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|title=Panchakarmiya Siddhi
|titlemode=append
|keywords=Asthapana-basti, Anuvasana-basti, Panchakarma, Siddhi, Shirovirechana, Vamana, Virechana,indications, contra-indications, therapeutic enema, therapeutic purgation, therapeutic emesis, therapeutic intra-nasal administration, Ayurveda, charak samhita, Indian system of medicine.
|description=Siddhi Sthana Chapter 2. Successful administration of [[Panchakarma]] therapies
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|type=article
}}
<big>'''[[Siddhi Sthana]] Chapter 2. Successful administration of [[Panchakarma]] therapies'''</big>
{{Infobox
|title = Panchakarmiya Siddhi
|label1 = Section/Chapter
|data1 = [[Siddhi Sthana]] Chapter 2
|label2 = Preceding Chapter
|data2 = [[Kalpana Siddhi]]
|label4 = Succeeding Chapter
|data4 = [[Bastisutriyam Siddhi]]
|label5 = Other Sections
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]]
|label6 = Translator and commentator
|data6 = Paliwal M.
|label7 = Reviewer 
|data7  = Mangalasseri P., Auti S.
|label8 = Editors
|data8  = Thakar A. B., Mangalasseri P., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
|label9 = Year of publication 
|data9 =  2020
|label10 = Publisher 
|data10 =  [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI 
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s08.003 10.47468/CSNE.2020.e01.s08.003]
}}
<big>'''Abstract </big>'''
<p style="text-align:justify;">[[Charaka Samhita]] [[Siddhi Sthana]] is designed to discuss the proper methods of application of [[Panchakarma]] as well as complications of the same due to improper use and their successful management. In the previous chapter ([[Kalpana Siddhi]]), various aspects of administration of [[Panchakarma]] were discussed. ''Pravritti'' (indications) and ''nivritti'' (contraindications) of [[Panchakarma]] are essential to discuss without which successful administration cannot be assured. In the beginning of the chapter, persons unsuitable for both ''[[shodhana]]'' and ''shamana chikitsa'' are mentioned. At the end of the chapter, it is stated that in spite of having all the instructions, a wise physician should use his own wisdom and reasoning in arriving at the correct judgment as in many cases contraindications turn into indications and vice versa according to the stage of disease and need of the patient.
<br/>
'''Keywords''':  Asthapana-basti, Anuvasana-basti, [[Panchakarma]], Siddhi, Shirovirechana, [[Vamana]], [[Virechana]], indications, contra-indications, therapeutic enema, therapeutic purgation, therapeutic emesis, therapeutic intra-nasal administration.
</p>

== Introduction ==
<div style="text-align:justify;">
''Dhatusamya'' i.e. equilibrium of body tissues needs to be maintained for disease free state. It is achieved by the prevention and promotion of health as well as cure of diseases. The cure of diseases is done by two means i.e. ''shodhana chikitsa'' (bio-purification therapy) and ''shamana-chikitsa'' (alleviation therapy). ''Shodhana-karma'' or ''chikitsa'' is generally considered as a synonym of [[Panchakarma]] and is accepted as the best therapy for cure of diseases without recurrence. If we go into the depth, we find that there are minor differences between ''shodhana-chikitsa'' and [[Panchakarma]]. ''Shodhana-chikitsa'' is of two types on the basis of external and internal purification where as [[Panchakarma]] is only related to internal purification of the body. Another important aspect is that there may be a long list of ''shodhana-karmas'' but [[Panchakarma]] are only five biopurificatory procedures. ''[[Vamana]]'' (therapeutic  emesis), ''[[virechana]]'' (therapeutic purgation), ''asthapana-[[basti]]'' (therapeutic enema having more quantity of decoction), ''anuvasana-[[basti]]'' (therapeutic enema with medicated oil, ghee etc. fatty substances) and ''shirovirechana'' (head-evacuation) are considered under the heading of [[Panchakarma]]. These five procedures, eliminate the ''[[dosha]]s'' in more quantity and are more potent in purification of the body. These procedures are intended to bring vitiated [[dosha]] from periphery (shakha) to gut (koshtha) and then expel them outside from nearest external orifice thoroughly. Some scholars include ''[[raktamokshana]]'' (blood-letting) among [[Panchakarma]]. However this opinion is not acceptable as it removes [[dosha]] directly from shakha without any prior effect on vitiated dosha in gut. Hence [[Raktamokshana]] cannot be considered under [[panchakarma]].  

[[Panchakarma]] are supposed to produce ''Kaya-kalpa'' i.e. dramatic changes in the body provided properly administered considering ''desha'' (habitat), ''[[kala]]'' (season), ''[[dosha]]'' i.e. ''[[vata]], [[pitta]]'' and ''[[kapha]], [[dushya]]'' (those which get vitiated), ''koshtha'' (nature of bowel), ''agni'' (digestive power), ''bala'' (body strength) and ''[[prakriti]]'' (constitution of the body). Before administration of [[Panchakarma]], indications and contra-indications are essential to be considered to achieve the desired effects. [[Panchakarmiya Siddhi]] is written to discuss the suitable and unsuitable persons or patients for each of the procedure of [[Panchakarma]] which is very much crucial in getting the success. Instructions laid down in this chapter are as per general rule which are followed in most of the cases but exceptions are also found in the text considering the particular stage of disease.
</div>
== Sanskrit text, Transliteration and English Translation ==
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अथातः पञ्चकर्मीयां  सिद्धिं व्याख्यास्यामः||१|| 

इति ह स्माह भगवानात्रेयः||२|| 
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athātaḥ Panchkarmiyaṁ  siddhiṁ vyākhyāsyāmaḥ||1||
 
iti ha smāha bhagavānātrēyaḥ||2||

athAtaH pa~jcakarmIyAM  siddhiM vyAkhyAsyAmaH||1|| 

iti ha smAha bhagavAnAtreyaH||2|| 
</div></div>

Now we shall expound the chapter "Panchakarmiya Siddhi" (Successful administration of [[Panchakarma]] therapies). Thus said Lord Atreya.  [1-2]
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येषां यस्मात् पञ्चकर्माण्यग्निवेश न कारयेत्| <br />
येषां च कारयेत्तानि तत् सर्वं सम्प्रवक्ष्यते||३|| <br />
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yēṣāṁ yasmāt pañcakarmāṇyagnivēśa na kārayēt| <br />
yēṣāṁ ca kārayēttāni tat sarvaṁ sampravakṣyatē||3|| <br />

yeShAM yasmAt pa~jcakarmANyAgniveśaa na kArayet| <br />
yeShAM ca kArayettAni tat sarvaM sampravakShyate||3||<br />
</div></div>
<div style="text-align:justify;">
O! Agnivesha, we will now describe about the patients for whom [[Panchakarma]] therapies are contra-indicated with proper reasoning and the patients for whom [[Panchakarma]] are indicated. [3]
</div>
=== Persons who are generally ''anupakramya'' (unsuitable for treatment) ===
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चण्डः साहसिको भीरुः कृतघ्नो व्यग्र एव च| 

सद्राजभिषजां  द्वेष्टा तद्द्विष्टः शोकपीडितः||४|| 

यादृच्छिको मुमूर्षुश्च विहीनः करणैश्च यः| 

वैरी वैद्यविदग्धश्च श्रद्धाहीनः सुशङ्कितः||५|| 

भिषजामविधेयश्च नोपक्रम्या भिषग्विदा| 

एतानुपचरन् वैद्यो बहून् दोषानवाप्नुयात्||६|| 

एभ्योऽन्ये समुपक्रम्या नराः सर्वैरुपक्रमैः| 

अवस्थां प्रविभज्यैषां वर्ज्यं कार्यं च वक्ष्यते||७||
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caṇḍaḥ sāhasiko bhīruḥ kr̥taghnō vyagra ēva ca| 

sadrājabhiṣajāṁ  dvēṣṭā taddviṣṭaḥ śōkapīḍitaḥ||4|| 

yādr̥cchiko mumūrṣuśca vihīnaḥ karaṇaiśca yaḥ| 

vairī vaidyavidagdhaśca śraddhāhīnaḥ suśaṅkitaḥ||5|| 

bhiṣajāmavidhēyaśca nōpakramyā bhiṣagvidā| 

ētānupacaran vaidyō bahūn dōṣānavāpnuyāt||6|| 

ēbhyō'nyē samupakramyā narāḥ sarvairupakramaiḥ| 

avasthāṁ pravibhajyaiṣāṁ varjyaṁ kāryaṁ ca vakṣyatē||7||

caNDaH sAhasiko bhIruH kRutaghno vyagra eva ca| 

sadrAjabhiShajAM  dveShTA taddviShTaH shokapIDitaH||4|| 

yAdRucchiko mumUrShushca vihInaH karaNaishca yaH| 

vairI vaidyavidagdhashca shraddhAhInaH susha~gkitaH||5|| 

bhiShajAmavidheyashca nopakramyA bhiShagvidA| 

etAnupacaran vaidyo bahUn doShAnavApnuyAt||6|| 

ebhyo~anye samupakramyA narAH sarvairupakramaiH| 

avasthAM pravibhajyaiShAM varjyaM kAryaM ca vakShyate||7|| 
</div></div>
<div style="text-align:justify;">
The wise physician should not treat the following types of patients:

#Who is fierceful or aggressive, adventurous, fearful, ungrateful and fickle minded; 
#Who hates good persons, kings and physicians and who is intensely disliked by them;
#Who is afflicted with grief;
#Who does not believe in God (''nastika'')
#Who is in the end stage of disease and is predicted to die soon;
#Who is not in position to collect the essential items (''karana'') for the treatment;
#Who is enemy or hostile to the physician;
#Who is an impostor and considers himself to be a physician;
#Who is unfaithful to the physician;
#Who is always suspicious (doubtful); and
#Who is not obedient to the physician. The physician, who administers [[Panchakarma]] or any medicine to the above mentioned types of patients, faces many difficulties and does not get success. Persons other than those mentioned above are suitable for all types of [[Panchakarma]] or treatment procedures.

Henceforth, we will discuss the indications and contra-indications of each of the procedure of [[Panchakarma]] therapies considering the different situations. [4-7]
</div>
=== Contra-indications of ''vamana karma'' ===
<div class="mw-collapsible mw-collapsed">

अवम्यास्तावत्-क्षतक्षीणातिस्थूलातिकृशबालवृद्धदुर्बलश्रान्तपिपासितक्षुधितकर्मभाराध्वहतोपवासमैथुनाध्ययनव्यायामचिन्ता-प्रसक्तक्षामगर्भिणीसुकुमारसंवृतकोष्ठदुश्छर्दनोर्ध्वरक्तपित्तप्रसक्तच्छर्दिरूर्ध्ववातास्थापितानुवासितहृद्रोगोदावर्तमूत्राघात-प्लीहगुल्मोदराष्ठीलास्वरोपघाततिमिरशिरशङ्खकर्णाक्षिशूलार्ताः||८|| 
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avamyāstāvat- kṣatakṣīṇātisthūlātikr̥śabālavr̥ddhadurbalaśrāntapipāsitakṣudhitakarmabhārādhvahatōpavāsamaithunādhyayanavyāyāmacintā-prasaktakṣāmagarbhiṇīsukumārasaṁvr̥takōṣṭhaduśchardanōrdhvaraktapittaprasaktacchardirūrdhvavātāsthāpitānuvāsitahr̥drōgōdāvartamūtrāghāta-plīhagulmōdarāṣṭhīlāsvarōpaghātatimiraśiraśaṅkhakarṇākṣiśūlārtāḥ||8|| 

avamyAstAvat- kShatakShINAtisthUlAtikRushabAlavRuddhadurbalashrAntapipAsitakShudhitakarmabhArAdhvahatopavAsamaithunAdhyayanavyAyAmacintA-prasaktakShAmagarbhiNIsukumArasaMvRutakoShThadushchardanordhvaraktapittaprasaktacchardirUrdhvavatasthApitAnuvAsitahRudrogodAvartamUtrAghAta-plIhagulmodarAShThIlAsvaropaghAtatimirashirasha~gkhakarNAkShishUlArtAH||8|| 
</div></div>

The persons or patients for whom ''vamana'' is contraindicated are mentioned in the following table:

{| class="wikitable" style="text-align: center;
|-
! scope="col"| Serial No.
! scope="col"| Disease or State in which ''[[vamana]]'' is contraindicated
! scope="col"| Translation in English
|-
| 1
| ''Kshata''
| Chest Injury
|-
| 2
| ''Kshina''
| Emaciated
|-
| 3
| ''Atishula''
| Excessively Obese
|-
| 4
| ''Atikrisha''
| Excessively Lean
|-
| 5
| ''Baala''
| Children (aged under 10 years)
|-
| 6
| ''Vriddha''
| Old/Elderly
|-
| 7
| ''Durbala''
| Weak
|-
| 8
| ''Shraanta''
| Fatigued
|-
| 9
| ''Pipasita''
| Thirsty
|-
| 10
| ''Kshudhita''
| Hungry
|-
| 11
| ''Karmahata''
| Work related fatigue
|-
| 12
| ''Bhaarahata''
| Exhaustion due to carrying heavy-weight
|-
| 13
| ''Adhvahata''
| Exhaustion due to wayfaring/walking on foot
|-
| 14
| ''Upavaasa-prasakta-kshaama''
| Weakness due to excessive fasting
|-
| 15
| ''Maithuna-prasakta-kshaama''
| Exhaustion due to excessive sexual activities
|-
| 16
| ''Adhyayana-prasakta-kshaama''
| Exhaustion due to excessive academic activities
|-
| 17
| ''[[Vyayama]]-prasakta-kshaama''
| Exhaustion due to excessive physical exercise
|-
| 18
| ''Chinta-prasakta-kshaama''
| Exhaustion due to excessive worry/anxiety
|-
| 19
| ''Garbhini''
| Pregnant Woman
|-
| 20
| ''Sukumara''
| One having tender health
|-
| 21
| ''Samvritta Koshtha''
| One having obstructed bowel
|-
| 22
| ''Dushchardana''
| One who does not respond to emesis easily
|-
| 23
| ''Urdhvaraktapitta''
| One suffering from bleeding from the upper tract.
|-
| 24
| ''Prasaktachhardi''
| (One suffering from) Continuous vomiting
|-
| 25
| ''Urdhvavata''
| One suffering from upward movement of vata.
|-
| 26
| ''Asthapita''
| One who has taken medicated enema (having higher amount of decoction)
|-
| 27
| ''Anuvasita''
| One who has taken medicated enema (having higher amount of decoction)
|-
| 28
| ''Hridroga''
| Heart disease
|-
| 29
| ''Udavarta''
| Disorder due to improper functioning of vata
|-
| 30
| ''Mutraghata''
| Anuria/Oliguria
|-
| 31
| ''Pleeha-roga''
| Splenic disorder
|-
| 32
| ''Gulma''
| Abdominal lump
|-
| 33
| ''Udara-roga''
| Obstinate abdominal diseases including ascites
|-
| 34
| ''Ashtheela''
| Enlarged prostrate
|-
| 35
| ''Svaropaghaata''
| Choked voice
|-
| 36
| ''Timira''
| Cataract
|-
| 37
| ''Shirahshoolaarta''
| One suffering from headache
|-
| 38
| ''Shankhashoolaarta''
| One suffering from pain in temporal region
|-
| 39
| ''Karnashoolaarta''
| One suffering from pain in the ears
|-
| 40
| ''Akshishoolaarta''
| One suffering from pain in the eyes
|}

[8]

=== Adverse effects of ''vamana karma'' administered in contra-indicated conditions ===
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तत्र क्षतस्य भूयः क्षणनाद्रक्तातिप्रवृत्तिः स्यात्, क्षीणातिस्थूलकृशबालवृद्धदुर्बलानामौषधबलासहत्वात् प्राणोपरोधः,श्रान्तपिपासितक्षुधितानां च तद्वत्, कर्मभाराध्वहतोपवासमैथुनाध्ययनव्यायामचिन्ताप्रसक्तक्षामाणां 
रौक्ष्याद्वातरक्तच्छेदक्षतभयं स्यात्, गर्भिण्या गर्भव्यापदामगर्भभ्रंशाच्चदारुणा रोगप्राप्तिः, सुकुमारस्यहृदयापकर्षणादूर्ध्वमधो  वा रुधिरातिप्रवृत्तिः, संवृतकोष्ठदुश्छर्दनयोरतिमात्रप्रवाहणाद्दोषाः समुत्क्लिष्टा अन्तःकोष्ठे जनयन्त्यन्तर्विसर्पं स्तम्भं जाड्यं वैचित्त्यं मरणं वा, ऊर्ध्वगरक्तपित्तिन उदानमुत्क्षिप्य प्राणान् हरेद्रक्तं चातिप्रवर्तयेत्,प्रसक्तच्छर्देस्तद्वत्, ऊर्ध्ववातास्थापितानुवासितानामूर्ध्वं वातातिप्रवृत्तिः, हृद्रोगिणोहृदयोपरोधः, उदावर्तिनो घोरतर उदावर्तःस्याच्छीघ्रतरहन्ता, मूत्राघातादिभिरार्तानां तीव्रतरशूलप्रादुर्भावः, तिमिरार्तानां तिमिरातिवृद्धिः, शिरःशूलादिषु शूलातिवृद्धिः;तस्मादेते न वम्याः| 
सर्वेष्वपि तु खल्वेतेषु विषगरविरुद्धाजीर्णाभ्यवहारामकृतेष्वप्रतिषिद्धं शीघ्रतरकारित्वादेषामिति  ||९|| 
<div class="mw-collapsible-content">

tatra kṣatasya bhūyaḥ kṣaṇanādraktātipravr̥ttiḥ syāt, kṣīṇātisthūlakr̥śabālavr̥ddhadurbalānāmauṣadhabalāsahatvāt prāṇōparōdhaḥ,śrāntapipāsitakṣudhitānāṁ ca tadvat, karmabhārādhvahatōpavāsamaithunādhyayanavyāyāmacintāprasaktakṣāmāṇāṁ 
raukṣyādvātaraktacchēdakṣatabhayaṁ syāt, garbhiṇyā garbhavyāpadāmagarbhabhraṁśāccadāruṇā rōgaprāptiḥ, sukumārasyahr̥dayāpakarṣaṇādūrdhvamadhō  vā rudhirātipravr̥ttiḥ, saṁvr̥takōṣṭhaduśchardanayōratimātrapravāhaṇāddōṣāḥ samutkliṣṭā antaḥkōṣṭhē janayantyantarvisarpaṁ stambhaṁ jāḍyaṁ vaicittyaṁ maraṇaṁ vā, ūrdhvagaraktapittina udānamutkṣipya prāṇān harēdraktaṁ cātipravartayēt,prasaktacchardēstadvat, ūrdhvavātāsthāpitānuvāsitānāmūrdhvaṁ vātātipravr̥ttiḥ, hr̥drōgiṇōhr̥dayōparōdhaḥ, udāvartinō ghōratara udāvartaḥsyācchīghratarahantā, mūtrāghātādibhirārtānāṁ tīvrataraśūlaprādurbhāvaḥ, timirārtānāṁ timirātivr̥ddhiḥ, śiraḥśūlādiṣu śūlātivr̥ddhiḥ; tasmādētē navamyāḥ| 
sarvēṣvapi tu khalvētēṣu viṣagaraviruddhājīrṇābhyavahārāmakr̥tēṣvapratiṣiddhaṁ śīghratarakāritvādēṣāmiti ||9||

tatra kShatasya bhUyaH kShaNanAdraktAtipravRuttiH syAt, kShINAtisthUlakRushabAlavRuddhadurbalAnAmauShadhabalAsahatvAt prANoparodhaH,shrAntapipAsitakShudhitAnAM ca tadvat, karmabhArAdhvahatopavAsamaithunAdhyayanavyAyAmacintAprasaktakShamanAM 
raukShyAdvataraktacchedakShatabhayaM syAt, garbhiNyA garbhavyApadAmagarbhabhraMshAccadAruNA rogaprAptiH, sukumArasyahRudayApakarShaNAdUrdhvamadho  vA rudhirAtipravRuttiH, saMvRutakoShThadushchardanayoratimAtrapravAhaNAddoShAH samutkliShTAantaHkoShThe  janayantyantarvisarpaM stambhaM jADyaM vaicittyaM maraNaM vA, Urdhvagaraktapittina udAnamutkShipya prANAn haredraktaMcAtipravartayet, prasaktacchardestadvat, UrdhvavatasthApitAnuvAsitAnAmUrdhvaM vatatipravRuttiH, hRudrogiNohRudayoparodhaH, udAvartino ghorataraudAvartaH syAcchIghratarahantA, mUtrAghAtAdibhirArtAnAM tIvratarashUlaprAdurbhAvaH, timirArtAnAM timirAtivRuddhiH, shiraHshUlAdiShu shUlAtivRuddhiH;tasmAdete na vamyAH| 
sarveShvapi tu khalveteShu viShagaraviruddhAjIrNAbhyavahArAmakRuteShvapratiShiddhaM shIghratarakAritvAdeShAmiti  ||9|| 
</div></div>
<div style="text-align:justify;">
If a person suffering from ''kshata'' (chest injury) is given ''vamana'' (emetic therapy), then it further aggravates the injury (to the lungs) and causes excessive haemoptysis. 

If ''[[vamana]]'' is given to a person who is ''ksheena'' (emaciated), ''atisthula, atikrisha, bala, vriddha'' and ''durbala'', then this produce danger to their life because such types of patients are incapable to tolerate the effects of drugs which are used for ''[[vamana]]''. The similar effect is observed when ''[[vamana]]'' is administered to a person who is fatigued, thirsty and hungry.

If ''[[vamana]]'' is administered to a person who is broken down by doing hard work, carrying excessive weight and travels long on foot, and who is weakened by long term fasting, sexual indulgence, study, exercise and worry, then because of dryness, the ''[[vata]]'' in his body gets aggravated. He may get hemorrhage and injury to his lungs.

If a pregnant woman is given ''[[vamana]]'', then this may produce complications of pregnancy and occurrence of severe diseases because of the abortion of immature fetus.

If the person who is delicate is given ''[[vamana]]'', then because of undue pressure on the heart, it may give rise to hemorrhage from the upward or downward tracts.

If a person whose ''koshtha'' (bowel) is occluded or who does not respond to ''[[vamana]]'' therapy easily, then the administration of this therapy leads to excessive bouts of urge for vomiting leading to the aggravation of ''[[dosha]]'' and these ''[[dosha]]'' cause internal ''visarpa'' (erysipelas), ''stambha'' (stiffness), ''jadya'' (dullness), ''vaichitya'' (mental perversion) or death.

If ''[[vamana]]'' is administered to a person suffering from ''urdhvaga-raktapitta'', it may take out vital breath by pushing ''udana'' upwards and may cause excessive bleeding. Similar effects are observed if ''[[vamana]]'' is given to a person who is already suffering from constant vomiting.

If the ''[[vamana]]'' is administered to a person suffering from ''urdhvavata'', and who has taken ''asthapana'' or ''anuvasana'' types of medicated enema, then it causes upward movement of the ''[[vata]]'' in excess.

If ''[[vamana]]'' is given to a person suffering from heart disease, it causes the sudden cessation of cardiac motion i.e. cardiac arrest.
If ''[[vamana]]'' is administered to a person suffering from ''udavarta'', it causes severe ''udavarta'' (disorder due to improper functioning of ''[[vata]]'') which results in death of the patient shortly.

''[[Vamana]]'' given to a person suffering from ''mutraghata'' (oliguria/anuria), ''pliha-roga'' (splenic disorder), ''gulma'' (abdominal lump) etc. diseases, causes pain of more severe nature.

''[[Vamana]]'' given to the patients suffering from ''timira'' (cataract), increases the cataract.

