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Kalpana Siddhi (view source)

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Now we shall expound the chapter [[Kalpana Siddhi]]. Thus said ~~lord~~ Atreya. [1-2]

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Now we shall expound the chapter "Kalpana Siddhi" (Standard administration of purification procedures). Thus said Lord Atreya. [1-2]

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==== Queries asked by Agnivesha ====

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=== Queries asked by Agnivesha ===

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*Why some diseases though curable do not get cured with its proper medication? Thus, in the view of welfare of society, Punarvasu who is the foremost among the physicians and who is knowledgeable in his subject replied as follows. [3-5½]

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==== Duration of oleation therapy ====

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=== Duration of oleation therapy ===

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Minimum for three days and maximum for seven days the oleation therapy can be employed as after seven days ''sneha'' becomes ''satmya'' i.e. habituated. [6-6½]

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==== Effect of oleation therapy ====

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=== Effect of oleation therapy ===

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''Sneha'' attenuates ''vata'', makes body soft and disintegrates the morbid material. [7]

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==== Effect of fomentation therapy ====

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=== Effect of fomentation therapy ===

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In the person who has undergone oleation therapy, fomentation liquefies the adhered morbid material in the fine channels of his body. [7½]

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==== Measures to be adopted before ''vamana'' and ''virechana'' ====

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=== Measures to be adopted before ''vamana'' and ''virechana'' ===

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Those who are about to undergo ''virechana'' should be given the soup of meat of animals inhabiting in arid area and vegetables-soup added with fat which do not cause aggravation of ''kapha''. [8-8½]

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==== Reasons for ''vamana'' and ''virechana'' working in opposite ways ====

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=== Reasons for ''vamana'' and ''virechana'' working in opposite ways ===

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Person with aggravated ''kapha'' vomits without any difficulty and the person having less aggravated ''kapha'' purges well. If there is less ''kapha'', then emetic drug causes purgation and in aggravation of ''kapha'' purgative drug leads to emesis. [9-9½]

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==== Order of administration of emesis and purgation ====

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=== Order of administration of emesis and purgation ===

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Oleated person should be given emesis as per given protocol and after emesis systematic dietary regimen with ''peya'' (thin gruel) etc. has to be followed. Thereafter, the person who has undergone oleation and fomentation therapies should be administered the best suited purgation therapy appropriately. [10-10½]

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==== Post purificatory regimen (''samsarjana krama'') ====

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=== Post purificatory regimen (''samsarjana krama'') ===

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As a small spark of fire gets kindled into a big and stable flame when gradually provided with dry grass, cow dung etc. similarly ''agni'' i.e. digestive strength in a purified person becomes strong and stable, capable of digesting all types of food by sequential administration of ''peya'' (thin gruel) etc.[12-12½]

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==== Characteristics of three types of emesis and purgation ====

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=== Characteristics of three types of emesis and purgation ===

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==== Features of proper emesis ====

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=== Features of proper emesis ===

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In case of a person that gets ''kapha, pitta'' and ''vata'' in succession, who experiences clarity in epigastrium side of chest, head, sense organs and lightness in the body is considered to have undergone proper emesis. [15-15½]

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==== Features of insufficient emesis ====

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=== Features of insufficient emesis ===

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If inappropriate emesis is administered then it gives rise to ''sphotaka'' (Vescicular eruptions), ''kotha'' (urticaria), ''kandu'' (itching), discomfort in epigastrium as well as in sense organs and heaviness of the body. [16]

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==== Features of excess emesis ====

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=== Features of excess emesis ===

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If excess emesis is administered then it gives rise to thirst, unconsciousness, fainting, aggravation of ''vata'', insomnia, debility etc. [16½]

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==== Features of proper purgation ====

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=== Features of proper purgation ===

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In case of proper purgation, a person experiences clarity in all channels of body, freshness in sense organs, lightness in the body, improvement in digestive strength and attains disease free status. Feces, ''pitta, kapha'' and ''vata'' are expelled in succession. [17-17½]

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==== Features of inadequate purgation ====

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=== Features of inadequate purgation ===

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When purgation is given improperly and inadequate then it causes vitiation of ''kapha, pitta, vata,'' suppression of digestive strength, heaviness in the body, coryza, drowsiness, vomiting, anorexia and absence of ''vatanulomana'' (reverse movement of ''vata''). [18-18½]

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==== Features of excess purgation ====

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=== Features of excess purgation ===

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Excess purgation leads to ''vata'' aggravation due to diminution of ''kapha'' and ''pitta'' that causes, numbness, body aches mental fatigue, tremor, insomnia, debility, black outs, insanity and hiccup. [19-19½]

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==== Follow up after purification ====

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=== Follow up after purification ===

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After finishing diet regulations on ninth day (of emesis) the person should be given ghee (if subsequently purgation is intended). Similarly, on ninth day of purgation therapy unctuous enema should be given (if medicated enema is intended to be given subsequently). For three days thereafter, the body should be massaged with medicated oil and then ''niruha'' i.e. medicated decoction enema should be given when person is not much hungry. After evacuation of enema person should be given meat soup of animals inhabiting arid forest zone or any other appropriate diet depending upon the nature of ''dosha'' and the strength of digestion. Then the person should be given unctuous enema if he has not taken heavy meal, the night before and if he is fit for the same. [20-21½]

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==== Time of ''anuvasana'' (unctuous enema) ====

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=== Time of ''anuvasana'' (unctuous enema) ===

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After evacuation of unctuous enema, the person should not take any food in the night. On the next day, food should be given to him during the day time and in the evening. Thereafter, on the second, third or fifth day unctuous enema should be given followed by ''niruha''. Thus on every third or fifth day unctuous enema should be given while giving ''niruha'' type of medicated enema. [23-24]

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==== Number of ''basti'' as per ''dosha'' dominance ====

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=== Number of ''basti'' as per ''dosha'' dominance ===

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Note: This number is related to ''anuvasana'' (unctuous enema).

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==== Sequence of ''niruha'' (decoction enema) and purgation ====

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=== Sequence of ''niruha'' (decoction enema) and purgation ===

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A person who has undergone purgation should avoid ''niruha'' type of medicated enema for seven days and person who has taken ''niruha'' type of medicated enema should avoid purgation therapy for seven days because it will have deleterious effects on body which is evacuated (of ''dosha'' and nourishing material) by earlier cleansing process. [26]

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==== Beneficial effects of ''basti'' ====

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=== Beneficial effects of ''basti'' ===

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*It cures all the diseases by removing accumulated ''dosha'' from entire body. [27-28]

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==== Benefits of unctuous enema ====

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=== Benefits of unctuous enema ===

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==== Specific indications and benefits of enema ====

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=== Specific indications and benefits of enema ===

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*It is also extremely useful for men having seminal debility and emaciation of the body. [32-34]

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==== Selection of type of enema ====

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=== Selection of type of enema ===

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In those patients suffering from diseases caused due to hotness, the cooling type of enema (i.e. prepared with drugs of cold nature and not much warm) should be given and in those affected with diseases caused due to increased coldness the warm enema (i.e. prepared with drugs of hot nature and slightly warm temperature) should be given. In all cases, different types of enema containing ingredients having attributes opposite to that of etiological factors of the disease should be administered. [35]

