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|title=Asthapana basti
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|description=Asthapana basti or niruha basti (therapeutic decoction enema) is a prime treatment for disorders due to vitiation of vata dosha.
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<p style="text-align:justify;">Asthapana basti or niruha basti (therapeutic decoction enema) is a prime treatment for disorders due to vitiation of [[Vata dosha|vata dosha]]. It can expel out the increased [[Dosha|dosha]]. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 1/27]<ref name="ref1">Charak. Charak Samhita. Edited by Jadavaji Trikamji Aacharya. 1st ed. Varanasi:     Krishnadas Academy;2000.</ref> Niruha basti (therapeutic decoction enema) can pacify [[Vata dosha|vata]] at its root i.e. colon. Thus, it protects the whole [[Sharira|body]] from [[Vyadhi|diseases]] due to [[Vata dosha|vata dosha]]. Both asthapana (therapeutic decoction enema) and [[Virechana|virechana]] (therapeutic purgation) remove the [[Dosha|doshas]] from the [[Sharira|body]] through the colon. Asthapana basti (therapeutic decoction enema) has the advantage of eliminating [[Dosha|dosha]] without causing difficulties like belching, pain in the heart region and [[Koshtha|koshtha]] (gut). [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 10/07]<ref name="ref1"/> Niruha (therapeutic decoction enema) can be administered in weak persons, where [[Virechana|virechana]] is contraindicated. (therapeutic purgation) [Cha.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 28/86]<ref name="ref1"/> [[Virechana|Virechana]] (therapeutic purgation) is contraindicated in children and old people, whereas asthapana (therapeutic decoction enema) can be used for lifetime. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 10/07]<ref name="ref1"/> This chapter focuses on the concept and practices of asthapana basti (therapeutic decoction enema).</p>

{{Infobox

|title =  Contributors

|label1 = Section/Chapter/topic
|data1 = Concepts/[[Basti]]/[[Asthapana basti]]  

|label2 = Authors
|data2 = Adarsh P. M. <sup>1</sup>, <br/>[[Yogesh Deole|Deole Y.S.]]<sup>2</sup> 

|label3 = Reviewer & Editor
|data3 = [[Gopal Basisht|Basisht G.]]<sup>3</sup> 

|label4 = Affiliations
|data4 = <sup>1</sup> [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India <br/><sup>2</sup> Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India <br/><sup>3</sup> Rheumatologist, Orlando, Florida, U.S.A.

|label6 = Correspondence emails
|data6 = [mailto:dryogeshdeole@gmail.com dryogeshdeole@gmail.com], <br/>[mailto:carakasamhita@gmail.com carakasamhita@gmail.com]

|label7 = Publisher 
|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

|label8 = Date of publication:
|data8 = August 25, 2023

|label9 = DOI
|data9 = {{DoiWithLink}}
}}

== Etymology and derivation ==
<p style="text-align:justify;">Asthapana: The word asthapana is derived from aan, stha with lyut suffix in Sanskrit. This means to stay in one place (for longer time). Asthapana prevents the aging process by fixing the malfunctioning [[Dosha|dosha]].<ref name="ref2">www.wisdomlib.org. Asthapana, Āsthāpana: 7 definitions [Internet]. 2021 [cited 2023 July 31st]. Available from https://www.wisdomlib.org/definition/asthapana.</ref> <br/>Niruha: The word niruha is derived from nir (निर्) (privative)+ uha (ऊहा) (reasoning)+ karane (करणे घञ्). Thus, the word niruha stands for the treatment whose effect is beyond reasoning (or effective without any doubt). <br/><br/><b>Synonyms: </b>Asthapana basti, niruha basti, [[Kashaya|kashaya]] basti</p>

