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Bastisutriyam Siddhi (view source)

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Now we shall ~~discuss~~ the ~~Chapter which deals with formulation~~ of ~~''Basti''~~ . Thus said Lord Atreya.[1-2]

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Now we shall expound the chapter "Bastisutriyam Siddhi" (Standard practices of therapeutic enema). Thus said Lord Atreya.[1-2]

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==== Questions of Agnivesha ====

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=== Questions of Agnivesha ===

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Hearing these questions, the great sage Punarvasu spoke to answer. [3-5]

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==== Consideration before administration of ''basti'' ====

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=== Consideration before administration of ''basti'' ===

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''Basti'' administered after careful examination of ''dosha'' (vitiating factors), ''aushadha'' (potency of drugs), ''desha'' (place of living and body of patient), ''kala'' (season and time of administration), ''satmya'' (accustom), ''agni'' (factor responsible for process of digestion and metabolism), ''sattva'' (mind), ''oka'' (habituation due to continuous use), ''vaya'' (age) and ''bala'' (strength) is certainly capable of providing the significant results, the benefits of the therapy and ultimately success.[6]

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==== ''Basti netra'' (nozzle apparatus) ====

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=== ''Basti netra'' (nozzle apparatus) ===

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The physician well versed in the method of administering ''basti'' should administer this therapy to a patient who is fit, after the digestion of the meal consumed by him and who has a complete focus of mind on the therapy. It should be given on an auspicious day in the ''shukla paksha'' having a propitious ''nakshatra, muhurta'' and ''yoga''.[12-121/2]

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==== Preparation and administration of ''basti'' formulation ====

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=== Preparation and administration of ''basti'' formulation ===

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The physician should not shake his hand, and quickly compress the bladder so that the content goes inside at one stretch. Thereafter, he should take out the nozzle slowly. [13-191/2]

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==== Sequels of wrong administration of nozzle ====

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=== Sequels of wrong administration of nozzle ===

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If the nozzle is obliquely inserted, then the fluid will not flow into the rectum. If the nozzle is shifted from one place to the other, then this may cause anal injury. If the bladder is compressed slowly, then the enema- fluid may not reach the colon. If the bladder is strongly compressed, then the fluid may rush very fast even up to the throat. If the enema- fluid is very cold, then it may cause stiffness. If the enema – fluid is very hot, then it may cause burning sensation and fainting. If the enema – fluid is very unctuous, then it may cause numbness. If the enema- fluid is ''ati ruksha'', then it may cause aggravation of ''vayu''. If the enema – fluid is very thin or added with less quantity of salt, then it may lead to ''ayoga''. If the enema- fluid is administered in large quantity, then it may cause ''ati-yoga''. If the enema-fluid is viscid, then it may cause emaciation of the patient, and it moves in the colon very slowly. If the enema- fluid contains salt in excess, then it may cause burning sensation and diarrhea. Therefore, ''basti'' should be properly administered.[20-221/2]

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==== Sequence in preparation of ''basti'' formulation ====

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=== Sequence in preparation of ''basti'' formulation ===

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The first enema helps in the elimination of ''vata'', the second enema helps in the elimination of ''pitta'', and the third enema helps in the elimination of ''kapha'' from their ''ashaya'' (locations).[26]

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==== Follow up regimen after ''basti'' administration ====

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=== Follow up regimen after ''basti'' administration ===

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The patient should lie on the bed in supine position, and the toe- joints of both of his legs should be pulled gently. The heel, calf and other painful parts should be massaged with the oil. Thereafter, the patient should take rest comfortably by keeping his head over a pillow.[27-291/2]

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==== Proportion according to ''dosha'' dominance ====

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=== Proportion according to ''dosha'' dominance ===

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In ''niruha basti'', the decoction should be five parts. If this is intended to be given to a patient suffering from ''paittika'' disease or to a healthy person, then the quantity of ''sneha'' should be one sixth of the total quantity. For ''vatika'' diseases, the quantity should be one fourth of the total quantity. For ''kaphaja'' diseases, the quantity of ''sneha'' should be about 1/8th of the total quantity.[30-301/2]

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==== Dose of ''niruha basti'' ====

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=== Dose of ''niruha basti'' ===

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Start the dose of ''niruha'' with one ''prasrita'' (approx.80 ml) on 1st year, then increase ½ ''prasrita'' till 12th year; then increase one''prasrita'' till 18th year, reaching the maximum dose i.e., twelve''prasrita''. The dose after 70 years is equal to the dose of 16th year. In children and elderly person ''mridu basti'' should be given. [32-321/2]

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==== Table/cot for administration of ''basti'' ====

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=== Table/cot for administration of ''basti'' ===

