Siddhi Sthana Chapter 1.Standard administration of purification procedures
|Section/Chapter||Siddhi Sthana Chapter 1|
|Succeeding Chapter||Panchakarmiya Siddhi|
|Other Sections||Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana|
|Translator and commentator||Thakar A. B.,Auti S.|
|Editors||Thakar A. B., Mangalasseri P., Deole Y.S., Basisht G.|
|Year of publication||2020|
|Publisher||Charak Samhita Research, Training and Skill Development Centre|
First chapter of Siddhi Sthana deals with a brief introduction of Panchakarma therapies. It describes sequence of Panchakarma procedures, method and duration of oleation, sudation, preparatory measures for cleansing processes, signs of proper, improper and excessive administration of therapies. Mode of Action of all the Panchakarma (five purification procedures) has been elaborated with examples.
Therapeutic applicability and vata diminishing properties of basti therapy makes it the half of whole Ayurvedic therapeutics. Yoga, kala and karma basti are the schedules developed by acharya that can be easily employed for better results depending upon severity of the disease. Excess sitting, standing, speaking, riding, day sleep, sexual intercourse, suppression of natural urges, cooling regimens, exposure to hot sunlight, grief, anger, untimely and unwholesome food are the factors that needs to be avoided in all Panchakarma therapies.
Keywords: Anuvasana, Basti, Niruha, Kalabasti, Karmabasti, Panchakarma, Satmya, Samyaklaxana, Snehana, Swedana, Yogavasti, Vamana,Virechana, purification procedures, therapeutic emesis, purgation, enema, sudation, oleation.
Kalpana Siddhi can be described as a guideline index for all cleansing processes described in various chapters. Kalpa Sthana deals with the formulations useful especially for vamana (therapeutic emesis) and virechana (therapeutic purgation). Thus, after meticulous knowledge of drugs useful for cleansing processes the clinical applicability is described. Hence Charaka named the chapter as Kalpana Siddhi meaning the excellence or successful application of the formulations described earlier. The chapter is formulated in a manner of answers given to the queries asked by Agnivesha which are actually meant for a brief and sequential description of the subject.
Sanskrit text, Transliteration and English Translation
अथातः कल्पनासिद्धिं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athātaḥ kalpanāsiddhiṁ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātrēyaḥ||2||
athAtaH kalpanAsiddhiM vyAkhyAsyAmaH||1||
iti ha smAha bhagavAnAtreyaH||2||
Now we shall expound the chapter Kalpana Siddhi (Standard administration of purification procedures). Thus said Lord Atreya. [1-2]
Queries asked by Agnivesha
का कल्पना पञ्चसु कर्मसूक्ता, क्रमश्च कः, किं च कृताकृतेषु|
लिड्गं तथैवातिकृतेषु, सङ्ख्या का, किङ्गुणः, केषु च कश्च बस्तिः||३||
किं वर्जनीयं प्रतिकर्मकाले, कृते कियान् वा परिहारकालः|
प्रणीयमानश्च न याति केन, केनैति शीघ्रं, सुचिराच्च बस्तिः||४||
साध्या गदाः स्वैः शमनैश्च केचित् कस्मात् प्रयुक्तैर्न शमं व्रजन्ति|
प्रचोदितः शिष्यवरेण सम्यगित्यग्निवेशेन भिषग्वरिष्ठः||५||
पुनर्वसुस्तन्त्रविदाह तस्मै सर्वप्रजानां हितकाम्ययेदम्|६|
kā kalpanā pañcasu karmasūktā, kramaśca kaḥ, kiṁ ca kr̥tākr̥tēṣu|
liḍgaṁ tathaivātikr̥tēṣu, saṅkhyā kā, kiṅguṇaḥ, kēṣu ca kaśca bastiḥ||3||
kiṁ varjanīyaṁ pratikarmakālē, kr̥tē kiyān vā parihārakālaḥ|
praṇīyamānaśca na yāti kēna, kēnaiti śīghraṁ, sucirācca bastiḥ||4||
sādhyā gadāḥ svaiḥ śamanaiśca kēcit kasmāt prayuktairna śamaṁ vrajanti|
pracōditaḥ śiṣyavarēṇa samyagityagnivēśēna bhiṣagvariṣṭhaḥ||5||
punarvasustantravidāha tasmai sarvaprajānāṁ hitakāmyayēdam|6|
kA kalpanA pa~jcasu karmasUktA, kramashca kaH, kiM ca kRutAkRuteShu|
liDgaM tathaivAtikRuteShu, sa~gkhyA kA, ki~gguNaH, keShu ca kashca bastiH||3||
kiM varjanIyaM pratikarmakAle, kRute kiyAn vA parihArakAlaH|
praNIyamAnashca na yAti kena, kenaiti shIghraM, sucirAcca bastiH||4||
sAdhyA gadAH svaiH shamanaishca kecit kasmAt prayuktairna shamaM vrajanti|
pracoditaH shiShyavareNa samyagityagniveshena bhiShagvariShThaH||5||
punarvasustantravidAha tasmai sarvaprajAnAM hitakAmyayedam|6|
Agnivesha, the foremost among the students of Punarvasu Atreya put forward some queries regarding Panchakarma therapies as follows:
- What are the procedures of Panchakarma therapies?
- What is the order of their administration?
- What are the signs of proper, improper and excess administration of these therapies?
- What is the number of basti (medicated enemas) to be given?
- What are the properties of basti?
- Which basti is to be given and in whom?
- What are the restrictions during the course of treatment?
- What should be the interval between the administrations of different therapies?
- Why during basti administration it does not enter rectum?
- Why administered basti comes out earlier than the scheduled time?
- What is the cause of delay in evacuation of the administered basti?
- Why some diseases though curable do not get cured with its proper medication? Thus, in the view of welfare of society, Punarvasu who is the foremost among the physicians and who is knowledgeable in his subject replied as follows. [3-5½]
Duration of oleation therapy
त्र्यहावरं सप्तदिनं परं तु स्निग्धो नरः स्वेदयितव्य उक्तः ||६||
नातः परं स्नेहनमादिशन्ति सात्म्यीभवेत् सप्तदिनात् परं तु|७|
tryahāvaraṁ saptadinaṁ paraṁ tu snigdhō naraḥ svēdayitavya uktaḥ ||6||
nātaḥ paraṁ snēhanamādiśanti sātmyībhavēt saptadināt paraṁ tu|7|
tryahAvaraM saptadinaM paraM tu snigdho naraH svedayitavya uktaH ||6||
nAtaH paraM snehanamAdishanti sAtmyIbhavet saptadinAt paraM tu|7|
Minimum for three days and maximum for seven days the oleation therapy can be employed as after seven days sneha becomes satmya i.e. habituated. [6-6½]
Effect of oleation therapy
स्नेहोऽनिलं हन्ति मृदूकरोति देहं मलानां विनिहन्ति सङ्गम्||७||
snēhō'nilaṁ hanti mr̥dūkarōti dēhaṁ malānāṁ vinihanti saṅgam||7||
sneho~anilaM hanti mRudUkaroti dehaM malAnAM vinihanti sa~ggam||7||
Sneha attenuates vata, makes body soft and disintegrates the morbid material. 
Effect of fomentation therapy
स्निग्धस्य सूक्ष्मेष्वयनेषु लीनं स्वेदस्तु दोषं नयति द्रवत्वम्|८|
snigdhasya sūkṣmēṣvayanēṣu līnaṁ svēdastu dōṣaṁ nayati dravatvam|8|
snigdhasya sUkShmeShvayaneShu lInaM svedastu doShaM nayati dravatvam|8|
In the person who has undergone oleation therapy, fomentation liquefies the adhered morbid material in the fine channels of his body. [7½]
ग्राम्यौदकानूपरसैः समांसैरुत्क्लेशनीयः पयसा च वम्यः||८||
रसैस्तथा जाङ्गलजैः सयूषैः स्निग्धैः कफावृद्धिकरैर्विरेच्यः|९|
grāmyaudakānūparasaiḥ samāṁsairutklēśanīyaḥ payasā ca vamyaḥ||8||
rasaistathā jāṅgalajaiḥ sayūṣaiḥ snigdhaiḥ kaphāvr̥ddhikarairvirēcyaḥ|9|
grAmyaudakAnUparasaiH samAMsairutkleshanIyaH payasA ca vamyaH||8||
rasaistathA jA~ggalajaiH sayUShaiH snigdhaiH kaphAvRuddhikarairvirecyaH|9|
Those who are about to undergo [virechana]] should be given the soup of meat of animals inhabiting in arid area and vegetables-soup added with fat which do not cause aggravation of kapha. [8-8½]
श्लेष्मोत्तरश्छर्दयति ह्यदुःखं विरिच्यते मन्दकफस्तु सम्यक्||९||
अधः कफेऽल्पे वमनं विरेचयेद्विरेचनं वृद्धकफे तथोर्ध्वम्|१०|
ślēṣmōttaraśchardayati hyaduḥkhaṁ viricyatē mandakaphastu samyak||9||
adhaḥ kaphē'lpē vamanaṁ virēcayēdvirēcanaṁ vr̥ddhakaphē tathōrdhvam|10|
shleShmottarashchardayati hyaduHkhaM viricyate mandakaphastu samyak||9||
adhaH kaphe~alpe vamanaM virecayedvirecanaM vRuddhakaphe tathordhvam|10|
Person with aggravated kapha vomits without any difficulty and the person having less aggravated kapha purges well. If there is less kapha, then emetic drug causes purgation and in aggravation of kapha purgative drug leads to emesis. [9-9½]
Order of administration of emesis and purgation
स्निग्धाय देयं वमनं यथोक्तं वान्तस्य पेयादिरनुक्रमश्च||१०||
स्निग्धस्य सुस्विन्नतनोर्यथावद्विरेचनं योग्यतमं प्रयोज्यम् |११|
snigdhāya dēyaṁ vamanaṁ yathōktaṁ vāntasya pēyādiranukramaśca||10||
snigdhasya susvinnatanōryathāvadvirēcanaṁ yōgyatamaṁ prayōjyam |11|
snigdhAya deyaM vamanaM yathoktaM vAntasya peyAdiranukramashca||10||
snigdhasya susvinnatanoryathAvadvirecanaM yogyatamaM prayojyam |11|
Oleated person should be given emesis as per given protocol and after emesis systematic dietary regimen with peya (thin gruel) etc. has to be followed. Thereafter, the person who has undergone oleation and fomentation therapies should be administered the best suited purgation therapy appropriately. [10-10½]
Post purificatory regimen (samsarjana krama)
पेयां विलेपीमकृतं कृतं च यूषं रसं त्रिर्द्विरथैकशश्च||११||
क्रमेण सेवेत विशुद्धकायः प्रधानमध्यावरशुद्धिशुद्धः|१२|
pēyāṁ vilēpīmakr̥taṁ kr̥taṁ ca yūṣaṁ rasaṁ trirdvirathaikaśaśca||11||
kramēṇa sēvēta viśuddhakāyaḥ pradhānamadhyāvaraśuddhiśuddhaḥ|12|
peyAM vilepImakRutaM kRutaM ca yUShaM rasaM trirdvirathaikashashca||11||
krameNa seveta vishuddhakAyaH pradhAnamadhyAvarashuddhishuddhaH|12|