== Types of asthapana basti ==
<ol style="text-align:justify;"><li style="font-weight:bold">Based on [[Veerya|veerya (potency)]] :</li>
<ol type="a"><li style="font-weight:bold">Mridu asthapana basti (mild potency): <span style="font-weight:normal">The [[Basti|basti]] with mild potency is indicated in [[Vyadhi|diseases]] of short duration, easy to cure, and having minimum strength.[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 10/15,16]<ref name="ref1" />. It is indicated in persons of inferior mental strength (avara sattva).[Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/90]<ref name="ref3">20Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005</ref>. It is indicated explicitly in old age and children.[Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/10]<ref name="ref3"/>The [[Basti|basti]] becomes mild (mridu), when milk (ksheera) etc. are added to it.[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 7/63]<ref name="ref1" /> <br/>Prasrutika basti is an example of mridu basti ([[Basti|basti]] with mild potency), which is indicated for tender/delicate persons(sukumaras). There are chatur prasrutika, pancha prasrutika, shat prasrutika, sapta prasrutika and nava prasrutika bastis mentioned in prasruthayogika siddhi.</span></li>
<li style="font-weight:bold">Teekshna asthapana basti (strong potency): <span style="font-weight:normal">The [[Basti|basti]] with strong potency is indicated in [[Vyadhi|diseases]] of prolonged duration, challenging to cure, and having maximum strength. It can be administered in persons having superior mental strength (pravara sattva). The [[Basti|basti]] will get sharpness (teekshnatvam), when it gets added with cow’s urine (gomutra), [[Pilu|pilu (Salvadora persica Linn)]], [[Chitraka|Chitraka (Plumbago zeylanica)]], salt ([[Lavana|lavana]]) and alkali (kshara).</span></li></ol>
<li style="font-weight:bold">Based on effect (karma): </li>
<ol type="a"><li style="font-weight:bold">Utkleshana basti: This type of [[Basti|basti]] is intended to aggravate [[Dosha|dosha]] in dormant state (leena avastha). After initial aggravation, the [[Basti|basti]] expelles the [[Dosha|dosha]] to create equilibrium. <span style="font-weight:normal">[[Eranda|Eranda]] beeja (seed of Ricinus communis), [[Madhuka|madhuka (Madhuka longifolia)]], [[Pippali|pippali (Piper longum)]], saindhava (rock salt) and [[Hapusha|hapusha phala (Juniperus communis Linn.)]] as kalka are the ingredients of utkleshana basti. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/93]<ref name="ref3" /></span></li>
<li style="font-weight:bold">Doshahara basti : <span style="font-weight:normal">This pacifies [[Dosha|dosha]] by removing them. The ingredients of doshahara basti are satahva (Anethum sowa), [[Madhuka|madhuka (Madhuca longifolia)]], [[Kutaja|kutaja]] beeja (Holarrhena antidysenterica), [[Madanaphala|madanaphala]] (Randia dumetorum) along with kanjika (fermented rice gruel) and gomutra (cow’s urine). [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/94]<ref name="ref3" />.</span></li>
<li style="font-weight:bold">[[Dosha|Dosha]] shamana basti: <span style="font-weight:normal">This pacifies [[Dosha|dosha]] with mild potency. Priyangu (Callicarpa macrophylla), [[Madhuka|Madhuka (Madhuca longifolia)]], [[Musta|Musta (Cyperus rotundus)]], Rasanjana (semisolid extract obtained from decotion of Berberis aristata with milk) along with cow’s milk (goksheera) are the ingredients. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/95]<ref name="ref3" /></span></li></ol>
<li style="font-weight:bold">[[Yapana basti|Yapana basti]] (enema for sustaining life) <br/><span style="font-weight:normal">[[Yapana basti|Yapana bastis]] can be administered in all seasons. There are 12 types of yapana bastis mentioned and they are indicated in different stages of all [[Vyadhi|diseases]]. They serve the action of niruha basti (therapeutic decoction enema) and sneha basti (therapeutic unctuous enema). Mustadi yapana basti. shaliparnyadi yapana basti, sthiradi yapana basti are examples of [[Yapana basti|yapana basti]]. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 12/16-17]<ref name="ref1" /></span></li>
<li style="font-weight:bold">[[Piccha basti|Piccha basti (enema for  healing)]] <br/><span style="font-weight:normal">[[Piccha basti|Piccha basti]] is a kind of asthapana basti prepared using slimy (picchila) dravyas. It is indicated in conditions like [[Atisara Chikitsa|diarrhea (atisara)]], where there is bleeding from rectum. [Cha.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 19/93]<ref name="ref1" /></span></li>
<li style="font-weight:bold">Ksheera basti (enema with medicated milk)<br/><span style="font-weight:normal">The type of asthapana basti where medicated milk (shrita ksheera) is used instead of decoction is known as ksheera basti. It is also a kind of mridu basti (basti with mild potency). It is indicated mainly in [[Vyadhi|diseases]] like [[Vatarakta Chikitsa|vatarakta]] (rheumatism due to vitiated [[Vata dosha|vata]] and [[Rakta dhatu|rakta]]), sandhigata vata (degenerative joint disorder), [[Visarpa Chikitsa|visarpa (erysipelas)]], [[Vatavyadhi Chikitsa|vatavyadhi]] (disorders due to [[Vata dosha|vata]]) etc.</span></li>
<li style="font-weight:bold">Rakta basti (enema with animal blood)<br/><span style="font-weight:normal">Rakta basti contains the blood of freshly killed animals which is indicated mainly in [[Atisara Chikitsa|atisara(diarrhea)]] where the patient is debilitated by losing blood through the rectum. It is indicated in raktatisara (ulcerative colitis with blood in stools) and jeevadana vyapat of [[Virechana|virechana]] (therapeutic purgation) and [[Basti|basti (therapeutic enema)]]. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 6/82]<ref name="ref1" /></span></li>
<li style="font-weight:bold">Doshaghna basti</li>
<ol type="a"><li style="font-weight:bold">Vataghna basti <br/><span style="font-weight:normal">In [[Vyadhi|diseases]] having the aggravation [[Vata dosha|vata dosha]], the [[Basti|basti]] processed with the decoction prepared out of drugs having the property to pacify [[Vata dosha|vata]] (vataghna aushadha). Trividha sneha (combination of three snehas viz [[Ghee|ghee]], plant oil and muscle fat.), [[Amla|amla]] dravyas (drugs having sour taste) and saindhava (rock salt) is used. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/77]<ref name="ref3" /></span></li>
<li style="font-weight:bold">Pittaghna basti<br/><span style="font-weight:normal">In [[Vyadhi|diseases]] associated with [[Pitta dosha|pitta dosha]], [[Basti|basti (therapeutic enema)]] processed with the decoction of nyagrodhadi gana combined with kakolyadi gana as kalka (paste) along with [[Ghee|ghee]] and sugar is advised. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/78]<ref name="ref3" /></span></li>
<li style="font-weight:bold">Kaphaghna basti<br/><span style="font-weight:normal">In [[Vyadhi|diseases]] having an association of [[Kapha dosha|kapha dosha]], [[Basti|basti (therapeutic enema)]] processed with the decoction of aragvadhadi gana combined with pippalyadi gana as kalka (medicinal paste) along with honey, cow’s urine (gomutra) is to be used. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/79]<ref name="ref3" /></span></li>
<li style="font-weight:bold">Rakta shamana basti<br/><span style="font-weight:normal">In [[Vyadhi|diseases]] having loss of blood (shonita pravrutti), the enema processed with the decoction prepared out of ksheeri vrikshas (group of trees starting from nyagrodha) combined with sugar cane juice), milk, [[Ghee|ghee]], and sugar is used. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/80]<ref name="ref3" /></span></li></ol>
<li style="font-weight:bold">[[Shodhana|Shodhana basti]]<br/><span style="font-weight:normal">The enema, which is processed with the decoction and medicinal paste of shodhana dravyas (group of drugs with purifying action), with rock salt and unctuous substance (sneha) is known as the [[Shodhana|shodhana basti]]. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/81]<ref name="ref3" /></span></li>
<li style="font-weight:bold">Lekhana basti:<br/><span style="font-weight:normal">The enema is processed with the decoction of triphala, cow’s urine, honey, alkali (kshara) and combined with ushakadi gana as a medicinal paste (kalka), known as lekhana basti. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/82]<ref name="ref3" /></span></li>
<li style="font-weight:bold">[[Brimhana|Brimhana]] basti:<br/><span style="font-weight:normal">The basti processed with the decoction of drugs having the nourishing property([[Brimhana|brimhana]]) combined with the drugs having a [[Madhura|sweet taste (madhura rasa)]] as a medicinal paste (kalka) along with [[Ghee|ghee]] and meat soup (mamsarasa) is known as [[Brimhana|brimhana]] basti. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/83]<ref name="ref3" /></span></li>
<li style="font-weight:bold">Grahi basti<br/><span style="font-weight:normal">The enema is processed with the drugs of priyangvadi gana combined with ambashtadi gana as medicinal paste and honey and [[Ghee|ghee]] known as grahi basti. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/87]<ref name="ref3" /></span></li>
<li style="font-weight:bold">[[Madhutailika Basti|Madhutailika basti]]<br/><span style="font-weight:normal">When honey (madhu) and oil (taila) are given equal importance in enema, then it is known as [[Madhutailika Basti|madhutailika basti]]<ref name="ref19">Damayanthie Fernando (2011): Assessment of Clinical Efficacy of ErandamuladiYapana Basti and ErandaBijaKshiraPaka in the management of Kati Graha w.s.r. to Lumbar Spondylosis. Department of Panchakarma, IPGT&RA Jamnagar</ref>. [[Yapana basti|Yapana basti]], yuktharadha basti and siddha basti are synonyms of [[Madhutailika Basti|madhutailika basti]]<ref name="ref20">Shital G Bhagiya (2015): A Comparative Clinical Study of Lekhana Basti and Shamana Sneha (Triphaladi Taila) In the Management of Sthaulya W.S.R. To Obesity.Department Of panchakarma, GAAC, Ahmedabad.</ref>. It helps remove the [[Dosha|doshas]] and bring up the strength and complexion of a patient. The peculiarity of this kind of enema is that there will be no restrictions on diet, beverages, travel, and sexual intercourse. The enema shows many benefits to the patient with no complications at all. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/114]<ref name="ref3" /></span></li>
<li style="font-weight:bold">Yuktaratha basti<br/><span style="font-weight:normal">The patient can travel in chariot (ratha) after taking this enema. Hence it is named as yuktaratha basti. This basti has ingredients like erandamuladi as decoction; [[Vacha|vacha (Acorus calamus)]], [[Madhuka|madhuka (Madhuca longifolia)]] and [[Pippali|pippali (Piper longum)]] as medicinal paste and taila (sesame oil) as unctuous substance (sneha). [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/8]<ref name="ref3" /></span></li>
<li style="font-weight:bold">Siddha basti<br/><span style="font-weight:normal">The attainment of strength, nourishment, and complexion and the cure of many [[Vyadhi|diseases]] can be possible by this basti, and thus, it is named siddha basti.<ref name="ref23">Rani Sangeeta Ishwar Singh (2017): A randomized clinical trial on brihatyadi yapana basti and patrapinda sweda with aadityapakaguggulu in the management of cervical spondylosis w.s.r to asthigatavata. Department of Panchakarma, IPGT&RA Jamnagar.</ref> Yavakoladi siddha basti is one of its examples processed with the decoction of [[Yava|yava (Hordeum vulgare)]], [[Kola|kola (Ziziphus mauritiana Lamk Z.jujuba Lamk)]], and kulattha (Dolichos biflorus ), along with the medicinal paste of magadhika (Piper longum) and yashtyahva (Glycyrrhiza glabra).[Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/97-99]<ref name="ref3" /></span></li>
<li style="font-weight:bold">[[Vaitarana Basti|Vaitarana basti]]</li>
<ol type="a"><li style="font-weight:bold">Gomutra vaitarana basti<br/><span style="font-weight:normal">Fruit pulp of Tamarindus indicus as paste (amleeka kalka), jaggery, rock salt and cow’s urine along with little quantity of oil (taila) is used for the preparation of gomutra [[Vaitarana Basti|vaitarana basti]]. [Chakradatta Niroohadhikara 72/33]<ref name="ref4">Chakrapanidatta, Cakradatta (Chikitsasangraha) with padartha bodhini Hindi commentary of Vaidya Ravidatta sastri, Varanasi; Chaukhambha Surabharathi prakashan;2006. p.313</ref></span></li>
<li style="font-weight:bold">Ksheera [[Vaitarana Basti|vaitarana basti]] <br/><span style="font-weight:normal">All the ingredients are the same as gomutra [[Vaitarana Basti|vaitarana basti]] except cow’s milk in place of cow’s urine here. [Vang.Sa. Basti Adhikara 86-189]<ref name="ref5">Vangasena-Vangasena Samhita, Vol.2. Second edition. By Nirmal Saxena. Varanasi: Chaukambha Sanskrit Sansthan; 2001.</ref></span></li></ol>
<li style="font-weight:bold">Ardhamatrika basti<br/><span style="font-weight:normal">It has a total quantity of 12 pala (1 pala equals 48g), which is half that of dvadasha prasrutha basti. Here decoction of dashamoola (group of roots of 10 drugs), honey, rock salt and [[Shatapushpa|shatapushpa (Anethum sowa)]] as medicinal paste is used. [Vang.Sa. Basti Adhikara 172-181]<ref name="ref5" /></span></li>
<li style="font-weight:bold">Vrishya basti<br/><span style="font-weight:normal">The decoction of egg of chataka (hen sparrow) and uchataka along with cow’s milk, [[Ghee|ghee]], sugar and athmagupta phala (fruit of Mucuna pruriens) as admixture (avapa) is [[Vajikarana Adhyaya|aphrodisiac (vajikarana)]] in nature. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/84]<ref name="ref3" /></span></li>
<li style="font-weight:bold">Chakshushya basti<br/><span style="font-weight:normal">Erandmauladi decoction, yashtyahva (Glycyrrhiza glabra) as the medicinal paste, and honey, rock salt, and oil are the ingredients of chakshushya basti. [A. Hri.Kalpa Sthana 4/27-29]<ref name="ref6">Vagbhata. Ashtanga Hridaya. With Commentaries SarvangaSundari of Arunadatta and Ayurvedarasayana of Hemadri.Varanasi; Chaukambha Sanskrit Sansthan; 2012.</ref></span></li>
<li style="font-weight:bold">Churna basti <br/><span style="font-weight:normal">Churnabasti has pain relieving (shulaghna) properties with hot water as a liquid component (dravadravya) instead of decoction. The medicinal paste of [[Rasna|rasna (Pluchea lanceolata)]], [[Vacha|vacha (Acorus calamus)]], [[Bilva|bilva (Aegle marmelos)]], shatahva (Anethum sowa), [[Ela|ela (Eletteria cardamomum)]], putika (Holoptelia integrifolia), krishna (Piper longum), daru (Cedrus deodara) and kushdha (Saussuria lappa C. B Clarke) is used. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 10/13-14]<ref name="ref1" /></span></li></ol>

