Bastisutriyam Siddhi

Siddhi Sthana Chapter 3.Standard practices of Basti (therapeutic enema)

Abstract

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

Bastrisutriyam Siddhi

Section/Chapter	Siddhi Sthana Chapter 3
Preceding Chapter	Panchakarmiya Siddhi
Succeeding Chapter	Snehavyapat Siddhi
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana

Introduction

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.

Sanskrit text, Transliteration and English Translation

अथातो बस्तिसूत्रीयां सिद्धिं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātō bastisūtrīyāṁ siddhiṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAto bastisUtrIyAM siddhiM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

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

Questions of Agnivesha

कृतक्षणं शैलवरस्य रम्ये स्थितं धनेशायतनस्य पार्श्वे|

महर्षिसङ्घैर्वृतमग्निवेशः पुनर्वसुं प्राञ्जलिरन्वपृच्छत्||३||

बस्तिर्नरेभ्यः किमपेक्ष्य दत्तः स्यात् सिद्धिमान् किम्मयमस्य नेत्रम्|

कीदृक्प्रमाणाकृति किङ्गुणं च केभ्यश्च किंयोनिगुणश्च बस्तिः||४||

निरूहकल्पः प्रणिधानमात्रा स्नेहस्य का वा शयने विधिः कः|

के बस्तयः केषु हिता इतीदं श्रुत्वोत्तरं प्राह वचो महर्षिः||५||

kr̥takṣaṇaṁ śailavarasya ramyē sthitaṁ dhanēśāyatanasya pārśvē|

maharṣisaṅghairvr̥tamagnivēśaḥ punarvasuṁ prāñjaliranvapr̥cchat||3||

bastirnarēbhyaḥ kimapēkṣya dattaḥ syāt siddhimān kimmayamasya nētram|

kīdr̥kpramāṇākr̥ti kiṅguṇaṁ ca kēbhyaśca kiṁyōniguṇaśca bastiḥ||4||

nirūhakalpaḥ praṇidhānamātrā snēhasya kā vā śayanē vidhiḥ kaḥ|

kē bastayaḥ kēṣu hitā itīdaṁ śrutvōttaraṁ prāha vacō maharṣiḥ||5||

kRutakShaNaM shailavarasya ramye sthitaM dhaneshAyatanasya pArshve|

maharShisa~gghairvRutamagniveshaH punarvasuM prA~jjaliranvapRucchat||3||

bastirnarebhyaH kimapekShya dattaH syAt siddhimAn kimmayamasya netram|

kIdRukpramANAkRuti ki~gguNaM ca kebhyashca kiMyoniguNashca bastiH||4||

nirUhakalpaH praNidhAnamAtrA snehasya kA vA shayane vidhiH kaH|

ke bastayaH keShu hitA itIdaM shrutvottaraM prAha vaco maharShiH||5||

Agnivesha, with folded hands, asked following questions to Punarvasu, as he was sitting at leisure surrounded by a host of great sages amidst the pleasant Himalaya as in the neighborhood of the abode of Kubera, the God of wealth.

• “What are the factors observing which the enema can be administered with success?
• What material shall be used to prepare a nozzle?
• What is its length and shape?
• What is its quality and what are the sources of enema bag/receptacle and what should be their qualities?
• What is the pharmaceutical formula of the niruha (enema with decoction)?
• What is its mode of administration?
• What is the measure of enema solution?
• What is the proportion of unctuous substance?
• What is the position and procedure followed for enema while the patient on examination bed?
• What are the varieties of enema and in whom are they indicated?"

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

Consideration before administration of basti

समीक्ष्य दोषौषधदेशकालसात्म्याग्निसत्त्वादिवयोबलानि|

बस्तिः प्रयुक्तो नियतं गुणाय स्यात् सर्वकर्माणि च सिद्धिमन्ति||६||

samīkṣya dōṣauṣadhadēśakālasātmyāgnisattvādivayōbalāni|

bastiḥ prayuktō niyataṁ guṇāya syāt sarvakarmāṇi ca siddhimanti||6||

samIkShya doShauShadhadeshakAlasAtmyAgnisattvAdivayobalAni|

bastiH prayukto niyataM guNAya syAt sarvakarmANi ca siddhimanti||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)

सुवर्णरूप्यत्रपुताम्ररीतिकांस्यास्थिशस्त्रद्रुमवेणुदन्तैः |

नलैर्विषाणैर्मणिभिश्च तैस्तैर्नेत्राणि कार्याणि सु(त्रि)कर्णिकानि ||७||

suvarṇarūpyatraputāmrarītikāṁsyāsthiśastradrumavēṇudantaiḥ |

nalairviṣāṇairmaṇibhiśca taistairnētrāṇi kāryāṇi su(tri)karṇikāni ||7||

suvarNarUpyatraputAmrarItikAMsyAsthishastradrumaveNudantaiH |

nalairviShANairmaNibhishca taistairnetrANi kAryANi su(tri)karNikAni ||7||

For preparing basti netra having three karnika (ridges) the following materials are used: gold, silver, copper, bronze, cow’s horn, bones of animals and others.[7]

षड्द्वादशाष्टाङ्गुलसम्मितानि षड्विंशतिद्वादशवर्षजानाम्|

स्युर्मुद्गकर्कन्धुसतीनवाहिच्छिद्राणि वर्त्याऽपिहितानि चैव||८||

यथावयोऽङ्गुष्ठकनिष्ठिकाभ्यां मूलाग्रयोः स्युः परिणाहवन्ति|

ऋजूनि गोपुच्छसमाकृतीनि श्लक्ष्णानि च स्युर्गुडिकामुखानि||९||

स्यात् कर्णिकैकाऽग्रचतुर्थभागे मूलाश्रिते बस्तिनिबन्धने द्वे|१०|

ṣaḍdvādaśāṣṭāṅgulasammitāni ṣaḍviṁśatidvādaśavarṣajānām|

syurmudgakarkandhusatīnavāhicchidrāṇi vartyā'pihitāni caiva||8||

yathāvayō'ṅguṣṭhakaniṣṭhikābhyāṁ mūlāgrayōḥ syuḥ pariṇāhavanti|

r̥jūni gōpucchasamākr̥tīni ślakṣṇāni ca syurguḍikāmukhāni||9||

syāt karṇikaikā'gracaturthabhāgē mūlāśritē bastinibandhanē dvē|10|

ShaDdvAdashAShTA~ggulasammitAni ShaDviMshatidvAdashavarShajAnAm|

syurmudgakarkandhusatInavAhicchidrANi vartyA~apihitAni caiva||8||

yathAvayo~a~gguShThakaniShThikAbhyAM mUlAgrayoH syuH pariNAhavanti|

RujUni gopucchasamAkRutIni shlakShNAni ca syurguDikAmukhAni||9||

syAt karNikaikA~agracaturthabhAge mUlAshrite bastinibandhane dve|10|

For the patients of the age of six, twenty and twelve years, the length of the nozzle should be of six, twelve and eight Angula respectively.

The caliber of the hole inside the nozzle should be such as to allow the passage of a seed of mudga (green gram), karkandhu (jujube berry- Zizyphus Jujuba) and satina (peanut) respectively. This hole should be corked with a varti (wick).

The circumference of the nozzle at the base and top should be the same as that of the thumb and little finger of the patient of that age respectively.

It should be straight and tapering like the tail of a cow. The mouth of the nozzle should be smooth and globular.

One ring should be fixed at the level of one fourth from the top, and two other rings should be fixed at the base in order to facilitate tying the mouth of the bladder around the nozzle. [8-91/2]

जारद्गवो माहिषहारिणौ वा स्याच्छौकरो बस्तिरजस्य वाऽपि||१०||

दृढस्तनुर्नष्टसिरो विगन्धः कषायरक्तः सुमृदुः सुशुद्धः |

नृणां वयो वीक्ष्य यथानुरूपं नेत्रेषु योज्यस्तु सुबद्धसूत्रः||११||

jāradgavō māhiṣahāriṇau vā syācchaukarō bastirajasya vā'pi||10||

dr̥ḍhastanurnaṣṭasirō vigandhaḥ kaṣāyaraktaḥ sumr̥duḥ suśuddhaḥ |

nr̥ṇāṁ vayō vīkṣya yathānurūpaṁ nētrēṣu yōjyastu subaddhasūtraḥ||11||

jAradgavo mAhiShahAriNau vA syAcchaukaro bastirajasya vA~api||10||

dRuDhastanurnaShTasiro vigandhaH kaShAyaraktaH sumRuduH sushuddhaH |

nRuNAM vayo vIkShya yathAnurUpaM netreShu yojyastu subaddhasUtraH||11||

The urinary bladder of the animals such as buffalo, sheep, goat, cow etc. should be used to prepare basti (the holder bag of basti dravya).

