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O! Agnivesha, we will now describe about the patients for whom [[Panchakarma]] therapies are contra-indicated with proper reasoning and the patients for whom [[Panchakarma]] are indicated. [3]
O! Agnivesha, we will now describe about the patients for whom [[Panchakarma]] therapies are contra-indicated with proper reasoning and the patients for whom [[Panchakarma]] are indicated. [3]
=== Persons who are generally ''anupakramya'' (unsuitable for treatment) ===
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Henceforth, we will discuss the indications and contra-indications of each of the procedure of [[Panchakarma]] therapies considering the different situations. [4-7]
Henceforth, we will discuss the indications and contra-indications of each of the procedure of [[Panchakarma]] therapies considering the different situations. [4-7]
=== Contra-indications of ''vamana karma'' ===
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[8]
[8]
=== Adverse effects of ''vamana karma'' administered in contra-indicated conditions ===
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[9]
[9]
=== Indications of ''vamana karma'' ===
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In these above mentioned conditions, action of ''vamana karma'' in causing cure of diseases caused by aggravation of ''kapha'' being similar to water laden paddy field getting spoiled due to clogging of water which can be corrected by the letting out the water out of the field like ''vamana'' does with ''kapha''. [10]
In these above mentioned conditions, action of ''vamana karma'' in causing cure of diseases caused by aggravation of ''kapha'' being similar to water laden paddy field getting spoiled due to clogging of water which can be corrected by the letting out the water out of the field like ''vamana'' does with ''kapha''. [10]
=== Contra-indications of ''virechana karma'' ===
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[11]
[11]
=== Adverse effects of ''virechana karma'' administered in contra-indicated conditions ===
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Therefore, above mentioned persons should not be treated with ''virechana karma''. [12]
Therefore, above mentioned persons should not be treated with ''virechana karma''. [12]
=== Indications of ''virechana karma'' ===
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For the above-mentioned diseases, ''virechana karma'' is the foremost therapy. As the extinguisher of fire normalizes a house on fire, similarly ''virechana karma'' cures the diseases by eliminating aggravated ''pitta''. [13]
For the above-mentioned diseases, ''virechana karma'' is the foremost therapy. As the extinguisher of fire normalizes a house on fire, similarly ''virechana karma'' cures the diseases by eliminating aggravated ''pitta''. [13]
=== Contra-indications of ''asthapana basti'' ===
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[14]
[14]
=== Adverse effects of ''asthapana basti'' administered in contra-indicated persons ===
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Application of ''Asthapana-basti'' (non-unctuous enema) in the persons suffering from indigestion, over-uncted and just taken unctuous substances causes ''dushyodara'' (''udara-roga'' caused by aggravation of all the three ''dosha''), fainting or edema. In the cases having excited ''dosha'' and suppression of digestion power, it causes severe type of anorexia. In a person exhausted due to riding, the ''asthapana''-''basti'' disturbed by agitation dry up the body quickly leading to emaciation. In the persons who are excessively weak and suffering from excessive hunger, thirst and tiredness, ''basti'' causes the same harms as discussed for exhausted due to riding. In excessively emaciated person if ''asthapana-basti'' is applied, it increases the emaciation. In those who have just taken food and water, ''asthapana basti'' causes provocation of ''vata'' which divert the enema upwards or downwards leading to manifestation of severe diseases soon. In that undergone emesis or purgation, the ''niruha'' or ''asthapana-basti'' burns the body as alkali does the wound. In a person who has undergone the snuffing, it causes the untoward effects related to sense organs and further obstruction of the channels of circulation. In the person having anger and fear, the ''basti'' may go upwards and produce agitation. In the condition of narcosis and fainting, the ''basti'' causes further agitation and there may be complications due to mental injury. If ''asthapana basti'' is applied in the conditions of constant vomiting, excessive spitting, dyspnea, cough and hiccup, ''vata'' moving upwards can cause upward movement of ''basti''. In the persons suffering from intestinal obstruction, intestinal perforation and ascites associated with tympanitis, ''asthapana basti'' further increase the distension and may lead to the death of the patient. In the persons suffering from ''alasaka, visuchika,'' premature delivery and ''amatisara'', it causes the disorders due to ''ama'' (product of improper digestion). In diabetes mellitus and ''kushtha'' (obstinate skin diseases including leprosy), application of ''asthapana basti'' further increases these diseases. Therefore, ''asthapana basti'' should not be given to the above mentioned persons.[15]