After the body is cleansed of the morbidities, the patient should be given as food peya (thin gruel), vilepi (thick gruel), akrita as well as krita yusha (plain and seasoned with fat vegetable juice) and akrita as well as krita rasa (plain meat soup seasoned with fat). Each of these dietary items should be given for three, two or one meal times to the persons whose body is cleansed in accordance with either pradhana (maximum), madhya (moderate) and avara (minimum) cleansing. [11-11½]
यथाऽणुरग्निस्तृणगोमयाद्यैः सन्धुक्ष्यमाणो भवति क्रमेण||१२||
महान् स्थिरः सर्वपचस्तथैव शुद्धस्य पेयादिभिरन्तरग्निः|१३|
yathā'ṇuragnistr̥ṇagōmayādyaiḥ sandhukṣyamāṇō bhavati kramēṇa||12||
mahān sthiraḥ sarvapacastathaiva śuddhasya pēyādibhirantaragniḥ|13|
yathA~aNuragnistRuNagomayAdyaiH sandhukShyamANo bhavati krameNa||12||
mahAn sthiraH sarvapacastathaiva shuddhasya peyAdibhirantaragniH|13|
As a small spark of fire gets kindled into a big and stable flame when gradually provided with dry grass, cow dung etc. similarly agni i.e. digestive strength in a purified person becomes strong and stable, capable of digesting all types of food by sequential administration of peya (thin gruel) etc.[12-12½]
Characteristics of three types of emesis and purgation
जघन्यमध्यप्रवरे तु वेगाश्चत्वार इष्टा वमने षडष्टौ||१३||
दशैव ते द्वित्रिगुणा विरेके प्रस्थस्तथा द्वित्रिचतुर्गुणश्च|
पित्तान्तमिष्टं वमनं विरेकादर्धं कफान्तं च विरेकमाहुः||१४||
द्वित्रान् सविट्कानपनीय वेगान्मेयं विरेके वमने तु पीतम्|१५|
jaghanyamadhyapravarē tu vēgāścatvāra iṣṭā vamanē ṣaḍaṣṭau||13||
daśaiva tē dvitriguṇā virēkē prasthastathā dvitricaturguṇaśca|
pittāntamiṣṭaṁ vamanaṁ virēkādardhaṁ kaphāntaṁ ca virēkamāhuḥ||14||
dvitrān saviṭkānapanīya vēgānmēyaṁ virēkē vamanē tu pītam|15|
jaghanyamadhyapravare tu vegAshcatvAra iShTA vamane ShaDaShTau||13||
dashaiva te dvitriguNA vireke prasthastathA dvitricaturguNashca|
pittAntamiShTaM vamanaM virekAdardhaM kaphAntaM ca virekamAhuH||14||
dvitrAn saviTkAnapanIya vegAnmeyaM vireke vamane tu pItam|15|
|Type of Cleansing||Maximum||Moderate||Minimum|
|Numbers of Emesis||8||6||4|
|Quantity of cleansing||2 prastha (1280 ml approx.)||1.5 prastha ( 960 ml approx.)||1 prastha ( 640 ml approx.)|
|End product of cleansing||pitta||pitta||pitta|
|Numbers of Purges||30||20||10|
|Quantity of cleansing||4 prastha (2560 ml approx.)||3 prastha (1920 ml approx.)||2 prastha (1280 ml approx.)|
|End product of cleansing||kapha||kapha||kapha|
Features of proper emesis
क्रमात् कफः पित्तमथानिलश्च यस्यैति सम्यग्वमितः स इष्टः||१५||
हृत्पार्श्वमूर्धेन्द्रियमार्गशुद्धौ तथा लघुत्वेऽपि च लक्ष्यमाणे|१६|
kramāt kaphaḥ pittamathānilaśca yasyaiti samyagvamitaḥ sa iṣṭaḥ||15||
hr̥tpārśvamūrdhēndriyamārgaśuddhau tathā laghutvē'pi ca lakṣyamāṇē|16|
kramAt kaphaH pittamathAnilashca yasyaiti samyagvamitaH sa iShTaH||15||
hRutpArshvamUrdhendriyamArgashuddhau tathA laghutve~api ca lakShyamANe|16|
In case of a person that gets kapha, pitta and vata in succession, who experiences clarity in epigastrium side of chest, head, sense organs and lightness in the body is considered to have undergone proper emesis. [15-15½]
Features of insufficient emesis
दुश्छर्दिते स्फोटककोठकण्डूहृत्खाविशुद्धिर्गुरुगात्रतां च||१६||
duścharditē sphōṭakakōṭhakaṇḍūhr̥tkhāviśuddhirgurugātratāṁ ca||16||
dushchardite sphoTakakoThakaNDUhRutkhAvishuddhirgurugAtratAM ca||16||
If inappropriate emesis is administered then it gives rise to sphotaka (Vescicular eruptions), kotha (urticaria), kandu (itching), discomfort in epigastrium as well as in sense organs and heaviness of the body. 
Features of excess emesis
तृण्मोहमूर्च्छानिलकोपनिद्राबलादिहानिर्वमनेऽति च स्यात्|१७|
tr̥ṇmōhamūrcchānilakōpanidrābalādihānirvamanē'ti ca syāt|17|
tRuNmohamUrcchAnilakopanidrAbalAdihAnirvamane~ati ca syAt|17|
If excess emesis is administered then it gives rise to thirst, unconsciousness, fainting, aggravation of vata, insomnia, debility etc. [16½]
Features of proper purgation
प्राप्तिश्च विट्पित्तकफानिलानां सम्यग्विरिक्तस्य भवेत् क्रमेण|१८|
prāptiśca viṭpittakaphānilānāṁ samyagviriktasya bhavēt kramēṇa|18|
prAptishca viTpittakaphAnilAnAM samyagviriktasya bhavet krameNa|18|
In case of proper purgation, a person experiences clarity in all channels of body, freshness in sense organs, lightness in the body, improvement in digestive strength and attains disease free status. Feces, pitta, kapha and vata are expelled in succession. [17-17½]
Features of inadequate purgation
स्याच्छ्लेष्मपित्तानिलसम्प्रकोपः सादस्तथाऽग्नेर्गुरुता प्रतिश्या||१८||
तन्द्रा तथा च्छर्दिररोचकश्च वातानुलोम्यं न च दुर्विरिक्ते|१९|
syācchlēṣmapittānilasamprakōpaḥ sādastathā'gnērgurutā pratiśyā||18||
tandrā tathā cchardirarōcakaśca vātānulōmyaṁ na ca durviriktē|19|
syAcchleShmapittAnilasamprakopaH sAdastathA~agnergurutA pratishyA||18||
tandrA tathA cchardirarocakashca vAtAnulomyaM na ca durvirikte|19|
When purgation is given improperly and inadequate then it causes vitiation of kapha, pitta, vata, suppression of digestive strength, heaviness in the body, coryza, drowsiness, vomiting, anorexia and absence of vatanulomana (reverse movement of vata). [18-18½]
Features of excess purgation
निद्राबलाभावतमःप्रवेशाः सोन्मादहिक्काश्च विरेचितेऽति|२०|
nidrābalābhāvatamaḥpravēśāḥ sōnmādahikkāśca virēcitē'ti|20|
nidrAbalAbhAvatamaHpraveshAH sonmAdahikkAshca virecite~ati|20|
Follow up after purification
संसृष्टभक्तं नवमेऽह्नि सर्पिस्तं पाययेताप्यनुवासयेद्वा||२०||
तैलाक्तगात्राय ततो निरूहं दद्यात्र्यहान्नातिबुभुक्षिताय|
प्रस्यागते धन्वरसेन भोज्यः समीक्ष्य वा दोषबलं यथार्हम्||२१||
नरस्ततो निश्यनुवासनार्हो नात्याशितः स्यादनुवासनीयः |२२|
saṁsr̥ṣṭabhaktaṁ navamē'hni sarpistaṁ pāyayētāpyanuvāsayēdvā||20||
tailāktagātrāya tatō nirūhaṁ dadyātryahānnātibubhukṣitāya|
prasyāgatē dhanvarasēna bhōjyaḥ samīkṣya vā dōṣabalaṁ yathārham||21||
narastatō niśyanuvāsanārhō nātyāśitaḥ syādanuvāsanīyaḥ |22|
saMsRuShTabhaktaM navame~ahni sarpistaM pAyayetApyanuvAsayedvA||20||
tailAktagAtrAya tato nirUhaM dadyAtryahAnnAtibubhukShitAya|
prasyAgate dhanvarasena bhojyaH samIkShya vA doShabalaM yathArham||21||
narastato nishyanuvAsanArho nAtyAshitaH syAdanuvAsanIyaH |22|
After finishing diet regulations on ninth day (of emesis) the person should be given ghee (if subsequently purgation is intended). Similarly, on ninth day of purgation therapy unctuous enema should be given (if medicated enema is intended to be given subsequently). For three days thereafter, the body should be massaged with medicated oil and then niruha i.e. medicated decoction enema should be given when person is not much hungry. After evacuation of enema person should be given meat soup of animals inhabiting arid forest zone or any other appropriate diet depending upon the nature of dosha and the strength of digestion. Then the person should be given unctuous enema if he has not taken heavy meal, the night before and if he is fit for the same. [20-21½]
Time of anuvasana (unctuous enema)
शीते वसन्ते च दिवाऽनुवास्यो रात्रौ शरद्ग्रीष्मघनागमेषु||२२||
तानेव दोषान् परिरक्षता ये स्नेहस्य पाने परिकीर्तिताः प्राक्|२३|
śītē vasantē ca divā'nuvāsyō rātrau śaradgrīṣmaghanāgamēṣu||22||
tānēva dōṣān parirakṣatā yē snēhasya pānē parikīrtitāḥ prāk|23|
shIte vasante ca divA~anuvAsyo rAtrau sharadgrIShmaghanAgameShu||22||
tAneva doShAn parirakShatA ye snehasya pAne parikIrtitAH prAk|23|
In the winter and spring seasons, unctuous enema should be given during the day time. In autumn, summer and rainy seasons, it should be administered during the night time. Care should be taken to avoid mistakes as described earlier [Cha.Sa.Sutra Sthana 13/19-21] in respect of administration of oleation therapy. [22-22½]
प्रत्यागते चाप्यनुवासनीये दिवा प्रदेयं व्युषिताय भोज्यम्||२३||
सायं च भोज्यं परतो द्व्यहे वा त्र्यहेऽनुवास्योऽहनि पञ्चमे वा |
त्र्यहे त्र्यहे वाऽप्यथ पञ्चमे वा दद्यान्निरूहादनुवासनं च||२४||
pratyāgatē cāpyanuvāsanīyē divā pradēyaṁ vyuṣitāya bhōjyam||23||
sāyaṁ ca bhōjyaṁ paratō dvyahē vā tryahē'nuvāsyō'hani pañcamē vā |
tryahē tryahē vā'pyatha pañcamē vā dadyānnirūhādanuvāsanaṁ ca||24||
pratyAgate cApyanuvAsanIye divA pradeyaM vyuShitAya bhojyam||23||
sAyaM ca bhojyaM parato dvyahe vA tryahe~anuvAsyo~ahani pa~jcame vA |
tryahe tryahe vA~apyatha pa~jcame vA dadyAnnirUhAdanuvAsanaM ca||24||
After evacuation of unctuous enema, the person should not take any food in the night. On the next day, food should be given to him during the day time and in the evening. Thereafter, on the second, third or fifth day unctuous enema should be given followed by niruha. Thus on every third or fifth day unctuous enema should be given while giving niruha type of medicated enema. [23-24]
एकं तथा त्रीन् कफजे विकारे पित्तात्मके पञ्च तु सप्त वाऽपि|
वाते नवैकादश वा पुनर्वा बस्तीनयुग्मान् कुशलो विदध्यात्||२५||
ēkaṁ tathā trīn kaphajē vikārē pittātmakē pañca tu sapta vā'pi|
vātē navaikādaśa vā punarvā bastīnayugmān kuśalō vidadhyāt||25||
ekaM tathA trIn kaphaje vikAre pittAtmake pa~jca tu sapta vA~api|
vAte navaikAdasha vA punarvA bastInayugmAn kushalo vidadhyAt||25||
Unctuous enema should be given in odd set of numbers in following manner:
|Type of Disorder||No. of Enema to be given|
|Kapha disorders||1 - 3|
|Pitta disorders||5 - 7|
|Vata disorders||9 - 11|
Note: This number is related to anuvasana (unctuous enema).