''[[Vamana]]'' given to the persons suffering from headache, pain in the ears and eyes etc. leads to aggravation of pain. Therefore, ''[[vamana]]'' is contra-indicated for all these types of patients. However, in all these cases ''[[vamana]]'' is not contra-indicated in the conditions of poisons, artificial poisons, incompatible food, intake of food during indigestion and ''ama'' (ailment caused by the product of improper digestion and metabolism) because these conditions are of emergent nature.                                                                                                                                          
[9]
</div>
=== Indications of ''vamana karma'' ===
<div class="mw-collapsible mw-collapsed">

शेषास्तु वम्याः; विशेषतस्तु  पीनसकुष्ठनवज्वरराजयक्ष्मकासश्वासगलग्रहगलगण्डश्लीपदमेहमन्दाग्निविरुद्धाजीर्णान्नविसूचिकालसकविषगरपीतदष्टदिग्धविद्धाधःशोणितपित्तप्रसेक (दुर्नाम  )हृल्लासारोचकाविपाकापच्यपस्मारोन्मादातिसारशोफपाण्डुरोगमुखपाकदुष्टस्तन्यादयः श्लेष्मव्याधयो विशेषेणमहारोगाध्यायोक्ताश्च; एतेषु हि वमनं प्रधानतममित्युक्तं केदारसेतुभेदे शाल्याद्यशोषदोषविनाशवत्||१०|| 
<div class="mw-collapsible-content">

śēṣāstu vamyāḥ; viśēṣatastu pīnasakuṣṭhanavajvararājayakṣmakāsaśvāsagalagrahagalagaṇḍaślīpadamēhamandāgniviruddhājīrṇānnavisūcikālasakaviṣagarapītadaṣṭadigdhaviddhādhaḥśōṇitapittaprasēka (durnāma  )hr̥llāsārōcakāvipākāpacyapasmārōnmādātisāraśōphapāṇḍurōgamukhapākaduṣṭastanyādayaḥślēṣmavyādhayō viśēṣēṇa mahārōgādhyāyōktāśca;

ētēṣu hi Vamanṁ pradhānatamamityuktaṁkēdārasētubhēdē śālyādyaśōṣadōṣavināśavat||10|| 
	
sheShAstu vamyAH; visheShatastu pInasakuShThanavajvararAjayakShmakAsashvAsagalagrahagalagaNDashlIpadamehamandAgniviruddhAj-

IrNAnnavisUcikAlasakaviShagarapItadaShTadigdhaviddhAdhaHshoNitapittapraseka (durnAma  )hRullAsArocakAvipAkApacyapasmAronmAdAtisArashophapANDurogamukhapAkaduShTastanyAdayaHshleShmavyAdhayo visheSheNa mahArogAdhyAyoktAshca; 

eteShu hi VamanM pradhAnatamamityuktaMkedArasetubhede shAlyAdyashoShadoShavinAshavat||10||
</div></div>
 
''vamana karma'' is indicated for the diseases other than above mentioned but especially useful in the diseases given in the following table:

{| class="wikitable" style="text-align: center;
|-
! scope="col"| Serial No.
! scope="col"| Disease or State (in which ''vamana'' is contraindicated)
! scope="col"| Translation in English
|-
| 1
| ''Peenasa''
| Coryza
|-
| 2
| ''Kushtha''
| All types of skin diseases, including leprosy
|-
| 3
| ''Navajwara''
| Acute fever
|-
| 4
| ''Rajayakshma''
| Tuberculosis
|-
| 5
| ''Kaasa''
| Cough
|-
| 6
| ''Shvaasa''
| Bronchia Asthma
|-
| 7
| ''Galagraha''
| Spasm in the throat
|-
| 8
| ''Galagandha''
| Goitre
|-
| 9
| ''Shleepada''
| Elephantiasis
|-
| 10
| ''Meha''
| Obstinate urinary disorders, including diabetes mellitus
|-
| 11
| ''Mandaagni''
| Supression of digestion fire
|-
| 12
| ''Viruddhaanna''
| Ailments caused due to intake of incompatible diet
|-
| 13
| ''Ajeernaanna''
| Ailments caused due to indigestion
|-
| 14
| ''Vishuchika''
| Cholera
|-
| 15
| ''Alasaka''
| Intestinal torpor
|-
| 16
| ''Visha-peeta''
| Ailments caused by ingesting natural poisons
|-
| 17
| ''Gara-peeta''
| Ailments caused by ingesting artificial/synthetic poisons
|-
| 18
| ''Visha-dashta''
| Poisonous bites
|-
| 19
| ''Visha-digdha-viddha''
| Ailments caused due to injury with weapons laced with poison
|-
| 20
| ''Adhah - shonitapitta''
| Diseases characterized by bleeding from downward tracts
|-
| 21
| ''Praseka''
| Excessive salivation
|-
| 22
| ''Durnaama''
| Piles
|-
| 23
| ''Hrillasa''
| Nausea
|-
| 24
| ''Arochaka''
| Anorexia
|-
| 25
| ''Avipaaka''
| Indigestion
|-
| 26
| ''Apachi''
| Cervical adenitis
|-
| 27
| ''Apasmara''
| Epilepsy
|-
| 28
| ''Unmada''
| Psychotic disorders
|-
| 29
| ''Atisara''
| Diarrhea
|-
| 30
| ''Shopha''
| Swelling
|-
| 31
| ''Pandu Roga''
| Anemia
|-
| 32
| ''Mukhapaaka''
| Stomatitis
|-
| 33
| ''Dushta-stanya''
| Vitiated breast milk
|-
| 34
| ''Shelshmavyadhayo Visheshena Maharogadhyayoktah''
| All ''[[Kapha dosha]]'' disorders mentioned in the [[Maharoga Adhyaya]] of [[Charaka Samhita]] [[Sutra Sthana]]
|}
<div style="text-align:justify;">
In these above mentioned conditions, action of ''[[vamana]] karma'' in causing cure of diseases caused by aggravation of ''[[kapha]]'' being similar to water laden paddy field getting spoiled due to clogging of water which can be corrected by the letting out the water out of the field like ''[[vamana]]'' does with ''[[kapha]]''. [10]
</div>
=== Contra-indications of ''[[virechana]] karma'' ===
<div class="mw-collapsible mw-collapsed">

अविरेच्यास्तु सुभगक्षतगुदमुक्तनालाधोभागरक्तपित्तिविलङ्घितदुर्बलेन्द्रियाल्पाग्निनिरूढकामादिव्यग्राजीर्णिनवज्वरि-मदात्ययिताध्मातशल्यार्दिताभिहतातिस्निग्धरूक्षदारुणकोष्ठाः क्षतादयश्च गर्भिण्यन्ताः||११|| 
<div class="mw-collapsible-content">

avirēcyāstusubhagakṣatagudamuktanālādhōbhāgaraktapittivilaṅghitadurbalēndriyālpāgninirūḍhakāmādivyagrājīrṇinavajvari-madātyayitādhmātaśalyārditābhihatātisnigdharūkṣadāruṇakōṣṭhāḥ kṣatādayaśca garbhiṇyantāḥ||11|| 

avirecyAstusubhagakShatagudamuktanAlAdhobhAgaraktapittivila~gghitadurbalendriyAlpAgninirUDhakAmAdivyagrAjIrNinavajvari-madAtyayitAdhmAtashalyArditAbhihatAtisnigdharUkShadAruNakoShThAH kShatAdayashca garbhiNyantAH||11|| 
</div></div>

The cases which are considered unfit for ''Virechana Karma'' are mentioned in the following table:

{| class="wikitable" style="text-align: center;
|-
! scope="col"| Serial No.
! scope="col"| Disease or State (in which ''[[virechana]]'' is contraindicated)
! scope="col"| Translation in English
|-
| 1
| ''Subhaga''
| A person with tender health or soft perineum
|-
| 2
| ''Kshataguda''
| (A person with) lacerated/bruised anorectum
|-
| 3
| ''Muktanaala''
| (A person with) prolapsed rectum
|-
| 4
| ''Adobhaaga-raktapitti''
| Bleeding through downward tracts
|-
| 5
| ''Vilanghita''
| (A person who is)weakened due to excessive fasting
|-
| 6
| ''Durbalendriya''
| (A person with) weak sensory and motor organs
|-
| 7
| ''Alpaagni''
| (A person with) poor digestive fire
|-
| 8
| ''Niruddha''
| (A person who has taken) ''niruha'' type of enema
|-
| 9
| ''Kaamadivyagra''
| (A person whose) mind is agitated by passion/sexual emotions.
|-
| 10
| ''Ajeerna''
| Indigestion
|-
| 11
| ''Navajwara''
| Acute fever
|-
| 12
| ''Madaatyayita''
| Suffering from alchoholism
|-
| 13
| ''Aadhmaata'' 
| Abdominal distention or tympanitis
|-
| 14
| ''Shalyaardita''
| Inflicted with foreign bodies
|-
| 15
| ''Abhihata''
| Injured
|-
| 16
| ''Atisnigdha''
| Over-unctuous
|-
| 17
| ''Atiruksha''
| Excessively dry/rough
|-
| 18
| ''Daarunakoshtha''
| (A person with) hard bowel
|-
| 19
| ''Kshataadayah Garbhinyantaah''
| Those in the category of conditions ranging from injured to pregnant, under contraindication of ''vamana''
|}
[11]

=== Adverse effects of ''[[virechana]] karma'' administered in contra-indicated conditions ===
<div class="mw-collapsible mw-collapsed">

तत्र सुभगस्य सुकुमारोक्तो दोषः स्यात्, क्षतगुदस्य क्षते गुदे प्राणोपरोधकरीं रुजां जनयेत्, मुक्तनालमतिप्रवृत्त्या हन्यात्,अधोभागरक्तपित्तिनं तद्वत्, विलङ्घितदुर्बलेन्द्रियाल्पाग्निनिरूढा औषधवेगं न सहेरन्, कामादिव्यग्रमनसो न प्रवर्तते कृच्छ्रेणवा प्रवर्तमानमयोगदोषान् कुर्यात्, अजीर्णिन आमदोषः स्यात्, नवज्वरिणोऽविपक्वान् दोषान् न निर्हरेद् वातमेव च कोपयेत्,मदात्ययितस्य मद्यक्षीणे देहे वायुः प्राणोपरोधं कुर्यात्, आध्मातस्याधमतो वा पुरीषकोष्ठे  निचितो वायुर्विसर्पन्सहसाऽऽनाहं तीव्रतरं मरणं वा जनयेत्, शल्यार्दिताभिहतयोः क्षते वायुराश्रितो जीवितं हिंस्यात्, अतिस्निग्धस्यातियोगभयंभवेत्, रूक्षस्य वायुरङ्गप्रग्रहं कुर्यात्, दारुणकोष्ठस्य विरेचनोद्धता दोषाहृच्छूलपर्वभेदानाहाङ्गमर्दच्छर्दिमूर्च्छाक्लमाञ्जनयित्वा प्राणान् हन्युः, क्षतादीनां गर्भिण्यन्तानां छर्दनोक्तो दोषः स्यात्;तस्मादेते न विरेच्याः||१२|| 
<div class="mw-collapsible-content">

tatra subhagasya sukumārōktō dōṣaḥ syāt, kṣatagudasya kṣatē gudē prāṇōparōdhakarīṁ rujāṁ janayēt,muktanālamatipravr̥ttyā hanyāt, adhōbhāgaraktapittinaṁ tadvat, vilaṅghitadurbalēndriyālpāgninirūḍhāauṣadhavēgaṁ na sahēran, kāmādivyagramanasō na pravartatē kr̥cchrēṇa vā pravartamānamayōgadōṣānkuryāt, ajīrṇina āmadōṣaḥ syāt, navajvariṇō'vipakvān dōṣān na nirharēd vātamēva ca kōpayēt, madātyayitasyamadyakṣīṇē dēhē vāyuḥ prāṇōparōdhaṁ kuryāt, ādhmātasyādhamatō vā purīṣakōṣṭhē  nicitō vāyurvisarpansahasā''nāhaṁ tīvrataraṁ maraṇaṁ vā janayēt, śalyārditābhihatayōḥ kṣatē vāyurāśritō jīvitaṁ hiṁsyāt,atisnigdhasyātiyōgabhayaṁ bhavēt, rūkṣasya vāyuraṅgapragrahaṁ kuryāt, dāruṇakōṣṭhasya virēcanōddhatādōṣā hr̥cchūlaparvabhēdānāhāṅgamardacchardimūrcchāklamāñjanayitvā prāṇān hanyuḥ, kṣatādīnāṁgarbhiṇyantānāṁ chardanōktō dōṣaḥ syāt; tasmādētē na virēcyāḥ||12|| 

tatra subhagasya sukumArokto doShaH syAt, kShatagudasya kShate gude prANoparodhakarIM rujAM janayet,muktanAlamatipravRuttyA hanyAt, adhobhAgaraktapittinaM tadvat, vila~gghitadurbalendriyAlpAgninirUDhAauShadhavegaM na saheran, kAmAdivyagramanaso na pravartate kRucchreNa vA pravartamAnamayogadoShAnkuryAt, ajIrNina AmadoShaH syAt, navajvariNo~avipakvAn doShAn na nirhared vAtameva ca kopayet, madAtyayitasyamadyakShINe dehe vĀyuH prANoparodhaM kuryAt, AdhmAtasyAdhamato vA purIShakoShThe  nicito vĀyurvisarpansahasA~a~anAhaM tIvrataraM maraNaM vA janayet, shalyArditAbhihatayoH kShate vĀyurAshrito jIvitaM hiMsyAt,atisnigdhasyAtiyogabhayaM bhavet, rUkShasya vĀyura~ggapragrahaM kuryAt, dAruNakoShThasya virecanoddhatAdoShA hRucchUlaparvabhedAnAhA~ggamardacchardimUrcchAklamA~jjanayitvA prANAn hanyuH, kShatAdInAMgarbhiNyantAnAM chardanokto doShaH syAt; tasmAdete na virecyAH||12|| 
</div></div>
<div style="text-align:justify;">
If ''[[virechana]]'' is given to a person who is ''subhaga'' (having tender health or soft perineum), then he or she will suffer from the same disorder as described for ''[[vamana]]'' administered to ''sukumara'' (having tender health).
 
