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<big>''' Abstract </big>'''

<big>''' Abstract </big>'''

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The chapter [[Bastisutriyam Siddhi]] deals with the best practices and procedure of ''basti'' (therapeutic enema) in detail. The examination before ''basti'' administration, features of ''basti netra'' (nozzle in enema apparatus), features of ''basti putaka'' (enema bag/pot), dose, preparation, procedure and formulations of ''niruha basti'' (enema with decoction) are explained. It also describes the procedure of ''anuvasana basti'' (enema with oil or unctuous substance), posture for ''basti'', and post-operative procedure.

The chapter [[Bastisutriyam Siddhi]] deals with the best practices and procedure of ''[[basti]]'' (therapeutic enema) in detail. The examination before ''[[basti]]'' administration, features of ''basti netra'' (nozzle in enema apparatus), features of ''basti putaka'' (enema bag/pot), dose, preparation, procedure and formulations of ''niruha basti'' (enema with decoction) are explained. It also describes the procedure of ''anuvasana basti'' (enema with oil or unctuous substance), posture for ''[[basti]]'', and post-operative procedure.

''Keywords'': ''Anuvasana basti, basti netra, basti putaka, basti vidhi, niruha basti''

''Keywords'': ''Anuvasana basti, basti netra, basti putaka, [[basti]] vidhi, niruha basti''

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== Introduction ==

== Introduction ==

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The previous chapter ([[Panchakarmiya Siddhi]]) dealt with the indications and contra-indications of [[Panchakarma]] and its applications. Now one of the content of [[Kalpana Siddhi]], ''basti kalpana'' is elaborated in the present chapter. ''Basti chikitsa'' is regarded as the prime treatment modality within [[Panchakarma]]. It not only has curative action, but also has preventive and promotive actions. ''Basti'' therapy is considered as ''chikitsardha'' (half of major treatments) among all therapy and some physicians even recognize it as a complete therapy because ''basti'' has a wide therapeutic area. It not only cures ''vatika'' disorders but also ''samsarga'' and ''sannipata'' condition of ''dosha, kaphaja'' and ''pittaja'' disorder, ''shakhagata'' (diseases of limbs) and ''koshthagata rogas'' (diseases of GIT) by making various permutations and combinations of different types of medicaments. Considering this rationale the third chapter is devoted for ''basti karma'' and given first place in the [[Siddhi Sthana]] among the [[Panchakarma]].  

The previous chapter ([[Panchakarmiya Siddhi]]) dealt with the indications and contra-indications of [[Panchakarma]] and its applications. Now one of the content of [[Kalpana Siddhi]], ''[[basti]] kalpana'' is elaborated in the present chapter. ''[[Basti]] chikitsa'' is regarded as the prime treatment modality within [[Panchakarma]]. It not only has curative action, but also has preventive and promotive actions. ''[[Basti]]'' therapy is considered as ''chikitsardha'' (half of major treatments) among all therapy and some physicians even recognize it as a complete therapy because ''[[basti]]'' has a wide therapeutic area. It not only cures ''vatika'' disorders but also ''samsarga'' and ''sannipata'' condition of ''[[dosha]], kaphaja'' and ''pittaja'' disorder, ''shakhagata'' (diseases of limbs) and ''koshthagata rogas'' (diseases of GIT) by making various permutations and combinations of different types of medicaments. Considering this rationale the third chapter is devoted for ''[[basti]] karma'' and given first place in the [[Siddhi Sthana]] among the [[Panchakarma]].  

''Basti'' is not merely termed as ‘enema’; rather it is a highly complex, sophisticated, and systemic therapy having a wide range of therapeutic actions and indications. It is considered as prime treatment modality for ''vata dosha''. Contrary to this, enema is simply used for evacuation of colon and in few instances to rehydrate for therapeutic purpose.

''[[Basti]]'' is not merely termed as ‘enema’; rather it is a highly complex, sophisticated, and systemic therapy having a wide range of therapeutic actions and indications. It is considered as prime treatment modality for ''[[vata dosha]]''. Contrary to this, enema is simply used for evacuation of colon and in few instances to rehydrate for therapeutic purpose.