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==== Contra-indications of unctuous enema ====

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=== Contra-indications of unctuous enema ===

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In diseases those are indicated for purification, ''kushtha'' (obstinate skin diseases), ''prameha'' (obstinate urinary diseases), ''sthaulya'' (obesity) etc. nourishing type of enema should not be given. [36]

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==== Contra-indications of decoction type of enema ====

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=== Contra-indications of decoction type of enema ===

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Evacuating type of enema should not be given to the patients suffering from weakness, severely wounded, emaciation, extreme debility, fainting, to those who have already undergone the process of purification, and to those whose life is dependent upon the holding up of ''dosha'' (morbid matter). [37]

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==== Importance of ''basti'' therapy ====

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=== Importance of ''basti'' therapy ===

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None other than ''vata'' is responsible for all diseases origination in ''shakha'' (peripheral tissues), ''koshtha'' (visceral organs), ''marma'' (vital points of the body), ''urdhva'' (upper part of body), ''sarvavaya'' (covering entire body) and ''anga'' (individual parts of the body). ''Vata'' is responsible for separation and combination of stool, urine, ''pitta'' etc. including other excreta and tissue elements. When it gets highly aggravated there is no remedy other than ''basti'' for its alleviation. Therefore, ''basti'' is considered by physicians to be the half of entire therapeutics. Some physicians even consider it as whole of the therapeutics. [38-39½]

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==== Mode of action of ''basti'' ====

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=== Mode of action of ''basti'' ===

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The therapy that while moving in umbilical region, lumbar region, sides of the chest and pelvic regions churns up stool including all the other morbid matter located there and appropriately eliminates them with ease after oleating the body is called ''basti''. [40-40½]

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==== Signs of properly administered ''niruha basti'' ====

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=== Signs of properly administered ''niruha basti'' ===

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When ''niruha'' i.e. evacuating type of enema is administered properly then it causes proper elimination of stool, urine and flatus; promotes appetite and power of digestion; gives lightness to the ''ashaya''; attenuates disease and restores natural health and strength. [41-41½]

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==== Signs of inadequately administered ''niruha basti'' ====

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=== Signs of inadequately administered ''niruha basti'' ===

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When ''niruha'' i.e. evacuating type of enema is not administered properly then it causes pain in head, cardiac region, anal region, urinary bladder and genital organs; edema, coryza, griping pain and nausea; retention of flatus and urine and dyspnea.

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==== Signs of excessively administered ''niruha basti'' ====

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=== Signs of excessively administered ''niruha basti'' ===

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Symptoms of excessive outcome of evacuative enema are similar to the symptoms to that of excessive administration of purgation therapy (as mentioned earlier). [43]

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==== Signs of proper administration of unctuous enema ====

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=== Signs of proper administration of unctuous enema ===

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*Proper manifestation of natural urges without any obstruction. [44]

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==== Signs of inadequate administration of unctuous enema ====

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=== Signs of inadequate administration of unctuous enema ===

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Improperly administered unctuous enema causes pain in lower part of the body, abdomen, arms, back and sides of the chest; gives rise to dryness and roughness of the body and obstruction in the passage of stool, urine and flatus.[45]

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==== Signs of excess administration of unctuous enema ====

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=== Signs of excess administration of unctuous enema ===

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Whereas excessively administered unctuous enema causes nausea, unconsciousness, mental fatigue, exhaustion, fainting and griping pain. [45½]

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==== Duration of retaining unctuous enema ====

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=== Duration of retaining unctuous enema ===

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If unctuous enema is retained for three ''yama'' (nine hours) then the body of the person gets cleansed of morbid matter. If it comes out quickly then another unctuous enema should be administered as the previous one did not produce unctuous effect in the body. [46-46½]

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==== Duration and schedule of ''karma, kala'' and ''yoga basti'' ====

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=== Duration and schedule of ''karma, kala'' and ''yoga basti'' ===

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Physician should administer three, five, four or six unctuous enemas in patients suffering from disorders caused by ''vata'' (''pitta'' and ''kapha'') etc. and then for the cleansing of micro channels should administer evacuating type of enema. [49-49½]

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==== Proper, inadequate and excess administration of ''shirovirechana'' ====

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=== Proper, inadequate and excess administration of ''shirovirechana'' ===

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The interval between two courses of any ''basti'' etc. (cleansing therapy) should be double the period required for administration of that therapy. [53½]

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==== Factors to be avoided during [[Panchakarma]] ====

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=== Factors to be avoided during [[Panchakarma]] ===

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*If the person has laxed bowel. [56-56½]

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==== Reason for failure of ''basti'' to cure curable diseases ====

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=== Reason for failure of ''basti'' to cure curable diseases ===

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When correct treatment is given but in low or excess doses, in inappropriate time or in wrong manner then it fails to cure diseases. [59-59½]

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==== Summary ====

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=== Summary ===

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Charaka has described formulations useful for [[Panchakarma]] procedures, methods of their preparation, their applications and successful management of any complications if arise. Thus the name [[Siddhi Sthana]] implies to the knowledge that gives excellence in [[Panchakarma]] therapies. It also ensures the concept of reproducibility in therapeutic administration as ''sidhhi'' is achieved not by chance, but by the characteristics of repeatability.

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==== Queries asked by Agnivesha ~~(verse 3-6) =~~===

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=== Queries asked by Agnivesha ===

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The word ''kalpana'' refers to the application of [[Panchakarma]] which is considered as main treatment among Ayurvedic therapeutics. Thus the whole [[Siddhi Sthana]] is devoted by Charaka to elaborate these measures. The queries asked by Agnivesha can be considered as an abstract of [[Siddhi Sthana]] because the whole section deals with the topics related to these questions.

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The word ''kalpana'' refers to the application of [[Panchakarma]] which is considered as main treatment among Ayurvedic therapeutics. Thus the whole [[Siddhi Sthana]] is devoted by Charaka to elaborate these measures. The queries asked by Agnivesha can be considered as an abstract of [[Siddhi Sthana]] because the whole section deals with the topics related to these questions.(verse 3-6)

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==== Duration of oleation therapy ~~(verse 7) =~~===

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=== Duration of oleation therapy ===

<div style="text-align:justify;">Duration for oleation therapy depends upon the sensitivity of GIT of an individual also termed as ''koshtha''.

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Those with ''mridu'' (mild) ''koshtha'' become easily oleated as ''vata'' is less compared to other ''dosha'' thus oleation is not hampered or attenuated at any point, giving early results. In addition ''pitta'' is said to be responsible for ''mridu koshtha'' which itself has ''snigdha'' property which assists the oleation.