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The cot or table used for ''basti'' should not be too high at head end, foot end should not be too low, having foot step. The table should be covered with soft bed and the patient should wear white dress and lie on the table facing the head to east. [33-331/2]

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==== Diet after ''basti'' ====

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=== Diet after ''basti'' ===

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''Yusha, kshira'' and ''mamsa rasa'' should be given as per the disease (''kapha, pitta'' and ''vata'' respectively). [34-341/2]

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==== Various ''basti'' formulations ====

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=== Various ''basti'' formulations ===

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''Guņa- Tridoshaja and dvandaja roga nāshaka.''[65-68]

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==== Maximum numbers of ''niruha basti'' ====

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=== Maximum numbers of ''niruha basti'' ===

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''Niruha basti'' should not be given in excess of these specified numbers.[69]

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==== Follow up diet for ''dosha'' dominance ====

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=== Follow up diet for ''dosha'' dominance ===

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== Vidhi Vimarsha (Applied Inferences ) ==

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==== Factors to be considered before ''basti'' administration ====

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=== Factors to be considered before ''basti'' administration ===

Ten fold examination is advised before the administration of ''basti''. These examinations are slightly different from the ''dashavisha pariksha'' explained in the [[Vimana Sthana]].

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''Basti'' should be administered after considering ''kala'' (''teekshna'' in ''sheeta kala, mridu'' in ''ushna kala''), ''bala, dosha'' (''teekshnadi basti'' in ''uttamadi bala'' of ''dosha''), ''roga'' (''teekshna, madhyama, mridu basti'' in ''uttamadi bala'' of ''dosha'', ''teekshna'' in ''kapha vata, mridu'' in ''raktapitta'', and ''madhyama'' in ''kaphapitta'')<ref>Dalhana, Commentator. Sushruta Samhita, Chikitsa Samhita, 38/71, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref> (Verse 6)

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==== Age wise differentiation ====

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=== Age wise differentiation ===

While describing the age of the patient as 6, 20 and 12, the sequence changed to emphasize the fact that before 6th year and after 20th year of age there should be no variation in the size of ''netra'' (nozzle). After the 6th year, the size of the ''netra'' should be increased 1/3rd ''angula'' every year. Thus for the 12th year of age, the size of the ''netra'' becomes 8 ''angula''. After 12th year of age, the size should be increased ½ ''angula'' every year. Thus for a patient of 20 year age the size of ''netra'' becomes 12 ''angula''.

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'''Table showing measurements of Basti Netra<ref>Sushruta, Sushruta Samhita, Chikitsa Samhita, 35/7-11, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>'''

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==== ''Basti yantra'' (instrument used for administration of enema) ====

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=== ''Basti yantra'' (instrument used for administration of enema) ===

In present practice enema can or pot are used for administering the ''niruha basti'' as it is having following advantages over the classical ''basti yantra''.

*Easy & simple to administer

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In olden days due to non availability of rubber, the use of metallic nozzle as ''basti netra'' was seen. Texts have have given freedom for the changes if better options are available. Some conservative Ayurvedic practitioners believe that ''basti'' given by ''basti netra'' provides better result than the methods that are used in current practice. Vaidya H.S.Kasture has disapproved this fact by saying that among the 17 lakh ''basti'' given using the enema pot and enema catheter by him (till 2005) he has observed same efficacy as that of classical ''basti yantra'' except for a very few complications due to the enema pot and catheter (lecture given at national seminar held in 2005 at Jamnagar). In a research work carried out by Juneja.Y et.al. (Jamnagar, 2008)<ref>Juneja.Y et.al. Standardization of procedure of administration of Basti w.s.r. to Kshinashukra (oligozoospermia), Gujrat Ayured University, Jamnagar, 2008</ref> have concluded work that ''basti'' administered by classical ''yantra'' and enema pot - rubber catheter provided same effect. Considering all these it can be concluded that the use of enema pot and catheter is simple, economical, safe, and free from complications.(verse 10-11)

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==== Time of administration ====

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=== Time of administration ===

''Shukla paksha'' of a lunar month is auspicious for initiating all good activities. Planning of ''basti'' according to ''paksha'' may not be practical in diseased. It may be ideally adopted in healthy.

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''Harita'' has described ''krishna paksha'' of lunar month is suitable for the ''basti prayoga'' because, all the diseases treated during this period get cured forever (radical cure) and the Gods appear during the ''shukla paksha'' where as demons as well as diseases appear during the ''krishna paksha''. Therefore, according to Harita, diseases should be treated during ''krishna paksha''.)<ref>Chakrapanidutta, Commentator. Charak samhita, Siddhi Sthana, 3/12-13, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990</ref> (Verse 12 -13)

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==== Precautions during administration of enema ====

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=== Precautions during administration of enema ===

The ''basti dravya'' should be administered in one squeeze or compress. If there is interruption, and the ''putaka'' is compressed again to push the remaining ''basti dravya'' into rectum, then there is possibility of entry of air into the ''pakvashaya'' which is not desirable.<ref>Chakrapanidutta, Commentator. Charak samhita, Siddhi Sthana, 3/13-20, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990</ref> (Verse 13-19)

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===== ''Kalka'' =====

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==== ''Kalka'' ====

''Putoyavanyadi kalka'':

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According to the condition, ''hinguvachadi, shaddharana, vaishvanara churna'' can also be used.