Application of ''Asthapana-basti'' (non-unctuous enema) in the persons suffering from indigestion, over-uncted and just taken unctuous substances causes ''dushyodara'' (''udara-roga'' caused by aggravation of all the three ''dosha''), fainting or edema. In the cases having excited ''dosha'' and suppression of digestion power, it causes severe type of anorexia. In a person exhausted due to riding, the ''asthapana''-''basti'' disturbed by agitation dry up the body quickly leading to emaciation. In the persons who are excessively weak and suffering from excessive hunger, thirst and tiredness, ''basti'' causes the same harms as discussed for exhausted due to riding. In excessively emaciated person if ''asthapana-basti'' is applied, it increases the emaciation. In those who have just taken food and water, ''asthapana basti'' causes provocation of ''vata'' which divert the enema upwards or downwards leading to manifestation of severe diseases soon. In that undergone emesis or purgation, the ''niruha'' or ''asthapana-basti'' burns the body as alkali does the wound. In a person who has undergone the snuffing, it causes the untoward effects related to sense organs and further obstruction of the channels of circulation. In the person having anger and fear, the ''basti'' may go upwards and produce agitation. In the condition of narcosis and fainting, the ''basti'' causes further agitation and there may be complications due to mental injury. If ''asthapana basti'' is applied in the conditions of constant vomiting, excessive spitting, dyspnea, cough and hiccup, ''vata'' moving upwards can cause upward movement of ''basti''. In the persons suffering from intestinal obstruction, intestinal perforation and ascites associated with tympanitis, ''asthapana basti'' further increase the distension and may lead to the death of the patient. In the persons suffering from ''alasaka, visuchika,'' premature delivery and ''amatisara'', it causes the disorders due to ''ama'' (product of improper digestion). In diabetes mellitus and ''kushtha'' (obstinate skin diseases including leprosy), application of ''asthapana basti'' further increases these diseases. Therefore, ''asthapana basti'' should not be given to the above mentioned persons.[15]
=== Indications of ''asthapana basti'' ===
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In the above mentioned diseases, ''asthapana basti'' is the foremost therapy. As a tree gets destroyed by cutting its roots, similarly the above mentioned diseases are eradicated by administration of ''asthapana basti''. [16]
In the above mentioned diseases, ''asthapana basti'' is the foremost therapy. As a tree gets destroyed by cutting its roots, similarly the above mentioned diseases are eradicated by administration of ''asthapana basti''. [16]
=== Contra-indications of ''anuvasana basti'' ===
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[17]
[17]
=== Adverse effects of ''anuvasana basti'' in contra-indicated conditions ===
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If ''anuvasana basti'' is administered to the person who is empty stomach, it goes upwards due to the absence of any obstruction in the passage. In the acute fever, anaemia, jaundice and ''prameha'', ''anuvasana basti'' causes excitement of ''dosha'' which further leads to ''Udara roga'' (obstinate abdominal disease including ascites). In the person suffering from piles, use of ''anuvasana basti'' may create obstruction in the piles leading to ''adhmana'' (abdominal distension). In the person suffering from anorexia, application of ''anuvasana basti'' further diminishes the desire for food. In case of suppression of power of digestion and weakness, the application of ''anuvasana basti'' makes the digestive power poorer. If ''anuvasana basti'' is administered to the persons suffering from coryza, splenic disorders and such other diseases, it causes the further excitement of ''dosha'' which are already aggravated. Therefore, the above mentioned persons are unfit for the administration of ''anuvasana basti''. [18]