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On contrary ''krura koshtha'' individuals have ''vata'' dominance in the digestive system that hampers the oleation to some extent by virtue of dry nature of ''vata'' hence it takes maximum i.e. seven days duration to complete oleation. Also as per the ''dhatu-parinaman'' (way how ''dhatu'' are produced) concept, minimum seven days duration is must for taking any nutritional property to the deepest i.e. ''shukra dhatu''. ''Madhyama koshtha'' individuals may get oleated in 5 days which is midpoint of limits. This is because ''madhyama koshtha'' individuals have dominance of ''kapha'' or sama ''dosha'' status. ''Kapha'' also has ''snigdha'' property but has stagnant and slow nature due to which ''sneha'' may take some extra time as compared to that of ''mridu koshtha''. Thus seven days seems to be the maximum possible limit for oleation therapy after which it is said that ''sneha'' becomes habituated that indicates the fact that body’s capacity to digest fats increases, as more and more fats are consumed. This hypothesis is supported by the fact that, high-fat feeding is associated with increased production of bile acid required for fat metabolism <ref>Stenman, Lotta & Holma, Reetta & Korpela, Riitta. (2012)High-fat-induced intestinal permeability dysfunction associated with altered fecal bile acids. World journal of gastroenterology : WJG. 18. 923-9. 10.3748/wjg.v18.i9.923 </ref>. Consequently, a high-fat diet elevates the fecal concentration of bile acids that is responsible for increased intestinal permeability<ref> Cummings JH, Wiggins HS, Jenkins DJ, Houston H, Jivraj T, Drasar BS, Hill MJ. Influence of diets high and low in animal fat on bowel habit, gastrointestinal transit time, fecal microflora, bile acid, and fat excretion. J Clin Invest. 1978;61:953–963 </ref>. ''Snehapana'' (internal oleation) is intended for creating ''asathmyata'' (non-acceptability). It is neither absorbed or assimilated upto 7 days in ''shodhananga'' (purification purpose). If exceeds 7 days, body will assimilate the ''sneha'' which is not intended in ''shodhananga sneghapana''. However, if patient is not oleated in 7 days then it can be continued a little more or after break of few days whole procedure can be repeated.

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On contrary ''krura koshtha'' individuals have ''vata'' dominance in the digestive system that hampers the oleation to some extent by virtue of dry nature of ''vata'' hence it takes maximum i.e. seven days duration to complete oleation. Also as per the ''dhatu-parinaman'' (way how ''dhatu'' are produced) concept, minimum seven days duration is must for taking any nutritional property to the deepest i.e. ''shukra dhatu''. ''Madhyama koshtha'' individuals may get oleated in 5 days which is midpoint of limits. This is because ''madhyama koshtha'' individuals have dominance of ''kapha'' or sama ''dosha'' status. ''Kapha'' also has ''snigdha'' property but has stagnant and slow nature due to which ''sneha'' may take some extra time as compared to that of ''mridu koshtha''. Thus seven days seems to be the maximum possible limit for oleation therapy after which it is said that ''sneha'' becomes habituated that indicates the fact that body’s capacity to digest fats increases, as more and more fats are consumed. This hypothesis is supported by the fact that, high-fat feeding is associated with increased production of bile acid required for fat metabolism <ref>Stenman, Lotta & Holma, Reetta & Korpela, Riitta. (2012)High-fat-induced intestinal permeability dysfunction associated with altered fecal bile acids. World journal of gastroenterology : WJG. 18. 923-9. 10.3748/wjg.v18.i9.923 </ref>. Consequently, a high-fat diet elevates the fecal concentration of bile acids that is responsible for increased intestinal permeability<ref> Cummings JH, Wiggins HS, Jenkins DJ, Houston H, Jivraj T, Drasar BS, Hill MJ. Influence of diets high and low in animal fat on bowel habit, gastrointestinal transit time, fecal microflora, bile acid, and fat excretion. J Clin Invest. 1978;61:953–963 </ref>. ''Snehapana'' (internal oleation) is intended for creating ''asathmyata'' (non-acceptability). It is neither absorbed or assimilated upto 7 days in ''shodhananga'' (purification purpose). If exceeds 7 days, body will assimilate the ''sneha'' which is not intended in ''shodhananga sneghapana''. However, if patient is not oleated in 7 days then it can be continued a little more or after break of few days whole procedure can be repeated.(verse 7)

</div>

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==== Effect of oleation and fomentation therapy ~~(verse 7-8) =~~===

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=== Effect of oleation and fomentation therapy ===

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Vitiated ''dosha'' as explained by Charaka can be considered to be the morbid matter adhering at cellular levels thus obstructing normal functioning of the micro-functional units of the body. ''Sneha'' consumption causes oleation of all body parts including cell membrane and other microcellular components. Cell membrane is basically made up of phospholipid bilayer <ref> Kotz, John, Treichel, Paul, Townsend, John ''Chemistry and Chemical Reactivity'', Seventh Edition, 2009, Thomson Brooks/Cole </ref> . Thus due to oleation ''sneha'' goes inside easily clearing the channels and dissolving impurities into it. These impurities along with fats are removed out of cell and other organic systems of the body by fomentation that increases the body temperature, opens up all channels and facilitate the transfer of ''dosha'' towards bowel.

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Vitiated ''dosha'' as explained by Charaka can be considered to be the morbid matter adhering at cellular levels thus obstructing normal functioning of the micro-functional units of the body. ''Sneha'' consumption causes oleation of all body parts including cell membrane and other microcellular components. Cell membrane is basically made up of phospholipid bilayer <ref> Kotz, John, Treichel, Paul, Townsend, John ''Chemistry and Chemical Reactivity'', Seventh Edition, 2009, Thomson Brooks/Cole </ref> . Thus due to oleation ''sneha'' goes inside easily clearing the channels and dissolving impurities into it. These impurities along with fats are removed out of cell and other organic systems of the body by fomentation that increases the body temperature, opens up all channels and facilitate the transfer of ''dosha'' towards bowel. (verse 7-8)

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==== Diet before ''shodhana'' and reasons for ''vamana'' and ''virechana'' working in opposite ways ~~(verse 8-10) =~~===

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=== Diet before ''shodhana'' and reasons for ''vamana'' and ''virechana'' working in opposite ways ===

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In ''vamana'', ''kapha utklesha''(excited) is expected which is evident by excess salivation, nausea etc. These factors plays an important role in induction of vomiting. The vagal and enteric nervous system inputs transmit information regarding the state of the gastrointestinal system. Irritation of the GI mucosa by any drug or distension activates the 5-HT3 receptors of these inputs<ref>Bunce, KT, Tyers MB, ''The Role of 5-HT in Postoperative Nausea and Vomiting'', 1992, British Journal of Anaesthesia; 69 (Suppl. 1): 60S-62S</ref>. Thus if ''kapha'' is not aggravated then the key mechanism of distension of stomach, excess salivary secretions and nausea fails to initiate vomiting thus drug passes to the intestine and causes purgation. On contrary if ''kapha'' is highly aggravated then drug for purgation may lead to vomiting due to above said mechanism. This is the probable reason for specific diet before cleansing processes.

