvasana basti causes nausea, unconsciousness, mental fatigue, exhaustion, fainting and griping pain. [Cha.Sa.Siddhi Sthana 1/46] Anemia and discharge through nose, mouth and anus are also observed. [A.H. Sutra Sthana 19/53][6]

Number of anuvasana basti based on dosha vitiation

General indications for administration of anuvasana basti based on dosha vitiation is as below.

Table 4: Number of anuvasana basti based on dosha
Dosha involved Number of anuvasana basti sessions
Vata vitiation 9 -11
Pitta vitiation 5 -7
Kapha vitiation 1 -3

[A.H. Sutra Sthana 19/54][6]

Complications

Complications may occur during basti procedure due to a variety of reasons like improper administration of basti, improper selection of patient or drug, defects in basti apparatus etc.

The major complications during decoction enema are as follows

  1. Inadequate expulsion
  2. Excessive expulsion
  3. Fatigue/exhaustion
  4. Abdominal distention
  5. Hiccups
  6. Chest congestion
  7. Vomiting
  8. Strenuous defecation
  9. Headache
  10. Bodyache
  11. Tearing pain in anus
  12. Rectal discharge [Cha.Sa.Siddhi Sthana 7/5]

The major complications during unctuous enema are caused due to obstruction of unctuous medication by vata, pitta, kapha or fecal matter. The obstruction may also happen due to excessive food intake prior to unctuous enema. If unctuous enema is performed in empty stomach it may also lead to complications.[Cha.Sa.Siddhi Sthana 4/25]

Safety precautions

Precautions at the time of selection of patient and drug/medication

An improper selection of drug or patient may lead to complications. The highly potent drug to a delicate person or a less potent drug to a strong person will lead to complications. A proper knowledge about the patient’s nature of gut and digestive capacity is necessary. Educate the patient properly about the whole procedure, so that complete co-operation from patient’s side can be assured.

Precautions at the time of administration

Practically most complications are observed by the improper administration of enema. Enema must be administered by a well trained physician. The patient should not be too much hungry at the time of administration of decoction enema. At the same time proper digestion is also required. Special care must be taken if the patient is having associated complaints like diabetes. After basti administration never allow the patient to withhold the urge. It is better to advice the patient not to close the toilet door from inside as fainting might happen during defecation. Advice the patient to take hot water bath followed by intake of moderate amount of food immediately after passing the bowels.

Importance in preservation of health and prevention

Basti provides nourishment and strength to the body. It helps to protect the health and improves longevity. [Su.Sa.Chikitsa Sthana35/4][3] For the protection of vital structures in the body (marma), basti is considered as the best treatment. [Cha.Sa.Siddhi Sthana 9/7] The eighteen schedules of unctuous enema involving 18 sessions in each schedule gives maximum strength like an elephant and increases the longevity. [Su.Sa.Chikitsa Sthana 37/76][3] Basti is administered in healthy individuals during pre-rainy and rainy season for management of naturally aggravated vata dosha and prevent its disorders to preserve health. [Cha.Sa.Sutra Sthana 7]

Importance in management of disease

Basti is the best treatment for aggravated vata dosha. [Cah.Sa.Siddhi Sthana 1/39] It can effectively manage the diseases due to associated doshas like pitta and kapha.[Su.Sa.Chikitsa Sthana 35/6][3] It is considered as the major treatment in gouty arthritis (vatarakta), [Cha.Sa.Chikitsa Sthana 29/88, abdominal lumps (gulma)[Cha.Sa.Chikitsa Sthana 5/100] etc. diseases. Basti shows its generalized action on all body parts.[Cha.Sa.Siddhi Sthana 7/64] The advantage of therapeutic enema over other purification procedures is that it can be administered in the most vulnerable age groups like old aged persons and young children.[Cha.Sa.Siddhi Sthana11/36] Basti is considered as half of the entire treatment or as the complete treatment itself in a given treatment protocol.[Cha.Sa.Siddhi Sthana 1/38-39]

Mode of action

The medicines administered through rectal route act on the morbidities and appropriately eliminates them with ease. [Cha.Sa.Siddhi Sthana 1/40]