If ''anuvasana basti'' is administered to the person who is empty stomach, it goes upwards due to the absence of any obstruction in the passage. In the acute fever, anaemia, jaundice and ''prameha'', ''anuvasana basti'' causes excitement of ''dosha'' which further leads to ''Udara roga'' (obstinate abdominal disease including ascites). In the person suffering from piles, use of ''anuvasana basti'' may create obstruction in the piles leading to ''adhmana'' (abdominal distension). In the person suffering from anorexia, application of ''anuvasana basti'' further diminishes the desire for food. In case of suppression of power of digestion and weakness, the application of ''anuvasana basti'' makes the digestive power poorer. If ''anuvasana basti'' is administered to the persons suffering from coryza, splenic disorders and such other diseases, it causes the further excitement of ''dosha'' which are already aggravated. Therefore, the above mentioned persons are unfit for the administration of ''anuvasana basti''. [18]
=== Indications of ''anuvasana basti'' ===
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In such patients, ''anuvasana basti'' is said to be the most effective and could be likened to watering a plant in its root.[19]
In such patients, ''anuvasana basti'' is said to be the most effective and could be likened to watering a plant in its root.[19]
=== Contra-indications of ''shirovirechana'' ===
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[20]
[20]
=== Adverse effects of ''shirovirechana'' in contra-indicated conditions ===
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''Shirovirechana'' applied in the case of indigestion and full stomach causes the occlusion of the channels moving upwards by vitiated ''dosha'' which further leads to manifestation of cough, dyspnea, vomiting and coryza. In those who have taken fatty substances or desirous of taking wine or water or take after head-evacuation, ''shirovirechana'' gives rise to discharge from mouth and nose, dirt and stickiness in eyes, cataract and head diseases. If the person who has taken head- bath or takes head-bath after the therapy, then it causes the coryza. Application of ''shirovirechana'' in a person afflicted with hunger causes aggravation of ''vata dosha''. If it is administered to the person afflicted with thirst then it further increases the thirst and causes the dryness of mouth. ''Shirovirechana'' applied in the cases of fatigue, intoxication and fainting produces the same adverse effects as mentioned under the ''asthapana basti''. If this therapy is administered in the persons injured with weapons or stick, it increases the pain. In those exhausted by sexual intercourse, physical exercise and intake of alcohol, it causes pain in head, shoulder, eyes and chest. ''Shirovirechana'' applied to those suffering from acute fever and grief causes the heat to spread into the channels of eye, produces the cataract and increases the fever. If this therapy is given to the person who has undergone purgation therapy, then it aggravates ''vata dosha'' which may further leads to the damage of the sense organs. ''Shirovirechana'' given to the person who has undergone ''anuvasana basti'', causes aggravation of ''kapha dosha'' which produces heaviness of head, itching and parasitic infestation. In the case of pregnant woman, this therapy inhibits the growth of the fetus and she gives birth to an offspring who may be blind by one eye, with deformity of upper limbs, hemiplegic and with deformity of lower limbs. ''Shirovirechana'' given to the person suffering from acute coryza causes the morbidity of the channels of circulation. If this therapy is given in unsuitable season and on a cloudy day then it causes the diseases due to cold, putrefied rhinitis and head-diseases. Therefore, these persons are not fit for head-evacuation therapy. [21]
''Shirovirechana'' applied in the case of indigestion and full stomach causes the occlusion of the channels moving upwards by vitiated ''dosha'' which further leads to manifestation of cough, dyspnea, vomiting and coryza. In those who have taken fatty substances or desirous of taking wine or water or take after head-evacuation, ''shirovirechana'' gives rise to discharge from mouth and nose, dirt and stickiness in eyes, cataract and head diseases. If the person who has taken head- bath or takes head-bath after the therapy, then it causes the coryza. Application of ''shirovirechana'' in a person afflicted with hunger causes aggravation of ''vata dosha''. If it is administered to the person afflicted with thirst then it further increases the