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In ''vamana'', ''kapha utklesha''(excited) is expected which is evident by excess salivation, nausea etc. These factors plays an important role in induction of vomiting. The vagal and enteric nervous system inputs transmit information regarding the state of the gastrointestinal system. Irritation of the GI mucosa by any drug or distension activates the 5-HT3 receptors of these inputs<ref>Bunce, KT, Tyers MB, ''The Role of 5-HT in Postoperative Nausea and Vomiting'', 1992, British Journal of Anaesthesia; 69 (Suppl. 1): 60S-62S</ref>. Thus if ''kapha'' is not aggravated then the key mechanism of distension of stomach, excess salivary secretions and nausea fails to initiate vomiting thus drug passes to the intestine and causes purgation. On contrary if ''kapha'' is highly aggravated then drug for purgation may lead to vomiting due to above said mechanism. This is the probable reason for specific diet before cleansing processes. (verse 8-10)

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==== Post therapeutic measures (''samsarjana krama'') ~~(verse 11-12) =~~===

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=== Post therapeutic measures (''samsarjana krama'') ===

Duration of post therapeutic measures varies with type/quality of cleansing. This is directly related to the extent of changes brought by cleansing the digestive system and duration required to regain its normal functioning. Mucosal layer in the digestive tract plays important functions like barrier to protect from acids, maintaining optimal immune function, proper digestion and assimilation of food and nutrients, etc <ref>

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Hansson GC. ''Role of mucus layers in gut infection and inflammation''. Current opinion in microbiology. 2012;15(1):57-62. doi:10.1016/j.mib.2011.11.002 </ref> <ref> Pang G, Xie, J '' Food Science and Human Wellness, ISSN: 2213-4530, Vol: 1, Issue: 1, Page: 26-60'', 2012.</ref>. Also the bacterial flora residing in intestine is also responsible for some functions like fermentation of undigested carbohydrates and the subsequent absorption of short-chain fatty acids, plays a role in synthesizing vitamin B and vitamin K as well as metabolising bile acids, sterols and xenobiotics <ref>Cummings, J.H.; MacFarlane, G.T. (1997).''Role of intestinal bacteria in nutrient metabolism ''. Clinical Nutrition 16: 3–9</ref>. Vomiting and purgation leads to cleansing of entire tract that causes removal of unhealthy bacterial flora and also inflammation and damage to the mucosal barrier. Thus till regeneration of new flora and proper mucosal barrier, the diet needs to be light and gradually increasing in thickness. Fats and some spices are given at later phases as they require proper mucosal functioning for absorption. Moreover this regimen facilitates the gradual induction of carbohydrate, vegetable protein, fat and meat protein as digestion improves gradually.

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Hansson GC. ''Role of mucus layers in gut infection and inflammation''. Current opinion in microbiology. 2012;15(1):57-62. doi:10.1016/j.mib.2011.11.002 </ref> <ref> Pang G, Xie, J '' Food Science and Human Wellness, ISSN: 2213-4530, Vol: 1, Issue: 1, Page: 26-60'', 2012.</ref>. Also the bacterial flora residing in intestine is also responsible for some functions like fermentation of undigested carbohydrates and the subsequent absorption of short-chain fatty acids, plays a role in synthesizing vitamin B and vitamin K as well as metabolising bile acids, sterols and xenobiotics <ref>Cummings, J.H.; MacFarlane, G.T. (1997).''Role of intestinal bacteria in nutrient metabolism ''. Clinical Nutrition 16: 3–9</ref>. Vomiting and purgation leads to cleansing of entire tract that causes removal of unhealthy bacterial flora and also inflammation and damage to the mucosal barrier. Thus till regeneration of new flora and proper mucosal barrier, the diet needs to be light and gradually increasing in thickness. Fats and some spices are given at later phases as they require proper mucosal functioning for absorption. Moreover this regimen facilitates the gradual induction of carbohydrate, vegetable protein, fat and meat protein as digestion improves gradually.(verse 11-12)

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==== Characteristics of three types of emesis and purgation ~~(verse 13-15) =~~===

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=== Characteristics of three types of emesis and purgation ===

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Yellowish-greenish vomiting along with bitter taste in mouth indicates that the pyloric valve is open and bile is flowing into the stomach from the duodenum<ref>http://en.wikipedia.org/wiki/Vomiting [cited on 28-04-14]</ref>. This is considered as end point of emesis and called ''pittanta vamana''. In case of ''virechana'', mucosal layer gets removed partially at the end point that can be considered as ''kaphanta virechana''. Continuing cleansing beyond these endpoints may cause deleterious effects on the health.

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Yellowish-greenish vomiting along with bitter taste in mouth indicates that the pyloric valve is open and bile is flowing into the stomach from the duodenum<ref>http://en.wikipedia.org/wiki/Vomiting [cited on 28-04-14]</ref>. This is considered as end point of emesis and called ''pittanta vamana''. In case of ''virechana'', mucosal layer gets removed partially at the end point that can be considered as ''kaphanta virechana''. Continuing cleansing beyond these endpoints may cause deleterious effects on the health.(verse 13-15)

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===== Symptomatic evaluation of cleansing processes ~~(verse 15-20) =~~====

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==== Symptomatic evaluation of cleansing processes ====

<div style="text-align:justify;">Properly administered cleansing processes causes lightness in the body, feeling of happiness, clarity of heart region and sense organs etc. Both ''vamana'' and ''virechana'' clear digestive tract that is filled of morbid matter and bulky food, fluid etc. Hence causes feeling of lightness. Sense organs respond to the stimuli either internal or external thus any adherence of morbid matter in these organs is responsible for ill functioning. Especially in ''vamana'' cleansing of nasal cavity, oral cavity is directly evident whereas skin is affected during oleation and fomentation. Removal of ''dosha'' causes blood purification which is responsible for health and proper functioning of skin.

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Similarly in case of purgation if drug fails to give proper effect of evacuation then it remains inside the body and gives an allergic reaction which is evident in the form of coryza.

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In Ayurvedic parlance, the probable reason for these symptoms is that when drug fails to attain desired cleansing and it is not removed from the body it act as a trigger for aggravation or excitement of ''dosha'' but is unable to throw them outside the body; thus either the disease gets aggravated or symptoms of ''dosha'' vitiation are evident.

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In Ayurvedic parlance, the probable reason for these symptoms is that when drug fails to attain desired cleansing and it is not removed from the body it act as a trigger for aggravation or excitement of ''dosha'' but is unable to throw them outside the body; thus either the disease gets aggravated or symptoms of ''dosha'' vitiation are evident.(verse 15-20)

</div>

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==== Time to ''anuvasana'' (unctuous enema) or oleation after cleansing process ~~(verse 20-22) =~~===

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=== Time to ''anuvasana'' (unctuous enema) or oleation after cleansing process ===

''Anuvasana'' or ''snehapana'' therapy is indicated on ninth day after cleansing processes. This duration of gap includes seven days of post therapeutic measures and one day of rest. Immediately after cleansing, the digestive power is reduced and it improves gradually in seven days. This gap of total eight days is very much necessary to regain the normal functioning of digestive components in the gastrointestinal tract. Mucosal membrane is one such component of digestive tract that establishes a barrier between external environments and the internal milieu. Normal well formed healthy mucosa is responsible for nutrient absorption and waste secretion, which require a selectively permeable barrier. These functions place the mucosal epithelium at the centre of interactions between the mucosal immune system and luminal contents, including dietary antigens and microbial products <ref> Turner JR, Intestinal mucosal barrier function in health and disease, Nature Reviews and Immunology. 2009 Nov;9(11):799-809 </ref>. Thus in view of regeneration of new healthy mucosal barrier this duration of gap may play a prime role.