Current researches

The rectal route of drug administration is an alternate route of drug delivery. Certain studies suggest that rectal route is more efficient than the intravenous route as it partially bypasses the first pass metabolism of liver.[10]

A study showed that basti medicine reaches up to ileo-caecal junction[11] however the active principles of formulation may extend their action to systemic levels. In an experimental study, the presence of active principle of a drug used in medicated enema is found in the systemic circulation. Gallic acid, a marker compound of Triphala (a compound containing Terminalia chebula, Terminalia belerica and Emblica officinalis), is observed in serum after administration of basti with triphala. Moreover, the concentration of gallic acid in serum is more, when the basti is added with catalytic adjuvant (prakshepakadravya). The concentration and rate of absorption depends on property of constituents in basti. The adjuvants might have irritant property, which cause mild inflammation in the colon. This inflammation alters the capillary permeability, which may enhance drug absorption.[12]

The efficacy of a treatment procedure highly depends upon the standard operative method. The method of administration of basti is very important. Basti administered through enema instrument (basti yantra) by exerting uniform manual pressure shows that the contents reach upto ileo-caecal junction and more concentration of contents seen in the proximal colon. On the other hand, basti administered using enema-can which uses atmospheric pressure, also shows the same extent of reaching ileo-cecal junction, however the concentration of contents is less in proximal colon. Proximal colon has significant role in colonic motility and absorption. The interstitial cells of Cajal in sub-mucosal surface (ICC) of the circular muscle, are present only in the proximal colon. Loss of ICC correlates with loss of pace maker activity, defects in propagation, reduction in neurotransmission etc. Short chain fatty acids (SCFA) which play a major role in maintaining the colonic health are chiefly synthesized in proximal colon. Butyrate, one of the SCFA, promotes the absorption of water and electrolytes from the proximal colon. More concentration of basti medicine at proximal colon may stimulate the ICC thereby stimulating the propagation, neurotransmission etc. It may also facilitate greater absorption of water and electrolytes along with other active principles.[13]

Therapeutic efficacy of basti

Enema intended for removal of morbidity (lekhana basti) is found effective in hyperlipidemia by reducing the serum cholesterol, serum LDL, serum apolipoprotein B. Significant reduction in weight, body mass index (BMI), body fat percentage and skin fold thickness were also reported.[14] The hypersensitivity or hyper responsiveness of hypothalamo-pituitary adrenal (HPA) axis is the main reason for endocrine malfunction in human obesity. Serum cortisol levels are found to be decreased in obese patients after basti treatment. This suggests normalizing of HPA axis through basti. Medicated enema shows immuno-modulatory effect by regulating pro-inflammatory cytokines, immunoglobulins and functional properties of T-cells.[15]

A study reported that low dose medicated oil enema (matra basti) is effective in reducing the signs and symptoms of osteoarthritis. There was significant reduction in pain and swelling in joints and reduction in pain during joint movements.[16] Erandamuladi yapana basti is found effective in reducing the pain, stiffness and tenderness related with lumbar spondylosis and improving the quality of life.[17]

Panchamooladikaala basti is reported to be effective in reducing the symptoms of rheumatoid arthritis (amavata) especially pain, stiffness, swelling and tenderness in the joints. It is also found effective in reducing the generalized symptoms like heaviness of body, fatigue, feverishness and anorexia. Basti acts over the prime seat of vata dosha i.e. large intestine (pakvashaya) and controls it. The alkali present in the kshara basti improves digestion and removes the accumulated toxins (ama).[18]

Unctuous enema in minimum dose (matra basti) is found effective in 12 cases of anovulation. Ovulation occurred in the maximum number of participants (63.64%) and increased follicular size is also reported after matra basti. Basti shows its action on Enteric Nervous System (ENS). The endogenous opioids especially beta endorphins may get stimulated. This may affect the GnRH secretion and there by regularize hypothalamo pituitary ovarian (HPO) axis. HPO axis regulates the ovarian cycle and ovulation. By the action over ENS, basti may also stimulate CNS and thereby stimulates pituitary. This results in the secretion of FSH and LH which plays an important role in ovulation.[19] More studies are needed to study the effect of basti on specific pathways.