''[[Virechana]]'' given to the person suffering from anal injury will cause severe pain in the injured anus which may be even life threatening.

''[[Virechana]]'' administered to the person suffering from prolapsed rectum may cause excessive diarrhea and prolapse which leads to the death of the patient. Similar adverse effects are observed if ''[[virechana]]'' is administered in the person suffering from ''adhobhaga-raktapitta''  (disease characterized by bleeding through the downward tract).

A person, who is specifically lightened due to fasting, has weak senses, low power of digestion or who has undergone ''niruha'' type of enema, cannot tolerate the effects of virechana medicines. 

If ''[[virechana]]'' is given to the person whose mind is agitated by passion etc., then there will be either no purgation or purgation with difficulty. In such conditions, harmful effects are observed due to improper administration of ''[[virechana]]''.

''[[Virechana]]'' administered in the persons suffering from ''ajirna'' (indigestion) causes diseases due to ''ama'' (product of improper digestion and metabolism).

''[[Virechana]]'' given to the patients suffering from acute fever does not eliminate the ''[[dosha]]'' which are unripened and causes aggravation of ''[[vata dosha]]''.

''[[Virechana]]'' administered to a person suffering from alcoholism and whose body is emaciated due to over use of wine leads to aggravation of ''[[vata dosha]]'' and causes danger to his life.

''[[Virechana]]'' given in that suffering from tympanitis, ''[[vata]]'' accumulated in the chamber of feces may spread further which cause sudden more severe abdominal distension or death.

''[[Virechana]]'' given in a person suffering from foreign body inside the body or injured by weapons, ''[[vata]]'' located in the wound may take away the life.

''[[Virechana]]'' administered in the person who is excessively uncted or oleated, exerts the excessive effects and in a "dry" (un-oily) person, ''[[vata]]'' may produce stiffness in the body parts. ''[[Virechana]]'' given to the person having costive bowel, ''[[dosha]]'' excited by purgation may produce cardiac pain, tearing pain in joints, ''anaha'' (hardness of bowels, constipation), body-ache, vomiting, fainting and exhaustion. This may lead to the death of the patient.

''[[Virechana]]'' given in those suffering from disease beginning with ''kshata'' (chest wound) and ending with pregnancy, the defects said under ''[[vamana]]'' may arise.
Therefore, above mentioned persons should not be treated with ''[[virechana]] karma''.                    [12]
</div>
=== Indications of ''[[virechana]] karma'' ===
<div class="mw-collapsible mw-collapsed">

शेषास्तु विरेच्याः; विशेषतस्तुकुष्ठज्वरमेहोर्ध्वरक्तपित्तभगन्दरोदरार्शोब्रध्नप्लीहगुल्मार्बुदगलगण्डग्रन्थिविसूचिकालसकमूत्राघातक्रिमिकोष्ठविसर्प-पाण्डुरोगशिरःपार्श्वशूलोदावर्तनेत्रास्यदाहहृद्रोगव्यङ्गनीलिकानेत्रनासिकास्यस्रवणहलीमकश्वासकासकामला-पच्यपस्मारोन्मादवातरक्तयोनिरेतोदोषतैमिर्यारोचकाविपाकच्छर्दिश्वयथूदरविस्फोटकादयः  पित्तव्याधयो विशेषेणमहारोगाध्यायोक्ताश्च; एतेषु हि विरेचनं प्रधानतममित्युक्तमग्न्युपशमेऽग्निगृहवत्||१३|| 
<div class="mw-collapsible-content">

śēṣāstu virēcyāḥ; viśēṣatastukuṣṭhajvaramēhōrdhvaraktapittabhagandarōdarārśōbradhnaplīhagulmārbudagalagaṇḍagranthivisūcikālasakamūtrāghātakrimikōṣṭhavisarpa-pāṇḍurōgaśiraḥpārśvaśūlōdāvartanētrāsyadāhahr̥drōgavyaṅganīlikānētranāsikāsyasravaṇahalīmakaśvāsakāsakāmalā-pacyapasmārōnmādavātaraktayōnirētōdōṣataimiryārōcakāvipākacchardiśvayathūdaravisphōṭakādayaḥ  pittavyādhayō viśēṣēṇamahārōgādhyāyōktāśca; ētēṣu hi virēcanaṁ pradhānatamamityuktamagnyupaśamē'gnigr̥havat||13|| 

sheShAstu virecyAH; visheShatastukuShThajvaramehordhvaraktapittabhagandarodarArshobradhnaplIhagulmArbudagalagaNDagranthivisUcikAlasakamUtrAghAtakrimikoShThavisarpa-pANDurogashiraHpArshvashUlodAvartanetrAsyadAhahRudrogavya~gganIlikAnetranAsikAsyasravaNahalImakashvAsakAsakAmalA-pacyapasmAronmAdavAtaraktayoniretodoShataimiryArocakAvipAkacchardishvayathUdaravisphoTakAdayaH  pittavyAdhayo visheSheNamahArogAdhyAyoktAshca; eteShu hi VirecanaM pradhAnatamamityuktamagnyupashame~agnigRuhavat||13||
</div></div>

The persons other than above-mentioned are fit for ''[[virechana]] karma''. It is specially advised for the persons mentioned in the table below:

{| class="wikitable" style="text-align: center;
|-
! scope="col"| Serial No.
! scope="col"| Disease or State (in which ''[[virechana]]'' is indicated)
! scope="col"| Translation in English
|-
| 1
| ''Kushtha''
| Obstinate skin diseases, including leprosy
|-
| 2
| ''[[Jwara]]''
| Fever
|-
| 3
| ''Meha''
| Obstinate urinary disorders, including diabetes mellitus
|-
| 4
| ''Urdhva-Raktapitta''
| Bleeding from upward tracts
|-
| 5
| ''Bhagandara''
| Fistula in ano
|-
| 6
| ''Udara roga''
| Obstinate abdominal diseases, including ascites
|-
| 7
| ''Arsha roga''
| Piles
|-
| 8
| ''Bradhna roga''
| Inguinal swelling
|-
| 9
| ''Pleeha roga''
| Splenomegaly
|-
| 10
| ''Gulma roga''
| Abdominal lump
|-
| 11
| ''Arbuda roga''
| Tumor
|-
| 12
| ''Galagandha''
| Goitre
|-
| 13
| ''Granthi roga''
| Lymphadenitis/cystic swellings
|-
| 14
| ''Visuchika roga''
| Cholera
|-
| 15
| ''Alasaka roga''
| Intestinal torpor
|-
| 16
| ''Mutraghata''
| Oliguria/Anuria
|-
| 17
| ''Krimikoshtha''
| Helminthiasis
|-
| 18
| ''Visarpa roga''
| Erysipelas
|-
| 19
| ''Pandu roga''
| Anemia
|-
| 20
| ''Sirah shula''
| Headache
|-
| 21
| ''Parshva shula''
| Pain in lateral sides of chest
|-
| 22
| ''Udavarta roga''
| Upward and oblique movement of wind in abdomen
|-
| 23
| ''Netra daaha''
| Burning sensation in the eyes
|-
| 24
| ''Aasya daaha''
| Burning sensation in the mouth
|-
| 25
| ''Hridroga'' 
| Heart disease
|-
| 26
| ''Vyanga roga''
| Dark brownish patches over the face
|-
| 27
| ''neelika roga''
| Bluish black moles
|-
| 28
| ''Netra sravana''
| Excessive discharge from the eyes
|-
| 29
| ''Naasika sravana''
| Excessive discharge from the nose
|-
| 30
| ''Aasya sravana''
| Excessive salivation
|-
| 31
| ''Haleemaka''
| A type of jaundice
|-
| 32
| ''Shvasa roga''
| Dyspnea
|-
| 33
| ''Kaasa roga''
| Cough
|-
| 34
| ''Kaamala''
| Jaundice
|-
| 35
| ''Apachi roga''
| Cervical adenitis
|-
| 36
| ''Apasmara roga''
| Epilepsy
|-
| 37
| ''Unmada roga''
| Psychotic disorders
|-
| 38
| ''Vatarakta''
| Gout
|-
| 39
| ''Yoni dosha''
| Defects of female genital tract
|-
| 40
| ''Retodosha''
| Defects of semen
|-
| 41
| ''Timira''
| Cataract
|-
| 42
| ''Arochaka''
| Anorexia
|-
| 43
| ''Avipaka''
| Indigestion
|-
| 44
| ''Chhardi''
| Vomiting
|-
| 45
| ''Shvayathu''
| Edema
|-
| 46
| ''Visphotaka''
| Pustular eruptions
|-
| 47
| ''Pitta vyadhyayo visheshena Maharogadhyayoktah''
| ''Paittika'' type disorders mentioned in [[Maharoga Adhyaya]] of [[Charaka Samhita]] [[Sutra Sthana]]
|}
<div style="text-align:justify;">
For the above-mentioned diseases, ''[[virechana]] karma'' is the foremost therapy. As the extinguisher of fire normalizes a house on fire, similarly ''[[virechana]] karma'' cures the diseases by eliminating aggravated ''[[pitta]]''. [13]
</div>
=== Contra-indications of ''asthapana [[basti]]'' ===
<div class="mw-collapsible mw-collapsed">

अनास्थाप्यास्तुअजीर्ण्यतिस्निग्धपीतस्नेहोत्क्लिष्टदोषाल्पाग्नियानक्लान्तातिदुर्बलक्षुत्तृष्णाश्रमार्तातिकृशभुक्तभक्तपीतोदकवमितविरिक्तकृतनस्तः-

कर्मकुद्धभीतमत्तमूर्च्छितप्रसक्तच्छर्दिनिष्ठीविकाश्वासकासहिक्काबद्धच्छिद्रोदकोदराध्मानालसकविसूचिकामप्रजातामातिसार-मधुमेहकुष्ठार्ताः||१४|| 
<div class="mw-collapsible-content">

anāsthāpyāstuajīrṇyatisnigdhapītasnēhōtkliṣṭadōṣālpāgniyānaklāntātidurbalakṣuttr̥ṣṇāśramārtātikr̥śabhuktabhaktapītōdakavamitaviriktakr̥tanastaḥ-

karmakuddhabhītamattamūrcchitaprasaktacchardiniṣṭhīvikāśvāsakāsahikkābaddhacchidrōdakōdarādhmānālasakavisūcikāmaprajātāmātisāra-madhumēhakuṣṭhārtāḥ||14|| 

anAsthApyAstuajIrNyatisnigdhapItasnehotkliShTadoShAlpAgniyAnaklAntAtidurbalakShuttRuShNAshramArtAtikRushabhuktabhaktapItodakavamitaviriktakRutanastaH-

karmakuddhabhItamattamUrcchitaprasaktacchardiniShThIvikAshvAsakAsahikkAbaddhacchidrodakodarAdhmAnAlasakavisUcikAmaprajAtAmAtisAra-madhumehakuShThArtAH||14|| 
</div></div>

Administration of ''asthapana'' or ''niruha [[basti]]'' is contra-indicated in the persons mentioned in the table given below:

{| class="wikitable" style="text-align: center;
|-
! scope="col"| Serial No.
! scope="col"| Disease or State (in which ''asthapana [[basti]]'' is contraindicated)
! scope="col"| Translation in English
|-
| 1
| ''Ajeerna''
| Indigestion
|-
| 2
| ''Atisnigdha''
| Over-unctuous
|-
| 3
| ''Peetasneha''
| (A person who has just ingested) smoothening/uncting substances
|-
| 4
| ''Utklishtha [[dosha]]''
| (A person who has) excited ''[[dosha]]''
|-
| 5
| ''Alpaagni''
| Suppression of the power of digestion
|-
| 6
| ''Yaanaklaanta''
| (A person who is) exhausted due to riding
|-
| 7
| ''Atidurbala''
| (A person who is) excessively weak
|-
| 8
| ''Kshudhaarta''
| (A person who is) excessively hungry
|-
| 9
| ''Trishnaarta''
| (A person who is) excessively thirsty
|-
| 10
| ''Shramaarta''
| (A person who is) excessively tired (of doing laborious work)
|-
| 11
| ''Atikrisha''
| (A person who is) excessively emaciated
|-
| 12
| ''Bhuktabhakta''
| (A person who has) just ingested food
|-
| 13
| ''Peetodaka''
| (A person who has) just drunk water
|-
| 14
| ''Vamita''
| (A person who has) just undergone emesis
|-
| 15
| ''Virikta''
| (A person who has) just undergone purgation
|-
| 16
| ''Krita nastah karma''
| (A person who has) just used snuff (powder)
|-
| 17
| ''Kruddha''
| Anger
|-
| 18
| ''Bheeta''
| (A person who is) under the grip of fear
|-
| 19
| ''Matta''
| (A person who is) under the influence of narcosis
|-
| 20
| ''Murchhita''
| (A person who has) fainted
|-
| 21
| ''Prasaktachhardi''
| (A person who is) continuously vomiting
|-
| 22
| ''Nishtheevika''
| (A person who is) excessively spitting
|-
| 23
| ''Shvasa roga''
| Dyspnea
|-
| 24
| ''Kaasa roga''
| Cough
|-
| 25
| ''Hikka roga''
| Hiccup
|-
| 26
| ''Baddhodaraadhmaana''
| Tympanitis due to intestinal obstruction
|-
| 27
| ''Chidrodaraadhmaana''
| Tympanitis due to intestinal perforation
|-
| 28
| ''Udakodaraadhmaana''
| Tympanitis due to ascites
|-
| 29
| ''Alasaka roga''
| Intestinal torpor
|-
| 30
| ''Visuchika roga''
| Cholera
|-
| 31
| ''Amaprajaata''
| A woman who has delivered a premature baby
|-
| 32
| ''Amatisaara''
| Diarrhea associated with the symptoms of ama, i.e., the product of indigestion
|-
| 33
| ''Madhumeha''
| Diabetes mellitus
|-
| 34
| ''Kushtha roga''
| Obstinate skin diseases including leprosy
|}
	