Features: Drudha (strong), tanu (thin), nashta shira (devoid of veins), vigandha (devoid of odor), kashayarakta (saffron-red), sumridu (soft), sushuddha (well cleaned), and yathanurupa (size accordingly).[10-11]

बस्तेरलाभे प्लवजो गलो वा स्यादङ्कपादः सुघनः पटो वा|१२|

bastēralābhē plavajō galō vā syādaṅkapādaḥ sughanaḥ paṭō vā|12|

basteralAbhe plavajo galo vA syAda~gkapAdaH sughanaH paTo vA|12|

In case of non availability, plavaja gala (throat of a pelican), ankapada (skin of a bat), ghana pata (strong cloth) should be used.[12]

[Note: Presently plastic bags are in use.]

आस्थापनार्हं पुरुषं विधिज्ञः समीक्ष्य पुण्येऽहनि शुक्लपक्षे||१२||

प्रशस्तनक्षत्रमुहूर्तयोगे जीर्णान्नमेकाग्रमुपक्रमेत |१३|

āsthāpanārhaṁ puruṣaṁ vidhijñaḥ samīkṣya puṇyē'hani śuklapakṣē||12||

praśastanakṣatramuhūrtayōgē jīrṇānnamēkāgramupakramēta|13|

AsthApanArhaM puruShaM vidhij~jaH samIkShya puNye~ahani shuklapakShe||12||

prashastanakShatramuhUrtayoge jIrNAnnamekAgramupakrameta |13|

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

बलां गुडूचीं त्रिफलां सरास्नां द्वे पञ्चमूले च पलोन्मितानि||१३||

अष्टौ फलान्यर्धतुलां च मांसाच्छागात् पचेदप्सु चतुर्थशेषम्|

पूतं यवानीफलबिल्वकुष्ठवचाशताह्वाघनपिप्पलीनाम्||१४||

कल्कैर्गुडक्षौद्रघृतैः सतैलैर्युतं सुखोष्णैस्तु पिचुप्रमाणैः|

गुडात् पलं द्विप्रसृतां तु मात्रां स्नेहस्य युक्त्या मधु सैन्धवं च||१५||

प्रक्षिप्य बस्तौ मथितं खजेन सुबद्धमुच्छ्वास्य च निर्वलीकम्|

अङ्गुष्ठमध्येन मुखं पिधाय नेत्राग्रसंस्थामपनीय वर्तिम्||१६||

तैलाक्तगात्रं कृतमूत्रविट्कं नातिक्षुधार्तं शयने मनुष्यम्|

समेऽथवेषन्नतशीर्षके वा नात्युच्छ्रिते स्वास्तरणोपपन्ने||१७||

सव्येन पार्श्वेन सुखं शयानं कृत्वर्जुदेहं स्वभुजोपधानम्|

सङ्कोच्य सव्येतरदस्य सक्थि वामं प्रसार्य प्रणयेत्ततस्तम्||१८||

स्निग्धे गुदे नेत्रचतुर्थभागं स्निग्धं शनैरृज्वन पृष्ठवंशम्|

अकम्पनावेपनलाघवादीन् पाण्योर्गुणांश्चापि विदर्शयंस्तम् ||१९||

प्रपीड्य चैकग्रहणेन दत्तं नेत्रं शनैरेव ततोऽपकर्षेत्|२०|

balāṁ guḍūcīṁ triphalāṁ sarāsnāṁ dvē pañcamūlē ca palōnmitāni||13||

aṣṭau phalānyardhatulāṁ ca māṁsācchāgāt pacēdapsu caturthaśēṣam|

pūtaṁ yavānīphalabilvakuṣṭhavacāśatāhvāghanapippalīnām||14||

kalkairguḍakṣaudraghr̥taiḥ satailairyutaṁ sukhōṣṇaistu picupramāṇaiḥ|

guḍāt palaṁ dviprasr̥tāṁ tu mātrāṁ snēhasya yuktyā madhu saindhavaṁ ca||15||

prakṣipya bastau mathitaṁ khajēna subaddhamucchvāsya ca nirvalīkam|

aṅguṣṭhamadhyēna mukhaṁ pidhāya nētrāgrasaṁsthāmapanīya vartim||16||

tailāktagātraṁ kr̥tamūtraviṭkaṁ nātikṣudhārtaṁ śayanē manuṣyam|

samē'thavēṣannataśīrṣakē vā nātyucchritē svāstaraṇōpapannē||17||

savyēna pārśvēna sukhaṁ śayānaṁ kr̥tvarjudēhaṁ svabhujōpadhānam|

saṅkōcya savyētaradasya sakthi vāmaṁ prasārya praṇayēttatastam||18||

snigdhē gudē nētracaturthabhāgaṁ snigdhaṁ śanaiṟujvana pr̥ṣṭhavaṁśam|

akampanāvēpanalāghavādīn pāṇyōrguṇāṁścāpi vidarśayaṁstam ||19||

prapīḍya caikagrahaṇēna dattaṁ nētraṁ śanairēva tatō'pakarṣēt|20|

balAM guDUcIM triphalAM sarAsnAM dve pa~jcamUle ca palonmitAni||13||

aShTau phalAnyardhatulAM ca mAMsAcchAgAt pacedapsu caturthasheSham|

pUtaM yavAnIphalabilvakuShThavacAshatAhvAghanapippalInAm||14||

kalkairguDakShaudraghRutaiH satailairyutaM sukhoShNaistu picupramANaiH|

guDAt palaM dviprasRutAM tu mAtrAM snehasya yuktyA madhu saindhavaM ca||15||

prakShipya bastau mathitaM khajena subaddhamucchvAsya ca nirvalIkam|

a~gguShThamadhyena mukhaM pidhAya netrAgrasaMsthAmapanIya vartim||16||

tailAktagAtraM kRutamUtraviTkaM nAtikShudhArtaM shayane manuShyam|

same~athaveShannatashIrShake vA nAtyucchrite svAstaraNopapanne||17||

savyena pArshvena sukhaM shayAnaM kRutvarjudehaM svabhujopadhAnam|

sa~gkocya savyetaradasya sakthi vAmaM prasArya praNayettatastam||18||

snigdhe gude netracaturthabhAgaM snigdhaM shanairRujvana pRuShThavaMsham|

akampanAvepanalAghavAdIn pANyorguNAMshcApi vidarshayaMstam ||19||

prapIDya caikagrahaNena dattaM netraM shanaireva tato~apakarShet|20|

One pala each of bala, guduchi, haritaki, vibhitaki, amalaki, rasna, bilva, shyonaka, gambhari, patala, shalaparni, prishniparni, brihati, kantakari and gokshura, eight fruits of madana and half tula of goat meat should be added with water, and boiled till one fourth of water remains. Then the decoction should be collected by filtration. To this decoction, one pichu (tola) each of the paste of yavani, madana phala, bilva, kushtha, vacha, shatahva, ghana and pippali, one pala of jaggery, two prasruta each of ghee and oil, and appropriate quantities of honey and rock salt should be added. The recipe should then be stirred with a stirrer, and kept inside the basti. The bladder should then be tied to the base of the nozzle, the air inside the bladder should be removed, and the bladder should be free from folds. Thereafter, varti (cotton plug) kept at the opening should be removed, and the opening should be covered with the middle part of the thumb.

The patient whose body is anointed with oil, who has passed urine and stool, and who is not very hungry should be made to sleep over a well spread and not very high bed which is uniform in level or which is slightly low in level at the head.

The patient should lay comfortably on his left side. He should keep his body straight, and use his folded left hand as pillow. He should then flex his right leg, keeping the left leg straight.