== Sanskrit text, Transliteration and English Translation ==

== Sanskrit text, Transliteration and English Translation ==

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

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

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

=== 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]

''[[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]

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

=== ''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]

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]

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

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

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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]

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]

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

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

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It is said that the ''basti'' should be administered to the patient lying on left lateral side as the ''grahani'' and ''guda'' are situated on the left side of the body, and the ''vali'' (valves) get relaxed. Therefore, ''basti'' should be given when the patient is lying on his left side.[24-241/2]

It is said that the ''[[basti]]'' should be administered to the patient lying on left lateral side as the ''grahani'' and ''guda'' are situated on the left side of the body, and the ''vali'' (valves) get relaxed. Therefore, ''[[basti]]'' should be given when the patient is lying on his left side.[24-241/2]

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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]

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]

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

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

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After the ''basti dravya'' has come out, the patient should be sprinkled with tepid water, and thereafter, the diet containing ''shali''- rice along with thin meat – soup should be given.

After the ''[[basti]] dravya'' has come out, the patient should be sprinkled with tepid water, and thereafter, the diet containing ''shali''- rice along with thin meat – soup should be given.

In the evening, after the previous meal is digested, light food in small quantity should be given. Thereafter, ''anuvasana basti'' should be given to the patient for the over all nourishment.  

In the evening, after the previous meal is digested, light food in small quantity should be given. Thereafter, ''anuvasana basti'' should be given to the patient for the over all nourishment.  

For ''anuvasana basti'', medicated oil cooked by adding ''amla'' and ''vataghna dravya'' should be one- fourth in quantity of the fluid used for ''niruha basti''. After the administration of oil, the buttocks of the patient should be tapped with palms to prevent early return of the ''basti dravya''.

For ''anuvasana basti'', medicated oil cooked by adding ''amla'' and ''vataghna dravya'' should be one- fourth in quantity of the fluid used for ''niruha basti''. After the administration of oil, the buttocks of the patient should be tapped with palms to prevent early return of the ''[[basti]] dravya''.

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]

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]

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

=== Proportion according to ''[[dosha]]'' dominance ===

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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]

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]

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

=== 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]

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]

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

=== 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]

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

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

=== Various ''[[basti]]'' formulations ===

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''Guna-Dipana'', increases ''mamsa'' and ''bala''; ''chakshushya''.

''[[Guna]]-[[Deepana]]'', increases ''[[mamsa]]'' and ''bala''; ''chakshushya''.

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''Guna''- ''Dipana, lekhana,'' relieves the ''shula'' of ''uru, jangha, pada, prushtha'' and ''trik''. It pacifies the ''kaphavrita vata, vid-mutra-vata graha, adhmana, anaha, ashmari, sharkara, arsha, & grahanii dosha''. [38-45]

''[[Guna]]''- ''[[Deepana]], lekhana,'' relieves the ''shula'' of ''uru, jangha, pada, prushtha'' and ''trik''. It pacifies the ''[[kapha]]vrita [[vata]], vid-mutra-[[vata]] graha, adhmana, anaha, ashmari, sharkara, arsha, & grahanii dosha''. [38-45]

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''Guna- Pitta roga naashaka''[46-47]

''[[Guna]]- [[Pitta]] roga naashaka''[46-47]

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''Guna''- destroys ''daha, atisara, pradara, raktapitta, hrodroga, pandu roga, vishama jwara, gulma, mūtrakricchra, kaamala'' and ''pittaja vikara''.[48-52]

''[[Guna]]''- destroys ''daha, atisara, pradara, raktapitta, hrodroga, pandu roga, vishama [[jwara]], gulma, mūtrakricchra, kaamala'' and ''pittaja vikara''.[48-52]

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''Guna- kapha roga, mandāgni, anna dvesha''.[56-571/2]

''[[Guna]]- [[kapha]] roga, mandāgni, anna dvesha''.[56-571/2]

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''Guņa- kapha roga, pandu roga, alasaka, aam dosha, maruta sanga, mutra sanga, basti atopa''.[58-60]

''[[Guņa]]- [[kapha]] roga, pandu roga, alasaka, aam dosha, maruta sanga, mutra sanga, basti atopa''.[58-60]

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''Guņa''- Indicated in ''krimi, kushţha, prameha, bradhna, udara, ajīrņa, kapha roga''. Can also be given in ''apatarpita rogi'' due to ''ruksha aushadha''. It pacifies the ''vata'', increases ''agni'' & ''bala''.[61-64]

''[[Guņa]]''- Indicated in ''krimi, kushţha, prameha, bradhna, udara, ajīrņa, [[kapha]] roga''. Can also be given in ''apatarpita rogi'' due to ''ruksha aushadha''. It pacifies the ''[[vata]]'', increases ''agni'' & ''bala''.[61-64]