[14]

=== Adverse effects of ''asthapana [[basti]]'' administered in contra-indicated persons ===
<div class="mw-collapsible mw-collapsed">

तत्राजीर्ण्यतिस्निग्धपीतस्नेहानां दूष्योदरं मूर्च्छाश्वयथुर्वा स्यात्, उत्क्लिष्टदोषमन्दाग्न्योररोचकस्तीव्रः, यानक्लान्तस्य क्षोभव्यापन्नोबस्तिराशु देहं शोषयेत्, अतिदुर्बलक्षुत्तृष्णाश्रमार्तानां पूर्वोक्तोदोषः स्यात्, अतिकृशस्य कार्श्यं पुनर्जनयेत्,भुक्तभक्तपीतोदकयोरुत्क्लिश्योर्ध्वमधो वा  वायुर्बस्तिमुत्क्षिप्य क्षिप्रं घोरान् विकाराञ्जनयेत्, वमितविरिक्तयोस्तु रूक्षं शरीरं निरूहःक्षतं क्षार इव दहेत्, कृतनस्तःकर्मणो विभ्रंशं भृशसंरुद्धस्रोतसः  कुर्यात्, क्रुद्धभीतयोर्बस्तिरूर्ध्वमुपप्लवेत्, मत्तमूर्च्छितयो र्भृशंविचलितायां सञ्ज्ञायां चित्तोपघाताद् व्यापत् स्यात्, प्रसक्तच्छर्दिर्निष्ठीविकाश्वासकासहिक्कार्तानामूर्ध्वीभूतो वायुरूर्ध्वं बस्तिं नयेत्,बद्धच्छिद्रोदकोदराध्मानार्तानां भृशतरमाध्माप्य बस्तिः प्राणान् हिंस्यात्, अलसकविसूचिकामप्रजातामातिसारिणामामकृतो दोषःस्यात्, मधुमेहकुष्ठिनोर्व्याधेः पुनर्वृद्धिः; तस्मादेते नास्थाप्याः||१५||
<div class="mw-collapsible-content">

tatrājīrṇyatisnigdhapītasnēhānāṁ dūṣyōdaraṁ mūrcchāśvayathurvā syāt, utkliṣṭadōṣamandāgnyōrarōcakastīvraḥ, yānaklāntasyakṣōbhavyāpannō bastirāśu dēhaṁ śōṣayēt, atidurbalakṣuttr̥ṣṇāśramārtānāṁ pūrvōktōdōṣaḥ syāt, atikr̥śasya kārśyaṁ punarjanayēt,bhuktabhaktapītōdakayōrutkliśyōrdhvamadhō vā  vāyurbastimutkṣipya kṣipraṁ ghōrān vikārāñjanayēt, vamitaviriktayōstu rūkṣaṁ śarīraṁnirūhaḥ kṣataṁ kṣāra iva dahēt, kr̥tanastaḥkarmaṇō vibhraṁśaṁ bhr̥śasaṁruddhasrōtasaḥ  kuryāt,kruddhabhītayōrbastirūrdhvamupaplavēt, mattamūrcchitayō rbhr̥śaṁ vicalitāyāṁ sañjñāyāṁ cittōpaghātād vyāpat syāt,prasaktacchardirniṣṭhīvikāśvāsakāsahikkārtānāmūrdhvībhūtō vāyurūrdhvaṁ bastiṁ nayēt, baddhacchidrōdakōdarādhmānārtānāṁ bhr̥śataramādhmāpya bastiḥ prāṇān hiṁsyāt, alasakavisūcikāmaprajātāmātisāriṇāmāmakr̥tō dōṣaḥ syāt, madhumēhakuṣṭhinōrvyādhēḥpunarvr̥ddhiḥ; tasmādētē nāsthāpyāḥ||15||

tatrAjIrNyatisnigdhapItasnehAnAM dUShyodaraM mUrcchAshvayathurvA syAt, utkliShTadoShamandAgnyorarocakastIvraH, yAnaklAntasyakShobhavyApanno bastirAshu dehaM shoShayet, atidurbalakShuttRuShNAshramArtAnAM pUrvoktodoShaH syAt, atikRushasya kArshyaMpunarjanayet, bhuktabhaktapItodakayorutklishyordhvamadho vA  vĀyurbastimutkShipya kShipraM ghorAn vikArA~jjanayet, vamitaviriktayosturUkShaM sharIraM nirUhaH kShataM kShAra iva dahet, kRutanastaHkarmaNo vibhraMshaM bhRushasaMruddhasrotasaH  kuryAt,kruddhabhItayorbastirUrdhvamupaplavet, mattamUrcchitayo rbhRushaM vicalitAyAM sa~jj~jAyAM cittopaghAtAd vyApat syAt,prasaktacchardirniShThIvikAshvAsakAsahikkArtAnAmUrdhvIbhUto vĀyurUrdhvaM bastiM nayet, baddhacchidrodakodarAdhmAnArtAnAMbhRushataramAdhyApya bastiH prANAn hiMsyAt, alasakavisUcikAmaprajAtAmAtisAriNAmAmakRuto doShaH syAt, madhumehakuShThinorvyAdheHpunarvRuddhiH; tasmAdete nAsthApyAH||15||
</div></div>
<div style="text-align:justify;">
Application of ''Asthapana-[[basti]]'' (non-unctuous enema) in the persons suffering from indigestion, over-uncted and just taken unctuous substances causes ''dushyodara'' (''udara-roga'' caused by aggravation of all the three ''[[dosha]]''), fainting or edema. In the cases having excited ''[[dosha]]'' and suppression of digestion power, it causes severe type of anorexia. In a person exhausted due to riding, the ''asthapana''-''[[basti]]'' disturbed by agitation dry up the body quickly leading to emaciation. In the persons who are excessively weak and suffering from excessive hunger, thirst and tiredness, ''[[basti]]'' causes the same harms as discussed for exhausted due to riding. In excessively emaciated person if ''asthapana-[[basti]]'' is applied, it increases the emaciation. In those who have just taken food and water, ''asthapana [[basti]]'' causes provocation of ''[[vata]]'' which divert the enema upwards or downwards leading to manifestation of severe diseases soon. In that undergone emesis or purgation, the ''niruha'' or ''asthapana-[[basti]]'' burns the body as alkali does the wound. In a person who has undergone the snuffing, it causes the untoward effects related to sense organs and further obstruction of the channels of circulation. In the person having anger and fear, the ''[[basti]]'' may go upwards and produce agitation. In the condition of narcosis and fainting, the ''[[basti]]'' causes further agitation and there may be complications due to mental injury. If ''asthapana [[basti]]'' is applied in the conditions of constant vomiting, excessive spitting, dyspnea, cough and hiccup, ''[[vata]]'' moving upwards can cause upward movement of ''[[basti]]''. In the persons suffering from intestinal obstruction, intestinal perforation and ascites associated with tympanitis, ''asthapana [[basti]]'' further increase the distension and may lead to the death of the patient. In the persons suffering from ''alasaka, visuchika,'' premature delivery and ''amatisara'', it causes the disorders due to ''ama'' (product of improper digestion). In diabetes mellitus and ''kushtha'' (obstinate skin diseases including leprosy), application of ''asthapana [[basti]]'' further increases these diseases. Therefore, ''asthapana [[basti]]'' should not be given to the above mentioned persons.[15]
</div>
=== Indications of ''asthapana [[basti]]'' ===
<div class="mw-collapsible mw-collapsed">

शेषास्त्वास्थाप्याः; विशेषतस्तुसर्वाङ्गैकाङ्गकुक्षिरोगवातवर्चोमूत्रशुक्रसङ्गबलवर्णमांसरेतःक्षयदोषाध्मानाङ्गसुप्तिक्रिमिकोष्ठोदावर्तशुद्धातिसार-पर्वभेदाभितापप्लीहगुल्मशूलहृद्रोगभगन्दरोन्मादज्वरब्रध्नशिरःकर्णशूलहृदयपार्श्वपृष्ठकटीग्रहवेपनाक्षेपकगौरवातिलाघव-रजःक्षयार्तविषमाग्निस्फिग्जानुजङ्घोरुगुल्फपार्ष्णिप्रपदयोनिबाह्वङ्गुलिस्तनान्तदन्तनखपर्वास्थिशूल-शोषस्तम्भान्त्रकूजपरिकर्तिकाल्पाल्पसशब्दोग्रगन्धोत्थानादयो  वातव्याधयो विशेषेण महारोगाध्यायोक्ताश्च;एतेष्वास्थापनं प्रधानतममित्युक्तं वनस्पतिमूलच्छेदवत्||१६|| 
<div class="mw-collapsible-content">
	
śēṣāstvāsthāpyāḥ; viśēṣatastusarvāṅgaikāṅgakukṣirōgavātavarcōmūtraśukrasaṅgabalavarṇamāṁsarētaḥkṣayadōṣādhmānāṅgasuptikrimikōṣṭhōdāvartaśuddhātisāra-parvabhēdābhitāpaplīhagulmaśūlahr̥drōgabhagandarōnmādajvarabradhnaśiraḥkarṇaśūlahr̥dayapārśvapr̥ṣṭhakaṭīgrahavēpanākṣēpakagauravātilāghava-rajaḥkṣayārtaviṣamāgnisphigjānujaṅghōrugulphapārṣṇiprapadayōnibāhvaṅgulistanāntadantanakhaparvāsthiśūla-śōṣastambhāntrakūjaparikartikālpālpasaśabdōgragandhōtthānādayō  vātavyādhayō viśēṣēṇa mahārōgādhyāyōktāśca; ētēṣvāsthāpanaṁpradhānatamamityuktaṁ vanaspatimūlacchēdavat||16||

sheShAstvAsthApyAH; visheShatastusarvA~ggaikA~ggakukShirogavatavarcomUtrashukrasa~ggabalavarNamAMsaretaHkShayadoShAdhmAnA~ggasuptikrimikoShThodAvartashuddhAtisAra-parvabhedAbhitApaplIhagulmashUlahRudrogabhagandaronmAdajvarabradhnashiraHkarNashUlahRudayapArshvapRuShThakaTIgrahavepanAkShepakagauravAtilAghava-rajaHkShayArtaviShamAgnisphigjAnuja~gghorugulphapArShNiprapadayonibAhva~ggulistanAntadantanakhaparvAsthishUla-shoShastambhAntrakUjaparikartikAlpAlpasashabdogragandhotthAnAdayo  vAtavyAdhayo visheSheNa mahArogAdhyAyoktAshca; eteShvĀsthāpanaMpradhAnatamamityuktaM vanaspatimUlacchedavat||16|| 
</div></div>

The persons other than above-mentioned are fit for ''asthapana [[basti]]''. It is especially useful for the persons mentioned in the table below:

{| class="wikitable" style="text-align: center;
|-
! scope="col"| Serial No.
! scope="col"| Disease or State (in which ''asthapana [[basti]]'' is indicated)
! scope="col"| Translation in English
|-
| 1
| ''Sarvaanga roga''
| Paralysis of the whole body
|-
| 2
| ''Ekaanga roga''
| Paralysis of one of the limb
|-
| 3
| ''Kukshi roga''
| Disorder of abdomen
|-
| 4
| ''[[Vata]] sanga''
| Retention of flatus
|-
| 5
| ''Varcho sanga''
| Retention of feces
|-
| 6
| ''Mootra sanga''
| Retention of urine
|-
| 7
| ''[[Shukra]] sanga''
| Retention of semen
|-
| 8
| ''Bala kshaya''
| Diminution of strength
|-
| 9
| ''Varna kshaya''
| Diminution of complexion
|-
| 10
| ''[[Mamsa]] kshaya''
| Diminution of muscle tissue
|-
| 11
| ''Retah kshaya''
| Diminution of semen
|-
| 12
| ''Doshaadhmaana''
| Tympanitis
|-
| 13
| ''Anga supti''
| Numbness of body parts
|-
| 14
| ''Krimikoshtha''
| Parasitic infestation of intestine
|-
| 15
| ''Udaavarta''
| Disorder due to reverse movement of the vata
|-
| 16
| ''Shuddhaatisaara''
| Diarrhea without association of ama
|-
| 17
| ''Parvabheda''
| Tearing pain in joints
|-
| 18
| ''Abhitaapa''
| Feeling of burning sensation
|-
| 19
| ''Pleeha roga''
| Splenic disorder
|-
| 20
| ''Gulma roga''
| Abdominal lump
|-
| 21
| ''Shula roga''
| Colic pain
|-
| 22
| ''Hridroga''
| Heart disease
|-
| 23
| ''Bhagandara''
| Fistula in ano
|-
| 24
| ''Unmada roga''
| Psychotic disorders
|-
| 25
| ''[[Jwara]]''
| Fever
|-
| 26
| ''Bradhna roga''
| Inguinal swelling
|-
| 27
| ''Shirahshula''
| Headache
|-
| 28
| ''Karnashula''
| Earache
|-
| 29
| ''Hridaya graha''
| Stiffness in heart
|-
| 30
| ''Paarshva graha''
| Stiffness in sides
|-
| 31
| ''Prishtha graha''
| Stiffness in back
|-
| 32
| ''Kati graha''
| Stiffness in waist
|-
| 33
| ''Vepana aarta''
| Suffering from tremor
|-
| 34
| ''Aakshepaka aarta''
| Suffering from convulsions
|-
| 35
| ''Gauravaarta''
| Suffering from heaviness
|-
| 36
| ''Atilaaghavaarta''
| Suffering from excessive lightness
|-
| 37
| ''Rajah-kshayaarta''
| Suffering from amenorrhea
|-
| 38
| ''Vishamaagni''
| Irregular power of digestion
|-
| 39
| ''Sphik-shula-shosha-stambha''
| Pain, atrophy and stiffness of hip
|-
| 40
| ''Jaanu-shula-shosha-stambha''
| Pain, atrophy and stiffness of knee-joints
|-
| 41
| ''Janghaa-shula-shosha-stambha''
| Pain, atrophy and stiffness of the calf region
|-
| 42
| ''Uru-shula-shosha-stambha''
| Pain, atrophy and stiffness of the thighs
|-
| 43
| ''Gulpha-shula-shosha-stambha''
| Pain, atrophy and stiffness of the ankles
|-
| 44
| ''Paarshni-shula-shosha-stambha''
| Pain, atrophy and stiffness of the heels
|-
| 45
| ''Prapada-shula-shosha-stambha''
| Pain, atrophy and stiffness of the feet
|-
| 46
| ''Yoni-shula-shosha-stambha''
| Pain, atrophy and stiffness of female genitals
|-
| 47
| ''Baahu-shula-shosha-stambha''
| Pain, atrophy and stiffness of arms
|-
| 48
| ''Anguli-shula-shosha-stambha''
| Pain, atrophy and stiffness of fingers
|-
| 49
| ''Stanaanta-shula-shosha-stambha''
| Pain, atrophy and stiffness of the periphery of the breasts
|-
| 50
| ''Danta-shula-shosha-stambha''
| Pain, atrophy and stiffness of teeth
|-
| 51
| ''Nakha-shula-shosha-stambha''
| Pain, atrophy and stiffness of nails
|-
| 52
| ''Parva-shula-shosha-stambha''
| Pain, atrophy and stiffness of joints
|-
| 53
| ''Asthi-shula-shosha-stambha''
| Pain, atrophy and stiffness of bones
|-
| 54
| ''Aantra koojana''
| Intestinal gurgling
|-
| 55
| ''Parikartika''
| Cutting pain in anal region
|-
| 56
| ''Alpaalpa-utthaana''
| Voiding stool in small quantity frequently
|-
| 57
| ''Sashabda-utthaana''
| Voiding stool with sound
|-
| 58
| ''Ugragandha-utthaana aadayo vyaadhyayah''
| (Diseases that cause) voiding stool with foul smell
|-
| 59
| ''Vata-vyaadhayo visheshena maharogadhyayoktah''
| Vatika disorders specially discussed in [[Maharoga Adhyaya]] of [[Charaka Samhita]] [[Sutra Sthana]]
|}
<div style="text-align:justify;">	
In the above mentioned diseases, ''asthapana [[basti]]'' is the foremost therapy. As a tree gets destroyed by cutting its roots, similarly the above mentioned diseases are eradicated by administration of ''asthapana [[basti]]''. [16]
</div>
=== Contra-indications of ''anuvasana [[basti]]'' ===
<div class="mw-collapsible mw-collapsed">

य एवानास्थाप्यास्त एवाननुवास्याः स्युः;विशेषतस्त्वभुक्तभक्तनवज्वरपाण्डुरोगकामलाप्रमेहार्शःप्रतिश्यायारोचकमन्दाग्निदुर्बलप्लीहकफोदरोरुस्तम्भवर्चोभेद-विषगरपीतपित्तकफाभिष्यन्दगुरुकोष्ठश्लीपदगलगण्डापचिक्रिमिकोष्ठिनः  ||१७|| 
<div class="mw-collapsible-content">

ya ēvānāsthāpyāsta ēvānanuvāsyāḥ syuḥ;viśēṣatastvabhuktabhaktanavajvarapāṇḍurōgakāmalāpramēhārśaḥpratiśyāyārōcakamandāgnidurbalaplīhakaphōdarōrustambhavarcōbhēda-viṣagarapītapittakaphābhiṣyandagurukōṣṭhaślīpadagalagaṇḍāpacikrimikōṣṭhinaḥ  ||17|| 

ya evAnAsthApyAsta evAnanuvAsyAH syuH;visheShatastvabhuktabhaktanavajvarapANDurogakAmalApramehArshaHpratishyAyArocakamandAgnidurbalaplIhakaphodarorustambhavarcobheda-viShagarapItapittakaphAbhiShyandagurukoShThashlIpadagalagaNDApacikrimikoShThinaH  ||17| 
</div></div>
<div style="text-align:justify;">
Those persons who are unfit for ''asthapana [[basti]]'', are considered unfit for ''anuvasana [[basti]]''. Conditions in which ''anuvasana [[basti]]'' is specifically contra-indicated, are listed in the table given below:
</div>
{| class="wikitable" style="text-align: center;
|-
! scope="col"| Serial No.
! scope="col"| Disease or State (in which ''anuvasana [[basti]]'' is contraindicated)
! scope="col"| Translation in English
|-
| 1
| ''Abhuktabhakta''
| A person who has not taken food
|-
| 2
| ''Navajwara''
| Acute fever
|-
| 3
| ''Pandu roga''
| Anemia
|-
| 4
| ''Kaamala''
| Jaundice
|-
| 5
| ''Prameha''
| Obstinate urinary disorders including diabetes
|-
| 6
| ''Arsha roga''
| Piles
|-
| 7
| ''Pratishyaya''
| Coryza
|-
| 8
| ''Arochaka'' 
| Anorexia
|-
| 9
| ''Mandaagni''
| Supression of the power of digestion
|-
| 10
| ''Durbala''
| Weak
|-
| 11
| ''Pleehodara''
| Splenic disorders
|-
| 12
| ''Kaphodara''
| Obstinate abdominal disease caused by aggravation of [[kapha]]
|-
| 13
| ''Urustambha''
| Stiffness of thigh and calf region
|-
| 14
| ''Varchobheda''
| Diarrhea
|-
| 15
| ''Vishapeeta''
| One who has ingested natural poison
|-
| 16
| ''Garapeeta''
| One who has ingested artificial/synthetic poison
|-
| 17
| ''Pittaabhishyanda''
| Conjuctivitis caused by aggravated ''[[pitta]]''
|-
| 18
| ''Kaphaabhishyanda''
| Conjuctivitis caused by aggravated ''[[kapha]]''
|-
| 19
| ''Gurukoshtha''
| Costive bowel
|-
| 20
| ''Shleepada roga''
| Filaria
|-
| 21
| ''Galagandha''
| Goitre
|-
| 22
| ''Apachi roga''
| Cervical adenitis
|-
| 23
| ''Krimikoshthi''
| (Those suffering from) intestinal parasites
|} 

[17]

=== Adverse effects of ''anuvasana [[basti]]'' in contra-indicated conditions ===
<div class="mw-collapsible mw-collapsed">

तत्राभुक्तभक्तस्यानावृतमार्गत्वादूर्ध्वमतिवर्तते स्नेहः, नवज्वरपाण्डुरोगकामलाप्रमेहिणां दोषानुत्क्लिश्योदरञ्जनयेत्,अर्शसस्यार्शांस्यभिष्यन्द्याध्मानं कुर्यात्, अरोचकार्तस्यान्नगृद्धिं पुनर्हन्यात्, मन्दाग्निदुर्बलयोर्मन्दतरमग्निं कुर्यात्,प्रतिश्यायप्लीहादिमतां भृशमुत्क्लिष्टदोषाणां भूय एव दोषं वर्धयेत्; तस्मादेते नानुवास्याः||१८|| 
<div class="mw-collapsible-content">

tatrābhuktabhaktasyānāvr̥tamārgatvādūrdhvamativartatē snēhaḥ, navajvarapāṇḍurōgakāmalāpramēhiṇāṁ dōṣānutkliśyōdarañjanayēt,arśasasyārśāṁsyabhiṣyandyādhmānaṁ kuryāt, arōcakārtasyānnagr̥ddhiṁ punarhanyāt, mandāgnidurbalayōrmandataramagniṁ kuryāt,pratiśyāyaplīhādimatāṁ bhr̥śamutkliṣṭadōṣāṇāṁ bhūya ēva dōṣaṁ vardhayēt; tasmādētē nānuvāsyāḥ||18|| 

tatrAbhuktabhaktasyAnAvRutamArgatvAdUrdhvamativartate snehaH, navajvarapANDurogakAmalApramehiNAM doShAnutklishyodara~jjanayet,arshasasyArshAMsyabhiShyandyAdhmAnaM kuryAt, arocakArtasyAnnagRuddhiM punarhanyAt, mandAgnidurbalayormandataramagniM kuryAt,pratishyAyaplIhAdimatAM bhRushamutkliShTadoShANAM bhUya eva doShaM vardhayet; tasmAdete nAnuvAsyAH||18|| 
</div></div>
<div style="text-align:justify;">
If  ''anuvasana [[basti]]'' is administered to the person who is empty stomach, it goes upwards due to the absence of any obstruction in the passage. In the acute fever, anaemia, jaundice and ''prameha'', ''anuvasana [[basti]]'' causes excitement of ''[[dosha]]'' which further leads to ''Udara roga'' (obstinate abdominal disease including ascites). In the person suffering from piles, use of ''anuvasana [[basti]]'' may create obstruction in the piles leading to ''adhmana'' (abdominal distension). In the person suffering from anorexia, application of ''anuvasana [[basti]]'' further diminishes the desire for food. In case of suppression of power of digestion and weakness, the application of ''anuvasana [[basti]]'' makes the digestive power poorer. If ''anuvasana [[basti]]'' is administered to the persons suffering from coryza, splenic disorders and such other diseases, it causes the further excitement of ''[[dosha]]'' which are already aggravated. Therefore, the above mentioned persons are unfit for the administration of ''anuvasana [[basti]]''. [18]
</div>
=== Indications of ''anuvasana [[basti]]'' ===
<div class="mw-collapsible mw-collapsed">

य एवास्थाप्यास्त एवानुवास्याः; विशेषतस्तु रूक्षतीक्ष्णाग्नयः केवलवातरोगार्ताश्च; एतेषु ह्यनुवासनं प्रधानतममित्युक्तं मूलेद्रुमप्रसेकवत्||१९|| 
<div class="mw-collapsible-content">

ya ēvāsthāpyāsta ēvānuvāsyāḥ; viśēṣatastu rūkṣatīkṣṇāgnayaḥ kēvalavātarōgārtāśca; ētēṣu hyanuvāsanaṁ pradhānatamamityuktaṁ mūlēdrumaprasēkavat||19|| 

ya evAsthApyAsta evAnuvAsyAH; visheShatastu rUkShatIkShNAgnayaH kevalavAtarogArtAshca; eteShu hyAnuvāsanaM pradhAnatamamityuktaMmUle drumaprasekavat||19||
</div></div>
<div style="text-align:justify;">
The persons who are fit for ''asthapana [[basti]]'' are considered fit for ''anuvasana [[basti]]'' also. The conditions where specifically it is indicated, are listed in the table given below:
</div>
{| class="wikitable" style="text-align: center;
|-
! scope="col"| Serial No.
! scope="col"| Disease or State (in which ''anuvasana [[basti]]'' is indicated)
! scope="col"| Translation in English
|-
| 1
| ''Rukshah''
| A person having dryness in the body
|-
| 2
| ''Teekshnagnayah''
| A person having intense power of digestion
|-
| 3
| ''Kevalavata rogaartah''
| A person suffering from diseases caused due to ''[[vata]]'' alone, and not associated with ''ama''.
|}