The anus of the patient should be lubricated, and the lubricated nozzle should be inserted into it up to one fourth part from the top slowly and straight following the position of the vertebral column.

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]

Sequels of wrong administration of nozzle

तिर्यक् प्रणीते तु न याति धारा गुदे व्रणः स्याच्चलिते तु नेत्रे||२०||

दत्तः शनैर्नाशयमेति बस्तिः कण्ठं प्रधावत्यतिपीडितश्च|

शीतस्त्वतिस्तम्भकरो विदाहं मूर्च्छां च कुर्यादतिमात्रमुष्णः||२१||

स्निग्धोऽतिजाड्यं पवनं तु रूक्षस्तन्वल्पमात्रालवणस्त्वयोगम्|

करोति मात्राभ्यधिकोऽतियोगं क्षामं तु सान्द्रः सुचिरेण चैति||२२||

दाहातिसारौ लवणोऽति कुर्यात्तस्मात् सुयुक्तं सममेव दद्यात्|२३|

tiryak praṇītē tu na yāti dhārā gudē vraṇaḥ syāccalitē tu nētrē||20||

dattaḥ śanairnāśayamēti bastiḥ kaṇṭhaṁ pradhāvatyatipīḍitaśca|

śītastvatistambhakarō vidāhaṁ mūrcchāṁ ca kuryādatimātramuṣṇaḥ||21||

snigdhō'tijāḍyaṁ pavanaṁ tu rūkṣastanvalpamātrālavaṇastvayōgam|

karōti mātrābhyadhikō'tiyōgaṁ kṣāmaṁ tu sāndraḥ sucirēṇa caiti||22||

dāhātisārau lavaṇō'ti kuryāttasmāt suyuktaṁ samamēva dadyāt|23|

tiryak praNIte tu na yAti dhArA gude vraNaH syAccalite tu netre||20||

dattaH shanairnAshayameti bastiH kaNThaM pradhAvatyatipIDitashca|

shItastvatistambhakaro vidAhaM mUrcchAM ca kuryAdatimAtramuShNaH||21||

snigdho~atijADyaM pavanaM tu rUkShastanvalpamAtrAlavaNastvayogam|

karoti mAtrAbhyadhiko~atiyogaM kShAmaM tu sAndraH sucireNa caiti||22||

dAhAtisArau lavaNo~ati kuryAttasmAt suyuktaM samameva dadyAt|23|

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

पूर्वं हि दद्यान्मधु सैन्धवं तु स्नेहं विनिर्मथ्यं ततोऽनु कल्कम्||२३||

विमथ्य संयोज्य पुनर्द्रवैस्तं बस्तौ निदध्यान्मथितं खजेन|२४|

pūrvaṁ hi dadyānmadhu saindhavaṁ tu snēhaṁ vinirmathyaṁ tatō'nu kalkam||23||

vimathya saṁyōjya punardravaistaṁ bastau nidadhyānmathitaṁkhajēna|24|

pUrvaM hi dadyAnmadhu saindhavaM tu snehaM vinirmathyaM tato~anu kalkam||23||

vimathya saMyojya punardravaistaM bastau nidadhyAnmathitaMkhajena|24|

At first madhu (honey) and saindhava (rock salt) should be taken khalva, then sneha followed by kalka, kashaya and avapa, churning should be while adding these dravya. [23-231/2]

वामाश्रये हि ग्रहणीगुद च तत् पार्श्वसंस्थस्य सुखोपलब्धिः||२४||

लीयन्त एवं वलयश्च तस्मात् सव्यं शयानोऽर्हति बस्तिदानम्|२५|

vāmāśrayē hi grahaṇīgudē ca tat pārśvasaṁsthasya sukhōpalabdhiḥ||24||

līyanta ēvaṁ valayaśca tasmāt savyaṁ śayānō'rhati bastidānam|25|

vAmAshraye hi grahaNIgude ca tat pArshvasaMsthasya sukhopalabdhiH||24||

lIyanta evaM valayashca tasmAt savyaM shayAno~arhati bastidAnam|25|

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]

विड्वातवेगो यदि चार्धदत्ते निष्कृष्य मुक्ते प्रणयेदशेषम् ||२५||

उत्तानदेहश्च कृतोपधानः स्याद्वीर्यमाप्नोति तथाऽस्य देहम् |२६|

viḍvātavēgō yadi cārdhadattē niṣkr̥ṣya muktē praṇayēdaśēṣam ||25||

uttānadēhaśca kr̥tōpadhānaḥ syādvīryamāpnōti tathā'sya dēham |26|

viDvAtavego yadi cArdhadatte niShkRuShya mukte praNayedasheSham ||25||

uttAnadehashca kRutopadhAnaH syAdvIryamApnoti tathA~asya deham |26|

If during middle of enema administration, the patient gets an urge to pass feces or flatus, the enema nozzle should be drawn out and the when the urge has passed away, the remaining solution, should be injected. The patient should lie supine on bed with his body in a raised position by means of a pillow in such a way that the effect of the enema pervades the whole body. [25-251/2]

एकोऽपकर्षत्यनिलं स्वमार्गात् पित्तं द्वितीयस्तु कफं तृतीयः||२६||

ēkō'pakarṣatyanilaṁ svamārgāt pittaṁ dvitīyastu kaphaṁ tr̥tīyaḥ||26||

eko~apakarShatyanilaM svamArgAt pittaM dvitIyastu kaphaM tRutIyaH||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

प्रत्यागते कोष्णजलावसिक्तः शाल्यन्नमद्यात्तनुना रसेन|

जीर्णे तु सायं लघु चाल्पमात्रं भुक्तोऽनुवास्यः परिबृंहणार्थम्||२७||

निरूहपादांशसमेन तैलेनाम्लानिलघ्नौषधसाधितेन|

दत्त्वा स्फिचौ पाणितलेन हन्यात् स्नेहस्य शीघ्रागमरक्षणार्थम्||२८||

ईषच्च पादाङ्गुलियुग्ममाञ्छेदुत्तानदेहस्य तलौ प्रमृज्यात्|

स्नेहेन पार्ष्ण्यङ्गुलिपिण्डिकाश्च ये चास्य गात्रावयवा रुगार्ताः||२९||

तांश्चावमद्गीत सुखं ततश्च निद्रामुपासीत कृतोपधानः|३०|

pratyāgatē kōṣṇajalāvasiktaḥ śālyannamadyāttanunā rasēna|

jīrṇē tu sāyaṁ laghu cālpamātraṁ bhuktō'nuvāsyaḥ paribr̥ṁhaṇārtham||27||

nirūhapādāṁśasamēna tailēnāmlānilaghnauṣadhasādhitēna|

dattvā sphicau pāṇitalēna hanyāt snēhasya śīghrāgamarakṣaṇārtham||28||

īṣacca pādāṅguliyugmamāñchēduttānadēhasya talau pramr̥jyāt|

snēhēna pārṣṇyaṅgulipiṇḍikāśca yē cāsya gātrāvayavā rugārtāḥ||29||

tāṁścāvamadgīta sukhaṁ tataśca nidrāmupāsīta kr̥tōpadhānaḥ|30|

pratyAgate koShNajalAvasiktaH shAlyannamadyAttanunA rasena|

jIrNe tu sAyaM laghu cAlpamAtraM bhukto~anuvAsyaH paribRuMhaNArtham||27||

nirUhapAdAMshasamena tailenAmlAnilaghnauShadhasAdhitena|

dattvA sphicau pANitalena hanyAt snehasya shIghrAgamarakShaNArtham||28||

IShacca pAdA~gguliyugmamA~jcheduttAnadehasya talau pramRujyAt|

snehena pArShNya~ggulipiNDikAshca ye cAsya gAtrAvayavA rugArtAH||29||

tAMshcAvamadgIta sukhaM tatashca nidrAmupAsIta kRutopadhAnaH|30|

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.