Sequence of niruha (decoction enema) and purgation
नरो विरिक्तस्तु निरूहदानं विवर्जयेत् सप्तदिनान्यवश्यम्|
शुद्धो निरूहेण विरेचनं च तद्ध्यस्य शून्यं विकसेच्छरीरम्||२६||
narō viriktastu nirūhadānaṁ vivarjayēt saptadinānyavaśyam|
śuddhō nirūhēṇa virēcanaṁ ca taddhyasya śūnyaṁ vikasēccharīram||26||
naro viriktastu nirUhadAnaM vivarjayet saptadinAnyavashyam|
shuddho nirUheNa virecanaM ca taddhyasya shUnyaM vikaseccharIram||26||
A person who has undergone purgation should avoid niruha type of medicated enema for seven days and person who has taken niruha type of medicated enema should avoid purgation therapy for seven days because it will have deleterious effects on body which is evacuated (of dosha and nourishing material) by earlier cleansing process. 
Beneficial effects of basti
सर्वार्थकारी शिशुवृद्धयूनां निरत्ययः सर्वगदापहश्च||२७||
विट्श्लेष्मपित्तानिलमूत्रकर्षी दार्ढ्यावहः शुक्रबलप्रदश्च|
विश्वक्स्थितं दोषचयं निरस्य सर्वान् विकारान् शमयेन्निरूहः||२८||
sarvārthakārī śiśuvr̥ddhayūnāṁ niratyayaḥ sarvagadāpahaśca||27||
viṭślēṣmapittānilamūtrakarṣī dārḍhyāvahaḥ śukrabalapradaśca|
viśvaksthitaṁ dōṣacayaṁ nirasya sarvān vikārān śamayēnnirūhaḥ||28||
sarvArthakArI shishuvRuddhayUnAM niratyayaH sarvagadApahashca||27||
viTshleShmapittAnilamUtrakarShI dArDhyAvahaH shukrabalapradashca|
vishvaksthitaM doShacayaM nirasya sarvAn vikArAn shamayennirUhaH||28||
Niruha type of medicated enema has following benefits:
- Prevents ageing
- Promotes happiness, longevity, strength, power of digestion, intellect, voice and complexion
- It accomplishes all objects.
- It is harmless for children, old persons and youth.
- Cures all diseases
- Evacuates feces, kapha, pitta, vata and urine
- Promotes sturdiness of the body
- Enriches semen and promotes strength
- It cures all the diseases by removing accumulated dosha from entire body. [27-28]
Benefits of unctuous enema
देहे निरूहेण विशुद्धमार्गे संस्नेहनं वर्णबलप्रदं च|
न तैलदानात् परमस्ति किञ्चिद्द्रव्यं विशेषेण समीरणार्ते ||२९||
स्नेहेन रौक्ष्यं लघुतां गुरुत्वादौष्ण्याच्च शैत्यं पवनस्य हत्वा|
तैलं ददात्याशु मनःप्रसादं वीर्यं बलं वर्णमथाग्निपुष्टिम् ||३०||
मूले निषिक्तो हि यथा द्रुमः स्यान्नीलच्छदः कोमलपल्लवाग्र्यः|
काले महान् पुष्पफलप्रदश्च तथा नरः स्यादनुवासनेन||३१||
dēhē nirūhēṇa viśuddhamārgē saṁsnēhanaṁ varṇabalapradaṁ ca|
na tailadānāt paramasti kiñciddravyaṁ viśēṣēṇa samīraṇārtē ||29||
snēhēna raukṣyaṁ laghutāṁ gurutvādauṣṇyācca śaityaṁ pavanasya hatvā|
tailaṁ dadātyāśu manaḥprasādaṁ vīryaṁ balaṁ varṇamathāgnipuṣṭim ||30||
mūlē niṣiktō hi yathā drumaḥ syānnīlacchadaḥ kōmalapallavāgryaḥ|
kālē mahān puṣpaphalapradaśca tathā naraḥ syādanuvāsanēna||31||
dehe nirUheNa vishuddhamArge saMsnehanaM varNabalapradaM ca|
na tailadAnAt paramasti ki~jciddravyaM visheSheNa samIraNArte ||29||
snehena raukShyaM laghutAM gurutvAdauShNyAcca shaityaM pavanasya hatvA|
tailaM dadAtyAshu manaHprasAdaM vIryaM balaM varNamathAgnipuShTim ||30||
mUle niShikto hi yathA drumaH syAnnIlacchadaH komalapallavAgryaH|
kAle mahAn puShpaphalapradashca tathA naraH syAdanuvAsanena||31||
Specific indications and benefits of enema
स्तब्धाश्च ये सङ्कुचिताश्च येऽपि ये पङ्गवो येऽपि च भग्नरुग्णाः|
येषां च शाखासु चरन्ति वाताः शस्तो विशेषेण हि तेषु बस्तिः||३२||
आध्मापने विग्रथिते पुरीषे शूले च भक्तानभिनन्दने च|
एवम्प्रकाराश्च भवन्ति कुक्षौ ये चामयास्तेषु च बस्तिरिष्टः||३३||
याश्च स्त्रियो वातकृतोपसर्गा गर्भं न गृह्णन्ति नृभिः समेताः|
क्षीणेन्द्रिया ये च नराः कृशाश्च बस्तिः प्रशस्तः परमं च तेषु||३४||
stabdhāśca yē saṅkucitāśca yē'pi yē paṅgavō yē'pi ca bhagnarugṇāḥ|
yēṣāṁ ca śākhāsu caranti vātāḥ śastō viśēṣēṇa hi tēṣu bastiḥ||32||
ādhmāpanē vigrathitē purīṣē śūlē ca bhaktānabhinandanē ca|
ēvamprakārāśca bhavanti kukṣau yē cāmayāstēṣu ca bastiriṣṭaḥ||33||
yāśca striyō vātakr̥tōpasargā garbhaṁ na gr̥hṇanti nr̥bhiḥ samētāḥ|
kṣīṇēndriyā yē ca narāḥ kr̥śāśca bastiḥ praśastaḥ paramaṁ ca tēṣu||34||
stabdhAshca ye sa~gkucitAshca ye~api ye pa~ggavo ye~api ca bhagnarugNAH|
yeShAM ca shAkhAsu caranti vAtAH shasto visheSheNa hi teShu bastiH||32||
AdhmApane vigrathite purIShe shUle ca bhaktAnabhinandane ca|
evamprakArAshca bhavanti kukShau ye cAmayAsteShu ca bastiriShTaH||33||
yAshca striyo vAtakRutopasargA garbhaM na gRuhNanti nRubhiH sametAH|
kShINendriyA ye ca narAH kRushAshca bastiH prashastaH paramaM ca teShu||34||
Medicated enema in general is indicated in following cases,
- Whose limbs have become stiff with contractures
- Who suffer from lameness
- Who are afflicted with fractures and dislocations
- Whole limbs are afflicted by the movement of different types of aggravated vata
- It is also effective in distension of abdomen by vata, hard stool, colic in abdomen, other such ailments affecting pelvic region.
- Basti is an excellent therapy for women who are affected with complications of vata and who are unable to conceive despite their mating with male partner.
- It is also extremely useful for men having seminal debility and emaciation of the body. [32-34]
Selection of type of enema
उष्णाभिभूतेषु वदन्ति शीताञ्छीताभिभूतेषु तथा सुखोष्णान्|
तत्प्रत्यनीकौषधसम्प्रयुक्तान् सर्वत्र बस्तीन् प्रविभज्य युञ्ज्यात् ||३५||
uṣṇābhibhūtēṣu vadanti śītāñchītābhibhūtēṣu tathā sukhōṣṇān|
tatpratyanīkauṣadhasamprayuktān sarvatra bastīn pravibhajya yuñjyāt ||35||
uShNAbhibhUteShu vadanti shItA~jchItAbhibhUteShu tathA sukhoShNAn|
tatpratyanIkauShadhasamprayuktAn sarvatra bastIn pravibhajya yu~jjyAt ||35||
In those patients suffering from diseases caused due to hotness, the cooling type of enema (i.e. prepared with drugs of cold nature and not much warm) should be given and in those affected with diseases caused due to increased coldness the warm enema (i.e. prepared with drugs of hot nature and slightly warm temperature) should be given. In all cases, different types of enema containing ingredients having attributes opposite to that of etiological factors of the disease should be administered. 
