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*Factors related to basti administration
*Factors related to basti administration
*Factors related to patients’ clinical condition
*Factors related to patients’ clinical condition
The signs and symptoms described for various basti complications are broadly categorised under
The signs and symptoms described for various basti complications are broadly categorised under
*Intestinal motility related
*Water and electrolyte balance related
*Local anal inflammatory conditions
Complications of basti may result either due to errors in compounding it or consistency basti, dose or temperature of basti dravya at the time of administration. However, these complications may result depending on body response to the above-mentioned factors. The responses may be explained under three headings viz. excessive response (atiyoga), poor/low/no response (ayoga) and faulty response (mithyayoga). [5-6]
Complications of basti may result either due to errors in compounding it or consistency basti, dose or temperature of basti dravya at the time of administration. However, these complications may result depending on body response to the above-mentioned factors. The responses may be explained under three headings viz. excessive response (atiyoga), poor/low/no response (ayoga) and faulty response (mithyayoga). [5-6]
Etiology, clinical manifestation and management of basti complication-ayoga:
==== Etiology, clinical manifestation and management of basti complication-ayoga ====
Ayoga (poor/low/no response) complication of basti may result either due to quality of dravya or due to patient condition or combination of both.
Ayoga (poor/low/no response) complication of basti may result either due to quality of dravya or due to patient condition or combination of both.
Poor response due to quality of bastidravya:
===== Poor response due to quality of bastidravya =====
Shitaguna causes sthambhana. Sthambhana means stationary or movement less. In this context decreased intestinal motility is to be considered. Decreased intestinal motility may result in abdominal distension.
Shitaguna causes sthambhana. Sthambhana means stationary or movement less. In this context decreased intestinal motility is to be considered. Decreased intestinal motility may result in abdominal distension.
• Sufficient quantity of lavana (salt – rock salt) is required to maintain optimum osmotic pressure so that ionic exchange takes place. If optimum osmolality is not attained the active ingredients which are supposed to be absorbed through osmotic pressure are not absorbed and thus desired efficacy may not be achieved.
• Sufficient quantity of lavana (salt – rock salt) is required to maintain optimum osmotic pressure so that ionic exchange takes place. If optimum osmolality is not attained the active ingredients which are supposed to be absorbed through osmotic pressure are not absorbed and thus desired efficacy may not be achieved.
• Sufficient quantity of sneha (unctuous part - oil/ghee) is also important. Lipids in the form of sneha facilitate lipid mediated transportation. Insufficient quantity of sneha minimizes the lipid mediated transportation and thus desired efficacy is not achieved. Further salt present in basti helps in micelle (smallest particle of lipid) formation of lipids and facilitates absorption of lipids.
• Sufficient quantity of sneha (unctuous part - oil/ghee) is also important. Lipids in the form of sneha facilitate lipid mediated transportation. Insufficient quantity of sneha minimizes the lipid mediated transportation and thus desired efficacy is not achieved. Further salt present in basti helps in micelle (smallest particle of lipid) formation of lipids and facilitates absorption of lipids.
Poor response due to patient condition:
===== Poor response due to patient condition =====
• Guru koshtha (hard bowel) is the condition where in the digestion process is delayed mostly due to sluggish intestinal motility. In such cases basti predominant of shitaguna further worsen the problem as shita does stambhana.
• Guru koshtha (hard bowel) is the condition where in the digestion process is delayed mostly due to sluggish intestinal motility. In such cases basti predominant of shitaguna further worsen the problem as shita does stambhana.
Vata predominace in general or ruksha in particular both require lavana or sneha to counteract. If bastidravya is compounded with insufficient quantity of lavana & sneha, there will be further aggravation of vata or ruksha of vatadosha. In this case it should be understood that, there is already negative ionic gradient (both osmotic / lipid mediated) and hence sufficient quantity of lavana/sneha are required to convert it into positive ionic gradient so that active ingredients are transported through osmotic pressure or lipid mediated ionic transportation.
Vata predominace in general or ruksha in particular both require lavana or sneha to counteract. If bastidravya is compounded with insufficient quantity of lavana & sneha, there will be further aggravation of vata or ruksha of vatadosha. In this case it should be understood that, there is already negative ionic gradient (both osmotic / lipid mediated) and hence sufficient quantity of lavana/sneha are required to convert it into positive ionic gradient so that active ingredients are transported through osmotic pressure or lipid mediated ionic transportation.
The management is mainly aimed at inducing/increasing intestinal peristaltic movements. Dipana-pachana drugs stimulates gastro-intestinal tract secretions and increases intestinal motility. Anal suppository, virechana and basti also induces/increases intestinal motility. [7-11]
The management is mainly aimed at inducing/increasing intestinal peristaltic movements. Dipana-pachana drugs stimulates gastro-intestinal tract secretions and increases intestinal motility. Anal suppository, virechana and basti also induces/increases intestinal motility. [7-11]
Etiology, clinical manifestation and management of basti complication-atiyoga:
==== Etiology, clinical manifestation and management of basti complication-atiyoga ====
Atiyoga (excessive response) complication of basti is seen when patients of mridukostha (sensitive GI tract) had undergone sneha & sveda which further sensitize the GI tract when administered with basti, prepared out of ushna & tikshna (high potent/irritant drugs), leads to hyper stimulation of intestinal tract, excessive elimination of bodily fluids, thus results in electrolyte imbalance and dehydration. The signs and symptoms mentioned are related to dehydration & electrolyte imbalance.