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]

Proportion according to dosha dominance

भागाः कषायस्य तु पञ्च, पित्ते स्नेहस्य षष्ठः प्रकृतौ स्थिते च||३०||

वाते विवृद्धे तु चतुर्थभागो, मात्रा निरूहेषु कफेऽष्टभागः|३१ |

bhāgāḥ kaṣāyasya tu pañca, pittē snēhasya ṣaṣṭhaḥ prakr̥tau sthitē ca||30||

vātē vivr̥ddhē tu caturthabhāgō, mātrā nirūhēṣu kaphē'ṣṭabhāgaḥ|31|

bhAgAH kaShAyasya tu pa~jca, pitte snehasya ShaShThaH prakRutau sthite ca||30||

vAte vivRuddhe tu caturthabhAgo, mAtrA nirUheShu kaphe~aShTabhAgaH|31|

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]

Dose of niruha basti

निरूहमात्रा प्रसृतार्धमाद्ये वर्षे ततोऽर्धप्रसृताभिवृद्धिः||३१||

आद्वादशात् स्यात् प्रसृताभिवृद्धिरष्टादशाद् द्वादशतः परं स्युः|

आसप्ततेस्तद्विहितं प्रमाणमतः परं षोडशवद्विधेयम्||३२||

निरूहमात्रा प्रसृतप्रमाणा बाले च वृद्धे च मृदुर्विशेषः|३३|

nirūhamātrā prasr̥tārdhamādyē varṣē tatō'rdhaprasr̥tābhivr̥ddhiḥ||31||

ādvādaśāt syāt prasr̥tābhivr̥ddhiraṣṭādaśād dvādaśataḥ paraṁ syuḥ|

āsaptatēstadvihitaṁ pramāṇamataḥ paraṁ ṣōḍaśavadvidhēyam||32||

nirūhamātrā prasr̥tapramāṇā bālē ca vr̥ddhē ca mr̥durviśēṣaḥ|33|

nirUhamAtrA prasRutArdhamAdye varShe tato~ardhaprasRutAbhivRuddhiH||31||

AdvAdashAt syAt prasRutAbhivRuddhiraShTAdashAd dvAdashataH paraM syuH|

AsaptatestadvihitaM pramANamataH paraM ShoDashavadvidheyam||32||

nirUhamAtrA prasRutapramANA bAle ca vRuddhe ca mRudurvisheShaH|33|

Start the dose of niruha with one prasrita (approx.80 ml) on 1st year, then increase ½ prasrita till 12th year; then increase oneprasrita till 18th year, reaching the maximum dose i.e., twelveprasrita. 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

नात्युच्छ्रितं नाप्यतिनीचपादं सपादपीठं शयनं प्रशस्तम्||३३||

प्रधानमृद्वास्तरणोपपन्नं प्राक्शीर्षकं शुक्लपटोत्तरीयम्|३४|

nātyucchritaṁ nāpyatinīcapādaṁ sapādapīṭhaṁ śayanaṁ praśastam||33||

pradhānamr̥dvāstaraṇōpapannaṁ prākśīrṣakaṁ śuklapaṭōttarīyam|34|

nAtyucchritaM nApyatinIcapAdaM sapAdapIThaM shayanaM prashastam||33||

pradhAnamRudvAstaraNopapannaM prAkshIrShakaM shuklapaTottarIyam|34|

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

भोज्यं पुनर्व्याधिमवेक्ष्य तद्वत् प्रकल्पयेद्यूषपयोरसाद्यैः||३४||

सर्वेषु विद्याद्विधिमेतमाद्यं वक्ष्यामि बस्तीनत उत्तरीयान्|३५|

bhōjyaṁ punarvyādhimavēkṣya tadvat prakalpayēdyūṣapayōrasādyaiḥ||34||

sarvēṣu vidyādvidhimētamādyaṁ vakṣyāmi bastīnata uttarīyān|35|

bhojyaM punarvyAdhimavekShya tadvat prakalpayedyUShapayorasAdyaiH||34||

sarveShu vidyAdvidhimetamAdyaM vakShyAmi bastInata uttarIyAn|35|

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

Various basti formulations

द्विपञ्चमूलस्य रसोऽम्लयुक्तः सच्छागमांसस्य सपूर्वपेष्यः||३५||

त्रिस्नेहयुक्तः प्रवरो निरूहः सर्वानिलव्याधिहरः प्रदिष्टः|

dvipañcamūlasya rasō'mlayuktaḥ sacchāgamāṁsasya sapūrvapēṣyaḥ||35||

trisnēhayuktaḥ pravarō nirūhaḥ sarvānilavyādhiharaḥ pradiṣṭaḥ|

dvipa~jcamUlasya raso~amlayuktaH sacchAgamAMsasya sapUrvapeShyaH||35||

trisnehayuktaH pravaro nirUhaH sarvAnilavyAdhiharaH pradiShTaH|

Dvipanchamuladi:

• Dravya
• Madhu
• Saindhava
• Sneha-trisneha
• Kalka
• Kvatha dravya-laghupanchamoola, bruhatpanchamoola
• Āvapa dravya-amla rasa, ajamamsa
• Guna- Sarva vatavyadhihara [35-351/2]

स्थिरादिवर्गस्य बलापटोलत्रायन्तिकैरण्डयवैर्युतस्य||३६||

प्रस्थो रसाच्छागरसार्धयुक्तः साध्यः पुनः प्रस्थसमस्तु यावत्|

प्रियङ्गुकृष्णाघनकल्कयुक्तः सतैलसर्पिर्मधुसैन्धवश्च||३७||

स्याद्दीपनो मांसबलप्रदश्च चक्षुर्बलं चापि ददाति बस्तिः |

sthirādivargasya balāpaṭōlatrāyantikairaṇḍayavairyutasya||36||

prasthō rasācchāgarasārdhayuktaḥ sādhyaḥ punaḥ prasthasamastu yāvat|

priyaṅgukr̥ṣṇāghanakalkayuktaḥ satailasarpirmadhusaindhavaśca||37||

syāddīpanō māṁsabalapradaśca cakṣurbalaṁ cāpi dadāti bastiḥ |

sthirAdivargasya balApaTolatrAyantikairaNDayavairyutasya||36||

prastho rasAcchAgarasArdhayuktaH sAdhyaH punaH prasthasamastu yAvat|

priya~ggukRuShNAghanakalkayuktaH satailasarpirmadhusaindhavashca||37||

syAddIpano mAMsabalapradashca cakShurbalaM cApi dadAti bastiH |

Dravya	Dose
Madhu	2 Prasrita
Saindhava	1 Karsha
Sneha-taila, ghrita	3 Prasrita
Kalka dravya-priyangu, pippali, musta	1 Prasrita
Kwatha dravya-sthiradi panchamula, bala, patola, trayamana, eranda, yava (1 prastha each); reduced to 1 prastha	4 Prasrita
Avapa-aja mamsa	2 Prasrita

Guna-Dipana, increases mamsa and bala; chakshushya.

