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Asthapana basti (view source)

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|title=Asthapana basti

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|keywords=Asthapana basti ~~in ayurveda~~, Adarsh P. M., Deole Y.S., Basisht G., Types of asthapana basti, Mridu asthapana basti (mild potency), Teekshna asthapana basti (strong potency), Utkleshana basti, Doshahara basti, Dosha shamana basti, Yapana basti, Piccha basti (enema for healing), Ksheera basti (enema with medicated milk), Rakta basti (enema with animal blood), Doshaghna basti, Vataghna basti, Pittaghna basti, Kaphaghna basti, Rakta shamana basti, Shodhana basti, Lekhana basti, Brimhana basti, Grahi basti, Madhutailika basti, Yuktaratha basti, Siddha basti, Vaitarana basti, Ksheera vaitarana basti, Ardhamatrika basti, Vrishya basti, Chakshushya basti, Churna basti, Indications of asthapana basti, Ingredients of niruha basti, Procedure of administration of asthapana basti

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|keywords=Asthapana basti,niruha basti, kashaya basti, Adarsh P. M., Deole Y.S., Basisht G., Types of asthapana basti, Mridu asthapana basti (mild potency), Teekshna asthapana basti (strong potency), Utkleshana basti, Doshahara basti, Dosha shamana basti, Yapana basti, Piccha basti (enema for healing), Ksheera basti (enema with medicated milk), Rakta basti (enema with animal blood), Doshaghna basti, Vataghna basti, Pittaghna basti, Kaphaghna basti, Rakta shamana basti, Shodhana basti, Lekhana basti, Brimhana basti, Grahi basti, Madhutailika basti, Yuktaratha basti, Siddha basti, Vaitarana basti, Ksheera vaitarana basti, Ardhamatrika basti, Vrishya basti, Chakshushya basti, Churna basti, Indications of asthapana basti, Ingredients of niruha basti, Procedure of administration of asthapana basti

|description=Asthapana basti or niruha basti (therapeutic decoction enema) is a prime treatment for disorders due to vitiation of vata dosha.

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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== Types of asthapana basti ==

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<ol style="text-align:justify;"><li style="font-weight:bold">Based on veerya (potency):</li>

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<ol style="text-align:justify;"><li style="font-weight:bold">Based on [[Veerya|veerya (potency)]] :</li>

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<ol type="a"><li style="font-weight:bold">Mridu asthapana basti (mild potency): The basti with mild potency is indicated in [[Vyadhi|diseases]] of short duration, easy to cure, and having minimum strength.[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 10/15,16]<ref name="ref1" />. It is indicated in persons of inferior mental strength (avara sattva).[Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/90]<ref name="ref3">20Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005</ref>. It is indicated explicitly in old age and children.[Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/10]<ref name="ref3"/>The basti becomes mild (mridu), when milk (ksheera) etc. are added to it.[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 7/63]<ref name="ref1" /> Prasrutika basti is an example of mridu basti (basti with mild potency), which is indicated for tender/delicate persons(sukumaras). There are chatur prasrutika, pancha prasrutika, shat prasrutika, sapta prasrutika and nava prasrutika bastis mentioned in prasruthayogika siddhi.</li>

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<ol type="a"><li style="font-weight:bold">Mridu asthapana basti (mild potency): The basti with mild potency is indicated in [[Vyadhi|diseases]] of short duration, easy to cure, and having minimum strength.[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 10/15,16]<ref name="ref1" />. It is indicated in persons of inferior mental strength (avara sattva).[Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/90]<ref name="ref3">20Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005</ref>. It is indicated explicitly in old age and children.[Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/10]<ref name="ref3"/>The [[Basti|basti]] becomes mild (mridu), when milk (ksheera) etc. are added to it.[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 7/63]<ref name="ref1" /> Prasrutika basti is an example of mridu basti ([[Basti|basti]] with mild potency), which is indicated for tender/delicate persons(sukumaras). There are chatur prasrutika, pancha prasrutika, shat prasrutika, sapta prasrutika and nava prasrutika bastis mentioned in prasruthayogika siddhi.</li>

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<li style="font-weight:bold">Teekshna asthapana basti (strong potency): The basti with strong potency is indicated in [[Vyadhi|diseases]] of prolonged duration, challenging to cure, and having maximum strength. It can be administered in persons having superior mental strength (pravara sattva). The basti will get sharpness (teekshnatvam), when it gets added with cow’s urine (gomutra), pilu (Salvadora persica Linn), Chitraka (Plumbago zeylanica), salt (lavana) and alkali (kshara).</li></ol>