== Importance in the preservation of health and prevention ==
<p style="text-align:justify;">Therapeutic enema is advised in healthy individuals during the rainy season where there is vitiation of all three doshas [A. Hri. [[Sutra Sthana|Sutra Sthana]] 3/42]<ref name="ref6" />, after the administration of [[Vamana|vamana (therapeutic emesis)]] and [[Virechana|virechana]] (therapeutic purgation). [A. Hri. [[Sutra Sthana|Sutra Sthana]] 3/45]<ref name="ref6" /></p>

== Importance in the management of diseases ==
<ul style="text-align:justify;"><li>[[Basti|Basti (therapeutic enema)]] therapy (asthapana and [[Anuvasana|anuvasana]]) is the most important among the therapies for treating [[Vata dosha|vata dosha]] disorders. It enters the intestine (pakvashaya) after the administration cuts the root of aggravation of [[Vata dosha|vata]] and thereby it pacifies [[Vata dosha|vata]] all over the [[Sharira|body]]. Its effect is like cutting the root of a tree ([[Vyadhi|disease]]) will destroy the whole tree ([[Vyadhi|disease]]). [Cha.Sa. [[Sutra Sthana|Sutra Sthana]] 20/13]<ref name="ref1" /></li>
<li>[[Basti|Basti (therapeutic enema)]], in general, is helpful in the prevention of aging, and it produces health, strength, proper digestion, intelligence, voice, and complexion.</li>
<li>It is recommended for both children and old age as it effectively cures [[Vyadhi|diseases]] without causing complications.</li>
<li>It removes the vit (stool), [[Shleshma|shleshma]], [[Pitta dosha|pitta]] and [[Vata dosha|vata dosha]] from the [[Sharira|body]].</li>
<li>It provides compactness to the [[Sharira|body]] and strength to [[Shukra dhatu|shukra dhatu]] (the 6<sup>th</sup> basic structural element of the [[Sharira|body]]).</li>
<li>It removes [[Dosha|doshas]] from the [[Sharira|body’s]] channels and thus pacifies all [[Vyadhi|diseases]]. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 1/27]<ref name="ref1" /></li>
<li>Administration of niruha basti (therapeutic decoction enema) before [[Anuvasana|anuvasana basti (therapeutic unctuous enema)]] clears the channels.. It helps properly transport [[Snehana (unction therapy)|unctuous substance (sneha)]] like the pipe which carries water when the impurities causing obstruction are removed. [Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/84]<ref name="ref3" /></li>
<li>[[Basti|Basti]] (asthapana and [[Anuvasana|anuvasana]]) is important as it is the prime treatment for [[Vata dosha|vata]]. [[Vata dosha|Vata]] is the reason for the [[Vyadhi|diseases]] originating in peripheral tissues (shakha), visceral organs ([[Koshtha|koshtha]]), vital points of the body ([[Marma|marma]]), upper part of the body (urdhva), entire body (sarvavayava) and individual parts of the body (anga). The same [[Vata dosha|vata]] is responsible for separating and combining stool, urine, [[Pitta dosha|pitta]], etc. at their sites. As [[Basti|basti]] is supreme in managing [[Vata dosha|vata]], it is said to be half of the entire therapeutics. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 1/38-40]<ref name="ref1" /></li></ul>