List of theses done

  1. Savjani Rekha T (2001): A clinical study on the management of sthaulya by panchatikta and lekhana basti, Department of Kayachikitsa, IPGT&RA Jamnagar
  2. Bhatted Santosh (2002): A comparative study of the role of vajeekarana drugs administered orally and by basti in the management of klaibya with reference to erectile dysfunction. Department of Kayachikitsa, IPGT&RA Jamnagar
  3. Mangalasseri Prakash (2002): A clinical study of shukragatavata w.s.r to premature ejaculation & its management with Akarakarbhati yoga yapana basti, Department of Kayachikitsa, IPGT&RA Jamnagar
  4. Varma S P (2002): Study of Vaitarana-Basti in the management of Kati-shoola. Department of Kayachikitsa, IPGT&RA Jamnagar
  5. Pawar Anand M (2003): A comparative study on the role of basti therapy and pramehaghna drugs in the management of madhumeha (Diabetes mellitus). Department of Kayachikitsa, IPGT&RA Jamnagar
  6. Chitte Srilekha (2004): A comparative study of Matra Basti and some indigenous compound drugs on Amavata (Rheumatoid arthritis). Department of Kayachikitsa, IPGT&RA Jamnagar
  7. Khagram Rita V (2004): Comparative study of Kati Basti and Matra-Basti in the management of Gridhrasi (sciatica). Department of Kayachikitsa, IPGT&RA Jamnagar
  8. Bhatkoti Mayank (2005): A comparative clinical study of vaitaranabasti and virechana karma in the management of amavata. Department of Kayachikitsa, IPGT&RA Jamnagar
  9. Tejal Khunt (2005) :Comparitive study on the Virechana Karma and Lekhana Basti in the management of Sthaulya. Department of Kayachikitsa, IPGT&RA Jamnagar
  10. Anamika Kumari (2006): A comparative study on the effect of some indigenous compound drug and matra basti in the management of Gridhrasi (Sciatica). Department of Kayachikitsa, IPGT&RA Jamnagar
  11. Mayuri Shah (2006): A comparative study of matra basti and some indigenous compound drug in the management of sandhigatavata (osteoarthritis). Department of Kayachikitsa, IPGT&RA Jamnagar
  12. Sanjay Gupta (2006): A clinical effect of Baladiyapana basti and vajikarana yoga in the management of sukradushti w.s.r to oligoasthenozoospermia. Department of Kayachikitsa, IPGT&RA Jamnagar
  13. Gajanan Kulkarni (2007): A comparative study of role of yapana basti and karma basti in the management of Pakshagata (CVA). Department of Panchakarma, IPGT&RA Jamnagar
  14. Vinay Chaudary (2007): A clinical study of standardization of Yapana basti in the management of Kampavata. Department of Panchakarma, IPGT&RA Jamnagar
  15. Jayadip Kumar P Shah (2008): Effect of Tiktakshira basti and patrapind sweda in the management of cervical spondylosis (Asthigatavata). Department of Panchakarma, IPGT&RA Jamnagar
  16. Vimal M Vekaria (2008): Comparative study of Virechana karma and kala basti in the management of Pakshaghata. Department of Panchakarma, IPGT&RA Jamnagar
  17. Geeta Jatav (2008): A Comparative Study on the effect Of VidarikandadiVati and KshirabalaTaila Basti in the management of Karshya in Children. Department of Kaumarabrithya, IPGT&RA Jamnagar
  18. Juneja Yaswant M (2009): Standardization of procedure of administration of basti w.s.r to Kshinashukra (oligozoospermia). Department of Panchakarma, IPGT&RA Jamnagar