एरण्डमूलं त्रिपलं पलाशा ह्रस्वानि मूलानि च यानि पञ्च||३८||

रास्नाश्वगन्धातिबलागुडूची पुनर्नवारग्वधदेवदारु|

भागाः पलांशा मदनाष्टयुक्ता जलद्विकंसे क्वथितेऽष्टशेषे||३९||

पेष्याः शताह्वा हपुषा प्रियङ्गुः सपिप्पलीकं मधुकं बला च|

रसाञ्जनं वत्सकबीजमुस्तं भागाक्षमात्रं लवणांशयुक्तम्||४०||

समाक्षिकस्तैलयुतः समूत्रो बस्तिर्नृणां दीपनलेखनीयः|

जङ्घोरुपादत्रिकपृष्ठशूलं कफावृतिं मारुतनिग्रहं च||४१||

विण्मूत्रवातग्रहणं सशूलमाध्मानतामश्मरिशर्करे च|

आनाहमर्शोग्रहणीप्रदोषानेरण्डबस्तिः शमयेत् प्रयुक्तः||४२||

चतुष्पले तैलघृतस्य भृष्टाच्छागाच्छतार्धो दधिदाडिमाम्लः|

रसः सपेष्यो बलमांसवर्णरेतोग्निदश्चान्ध्यशिरोर्तिशस्तः ||४३||

जलद्विकंसेऽष्टपलं पलाशात् पक्त्वा रसोऽर्धाढकमात्रशेषः|

कल्कैर्वचामागधिकापलाभ्यां युक्तः शताह्वाद्विपलेन चापि||४४||

ससैन्धवः क्षौद्रयुतः सतैलो देयो निरूहो बलवर्णकारी|

आनाहपार्श्वामययोनिदोषान् गुल्मानुदावर्तरुजं च हन्यात्||४५||

ēraṇḍamūlaṁ tripalaṁ palāśā hrasvāni mūlāni ca yāni pañca||38||

rāsnāśvagandhātibalāguḍūcī punarnavāragvadhadēvadāru|

bhāgāḥ palāṁśā madanāṣṭayuktā jaladvikaṁsē kvathitē'ṣṭaśēṣē||39||

pēṣyāḥ śatāhvā hapuṣā priyaṅguḥ sapippalīkaṁ madhukaṁ balā ca|

rasāñjanaṁ vatsakabījamustaṁ bhāgākṣamātraṁ lavaṇāṁśayuktam||40||

samākṣikastailayutaḥ samūtrō bastirnr̥ṇāṁ dīpanalēkhanīyaḥ|

jaṅghōrupādatrikapr̥ṣṭhaśūlaṁ kaphāvr̥tiṁ mārutanigrahaṁ ca||41||

viṇmūtravātagrahaṇaṁ saśūlamādhmānatāmaśmariśarkarē ca|

ānāhamarśōgrahaṇīpradōṣānēraṇḍabastiḥ śamayēt prayuktaḥ||42||

catuṣpalē tailaghr̥tasya bhr̥ṣṭācchāgācchatārdhō dadhidāḍimāmlaḥ|

rasaḥ sapēṣyō balamāṁsavarṇarētōgnidaścāndhyaśirōrtiśastaḥ ||43||

jaladvikaṁsē'ṣṭapalaṁ palāśāt paktvā rasō'rdhāḍhakamātraśēṣaḥ|

kalkairvacāmāgadhikāpalābhyāṁ yuktaḥ śatāhvādvipalēna cāpi||44||

sasaindhavaḥ kṣaudrayutaḥ satailō dēyō nirūhō balavarṇakārī|

ānāhapārśvāmayayōnidōṣān gulmānudāvartarujaṁ ca hanyāt||45||

eraNDamUlaM tripalaM palAshA hrasvAni mUlAni ca yAni pa~jca||38||

rAsnAshvagandhAtibalAguDUcI punarnavAragvadhadevadAru|

bhAgAH palAMshA madanAShTayuktA jaladvikaMse kvathite~aShTasheShe||39||

peShyAH shatAhvA hapuShA priya~gguH sapippalIkaM madhukaM balA ca|

rasA~jjanaM vatsakabIjamustaM bhAgAkShamAtraM lavaNAMshayuktam||40||

samAkShikastailayutaH samUtro bastirnRuNAM dIpanalekhanIyaH|

ja~gghorupAdatrikapRuShThashUlaM kaphAvRutiM mArutanigrahaM ca||41||

viNmUtravAtagrahaNaM sashUlamAdhmAnatAmashmarisharkare ca|

AnAhamarshograhaNIpradoShAneraNDabastiH shamayet prayuktaH||42||

catuShpale tailaghRutasya bhRuShTAcchAgAcchatArdho dadhidADimAmlaH|

rasaH sapeShyo balamAMsavarNaretognidashcAndhyashirortishastaH ||43||

jaladvikaMse~aShTapalaM palAshAt paktvA raso~ardhADhakamAtrasheShaH|

kalkairvacAmAgadhikApalAbhyAM yuktaH shatAhvAdvipalena cApi||44||

sasaindhavaH kShaudrayutaH satailo deyo nirUho balavarNakArI|

AnAhapArshvAmayayonidoShAn gulmAnudAvartarujaM ca hanyAt||45||

Dravya	Dose
Madhu	1.5 Prasrita
Saindhava	1 Karsha
Sneha-taila	3 Prasrita
Kalka dravya-shatahva, hapusha, priyangu, pippali, madhuka, bala, rasanjana, vatsaka bija, musta.	1 Prasrita
Kvatha dravya-erandamūla-3 pala, palasha, laghupanchamula, rasna, ashvagandha, atibala, guduchi, punarnava, aragvadha, devadaru (1 Pala each), madanaphala-8, jala-2 adhaka; reduced to 1/8th	4 Prasrita
Avapa-gomutra	2 Prasrita

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]

यष्ट्याह्वयस्याष्टपलेन सिद्धं पयः शताह्वाफलपिप्पलीभिः|

युक्तं ससर्पिर्मधु वातरक्तवैस्वर्यवीसर्पहितो निरूहः||४६||

यष्ट्याह्वलोध्राभयचन्दनैश्च शृतं पयोऽग्र्यं कमलोत्पलैश्च|

सशर्करं क्षौद्रयुतं सुशीतं पित्तामयान् हन्ति सजीवनीयम्||४७||

yaṣṭyāhvayasyāṣṭapalēna siddhaṁ payaḥ śatāhvāphalapippalībhiḥ|

yuktaṁ sasarpirmadhu vātaraktavaisvaryavīsarpahitō nirūhaḥ||46||

yaṣṭyāhvalōdhrābhayacandanaiśca śr̥taṁ payō'gryaṁ kamalōtpalaiśca|

saśarkaraṁ kṣaudrayutaṁ suśītaṁ pittāmayān hanti sajīvanīyam||47||

yaShTyAhvayasyAShTapalena siddhaM payaH shatAhvAphalapippalIbhiH|

yuktaM sasarpirmadhu vAtaraktavaisvaryavIsarpahito nirUhaH||46||

yaShTyAhvalodhrAbhayacandanaishca shRutaM payo~agryaM kamalotpalaishca|

sasharkaraM kShaudrayutaM sushItaM pittAmayAn hanti sajIvanIyam||47||

Dravya	Dose
Madhu	2 Madhu-prasrita
Saindhava	1 Karsha
Sneha-ghrita	2 Prasrita
Kalka jeevaniya gana	1 Prasrita
Kwatha dravya-ksheerapaakaartha kalka dravya- yashthi, lodhra, usheera, chandana, padma, utpala	4 Prasrita
Avapa-sharkara

Guna- Pitta roga naashaka[46-47]