Atiyoga (excessive response) complication of basti is seen when patients of mridukostha (sensitive GI tract) had undergone sneha & sveda which further sensitize the GI tract when administered with basti, prepared out of ushna & tikshna (high potent/irritant drugs), leads to hyper stimulation of intestinal tract, excessive elimination of bodily fluids, thus results in electrolyte imbalance and dehydration. The signs and symptoms mentioned are related to dehydration & electrolyte imbalance.
The drugs and other mediums used for management of atiyoga are rich in drava guna , also having characteristics like balya (promotive of strength) brumhana (promotes growth) and jeevaniya (promotes life). These can help to make up for the loss of body fluids and other vital body elements that may be lost due to atiyoga of basti. [12-14]
The drugs and other mediums used for management of atiyoga are rich in drava guna , also having characteristics like balya (promotive of strength) brumhana (promotes growth) and jeevaniya (promotes life). These can help to make up for the loss of body fluids and other vital body elements that may be lost due to atiyoga of basti. [12-14]
Management:
===== Management =====
Amashesha indicates incomplete digestion process. In such conditions mridu basti further suppress digestion. In case of indigestion we need to stimulate secretion of digestive juices and hence the management is to use measures which hasten the digestive process.
Amashesha indicates incomplete digestion process. In such conditions mridu basti further suppress digestion. In case of indigestion we need to stimulate secretion of digestive juices and hence the management is to use measures which hasten the digestive process.
Management with pachana in conditions precipitated with presence of ama is very logical. Ama primarily accounts for agnimandya (lowers the digestive power) and action of pachana as told by Arundatta at Ash. Hru. Su.8/21-22, is removing causes of obstruction that come in the way of function of agni, and ama is one of them, signifying role of pachana.
Management with pachana in conditions precipitated with presence of ama is very logical. Ama primarily accounts for agnimandya (lowers the digestive power) and action of pachana as told by Arundatta at Ash. Hru. Su.8/21-22, is removing causes of obstruction that come in the way of function of agni, and ama is one of them, signifying role of pachana.
Basti given in this avastha (condition) should be vyakta lavana (salt in profound quantity). Basic characteristics of lavana as told by Vagbhata in As. Hru, Su.6/144, are vishyandi (means one which helps to liquify and release the doshas from obtruction if any), sukshma (which can reach easily at cellular level), srushtamala (which accounts for easy elimination of mutra (urine) purisha (stool) etc. ama in present context), and mrudu (soft) in nature. These charactristics of lavana helps in releasing the obstruction caused by pitta kapha dosha along with ama.[15-20]
Basti given in this avastha (condition) should be vyakta lavana (salt in profound quantity). Basic characteristics of lavana as told by Vagbhata in As. Hru, Su.6/144, are vishyandi (means one which helps to liquify and release the doshas from obtruction if any), sukshma (which can reach easily at cellular level), srushtamala (which accounts for easy elimination of mutra (urine) purisha (stool) etc. ama in present context), and mrudu (soft) in nature. These charactristics of lavana helps in releasing the obstruction caused by pitta kapha dosha along with ama.[15-20]
As already discussed, the basti should contain enough tikshanata to induce enough peristalsis as well as to stimulate secretion of digestive enzymes. In case of krura kostha naturally there will be alternate phases of samavastha and vishamagni. Hence in krurakostha, mahadoshavastha drugs with less potency are administered which further decrease peristaltic movements thus leading to abdominal distension.
As already discussed, the basti should contain enough tikshanata to induce enough peristalsis as well as to stimulate secretion of digestive enzymes. In case of krura kostha naturally there will be alternate phases of samavastha and vishamagni. Hence in krurakostha, mahadoshavastha drugs with less potency are administered which further decrease peristaltic movements thus leading to abdominal distension.
Due to doshas obstructing the path of vayu by covering it, resultant vata prakopa causes vimargagamana of vayu (vayu changing its normal path) leading to adhmana (flatulance) which creates marmapida (pain in vital parts) making koshtha (abdomen) guru i.e. krura (which leads to constipating habits) or malapurna (due to inaction of vayu mala gets accumulated (as per Chakrapani commentary at Cha.Si. 7/7-11). [21-26]
Due to doshas obstructing the path of vayu by covering it, resultant vata prakopa causes vimargagamana of vayu (vayu changing its normal path) leading to adhmana (flatulance) which creates marmapida (pain in vital parts) making koshtha (abdomen) guru i.e. krura (which leads to constipating habits) or malapurna (due to inaction of vayu mala gets accumulated (as per Chakrapani commentary at Cha.Si. 7/7-11). [21-26]
Due to excess elimination of doshas from strong basti given to weak patient, vata prakopa takes place leading to upward movement of vitiated vata, as a result of which hikka, which originates from amashaya (stomach) is observed. Line of treatment of hikka along with brumhana is applied. Brumhana counters vata and at the same time will also increase dhatu which is in a debilitated state in this case.[27-29]
Due to excess elimination of doshas from strong basti given to weak patient, vata prakopa takes place leading to upward movement of vitiated vata, as a result of which hikka, which originates from amashaya (stomach) is observed. Line of treatment of hikka along with brumhana is applied. Brumhana counters vata and at the same time will also increase dhatu which is in a debilitated state in this case.[27-29]
Considering aetiology, signs & symptoms and management, hritghattana may be understood as epigastric discomfort. The air present in the basti may cause obstruction. The management is also aimed to stimulate gastrointestinal secretions, and intestinal motility to relieve colic.