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

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

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

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

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After the return of ''niruha basti, mamsarasa, ksheera,'' and ''yusha'' should be given along with rice in ''vata, pitta,'' and ''kapha'' diseases respectively. After prescribed light meal, in persons fit for ''anuvasana'' with ''bilva taila, jeevaniya taila'' and ''madanaphala siddha taila'' should be given in ''vata, pitta'' and ''kapha'' diseases respectively. Here the complete details of best practices of ''basti'' administration are described; the intelligent physician who adopts it in practice will get success in the world.  [70-71]

After the return of ''niruha basti, mamsarasa, ksheera,'' and ''yusha'' should be given along with rice in ''[[vata]], [[pitta]],'' and ''[[kapha]]'' diseases respectively. After prescribed light meal, in persons fit for ''anuvasana'' with ''bilva taila, jeevaniya taila'' and ''madanaphala siddha taila'' should be given in ''[[vata]], [[pitta]]'' and ''[[kapha]]'' diseases respectively. Here the complete details of best practices of ''[[basti]]'' administration are described; the intelligent physician who adopts it in practice will get success in the world.  [70-71]

Thus ends the chapter [[Bastisutriyam Siddhi]]

Thus ends the chapter [[Bastisutriyam Siddhi]]

== Tattva Vimarsha (Fundamental Principles) ==

== Tattva Vimarsha (Fundamental Principles) ==

*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'' (accustom due to continuous use), ''vaya'' (age) and ''bala'' (strength) is essential for success of ''basti'' therapy (enema). [Verse 6]

*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'' (accustom due to continuous use), ''vaya'' (age) and ''bala'' (strength) is essential for success of ''[[basti]]'' therapy (enema). [Verse 6]

*The size, shape of enema apparatus should be decided as per patient’s ano-rectal dimensions.  

*The size, shape of enema apparatus should be decided as per patient’s ano-rectal dimensions.  

*The sequence of adding ''madhu'' (honey), ''saindhava'' (rock salt), then ''sneha'' followed by ''kalka'' (paste of herbs), ''kashaya'' (decoction) and ''avapa'' (additional powdered medicine) is important to prepare a ''basti'' formulation.  

*The sequence of adding ''madhu'' (honey), ''saindhava'' (rock salt), then ''sneha'' followed by ''kalka'' (paste of herbs), ''kashaya'' (decoction) and ''avapa'' (additional powdered medicine) is important to prepare a ''[[basti]]'' formulation.  

*''Basti'' shall always be administered when the patient is lying in left lateral position.  

*''[[Basti]]'' shall always be administered when the patient is lying in left lateral position.  

*Incorrect insertion of nozzle into anal canal, faulty enema pot, incorrect administration of ''basti'' may lead to complications.   

*Incorrect insertion of nozzle into anal canal, faulty enema pot, incorrect administration of ''[[basti]]'' may lead to complications.   

*Penetration and distribution of ''basti'' drugs increases as the number of consequently given ''basti'' increases. The first enema helps in the elimination of ''vata dosha'' from its own site i.e. from large intestine; the second enema helps in the elimination of ''pitta dosha'' from its site i.e. small intestine and duodenum, and the third enema helps in the elimination of ''kapha'' from its site i.e. stomach and upper gastro-intestinal tract.

*Penetration and distribution of ''[[basti]]'' drugs increases as the number of consequently given ''[[basti]]'' increases. The first enema helps in the elimination of ''[[vata dosha]]'' from its own site i.e. from large intestine; the second enema helps in the elimination of ''[[pitta dosha]]'' from its site i.e. small intestine and duodenum, and the third enema helps in the elimination of ''[[kapha]]'' from its site i.e. stomach and upper gastro-intestinal tract.

*The follow-up diet and lifestyle instructions are important to be followed by patient in order to achieve maximum efficacy of ''basti''.

*The follow-up diet and lifestyle instructions are important to be followed by patient in order to achieve maximum efficacy of ''[[basti]]''.

*The proportion of decoction in preparation of ''basti'' formulation shall be decided as per ''dosha'' dominance.

*The proportion of decoction in preparation of ''[[basti]]'' formulation shall be decided as per ''[[dosha]]'' dominance.

*The dose of ''basti'' differs according to age of patient. The minimum dose for patient of one year is half ''prasrita'' (approximately 40 ml) and maximum dose from age 18 years to 70 years is twelve ''prasrita'' (approximately 960 ml).

*The dose of ''[[basti]]'' differs according to age of patient. The minimum dose for patient of one year is half ''prasrita'' (approximately 40 ml) and maximum dose from age 18 years to 70 years is twelve ''prasrita'' (approximately 960 ml).