द्विकार्षिकाश्चन्दनपद्मकर्धियष्ट्याह्वरास्नावृषसारिवाश्च|

सलोध्रमञ्जिष्ठमथाप्यनन्ताबलास्थिरादितृणपञ्चमूलम् ||४८||

तोये समुत्क्वाथ्य रसेन तेन शृतं पयोऽर्धाढकमम्बुहीनम्|

जीवन्तिमेदर्धिशतावरीभिर्वीराद्विकाकोलिकशेरुकाभिः||४९||

सितोपलाजीवकपद्मरेणु प्रपौण्डरीकैः कमलोत्पलैश्च|

लोध्रात्मगुप्तामधुकैर्विदारीमुञ्जातकैः केशरचन्दनैश्च||५०||

पिष्टैर्घृतक्षौद्रयुतैर्निरूहं ससैन्धवं शीतलमेव दद्यात्|

प्रत्यागते धन्वरसेन शालीन् क्षीरेण वाऽद्यात् परिषिक्तगात्रः||५१||

दाहातिसारप्रदरास्रपित्तहृत्पाण्डुरोगान् विषमज्वरं च|

सगुल्ममूत्रग्रहकामलादीन् सर्वामयान् पित्तकृतान्निहन्ति||५२||

dvikārṣikāścandanapadmakardhiyaṣṭyāhvarāsnāvr̥ṣasārivāśca|

salōdhramañjiṣṭhamathāpyanantābalāsthirāditr̥ṇapañcamūlam ||48||

tōyē samutkvāthya rasēna tēna śr̥taṁ payō'rdhāḍhakamambuhīnam|

jīvantimēdardhiśatāvarībhirvīrādvikākōlikaśērukābhiḥ||49||

sitōpalājīvakapadmarēṇu prapauṇḍarīkaiḥ kamalōtpalaiśca|

lōdhrātmaguptāmadhukairvidārīmuñjātakaiḥ kēśaracandanaiśca||50||

piṣṭairghr̥takṣaudrayutairnirūhaṁ sasaindhavaṁ śītalamēva dadyāt|

pratyāgatē dhanvarasēna śālīn kṣīrēṇa vā'dyāt pariṣiktagātraḥ||51||

dāhātisārapradarāsrapittahr̥tpāṇḍurōgān viṣamajvaraṁ ca|

sagulmamūtragrahakāmalādīn sarvāmayān pittakr̥tānnihanti||52||

dvikArShikAshcandanapadmakardhiyaShTyAhvarAsnAvRuShasArivAshca|

salodhrama~jjiShThamathApyanantAbalAsthirAditRuNapa~jcamUlam ||48||

toye samutkvAthya rasena tena shRutaM payo~ardhADhakamambuhInam|

jIvantimedardhishatAvarIbhirvIrAdvikAkolikasherukAbhiH||49||

sitopalAjIvakapadmareNu prapauNDarIkaiH kamalotpalaishca|

lodhrAtmaguptAmadhukairvidArImu~jjAtakaiH kesharacandanaishca||50||

piShTairghRutakShaudrayutairnirUhaM sasaindhavaM shItalameva dadyAt|

pratyAgate dhanvarasena shAlIn kShIreNa vA~adyAt pariShiktagAtraH||51||

dAhAtisArapradarAsrapittahRutpANDurogAn viShamajvaraM ca|

sagulmamUtragrahakAmalAdIn sarvAmayAn pittakRutAnnihanti||52||

Dravya	Dose
Madhu	2 Madhu-prasrita
Saindhava	1 Karsha
Sneha-ghrita	2 Prasrita
Kalka dravya- Jivanti, Meda, Vriddhi, Shatavari, Kshiravidari, Kakoli, Kasheru, Mishri, Jivaka, Kamala Kesara, Pundarika kashtha, Rakta Kamala, Nila Kamala, Atmagupta, Yashti,Vidarikanda, Munjataka, Nagakesara, Chandana	1 Prasrita
Kvatha dravya- Chandana, Padmakashtha, Vriddhi, Yashti, Rasna, Vasa, Anantamula, Lodhra,Manjishtha, Ananta, Balamula, Sthiradi Varga, Trunapanchamula (2 Tola each)Jala-8 parts; reduced to 1/4th Kshira-½ Adhaka; Boiled till Kshiravasesha.	4 Prasrita

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

द्राक्षादिकाश्मर्यमधूकसेव्यैः ससारिवाचन्दनशीतपाक्यैः|

पयः शृतं श्रावणिमुद्गपर्णीतुगात्मगुप्तामधुयष्टिकल्कैः||५३||

गोधूमचूर्णैश्च तथाऽक्षमात्रैः सक्षौद्रसर्पिर्मधुयष्टितैलैः|

पथ्याविदारीक्षुरसैर्गुडेन बस्तिं युतं पित्तहरं विदध्यात्||५४||

हृन्नाभिपार्श्वोत्तमदेहदाहे दाहेऽन्तरस्थे च सकृच्छ्रमूत्रे|

क्षीणे क्षते रेतसि चापि नष्टे पैत्तेऽतिसारे च नृणां प्रशस्तः||५५||

drākṣādikāśmaryamadhūkasēvyaiḥ sasārivācandanaśītapākyaiḥ|

payaḥ śr̥taṁ śrāvaṇimudgaparṇītugātmaguptāmadhuyaṣṭikalkaiḥ||53||

gōdhūmacūrṇaiśca tathā'kṣamātraiḥ sakṣaudrasarpirmadhuyaṣṭitailaiḥ|

pathyāvidārīkṣurasairguḍēna bastiṁ yutaṁ pittaharaṁ vidadhyāt||54||

hr̥nnābhipārśvōttamadēhadāhē dāhē'ntarasthē ca sakr̥cchramūtrē|

kṣīṇē kṣatē rētasi cāpi naṣṭē paittē'tisārē ca nr̥ṇāṁ praśastaḥ||55||

drAkShAdikAshmaryamadhUkasevyaiH sasArivAcandanashItapAkyaiH|

payaH shRutaM shrAvaNimudgaparNItugAtmaguptAmadhuyaShTikalkaiH||53||

godhUmacUrNaishca tathA~akShamAtraiH sakShaudrasarpirmadhuyaShTitailaiH|

pathyAvidArIkShurasairguDena bastiM yutaM pittaharaM vidadhyAt||54||

hRunnAbhipArshvottamadehadAhe dAhe~antarasthe ca sakRucchramUtre|

kShINe kShate retasi cApi naShTe paitte~atisAre ca nRuNAM prashastaH||55||

Dravya
Kvatha Dravya: kshīrapākārtha dravya-draksha, kashmarya, madhuka, sariva, chandana kalka dravyas- mundi, mudgaparni, vamshalochana, kapikachu,yastimadhu, godhooma choorna. madhu, ghritha, vidaryadi swarasa, ikshu rasa

Indications:

Daha, antardaha, pittaja atisara, mutrkricchra, kshataksheena, shukrakshaya [53-55]

कोषातकारग्वधदेवदारुशार्ङ्गेष्टमूर्वाकुटजार्कपाठाः |

पक्त्वा कुलत्थान् बृहतीं च तोये रसस्य तस्य प्रसृता दश स्युः||५६||

तान् सर्षपैलामदनैः सकुष्ठैरक्षप्रमाणैः प्रसृतैश्च युक्तान्|

फलाह्वतैलस्य समाक्षिकस्य क्षारस्य तैलस्य च सार्षपस्य||५७||

दद्यान्निरूहं कफरोगिणे ज्ञो मन्दाग्नये चाप्यशनद्विषे च|

kōṣātakāragvadhadēvadāruśārṅgēṣṭamūrvākuṭajārkapāṭhāḥ |

paktvā kulatthān br̥hatīṁ ca tōyē rasasya tasya prasr̥tā daśa syuḥ||56||

tān sarṣapailāmadanaiḥ sakuṣṭhairakṣapramāṇaiḥ prasr̥taiśca yuktān|

phalāhvatailasya samākṣikasya kṣārasya tailasya ca sārṣapasya||57||

dadyānnirūhaṁ kapharōgiṇē jñō mandāgnayē cāpyaśanadviṣē ca|

koShAtakAragvadhadevadArushAr~ggeShTamUrvAkuTajArkapAThAH |

paktvA kulatthAn bRuhatIM ca toye rasasya tasya prasRutA dasha syuH||56||

tAn sarShapailAmadanaiH sakuShThairakShapramANaiH prasRutaishca yuktAn|

phalAhvatailasya samAkShikasya kShArasya tailasya ca sArShapasya||57||

dadyAnnirUhaM kapharogiNe j~jo mandAgnaye cApyashanadviShe ca|

Dravya	Dose
Madhu	1 Prasrita
Saindhava	1 Karsha
Sneha-madanaphala siddha taila, sarshapa taila	2 Pala, 1 Prasrita
Kalka sarshapa, ela, madanaphala, kushtha (1 karsha each)	1 Prasrita
Kvatha dravya- koshātaki, aragvadha, arkamūla, devadāru, gunjā, murvā, kuţaja, pāţhā, kulattha, kanţhakāri (2 Pala each) + water 8 parts; reduced to 1/8th	5 Prasrita
Avapa- yava kshāra	1 Karsha
Amla dravya (kānji)	1 Prasrita