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<li style="font-weight:bold">Teekshna asthapana basti (strong potency): The [[Basti|basti]] with strong potency is indicated in [[Vyadhi|diseases]] of prolonged duration, challenging to cure, and having maximum strength. It can be administered in persons having superior mental strength (pravara sattva). The [[Basti|basti]] will get sharpness (teekshnatvam), when it gets added with cow’s urine (gomutra), pilu (Salvadora persica Linn), Chitraka (Plumbago zeylanica), salt (lavana) and alkali (kshara).</li></ol>

<li style="font-weight:bold">Based on effect (karma): </li>

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<ol type="a"><li style="font-weight:bold">Utkleshana basti: This type of basti is intended to aggravate [[Dosha|dosha]] in dormant state (leena avastha). After initial aggravation, the basti expelles the [[Dosha|dosha]] to create equilibrium. Eranda beeja (seed of Ricinus communis), madhuka (Madhuka longifolia), pippali (Piper longum), saindhava (rock salt) and hapusha phala (Juniperus communis Linn.) as kalka are the ingredients of utkleshana basti. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/93]<ref name="ref3" /></li>

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<ol type="a"><li style="font-weight:bold">Utkleshana basti: This type of [[Basti|basti]] is intended to aggravate [[Dosha|dosha]] in dormant state (leena avastha). After initial aggravation, the [[Basti|basti]] expelles the [[Dosha|dosha]] to create equilibrium. Eranda beeja (seed of Ricinus communis), madhuka (Madhuka longifolia), pippali (Piper longum), saindhava (rock salt) and hapusha phala (Juniperus communis Linn.) as kalka are the ingredients of utkleshana basti. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/93]<ref name="ref3" /></li>

<li style="font-weight:bold">Doshahara basti : This pacifies [[Dosha|dosha]] by removing them.The ingredients of doshahara basti are satahva (Anethum sowa), madhuka (Madhuca longifolia), kutaja beeja (Holarrhena antidysenterica), madanaphala (Randia dumetorum) along with kanjika (fermented rice gruel) and gomutra (cow’s urine). [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/94]<ref name="ref3" />.</li>

<li style="font-weight:bold">[[Dosha|Dosha]] shamana basti: This pacifies [[Dosha|dosha]] with mild potency.Priyangu (Callicarpa macrophylla), Madhuka (Madhuca longifolia), Musta (Cyperus rotundus), Rasanjana (semisolid extract obtained from decotion of Berberis aristata with milk) along with cow’s milk (goksheera) are the ingredients. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/95]<ref name="ref3" /></li></ol>

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== Importance in the management of diseases ==

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<ul style="text-align:justify;"><li>Basti (therapeutic enema) therapy (asthapana and anuvasana) is the most important among the therapies for treating [[Vata dosha|vata dosha]] disorders. It enters the intestine (pakvashaya) after the administration cuts the root of aggravation of [[Vata dosha|vata]] and thereby it pacifies [[Vata dosha|vata]] all over the [[Sharira|body]]. Its effect is like cutting the root of a tree ([[Vyadhi|disease]]) will destroy the whole tree ([[Vyadhi|disease]]). [Cha.Sa. Sutra Sthana 20/13]<ref name="ref1" /></li>

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<ul style="text-align:justify;"><li>[[Basti|Basti (therapeutic enema)]] therapy (asthapana and anuvasana) is the most important among the therapies for treating [[Vata dosha|vata dosha]] disorders. It enters the intestine (pakvashaya) after the administration cuts the root of aggravation of [[Vata dosha|vata]] and thereby it pacifies [[Vata dosha|vata]] all over the [[Sharira|body]]. Its effect is like cutting the root of a tree ([[Vyadhi|disease]]) will destroy the whole tree ([[Vyadhi|disease]]). [Cha.Sa. Sutra Sthana 20/13]<ref name="ref1" /></li>

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<li>Basti (therapeutic enema), in general, is helpful in the prevention of aging, and it produces health, strength, proper digestion, intelligence, voice, and complexion.</li>

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<li>[[Basti|Basti (therapeutic enema)]], in general, is helpful in the prevention of aging, and it produces health, strength, proper digestion, intelligence, voice, and complexion.</li>

<li>It is recommended for both children and old age as it effectively cures [[Vyadhi|diseases]] without causing complications.</li>

<li>It removes the vit (stool), shleshma, pitta and [[Vata dosha|vata dosha]] from the [[Sharira|body]].</li>