== Vidhi Vimarsha (Applied Inferences ) ==

== Vidhi Vimarsha (Applied Inferences ) ==

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

=== 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]].  

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

''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, Sushruta. Chikitsa Sthana, Cha.38 Netrabasti vyapat Chikitsitam Adhyaya verse 71. In: Jadavaji Trikamji Aacharya, Editor. Sushruta Samhita. 2nd edition. Varanasi: Chaukhamba Sanskrit Sansthan;1996.</ref>

''[[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 ''[[kapha]][[pitta]]'')<ref>Dalhana, Sushruta. Chikitsa Sthana, Cha.38 Netrabasti vyapat Chikitsitam Adhyaya verse 71. In: Jadavaji Trikamji Aacharya, Editor. Sushruta Samhita. 2nd edition. Varanasi: Chaukhamba Sanskrit Sansthan;1996.</ref>

=== Age wise differentiation ===

=== Age wise differentiation ===

*Sterile and disposable and hence no chances of infection

*Sterile and disposable and hence no chances of infection

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)

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)

=== Time of administration ===

=== 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.

''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.

''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>Chakrapani, Charak. Sidhi Sthana, Cha.3 astisutiyam Siddhi Adhyaya ver.12-13. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan;1990 </ref> (Verse 12 -13)

''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>Chakrapani, Charak. Sidhi Sthana, Cha.3 astisutiyam Siddhi Adhyaya ver.12-13. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan;1990 </ref> (Verse 12 -13)

=== Precautions during administration of enema ===

=== 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>Chakrapani, Charak. Sidhi Sthana, Cha.3 astisutiyam Siddhi Adhyaya ver.13-20. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan;1990</ref> (Verse 13-19)

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>Chakrapani, Charak. Sidhi Sthana, Cha.3 astisutiyam Siddhi Adhyaya ver.13-20. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan;1990</ref> (Verse 13-19)

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

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

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This is most commonly used ''kalka'' in the ''niruha'' described by Charak. Whenever there is no mention of ''kalka dravya'', then it should be used. It is having ''vata-kaphahara, vatanulomana, malanulomana, deepana, pachana, srotoshodhana'' properties.

This is most commonly used ''kalka'' in the ''niruha'' described by Charak. Whenever there is no mention of ''kalka dravya'', then it should be used. It is having ''[[vata]]-[[kapha]]hara, vatanulomana, malanulomana, [[deepana]], [[pachana]], srotoshodhana'' properties.

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

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

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

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

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

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

*''Kalka'' helps in retention of enema  

*''Kalka'' helps in retention of enema  

*''Kalka'' helps in ''pratyagamana'' (return)of ''basti dravya'' within the stipulated time

*''Kalka'' helps in ''pratyagamana'' (return)of ''[[basti]] dravya'' within the stipulated time

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

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

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

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

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

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

*''Kalka''- ''samsrujyate cha ashu'' (quickly disperses & mixes)  

*''Kalka''- ''samsrujyate cha ashu'' (quickly disperses & mixes)  

*''Kashaya'' for ''samatam vrajet'' (mixture becomes homogenous)

*''Kashaya'' for ''samatam vrajet'' (mixture becomes homogenous)

*''Mutra''- increases the action & potency ''basti''.<ref>Kashyapa, Kashyapa Samhita, Siddhisthana, chapter 1, Chaukhamba Sanskrit Sansthan, Varanasi, 1990</ref>

*''Mutra''- increases the action & potency ''[[basti]]''.<ref>Kashyapa, Kashyapa Samhita, Siddhisthana, chapter 1, Chaukhamba Sanskrit Sansthan, Varanasi, 1990</ref>

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.

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 ([[Kapha]]chedana-[[Kapha]]vilayana) which signifies the changes in permeability.

=== Suitable position for administration ===

=== 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.

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.

When the patient lies on his left side, both the grahaņi and guda remain in normal position. ''Basti'' administered in this position gets absorbed properly and distributed easily. In this position, the sphincters remain relaxed. Therefore, the enema fluid enters into rectum easily without any obstruction and impregnates the ''grahani'' to produce the desired therapeutic effect.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.3 astisutiyam Siddhi Adhyaya ver.24-25. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan;1990</ref>

When the patient lies on his left side, both the grahaņi and guda remain in normal position. ''[[Basti]]'' administered in this position gets absorbed properly and distributed easily. In this position, the sphincters remain relaxed. Therefore, the enema fluid enters into rectum easily without any obstruction and impregnates the ''grahani'' to produce the desired therapeutic effect.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.3 astisutiyam Siddhi Adhyaya ver.24-25. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan;1990</ref>

''Basti'' drug reaches first to the ''pakvashaya'' and then to the ''grahani''. ''Pakvashaya'' is the site of ''pureeshadhara kala'' and ''grahani'' is the site of ''pittadhara kala''. So basti directly acts on ''pureeshadhara kala'' and ''pittadhara kala''.  