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===== Preparation of ''kalka'' =====

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==== Preparation of ''kalka'' ====

Very fine powder of the prescribed drug are taken in ''khalva'' and combined one by one with the pestle. Add warm water to the powder and mash the mixture with pestle for 1-2 minutes. Now ''kalka'' is ready for use.

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===== Dose of ''kalka'' =====

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==== Dose of ''kalka'' ====

*Charak has not mentioned the dose of ''kalka''

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*Jatukarna, Vrinda Madhava, Chakrapani told two ''Pala''

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===== Utility of ''kalka'' =====

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==== Utility of ''kalka'' ====

*''Kalka'' confers the viscosity (''sandrata'') to the ''basti dravya'' and will not change the volume.

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*Prevents ''ayoga'' (insufficient action), ''adhmana'' (flatulence) etc. ''upadrava''

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==== Rationale for mixing sequence of ''basti'' ====

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=== Rationale for mixing sequence of ''basti'' ===

*''Madhu''- ''mangalakaraka'' auspicious

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This is very important concept for enhancing bio availability of rectally administered drugs. Honey, rock salt (saindhava), unctuous material (sneha) and paste of medicines (kalka) are found commonly in all the therapeutic enema (basti). They act as the vehicle to enhance the effect of drugs administered rectally and also has specific action depending upon their own properties. Actually basti is a homogeneous oil in water type of emulsion somewhat similar to milk which is best example of natural emulsion. Studies on certain drugs suggest significant bio-availability enhancement relative to their aqueous formulations.<ref>Constantinides, P.P., Scalart, J., Lancaster, C. et al. Formulation and Intestinal Absorption Enhancement Evaluation of Water-in-Oil Microemulsions Incorporating Medium-Chain Glycerides. Pharm Res 11, 1385–1390 (1994)</ref> This effect is attributed to the reduced droplet size, improved drug solubility, protection against enzymatic hydrolysis and potential for enhance absorption afforded by surfactant induced membrane fluidity and thus permeability changes.<ref>E. C. Swenson and W. J. Curatolo. Intestinal permeability enhancement for proteins, peptides and other polar drugs: mechanisms and potential toxicity. Adv. Drug Deliv. Rev. 8: 39–92, (1992).</ref> In case of basti combination of honey and rock salt mainly acts as surfactant. Classical texts also gives mode of action of this combination as to disintegrate kapha dosha and detach it from its site (Kaphachedana-Kaphavilayana) which signifies the changes in permeability.

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==== Suitable position for administration ====

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=== Suitable position for administration ===

The patient, before the ''basti pranidana'' (administration), is required to lie down on his left side on a bed which has uniform level or which is low in the head side. These two alternatives are described for the comfort of the patient. This can be explained in a different way also. If the patient has a bulky buttock, then the head side of the cot should be uniform. If he has thin buttock, then the head side of bed should be lowered to facilitate the uniform distribution of ''basti dravya'' in the body.

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It is thought that an enema introduced would never ascend so high as the stomach. There is a reference from the Best and Taylor that “materials introduced by enema, in some instances pass through the walls into the ilium, such incompetence may permit the enema fluid to reach the duodenum.” Also the possibility of materials from even the lower bowel, reaching the mouth is strongly suggested by the fact that lycopodium sporce, introduced into the colon by enema, has been recovered some hours later from washing of the stomach.<ref>Best and Taylor, Physiological Basis of Medicine</ref>

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==== ''Dosha'' specific dose ====

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=== ''Dosha'' specific dose ===

For ''vata prakopa'', one ''basti'', for ''pitta prakopa'' one ''basti'' and for ''kapha prakopa'' one ''basti'' should be given. It is not that three ''basti prayoga'' for ''tridosha prakopa'', the first ''basti'' eliminates the ''vata'', second ''pitta'' and third, ''kapha''. The author himself will explain the need of giving one ''basti'' for ''vayu,'' two for ''pitta'' and three for ''kapha'' in verse no. 69. Thus, the one ''basti'' eliminates the aggravated ''vata'' from its location, two of them (given on after the other) eliminate the ''pitta'' from its location and three of them (given on after the other) eliminate ''kapha'' from its location.