thirst and causes the dryness of mouth. ''Shirovirechana'' applied in the cases of fatigue, intoxication and fainting produces the same adverse effects as mentioned under the ''asthapana basti''. If this therapy is administered in the persons injured with weapons or stick, it increases the pain. In those exhausted by sexual intercourse, physical exercise and intake of alcohol, it causes pain in head, shoulder, eyes and chest. ''Shirovirechana'' applied to those suffering from acute fever and grief causes the heat to spread into the channels of eye, produces the cataract and increases the fever. If this therapy is given to the person who has undergone purgation therapy, then it aggravates ''vata dosha'' which may further leads to the damage of the sense organs. ''Shirovirechana'' given to the person who has undergone ''anuvasana basti'', causes aggravation of ''kapha dosha'' which produces heaviness of head, itching and parasitic infestation. In the case of pregnant woman, this therapy inhibits the growth of the fetus and she gives birth to an offspring who may be blind by one eye, with deformity of upper limbs, hemiplegic and with deformity of lower limbs. ''Shirovirechana'' given to the person suffering from acute coryza causes the morbidity of the channels of circulation. If this therapy is given in unsuitable season and on a cloudy day then it causes the diseases due to cold, putrefied rhinitis and head-diseases. Therefore, these persons are not fit for head-evacuation therapy. [21]
=== Indications of ''shirovirechana'' ===
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In these conditions, head-evacuation is the foremost therapy as it entering into the head eliminates the entire pathogenic impurities like fibrous coating of ''munja'' (a type of grass) from the ''pith'' (''ishika''). [22]
In these conditions, head-evacuation is the foremost therapy as it entering into the head eliminates the entire pathogenic impurities like fibrous coating of ''munja'' (a type of grass) from the ''pith'' (''ishika''). [22]
=== Consideration of appropriate time for ''shirovirechana'' in emergency conditions ===
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In the case of emergency, ''shirovirechana'' (head-evacuation therapy) should be given in the season other than ''pravriṭ'' (early rain), ''Sharad'' (autumn) and ''Vasanta'' (spring) by arranging environment artificially. In summer, it should be applied in the morning, in winter during noon time and in rainy season when sky is free from clouds. [23]
In the case of emergency, ''shirovirechana'' (head-evacuation therapy) should be given in the season other than ''pravriṭ'' (early rain), ''Sharad'' (autumn) and ''Vasanta'' (spring) by arranging environment artificially. In summer, it should be applied in the morning, in winter during noon time and in rainy season when sky is free from clouds. [23]
=== Summary ===
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== Vidhi Vimarsha (Applied Inferences ) ==
== Vidhi Vimarsha (Applied Inferences ) ==
=== Chapter authority ===
It is the pattern of this classic that in the beginning of every chapter, Charaka proposes the topic which is to be discussed and secondly the common sentence for all the chapter (इति ह स्माह भगवानात्रेयः) is used which shows the authenticity of the text. There are number of discourses in medical science and it is not possible for all to discuss them completely and meticulously that’s why Agnivesha declares very honestly in the beginning of all the chapters that whatever has been discussed is as per the preaching of his teacher Lord Punarvasu Atreya. The title ''Bhagavana'' (lord) itself reveals that Punarvasu Atreya was an extraordinary personality who could completely discuss the medical science without any mistake and lacunae<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No-1-4 </ref>.
It is the pattern of this classic that in the beginning of every chapter, Charaka proposes the topic which is to be discussed and secondly the common sentence for all the chapter (इति ह स्माह भगवानात्रेयः) is used which shows the authenticity of the text. There are number of discourses in medical science and it is not possible for all to discuss them completely and meticulously that’s why Agnivesha declares very honestly in the beginning of all the chapters that whatever has been discussed is as per the preaching of his teacher Lord Punarvasu Atreya. The title ''Bhagavana'' (lord) itself reveals that Punarvasu Atreya was an extraordinary personality who could completely discuss the medical science without any mistake and lacunae<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No-1-4 </ref>.