Contra-indications of unctuous enema
न बृंहणीयान् विदधीत बस्तीन् विशोधनीयेषु गदेषु वैद्यः|
कुष्ठप्रमेहादिषु मेदुरेषु नरेषु ये चापि विशोधनीयाः||३६||
na br̥ṁhaṇīyān vidadhīta bastīn viśōdhanīyēṣu gadēṣu vaidyaḥ|
kuṣṭhapramēhādiṣu mēdurēṣu narēṣu yē cāpi viśōdhanīyāḥ||36||
na bRuMhaNIyAn vidadhIta bastIn vishodhanIyeShu gadeShu vaidyaH|
kuShThapramehAdiShu medureShu nareShu ye cApi vishodhanIyAH||36||
In diseases that are indicated for purification, kushtha (obstinate skin diseases), prameha (obstinate urinary diseases), sthaulya (obesity) etc. nourishing type of enema should not be given. 
Contra-indications of decoction type of enema
क्षीणक्षतानां न विशोधनीयान्न शोषिणां नो भृशदुर्बलानाम्|
न मूर्च्छितानां न विशोधितानां येषां च दोषेषु निबद्धमायुः||३७||
kṣīṇakṣatānāṁ na viśōdhanīyānna śōṣiṇāṁ nō bhr̥śadurbalānām|
na mūrcchitānāṁ na viśōdhitānāṁ yēṣāṁ ca dōṣēṣu nibaddhamāyuḥ||37||
kShINakShatAnAM na vishodhanIyAnna shoShiNAM no bhRushadurbalAnAm|
na mUrcchitAnAM na vishodhitAnAM yeShAM ca doSheShu nibaddhamAyuH||37||
Evacuating type of enema should not be given to the patients suffering from weakness, severely wounded, emaciation, extreme debility, fainting, to those who have already undergone the process of purification, and to those whose life is dependent upon the holding up of dosha (morbid matter). 
Importance of basti therapy
शाखागताः कोष्ठगताश्च रोगा मर्मोर्ध्वसर्वावयवाङ्गजाश्च|
ये सन्ति तेषां न हि कश्चिदन्यो वायोः परं जन्मनि हेतुरस्ति||३८||
विण्मूत्रपित्तादिमलाशयानां विक्षेपसङ्घातकरः स यस्मात्|
तस्यातिवृद्धस्य शमाय नान्यद्बस्तिं विना भेषजमस्ति किञ्चित्||३९||
तस्माच्चिकित्सार्धमिति ब्रुवन्ति सर्वां चिकित्सामपि बस्तिमेके|४०|
śākhāgatāḥ kōṣṭhagatāśca rōgā marmōrdhvasarvāvayavāṅgajāśca|
yē santi tēṣāṁ na hi kaścidanyō vāyōḥ paraṁ janmani hēturasti||38||
viṇmūtrapittādimalāśayānāṁ vikṣēpasaṅghātakaraḥ sa yasmāt|
tasyātivr̥ddhasya śamāya nānyadbastiṁ vinā bhēṣajamasti kiñcit||39||
tasmāccikitsārdhamiti bruvanti sarvāṁ cikitsāmapi bastimēkē|40|
shAkhAgatAH koShThagatAshca rogA marmordhvasarvAvayavA~ggajAshca|
ye santi teShAM na hi kashcidanyo vAyoH paraM janmani heturasti||38||
viNmUtrapittAdimalAshayAnAM vikShepasa~gghAtakaraH sa yasmAt|
tasyAtivRuddhasya shamAya nAnyadbastiM vinA bheShajamasti ki~jcit||39||
tasmAccikitsArdhamiti bruvanti sarvAM cikitsAmapi bastimeke|40|
None other than vata is responsible for all diseases origination in shakha (peripheral tissues), koshtha (visceral organs), marma (vital points of the body), urdhva (upper part of body), sarvavaya (covering entire body) and anga (individual parts of the body). Vata is responsible for separation and combination of stool, urine, pitta etc. including other excreta and tissue elements. When it gets highly aggravated there is no remedy other than basti for its alleviation. Therefore, basti is considered by physicians to be the half of entire therapeutics. Some physicians even consider it as whole of the therapeutics. [38-39½]
Mode of action of basti
नाभिप्रदेशं कटिपार्श्वकुक्षिं गत्वा शकृद्दोषचयं विलोड्य ||४०||
संस्नेह्य कायं सपुरीषदोषः सम्यक् सुखेनैति च यः स बस्तिः |४१|
nābhipradēśaṁ kaṭipārśvakukṣiṁ gatvā śakr̥ddōṣacayaṁ vilōḍya ||40||
saṁsnēhya kāyaṁ sapurīṣadōṣaḥ samyak sukhēnaiti ca yaḥ sa bastiḥ |41|
nAbhipradeshaM kaTipArshvakukShiM gatvA shakRuddoShacayaM viloDya ||40||
saMsnehya kAyaM sapurIShadoShaH samyak sukhenaiti ca yaH sa bastiH |41|
The therapy that while moving in umbilical region, lumbar region, sides of the chest and pelvic regions churns up stool including all the other morbid matter located there and appropriately eliminates them with ease after oleating the body is called basti. [40-40½]
Signs of properly administered niruha basti
रोगोपशान्तिः प्रकृतिस्थता च बलं च तत् स्यात् सुनिरूढलिङ्गम्|४२|
rōgōpaśāntiḥ prakr̥tisthatā ca balaṁ ca tat syāt sunirūḍhaliṅgam|42|
rogopashAntiH prakRutisthatA ca balaM ca tat syAt sunirUDhali~ggam|42|
When niruha i.e. evacuating type of enema is administered properly then it causes proper elimination of stool, urine and flatus; promotes appetite and power of digestion; gives lightness to the ashaya; attenuates disease and restores natural health and strength. [41-41½]
Signs of inadequately administered niruha basti
स्याद्रुक्छिरोहृद्गुदबस्तिलिङ्गे शोफः प्रतिश्यायविकर्तिके च||४२||
हृल्लासिका मारुतमूत्रसङ्गः श्वासो न सम्यक् च निरूहिते स्युः|४३|
syādrukchirōhr̥dgudabastiliṅgē śōphaḥ pratiśyāyavikartikē ca||42||
hr̥llāsikā mārutamūtrasaṅgaḥ śvāsō na samyak ca nirūhitē syuḥ|43|
syAdrukchirohRudgudabastili~gge shophaH pratishyAyavikartike ca||42||
hRullAsikA mArutamUtrasa~ggaH shvAso na samyak ca nirUhite syuH|43|
When niruha i.e. evacuating type of enema is not administered properly then it causes pain in head, cardiac region, anal region, urinary bladder and genital organs; edema, coryza, griping pain and nausea; retention of flatus and urine and dyspnea.
Signs of excessively administered niruha basti
लिङ्गं यदेवातिविरेचितस्य भवेत्तदेवातिनिरूहितस्य||४३||
liṅgaṁ yadēvātivirēcitasya bhavēttadēvātinirūhitasya||43||
li~ggaM yadevAtivirecitasya bhavettadevAtinirUhitasya||43||
Symptoms of excessive outcome of evacuative enema are similar to the symptoms to that of excessive administration of purgation therapy (as mentioned earlier). 
Signs of proper administration of unctuous enema
प्रत्येत्यसक्तं सशकृच्च तैलं रक्तादिबुद्धीन्द्रियसम्प्रसादः |
स्वप्नानुवृत्तिर्लघुता बलं च सृष्टाश्च वेगाः स्वनुवासिते स्युः||४४||
pratyētyasaktaṁ saśakr̥cca tailaṁ raktādibuddhīndriyasamprasādaḥ |
svapnānuvr̥ttirlaghutā balaṁ ca sr̥ṣṭāśca vēgāḥ svanuvāsitē syuḥ||44||
pratyetyasaktaM sashakRucca tailaM raktAdibuddhIndriyasamprasAdaH |
svapnAnuvRuttirlaghutA balaM ca sRuShTAshca vegAH svanuvAsite syuH||44||
Proper administration of anuvasana basti i.e. unctuous enema gives following symptoms,
- Return of administered enema with fecal matter without any obstruction.
- Purifies body elements such as blood etc.
- Clarifies intellect and senses
- Imparts sound sleep
- Causes lightness and strength in the body
- Proper manifestation of natural urges without any obstruction. 
Signs of inadequate administration of unctuous enema
अधःशरीरोदरबाहुपृष्ठपार्श्वेषु रुग्रूक्षखरं च गात्रम् |
ग्रहश्च विण्मूत्रसमीरणानामसम्यगेतान्यनुवासितस्य ||४५||
adhaḥśarīrōdarabāhupr̥ṣṭhapārśvēṣu rugrūkṣakharaṁ ca gātram |
grahaśca viṇmūtrasamīraṇānāmasamyagētānyanuvāsitasya ||45||
adhaHsharIrodarabAhupRuShThapArshveShu rugrUkShakharaM ca gAtram |
grahashca viNmUtrasamIraNAnAmasamyagetAnyanuvAsitasya ||45||
Improperly administered unctuous enema causes pain in lower part of the body, abdomen, arms, back and sides of the chest; gives rise to dryness and roughness of the body and obstruction in the passage of stool, urine and flatus.