== Indications of asthapana basti ==
<ul style="text-align:justify;"><li>Sarvanga roga – The [[Vyadhi|diseases]] are affecting the whole [[Sharira|body]].</li>
<li>Ekanga roga – The [[Vyadhi|diseases]] are affecting the organs. </li>
<li>Kukshiroga – [[Vyadhi|Diseases]] affecting the abdomen and pelvis</li>
<li>Vata varcha mutra sanga – Obstruction to flatus, feces, urine</li>
<li>Adhmana – abdominal distension</li>
<li>Angasupti – Organ-level numbness</li>
<li>Krimikoshtha – The gut infested with worms.</li>
<li>Balavarnamamsaretaskshaya – depletion of strength, complexion, muscle, and sperms</li>
<li>[[Atisara Chikitsa|Atisara]] – Diarrhea without the involvement of metabolic dysfunction ([[Ama|ama]])</li>
<li>Udavarta - Upward movement of  [[Vata dosha|vata]] due to retention of stool and urine</li>
<li>Parvabheda – Pain in joints</li>
<li>Pleeha - Splenomegaly</li>
<li>Abhitapa – Burning sensation</li>
<li>[[Gulma Nidana|Gulma]] – A type of lump</li>
<li>Shula – Abdominal colic of different pathologies</li>
<li>Shirakarnashula – Pain on head and ear</li>
<li>Bhagandra – Fistula </li>
<li>[[Unmada Chikitsa|Unmada]] - Insanity</li>
<li>[[Jwara Chikitsa|Jwara]] - Fever</li>
<li>Hrudaya parshva prushta katigraha – Pain over heart, sides of chest, lower back, and hip.</li>
<li>Hrudroga – [[Vyadhi|Diseases]] affecting heart</li>
<li>Bhradhna - Inguinal hernia</li>
<li>Vepana - Tremor</li>
<li>Sphikjanujangha shula – Pain on flanks, knee, and calf</li>
<li>Akshepaka - convulsions</li>
<li>Gourava – Heaviness of [[Sharira|body]]</li>
<li>Ati laghava – Excessive lightness of [[Sharira|body]]</li>
<li>Uru gulpha parshnishula – Pain over thigh, ankle, and heel</li>
<li>Rajakshaya – loss of menstrual blood with burning</li>
<li>Vishamagni – Irregular state of agni</li>
<li>[[Shosha Nidana|Shosha]] - Emaciation</li>
<li>Bahu, anguli, stanantashula – Pain over arms, fingers, and middle of chest</li>
<li>[[Stambhana|Stambha]] - Stiffness</li>
<li>Antrakujana – Gurgling sound in the intestine</li>
<li>Parikartika – sharp cutting pain in anus</li>
<li>Danta nakha parvasthi shula – Pain on teeth, nails bones and joints</li>
<li>Anaha - Barborygmus with distention</li>
<li>Pratishyaya – A type [[Vyadhi|disease]] affecting nose including coryza</li>
<li>Ashmari – Renal calculi</li>
<li>Khuda – A disesase which is affecting the skin and muscle over the joints of legs and hands first and later spreads to deeper sites</li>
<li>[[Vatavyadhi Chikitsa|Vatavyadhi]] – [[Vyadhi|Diseases]] originates from vitiated [[Vata dosha|vata]]</li>
<li>Alpalpodhana – Voidance of stool frequently in less quantity</li>
<li>Sashabdodhana – Voidance of stool with sound</li>
<li>Ugragandhodhana- Voidance of stool having foul smell. [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 2/16]<ref name="ref1" /></li></ul>

<br/>Niruha basti is also indicated in following [[Vyadhi|diseases]]
<ul style="text-align:justify;"><li>Adhimantha - glaucoma</li>
<li>Ardita - facial paralysis</li>
<li>Pakshaghata - hemiplegia</li>
<li>[[Udara Chikitsa|Udara]] - obstinate disorders affecting the abdomen including Ascites.</li>
<li>Upadamsha - syphilis</li>
<li>Mutrakruchhra - dysuria</li>
<li>Shukra artava stanya nasha: Depletion of semen, menstruation, and breast milk</li>
<li>Hanugraha – lock jaw</li>
<li>Manyagraha – neck stiffness</li>
<li>Sharkara – multiple gravel like particle in urine</li>
<li>Mudhagarbha – abnormal fetal presentation. [Su. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 35/5]<ref name="ref3" /></li></ul>

== Contraindications ==
<ul style="text-align:justify;"><li>Persons suffering from severe weakness</li>
<li>Injuries.</li>
<li>Fainting</li>
<li>Those who have undergone the process of purification any.</li>
<li>Those whose life depends on the strength of morbid matter ([[Agantu roga|agantu dosha]]) to survive [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] .1/37]<ref name="ref1" /></li></ul>

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

== Quantity of ingredients ==
The general dosage of ingredients for 1152 ml (dvadasha prasruta) [[Basti|basti]] are as follows. While preparing, there is a specific sequence of mixing the ingredients and their quantity is listed below.
<ol style="text-align:justify;"><li>Honey (madhu): 192 ml (2 prasruta)</li>
<li>Rock salt (saindhava): 12 gram (1 karsha)</li>
<li>Oil/[[Ghee|ghee]]/unctuous substance (sneha): 288 ml (3 prasruta)</li>
<li>Medicinal paste (kalka): 96 gram (1 prasruta)</li>
<li>Decoction ([[Kashaya|kashaya]]): 384 ml (4 prasruta) to 480 ml (5 prasruta) *[Su.Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 38/37-39]<ref name="ref3" /></li>
<li>Additives (avapadravya): 192 ml (2 prasruta) [Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 3/30]<ref name="ref1" /></li></ol>
The proportion of sneha (unctuous substance) and honey is based on [[Dosha|dosha]] association.
{| class="wikitable"
|+ '''Table 1. Ingredients’ proportion in basti formulation based on dosha association'''
! 
!'''Vata predominance'''
!'''Pitta dosha anubandha'''
!'''Kapha dosha anubandha'''
|-
|Honey
|3 pala (144 ml)
|4 pala (192 ml)
|6 pala (288 ml)
|-
|Unctuous substance
|6 pala (288 ml)
|4 pala (192 ml)
|3 pala (144 ml)
|}
[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 3/30]<ref name="ref1" />