=== Success of treatment ===
''Chikitsa'' is indicated in curable disease <ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No-17.</ref> and another important concept of [[Ayurveda]] in this regard is that ''chatushpada upapatti'' (desired qualities of four limbs of treatment) are one of the important cause in the success of treatment<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No-66.</ref>. In the above mentioned verses the desired qualities of patients are lacking and patient is one of the important components among ''chatushpada''. In such situations chances of complications are also high.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-687</ref>
''Chikitsa'' is indicated in curable disease <ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No-17.</ref> and another important concept of [[Ayurveda]] in this regard is that ''chatushpada upapatti'' (desired qualities of four limbs of treatment) are one of the important cause in the success of treatment<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No-66.</ref>. In the above mentioned verses the desired qualities of patients are lacking and patient is one of the important components among ''chatushpada''. In such situations chances of complications are also high.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-687</ref>
=== Contraindications of ''vamana'' ===
The above mentioned contra-indications are as per general rule but in specific conditions exceptions are also found such as generally ''vamana'' is contra-indicated in ''gulma roga'' but when ''kapha'' is increased and causing diminution of digestive fire, anorexia, nausea etc. in ''vatika gulma'', ''vamana'' is indicated exceptionally.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-437 </ref>. Similarly ''vamana'' is advised in vomiting and heart disease according to condition <ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.- 690</ref> which is the exception of the general instruction. In all the above mentioned states of contra-indications, ''vamana'' is not contra-indicated in the conditions of poisons, artificial poisons, incompatible food, intake of food during indigestion and ''ama'' (ailment caused by the product of improper digestion and metabolism) because these conditions are of emergent nature. <ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.- 687</ref>
The above mentioned contra-indications are as per general rule but in specific conditions exceptions are also found such as generally ''vamana'' is contra-indicated in ''gulma roga'' but when ''kapha'' is increased and causing diminution of digestive fire, anorexia, nausea etc. in ''vatika gulma'', ''vamana'' is indicated exceptionally.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-437 </ref>. Similarly ''vamana'' is advised in vomiting and heart disease according to condition <ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.- 690</ref> which is the exception of the general instruction. In all the above mentioned states of contra-indications, ''vamana'' is not contra-indicated in the conditions of poisons, artificial poisons, incompatible food, intake of food during indigestion and ''ama'' (ailment caused by the product of improper digestion and metabolism) because these conditions are of emergent nature. <ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.- 687</ref>
krimikoshtha, ashthila, arsha, bhrama, parshwaruk, Vatavyadhi
krimikoshtha, ashthila, arsha, bhrama, parshwaruk, Vatavyadhi
=== Indications of ''vamana'' ===
''Vamana karma'' is mainly indicated in the diseases caused by ''kapha dosha'' reason being it is considered the best therapy among all causing elimination of ''kapha dosha''.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-131</ref><ref>Vriddha Vagbhata, Ashtanga-Sangraha with “Shashilekha” commentary by Indu, Edited by Dr. Shivprasad Sharma, Chaukhamba Sanskrit Series Office, Varanasi (India), 2nd edition-2008, Page No.-9</ref><ref>Vagbhata, Ashtanga-Hridaya, with the commentaries “Sarvangasundara” of Arunadatta