''[[Basti]]'' drug reaches first to the ''pakvashaya'' and then to the ''grahani''. ''Pakvashaya'' is the site of ''pureeshadhara kala'' and ''grahani'' is the site of ''pittadhara kala''. So [[basti]] directly acts on ''pureeshadhara kala'' and ''pittadhara kala''.  

Commentator Dalhana has commented that ''pureeshadhara kala'' and ''asthidhara kala'' are same and ''pittadhara kala'' and ''majjadhara kala'' are one and same.<ref>Dalhana, Sushruta. Kalpa Sthana, Cha.4 Sarpadashtavisha vijnaniya kalpa Adhyaya verse 40. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>.So from these evidences it is clear that ''basti'' has direct action on ''asthi'' and ''majja dhatu''. ''Majja'' is present in the ''asthi''. Also ''mastulunga'' is considered as ''mastaka majja''.<ref>Dalhana, Sushruta. Sutra Sthana, Cha.32 Swabhava viprtipatti Adhyaya verse 12. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref> ''Vata nadi'' are also made by ''majja'' which is the seat of ''vata dosha''. So in this way, ''basti'' is useful in the disorders of central nervous system.

Commentator Dalhana has commented that ''pureeshadhara kala'' and ''asthidhara kala'' are same and ''pittadhara kala'' and ''majjadhara kala'' are one and same.<ref>Dalhana, Sushruta. Kalpa Sthana, Cha.4 Sarpadashtavisha vijnaniya kalpa Adhyaya verse 40. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>.So from these evidences it is clear that ''[[basti]]'' has direct action on ''[[asthi dhatu]]'' and ''[[majja dhatu]]''. ''Majja'' is present in the ''asthi''. Also ''mastulunga'' is considered as ''mastaka majja''.<ref>Dalhana, Sushruta. Sutra Sthana, Cha.32 Swabhava viprtipatti Adhyaya verse 12. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref> ''Vata nadi'' are also made by ''majja'' which is the seat of ''[[vata dosha]]''. So in this way, ''[[basti]]'' is useful in the disorders of central nervous system.

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>

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>

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

=== ''[[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.

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 ''[[vata]],'' 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.

''Basti'' is given to eliminate the aggravated ''vata'' from ''pakvashaya''. But as specific effect, this ''basti'' is also capable of eliminating the aggravated ''dosha'' even from the locations of ''pitta'' and ''kapha''. Thus, in general ''basti'' eliminates the ''vata'' from ''pakvashaya''. But by the application of special methods, this ''basti'' becomes capable of eliminating the ''dosha'' from other parts.

''[[Basti]]'' is given to eliminate the aggravated ''[[vata]]'' from ''pakvashaya''. But as specific effect, this ''[[basti]]'' is also capable of eliminating the aggravated ''[[dosha]]'' even from the locations of ''[[pitta]]'' and ''[[kapha]]''. Thus, in general ''[[basti]]'' eliminates the ''[[vata]]'' from ''pakvashaya''. But by the application of special methods, this ''[[basti]]'' becomes capable of eliminating the ''[[dosha]]'' from other parts.

''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>Chakrapani, Charak. Siddhi Sthana, Cha.3 Bastisutriya Siddhi Adhyaya ver.26. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan,1990</ref>

''[[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>Chakrapani, Charak. Siddhi Sthana, Cha.3 Bastisutriya Siddhi Adhyaya ver.26. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan,1990</ref>

=== Diet ===

=== 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''.  

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''.  

   

   

''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>Chakrapani, Charak. Sidhi Sthana, Cha.1 Kalpana Siddhi Adhyaya ver.20-21. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan,1990</ref>

''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>Chakrapani, Charak. Sidhi Sthana, Cha.1 Kalpana Siddhi Adhyaya ver.20-21. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan,1990</ref>

=== Ratio of combination ===

=== 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.  

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.  