== Dose of asthapana basti in different age groups ==
The dose of [[Basti|basti]] formulation as per age. It is shown in table 2.
{| class="wikitable"
|+'''Table 2: Age specific dose of basti formulation'''
!'''Age''' 
!'''Dosage''' 
|-
|1  year
|½ prasruta (48 ml)
|-
|Increase  the dosage by ½ prasrutha each year till 12 years
|48  ml to 576 ml
|-
|12  years
|576  ml (6 prasruta)
|-
|Increase  the dosage by 1 prasruta each year till 18 years
|576  ml to 1152 ml 
|-
|18  year and above until age 70
|1152  ml (12 prasruta)
|-
|Above  70 years
|960  ml (10 prasruta)
|}
[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 3/31-32]<ref name="ref1" />

{| class="wikitable"
|+'''Table 3: Sushruta’s view on age specific dose of basti formulation'''
!'''Age'''
!'''Dosage'''
|-
|1 year
|2  prasruta (192 ml)
|-
|8  years
|4 prastuta (384 ml)
|-
|16  years
|8  prasruta (768ml)
|-
|25  years and above up to 70 years
|12  prsruta (1152 ml)
|-
|Above  70 years
|8 prasruta (768 ml)
|}
[Su.Sa. [[Chikitsa Sthana|Chikitsa sthana]] 35/7]<ref name="ref3" />

== Procedure of administration of asthapana basti ==
<p style="text-align:justify;">The procedure of administration of [[Basti|basti]] can be divided into three stages like the [[Samshodhana|samshodhana]] (therapeutic emesis and purgation) procedures. They are.</p>
<ol style="text-align:justify;"><li>Pre therapeutic procedure (purvakarma)</li>
<li>Chief therapeutic procedure (pradhana karma)</li>
<li>Post therapeutic procedure (paschat karma)</li></ol>

<ol style="text-align:justify;"><li style="font-weight: bold;">Pre therapeutic procedure (purvakarma)</li>
<ol type="a"><li style="font-weight: bold;">Preparation of the medicine</li>
<ol type="i"><li>Preparation of asthapana basti (therapeutic decoction enema) formulation by the collective missing of ingredients mentioned above using a churner (khaja).</li>
<li>The prepared formulation filled into the enema bag by tying it with the enema nozzle (bastinetra) without catching air inside and without producing wrinkles above the bag.</li>
<li>The tip of the enema nozzle should be inserted with a wick (varti) to prevent its leaking.</li></ol>
<li style="font-weight: bold;">Preparation of the patient</li>
<ol type="i"><li>The patient must have undergone oil application and sudation.</li>
<li>The patient must have an empty bowel and bladder.</li>
<li>The patient must not have a severe appetite. </li></ol></ol>
<li style="font-weight: bold;">Therapeutic procedure (pradhana karma)</li>
<ul><li>The patient should be lying in the left lateral position with the head side either raised or at the same height as that of the leg on a fair couch which is not lifted too much.</li>
<li>The patient should be lying in an left lateral position with his own arm as the pillow below head.</li>
<li>The right leg should be flexed at the knee whereas the left leg should be in extended position.</li>
<li>The anal orifice ([[Guda|guda]]) should be lubricated and the 1/4th of the total length of the lubricated enema nozzle (which is equal to the distance from the tip of nozzle to the karnika at the tip) should be inserted in the same direction of the vertebral column.</li>
<li>The hand of the person giving enema should not be shaking during the insertion of the nozzle.</li>
<li>Repeated squeezing of the enema bag is not favorable, and the nozzle should be withdrawn slowly and carefully.
[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 3/17-20]<ref name="ref1"/></li></ul>
<li style="font-weight: bold;">Post therapeutic procedure (paschat karma)</li>
<ul><li>After the proper elimination of enema, the patient should have undergone bath with lukewarm water and take boiled rice with thin meat soup.</li>
<li>The patient should be given [[Anuvasana|anuvasana basti (therapeutic unctuous enema)]] with the oil (taila) having 1/4<sup>th</sup> quantity of that of asthapana (therapeutic decoction enema) processed with drugs having the property to pacify [[Vata dosha|vata]] and having sour taste, for the nourishment of the [[Sharira|body]] after the digestion of the above-mentioned diet in the evening.
[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 3/27-30]<ref name="ref1"/></li></ul></ol>

== Diet after the niruha basti (therapeutic decoction enema) ==
{| class="wikitable"
|+'''Table 4: Diet after niruha basti in different dosha involvement'''
!'''Dosha Involvement'''
!'''Diet'''
|-
|[[Vata dosha|Vata]] 
|meat soup (mamsarasa)
|-
|Pittanubandha (association of Pitha)
|milk (ksheera)
|-
|Kaphanubandha (association of [[Kapha dosha|kapha]])
|soup of pulses of various kinds (yusha)
|}
[Cha.Sa. [[Siddhi Sthana|Siddhi Sthana]] 3/70]<ref name="ref1"/>

== Number, adjuvant, and properties of niruha basti in different dosha involvement ==
{| class="wikitable"
|+ '''Table 5: Number, adjuvant, and properties of niruha basti in different doshas'''
!'''Dosha involvement'''
!'''Adjuvant'''
!'''properties'''
!'''number'''
|-
|[[Vata dosha|Vata]]
|Meat soup ([[Mamsa dhatu|mamsa]] rasa)
|Unctuous (snigdha), Hot in potency (ushna)
|style="text-align:center;" |1
|-
|[[Pitta dosha|Pitta]] association
|Milk (payas)
|Sweet (svadu), cold in potency ([[Sheeta|sheeta]])
|style="text-align:center;"|2
|-
|[[Kapha dosha|Kapha]] association
|Cows’ urine ([[Mutra|mutra]])
|[[Katu|Pungent (katu)]], hot in potency (ushna), sharp in action (teekshna)
|style="text-align:center;"|3
|}

== Complications of asthapana basti ==
There are mainly 12 complications of asthapana basti (therapeutic decoction enema) arise because of its improper administration. They are as below.
<ol><li>Ayoga – Untoward effects due to insufficient dose administration</li>
<li>Athiyoga – Untoward effects due to excess dose administration </li>
<li>Klama - exhaustion without exertion</li>
<li>Adhmana – abdominal distension </li>
<li>[[Hikka Shwasa Chikitsa|Hikka]] - hiccups</li>
<li>Hrudprapti – reaching cardiac region</li>
<li>Urdhvavata – upward dislocation of [[Vata dosha|vata]]</li>
<li>Pravahika - dysentery</li>
<li>Shiro arti – headache</li>
<li>Angaarti – bodyache</li>
<li>Parikartha – sharp cutting pain in anus</li>
<li>Parisrava - excessive secretion</li></ol>

The following table shows details about these complications. 
{| class="wikitable" style="text-align:justify;"
!'''Name of complication'''
!'''Etiology'''
!'''Signs and Symptoms'''
!'''Management'''
|-
|Ayoga
|Administration  of decoction enema which is. 