In such patients, ''anuvasana [[basti]]'' is said to be the most effective and could be likened to watering a plant in its root.[19]

=== Contra-indications of ''shirovirechana'' ===
<div class="mw-collapsible mw-collapsed">

अशिरोविरेचनार्हास्तु अजीर्णिभुक्तभक्तपीतस्नेहमद्यतोयपातुकामाः स्नातशिराः स्नातुकामःक्षुत्तृष्णाश्रमार्तमत्तमूर्च्छितशस्त्रदण्डहतव्यवायव्यायामपानक्लान्तनवज्वरशोकाभितप्तविरिक्तानुवासितगर्भिणीनवप्रतिश्यायार्ताः,अनृतौ दुर्दिने चेति||२०|| 
<div class="mw-collapsible-content">

aśirōvirēcanārhāstu ajīrṇibhuktabhaktapītasnēhamadyatōyapātukāmāḥ snātaśirāḥ snātukāmaḥkṣuttr̥ṣṇāśramārtamattamūrcchitaśastradaṇḍahatavyavāyavyāyāmapāna-

klāntanavajvaraśōkābhitaptaviriktānuvāsitagarbhiṇīnavapratiśyāyārtāḥ,anr̥tau durdinē cēti||20|| 

aShirovirechnarhAstu ajIrNibhuktabhaktapItasnehamadyatoyapAtukAmAH snAtashirAH snAtukAmaHkShuttRuShNAshramArtamattamUrcchitashastradaNDahatavyavAyavyAyAmapAna-

klAntanavajvarashokAbhitaptaviriktAnuvAsitagarbhiNInavapratishyAyArtAH,anRutau durdine ceti||20|| 
</div></div>

The persons unfit for ''shirovirechana'' (head- evacuation therapy) are listed in the table given below:

{| class="wikitable" style="text-align: center;
|-
! scope="col"| Serial No.
! scope="col"| Disease or State (in which ''shirovirechana'' is contraindicated)
! scope="col"| Translation in English
|-
| 1
| ''Ajeerni''
| A person suffering from indigestion
|-
| 2
| ''Bhuktabhakta''
| A person who has taken food
|-
| 3
| ''Peetasneha''
| A person who has ingested fatty substances.
|-
| 4
| ''Madyapaatukaama''
| A person who is desirous of drinking wine (and other alcoholic beverages)
|-
| 5
| ''Toyapaatukaama''
| A person who is desirous of drinking water
|-
| 6
| ''Snaatashira''
| A person who has taken head bath
|-
| 7
| ''Snaatukaama''
| A person who is desirous of taking bath
|-
| 8
| ''Kshudhaarta''
| A person who is afflicted with hunger, i.e., one who is starving
|-
| 9
| ''Trishnaarta''
| A person who is afflicted with thirst
|-
| 10
| ''Shramaarta''
| A person who is afflicted with exertion
|-
| 11
| ''Matta''
| A person who is afflicted with intoxication
|-
| 12
| ''Murchhita''
| A person who is afflicted with fainting
|-
| 13
| ''Shashtrahata''
| A person who has been injured with a weapon
|-
| 14
| ''Dandahata''
| A person who has been injured with a stick
|-
| 15
| ''Vyavaayaklaanta''
| A person who is exhausted by sexual intercourse
|-
| 16
| ''Vyayaamaklaanta''
| A person who is exhausted by physical exercise
|-
| 17
| ''Paanaklaanta''
| A person who is exhausted by intake of alcohol
|-
| 18
| ''Navajwara''
| Acute fever
|-
| 19
| ''Shokaabhitapta''
| A person who is afflicted with grief
|-
| 20
| ''Virikta''
| A person who has undergone purgation
|-
| 21
| ''Anuvasita''
| A person who has undergone ''Anuvasana [[Basti]]''
|-
| 22
| ''Garbhini''
| A pregnant woman
|-
| 23
| ''Navapratishyaayaarta''
| A person suffering from acute coryza.
|-
| 24
| ''Anritu''
| Unsuitable season
|-
| 25
| ''Durdine''
| Cloudy/Overcast day
|}

[20]

=== Adverse effects of ''shirovirechana'' in contra-indicated conditions ===
<div class="mw-collapsible mw-collapsed">

तत्राजीर्णिभुक्तभक्तयोर्दोष ऊर्ध्ववहानि स्रोतांस्यावृत्य कासश्वासच्छर्दिप्रतिश्यायाञ्जनयेत्, पीतस्नेहमद्यतोयपातुकामानां कृते चपिबतां मुखनासास्रावाक्ष्युपदेहतिमिरशिरोरोगाञ्जनयेत्, स्नातशिरसः कृते च स्नानाच्छिरसः   प्रतिश्यायं, क्षुधार्तस्य वातप्रकोपं,तृष्णार्तस्य पुनस्तृष्णाभिवृद्धिं मुखशोषं च, श्रमार्तमत्तमूर्च्छितानामास्थापनोक्तं दोषं जनयेत्, शस्त्रदण्डहतयोस्तीव्रतरां रुजंजनयेत्, व्यवायव्यायामपानक्लान्तानां शिरःस्कन्धनेत्रोरःपीडनं, नवज्वरशोकाभितप्तयोरूष्मा नेत्रनाडीरनुसृत्य तिमिरं ज्वरवृद्धिंच कुर्यात्, विरिक्तस्य वायुरिन्द्रियोपघातं कुर्यात्, अनुवासितस्य कफः शिरोगुरुत्वकण्डूक्रिमिदोषाञ्जनयेत्, गर्भिण्या गर्भंस्तम्भयेत् स काणः कुणिः पक्षहतः पीठसर्पी वा जायते, नवप्रतिश्यायार्तस्य स्रोतांसि व्यापादयेत्, अनृतौ दुर्दिने च शीतदोषान्पूतिनस्यं शिरोरोगं च जनयेत्; तस्मादेते न शिरोविरेचनार्हाः||२१|| 
<div class="mw-collapsible-content">

tatrājīrṇibhuktabhaktayōrdōṣa ūrdhvavahāni srōtāṁsyāvr̥tya kāsaśvāsacchardipratiśyāyāñjanayēt, pītasnēhamadyatōyapātukāmānāṁ kr̥tē capibatāṁ mukhanāsāsrāvākṣyupadēhatimiraśirōrōgāñjanayēt, snātaśirasaḥ kr̥tē ca snānācchirasaḥ  pratiśyāyaṁ, kṣudhārtasya vātaprakōpaṁ,tr̥ṣṇārtasya punastr̥ṣṇābhivr̥ddhiṁ mukhaśōṣaṁ ca, śramārtamattamūrcchitānāmāsthāpanōktaṁ dōṣaṁ janayēt, śastradaṇḍahatayōstīvratarāṁrujaṁ janayēt, vyavāyavyāyāmapānaklāntānāṁ śiraḥskandhanētrōraḥpīḍanaṁ, navajvaraśōkābhitaptayōrūṣmā nētranāḍīranusr̥tya timiraṁjvaravr̥ddhiṁ ca kuryāt, viriktasya vāyurindriyōpaghātaṁ kuryāt, anuvāsitasya kaphaḥ śirōgurutvakaṇḍūkrimidōṣāñjanayēt, garbhiṇyā garbhaṁstambhayēt sa kāṇaḥ kuṇiḥ pakṣahataḥ pīṭhasarpī vā jāyatē, navapratiśyāyārtasya srōtāṁsi vyāpādayēt, anr̥tau durdinē ca śītadōṣān pūtinasyaṁśirōrōgaṁ ca janayēt; tasmādētē na śirōvirēcanārhāḥ||21|| 

tatrAjIrNibhuktabhaktayordoSha UrdhvavahAni srotAMsyAvRutya kAsashvAsacchardipratishyAyA~jjanayet, pItasnehamadyatoyapAtukAmAnAM kRute capibatAM mukhanAsAsrAvAkShyupadehatimirashirorogA~jjanayet, snAtashirasaH kRute ca snAnAcchirasaH  pratishyAyaM, kShudhArtasya vAtaprakopaM,tRuShNArtasya punastRuShNAbhivRuddhiM mukhashoShaM ca, shramArtamattamUrcchitAnAmĀsthāpanaoktaM doShaM janayet,shastradaNDahatayostIvratarAM rujaM janayet, vyavAyavyAyAmapAnaklAntAnAM shiraHskandhanetroraHpIDanaM, navajvarashokAbhitaptayorUShmAnetranADIranusRutya timiraM jvaravRuddhiM ca kuryAt, viriktasya vĀyurindriyopaghAtaM kuryAt, anuvAsitasya kaphaHshirogurutvakaNDUkrimidoShA~jjanayet, garbhiNyA garbhaM stambhayet sa kANaH kuNiH pakShahataH pIThasarpI vA jAyate, navapratishyAyArtasyasrotAMsi vyApAdayet, anRutau durdine ca shItadoShAn pUtinasyaM shirorogaM ca janayet; tasmAdete na ŚirovirecanarhAH||21|| 
</div></div>
<div style="text-align:justify;">
''Shirovirechana'' applied in the case of indigestion and full stomach causes the occlusion of the channels moving upwards by vitiated ''[[dosha]]'' which further leads to manifestation of cough, dyspnea, vomiting and coryza. In those who have taken fatty substances or desirous of taking wine or water or take after head-evacuation, ''shirovirechana'' gives rise  to discharge from mouth and nose, dirt and stickiness in eyes, cataract and head diseases. If the person who has taken head- bath or takes head-bath after the therapy, then it causes the coryza. Application of ''shirovirechana'' in a person afflicted with hunger causes aggravation of ''[[vata dosha]]''. If it is administered to the person afflicted with thirst then it further increases the thirst and causes the dryness of mouth. ''Shirovirechana'' applied in the cases of fatigue, intoxication and fainting produces the same adverse effects as mentioned under the ''asthapana [[basti]]''. If this therapy is administered in the persons injured with weapons or stick, it increases the pain. In those exhausted by sexual intercourse, physical exercise and intake of alcohol, it causes pain in head, shoulder, eyes and chest. ''Shirovirechana'' applied to those suffering from acute fever and grief causes the heat to spread into the channels of eye, produces the cataract and increases the fever. If this therapy is given to the person who has undergone purgation therapy, then it aggravates ''[[vata dosha]]'' which may further leads to the damage of the sense organs. ''Shirovirechana'' given to the person who has undergone ''anuvasana [[basti]]'', causes aggravation of ''[[kapha dosha]]'' which produces heaviness of head, itching and parasitic infestation. In the case of pregnant woman, this therapy inhibits the growth of the fetus and she gives birth to an offspring who may be blind by one eye, with deformity of upper limbs, hemiplegic and with deformity of lower limbs. ''Shirovirechana'' given to the person suffering from acute coryza causes the morbidity of the channels of circulation. If this therapy is given in unsuitable season and on a cloudy day then it causes the diseases due to cold, putrefied rhinitis and head-diseases. Therefore, these persons are not fit for head-evacuation therapy.  [21]
</div>
=== Indications of ''shirovirechana'' ===
<div class="mw-collapsible mw-collapsed">

शेषास्त्वर्हाः, विशेषतस्तु शिरोदन्तमन्यास्तम्भगलहनुग्रहपीनसगलशुण्डिकाशालूकशुक्रतिमिरवर्त्मरोगव्यङ्गो 
पजिह्विकार्धावभेदकग्रीवास्कन्धांसास्यनासिकाकर्णाक्षिमूर्धकपालशिरोरोगार्दितापतन्त्रकापतानकगलगण्ड-दन्तशूलहर्षचालाक्षिराज्यर्बुदस्वरभेदवाग्ग्रहगद्गदक्रथनादय ऊर्ध्वजत्रुगताश्चवातादिविकाराः परिपक्वाश्च; एतेषु शिरोविरेचनंप्रधानतममित्युक्तं, तद्ध्युत्तमाङ्गमनुप्रविश्य मुञ्जादीषिकामिवासक्तां केवलं विकारकरं दोषमपकर्षति||२२|| 
<div class="mw-collapsible-content">