  19. Gohil Jalpa H (2009): A comparative clinical study of Virechana karma and kala basti in management of Amavata. Department of Panchakarma, IPGT&RA Jamnagar
  20. Ajay K Gupta (2010): Effect of Majja basti and AsthiShrinkhala in the management of osteoporosis w.s.r to Asti Majjakshaya A clinical study. Department of Panchakarma, IPGT&RA Jamnagar
  21. Gyanendra D Shukla (2010): A Comparative Study of efficacy of Virechana and Basti Karma with Shamana therapy in the management of Essential Hypertension. Department of Panchakarma, IPGT&RA Jamnagar
  22. Damayanthie Fernando (2011): Assessment of Clinical Efficacy of ErandamuladiYapana Basti and ErandaBijaKshiraPaka in the management of Kati Graha w.s.r. to Lumbar Spondylosis. Department of Panchakarma, IPGT&RA Jamnagar
  23. Swapnil S Auti (2011): Assessment of Lekhana Basti in management of Hyperlipidaemia (A Randomised Controlled Clinico-Experimental Study). Department of Panchakarma, IPGT&RA Jamnagar
  24. Nikunj M (2012): A comparative study of vrishya basti and kulinga (Blepharis edulis) after virechana karma in the management of kshinashukra w.s.r to oligozoospermia. Department of Panchakarma, IPGT&RA Jamnagar
  25. Saurabh R Bhuva (2012): A comparative study of matra basti and brimhanasnehana by asthishrinkhalaghrita in the management of asthi-majjakshaya w.s.r to osteopenia/osteoporosis. Department of Panchakarma, IPGT&RA Jamnagar
  26. Siddharth Kumar J (2012): Role of matra basti as chemoprotective adjuvant in the management of cancer. Department of Panchakarma, IPGT&RA Jamnagar
  27. Hemal Kumar V Dodiya (2013): A comparative clinical study on the effect of Guduchi-Bhadramustadi yoga administered orally and by basti in the management of sthaulya w.s.r to obesity. Department of Panchakarma, IPGT&RA Jamnagar
  28. Chughdeepa surrender pal (2014): A comparative study of shwadanshtradi basti and chitrakadighrita management of sandhivata with special reference to osteoarthritis. Department of Panchakarma, IPGT&RA Jamnagar
  29. Jadav Hasmukh Bhavanbhai (2014): Management of premature ejaculation (shukragatavata) with erandamool basti and vanarikalpa- A clinical study. Department of Panchakarma, IPGT&RA Jamnagar
  30. Paikrao Sumedh Narayanrao (2014): A clinical study on siravedha and vaitarana basti in the management of gridhrasi with special reference to sciatica. Department of Panchakarma, IPGT&RA Jamnagar
  31. Rani Sangeeta Ishwar Singh (2017): A randomized clinical trial on brihatyadiyapana basti and patrapinda sweda with aadityapakaguggulu in the management of cervical spondylosis w.s.r to asthigatavata. Department of Panchakarma, IPGT&RA Jamnagar
  32. Kumar Surendra Ganesh Ram (2017): Comparative efficacy of vajigandhaditailapana and basti in the management of gridhrasi (sciatica) – A randomized clinical trial. Department of Panchakarma, IPGT&RA Jamnagar
  33. Ram Poojan Verma (2018): Efficacy of erandamooladiniruha basti and shunthikwatha with erandataila in the management of katishoola (lumbar spondylosis): A open labeled, Randomised, comparative clinical trial. Department of Panchakarma, IPGT&RA Jamnagar
  34. Shiho Oikawa (2018): Virechana karma along with vaitarana basti followed by mahabhallatakaavaleha in the management of amavata wsr to rheumatoid arthritis-A compararive randomized controlled study. Department of Panchakarma, IPGT&RA Jamnagar