Signs of excess administration of unctuous enema
Whereas excessively administered unctuous enema causes nausea, unconsciousness, mental fatigue, exhaustion, fainting and griping pain. [45½]
Duration of retaining unctuous enema
यस्येह यामाननुवर्तते त्रीन् स्नेहो नरः स्यात् स विशुद्धदेहः||४६||
आश्वागतेऽन्यस्तु पुनर्विधेयः स्नेहो न संस्नेहयति ह्यतिष्ठन्|४७|
yasyēha yāmānanuvartatē trīn snēhō naraḥ syāt sa viśuddhadēhaḥ||46||
āśvāgatē'nyastu punarvidhēyaḥ snēhō na saṁsnēhayati hyatiṣṭhan|47|
yasyeha yAmAnanuvartate trIn sneho naraH syAt sa vishuddhadehaH||46||
AshvAgate~anyastu punarvidheyaH sneho na saMsnehayati hyatiShThan|47|
If unctuous enema is retained for three yama (nine hours) then the body of the person gets cleansed of morbid matter. If it comes out quickly then another unctuous enema should be administered as the previous one did not produce unctuous effect in the body. [46-46½]
Duration and schedule of karma, kala and yoga basti
त्रिंशन्मताः कर्म नु बस्तयो हि कालस्ततोऽर्धेन ततश्च योगः||४७||
सान्वासना द्वादश वै निरूहाः प्राक् स्नेह एकः परतश्च पञ्च|
काले त्रयोऽन्ते पुरतस्तथैकः स्नेहा निरूहान्तरिताश्च षट् स्युः||४८||
योगे निरूहास्त्रय एव देयाः स्नेहाश्च पञ्चैव परादिमध्याः|४९|
triṁśanmatāḥ karma nu bastayō hi kālastatō'rdhēna tataśca yōgaḥ||47||
sānvāsanā dvādaśa vai nirūhāḥ prāk snēha ēkaḥ parataśca pañca|
kālē trayō'ntē puratastathaikaḥ snēhā nirūhāntaritāśca ṣaṭ syuḥ||48||
yōgē nirūhāstraya ēva dēyāḥ snēhāśca pañcaiva parādimadhyāḥ|49|
triMshanmatAH karma nu bastayo hi kAlastato~ardhena tatashca yogaH||47||
sAnvAsanA dvAdasha vai nirUhAH prAk sneha ekaH paratashca pa~jca|
kAle trayo~ante puratastathaikaH snehA nirUhAntaritAshca ShaT syuH||48||
yoge nirUhAstraya eva deyAH snehAshca pa~jcaiva parAdimadhyAH|49|
In karma basti twelve unctuous enemas and twelve evacuating enemas should be given alternately. Before this one unctuous enema in the beginning and at the end five unctuous enemas should be administered.
In kala basti six unctuous enemas and six evacuating enemas should be given alternately. Before this one unctuous enema in the beginning and at the end three unctuous enemas should be administered.
In yoga basti three evacuating enemas should be given. In the beginning, in the middle and at the end, total of five unctuous enemas should be administered. [46-48½]
त्रीन् पञ्च वाऽऽहुश्चतुरोऽथ षड्वा वातादिकानामनुवासनीयान् ||४९||
स्नेहान् प्रदायाशु भिषग्विदध्यात् स्रोतोविशुद्यर्थमतो निरूहान्|५०|
trīn pañca vāhuścaturō'tha ṣaḍvā vātādikānāmanuvāsanīyān ||49||
snēhān pradāyāśu bhiṣagvidadhyāt srōtōviśudyarthamatō nirūhān|50|
trIn pa~jca vA~a~ahushcaturo~atha ShaDvA vAtAdikAnAmanuvAsanIyAn ||49||
snehAn pradAyAshu bhiShagvidadhyAt srotovishudyarthamato nirUhAn|50|
Physician should administer three, five, four or six unctuous enemas in patients suffering from disorders caused by vata (pitta and kapha) etc. and then for the cleansing of micro channels should administer evacuating type of enema. [49-49½]
Proper, inadequate and excess administration of shirovirechana
विशुद्धदेहस्य ततः क्रमेण स्निग्धं तलस्वेदितमुत्तमाङ्गम्||५०||
विरेचयेत्त्रिर्द्विरथैकशो वा बलं समीक्ष्य त्रिविधं मलानाम्|
उरःशिरोलाघवमिन्द्रियाच्छ्यं स्रोतोविशुद्धिश्च भवेद्विशुद्धे||५१||
गलोपलेपः शिरसो गुरुत्वं निष्ठीवनं चाप्यथ दुर्विरिक्ते|
शिरोक्षिशङ्खश्रवणार्तितोदावत्यर्थशुद्धे तिमिरं च पश्येत्||५२||
स्यात्तर्पणं तत्र मृदु द्रवं च स्निग्धस्य तीक्ष्णं तु पुनर्न योगे|५३|
viśuddhadēhasya tataḥ kramēṇa snigdhaṁ talasvēditamuttamāṅgam||50||
virēcayēttrirdvirathaikaśō vā balaṁ samīkṣya trividhaṁ malānām|
uraḥśirōlāghavamindriyācchyaṁ srōtōviśuddhiśca bhavēdviśuddhē||51||
galōpalēpaḥ śirasō gurutvaṁ niṣṭhīvanaṁ cāpyatha durviriktē|
śirōkṣiśaṅkhaśravaṇārtitōdāvatyarthaśuddhē timiraṁ ca paśyēt||52||
syāttarpaṇaṁ tatra mr̥du dravaṁ ca snigdhasya tīkṣṇaṁ tu punarna yōgē|53|
vishuddhadehasya tataH krameNa snigdhaM talasveditamuttamA~ggam||50||
virecayettrirdvirathaikasho vA balaM samIkShya trividhaM malAnAm|
uraHshirolAghavamindriyAcchyaM srotovishuddhishca bhavedvishuddhe||51||
galopalepaH shiraso gurutvaM niShThIvanaM cApyatha durvirikte|
shirokShisha~gkhashravaNArtitodAvatyarthashuddhe timiraM ca pashyet||52||
syAttarpaNaM tatra mRudu dravaM ca snigdhasya tIkShNaM tu punarna yoge|53|
After proper body cleansing/purification his head should be consecutively anointed and fomented with the help of the palm. After ascertaining the strength of the three types of dosha he should be given shirovirechana (errhine) therapy, once, twice or thrice. Appropriately administered shirovirechana gives rise to lightening of the chest and head, clarity of the senses and cleansing of the micro channels of the body. Inappropriate administration leads to adhesion of sticky material in the throat, heaviness of the head and ptyalism.
Excessive administration of shirovirechana causes cutting and aching pain in head, eyes, temples, ears and leads to fainting. Excessive administration hazards should be treated with demulcent drinks and medications which are soft and liquid in nature. For the management of conditions arising out of inappropriate administration of shirovirechana the patient should be given oleation therapy and thereafter strong shirovirechana should be administered. [50-52½]
इत्यातुरस्वस्थसुखः प्रयोगो बलायुषोर्वृद्धिकृदामयघ्नः||५३||
ityāturasvasthasukhaḥ prayōgō balāyuṣōrvr̥ddhikr̥dāmayaghnaḥ||53||
ityAturasvasthasukhaH prayogo balAyuShorvRuddhikRudAmayaghnaH||53||
In this manner the Panchakarma therapies are described to ensure happiness in both patient and healthy persons by promoting their strength and longevity and also curing the diseases. 
कालस्तु बस्त्यादिषु याति यावांस्तावान् भवेद्द्विः परिहारकालः|५४|
kālastu bastyādiṣu yāti yāvāṁstāvān bhavēddviḥ parihārakālaḥ|54|
kAlastu bastyAdiShu yAti yAvAMstAvAn bhaveddviH parihArakAlaH|54|
The interval between two courses of any basti etc. (cleansing therapy) should be double the period required for administration of that therapy. [53½]
Factors to be avoided during Panchakarma
अत्यासनस्थानवचांसि यानं स्वप्नं दिवा मैथुनवेगरोधान्||५४||
atyāsanasthānavacāṁsi yānaṁ svapnaṁ divā maithunavēgarōdhān||54||
atyAsanasthAnavacAMsi yAnaM svapnaM divA maithunavegarodhAn||54||
During cleansing therapies one should avoid excessive sitting, standing, speaking and riding, sleep during day time, sexual intercourse, suppression of natural urges, cooling regimens, exposure to sun, grief, anger and intake of untimely and unwholesome food.[54-54½]
बद्धे प्रणीते विषमं च नेत्रे मार्गे तथाऽर्शःकफविड्विबद्धे ||५५||
न याति बस्तिर्न सुखं निरेति दोषावृतोऽल्पो यदि वाऽल्पवीर्यः|५६|
baddhē praṇītē viṣamaṁ ca nētrē mārgē tathā'rśaḥkaphaviḍvibaddhē ||55||
na yāti bastirna sukhaṁ nirēti dōṣāvr̥tō'lpō yadi vā'lpavīryaḥ|56|
baddhe praNIte viShamaM ca netre mArge tathA~arshaHkaphaviDvibaddhe ||55||
na yAti bastirna sukhaM nireti doShAvRuto~alpo yadi vA~alpavIryaH|56|
Factors responsible for inhibiting enema to enter smoothly:
- If nozzle is clogged or inserted obliquely
- If rectal passage is blocked by piles, mucus or hard stool
Factors responsible for inappropriate evacuation enema:
- If the path is obstructed by dosha
- If enema is administered in less amount
- If the enema is of low potency [55-55½]
प्राप्ते तु वर्चोनिलमूत्रवेगे वातेऽतिवृद्धेऽल्पबले गुदे वा||५६||
अत्युष्णतीक्ष्णश्च मृदौ च कोष्ठे प्रणीतमात्रः पुनरेति बस्तिः|५७|
prāptē tu varcōnilamūtravēgē vātē'tivr̥ddhē'lpabalē gudē vā||56||
atyuṣṇatīkṣṇaśca mr̥dau ca kōṣṭhē praṇītamātraḥ punarēti bastiḥ|57|
prApte tu varconilamUtravege vAte~ativRuddhe~alpabale gude vA||56||
atyuShNatIkShNashca mRudau ca koShThe praNItamAtraH punareti bastiH|57|
Factors responsible for immediate evacuation of enema:
- If there is sudden urge for voiding feces, flatus or urine
- If there is excessive aggravation of vata
- If there is lack of strength in anal muscles to retain the enema
- If the enema contains ingredients which are excessively hot and strong
- If the person has laxed bowel. [56-56½]
Reason for failure of basti to cure curable diseases
मेदःकफाभ्यामनिलो निरुद्धः शूलाङ्गसुप्तिश्वयथून् करोति||५७||
स्नेहं तु युञ्जन्नबुधस्तु तस्मै संवर्धयत्येव हि तान् विकारान्|
सन्दूषिता धातुभिरेव चान्यैः स्वैर्भेषजैर्नोपशमं व्रजन्ति|५९|
mēdaḥkaphābhyāmanilō niruddhaḥ śūlāṅgasuptiśvayathūn karōti||57||
snēhaṁ tu yuñjannabudhastu tasmai saṁvardhayatyēva hi tān vikārān|
sandūṣitā dhātubhirēva cānyaiḥ svairbhēṣajairnōpaśamaṁ vrajanti|59|
medaHkaphAbhyAmanilo niruddhaH shUlA~ggasuptishvayathUn karoti||57||
snehaM tu yu~jjannabudhastu tasmai saMvardhayatyeva hi tAn vikArAn|
sandUShitA dhAtubhireva cAnyaiH svairbheShajairnopashamaM vrajanti|59|
If the vata gets occluded by meda (fats) and kapha then it gives rise to colic pain, numbness of the body and edema. When an ignorant physician administers sneha then they actually get aggravated. Similarly, other dosha overlap each other in their pathway and get afflicted with tissue elements of different nature. If not differentially diagnosed, these ailments do not get alleviated even though specific remedies are administered. [57-58½]
सर्वं च रोगप्रशमाय कर्म हीनातिमात्रं विपरीतकालम्||५९||
मिथ्योपचाराच्च न तं विकारं शान्तिं नयेत् पथ्यमपि प्रयुक्तम्|६०|
sarvaṁ ca rōgapraśamāya karma hīnātimātraṁ viparītakālam||59||
mithyōpacārācca na taṁ vikāraṁ śāntiṁ nayēt pathyamapi prayuktam|60|
sarvaM ca rogaprashamAya karma hInAtimAtraM viparItakAlam||59||
mithyopacArAcca na taM vikAraM shAntiM nayet pathyamapi prayuktam|60|
When correct treatment is given but in low or excess doses, in inappropriate time or in wrong manner then it fails to cure diseases. [59-59½]
प्रश्नानिमान् द्वादश पञ्चकर्माण्युद्दिश्य सिद्धाविह कल्पनायाम्||६०||
प्रजाहितार्थं भगवान् महार्थान् सम्यग्जगादर्षिवरोऽत्रिपुत्रः||६१||
praśnānimān dvādaśa pañcakarmāṇyuddiśya siddhāviha kalpanāyām||60||
prajāhitārthaṁ bhagavān mahārthān samyagjagādarṣivarō'triputraḥ||61||
prashnAnimAn dvAdasha pa~jcakarmANyuddishya siddhAviha kalpanAyAm||60||
prajAhitArthaM bhagavAn mahArthAn samyagjagAdarShivaro~atriputraH||61||
To sum up,
Lord Atreya the foremost among the sages described the successful administration of Panchakarma for the well being of the people in the form of answer to the twelve queries. [60-61½]
Tattva Vimarsha (Fundamental Principles)
- Siddhi Sthana implies the concept of reproducibility in therapeutic administration as sidhhi is achieved not by chance, but by the characteristics of repeatability.