−

After ''niruha'', type of medicated enema the unctuous enema is indicated on the same day in the evening for the pacification ''vata'' that is remained in the gut even after removal by ''niruha'' or to pacify ''vata'' that is produced due to possible overdose of ''niruha''. Also as per modern perspectives it is possible that due to ''niruha'' type of medicated enema the colon gets cleared providing minimal barrier for absorption and due to increased permeability on virtue of transient inflammation, the transmucosal entry of fats of unctuous enema is facilitated <ref>Hollander, Daniel, ''Increased Intestinal Permeability in Patients with Crohn's Disease and Their Relatives: A Possible Etiologic Factor'', Annals of Internal Medicine, 1986;105(6):883-885</ref>.

+

After ''niruha'', type of medicated enema the unctuous enema is indicated on the same day in the evening for the pacification ''vata'' that is remained in the gut even after removal by ''niruha'' or to pacify ''vata'' that is produced due to possible overdose of ''niruha''. Also as per modern perspectives it is possible that due to ''niruha'' type of medicated enema the colon gets cleared providing minimal barrier for absorption and due to increased permeability on virtue of transient inflammation, the transmucosal entry of fats of unctuous enema is facilitated <ref>Hollander, Daniel, ''Increased Intestinal Permeability in Patients with Crohn's Disease and Their Relatives: A Possible Etiologic Factor'', Annals of Internal Medicine, 1986;105(6):883-885</ref>.(verse 20-22)

−

==== Number and sequence of unctuous and ''niruha'' type of enema ~~(verse 23-25) =~~===

+

=== Number and sequence of unctuous and ''niruha'' type of enema ===

After ''niruha'', unctuous enema is indicated. Also the minimum unctuous enema required for a patient also depends upon aggravated ''dosha''.

Thus,

*If ''vata'' aggravation is there then alternate ''niruha'' and unctuous enema are indicated or in case of excess ''vata'' vitiation, physician can administer continuous two unctuous enema. 9 to 11 unctuous enema are indicated to combat ''vata'' disorder in general along with ''niruha'' in between.

−

*If ''kapha'' is aggravated then 1-3 unctuous enema and if ''pitta'' is aggravated then 5-7 unctuous enema are indicated along with ''niruha'' in between. In such condition continuous three ''niruha'' type of medicated enema can be given so as to remove the vitiated ''kapha-pitta'' and then unctuous enema can be administered to combat ''vata'' aggravation.

+

*If ''kapha'' is aggravated then 1-3 unctuous enema and if ''pitta'' is aggravated then 5-7 unctuous enema are indicated along with ''niruha'' in between. In such condition continuous three ''niruha'' type of medicated enema can be given so as to remove the vitiated ''kapha-pitta'' and then unctuous enema can be administered to combat ''vata'' aggravation.(verse 23-25)

−

==== Benefits of ''niruha'' type of medicated enema ~~(verse 27-28) =~~===

+

=== Benefits of ''niruha'' type of medicated enema ===

Ageing is a process that causes aggravation of ''vata'' due to loss of body’s vital elements gradually and aggravated ''vata'' also fastens the ageing. Thus being best treatment for ''vata, basti'' proves to be an anti-ageing therapy. Moreover, it has a cleansing spectrum in the lower part of gut. This portion is surrounded by vital organs like liver, spleen, pancreas, kidneys. Thus, the effect of cleansing is more marked for these organs. Liver and kidney plays an important role of detoxification thus maintaining body homeostasis that is helpful to avoid ageing.

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''Vata'' is responsible for movement of ''pitta'' and ''kapha''. Hence it plays main role in the production of all diseases. Thus, being remedy for ''vata, basti'' is said to cure all diseases.

−

Body strength and all ''kapha'' dominant body elements like semen are inversely related with ''vata''. Thus, if vitiated ''vata'' is evacuated, the strength, sturdiness are enhanced bringing a new essence to body elements.

+

Body strength and all ''kapha'' dominant body elements like semen are inversely related with ''vata''. Thus, if vitiated ''vata'' is evacuated, the strength, sturdiness are enhanced bringing a new essence to body elements.(verse 27-28)

−

==== Benefits of unctuous type of medicated enema ~~(verse 29-31) =~~===

+

=== Benefits of unctuous type of medicated enema ===

−

Evacuating type of enema cleanses the gut thus facilitating the absorption of fats. Oil is considered to be the best for ''vata'' on virtue of its properties. The example given by ''acharya'' points towards the colonic and rectal absorption of fats given through unctuous enema and also it specifies the superiority of rectal route over oral consumption of fats. This may be because of the fact that ''vata'' is nothing but increase in some properties like dryness, lightness, cold, movement etc. in the body and these properties are introduced in human gut in the last part of digestion that occurs in colon. Unctuous enema directly oleates the colon and after absorption affects whole body by properties like unctuousness, heaviness and warmth. As site of production of ''vata'' is treated, no new ''vata'' formation occurs in the body bringing about the phenomena of ''vata-nigraha'' that is responsible for movement of all ''dosha'' from ''shakha'' (extremities) to ''koshtha'' (gut). Even proper function of ''agni'' (digestive strength) is dependent upon normal activity of ''vata'' as it has a vital function of igniting the digestive fire. Other functions like mental harmony, strength, vitality, complexion etc. are taken care of by unctuous enema as pacification of ''vata'' affects positively on mind, improves production of new body elements and gives health to the skin as it is also a site of residence for ''vata''.

+

Evacuating type of enema cleanses the gut thus facilitating the absorption of fats. Oil is considered to be the best for ''vata'' on virtue of its properties. The example given by ''acharya'' points towards the colonic and rectal absorption of fats given through unctuous enema and also it specifies the superiority of rectal route over oral consumption of fats. This may be because of the fact that ''vata'' is nothing but increase in some properties like dryness, lightness, cold, movement etc. in the body and these properties are introduced in human gut in the last part of digestion that occurs in colon. Unctuous enema directly oleates the colon and after absorption affects whole body by properties like unctuousness, heaviness and warmth. As site of production of ''vata'' is treated, no new ''vata'' formation occurs in the body bringing about the phenomena of ''vata-nigraha'' that is responsible for movement of all ''dosha'' from ''shakha'' (extremities) to ''koshtha'' (gut). Even proper function of ''agni'' (digestive strength) is dependent upon normal activity of ''vata'' as it has a vital function of igniting the digestive fire. Other functions like mental harmony, strength, vitality, complexion etc. are taken care of by unctuous enema as pacification of ''vata'' affects positively on mind, improves production of new body elements and gives health to the skin as it is also a site of residence for ''vata''.(verse 29-31)

−

==== Effects of unctuous and evacuating type of medicated enema in general ~~(verse 32-34) =~~===

+

=== Effects of unctuous and evacuating type of medicated enema in general ===

−

All the disease quoted by acharya are exclusively ''vata'' disorders and thus ''basti'' seems to be the best remedy for them. Especially in females not conceiving despite their mating with male partner and in men’s having seminal debility basti acts potentially because both the abnormalities are related to ''apana vata''. ''Apana'' is well regulated to the downward direction and its site of production is cleansed by ''basti'' bringing about the optimum therapeutic effect.