''Vamana karma'' is mainly indicated in the diseases caused by ''kapha dosha'' reason being it is considered the best therapy among all causing elimination of ''kapha dosha''.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-131</ref><ref>Vriddha Vagbhata, Ashtanga-Sangraha with “Shashilekha” commentary by Indu, Edited by Dr. Shivprasad Sharma, Chaukhamba Sanskrit Series Office, Varanasi (India), 2nd edition-2008, Page No.-9</ref><ref>Vagbhata, Ashtanga-Hridaya, with the commentaries “Sarvangasundara” of Arunadatta
Granthi, arbuda, medoroga, vidarika, hridroga, chittavibhrama, visarpa, vidradhi, putinasa, kanthapaka, adhijivhika, galashundika
Granthi, arbuda, medoroga, vidarika, hridroga, chittavibhrama, visarpa, vidradhi, putinasa, kanthapaka, adhijivhika, galashundika
=== Contraindications of ''virechana'' ===
''Virechana'' is not advised in the conditions when ''kapha dosha'' is increased because ''manda'' (''alpa'') ''kapha'' is considered as an ideal condition for proper administration of ''virechana karma''.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-678</ref>.[[Panchakarma]] is not administered in the state of indigestion.<ref>Vagbhata, Ashtanga -Hridaya, with the commentaries “Sarvangasundara” of Arunadatta and “[[Ayurveda]]-Rasayana” of Hemadri Edited by Bhishagacharya Harishastri Paradakar Vaidya, Chaukhambha Orientalia, Varanasi (India), reprint ninth edition-2005, Page No.-261</ref>
''Virechana'' is not advised in the conditions when ''kapha dosha'' is increased because ''manda'' (''alpa'') ''kapha'' is considered as an ideal condition for proper administration of ''virechana karma''.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-678</ref>.[[Panchakarma]] is not administered in the state of indigestion.<ref>Vagbhata, Ashtanga -Hridaya, with the commentaries “Sarvangasundara” of Arunadatta and “[[Ayurveda]]-Rasayana” of Hemadri Edited by Bhishagacharya Harishastri Paradakar Vaidya, Chaukhambha Orientalia, Varanasi (India), reprint ninth edition-2005, Page No.-261</ref>
Navaprasuta, navapratishyaya, Rajyakshma, Atisara, nityadukkhi, hridrogi, bhayabhita
Navaprasuta, navapratishyaya, Rajyakshma, Atisara, nityadukkhi, hridrogi, bhayabhita
=== Indications of ''virechana'' ===
''Virechana'' is considered the best therapy to purify ''pitta dosha'' especially. <ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-131</ref><ref>Vriddha Vagbhata, Ashtanga -Sangraha with “Shashilekha”commentary by Indu, Edited by Dr. Shivprasad Sharma, Chaukhamba Sanskrit Series Office, Varanasi (India), 2nd edition-2008,
''Virechana'' is considered the best therapy to purify ''pitta dosha'' especially. <ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-131</ref><ref>Vriddha Vagbhata, Ashtanga -Sangraha with “Shashilekha”commentary by Indu, Edited by Dr. Shivprasad Sharma, Chaukhamba Sanskrit Series Office, Varanasi (India), 2nd edition-2008,
Garavisha, pakwashayaruja, vibandha, Vidradhi, dushtavrana, akshipaka, abhishyanda, kacha, gudadaha, medhradaha, nasadaha, anaha, stanyadosha
Garavisha, pakwashayaruja, vibandha, Vidradhi, dushtavrana, akshipaka, abhishyanda, kacha, gudadaha, medhradaha, nasadaha, anaha, stanyadosha
=== Contraindications of ''asthapana basti'' ===
''Asthapana basti'' is contra-indicated in the stage of ''ajeerna''<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-692</ref> or ''ama''. ''Asthapana'' and ''anuvasana basti'' are indicated in the treatment of ''baddhodara''<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-496</ref>, so ''baddhodara'' mentioned in the contra-indications of ''asthapana'' should be read as ''baddhodaradhmana'' means it is contraindicated in ''adhmana'' due to ''baddhodara''<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika”commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-689</ref>. ''Asthapana basti'' is contraindicated in ''kushtha roga'' but in a particular stage of the disease, Charaka has exceptionally indicated the ''asthapana'' and ''Anuvasana basti'' <ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta
''Asthapana basti'' is contra-indicated in the stage of ''ajeerna''<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-692</ref> or ''ama''. ''Asthapana'' and ''anuvasana basti'' are indicated in the treatment of ''baddhodara''<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-496</ref>, so ''baddhodara'' mentioned in the contra-indications of ''asthapana'' should be read as ''baddhodaradhmana'' means it is contraindicated in ''adhmana'' due to ''baddhodara''<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika”commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-689</ref>. ''Asthapana basti'' is contraindicated in ''kushtha roga'' but in a particular stage of the disease, Charaka has exceptionally indicated the ''asthapana'' and ''Anuvasana basti'' <ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta
Pandu, bhrama, arochaka, unmada, shokagrasta, sthaulya, kanthashosha, kshatakshina, pregnant woman upto 7th month of gestation, gudashotha
Pandu, bhrama, arochaka, unmada, shokagrasta, sthaulya, kanthashosha, kshatakshina, pregnant woman upto 7th month of gestation, gudashotha
=== Indications of ''asthapana basti'' ===
''Asthapana basti'' is considered the best therapy in ''vatika'' disorders.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.- 114</ref><ref>Vagbhata, Ashtanga -Hridaya, with the commentaries “Sarvanׂgasundara” of Arunadatta
''Asthapana basti'' is considered the best therapy in ''vatika'' disorders.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.- 114</ref><ref>Vagbhata, Ashtanga -Hridaya, with the commentaries “Sarvanׂgasundara” of Arunadatta
Jwara, ashmari, upadamsha, vatarakta, arsha, stanyakshaya, mudhagarbha, mutakrichhra
Jwara, ashmari, upadamsha, vatarakta, arsha, stanyakshaya, mudhagarbha, mutakrichhra
=== Contraindications of ''anuvasana basti'' ===
''Anuvasana basti'' is not advised in ''kaphaja'' disorders, ''medo vriddhi'' and ''ama dosha''. Contraindications given in the text are as per general rule. Exceptional instructions are also found in the text considering the need of therapy in particular stage of disease such as in the patient suffering from piles if patient comes with associated symptoms like ''udavarta'', excessive dryness of the body, abnormal movement of ''vata'' and pain, then ''anuvasana basti'' is advised.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika”commentary by Chakrapanidatta
''Anuvasana basti'' is not advised in ''kaphaja'' disorders, ''medo vriddhi'' and ''ama dosha''. Contraindications given in the text are as per general rule. Exceptional instructions are also found in the text considering the need of therapy in particular stage of disease such as in the patient suffering from piles if patient comes with associated symptoms like ''udavarta'', excessive dryness of the body, abnormal movement of ''vata'' and pain, then ''anuvasana basti'' is advised.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika”commentary by Chakrapanidatta
Prameha, Kushtha, Sthaulya, Pinasa, Krisha
Prameha, Kushtha, Sthaulya, Pinasa, Krisha
=== Indications of ''anuvasana basti'' ===
''Anuvasana basti'' and ''asthapana basti'' are considered the best therapy in ''vatika'' disorders.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta
''Anuvasana basti'' and ''asthapana basti'' are considered the best therapy in ''vatika'' disorders.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta
</ref> It has been stated that patients suitable for ''asthapana basti'' are suitable for ''anuvasana basti'' is general instruction, because ''krimikoshthi'' and patient suffering from heaviness in the body are suitable for ''asthapana basti'' but not for ''anuvasana basti''. In ''krimikoshthi'', first of all ''asthapana basti'' is administered, then ''vamana'' and ''virechana'' to purify the ''koshtha''. When ''koshtha'' is purified, then ''anuvasana basti'' is advised as it is discussed in [[Vimana Sthana]]. So it should be accepted that instructions given in the text are applicable in most cases, but not in all cases. [19]