''Jatukarna'' has prescribed two ''pala'' of paste to be added to the ''basti kalpana''. According to him, six ''pala'' of ''sneha'' for ''vata roga'' and for healthy persons; four ''pala'' of ghee should be added for ''pitta roga'' and three ''pala'' of ''taila'' for ''kapha roga''. ''Saindhava'' should be added in one ''tola'' dose.

''Jatukarna'' has prescribed two ''pala'' of paste to be added to the ''[[basti]] kalpana''. According to him, six ''pala'' of ''sneha'' for ''[[vata]] roga'' and for healthy persons; four ''pala'' of ghee should be added for ''[[pitta]] roga'' and three ''pala'' of ''taila'' for ''[[kapha]] roga''. ''Saindhava'' should be added in one ''tola'' dose.

Sushruta has described one ''tola saindhava'' and 2 ''prasrita madhu'' for ''basti kalpana''.<ref>Sushruta. Chikitsa Sthana, Cha.38 Niruhakrama Chikitsitam Adhyaya verse 37. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, 1996</ref>

Sushruta has described one ''tola saindhava'' and 2 ''prasrita madhu'' for ''[[basti]] kalpana''.<ref>Sushruta. Chikitsa Sthana, Cha.38 Niruhakrama Chikitsitam Adhyaya verse 37. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, 1996</ref>

''Harita'' has prescribed one ''prasrita'' of honey and one ''tola'' of ''saindhava''.  

''Harita'' has prescribed one ''prasrita'' of honey and one ''tola'' of ''saindhava''.  

Charak recommended five ''prasrita'' of ''kashaya'' to be added. Sushruta recommended four ''prasrita''.This change in the quantity of ''kashaya'' is not acceptable.<ref>Chakrapani, Charak. Sutra Sthana, Cha.3 Bastisutriyam Siddhi Adhyaya ver.31. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1990</ref>

Charak recommended five ''prasrita'' of ''kashaya'' to be added. Sushruta recommended four ''prasrita''.This change in the quantity of ''kashaya'' is not acceptable.<ref>Chakrapani, Charak. Sutra Sthana, Cha.3 Bastisutriyam Siddhi Adhyaya ver.31. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1990</ref>

''Basti kalpana'' according to ''dosha'':<ref>Sushruta, Sushruta Samhita, Chikitsa Samhita, 38/29-32, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>

''[[Basti]] kalpana'' according to ''[[dosha]]'':<ref>Sushruta, Sushruta Samhita, Chikitsa Samhita, 38/29-32, edited by Vaidya Jadavaji Trikamji Acharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>

{|class = "wikitable"

{|class = "wikitable"

|-

|-

!scope = "col"|Ingredients of ''Basti''

!scope = "col"|Ingredients of ''[[Basti]]''

!scope = "col"|''Vata''

!scope = "col"|''[[Vata]]''

!scope = "col"|''Pitta''

!scope = "col"|''[[Pitta]]''

!scope = "col"|''Kapha''

!scope = "col"|''[[Kapha]]''

!scope = "col"|''Swastha''

!scope = "col"|''[[Swastha]]''

|-

|-

|''Madhu''

|''Madhu''

|}

|}

In case of a healthy person (marked by an equilibrium of ''vata, pitta'' and ''kapha''), the solution to be administered should be composed of four parts of the decoction of drugs and one part (a fifth part of the ''basti'') of the ''sneha'' (any oleaginous substance). In any case marked by a preponderance of the deranged ''vata'', the ''sneha'' should measure a quarter part of the whole, one-sixth in a case of a preponderance of the deranged ''pitta'' and an eighth part in a case of the deranged ''kapha''. In a case of aggravation of all the (three) ''dosha'', the ''kalka'' should measure an eighth part (of the entire quantity of ''basti dravya''), and the following drugs, viz. salt, honey, cow's urine, ''phala'' (''madana''), milk, ''avapa'' (additives) such as ''kanjika'', etc. and soup of meat. In formulating ''niruha basti'' the dosage should be determined by a due consideration of the requirements in each case. When the ''kalka'', the ''sneha'', and the decoction would be well mixed together, the solution for administration should be considered to have been well prepared. The application of such a solution would be supposed to produce the desired results. Dalhana says that of the whole mixture measuring 12 ''prasrita'' (twenty-four ''palas''), there should be four ''prasrita'' of the decoction, and so on.<ref>Dalhana,Sushruta. Sutra Sthana, Cha.38 Dravyasangrahaniya Adhyaya verse 29-32. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, 1996</ref>