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

पटोलपथ्यामरदारुभिर्वा सपिप्पलीकैः क्वथितैर्जलेऽग्नौ||५८||

द्विपञ्चमूले त्रिफलां सबिल्वां फलानि गोमूत्रयुतः कषायः|

कलिङ्गपाठाफलमुस्तकल्कः ससैन्धवः क्षारयुतः सतैलः||५९||

निरूहमुख्यः कफजान् विकारान् सपाण्डुरोगालसकामदोषान्|

हन्यात्तथा मारुतमूत्रसङ्गं बस्तेस्तथाऽऽटोपमथापि घोरम्||६०||

paṭōlapathyāmaradārubhirvā sapippalīkaiḥ kvathitairjalē'gnau||58||

dvipañcamūlē triphalāṁ sabilvāṁ phalāni gōmūtrayutaḥ kaṣāyaḥ|

kaliṅgapāṭhāphalamustakalkaḥ sasaindhavaḥ kṣārayutaḥ satailaḥ||59||

nirūhamukhyaḥ kaphajān vikārān sapāṇḍurōgālasakāmadōṣān|

hanyāttathā mārutamūtrasaṅgaṁ bastēstathāṭōpamathāpi ghōram||60||

paTolapathyAmaradArubhirvA sapippalIkaiH kvathitairjale~agnau||58||

dvipa~jcamUle triphalAM sabilvAM phalAni gomUtrayutaH kaShAyaH|

kali~ggapAThAphalamustakalkaH sasaindhavaH kShArayutaH satailaH||59||

nirUhamukhyaH kaphajAn vikArAn sapANDurogAlasakAmadoShAn|

hanyAttathA mArutamUtrasa~ggaM bastestathA~a~aTopamathApi ghoram||60||

Dravya	Dose
Madhu	1 Prasrita
Saindhava	1 Karsha
Sneha-madanaphala siddha taila, sarshapa taila	2 Pala, 1 Prasrita
Kalka sarshapa, ela, madanaphala, kushtha (1 karsha each)	1 Prasrita
Kvatha Dravya- Patola, Haritaki, Pippali, Devadaru + 8 parts of Jala, reduced to 1/8th	5 Prasrita
Avapa-yava kshāra	1 Karsha
Amla dravya (kānji)	1 Prasrita

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

रास्नामृतैरण्डविडङ्गदार्वीसप्तच्छदोशीरसुराह्वनिम्बैः|

शम्पाकभूनिम्बपटोलपाठातिक्ताखुपर्णीदशमूलमुस्तैः||६१||

त्रायन्तिकाशिग्रुफलत्रिकैश्च क्वाथः सपिण्डीतकतोयमूत्रः|

यष्ट्याह्वकृष्णाफलिनीशताह्वारसाञ्जनश्वेतवचाविडङ्गैः||६२||

कलिङ्गपाठाम्बुदसैन्धवैश्च कल्कैः ससर्पिर्मधुतैलमिश्रः|

अयं निरूहः क्रिमिकुष्ठमेहब्रध्नोदराजीर्णकफातुरेभ्यः||६३||

रूक्षौषधैरप्यपतर्पितेभ्य एतेषु रोगेष्वपि सत्सु दत्तः|

निहत्य वातं ज्वलनं प्रदीप्य विजित्य रोगांश्च बलं करोति||६४||

rāsnāmr̥tairaṇḍaviḍaṅgadārvīsaptacchadōśīrasurāhvanimbaiḥ|

śampākabhūnimbapaṭōlapāṭhātiktākhuparṇīdaśamūlamustaiḥ||61||

trāyantikāśigruphalatrikaiśca kvāthaḥ sapiṇḍītakatōyamūtraḥ|

yaṣṭyāhvakr̥ṣṇāphalinīśatāhvārasāñjanaśvētavacāviḍaṅgaiḥ||62||

kaliṅgapāṭhāmbudasaindhavaiśca kalkaiḥ sasarpirmadhutailamiśraḥ|

ayaṁ nirūhaḥ krimikuṣṭhamēhabradhnōdarājīrṇakaphāturēbhyaḥ||63||

rūkṣauṣadhairapyapatarpitēbhya ētēṣu rōgēṣvapi satsu dattaḥ|

nihatya vātaṁ jvalanaṁ pradīpya vijitya rōgāṁśca balaṁ karōti||64||

rAsnAmRutairaNDaviDa~ggadArvIsaptacchadoshIrasurAhvanimbaiH|

shampAkabhUnimbapaTolapAThAtiktAkhuparNIdashamUlamustaiH||61||

trAyantikAshigruphalatrikaishca kvAthaH sapiNDItakatoyamUtraH|

yaShTyAhvakRuShNAphalinIshatAhvArasA~jjanashvetavacAviDa~ggaiH||62||

kali~ggapAThAmbudasaindhavaishca kalkaiH sasarpirmadhutailamishraH|

ayaM nirUhaH krimikuShThamehabradhnodarAjIrNakaphAturebhyaH||63||

rUkShauShadhairapyapatarpitebhya eteShu rogeShvapi satsu dattaH|

nihatya vAtaM jvalanaM pradIpya vijitya rogAMshca balaM karoti||64||

Dravya	Dose
Madhu	3 Prasrita
Saindhava	1 Karsha
Sneha-Ghrita, Taila	2 Prasrita
Kalka Dravya- Madanaphala, Sugandhavala, Gomutra, Yashti, Pippali, Priyangu, Satahva, Rasanjana, Sveta Vacha, Vidanga, Kalinga, Patha, Musta.	1 Prasrita
Kvatha Dravya- Rasna, Eranda, Guduchi, Nimba, Patola, Patha,Katuki, Kirata, Vidanga, Daruharidra, Saptacchada, Usira, Devadaru, Aragvadha, Mushakakarni, Dasamula, Musta, Trayamana, Sighru, Triphala + 8 parts of Jala; reduced to 1/4th	5 Prasrita
Avapa – Gomutra

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]

पुनर्नवैरण्डवृषाश्मभेदवृश्चीरभूतीकबलापलाशाः |

द्विपञ्चमूलं च पलांशिकानि क्षुण्णानि धौतानि फलानि चाष्टौ||६५||

बिल्वं यवान् कोलकुलत्थधान्यफलानि चैव प्रसृतोन्मितानि|

पयोजलद्व्याढकवच्छृतं तत् क्षीरावशेषं सितवस्त्रपूतम्||६६||

वचाशताह्वामरदारुकुष्ठयष्ट्याह्वसिद्धार्थकपिप्पलीनाम् |

कल्कैर्यवान्या मदनैश्च युक्तं नात्युष्णशीतं गुडसैन्धवाक्तम्||६७||

क्षौद्रस्य तैलस्य च सर्पिषश्च तथैव युक्तं प्रसृतैस्त्रिभिश्च |

दद्यान्निरूहं विधिना विविज्ञः स सर्वसंसर्गकृतामयघ्नः||६८||

punarnavairaṇḍavr̥ṣāśmabhēdavr̥ścīrabhūtīkabalāpalāśāḥ |

dvipañcamūlaṁ ca palāṁśikāni kṣuṇṇāni dhautāni phalāni cāṣṭau||65||

bilvaṁ yavān kōlakulatthadhānyaphalāni caiva prasr̥tōnmitāni|

payōjaladvyāḍhakavacchr̥taṁ tat kṣīrāvaśēṣaṁ sitavastrapūtam||66||

vacāśatāhvāmaradārukuṣṭhayaṣṭyāhvasiddhārthakapippalīnām |

kalkairyavānyā madanaiśca yuktaṁ nātyuṣṇaśītaṁ guḍasaindhavāktam||67||

kṣaudrasya tailasya ca sarpiṣaśca tathaiva yuktaṁ prasr̥taistribhiśca |

dadyānnirūhaṁ vidhinā vivijñaḥ sa sarvasaṁsargakr̥tāmayaghnaḥ||68||

punarnavairaNDavRuShAshmabhedavRushcIrabhUtIkabalApalAshAH |

dvipa~jcamUlaM ca palAMshikAni kShuNNAni dhautAni phalAni cAShTau||65||

bilvaM yavAn kolakulatthadhAnyaphalAni caiva prasRutonmitAni|

payojaladvyADhakavacchRutaM tat kShIrAvasheShaM sitavastrapUtam||66||

vacAshatAhvAmaradArukuShThayaShTyAhvasiddhArthakapippalInAm |

kalkairyavAnyA madanaishca yuktaM nAtyuShNashItaM guDasaindhavAktam||67||

kShaudrasya tailasya ca sarpiShashca tathaiva yuktaM prasRutaistribhishca |

dadyAnnirUhaM vidhinA vivij~jaH sa sarvasaMsargakRutAmayaghnaH||68||

Dravya	Dose
Madhu	1 Prasrita
Saindhava	1 Karsha
Sneha-Ghrita, Taila	2 Prasrita
Kalka Dravya- Vacha, Satahva, Devadaru, Kushtha, Yashti, Sarshapa, Pippali, Ajamoda, Madanaphala,Guda	1 Prasrita
Kvatha Dravya- Punarnava, Eranda, Bala, Vasa, Pashanabheda, Rakta Punarnava, Palasa,Dasamula (Each 1 Pala) Madanaphala-8 Bilva Majja, kulattha, Yava, Badara, + 1 Adhaka Jala + 1 Adhaka Kshira; Reduced to kshiravasesha	5 Prasrita