Considering aetiology, signs & symptoms and management, hritghattana may be understood as epigastric discomfort. The air present in the basti may cause obstruction. The management is also aimed to stimulate gastrointestinal secretions, and intestinal motility to relieve colic.
In the management amla and lavana rasa is prefered over other rasa, because of its anulomana (downward direction) action. Furthermore amla rasa is known for its specific function related to vata, as moodhavatanulomana (brings about vata doing abnormal movement to its normal movement). In this vyapat as hrudaya is involved amla which is best among hrudya articles (Ch. Su. 25/40) is a natural choice. [30-31]
In the management amla and lavana rasa is prefered over other rasa, because of its anulomana (downward direction) action. Furthermore amla rasa is known for its specific function related to vata, as moodhavatanulomana (brings about vata doing abnormal movement to its normal movement). In this vyapat as hrudaya is involved amla which is best among hrudya articles (Ch. Su. 25/40) is a natural choice. [30-31]
The management is done by shodhaniya and anulomika basti. Anulomika basti is to be given by ksheera (milk) ikshurasa (sugarcane juice). Here milk, ikshurasa etc is brumhana, which acts as vatashamana, at the same time it induces shodhana due to its sara guna. This can be understood by opinion of Arundatta at Ash.Hru.Su 14/7, where he says that in case of vata and vata-pitta, brumhana like milk etc. acts as shodhana.[40-42]
The management is done by shodhaniya and anulomika basti. Anulomika basti is to be given by ksheera (milk) ikshurasa (sugarcane juice). Here milk, ikshurasa etc is brumhana, which acts as vatashamana, at the same time it induces shodhana due to its sara guna. This can be understood by opinion of Arundatta at Ash.Hru.Su 14/7, where he says that in case of vata and vata-pitta, brumhana like milk etc. acts as shodhana.[40-42]
The treatment goes in a very methodical way with application of oil with salt for countering vata vitiation, followed by nasya in form of powders blown in to nostrils and dhoom medicated fumes made to inhale, acts for elimination of doshas that are present in the head. This is followed by food which is tikshna in property and anulomika which helps to regulate vata in its normal direction, followed by anuvasana basti. This takes care of agitated vata having taken the course of head to go out through anus which is its normal root of elimination.[43-46]
The treatment goes in a very methodical way with application of oil with salt for countering vata vitiation, followed by nasya in form of powders blown in to nostrils and dhoom medicated fumes made to inhale, acts for elimination of doshas that are present in the head. This is followed by food which is tikshna in property and anulomika which helps to regulate vata in its normal direction, followed by anuvasana basti. This takes care of agitated vata having taken the course of head to go out through anus which is its normal root of elimination.[43-46]
To manage angarti (bodyache) types of swedana selected are sarvadehika (applicable to whole body) like prastara, seka. To counter vata these are preceded with application of oil with salt. Which takes care of vitiation of vata all over the body.[ 47-53]
To manage angarti (bodyache) types of swedana selected are sarvadehika (applicable to whole body) like prastara, seka. To counter vata these are preceded with application of oil with salt. Which takes care of vitiation of vata all over the body.[ 47-53]
The management given aims at soothening and softening the bowels and to also promote healing. Milk, sugarcane juice helps in countering dryness of the large intestine due to their snigdha guna. Diet rich in mrudu guna and amla rasa further helps in keeping softness of the bowel intact as well as maintaining normal actin of vata. [54-57]
The management given aims at soothening and softening the bowels and to also promote healing. Milk, sugarcane juice helps in countering dryness of the large intestine due to their snigdha guna. Diet rich in mrudu guna and amla rasa further helps in keeping softness of the bowel intact as well as maintaining normal actin of vata. [54-57]
Basti dominating with amla lavana rasa and ushna tikshna properties in a patient suffering from disease of pitta dosha leads to further vitiation of pitta, this in turn vitiates rakta which is seat of pitta dosha, starts coming out through anus. The best remedy for this is piccha basti which has medicines acting for stopping the blood flow and also promotes healing. [58-62]
Basti dominating with amla lavana rasa and ushna tikshna properties in a patient suffering from disease of pitta dosha leads to further vitiation of pitta, this in turn vitiates rakta which is seat of pitta dosha, starts coming out through anus. The best remedy for this is piccha basti which has medicines acting for stopping the blood flow and also promotes healing. [58-62]