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<li>It removes [[Dosha|doshas]] from the [[Sharira|body’s]] channels and thus pacifies all [[Vyadhi|diseases]]. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 1/27]<ref name="ref1" /></li>

<li>Administration of niruha basti (therapeutic decoction enema) before anuvasana basti (therapeutic unctuous enema) clears the channels.. It helps properly transport unctuous substance (sneha) like the pipe which carries water when the impurities causing obstruction are removed. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/84]<ref name="ref3" /></li>

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<li>Basti (asthapana and anuvasana) is important as it is the prime treatment for [[Vata dosha|vata]]. [[Vata dosha|Vata]] is the reason for the [[Vyadhi|diseases]] originating in peripheral tissues (shakha), visceral organs (koshtha), vital points of the body (marma), upper part of the body (urdhva), entire body (sarvavayava) and individual parts of the body (anga). The same [[Vata dosha|vata]] is responsible for separating and combining stool, urine, pitta, etc. at their sites. As basti is supreme in managing [[Vata dosha|vata]], it is said to be half of the entire therapeutics. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 1/38-40]<ref name="ref1" /></li></ul>

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<li>[[Basti|Basti]] (asthapana and anuvasana) is important as it is the prime treatment for [[Vata dosha|vata]]. [[Vata dosha|Vata]] is the reason for the [[Vyadhi|diseases]] originating in peripheral tissues (shakha), visceral organs (koshtha), vital points of the body (marma), upper part of the body (urdhva), entire body (sarvavayava) and individual parts of the body (anga). The same [[Vata dosha|vata]] is responsible for separating and combining stool, urine, pitta, etc. at their sites. As [[Basti|basti]] is supreme in managing [[Vata dosha|vata]], it is said to be half of the entire therapeutics. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 1/38-40]<ref name="ref1" /></li></ul>

== Indications of asthapana basti ==

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== Ingredients of niruha basti ==

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As the name suggests, the important and predominant content of niruha basti (therapeutic decoction enema) is a decoction of herbs depending upon the [[Vyadhi|disease]] condition of the patient. Its other ingredients are honey, rock salt, unctuous substances (usually oil or ghee) and medicinal paste. In some conditions, cow’s urine, fermented liquid preparation out of grains (dhanyamla), meat soup, milk etc. are used either as an alternative or as an admixture (Avapa) to the combination of basti.

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As the name suggests, the important and predominant content of niruha basti (therapeutic decoction enema) is a decoction of herbs depending upon the [[Vyadhi|disease]] condition of the patient. Its other ingredients are honey, rock salt, unctuous substances (usually oil or ghee) and medicinal paste. In some conditions, cow’s urine, fermented liquid preparation out of grains (dhanyamla), meat soup, milk etc. are used either as an alternative or as an admixture (Avapa) to the combination of [[Basti|basti]].

== Quantity of ingredients ==

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The general dosage of ingredients for 1152 ml (dvadasha prasruta) basti are as follows. While preparing, there is a specific sequence of mixing the ingredients and their quantity is listed below.

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The general dosage of ingredients for 1152 ml (dvadasha prasruta) [[Basti|basti]] are as follows. While preparing, there is a specific sequence of mixing the ingredients and their quantity is listed below.

<ol style="text-align:justify;"><li>Honey (madhu): 192 ml (2 prasruta)</li>

<li>Rock salt (saindhava): 12 gram (1 karsha)</li>

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== Dose of asthapana basti in different age groups ==

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

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The dose of [[Basti|basti]] formulation as per age. It is shown in table 2.

{| class="wikitable"

|+'''Table 2: Age specific dose of basti formulation'''

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== Procedure of administration of asthapana basti ==

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The procedure of administration of basti can be divided into three stages like the samshodhana (therapeutic emesis and purgation) procedures. They are.

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The procedure of administration of [[Basti|basti]] can be divided into three stages like the samshodhana (therapeutic emesis and purgation) procedures. They are.

<ol style="text-align:justify;"><li>Pre therapeutic procedure (purvakarma)</li>

<li>Chief therapeutic procedure (pradhana karma)</li>

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== Contemporary approach ==

The oral route is considered as the most convenient route for drug administration. However, oral medications are not possible in some clinical and pharmaceutical perspective in several circumstances. Rectal route may be used as a clinical alternative in these circumstances which yields both systemic and local actions. The hepatic first-pass metabolism effect can be reduced by rectal administration by partially bypassing the liver following systemic absorption. Rectal formulations are mainly used in the systemic conditions such as pain, fever, nausea, vomiting, migraines, allergies, and sedation.<ref name="ref7">Susan Hua. Physiological and Pharmaceutical Considerations for Rectal Drug Formulations. Front Pharmacol. 2019; 10: 1196. doi: 10.3389/fphar.2019.01196. PMCID: PMC6805701, PMID: 31680970.</ref>