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''Basti'' is, no doubt, not the most effective therapy for aggravated ''pitta'' and ''kapha''. But it is very effective only when these two ''dosha'' are associated with aggravated ''vata''.<ref>Chakrapanidutta, Commentator. Charak samhita, Siddhi Sthana, 3/26, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990</ref>

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==== Diet ====

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=== Diet ===

The patient is instructed to take the thin meat soup etc. after ''niruha basti'' to protect his ''agni'' which is slightly reduced due to therapy. ''Peyadi krama'' is not necessary after ''niruha''.

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''Niruha basti'' does not cause ''agnimandya, bala kshaya, prana kshaya'' like ''virechana'', so ''peyadi krama'' is not needed. Bhoja stated that the ''virechana'' causes ''agnimandya'' by ''adhisthana samplavat'' whereas ''basti'' does not decrease the ''agni'' instead kindles it.<ref>Chakrapanidutta, Commentator. Charak samhita, Siddhi Sthana, 1/20-21, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990</ref>

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==== Ratio of combination ====

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=== Ratio of combination ===

The above-mentioned ratio of decoction and ''sneha'' should be adopted even if the ''niruha basti'' is administered in minimum quantity. Apart from the decoction and ''sneha'', the ''niruha kalpana'' also contains ''madhu, kalka,'' and ''saindhava'' etc. The quantity of these ingredients is variable according to the ''dosha, prakriti'' etc. of the patient. However, the quantity of the ingredients should be such that it should make the kalpana equal to 12 ''prasrita'' in total.

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|}

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==== Procedures after ''basti'' ====

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=== Procedures after ''basti'' ===

After the manifestation of ''samyak nirudha'' symptoms, the patient should be advised to take bathe (in hot water) and to take meat-soup (''rasa''), milk and pulse-soup (''yusha'') in diseases due to the action of the deranged ''vata, pitta'' and ''kapha'' respectively. The essence (''rasa'') of the meat of any ''jangala'' animal may, however, be prescribed in all cases under the circumstances, since it would produce no harm. Only a quarter, a half or three-quarter part of the usual diet should be prescribed according to the digestive capacity of the patient, and the nature and intensity of the ''dosha'' involved in each case.<ref>Sushruta, Sushruta Samhita, Chikitsa Samhita, 38/11-13, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>

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After ''anuvasana, yusha, ksheera'' and ''mamsa rasa, yusha, ksheera'' and ''mamsa rasa'' should be given along with ''anna'' in ''kapha, pitta'' and ''vata'' respectively. ''Peya'' should not be given as it causes ''abhishyandana'' of ''koshtha'' because of ''sneha'' in ''koshtha''.<ref>Sushruta, Sushruta Samhita, Chikitsa Samhita, 37/57, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>

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==== ''Dvipanchalamudi basti'' ====

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=== ''Dvipanchalamudi basti'' ===

This ''basti'' is also highlighted in Ashtanga Hridaya which is detailed below for a practical understanding.

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''Guņa- Sarva vātavyādhihara''

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==== ''Niruha basti'' ====

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=== ''Niruha basti'' ===

In the same method given in verses, the skilled physician should administer second, third or fourth ''niruha basti'' or till ''samyak nirudha'' and then stop.<ref>Sushruta, Sushruta Samhita, Chikitsa Samhita, 37/6-7, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref> Dalhaņa while commenting has justified that, in ''krura koshtha'' if improperly administered or if ''sunirudha lakshana'' not observed and ''dosha'' to be eliminated are present, in such condition fourth ''basti'' should be used judiciously.<ref>Dalhana, Commentator. Sushruta Samhita, Sutrasthana, 38/3-6, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>

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*If the ''dosha'' and ''mala'' are not eliminated in ''krura koshtha'' patient

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~~=== Glossary ===~~

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~~#''Abhisyandi'' (''dravya''): The diet or drug which on account of its heavy and slimy properties causes retention of secretions, thus giving rise to heaviness and fullness e.g. curd.~~

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== References ==

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~~#''Abhyanga'': Massage or rubbing of body or body parts usually with simple or medicated oil.~~

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~~#''Anuvasana basti'': Medicated oil enemata meant to be retained in the colon for some time. It is also referred as ''snigdhabasti'' (unctuous).~~

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~~#''Karsha'': measurement equal to 12gms~~

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~~#''Niruha basti'': Medicated enemata prepared from herbal decoctions, milk, oil to be retained in the colon.~~

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~~#''Nirvapana'': Extinguishing, alleviation, pacifying. To alleviate or reduce pain and burning of a suppurating inflammatory swelling by application of refrigerant or cooling application.~~

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~~#''Pala'': measurement equal to 4 ''karsha'' (48gms)~~

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~~#''Prasrita'': measurement equal to 8 ''Karsha'' (96gms)~~

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=== References ===

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