- Snehana (oleation) is necessary for pacification of vata, internal unctuousness for smooth passage, and reducing obstruction.
- Swedana (fomentation) leads to liquification of dosha in micro-circulation.
- Duration for oleation therapy depends upon the sensitivity of gastro-intestinal tract of an individual also termed as koshtha.
- Oleation and fomentation cleanse vitiated dosha adhered to cells of microchannels causing obstruction and normal functioning of the micro-functional units of the body.
- Vamana can give best results when kapha is aggravated. Virechana can produce best results when pitta is aggravated and kapha is less. If kapha is not aggravated then the key mechanism of distension of stomach, excess salivary secretions and nausea fails to initiate vomiting thus drug passes to the intestine and causes purgation. On contrary if kapha is highly aggravated then drug for purgation may lead to vomiting due to above said mechanism. This is the probable reason for specific diet before cleansing processes.
- Significance of samsarjana krama: Till regeneration of new flora and proper mucosal barrier, the diet needs to be light to digest and solid food is gradually increased.
- Pittanta (when pitta is expelled at the end) and kaphanta (when kapha is expelled at the end) are the end points of vamana and virechana karma respectively.
- Signs and symptoms of improper cleansing should be carefully observed for appropriate timely management.
- A gap of eight days is very much necessary to regain the normal functioning of digestive tract after cleaning therapy before giving anuvasana (unctuous enema) or oleation.
- The status of dosha shall be examined properly to decide suitable purification process and duration between two consequent purifications.
- Basti is best treatment for vata disorders. Niruha (evacuative enema with decoction) is generally given for purification purpose in case of diseases with obstructive vata pathology. Anuvasana (unctuous enema) is generally given for nourishment purpose in case of diseases with degenerative vata pathology.
- Samsarjana karma ( post-purification therapeutic measures) in terms of specific diet and lifestyle are important to attain maximum effect of administered purification.
Vidhi Vimarsha (Applied Inferences )
Charaka has described formulations useful for Panchakarma procedures, methods of their preparation, their applications and successful management of any complications if arise. Thus the name Siddhi Sthana implies to the knowledge that gives excellence in Panchakarma therapies. It also ensures the concept of reproducibility in therapeutic administration as sidhhi is achieved not by chance, but by the characteristics of repeatability.
Queries asked by Agnivesha
The word kalpana refers to the application of Panchakarma which is considered as main treatment among Ayurvedic therapeutics. Thus the whole Siddhi Sthana is devoted by Charaka to elaborate these measures. The queries asked by Agnivesha can be considered as an abstract of Siddhi Sthana because the whole section deals with the topics related to these questions.(verse 3-6)
Duration of oleation therapy
Those with mridu (mild) koshtha become easily oleated as vata is less compared to other dosha thus oleation is not hampered or attenuated at any point, giving early results. In addition pitta is said to be responsible for mridu koshtha which itself has snigdha property which assists the oleation.
On contrary krura koshtha individuals have vata dominance in the digestive system that hampers the oleation to some extent by virtue of dry nature of vata hence it takes maximum i.e. seven days duration to complete oleation. Also as per the dhatu-parinaman (way how dhatu are produced) concept, minimum seven days duration is must for taking any nutritional property to the deepest i.e. shukra dhatu. Madhyama koshtha individuals may get oleated in 5 days which is midpoint of limits. This is because madhyama koshtha individuals have dominance of kapha or sama dosha status. Kapha also has snigdha property but has stagnant and slow nature due to which sneha may take some extra time as compared to that of mridu koshtha. Thus seven days seems to be the maximum possible limit for oleation therapy after which it is said that sneha becomes habituated that indicates the fact that body’s capacity to digest fats increases, as more and more fats are consumed. This hypothesis is supported by the fact that, high-fat feeding is associated with increased production of bile acid required for fat metabolism . Consequently, a high-fat diet elevates the fecal concentration of bile acids that is responsible for increased intestinal permeability. Snehapana (internal oleation) is intended for creating asathmyata (non-acceptability). It is neither absorbed or assimilated upto 7 days in shodhananga (purification purpose). If exceeds 7 days, body will assimilate the sneha which is not intended in shodhananga sneghapana. However, if patient is not oleated in 7 days then it can be continued a little more or after break of few days whole procedure can be repeated.(verse 7)
Effect of oleation and fomentation therapy
Vitiated dosha as explained by Charaka can be considered to be the morbid matter adhering at cellular levels thus obstructing normal functioning of the micro-functional units of the body. Sneha consumption causes oleation of all body parts including cell membrane and other microcellular components. Cell membrane is basically made up of phospholipid bilayer  . Thus due to oleation sneha goes inside easily clearing the channels and dissolving impurities into it. These impurities along with fats are removed out of cell and other organic systems of the body by fomentation that increases the body temperature, opens up all channels and facilitate the transfer of dosha towards bowel. (verse 7-8)
In vamana, kapha utklesha(excited) is expected which is evident by excess salivation, nausea etc. These factors plays an important role in induction of vomiting. The vagal and enteric nervous system inputs transmit information regarding the state of the gastrointestinal system. Irritation of the GI mucosa by any drug or distension activates the 5-HT3 receptors of these inputs. Thus if kapha is not aggravated then the key mechanism of distension of stomach, excess salivary secretions and nausea fails to initiate vomiting thus drug passes to the intestine and causes purgation. On contrary if kapha is highly aggravated then drug for purgation may lead to vomiting due to above said mechanism. This is the probable reason for specific diet before cleansing processes. (verse 8-10)
Post therapeutic measures (samsarjana krama)
Duration of post therapeutic measures varies with type/quality of cleansing. This is directly related to the extent of changes brought by cleansing the digestive system and duration required to regain its normal functioning. Mucosal layer in the digestive tract plays important functions like barrier to protect from acids, maintaining optimal immune function, proper digestion and assimilation of food and nutrients, etc  . Also the bacterial flora residing in intestine is also responsible for some functions like fermentation of undigested carbohydrates and the subsequent absorption of short-chain fatty acids, plays a role in synthesizing vitamin B and vitamin K as well as metabolising bile acids, sterols and xenobiotics . Vomiting and purgation leads to cleansing of entire tract that causes removal of unhealthy bacterial flora and also inflammation and damage to the mucosal barrier. Thus till regeneration of new flora and proper mucosal barrier, the diet needs to be light and gradually increasing in thickness. Fats and some spices are given at later phases as they require proper mucosal functioning for absorption. Moreover this regimen facilitates the gradual induction of carbohydrate, vegetable protein, fat and meat protein as digestion improves gradually.(verse 11-12)
Characteristics of three types of emesis and purgation
Yellowish-greenish vomiting along with bitter taste in mouth indicates that the pyloric valve is open and bile is flowing into the stomach from the duodenum. This is considered as end point of emesis and called pittanta vamana. In case of virechana, mucosal layer gets removed partially at the end point that can be considered as kaphanta virechana. Continuing cleansing beyond these endpoints may cause deleterious effects on the health.(verse 13-15)
Symptomatic evaluation of cleansing processes
Improper administration of emesis causes itching, urticaria etc. which can be considered as allergic reaction in response to the allergen in the form of emetic drug. The protein in the food is the most common allergic component. Some proteins or fragments of proteins are resistant to digestion and those that are not broken down in the digestive process are tagged by the Immunoglobulin E (IgE) causing allergic reaction. Possibility cannot be ruled out that the drug administered for emesis may irritate gastric mucosa, increases intracellular space due to transient inflammation thereby escaping into circulation directly without digestion and acts as a trigger for allergy.
Similarly in case of purgation if drug fails to give proper effect of evacuation then it remains inside the body and gives an allergic reaction which is evident in the form of coryza.
In Ayurvedic parlance, the probable reason for these symptoms is that when drug fails to attain desired cleansing and it is not removed from the body it act as a trigger for aggravation or excitement of dosha but is unable to throw them outside the body; thus either the disease gets aggravated or symptoms of dosha vitiation are evident.(verse 15-20)
Time to anuvasana (unctuous enema) or oleation after cleansing process
Anuvasana or snehapana therapy is indicated on ninth day after cleansing processes. This duration of gap includes seven days of post therapeutic measures and one day of rest. Immediately after cleansing, the digestive power is reduced and it improves gradually in seven days. This gap of total eight days is very much necessary to regain the normal functioning of digestive components in the gastrointestinal tract. Mucosal membrane is one such component of digestive tract that establishes a barrier between external environments and the internal milieu. Normal well formed healthy mucosa is responsible for nutrient absorption and waste secretion, which require a selectively permeable barrier. These functions place the mucosal epithelium at the centre of interactions between the mucosal immune system and luminal contents, including dietary antigens and microbial products . Thus in view of regeneration of new healthy mucosal barrier this duration of gap may play a prime role.