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Boofing or rectal administration medication and other fluids are administered through rectum. There they are absorbed by capillaries of rectum and thus enter the circulatory system and distribute them to whole [[Sharira|body]].<ref name="ref8">www.en.wikipedia.org.Rectal administration. [Internet].2023 [cited 2023 July 31]. Available from https://en.wikipedia.org/wiki/Rectal_administration#:~:text=Rectal%20administration%2C%20colloquially%20known%20as,body's%20organs%20and%20bodily%20systems.</ref> One of the studies also showed that basti medicine reaches up to ileo-caecal junction.<ref name="ref9">Juneja Yashwant M, Thakar A. B. Standardization of procedure of administration of Basti w.s.r to Kshinashukra (oligozoospermia), MD Dissertation, IPGT& RA. Jamnagar: Gujarat Ayurved University; 2010</ref>

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Boofing or rectal administration medication and other fluids are administered through rectum. There they are absorbed by capillaries of rectum and thus enter the circulatory system and distribute them to whole [[Sharira|body]].<ref name="ref8">www.en.wikipedia.org.Rectal administration. [Internet].2023 [cited 2023 July 31]. Available from https://en.wikipedia.org/wiki/Rectal_administration#:~:text=Rectal%20administration%2C%20colloquially%20known%20as,body's%20organs%20and%20bodily%20systems.</ref> One of the studies also showed that [[Basti|basti]] medicine reaches up to ileo-caecal junction.<ref name="ref9">Juneja Yashwant M, Thakar A. B. Standardization of procedure of administration of [[Basti|Basti]] w.s.r to Kshinashukra (oligozoospermia), MD Dissertation, IPGT& RA. Jamnagar: Gujarat Ayurved University; 2010</ref>

As compared with oral administration, rectal administration is faster in action and higher in bioavailability. Vomiting can be prevented by rectal administration thus it prevents the loss of drug. The two third of rectum’s venous drainage is in the middle and inferior rectal vein which drains directly to systemic circulation and only one third of it goes to the hepatic portal system. Thus, two third of rectal administered drug bypasses the metabolic phase. It can be administered at home which doesn’t require inpatient setup as in intravenous administration. Many of the oral drugs can be modified for rectal administration by crushing and suspending them in water.

There are many digestive tract problems where the rectal route can be selected for drug administration such as bowel obstruction, dysphagia etc. In palliative care and long-term care, it is the cheap and safe alternative to intravenous or subcutaneous delivery of medications.<ref name="ref10">www.en.wikipedia.org.Rectal administration.[Internet] 2023 [cited 2023 July 31].Available from https://en.wikipedia.org/wiki/Rectal_administration#:~:text=Rectal%20administration%2C%20colloquially%20known%20as,body's%20organs%20and%20bodily%20systems.</ref>

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The rectal region is drained by rectal (hemorrhoidal) veins and lymphatic vessels. The superior rectal vein drains the upper part of the rectum, and its lower part drains by inferior and middle rectal veins. More specifically, the superior rectal vein drains into the portal vein, hence it passes through the liver before getting into the systemic circulation. In contrast, the inferior and middle rectal veins drain into the inferior vena cava and, therefore, directly into systemic circulation. Between these three rectal veins exist extensive anastomoses, which connect all three veins throughout the rectum. The rectum is also extensively drained by the lymphatic system that originates in the mucosa and submucosa. The influence of the lymphatic vessels on the absorption of drugs is not well established; however, it may contribute to the systemic absorption of highly lipophilic drugs. Lymphatic drainage also avoids the hepatic first-pass effect.<ref name="ref12">Susan Hua. Physiological and Pharmaceutical Considerations for Rectal Drug Formulations. Front Pharmacol. 2019; 10: 1196. doi: 10.3389/fphar.2019.01196. PMCID: PMC6805701, PMID: 31680970.</ref>

Depending on the physicochemical characteristics of the drug, transportation of drug molecules occurs passively via paracellular diffusion (between cells) or transcellular diffusion (through the cell). Paracellular transport is preferred for more hydrophilic molecules, ionized molecules, and high molecular weight compounds. However, by the narrow tight junction space in rectum it can be restricted. Therefore, the transcellular route is the main mechanism for drug absorption in the rectum.<ref name="ref13">Nunes R., Sarmento B., das Neves J. (2014). Formulation and delivery of anti-HIV rectal microbicides: advances and challenges. J. Control Release 28194, 278–294. 10.1016/j.jconrel.2014.09.013</ref> Transcellular diffusion is affected by many factors, but it is usually proportional to the lipid solubility of the drug. Drug molecules in the non-ionized form are much more lipophilic than the ionized form. At the relatively neutral pH of the rectum, basic drugs with an acid dissociation constant (pKa) near or above the physiologic range tend to be more readily absorbed, as they will predominantly be in their non-ionized form.