* cold in nature
* having less quantity of salt, unctuous substance  fluid part (drava dravya) 
* thick in nature
* In patients having heaviness due to chronic constipation, [[Vata dosha|vata]] dominance and dry [[Koshtha|koshtha]] (Viscera).
|
* Increased abdominal heaviness,
* obstruction of flatus, urine and fecus.
* Severe pain in umbilicus
* Burning sensation
* Itching
* Discolouration
* Anorexia
* Loss of appetite
|
* Intake of  hot decoction mentioned in the management of diarrhea (pramathya)
* Different types of sudations
* Anal suppositories
* [[Virechana|Virechana]] (therapeutic purgation)
* Bilvadi decoction enema
|-
|Atiyoga
|
* Use of extreme sharp and hot formulation in mridukoshtha  (delicate bowel nature)
|
* Signs and symptoms same as that of atiyoga (exceeded  effect) mentioned in [[Vamana|vamana (therapeutic emesis)]] and [[Virechana|virechana]] (therapeutic  purgation)
|
* Administration of decoction enema having the 
* Medicinal paste (kalka) of prushni parni (Uraria picta), Sthira (Desmodium gangeticum), padma (Nelumbo nucifera), [[Kashmarya|kashmarya (gmelina  arborea)]], [[Madhuka|madhuka (Madhuca longifolia)]] and bala (Sida cordifolia)
* Fluid part (drava dravya) having the decoction  of [[Draksha|draksha (Vitis vinifera)]], water prepared out of pakva loshta (heated iron  or earth) and [[Madhuka|madhuka (madhuca longifolia)]]

Unctuous  part – [[Ghee|Ghee]]
|-
|Klama
|
* Soft Enema administered in remanence of [[Ama|ama]] (product  of impaired digestion and metabolism)
|
* Weariness
* Burning sensation
* Chest pain
* Loss of consciousness
* feeling as if wrapped/cramps.
* heaviness
|
* Sudation with dry drugs
* [[Deepana|Deepana]] (drugs enhancing digestion and  metabolism)
* Decoction enema with dashamula (group of ten  roots) and gomutra (Cow’s urine)
|-
|Adhmana
|
* Administration of enema having less potency in  patients having great aggravation of [[Dosha|doshas]], dryness and constipation
|
* Abdominal distension
* severe form of flatulence as if vital point ([[Marma|marma]]) is afflicted.
* Burning sensation
* Heaviness of abdomen
* Pain on inguinal region and testes.
|
* Suppository prepared out of shyamaphaladi yoga.
* Bilvadi niruha basti 
* [[Anuvasana|Anuvasana (Therapeutic unctuous enema)]] with  [[Sarala|Sarala (Pinus longifolia)]] and [[Devadaru|devadaru (Cedrus deodara)]]
|-
|[[Hikka Shwasa Chikitsa|Hikka]]
|
* Administration of enema having extreme sharpness  in action in patients who are weak and having delicate bowel nature.
|
*     
|
* The medications of hiccup and drugs having  nourishment property
* Therapeutic unctuous enema with balasthiradi thaila
* Intake of black salt (krishna lavana) with hot  water medicated smoking, linctus, milk, sudations, and food processed with [[Vata dosha|vata]] pacifying drugs
|-
|Hrudprapti
|
* Administration of enema which is having extremely high potency or by pushing the [[Vata dosha|vata]] to the rectum by its complete  drainage
|
* Shaking the heart
|
* Kasadi basti
* Therapeutic unctuous enema processed with drugs  pacifying [[Vata dosha|vata]]
|-
|Urdhvata
|
* Administration of enema at the time of  suppression of urges of flatus, urine, and feces.
|
* Enema comes out through mouth.
* Syncope
| 
* Flashing water on the face 
* Rub gently over the sides of chest and abdomen. 
* Fanning over him
* Terrifying the patient with fearful sounds
* Torturing the patient by pulling him up in the  air by holding his hair and shaking it.
* Holding the neck of the patient tightly not  causing death
* Intake of paste of Areca catechu (kramuka kalka)  mixed with sour substances.
* Dashamulika asthapana basti (medicated decoction  enema) with cow’s urine (gomutra) as adjuvant (avapa) when the enema is  obstructed in large intestine.
* Bilvadi siddha basti when the enema is  obstructed in chest region.
* Nasal medication, medicated smoking and wrapping  the head with [[sarshapa|sarshapa (Brassica indica)]] when it is blocked there in the  head.
|-
|Pravahika
|
* Administration of soft potency drug or less quantity drug in greatly aggravated [[Dosha|doshas]].
|
* Dysentery
* Swelling of urinary bladder and anal region
* Exhaustion of calf and thigh
|
* [[Abhyanga|Abhyanga (Massage)]]
* [[Sweda|Sweda (sudation)]]
* Niruha (therapeutic decoction enema) added with sodhana dravyas (purifying drugs) like trivruth (Operculina turpethum) or anulomana dravyas like milk.
|-
|Shiro arti
|
* Enema having soft potency and less quantity in weak, constipated, and severely aggravated [[Dosha|dosha]].
|
* Deafness
* Tinnitus
* Coryza
* Visual Illusions
|
* Massage with taila (sesame oil) processed with [[Lavana|lavana(salt)]]
* Pradhamana nasya (Nasal medication using  medicated powder)
* [[Dhumapana|Dhumapana (medicated smoking)]] of purificatory  variety.
* [[Anuvasana|Anuvasana (therapeutic unctuous enema)]] with teekshna anulomana drugs (sharp and directive)
|-
|Angarti
|
* Administering enema which has the properties like heaviness and sharp potency in more than required quantity in patients who haven’t undergone [[Snehana (unction therapy)|snehana]] and [[Swedana|swedana (sudation therapy)]]
|
* Pain all over the [[Sharira|body]] resembling wrapping, pricking, breaking, and quivering.
|
* Massage with sesame oil (taila) processed with salt.
* Seka (sudation by streaming of pre-warmed liquid) with hot water, decoction prepared out of the leaves of [[Eranda|Eranda (Ricinus communis)]]
* Prasthara sweda (Sudation by lying on bed)
* Niruha basti (Therapeutic decoction enema) with dasamula and bilva thaila.
* Avagaha (sudation by sitting in tub)
* [[Anuvasana|Anuvasana basti (Therapeutic unctuous enema)]] with yashti madhu taila or bilva thaila.
|-
|Parikartika
|
* Administering dry, sharp potent and excess quantity  of enema in delicate bowels and minimally increased [[Dosha|doshas]] 
|
* Sharp cutting pain in anus
* Pricking pain on sacral region, groin, and urinary bladder.
* Pain below the umbilicus
|
* Enema with the medicines having sweet taste and cold potency.
* Enema with srajarasa (Vateria indica) yashtyahva (Glycyrrhiza glabra) Jingini (lannea coromandelica) etc.
|-
|Parisrava
|
* Administration of enema having sour taste, salt, hot and sharp potency in patients having the [[Vyadhi|disease]] of [[Pitta dosha|Pitta]] 
|
* Excretion of [[Pitta dosha|pitta]] (bilious humor) of different colours
* Loss of consciousness
* Uncontrolled diarrhea
|
* Enema is prepared out of goat’s milk processed  with fresh (ardra) [[Shalmali|shalmali (salmalia malabarica)]] leaf sprouts.
* Enema is prepared with the leaves of vata (Ficus bengalensis) etc. in milk.
* Seka (streaming of liquid) and [[Pradeha|pradeha]] (thick anointment) out of sweet and cold drugs
|}