After niruha, type of medicated enema the unctuous enema is indicated on the same day in the evening for the pacification vata that is remained in the gut even after removal by niruha or to pacify vata that is produced due to possible overdose of niruha. Also as per modern perspectives it is possible that due to niruha type of medicated enema the colon gets cleared providing minimal barrier for absorption and due to increased permeability on virtue of transient inflammation, the transmucosal entry of fats of unctuous enema is facilitated .(verse 20-22)
Number and sequence of unctuous and niruha type of enema
After niruha, unctuous enema is indicated. Also the minimum unctuous enema required for a patient also depends upon aggravated dosha. Thus,
- If vata aggravation is there then alternate niruha and unctuous enema are indicated or in case of excess vata vitiation, physician can administer continuous two unctuous enema. 9 to 11 unctuous enema are indicated to combat vata disorder in general along with niruha in between.
- If kapha is aggravated then 1-3 unctuous enema and if pitta is aggravated then 5-7 unctuous enema are indicated along with niruha in between. In such condition continuous three niruha type of medicated enema can be given so as to remove the vitiated kapha-pitta and then unctuous enema can be administered to combat vata aggravation.(verse 23-25)
Benefits of niruha type of medicated enema
Ageing is a process that causes aggravation of vata due to loss of body’s vital elements gradually and aggravated vata also fastens the ageing. Thus being best treatment for vata, basti proves to be an anti-ageing therapy. Moreover, it has a cleansing spectrum in the lower part of gut. This portion is surrounded by vital organs like liver, spleen, pancreas, kidneys. Thus, the effect of cleansing is more marked for these organs. Liver and kidney plays an important role of detoxification thus maintaining body homeostasis that is helpful to avoid ageing.
Basti is considered as a harmless treatment mainly because in this treatment unlike that of purgation the fluid is supplied from outside for cleansing process and the amount of evacuation is also very less as compared to purgation. It acts in the colon and rectum which has a dominant function of excretion rather than absorption of nutrients. Thus, enema hardly alters the process of digestion; on the contrary it supports body’s natural process of excretion. Whereas in case of emesis the treatment goes in opposite direction of peristalsis and it mainly affects process of digestion. This is the reason for which no post therapeutic measures (samsarjana krama) are indicated in medicated enema.
Body strength and all kapha dominant body elements like semen are inversely related with vata. Thus, if vitiated vata is evacuated, the strength, sturdiness are enhanced bringing a new essence to body elements.(verse 27-28)
Benefits of unctuous type of medicated enema
Evacuating type of enema cleanses the gut thus facilitating the absorption of fats. Oil is considered to be the best for vata on virtue of its properties. The example given by acharya points towards the colonic and rectal absorption of fats given through unctuous enema and also it specifies the superiority of rectal route over oral consumption of fats. This may be because of the fact that vata is nothing but increase in some properties like dryness, lightness, cold, movement etc. in the body and these properties are introduced in human gut in the last part of digestion that occurs in colon. Unctuous enema directly oleates the colon and after absorption affects whole body by properties like unctuousness, heaviness and warmth. As site of production of vata is treated, no new vata formation occurs in the body bringing about the phenomena of vata-nigraha that is responsible for movement of all dosha from shakha (extremities) to koshtha (gut). Even proper function of agni (digestive strength) is dependent upon normal activity of vata as it has a vital function of igniting the digestive fire. Other functions like mental harmony, strength, vitality, complexion etc. are taken care of by unctuous enema as pacification of vata affects positively on mind, improves production of new body elements and gives health to the skin as it is also a site of residence for vata.(verse 29-31)
Effects of unctuous and evacuating type of medicated enema in general
All the disease quoted by acharya are exclusively vata disorders and thus basti seems to be the best remedy for them. Especially in females not conceiving despite their mating with male partner and in men’s having seminal debility basti acts potentially because both the abnormalities are related to apana vata. Apana is well regulated to the downward direction and its site of production is cleansed by basti bringing about the optimum therapeutic effect.(verse 32-34)
Selection of type of enema
Disease specific medicine is to be given through the enema because when medicated enema is given it brings about multiple actions at a time that includes evacuation which is a local action, affects certain receptors which need a specific molecule that acts as a stimulant over gut receptors for secretion of particular chemical messenger for disease attenuation besides cleansing. Dosha pacification is also evident due to action of absorbed active principles from drug specific to disease. Acharya has quoted a condition where life depends upon the morbid matter. This particular condition can be seen in the patient who is bed ridden, not consuming food and highly emaciated. Generally nutrition comes from the food that we consume and if food is not available then energy is produced from optional processes of metabolism like gluconeogenesis, lipolysis, etc . This can be termed in Ayurvedic parlance as use of dhatu (body elements) for nutrition. But if patient is so emaciated that gluconeogenesis is also not possible then the life supports comes from absorption of nutrients from fecal matter. Precursor of fecal matter i.e. chyme in the colon contains some electrolytes like sodium, magnesium, and chloride which are left as well as indigestible parts of ingested food (e.g., a large part of ingested amylose, starch which has been shielded from digestion, and dietary fiber, which is largely indigestible carbohydrate in either soluble or insoluble form). The bacteria break down some of the fiber for their own nourishment and create acetate, propionate, and butyrate as waste products, which in turn are used by the cell lining of the colon for nourishment . Perhaps 10% of the undigested carbohydrate thus becomes available, through this last but an important part of digestion. Hence in such patients giving enema may prove fatal as no nutrition will be available if colon is cleansed. Since it is explained that mala is responsible for bala in the context of rajayakshnma.(verse 35-37)
Importance of basti therapy
Ayurveda states only two types of therapies i.e. samshamana (dosha pacifying) and samshodhana (cleansing). Vata is responsible for all diseases as beside its own hazards it moves other vitiated dosha also. Basti has duel nature of action i.e. cleansing with dosha pacification. It acts mainly on vata hence basti can be considered as a single remedy for all the diseases; however, its formulation needs to vary as per disease.(verse 38-40)
Mode of action of basti
Here, Charaka details the mode of action of medicated enema , pointing towards various sites for proper evacuation. Medicated enema, when given properly, passes through the rectum and reaches the colon, where the maximum possible limit is up to cecum since the ileocecal valve prevents further movement. Proper evacuation of enema is also an important phenomenon as enema retaining for longer duration may cause abdominal discomfort, loss of osmotic balance, etc. and early removal of enema may not produce desired clinical effect.(verse 41)
Sign and symptoms of proper, improper and excess use of evacuating type of medicated enema
Properly administered enema causes cleansing of colon and rectum but in proportionate manner causing less harm to the mucosal membrane and nourishing the bacterial flora of colon. This may improve the process of proper formation of feces and gives sense of lightness in lower abdomen. Agni i.e. digestion is improved due to regularisation of vata that ignites digestive fire.
Improper enema or retention of enema gives symptoms that mimic bowel obstruction and hypervolemia. Especially symptoms like edema and dyspnea are produced as a result of excess fluid load, primarily salt and water, that builds up in various locations in the body and leads to an increase in weight, swelling in the legs and arms (peripheral edema), and/or fluid in the abdomen (ascites). Eventually, the fluid enters the air spaces in the lungs (pulmonary edema) reduces the amount of oxygen that can enter the blood, and causes shortness of breath (dyspnea).
Excess enema is nothing but purgation produced by overdose of evacuating enema thus the symptoms are same as that of excessive purgation. (verse 41-43)
Sign and symptoms of proper, improper and excess use of unctuous type of medicated enema
Unctuous enema though considered as a dosha pacifying enema it acts as a cleansing therapy because it cleanses the colon and rectum to remove adhered fecal matter. Moreover, the unctuousness makes colonic and rectal lining more slippery so that no feces remains and quantity of defecation increases. It brings about proper sleep as [[[vata]] is responsible for insomnia and it takes care of vata.
Improper administration of unctuous enema cannot meet the extent of oleation needed in colon, rectum and whole body thus causes dryness. Vitiated vata thus leads to the symptoms stated as in verse.
Excess unctuous enema gives symptoms somewhat similar to that of excess oleation. However local symptom like griping pain may be due to excess motions is more prominent.(verse 44-47)
Karma, kala and yoga basti
The concept of karma, kala and yoga basti denotes the use of basti therapy as per the severity of the disease. Generally diseases of vital organs like brain, heart, kidney etc. are considered more serious in nature and dosha vitiation is so severe that repeated medicated enema for long duration is a must hence karma basti is used in such instances. Another view suggests that 18 unctuous enema cause oleation of semen. Thus karma basti is meant for body elements which are far apart for the unctuousness to reach like shukra (semen), majja dhatu (bone marrow) etc. Yoga basti is the smallest duration or schedule that is required generally for healthy individuals doing cleansing according to particular season or in patients having disease newly diagnosed or of less severe nature. Kala basti is used in conditions which are in between the highly severe, chronic and less severe, newly diagnosed category. (verse 47-49)
Shirovirechana comes in sequence of shodhana after vamana-virechana etc. It has direct cleansing effect on the part above the clavicle hence termed shirovirechana. As head is a vital part and eyes are to be avoided during any fomentation, only fomentation with the help of the palm is an ideal procedure before shirovirechana. Inappropriate administration may cause only irritation and not the removal of morbid matter that leads to increase in secretions as result of allergic reaction causing adhesion of sticky material in the throat, heaviness of the head etc. Excessive administration of shirovirechana may cause rupture of certain capillaries in the Little's area, lying in antero-inferior part of the nasal septum having rich vascularisation. This may results in cutting type of pain. Due to sudden entry of foreign bodies in the nasal cavity fainting occurs rarely which may be due to vagal shock.(verse 50-53)
Do’s and don’ts in Panchakarma procedures
All the procedures involved in cleansing therapies act on the common principles, as follows:
- Stimulation of certain receptors
- Establishing body homeostasis by exchange between nutritive and morbid matters across the various membranes including gastric, intestinal or cell membrane.