+

All the disease quoted by acharya are exclusively ''vata'' disorders and thus ''basti'' seems to be the best remedy for them. Especially in females not conceiving despite their mating with male partner and in men’s having seminal debility basti acts potentially because both the abnormalities are related to ''apana vata''. ''Apana'' is well regulated to the downward direction and its site of production is cleansed by ''basti'' bringing about the optimum therapeutic effect.(verse 32-34)

−

==== Selection of type of enema ~~(verse 35-37) =~~===

+

=== Selection of type of enema ===

Disease specific medicine is to be given through the enema because when medicated enema is given it brings about multiple actions at a time that includes evacuation which is a local action, affects certain receptors which need a specific molecule that acts as a stimulant over gut receptors for secretion of particular chemical messenger for disease attenuation besides cleansing. ''Dosha'' pacification is also evident due to action of absorbed active principles from drug specific to disease. ''Acharya'' has quoted a condition where life depends upon the morbid matter. This particular condition can be seen in the patient who is bed ridden, not consuming food and highly emaciated. Generally nutrition comes from the food that we consume and if food is not available then energy is produced from optional processes of metabolism like gluconeogenesis, lipolysis, etc <ref>

−

Rui L. Energy Metabolism in the Liver. Comprehensive Physiology. 2014;4(1):177-197. doi:10.1002/cphy.c130024 </ref>. This can be termed in Ayurvedic parlance as use of ''dhatu'' (body elements) for nutrition. But if patient is so emaciated that gluconeogenesis is also not possible then the life supports comes from absorption of nutrients from fecal matter. Precursor of fecal matter i.e. chyme in the colon contains some electrolytes like sodium, magnesium, and chloride which are left as well as indigestible parts of ingested food (e.g., a large part of ingested amylose, starch which has been shielded from digestion, and dietary fiber, which is largely indigestible carbohydrate in either soluble or insoluble form). The bacteria break down some of the fiber for their own nourishment and create acetate, propionate, and butyrate as waste products, which in turn are used by the cell lining of the colon for nourishment <ref>Miller, Terry, Wolin, Meyer, ''Pathways of Acetate, Propionate, and Butyrate Formation by the Human Fecal Microbial Flora'',1996, Applied and Environmental Microbiology 62 (5): 1589–1592 </ref>. Perhaps 10% of the undigested carbohydrate thus becomes available, through this last but an important part of digestion<ref>McNeil, NI (1984). "The contribution of the large intestine to energy supplies in man". The American journal of clinical nutrition 39 (2): 338–342</ref>. Hence in such patients giving enema may prove fatal as no nutrition will be available if colon is cleansed. Since it is explained that ''mala'' is responsible for ''bala'' in the context of ''rajayakshnma''.

+

Rui L. Energy Metabolism in the Liver. Comprehensive Physiology. 2014;4(1):177-197. doi:10.1002/cphy.c130024 </ref>. This can be termed in Ayurvedic parlance as use of ''dhatu'' (body elements) for nutrition. But if patient is so emaciated that gluconeogenesis is also not possible then the life supports comes from absorption of nutrients from fecal matter. Precursor of fecal matter i.e. chyme in the colon contains some electrolytes like sodium, magnesium, and chloride which are left as well as indigestible parts of ingested food (e.g., a large part of ingested amylose, starch which has been shielded from digestion, and dietary fiber, which is largely indigestible carbohydrate in either soluble or insoluble form). The bacteria break down some of the fiber for their own nourishment and create acetate, propionate, and butyrate as waste products, which in turn are used by the cell lining of the colon for nourishment <ref>Miller, Terry, Wolin, Meyer, ''Pathways of Acetate, Propionate, and Butyrate Formation by the Human Fecal Microbial Flora'',1996, Applied and Environmental Microbiology 62 (5): 1589–1592 </ref>. Perhaps 10% of the undigested carbohydrate thus becomes available, through this last but an important part of digestion<ref>McNeil, NI (1984). "The contribution of the large intestine to energy supplies in man". The American journal of clinical nutrition 39 (2): 338–342</ref>. Hence in such patients giving enema may prove fatal as no nutrition will be available if colon is cleansed. Since it is explained that ''mala'' is responsible for ''bala'' in the context of ''rajayakshnma''.(verse 35-37)

−

==== Importance of ''basti'' therapy ~~(verse 38-40) =~~===

+

=== Importance of ''basti'' therapy ===

−

[[Ayurveda]] states only two types of therapies i.e. ''samshamana'' (''dosha'' pacifying) and ''samshodhana'' (cleansing). ''Vata'' is responsible for all diseases as beside its own hazards it moves other vitiated dosha also. ''Basti'' has duel nature of action i.e. cleansing with ''dosha'' pacification. It acts mainly on ''vata'' hence ''basti'' can be considered as a single remedy for all the diseases; however, its formulation needs to vary as per disease.

+

[[Ayurveda]] states only two types of therapies i.e. ''samshamana'' (''dosha'' pacifying) and ''samshodhana'' (cleansing). ''Vata'' is responsible for all diseases as beside its own hazards it moves other vitiated dosha also. ''Basti'' has duel nature of action i.e. cleansing with ''dosha'' pacification. It acts mainly on ''vata'' hence ''basti'' can be considered as a single remedy for all the diseases; however, its formulation needs to vary as per disease.(verse 38-40)

−

==== Mode of action of ''basti'' ~~(verse 41) =~~===

+

=== Mode of action of ''basti'' ===

−

Here, Charaka details the mode of action of medicated enema , pointing towards various sites for proper evacuation. Medicated enema, when given properly, passes through the rectum and reaches the colon, where the maximum possible limit is up to cecum since the ileocecal valve prevents further movement<ref>Gore, Richard, Levine, Mark ''Textbook of Gastrointestinal Radiology'' Fourth Edition, Elsevier 2015 </ref>. Proper evacuation of enema is also an important phenomenon as enema retaining for longer duration may cause abdominal discomfort, loss of osmotic balance, etc. and early removal of enema may not produce desired clinical effect.

+

Here, Charaka details the mode of action of medicated enema , pointing towards various sites for proper evacuation. Medicated enema, when given properly, passes through the rectum and reaches the colon, where the maximum possible limit is up to cecum since the ileocecal valve prevents further movement<ref>Gore, Richard, Levine, Mark ''Textbook of Gastrointestinal Radiology'' Fourth Edition, Elsevier 2015 </ref>. Proper evacuation of enema is also an important phenomenon as enema retaining for longer duration may cause abdominal discomfort, loss of osmotic balance, etc. and early removal of enema may not produce desired clinical effect.(verse 41)

−

==== Sign and symptoms of proper, improper and excess use of evacuating type of medicated enema ~~(verse 41-43) =~~===

+

=== Sign and symptoms of proper, improper and excess use of evacuating type of medicated enema ===

Properly administered enema causes cleansing of colon and rectum but in proportionate manner causing less harm to the mucosal membrane and nourishing the bacterial flora of colon. This may improve the process of proper formation of feces and gives sense of lightness in lower abdomen. ''Agni'' i.e. digestion is improved due to regularisation of ''vata'' that ignites digestive fire.