== Contemporary approach ==
<p style="text-align:justify;">The oral route is considered as the most convenient route for drug administration. However, oral medications are not possible in some clinical and pharmaceutical perspective in several circumstances. Rectal route may be used as a clinical alternative in these circumstances which yields both systemic and local actions. The hepatic first-pass metabolism effect can be reduced by rectal administration by partially bypassing the liver following systemic absorption. Rectal formulations are mainly used in the systemic conditions such as pain, fever, nausea, vomiting, migraines, allergies, and sedation.<ref name="ref7">Susan Hua. Physiological and Pharmaceutical Considerations for Rectal Drug Formulations. Front Pharmacol. 2019; 10: 1196. doi: 10.3389/fphar.2019.01196. PMCID: PMC6805701, PMID: 31680970.</ref> 
<br/>Boofing or rectal administration medication and other fluids are administered through rectum. There they are absorbed by capillaries of rectum and thus enter the circulatory system and distribute them to whole [[Sharira|body]].<ref name="ref8">www.en.wikipedia.org.Rectal administration. [Internet].2023 [cited 2023 July 31]. Available from https://en.wikipedia.org/wiki/Rectal_administration#:~:text=Rectal%20administration%2C%20colloquially%20known%20as,body's%20organs%20and%20bodily%20systems.</ref> One of the studies also showed that [[Basti|basti]] medicine reaches up to ileo-caecal junction.<ref name="ref9">Juneja Yashwant M, Thakar A. B. Standardization of procedure of administration of [[Basti|Basti]] w.s.r to Kshinashukra (oligozoospermia), MD Dissertation, IPGT& RA. Jamnagar: Gujarat Ayurved University; 2010</ref>
<br/>As compared with oral administration, rectal administration is faster in action and higher in bioavailability. Vomiting can be prevented by rectal administration thus it prevents the loss of drug. The two third of rectum’s venous drainage is in the middle and inferior rectal vein which drains directly to systemic circulation and only one third of it goes to the hepatic portal system. Thus, two third of rectal administered drug bypasses the metabolic phase. It can be administered at home which doesn’t require inpatient setup as in intravenous administration. Many of the oral drugs can be modified for rectal administration by crushing and suspending them in water.
<br/>There are many digestive tract problems where the rectal route can be selected for drug administration such as bowel obstruction, dysphagia etc. In palliative care and long-term care, it is the cheap and safe alternative to intravenous or subcutaneous delivery of medications.<ref name="ref10">www.en.wikipedia.org.Rectal administration.[Internet] 2023 [cited 2023 July 31].Available from https://en.wikipedia.org/wiki/Rectal_administration#:~:text=Rectal%20administration%2C%20colloquially%20known%20as,body's%20organs%20and%20bodily%20systems.</ref></p>

== Methods of rectal route administration ==
<ol type="a" style="text-align:justify;"><li style="font-weight: bold;">Suppository – <span style="font-weight: normal;">Insertion of a solid drug into the rectum which dissolves to produce local and systemic effects.</span></li>
<li style="font-weight: bold;">micro-enema – <span style="font-weight: normal;">Less than 10 ml of liquid drug solution </span></li>
<li style="font-weight: bold;">large volume enema - <span style="font-weight: normal;">Greater in quantity so that it can expel the feces out and deliver the drug.</span></li>
<li style="font-weight: bold;">catheter – <span style="font-weight: normal;">A catheter that can safely remain in the rectum for repeated use is inserted.</span></li></ol>
Asthapana basti (therapeutic decoction enema) can be considered as large volume enema where the quantity of liquid helps in the propulsion of the contents from colon by peristalsis.

== Solutions used for enema ==
<ul style="text-align:justify;"><li>Plain water – It works simply by the mechanical expansion of colon.</li>
<li>Normal saline – normal saline does almost the same work except it prevents the loss of electrolytes and retains the fluid for long time which may soften an impaction.</li>
<li>Castile soap – It causes irritation of colon’s lining and increases the urgency to defecate.</li>
<li>Glycerol – It is a bowel mucosa irritant which induces peristalsis via hyperosmotic effect.</li>
<li>Equal parts of milk and molasses – They are heated together slightly above the [[Sharira|body]] temperature. It can retain the water portion of enema in the intestine.</li>
<li>Mineral oils – These can act as lubricants and stool softener.<ref name="ref11">www.en.wikipedia.org.Enema.[Internet] 2023 .[Internet] 2023 [cited 2023 July 31].Available from https://en.wikipedia.org/wiki/Enema#Large_volume_enemas</ref></li></ul>

== Mode of absorption in rectal route ==
<p style="text-align:justify;">The rectal region is drained by rectal (hemorrhoidal) veins and lymphatic vessels. The superior rectal vein drains the upper part of the rectum, and its lower part drains by inferior and middle rectal veins. More specifically, the superior rectal vein drains into the portal vein, hence it passes through the liver before getting into the systemic circulation. In contrast, the inferior and middle rectal veins drain into the inferior vena cava and, therefore, directly into systemic circulation. Between these three rectal veins exist extensive anastomoses, which connect all three veins throughout the rectum. The rectum is also extensively drained by the lymphatic system that originates in the mucosa and submucosa. The influence of the lymphatic vessels on the absorption of drugs is not well established; however, it may contribute to the systemic absorption of highly lipophilic drugs. Lymphatic drainage also avoids the hepatic first-pass effect.<ref name="ref12">Susan Hua. Physiological and Pharmaceutical Considerations for Rectal Drug Formulations. Front Pharmacol. 2019; 10: 1196. doi: 10.3389/fphar.2019.01196. PMCID: PMC6805701, PMID: 31680970.</ref>
<br/>Depending on the physicochemical characteristics of the drug, transportation of drug molecules occurs passively via paracellular diffusion (between cells) or transcellular diffusion (through the cell). Paracellular transport is preferred for more hydrophilic molecules, ionized molecules, and high molecular weight compounds. However, by the narrow tight junction space in rectum it can be restricted. Therefore, the transcellular route is the main mechanism for drug absorption in the rectum.<ref name="ref13">Nunes R., Sarmento B., das Neves J. (2014). Formulation and delivery of anti-HIV rectal microbicides: advances and challenges. J. Control Release 28194, 278–294. 10.1016/j.jconrel.2014.09.013</ref> Transcellular diffusion is affected by many factors, but it is usually proportional to the lipid solubility of the drug. Drug molecules in the non-ionized form are much more lipophilic than the ionized form. At the relatively neutral pH of the rectum, basic drugs with an acid dissociation constant (pKa) near or above the physiologic range tend to be more readily absorbed, as they will predominantly be in their non-ionized form.
<br/>The rate of absorption depends on the property of constituents of [[Basti|basti (enema)]] too. The irritant property of adjuvants causes mild inflammation in the colon which alters the permeability of capillaries and thus enhances the absorption.<ref name="ref14">Swapnil SA, BK Ashok, Anup B Thakar et al. An experimental study to evaluate the pharmacokinetic aspect of Lekhana Basti (Emaciating/ Desiccating Medicated Enema). Anc Sci Life. 2011 Oct;31(2):38-43</ref></p>