More information

Bastisutriyam Siddhi, Panchakarmiya Siddhi, Kalpana Siddhi, Snehavyapat Siddhi, Netrabastivyapat Siddhi, Bastivyapat Siddhi, Prasrita Yogiyam Siddhi, Phalamatra Siddhi, Uttar Basti Siddhi, Basti Siddhi

Abbreviations

Cha. = Charak, Su. = Sushruta, A. = Ashtanga, S. = Sangraha, Hr. = Hridayam, Sa. = Samhita, Sha. = Sharangadara, Ka. = Kashyapa

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Reference

  1. ↑ Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Vasti, Page 933
  2. ↑ 2.0 2.1 2.2 2.3 Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.
  4. ↑ Sharangadhara. Sharangadhara Samhita. Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Chaukhambha orientalia;2016.
  5. ↑ Singh Nita S. An open clinical trial to assess samyak nirooha lakshana of maadhutailika vasti administered with standardized aaturahastapramaana in kat’eegraha [MD Dissertation]. Kottakkkal: Kerala University of Health Sciences; 2015.
  6. ↑ 6.0 6.1 6.2 6.3 Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.
  7. ↑ Savrikar SS, Lagad CE. Study of Preparation and Standardization of 'Maadhutailika Basti' with special reference to Emulsion Stability. Ayu. 2010 Jan;31(1):1-6. doi: 10.4103/0974-8520.68190. PMID: 22131675; PMCID: PMC3215309.
  8. ↑ 8.0 8.1 Thanki K, Bhatt N, Shukla VD. Effect of kshara basti and nirgundi ghana vati on amavata (rheumatoid arthritis). Ayu. 2012 Jan;33(1):50-3. doi: 10.4103/0974-8520.100310. PMID: 23049184; PMCID: PMC3456864.
  9. ↑ 9.0 9.1 Vrddhajivaka, Kasyapa Samhita. Edited by Tewari P V, Reprint edition. Varanasi: Chaukhambha visvabharati; 2008
  10. ↑ Kadus PA, Vedpathak SM. Anuvasana Basti in escalating dose is an alternative for Snehapana before Vamana and Virechana: Trends from a pilot study. J Ayurveda Integr Med 2014;5:246-50.
  11. ↑ Juneja Yashwant M, Thakar A. B. Standardization of procedure of administration of Basti w.s.r to Kshinashukra (oligozoospermia), MD Dissertation, IPGT& RA. Jamnagar: Gujarat Ayurved University; 2010
  12. ↑ Swapnil SA, BK Ashok, Anup B Thakar et al. An experimental study to evaluate the pharmacokinetic aspect of Lekhana Basti (Emaciating/ Desiccating Medicated Enema). Anc Sci Life. 2011 Oct;31(2):38-43.
  13. ↑ Manohar SG, Ashwinikumar AR, Nitin MK. Basti: Does the equipment and method of administration matter? J Ayurveda Integr Med. 2013 Jan;4(1):9-12. doi: 10.4103/0975-9476.109543.
  14. ↑ Swapnil SA, Anup B Thakar et al. Assessment of Lekhana Basti in the management of hyperlipidemia. Ayu. 2013 Oct;34(4):339-45. doi: 10.4103/0974-8520.127683.
  15. ↑ Urmila T, Shubhada C et al. Immunological & metabolic responses to a therapeutic course of Basti in obesity. Indian J Med Res. 2015 Jul;142(1):53-62. doi: 10.4103/0971-5916.162099.
  16. ↑ Mayuri RS, Charmi SM et al. A Clinical study of Matra Vasti and an ayurvedic indigenous compound drug in the management of Sandhigatavata (Osteoarthritis). Ayu. 2010 Apr;31(2):210-7. doi: 10.4103/0974-8520.72399.
  17. ↑ Damayanthie Fernando, Anup B Thakar, VD Shukla. Clinical efficacy of Eranda Muladi Yapana Basti in the management of Kati Graha (Lumbar spondylosis). Ayu. 2013 Jan;34(1):36-41. doi: 10.4103/0974-8520.115444.
  18. ↑ Baria R, Joshi N, Pandya D. Clinical efficacy of Panchamuladi Kaala Basti (enema) in the management of Amavata (Rheumatoid Arthritis). Ayu. 2011 Jan;32(1):90-4. doi: 10.4103/0974-8520.85737. PMID: 22131764; PMCID: PMC3215425.
  19. ↑ Donga KR, Donga SB, Dei LP. Role of Nasya and Matra Basti with Narayana Taila on anovulatory factor. Ayu. 2013 Jan;34(1):81-5. doi: 10.4103/0974-8520.115453. PMID: 24049410; PMCID: PMC3764886.
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