- Rearrangement of gastrointestinal bacterial flora
Thus, during any cleansing procedure body should be protected from any type of exertion as it may adversely affect the mechanism involved in trans-membrane movement of matter or inhibit the receptor stimulation activity. Intake of untimely and unwholesome food leads to indigestion that may alter the digestion of sneha during oleation or even can suppress digestive power so that therapy like basti may not affect with proper potency and problems like fever or cold due to ama (i.e. indigested food) may arise hampering the treatments. Sleep during day time in itself causes pitta-kapha vitiation; anger, sun exposure etc. causes pitta vitiation. As in shodhana, utklesha i.e. exciting the dosha is always a first step in cleansing, hence excess dosha vitiation along with already excited dosha may cause diseases symptoms aggravation. (verse 54-55)
Reason for failure of basti to cure curable diseases and importance of dose in cleansing therapies
Acharya has attracted the attention to an important concept of avarana i.e. occlusion of one dosha by other causing its vitiation. In such instances treatment of the dosha or dhatu that is the reason for occlusion must be treated first then the one which is occluded [Cha.Sa.Chikitsa Sthana 28/239]. Otherwise the symptoms get aggravated as occlusion is potentiated.
Similarly, though one cannot measure the exact quantity of dosha, still on basis of symptoms, koshtha, agni etc. one need to decide the dose of drug to be given for cleansing. If dose calculation or the treatment is administered is wrong, then even if the drug is proper then also results may be adverse.(verse 57-60)
- After proper deepana and pachana, 30-40 ml of the fat is given empty stomach in the morning around 6.00 to 7.00 a. m. This dose is considered as test dose.
- Depending upon time taken for complete digestion of this dose, the dose required as per disease severity is calculated. Generally the dose which can be digested in 12 hours is considered as moderate.
- The quantity of fat to be administered is increased gradually till required dose is administered. Hence the dose for oleation decided on the basis of test dose is the actual quantity of fat to be administered on last day of oleation.
- Maximum duration for oleation is seven days which is for krura koshtha (literally, hard guts) and least duration is three days which is for mridu koshtha (soft guts).
- Proper oleation is decided on basis of symptoms like fats in feces, oiliness in skin etc.
- Fomentation with whole body massage is practised in certain areas twice in one day for vamana and twice for three days in case of virechana after completion of oleation.
- During this period of fomentation the diet as specified above in verse 8-9 is given for better results.
- On the day of vamana, in the morning again whole body massage with fomentation is given. Milk or any other material like sugarcane juice that helps initiating emesis is given to fill the stomach especially if the patient is weak. The quantity administered ranges from 500 ml to 1200ml depending upon patient’s gastric capacity. After that vamana drug is administered at around 7.00 a.m. (commonly used formulation- madanaphala pippali powder 5-7 gm+ vacha powder 2-3 gm+ rock salt powder 1-2 gm+ honey Q.S.) and wait and watch strategy is used for 45 minutes till emesis starts. Then yashtimadhu fanta (prepared by adding coarse yashtimadhu powder in hot water) is given continuously to induce and to facilitate the emesis till pitta is observed in bouts of vomitus. At the end of the procedure luke warm salt water is given to cleans the stomach. Medicated smoke inhalation is preferred in order to clear the kapha in upper upper respiratory tract.
- On day of purgation, in the morning again whole body massage with fomentation is given. Then virechana drug as per the koshtha and disease is administered at around 10.00-10.30 a.m. in the morning. This time specification is not always suitable, varies according to season, desha (place), appetite of patient etc. better to detail the concept of shleshmakale gate
- Purgation is continued till mucus is visible in the feces. If proper purgation is not occurring with given dose then strong purgative like icchabhedi rasa or abhayadi modaka may be given to boost up the process.
- Post therapeutic measures are followed in both virechana and vamana.
Practical guideline for therapeutic enema procedure
- Evacuating type of medicated enema is given at around 10.00-10.30 a.m. in the morning when the food taken on earlier day is digested and patient is not too hungry. Unctuous type of enema is given immediately after meal.
- Initially local massage with suitable oil is done at stomach, abdomen and buttocks and fomentation is given on the same part.
- The in left lateral position either evacuating or unctuous enema is administered. Then person is asked to lie supine. In case of evacuating type of enema he is advised to immediately pass the stool to evacuate enema completely. However in case of unctuous enema his buttocks are clapped, palms and sole are massaged, patients bed is lifted thrice from his feet so that the enema can retain for longer duration.
- After evacuating type of enema classics advise to give unctuous enema in the evening but practically unctuous enema is given on next day after having food. This alternate use of evacuating and unctuous enema avoids any possible vata vitiation.
Practical guideline for shirovirechana procedure
- Before administering shirovirechana local massage with suitable oil and mild fomentation is given on parts above the clavicles.
- Then patient is made to lie supine with neck slightly lifted and head tilted down. This position allows easy entry of drug to the intracranial organs.
- Nasya drug is administered in one nasal aperture at a time closing the other.
- After instillation of drug patient is made to lie in supine position for 3-5 minutes. During this time palms and soles of the patient are massaged which stimulates the absorption of nasal drug.
There are many research works carried out in field of Panchakarma therapies, some published researches on procedural standardisation are as follows:
- Bharti Gupta, Physiological and biochemical changes with Vamana procedure, AYU, 2012, 33,3:348-355
- Santoshkumar Bhatted, VD Shukla, Anup Thakar, NN Bhatt, A study on Vasantika Vamana (therapeutic emesis in spring season) - A preventive measure for diseases of Kapha origin, 2011, 32( 2): 181-186
- Ranjip Kumar Dass, Nilesh N Bhatt, Anup B Thakar, Vagish Dutt Shukla, A comparative clinical study on standardization of Vamana Vidhi by classical and traditional methods, 2012, 33 (4) : 517-522
- Somsri Wiwanitkit, Viroj Wiwanitkit, Vamana procedure, AYU, 2011, 32(3): 434
- Adil Rais, Santoshkumar Bhatted, Clinical study to evaluate the effect of Virechanakarma on serum electrolytes, AYU, 2013,34(4):379-382
- Anand RM, Gurjar GK, Virechana Karma in Indian literature, Bulletin of Indian Institute of History of Medicine, 1976;6(1):37-41.
- Yashwant M Juneja, Anup B Thakar, Clinical evaluation of Basti administered by Basti Putak (Pressure method), Enema pot method (Gravity fed method), and syringe method in Kshinashukra (Oligozoospermia), 2011 , 32 (2) : 234-240
- SS Savrikar, CE Lagad, Study of preparation and standardization of Maadhutailika Basti' with special reference to emulsion stability, 2010, 31(1) : 1-6
- Pharmacodynamics of Nasya Karma K.Y., Srikanth, V. Krishna murthy, M. Srinivasulu, International Journal of Research in Ayurveda & Pharmacy, 2011; 2(1):24-26.
Scope for further research
Beside yoga, karma and kala basti schedule the modified regimen can be prepared as per disease. For e.g. in case of kapha dominant disorders continuous three evacuating enema followed by one unctuous enema can be given.
Lord Atreya have described the successful administration of Panchakarma in the form of answer to the twelve queries. Oleation and fomentation are the pre-treatment measure in cleansing processes that follows emesis and purgation. After cleansing post therapeutic measures (samsarjana krama) are necessary to bring digestion to its original state. Unctuous enema or oleation therapy can be started from ninth day. Unctuous enema should be followed by evacuating type of enema. Medicated enema cures all the diseases by removing accumulated dosha from entire body. Acharya have advised an ideal treatment schedule in the form of yoga, kala and karma basti as per disease severity. Shirovirechana (errhine) therapy acts over the things that need to be avoided during Panchakarma includes excessive sitting, standing, speaking and riding, sleep during day time, sexual intercourse, suppression of natural urges, cooling regimens, exposure to sun, grief, anger and intake of untimely and unwholesome food. However after following all measure correct treatment is given but in low or excess doses, in inappropriate time or in wrong manner then it fails to cure diseases.
- Stenman, Lotta & Holma, Reetta & Korpela, Riitta. (2012)High-fat-induced intestinal permeability dysfunction associated with altered fecal bile acids. World journal of gastroenterology : WJG. 18. 923-9. 10.3748/wjg.v18.i9.923
- Cummings JH, Wiggins HS, Jenkins DJ, Houston H, Jivraj T, Drasar BS, Hill MJ. Influence of diets high and low in animal fat on bowel habit, gastrointestinal transit time, fecal microflora, bile acid, and fat excretion. J Clin Invest. 1978;61:953–963
- Kotz, John, Treichel, Paul, Townsend, John Chemistry and Chemical Reactivity, Seventh Edition, 2009, Thomson Brooks/Cole
- Bunce, KT, Tyers MB, The Role of 5-HT in Postoperative Nausea and Vomiting, 1992, British Journal of Anaesthesia; 69 (Suppl. 1): 60S-62S
- Hansson GC. Role of mucus layers in gut infection and inflammation. Current opinion in microbiology. 2012;15(1):57-62. doi:10.1016/j.mib.2011.11.002
- Pang G, Xie, J Food Science and Human Wellness, ISSN: 2213-4530, Vol: 1, Issue: 1, Page: 26-60, 2012.
- Cummings, J.H.; MacFarlane, G.T. (1997).Role of intestinal bacteria in nutrient metabolism . Clinical Nutrition 16: 3–9
- http://en.wikipedia.org/wiki/Vomiting [cited on 28-04-14]
- Alpas H, Smith, M, Kulmyrzaev A, Strategies for Achieving Food Security in Central Asia, 2011, Springer
- Turner JR, Intestinal mucosal barrier function in health and disease, Nature Reviews and Immunology. 2009 Nov;9(11):799-809
- Hollander, Daniel, Increased Intestinal Permeability in Patients with Crohn's Disease and Their Relatives: A Possible Etiologic Factor, Annals of Internal Medicine, 1986;105(6):883-885
- Rui L. Energy Metabolism in the Liver. Comprehensive Physiology. 2014;4(1):177-197. doi:10.1002/cphy.c130024
- Miller, Terry, Wolin, Meyer, Pathways of Acetate, Propionate, and Butyrate Formation by the Human Fecal Microbial Flora,1996, Applied and Environmental Microbiology 62 (5): 1589–1592
- McNeil, NI (1984). "The contribution of the large intestine to energy supplies in man". The American journal of clinical nutrition 39 (2): 338–342
- Gore, Richard, Levine, Mark Textbook of Gastrointestinal Radiology Fourth Edition, Elsevier 2015
- Sushruta.Chikitsa Sthana, Cha.37 Vedotpattim Adhyaya verse 71-74. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.
- Moore, Keith L. et al. (2010) Clinically Oriented Anatomy, 6th Ed, p.959