== Importance of retention of the formulation ==
<p style="text-align:justify;">For local and systemic drug absorption the drugs need to be retained for an adequate period. The bio availability and efficacy of the drug is directly proportional to the contact time of the drug with the rectal mucosa. The drug molecules must cross the mucosal layer to reach the epithelial cells lining the rectum.</p>

== Importance of fluid volume ==
<p style="text-align:justify;">The small fluid volume may reduce the absorption of the drug as the rectum is deficient in fluid levels which may produce problem of dissolution of some drugs<ref name="ref15">Nunes R., Sarmento B., das Neves J. (2014). Formulation and delivery of anti-HIV rectal microbicides: advances and challenges. J. Control Release 28194, 278–294. 10.1016/j.jconrel.2014.09.013</ref> </p>

== Current research works ==
<ul style="text-align:justify;"><li>A comparative study on the effect of [[Virechana|virechana]] (therapeutic purgation) and [[Vaitarana Basti|vaitarana basti]] in [[Amavata|amavata (rheumatoid arthritis)]] patients concluded that [[Vaitarana Basti|vaitarana basti]] had given better relief in [[Amavata|amavata]] than viechana.<ref name="ref16">Bhatkoti Mayank (2005): A comparative clinical study of vaitaranabasti and virechana karma in the management of amavata. Department of Kayachikitsa, IPGT&RA Jamnagar</ref></li>
<li>[[Yapana basti|Yapana basti]] administered through drip method and putaka method have shown definite improvement in patients of kampavata (parkinsonism). The drip method has shown better improvement in general symptoms, associated symptoms, functional assessment, and signs.<ref name="ref17">Vinay Chaudary (2007): A clinical study of standardization of Yapana basti in the management of Kampavata. Department of Panchakarma, IPGT&RA Jamnagar</ref></li>
<li>Kala basti has shown better improvement in [[Amavata|amavata]] (rheumatoid arthritis) when compared with [[Virechana|virechana]].<ref name="ref18">Gohil Jalpa H (2009): A comparative clinical study of Virechana karma and kala basti in   management of Amavata. Department of Panchakarma, IPGT&RA Jamnagar</ref></li>
<li>Administration of Erandamuladi yapana basti in comparison with Erandabija ksheera paka in patients of katigraha have shown better improvement in signs and symptoms of [[Basti|basti]] group.<ref name="ref19"/>Damayanthie Fernando (2011): Assessment of Clinical Efficacy of ErandamuladiYapana Basti and ErandaBijaKshiraPaka in the management of Kati Graha w.s.r. to Lumbar Spondylosis. Department of Panchakarma, IPGT&RA Jamnagar</li>
<li>Clinically in patients treated with lekhana basti there was a decrease in s. cholesterol, s.low density lipoprotein and s. apolipoprotein B. There was a significant reduction in BMI, weight, [[Sharira|body]] fat storage etc. It was effective to a lesser extent on lipid profile than triphala [[Guggulu|guggulu]].<ref name="ref20">Shital G Bhagiya (2015): A Comparative Clinical Study of Lekhana Basti and Shamana Sneha (Triphaladi Taila) In the Management of Sthaulya W.S.R. To Obesity.Department Of panchakarma, GAAC, Ahmedabad.</ref></li>
<li>A comparative study between the effect of rectal administration and oral administration of the same group of drugs (guduchi bhadramustadi) have proved the higher efficacy of rectal administration for the management of sthoulya.<ref name="ref21">Hemal Kumar V Dodiya (2013): A comparative clinical study on the effect of Guduchi-Bhadramustadi yoga administered orally and by basti in the management of sthaulya w.s.r to obesity. Department of Panchakarma, IPGT&RA Jamnagar</ref></li>
<li>In a comparative study, vaitararana basti has shown marked improvement in 45% of patients of ghridrasi. Whereas siravyadha has shown marked improvement in 55% of patients. [[Vaitarana Basti|Vaitarana basti]] was found more effective than siravedha in [[Stambhana|stambha (stiffness)]], spandana (twitching), suptata (numbness), sakthikshephanigraha (SLR) and gaurava(heaviness).<ref name="ref22">Paikrao Sumedh Narayanrao (2014): A clinical study on siravedha and vaitarana basti in the management of gridhrasi with special reference to sciatica. Department of Panchakarma, IPGT&RA Jamnagar</ref></li>
<li>[[Yapana basti|Yapana basti]] combined with patrapinda sweda and [[Shamana|shamana]] medicine has shown relatively more effectiveness in the management of majority of symptoms in cervical spondylosis than the group in which [[Yapana basti|yapana basti]] was not administered in combination.<ref name="ref23"/> The group in which [[Yapana basti|yapana basti]] combined has also shown prevention from recurrence and long-lasting effects.</li>
<li>Study of dashamooladi basti in the management of acute stage of [[Amavata|amavata]] has revealed an overall mild improvement in 40% patients, and minor improvement was observed in remaining 60% patients. Complete remission or marked improvement was not found in any of the patient.<ref name="ref24">Anjali V Makodiya (2017): A Clinical Study on Basti Karma in The Short-Term Management of Amavata W.S. R Rheumatoid Arthtitis.Department of Panchakarma, GAAC, Ahmedabad.</ref></li>
<li>The study of lekhana basti in sthoulya has shown marked improvement in 6.66% patients. The 90.90% patients achieved moderate improvement, and 3.03% patients had mild improvement whereas no patients remain unimproved after the treatment.<ref name="ref25">Chintan J Bhatt (2018): A Clinical Study of Lekhana Basti Karma in The Management of Sthaulya (Obesity), Department of Panchakarma, JSAM, Nadiad.</ref></li>
<li>Asthapana basti with udumbara kwatha in raktatisara (ulcerative colitis) has shown complete relief from signs and symptoms in one patient, marked and moderate improvement in 7 and 9 patients respectively.<ref name="ref26">Vimixa D Patel (2018): A Clinical Study of Udumbara Kvatha Basti in the Management of Raktatisara, Department Of panchakarma, JSAM, Nadiad.</ref></li></ul>

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