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The rate of absorption depends on the property of constituents of basti (enema) too. The irritant property of adjuvants causes mild inflammation in the colon which alters the permeability of capillaries and thus enhances the absorption.<ref name="ref14">Swapnil SA, BK Ashok, Anup B Thakar et al. An experimental study to evaluate the pharmacokinetic aspect of Lekhana Basti (Emaciating/ Desiccating Medicated Enema). Anc Sci Life. 2011 Oct;31(2):38-43</ref>

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The rate of absorption depends on the property of constituents of [[Basti|basti (enema)]] too. The irritant property of adjuvants causes mild inflammation in the colon which alters the permeability of capillaries and thus enhances the absorption.<ref name="ref14">Swapnil SA, BK Ashok, Anup B Thakar et al. An experimental study to evaluate the pharmacokinetic aspect of Lekhana Basti (Emaciating/ Desiccating Medicated Enema). Anc Sci Life. 2011 Oct;31(2):38-43</ref>

== Importance of retention of the formulation ==

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<li>Clinically in patients treated with lekhana basti there was a decrease in s. cholesterol, s.low density lipoprotein and s. apolipoprotein B. There was a significant reduction in BMI, weight, [[Sharira|body]] fat storage etc. It was effective to a lesser extent on lipid profile than triphala guggulu.<ref name="ref20">Shital G Bhagiya (2015): A Comparative Clinical Study of Lekhana Basti and Shamana Sneha (Triphaladi Taila) In the Management of Sthaulya W.S.R. To Obesity.Department Of panchakarma, GAAC, Ahmedabad.</ref></li>

<li>A comparative study between the effect of rectal administration and oral administration of the same group of drugs (guduchi bhadramustadi) have proved the higher efficacy of rectal administration for the management of sthoulya.<ref name="ref21">Hemal Kumar V Dodiya (2013): A comparative clinical study on the effect of Guduchi-Bhadramustadi yoga administered orally and by basti in the management of sthaulya w.s.r to obesity. Department of Panchakarma, IPGT&RA Jamnagar</ref></li>

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<li>In a comparative study,vaitararana basti has shown marked improvement in 45% of patients of ghridrasi. Whereas siravyadha has shown marked improvement in 55% of patients. Vaitarana basti was found more effective than siravedha in stambha (stiffness), spandana (twitching), suptata (numbness), sakthikshephanigraha (SLR) and gaurava(heaviness).<ref name="ref22">Paikrao Sumedh Narayanrao (2014): A clinical study on siravedha and vaitarana basti in the management of gridhrasi with special reference to sciatica. Department of Panchakarma, IPGT&RA Jamnagar</ref></li>

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<li>In a comparative study, vaitararana basti has shown marked improvement in 45% of patients of ghridrasi. Whereas siravyadha has shown marked improvement in 55% of patients. Vaitarana basti was found more effective than siravedha in stambha (stiffness), spandana (twitching), suptata (numbness), sakthikshephanigraha (SLR) and gaurava(heaviness).<ref name="ref22">Paikrao Sumedh Narayanrao (2014): A clinical study on siravedha and vaitarana basti in the management of gridhrasi with special reference to sciatica. Department of Panchakarma, IPGT&RA Jamnagar</ref></li>

<li>Yapana basti combined with patrapinda sweda and shamana medicine has shown relatively more effectiveness in the management of majority of symptoms in cervical spondylosis than the group in which yapana basti was not administered in combination.<ref name="ref23"/> The group in which yapana basti combined has also shown prevention from recurrence and long-lasting effects.</li>

<li>Study of dashamooladi basti in the management of acute stage of amavata has revealed an overall mild improvement in 40% patients, and minor improvement was observed in remaining 60% patients. Complete remission or marked improvement was not found in any of the patient.<ref name="ref24">Anjali V Makodiya (2017): A Clinical Study on Basti Karma in The Short-Term Management of Amavata W.S. R Rheumatoid Arthtitis.Department of Panchakarma, GAAC, Ahmedabad.</ref></li>

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