In case of a healthy person (marked by an equilibrium of ''[[vata]], [[pitta]]'' and ''[[kapha]]''), the solution to be administered should be composed of four parts of the decoction of drugs and one part (a fifth part of the ''[[basti]]'') of the ''sneha'' (any oleaginous substance). In any case marked by a preponderance of the deranged ''[[vata]]'', the ''sneha'' should measure a quarter part of the whole, one-sixth in a case of a preponderance of the deranged ''[[pitta]]'' and an eighth part in a case of the deranged ''[[kapha]]''. In a case of aggravation of all the (three) ''[[dosha]]'', the ''kalka'' should measure an eighth part (of the entire quantity of ''[[basti]] dravya''), and the following drugs, viz. salt, honey, cow's urine, ''phala'' (''madana''), milk, ''avapa'' (additives) such as ''kanjika'', etc. and soup of meat. In formulating ''niruha basti'' the dosage should be determined by a due consideration of the requirements in each case. When the ''kalka'', the ''sneha'', and the decoction would be well mixed together, the solution for administration should be considered to have been well prepared. The application of such a solution would be supposed to produce the desired results. Dalhana says that of the whole mixture measuring 12 ''prasrita'' (twenty-four ''palas''), there should be four ''prasrita'' of the decoction, and so on.<ref>Dalhana,Sushruta. Sutra Sthana, Cha.38 Dravyasangrahaniya Adhyaya verse 29-32. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, 1996</ref>

''Vrinda Madhava'' has given different formula as follows: <ref>Vrinda Madhava</ref>

''Vrinda Madhava'' has given different formula as follows: <ref>Vrinda Madhava</ref>

|-

|-

!scope = "col"|''Kalpana''

!scope = "col"|''Kalpana''

!scope = "col"|Qty in ''Pala'' for ''Vata''

!scope = "col"|Qty in ''Pala'' for ''[[Vata]]''

!scope = "col"|Qty in ''Pala'' for ''Pitta''

!scope = "col"|Qty in ''Pala'' for ''[[Pitta]]''

!scope = "col"|Qty in ''Pala'' for ''Kapha''

!scope = "col"|Qty in ''Pala'' for ''[[Kapha]]''

|-

|-

|''Madhu''

|''Madhu''

|}

|}

=== Procedures after  ''basti'' ===

=== 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. Chikitsa Sthana, Cha.38  Niruhakrama Chikitsitam Adhyaya verse 11-13. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1996.</ref>

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. Chikitsa Sthana, Cha.38  Niruhakrama Chikitsitam Adhyaya verse 11-13. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1996.</ref>

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. Chikitsa Sthana, Cha.37  Anuvasanautarabasti Chikitsitam Adhyaya verse 57. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1996.</ref>

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. Chikitsa Sthana, Cha.37  Anuvasanautarabasti Chikitsitam Adhyaya verse 57. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1996.</ref>

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

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

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

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

''Dvipanchalamudi'' (A.H.Ka.4/4):

''Dvipanchalamudi'' (A.H.Ka.4/4):

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. Chikitsa Sthana, Cha.37 Anuvasanauttarabasti Chikitsitam Adhyaya verse 6-7. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>  

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. Chikitsa Sthana, Cha.37 Anuvasanauttarabasti Chikitsitam Adhyaya verse 6-7. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi: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,Sushruta. Chikitsa Sthana, Cha.38 Niruhakrama Chikitsitam Adhyaya verse 3-6. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi: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,Sushruta. Chikitsa Sthana, Cha.38 Niruhakrama Chikitsitam Adhyaya verse 3-6. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>

Some other considered fourth ''basti'' is advocated for ''rakta''. Some other considered that the fourth ''basti'' with ''madhura'' and ''sheeta dravya'' for ''daha nirvapana''.<ref>Dalhana,Sushruta. Chikitsa Sthana, Cha.38 Niruhakrama Chikitsitam Adhyaya verse 7. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>

Some other considered fourth ''[[basti]]'' is advocated for ''[[rakta]]''. Some other considered that the fourth ''[[basti]]'' with ''madhura'' and ''sheeta dravya'' for ''daha nirvapana''.<ref>Dalhana,Sushruta. Chikitsa Sthana, Cha.38 Niruhakrama Chikitsitam Adhyaya verse 7. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1996</ref>

Some others opine that the ''utkleshana, shodhana'' and ''shamana basti'' should be formulated sequentially.<ref>Vagbhata. Sutra Sthana, Cha.19 Bastividhi Adhyaya. Verse 61 In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000. p.1-23.</ref>