</ref> It has been stated that patients suitable for ''asthapana basti'' are suitable for ''anuvasana basti'' is general instruction, because ''krimikoshthi'' and patient suffering from heaviness in the body are suitable for ''asthapana basti'' but not for ''anuvasana basti''. In ''krimikoshthi'', first of all ''asthapana basti'' is administered, then ''vamana'' and ''virechana'' to purify the ''koshtha''. When ''koshtha'' is purified, then ''anuvasana basti'' is advised as it is discussed in [[Vimana Sthana]]. So it should be accepted that instructions given in the text are applicable in most cases, but not in all cases. [19]
=== Indications of ''Shirovirechana'' ===
''Shirovirechana'' type of ''nasya'' is mainly beneficial in ''kaphaja'' disorders.<ref>Vriddha Vagbhata, Ashtanׂga-Samgraha with “Shashilekha” commentary by Indu, Edited by Dr. Shivprasad Sharma, Chaukhamba Sanskrit Series Office, Varanasi (India), 2nd edition-2008, Page No.-223</ref>
''Shirovirechana'' type of ''nasya'' is mainly beneficial in ''kaphaja'' disorders.<ref>Vriddha Vagbhata, Ashtanׂga-Samgraha with “Shashilekha” commentary by Indu, Edited by Dr. Shivprasad Sharma, Chaukhamba Sanskrit Series Office, Varanasi (India), 2nd edition-2008, Page No.-223</ref>
</ref> as ''shirovirechana'' is contraindicated in the patients suffering from ''nava pratishyaya'' (acute coryza). [22]
</ref> as ''shirovirechana'' is contraindicated in the patients suffering from ''nava pratishyaya'' (acute coryza). [22]
=== Contra-indications of ''Shirovirechana'' ===
Vagbhata added the following conditions in list of contra-indications:
Vagbhata added the following conditions in list of contra-indications:
Apatarpita, Pitadrava, Gararta, Kruddha, vegavarodhita, Raktasravita, Sutika, Shwasapidita, Kasapidita
Apatarpita, Pitadrava, Gararta, Kruddha, vegavarodhita, Raktasravita, Sutika, Shwasapidita, Kasapidita
== Current researches ==
Prameha and Kushtha are considered as contraindications of Asthapana Basti. Thus the conditions of diabetes and skin diseases comes under this umbrella of contraindication. However, more precisely, if these conditions are associated with aggravated vata, Asthapana Basti is used with good efficacy. The basti of gokshura and punarnava has shown good results in microalbuminuria in diabetic patients.<ref>Ramteke RS, Thakar AB, Trivedi AH, Patil PD. Clinical efficacy of Gokshura-Punarnava Basti in the management of microalbuminuria in diabetes mellitus. Ayu. 2012;33(4):537–541. doi:10.4103/0974-8520.110535</ref> Likewise basti has shown good results in skin condition like psoriatic arthritis.<ref>S. Shruthi, M Kumar Ashvini, Lohith B A, M Uday Shankar, Mishra Gaurav, AyurvedicManagement of Psoriatic Arthritis: A Case Study, International Journal of Applied Ayurved Research,2017; 2(11):1472-77</ref>
Prameha and Kushtha are considered as contraindications of Asthapana Basti. Thus the conditions of diabetes and skin diseases comes under this umbrella of contraindication. However, more precisely, if these conditions are associated with aggravated vata, Asthapana Basti is used with good efficacy. The basti of gokshura and punarnava has shown good results in microalbuminuria in diabetic patients.<ref>Ramteke RS, Thakar AB, Trivedi AH, Patil PD. Clinical efficacy of Gokshura-Punarnava Basti in the management of microalbuminuria in diabetes mellitus. Ayu. 2012;33(4):537–541. doi:10.4103/0974-8520.110535</ref> Likewise basti has shown good results in skin condition like psoriatic arthritis.<ref>S. Shruthi, M Kumar Ashvini, Lohith B A, M Uday Shankar, Mishra Gaurav, AyurvedicManagement of Psoriatic Arthritis: A Case Study, International Journal of Applied Ayurved Research,2017; 2(11):1472-77</ref>
== Scope of further research ==
General indications and contraindications of all [[panchakarma]] are included in this chapter. Further it is needed to elaborate efficacy of these procedures in the specific stages of the disease.
General indications and contraindications of all [[panchakarma]] are included in this chapter. Further it is needed to elaborate efficacy of these procedures in the specific stages of the disease.