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Improper enema or retention of enema gives symptoms that mimic bowel obstruction and hypervolemia. Especially symptoms like edema and dyspnea are produced as a result of excess fluid load, primarily salt and water, that builds up in various locations in the body and leads to an increase in weight, swelling in the legs and arms (peripheral edema), and/or fluid in the abdomen (ascites). Eventually, the fluid enters the air spaces in the lungs (pulmonary edema) reduces the amount of oxygen that can enter the blood, and causes shortness of breath (dyspnea).

−

Excess enema is nothing but purgation produced by overdose of evacuating enema thus the symptoms are same as that of excessive purgation.

+

Excess enema is nothing but purgation produced by overdose of evacuating enema thus the symptoms are same as that of excessive purgation. (verse 41-43)

−

==== Sign and symptoms of proper, improper and excess use of unctuous type of medicated enema ~~(verse 44-47) =~~===

+

=== Sign and symptoms of proper, improper and excess use of unctuous type of medicated enema ===

Unctuous enema though considered as a ''dosha'' pacifying enema it acts as a cleansing therapy because it cleanses the colon and rectum to remove adhered fecal matter. Moreover, the unctuousness makes colonic and rectal lining more slippery so that no feces remains and quantity of defecation increases. It brings about proper sleep as ''vata'' is responsible for insomnia and it takes care of ''vata''.

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Improper administration of unctuous enema cannot meet the extent of oleation needed in colon, rectum and whole body thus causes dryness. Vitiated ''vata'' thus leads to the symptoms stated as in verse.

−

Excess unctuous enema gives symptoms somewhat similar to that of excess oleation. However local symptom like griping pain may be due to excess motions is more prominent.

+

Excess unctuous enema gives symptoms somewhat similar to that of excess oleation. However local symptom like griping pain may be due to excess motions is more prominent.(verse 44-47)

−

==== ''Karma, kala'' and ''yoga basti'' ~~(verse 47-49) =~~===

+

=== ''Karma, kala'' and ''yoga basti'' ===

−

The concept of ''karma, kala'' and ''yoga basti'' denotes the use of ''basti'' therapy as per the severity of the disease. Generally diseases of vital organs like brain, heart, kidney etc. are considered more serious in nature and ''dosha'' vitiation is so severe that repeated medicated enema for long duration is a must hence ''karma basti'' is used in such instances. Another view suggests that 18 unctuous enema cause oleation of semen (Su. Chi. 37/71-74) Thus ''karma basti'' is meant for body elements which are far apart for the unctuousness to reach like ''shukra'' (semen), ''majja'' (bone marrow) etc. ''Yogabasti'' is the smallest duration or schedule that is required generally for healthy individuals doing cleansing according to particular season or in patients having disease newly diagnosed or of less severe nature. ''Kala basti'' is used in conditions which are in between the highly severe, chronic and less severe, newly diagnosed category.

+

The concept of ''karma, kala'' and ''yoga basti'' denotes the use of ''basti'' therapy as per the severity of the disease. Generally diseases of vital organs like brain, heart, kidney etc. are considered more serious in nature and ''dosha'' vitiation is so severe that repeated medicated enema for long duration is a must hence ''karma basti'' is used in such instances. Another view suggests that 18 unctuous enema cause oleation of semen (Su. Chi. 37/71-74) Thus ''karma basti'' is meant for body elements which are far apart for the unctuousness to reach like ''shukra'' (semen), ''majja'' (bone marrow) etc. ''Yogabasti'' is the smallest duration or schedule that is required generally for healthy individuals doing cleansing according to particular season or in patients having disease newly diagnosed or of less severe nature. ''Kala basti'' is used in conditions which are in between the highly severe, chronic and less severe, newly diagnosed category. (verse 47-49)

−

==== ''Shirovirechana'' ~~(verse 50-53) =~~===

+

=== ''Shirovirechana'' ===

−

''Shirovirechana'' comes in sequence of ''shodhana'' after ''vamana-virechana'' etc. It has direct cleansing effect on the part above the clavicle hence termed ''shirovirechana''. As head is a vital part and eyes are to be avoided during any fomentation, only fomentation with the help of the palm is an ideal procedure before ''shirovirechana''. Inappropriate administration may cause only irritation and not the removal of morbid matter that leads to increase in secretions as result of allergic reaction causing adhesion of sticky material in the throat, heaviness of the head etc. Excessive administration of ''shirovirechana'' may cause rupture of certain capillaries in the Little's area, lying in antero-inferior part of the nasal septum having rich vascularisation<ref>Moore, Keith L. et al. (2010) Clinically Oriented Anatomy, 6th Ed, p.959</ref>. This may results in cutting type of pain. Due to sudden entry of foreign bodies in the nasal cavity fainting occurs rarely which may be due to vagal shock.

+

''Shirovirechana'' comes in sequence of ''shodhana'' after ''vamana-virechana'' etc. It has direct cleansing effect on the part above the clavicle hence termed ''shirovirechana''. As head is a vital part and eyes are to be avoided during any fomentation, only fomentation with the help of the palm is an ideal procedure before ''shirovirechana''. Inappropriate administration may cause only irritation and not the removal of morbid matter that leads to increase in secretions as result of allergic reaction causing adhesion of sticky material in the throat, heaviness of the head etc. Excessive administration of ''shirovirechana'' may cause rupture of certain capillaries in the Little's area, lying in antero-inferior part of the nasal septum having rich vascularisation<ref>Moore, Keith L. et al. (2010) Clinically Oriented Anatomy, 6th Ed, p.959</ref>. This may results in cutting type of pain. Due to sudden entry of foreign bodies in the nasal cavity fainting occurs rarely which may be due to vagal shock.(verse 50-53)

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==== Do’s and don’ts in [[Panchakarma]] procedures ~~(verse 54-55) =~~===

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=== Do’s and don’ts in [[Panchakarma]] procedures ===

All the procedures involved in cleansing therapies act on the common principles, as follows:

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*Rearrangement of gastrointestinal bacterial flora

−

Thus, during any cleansing procedure body should be protected from any type of exertion as it may adversely affect the mechanism involved in trans-membrane movement of matter or inhibit the receptor stimulation activity. Intake of untimely and unwholesome food leads to indigestion that may alter the digestion of ''sneha'' during oleation or even can suppress digestive power so that therapy like ''basti'' may not affect with proper potency and problems like fever or cold due to ''ama'' (i.e. indigested food) may arise hampering the treatments. Sleep during day time in itself causes ''pitta-kapha'' vitiation; anger, sun exposure etc. causes ''pitta'' vitiation. As in ''shodhana, utklesha'' i.e. exciting the ''dosha'' is always a first step in cleansing, hence excess ''dosha'' vitiation along with already excited ''dosha'' may cause diseases symptoms aggravation.