Some others opine that the ''utkleshana, [[shodhana]]'' and ''shamana [[basti]]'' should be formulated sequentially.<ref>Vagbhata. Sutra Sthana, Cha.19 Bastividhi Adhyaya. Verse 61 In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000. p.1-23.</ref>

In case of ''sannipata dosha'' also three ''basti'' are enough as mentioned in order of ''dosha'' above. Hence, some other physicians do not desire a fourth ''basti'' as there is no fourth ''dosha'' for which ''basti'' is to be given.<ref>Vagbhata. Sutra Sthana, Cha.19 Bastividhi Adhyaya. Verse 56 In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000. p.1-23.</ref>

In case of ''sannipata [[dosha]]'' also three ''[[basti]]'' are enough as mentioned in order of ''[[dosha]]'' above. Hence, some other physicians do not desire a fourth ''[[basti]]'' as there is no fourth ''[[dosha]]'' for which ''[[basti]]'' is to be given.<ref>Vagbhata. Sutra Sthana, Cha.19 Bastividhi Adhyaya. Verse 56 In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000. p.1-23.</ref>

The physicians regard that there is no more than three ''basti'' should be given because there is no fourth ''dosha'' to give ''basti''.<ref>Vagbhata, Ashtanga Hridaya, Sutrasthana, 19/60, Choukhambha Sanskrit Sansthan,  Varanasi, 2002</ref>

The physicians regard that there is no more than three ''[[basti]]'' should be given because there is no fourth ''[[dosha]]'' to give ''[[basti]]''.<ref>Vagbhata, Ashtanga Hridaya, Sutrasthana, 19/60, Choukhambha Sanskrit Sansthan,  Varanasi, 2002</ref>

Vagbhata another context in the same chapter told that after self returning (''svayam nivritti'') second, third or fourth ''basti'' should be given or till ''samyak nirudha lakshana''.<ref>Vagbhata. Sutra Sthana, Cha.19 Bastividhi Adhyaya. Verse 49-50 In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000. p.1-23.</ref>

Vagbhata another context in the same chapter told that after self returning (''svayam nivritti'') second, third or fourth ''[[basti]]'' should be given or till ''samyak nirudha lakshana''.<ref>Vagbhata. Sutra Sthana, Cha.19 Bastividhi Adhyaya. Verse 49-50 In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000. p.1-23.</ref>

Arunadatta commenting on above verse, told that ''svayameva'' means, without stimulation by ''phalavarti'' etc. If by stimulus i.e. ''phalavarti, tīkshņa virechana'' etc. are used, then subsequent ''basti'' should not be given. Fourth, fifth ''basti'' etc. can be given till ''samyak nirudha lakshana'' are observed.<ref>Arunadatta, Vagbhata. Sutra Sthana, Cha.19 Bastividhi Adhyaya verse 3. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>

Arunadatta commenting on above verse, told that ''svayameva'' means, without stimulation by ''phalavarti'' etc. If by stimulus i.e. ''phalavarti, tīkshņa [[virechana]]'' etc. are used, then subsequent ''[[basti]]'' should not be given. Fourth, fifth ''[[basti]]'' etc. can be given till ''samyak nirudha lakshana'' are observed.<ref>Arunadatta, Vagbhata. Sutra Sthana, Cha.19 Bastividhi Adhyaya verse 3. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>

''Vaidya'' Kasture referring to the Sushruta’s view told that, one should not administer more than four ''basti'' in a day; otherwise it causes ''pakvashaya kshobha'' (irritation of colon).   

''Vaidya'' Kasture referring to the Sushruta’s view told that, one should not administer more than four ''[[basti]]'' in a day; otherwise it causes ''pakvashaya kshobha'' (irritation of colon).   

   

   

So the above discussion may be concluded that the second, third or fourth ''basti'' can be given after assessing the ''doshadi'' factors<ref>Charak. Siddhi Sthana, Cha.3 Bastsutriyam Siddhi Adhyaya verse 06. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1990</ref> in following conditions-

So the above discussion may be concluded that the second, third or fourth ''[[basti]]'' can be given after assessing the ''doshadi'' factors<ref>Charak. Siddhi Sthana, Cha.3 Bastsutriyam Siddhi Adhyaya verse 06. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.2nd ed. Varanasi:Chaukhamba Sanskrit Sansthan, Varanasi, 1990</ref> in following conditions-

*After the self returning of first ''basti'' without any stimulation.

*After the self returning of first ''[[basti]]'' without any stimulation.

*If ''sunirudha lakshana'' are not observed  

*If ''sunirudha lakshana'' are not observed  

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

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

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