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

Maximum numbers of niruha basti

स्निग्धोष्ण एकः पवने समांसो द्वौ स्वादुशीतौ पयसा च पित्ते|

त्रयः समूत्राः कटुकोष्णतीक्ष्णाः कफे निरूहा न परं विधेयाः||६९||

snigdhōṣṇa ēkaḥ pavanē samāṁsō dvau svāduśītau payasā ca pittē|

trayaḥ samūtrāḥ kaṭukōṣṇatīkṣṇāḥ kaphē nirūhā na paraṁ vidhēyāḥ||69||

snigdhoShNa ekaH pavane samAMso dvau svAdushItau payasA ca pitte|

trayaH samUtrAH kaTukoShNatIkShNAH kaphe nirUhA na paraM vidheyAH||69||

The number of niruha basti is as follows-

Vataja roga - snigdha, ushņa, mamsarasayukta – 1

Pittaja roga - madhura, sheeta , dugdha – 2

Kaphaja roga- mutra, katu, ushņa, tīkshņa - 3

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

Follow up diet for dosha dominance

रसेन वाते प्रतिभोजनं स्यात् क्षीरेण पित्ते तु कफे च यूषैः|

तथाऽनुवास्येषु च बिल्वतैलं स्याज्जीवनीयं फलसाधितं च||७०||

इतीदमुक्तं निखिलं यथावद्बस्तिप्रदानस्य विधानमग्र्यम्|

योऽधीत्य विद्वानिह बस्तिकर्म करोति लोके लभते स सिद्धिम्||७१||

rasēna vātē pratibhōjanaṁ syāt kṣīrēṇa pittē tu kaphē ca yūṣaiḥ|

tathā'nuvāsyēṣu ca bilvatailaṁ syājjīvanīyaṁ phalasādhitaṁ ca||70||

itīdamuktaṁ nikhilaṁ yathāvadbastipradānasya vidhānamagryam|

yō'dhītya vidvāniha bastikarma karōti lōkē labhatē sa siddhim||71||

rasena vAte pratibhojanaM syAt kShIreNa pitte tu kaphe ca yUShaiH|

tathA~anuvAsyeShu ca bilvatailaM syAjjIvanIyaM phalasAdhitaM ca||70||

itIdamuktaM nikhilaM yathAvadbastipradAnasya vidhAnamagryam|

yo~adhItya vidvAniha bastikarma karoti loke labhate sa siddhim||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

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]
• 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.
• 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.
• 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 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).

Vidhi Vimarsha (Applied Inferences )

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.

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) (Verse 6)

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.

For 20 year old patient, the size of the calibre (diameter) of the opening in the nozzle should be of the diameter of a seed of karkandhu (karkandhu vahi). This karkandhu is srigala badari which is smaller in size. Keeping this in view Sushruta stated that the diameter of netra should allow the passage of kolasthi (seed of kola). If, karkandhu is interpreted as brihad badari (big jujube fruit), then its size will be larger than the opening of netra and hence, In view of this contradiction, some vaidya interpret the term kola as the pulp inside the seed of fruit kolasthi majja which is obviously smaller in size.

The mouth of the netra is plugged with a varti to prevent foreign matter to enter into it when not in use.

One of the karnika fixed at level of 1/4th angula from the agrabhaga (anterior or rectal end) to limit the entry of netra beyond the guda vali. The other 2 karnika placed at the mula bhaga (posterior or putaka end) will help in tying the basti putaka.

Vriņa basti netra- 8 angula & mudgavahi srota at agrabhāga.

Table showing measurements of Basti Netra

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
• Easy for cleaning
• 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) 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

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.) (Verse 12 -13)

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. (Verse 13-19)

Kalka

Putoyavanyadi kalka:

Name of drug	Botanical Name	Parts used
Puto Yavani	Tachyspermum ammi	Seeds
Madanaphala	Randia Duamtorum	Whole dried fruit
Bilva	Aegle marmaleos	Root
Kushta	Sasuurea Lappa	Root
Vacha	Acorus calomus	Rhizome
Shatapushpa	Anethum Graveolense	Seeds
Musta	Cypurus rotundus	Tuber
Pippali	Piper longum	Dried seeds

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.

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

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.

Dose of kalka

• Charak has not mentioned the dose of kalka
• Sushruta mentions it as one prasrita
• According to Vriddha Vagbhata, 1/8th of 12 prasrita=1.5 prasrita
• Jatukarna, Vrinda Madhava, Chakrapani told two Pala

Utility of kalka

• Kalka confers the viscosity (sandrata) to the basti dravya and will not change the volume.
• Kalka helps in retention of enema
• Kalka helps in pratyagamana (return)of basti dravya within the stipulated time
• Prevents ayoga (insufficient action), adhmana (flatulence) etc. upadrava

Rationale for mixing sequence of basti

• Madhu- mangalakaraka auspicious
• Saindhava- disintegrates (bhedana) the picchilata, bahulatva and kashayatva of madhu
• Sneha- ekibhavaya kalpate (homogeneous)
• Kalka- samsrujyate cha ashu (quickly disperses & mixes)
• Kashaya for samatam vrajet (mixture becomes homogenous)
• Mutra- increases the action & potency basti.

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. 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. 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.

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.

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.

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.. 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. 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.

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.

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.

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.

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.

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.

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.

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

Use of these avapa is also described in Harita Samhita.

In the exact quantity of these ingredients are told as follows - saindhava-1 tola, madhu-2 prasrita, sneha-3 prasrita, kalka-1 prasrita, kashaya-4 prasrita and avapa-2 prasrita. Thus, the total quantity becomes 12 prasrita ½ which is rounded to 12 prasruta. This kalpanā is meant for vāta roga.

Charak recommended five prasrita of kashaya to be added. Sushruta recommended four prasrita.This change in the quantity of kashaya is not acceptable.

Basti kalpana according to dosha:

Ingredients of Basti	Vata	Pitta	Kapha	Swastha
Madhu	1 ½ Prasrita	2 Prasrita	3 Prasrita	2 Prasrita
Saindhava	1 Tola	1 Tola	1 Tola	1 Tola
Sneha	3 Prasrita	2 Prasrita	1 ½ Prasrita	2 Prasrita
Kalka	1 Prasrita	1 Prasrita	1 Prasrita	1 Prasrita
Kwatha	5 Prasrita	5 Prasrita	5 Prasrita	5 Prasrita
Avapa Dravya	1 ½ Prasrita	2 Prasrita	1 ½ Prasrita	2 Prasrita

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.

Vrinda Madhava has given different formula as follows:

Kalpana	Qty in Pala for Vata	Qty in Pala for Pitta	Qty in Pala for Kapha
Madhu	3	4	6
Sneha	6	4	3
Kalka	2	2	2
Kashaya	10	10	10
Avapa	3	4	3
Total	24 pala or 12 prasrita	24 pala	24 pala

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.

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.

Dvipanchalamudi basti

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

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

Dravya	Dose (classics)	Practicing Dose
Madhu	2 Prasrita	200ml
Saindhava	1 Karsha	12gm
Sneha-trisneha(sukumara ghrita +sahacharadi taila + vasa)	4 Prasrita	150ml+150ml
Kalka- putoyavanadi*	1 Prasrita	30gm
Kvatha dravya-laghupanchamula, brihatpanchamula	5 Prasrita	400ml
Avapa dravya-amla rasa, ajamamsa	1 Pala	50gm

Guņa- Sarva vātavyādhihara

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. 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.

Some other considered fourth basti is advocated for rakta. Some other considered that the fourth basti with madhura and sheeta dravya for daha nirvapana.

Some others opine that the utkleshana, shodhana and shamana basti should be formulated sequentially.

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.

The physicians regard that there is no more than three basti should be given because there is no fourth dosha to give basti. 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.

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.

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 in following conditions-

• After the self returning of first basti without any stimulation.
• If sunirudha lakshana are not observed
• If the dosha and mala are not eliminated in krura koshtha patient