+

Thus, during any cleansing procedure body should be protected from any type of exertion as it may adversely affect the mechanism involved in trans-membrane movement of matter or inhibit the receptor stimulation activity. Intake of untimely and unwholesome food leads to indigestion that may alter the digestion of ''sneha'' during oleation or even can suppress digestive power so that therapy like ''basti'' may not affect with proper potency and problems like fever or cold due to ''ama'' (i.e. indigested food) may arise hampering the treatments. Sleep during day time in itself causes ''pitta-kapha'' vitiation; anger, sun exposure etc. causes ''pitta'' vitiation. As in ''shodhana, utklesha'' i.e. exciting the ''dosha'' is always a first step in cleansing, hence excess ''dosha'' vitiation along with already excited ''dosha'' may cause diseases symptoms aggravation. (verse 54-55)

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==== Reason for failure of ''basti'' to cure curable diseases and importance of dose in cleansing therapies ~~(verse 57-60) =~~===

+

=== Reason for failure of ''basti'' to cure curable diseases and importance of dose in cleansing therapies ===

Acharya has attracted the attention to an important concept of ''avarana'' i.e. occlusion of one ''dosha'' by other causing its vitiation. In such instances treatment of the ''dosha'' or ''dhatu'' that is the reason for occlusion must be treated first then the one which is occluded (Ch.Chi.28/239). Otherwise the symptoms get aggravated as occlusion is potentiated.

−

Similarly, though one cannot measure the exact quantity of ''dosha'', still on basis of symptoms, ''koshtha, agni'' etc. one need to decide the dose of drug to be given for cleansing. If dose calculation or the treatment is administered is wrong, then even if the drug is proper then also results may be adverse.

+

Similarly, though one cannot measure the exact quantity of ''dosha'', still on basis of symptoms, ''koshtha, agni'' etc. one need to decide the dose of drug to be given for cleansing. If dose calculation or the treatment is administered is wrong, then even if the drug is proper then also results may be adverse.(verse 57-60)

−

===~~= Procedures followed practically~~ for ''vamana'' and ''virechana'' ~~are as follows =~~===

+

=== Practical guidelines for ''vamana'' and ''virechana'' procedures ===

*After proper ''deepana'' and ''pachana'', 30-40 ml of the fat is given empty stomach in the morning around 6.00 to 7.00 a. m. This dose is considered as test dose.

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*Post therapeutic measures are followed in both ''virechana'' and ''vamana''.

−

===~~= Procedure followed practically~~ for ~~medicated~~ enema ~~is as follows =~~===

+

=== Practical guideline for therapeutic enema procedure ===

*Evacuating type of medicated enema is given at around 10.00-10.30 a.m. in the morning when the food taken on earlier day is digested and patient is not too hungry. Unctuous type of enema is given immediately after meal.

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*After evacuating type of enema classics advise to give unctuous enema in the evening but practically unctuous enema is given on next day after having food. This alternate use of evacuating and unctuous enema avoids any possible ''vata'' vitiation.

−

===~~= Procedure followed practically~~ for ''shirovirechana'' ====

+

=== Practical guideline for ''shirovirechana'' procedure ===

*Before administering ''shirovirechana'' local massage with suitable oil and mild fomentation is given on parts above the clavicles.

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*After instillation of drug patient is made to lie in supine position for 3-5 minutes. During this time palms and soles of the patient are massaged which stimulates the absorption of nasal drug.

−

==== Advanced researches ====

+

=== Advanced researches ===

There are many research works carried out in field of [[Panchakarma]] therapies, some published researches on procedural standardisation are as follows:

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*Pharmacodynamics of Nasya Karma K.Y., Srikanth, V. Krishna murthy, M. Srinivasulu, International Journal of Research in [[Ayurveda]] & Pharmacy, 2011; 2(1):24-26.

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==== Scope for further research ====

+

=== Scope for further research ===

• Beside ''yoga, karma'' and ''kala basti'' schedule the modified regimen can be prepared as per disease. For e.g. in case of ''kapha'' dominant disorders continuous three evacuating enema followed by one unctuous enema can be given.

−

==== Summary ====

+

=== Summary ===

Lord Atreya have described the successful administration of [[Panchakarma]] in the form of answer to the twelve queries. Oleation and fomentation are the pre-treatment measure in cleansing processes that follows emesis and purgation. After cleansing post therapeutic measures (''samsarjana krama'') are necessary to bring digestion to its original state. Unctuous enema or oleation therapy can be started from ninth day. Unctuous enema should be followed by evacuating type of enema. Medicated enema cures all the diseases by removing accumulated ''dosha'' from entire body. Acharya have advised an ideal treatment schedule in the form of ''yoga, kala'' and ''karma basti'' as per disease severity. ''Shirovirechana'' (errhine) therapy acts over the things that need to be avoided during [[Panchakarma]] includes excessive sitting, standing, speaking and riding, sleep during day time, sexual intercourse, suppression of natural urges, cooling regimens, exposure to sun, grief, anger and intake of untimely and unwholesome food. However after following all measure correct treatment is given but in low or excess doses, in inappropriate time or in wrong manner then it fails to cure diseases.

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~~=== Glossary ===~~

−

*''Sneha'' (स्नेह): Oiliness, unctousness, lubricity, Moisture, Oil

+

== References ==

−

*''Vamana'' (वमन): Therapeutic emesis. ''Vamana'' is first of the Bio-cleansing series and consists in causing vomiting of the vitiated ''dosha'' especially ''kapha'' from the upper regions of the body, by means of consuming suitable drugs which are repulsive, nauseating, indigestible and tending to move upwards. Mainly used for diseases manifesting in upper part of body and caused by ''kapha dosha''.

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*''Virechana'' (विरेचन): therapeutic purgation. ''Virechana'' literally means catharsis, consists in administration of the purgative drugs which are pleasant and tending to move downward in order to eliminate the vitiated ''dosha'' especially Pitta from the lower regions of the body

−

*''Anuvasana'' (अनुवासनं): A form of medicated unctous enema which can be given every day and which doesn’t harm the body even if retained inside. The dose of the ''Anuvasana Basti'' is half to that of ''Sneha Basti''.

−

*''Niruha'' (निरूह): The Medicated enema having more quantity of the decoction prepared out of various drugs and possessing very potent action by which it expels the Dosha out of the body ( ''Niruha'' ) and there by gives relief from the diseases prolongs life and stabilizes the body tissues ( ''Asthapana'' ).

−

*''Ashayalaghava'' (आशय): place in the body that offers a storage for certain element, excreta or food etc.

−

*Shirovirechana (शिरोविरेचन ):A kind of errhine therapy which eliminates the morbid factors out of the head region

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*[[Panchakarma]] (पञ्चकर्म): Internal Bio-cleansing therapy / Detoxification therapy. Literally means fivefold therapeutic action, is a collective expression for the cleansing of one’s physical constitution. The five fold therapies comprises of Emesis, Catharsis, Decoction enema, Unctuous enema and Errhine therapy.

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*''Koshtha'' (कोष्ठ): bowel habit

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*''Shukra'' (शुक्र): The seventh ''dhatu'', whose function is reproduction. Generally equated with Semen; Present in two forms: 1. Pervading the entire body 2. Fertilizing the ovum. It is dominant of ''Jala Mahabhuta''.

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