śēṣāstvarhāḥ, viśēṣatastuśirōdantamanyāstambhagalahanugrahapīnasagalaśuṇḍikāśālūkaśukratimiravartmarōgavyaṅgō 
pajihvikārdhāvabhēdakagrīvāskandhāṁsāsyanāsikākarṇākṣimūrdhakapālaśirōrōgārditāpatantrakāpatānakagalagaṇḍa-dantaśūlaharṣacālākṣirājyarbudasvarabhēdavāggrahagadgadakrathanādaya ūrdhvajatrugatāścavātādivikārāḥparipakvāśca; ētēṣu śirōvirēcanaṁ pradhānatamamityuktaṁ, taddhyuttamāṅgamanupraviśya muñjādīṣikāmivāsaktāṁkēvalaṁ vikārakaraṁ dōṣamapakarṣati||22||

sheShAstvarhAH, visheShatastushirodantamanyAstambhagalahanugrahapInasagalashuNDikAshAlUkashukratimiravartmarogavya~ggo 
pajihvikArdhAvabhedakagrIvAskandhAMsAsyanAsikAkarNAkShimUrdhakapAlashirorogA-

rditApatantrakApatAnakagalagaNDadantashUlaharShacAlAkShirAjyarbudasvarabhedavAggrahagadgadakrathanAdaya UrdhvajatrugatAshcavAtAdivikArAHparipakvAshca; eteShu ŚirovirecanaM pradhAnatamamityuktaM, taddhyuttamA~ggamanupravishyamu~jjAdIShikAmivAsaktAM kevalaM vikArakaraM doShamapakarShati||22||
</div></div>
<div style="text-align:justify;">
The persons other than above mentioned are fit for ''shirovirechana'' (head-evacuation therapy). It is especially useful in the conditions mentioned in the table given below:
</div>
{| class="wikitable" style="text-align: center;
|-
! scope="col"| Serial No.
! scope="col"| Disease or State (in which ''shirovirechana'' is indicated)
! scope="col"| Translation in English
|-
| 1
| ''Shirostambha''
| Stiffness of head
|-
| 2
| ''Dantastambha''
| Stiffness of teeth
|-
| 3
| ''Manyaastambha''
| torticollis
|-
| 4
| ''Galagraha''
| Spasm of the throat
|-
| 5
| ''Hanugraha''
| Lock-jaw
|-
| 6
| ''Peenasa''
| Chronic coryza
|-
| 7
| ''Galashundika''
| Tonsillitis
|-
| 8
| ''Galashaaluka''
| Tumor in the throat
|-
|9
|''Shukra-roga	''
|Disorder of cornea
|-
|10
|''Timira	''
|Cataract, Disorder of vision
|-
|11
|''Vartma-roga	''
|Disorders of eye-lids
|-
|12
|''Vyanga-roga	''
|Freckles 
|-
|13
|''Upajihvika''
|Uvulitis
|-
|14
|''Ardhavabhedaka''	
|Hemicrania, migraine
|-
|15
|''Greeva-roga''
|Diseases of the neck
|-
|16
|''Skandha-roga	''
|Diseases of the shoulders
|-
|17
|''Amsa-roga''
|Diseases of the scapula
|-
|18
|''Asya-roga''
|Diseases of the mouth
|-
|19
|''Nasika-roga''
|Diseases of the nose
|-
|20
|''Karna-roga''
|Diseases of the ears
|-
|21
|''Akshi-roga''
|Diseases of the eyes
|-
|22
|''Murdha-roga''
|Diseases of the cranium
|-
|23
|''Kapala-roga''
|Diseases of the forehead
|-
|24
|''Shiroroga''	
|Diseases of the head
|-
|25
|''Ardita ''
|Facial paralysis
|-
|26
|''Apatantraka''	
|Convulsions with unconsciousness
|-
|27
|''Apatanaka''
|Convulsions with consciousness
|-
|28
|''Galagandha''	
|Goitre 
|-
|29
|''Dantashula''
|Toothache
|-
|30
|''Dantaharsha''
|Tingling sensation of teeth
|-
|31
|''Dantachala'' 	
|Looseness of teeth
|-
|32
|''Akshiraji'' 	
|Streaks in eye
|-
|33
|''Arbuda''
|Tumor
|-
|34
|''Svarabheda''
|Hoarseness of voice
|-
|35
|''Vaggraha'' 	
|Obstructed speech
|-
|36
|''Gadgad'' 	
|Spasmodic speech
|-
|37
|''Krathana-adayah''	
|Stammering etc.
|-
|38
|''Urdhvajatrugatashcha vatadi vikarah paripakvashcha''	
|Diseases of the part above clavicle caused by aggravation of ''[[vata]]'' etc. [[dosha]]'' and which are free from ''ama dosha''
|}
<div style="text-align:justify;">
In these conditions, head-evacuation is the foremost therapy as it entering into the head eliminates the entire pathogenic impurities like fibrous coating of ''munja'' (a type of grass) from the ''pith'' (''ishika''). [22]
</div>
=== Consideration of appropriate time for ''shirovirechana'' in emergency conditions ===
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प्रावृट्शरद्वसन्तेतरेष्वात्ययिकेषु रोगेषु नावनं कुर्यात् कृत्रिमगुणोपधानात्; ग्रीष्मे पूर्वाह्णे, शीते मध्याह्ने, वर्षास्वदुर्दिने चेति||२३|| 
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prāvr̥ṭśaradvasantētarēṣvātyayikēṣu rōgēṣu nāvanaṁ kuryāt kr̥trimaguṇōpadhānāt; grīṣmē pūrvāhṇē, śītēmadhyāhnē, varṣāsvadurdinē cēti||23|| 

prAvRuTsharadvasantetareShvAtyayikeShu rogeShu nAvanaM kuryAt kRutrimaguNopadhAnAt; grIShmepUrvAhNe, shIte madhyAhne, varShAsvadurdine ceti||23|| 
</div></div>
<div style="text-align:justify;">
In the case of emergency, ''shirovirechana'' (head-evacuation therapy) should be given in the season other than ''pravriṭ'' (early rain), ''Sharad'' (autumn) and ''Vasanta'' (spring) by arranging environment artificially. In summer, it should be applied in the morning, in winter during noon time and in rainy season when sky is free from clouds. [23]
</div>
=== Summary ===
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तत्र श्लोकाः- 

इति पञ्चविधं कर्म विस्तरेण निदर्शितम्| 
येभ्यो यन्न हितं यस्मात् कर्म येभ्यश्च यद्धितम्||२४|| 

न  चैकान्तेन निर्दिष्टेऽप्यर्थेऽभिनिविशेद्बुधः| 
स्वयमप्यत्र वैद्येन  तर्क्यं बुद्धिमता भवेत्||२५||
 
उत्पद्येत हि साऽवस्था देशकालबलं प्रति| 
यस्यां कार्यमकार्यं स्यात्  कर्म कार्यं च वर्जितम्||२६|| 

छर्दिर्हृद्रोगगुल्मानां वमनं स्वे चिकित्सिते| 
अवस्थां प्राप्य निर्दिष्टं कुष्ठिनां  बस्तिकर्म च||२७|| 

तस्मात् सत्यपि निर्देशे कुर्यादूह्य स्वयं धिया| 
विना तर्केण या सिद्धिर्यदृच्छासिद्धिरेव सा||२८|| 
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tatra ślōkāḥ- 

iti pañcavidhaṁ karma vistarēṇa nidarśitam| 
yēbhyō yanna hitaṁ yasmāt karma yēbhyaśca yaddhitam||24|| 

na caikāntēna nirdiṣṭē'pyarthē'bhiniviśēdbudhaḥ| 
svayamapyatra vaidyēna  tarkyaṁ buddhimatā bhavēt||25|| 

utpadyēta hi sā'vasthā dēśakālabalaṁ prati| 
yasyāṁ kāryamakāryaṁ syāt  karma kāryaṁ ca varjitam||26|| 

chardirhr̥drōgagulmānāṁ Vamanṁ svē cikitsitē| 
avasthāṁ prāpya nirdiṣṭaṁ kuṣṭhināṁ  bastikarma ca||27|| 

tasmāt satyapi nirdēśē kuryādūhya svayaṁ dhiyā| 
vinā tarkēṇa yā siddhiryadr̥cchāsiddhirēva sā||28|| 

tatra shlokAH- 
iti pa~jcavidhaM karma vistareNa nidarshitam| 
yebhyo yanna hitaM yasmAt karma yebhyashca yaddhitam||24|| 

na  caikAntena nirdiShTe~apyarthe~abhinivishedbudhaH| 
svayamapyatra vaidyena  tarkyaM buddhimatA bhavet||25|| 

utpadyeta hi sA~avasthA deshakAlabalaM prati| 
yasyAM kAryamakAryaM syAt  karma kAryaM ca varjitam||26|| 

chardirhRudrogagulmAnAM VamanM sve cikitsite| 
avasthAM prApya nirdiShTaM kuShThinAM  bastikarma ca||27|| 

tasmAt satyapi nirdeshe kuryAdUhya svayaM dhiyA| 
vinA tarkeNa yA siddhiryadRucchAsiddhireva sA||28|| 
</div></div>
<div style="text-align:justify;">
Now the summing up verses:-

Thus, the [[Panchakarma]] has been described in detail in following sub-headings-

#Contra-indications of each of the ''karma'' (therapy) along with reasoning;
#Indications of each of the ''karma'' (therapy) of [[Panchakarma]].

The wise physician should not blindly follow the general instructions laid down in this chapter in the form of conclusions but he should decide rationally using his own discretion because condition may arise due to the nature of place, time and strength of the patient in which the prescribed therapy may be ineffective and the prohibited therapy may be applicable such as emesis is prescribed in certain stage of vomiting, heart-disease and ''gulma'' (abdominal lump) though it is generally contra-indicated. Similarly ''[[basti]]'' is advised in the treatment of ''kushtha roga'' though it is generally contra-indicated depending upon the particular stage of the disease. Hence, in spite of general instructions available in the text, a physician should rationally think all the aspects using his intellect. The success achieved without proper reasoning is nothing but the success by chance. [24-28]
</div>
<div class="mw-collapsible mw-collapsed">

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसंपूरिते सिद्धिस्थाने पञ्चकर्मीयसिद्धिर्नाम द्वितीयोऽध्यायः॥२॥
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Ityagniveśakṛte tantre Carakapratisaṃskṛteˈprāpte Dṛḍhabalasampūrite Siddhisthāne Pañcakarmīyasiddhirnāma dvitīyoˈdhyāyaḥ .||2||

ityAgniveśaakRute tantre carakapratisaMskRute~prApte dRuDhabalasaMpUrite siddhisthAne pa~jcakarmIyasiddhirnAma dvitIyo~dhyAyaH. ||2||
</div></div>
<div style="text-align:justify;">
Thus, ends the second chapter on successful management of [[Panchakarma]] in the treatise composed by Agnivesha, redacted by Charaka and because of its non-availability, supplemented by Dridhabala. [2]

== Tattva Vimarsha (Fundamental Principles) ==
 
*All the [[Panchakarma]] procedures like ''[[vamana]]'' (therapeutic emesis), ''[[virechana]]''( therapeutic purgation), ''asthapana'' (medicated enema with decoction), ''anuvasana'' ( medicated enema with oil), ''shirovirechana'' (purification of head and supraclavicular region) shall be performed after through examination of patients about indications and contra-indications. 
*If these procedures are performed in the contra-indicated state, it leads to iatrogenic diseases. 
*''[[Vamana]]'' (therapeutic emesis) is mainly indicated in ''[[kapha]]'' dominant diseases. 
*''[[Virechana]]''( therapeutic purgation) is mainly indicated in ''[[pitta]]'' dominant diseases.
*''Asthapana'' (medicated enema with decoction) is mainly indicated in ''[[vata]]'' dominant diseases in which purification is the objective of treatment.
*''Anuvasana'' (medicated enema with oil) is mainly indicated in ''[[vata]]'' dominant diseases in which nourishment and sustaining growth of tissues is the objective of treatment.
*''Shirovirechana'' (purification of head and supraclavicular region) is mainly indicated in ''[[dosha]]'' dominant diseases of all organs present in supraclavicular region including brain.

== Vidhi Vimarsha (Applied Inferences ) ==

=== Chapter authority ===

It is the pattern of this classic that in the beginning of every chapter, Charaka proposes the topic which is to be discussed and secondly the common sentence for all the chapter (इति ह स्माह भगवानात्रेयः) is used which shows the authenticity of the text. There are number of discourses in medical science and it is not possible for all to discuss them completely and meticulously that’s why Agnivesha declares very honestly in the beginning of all the chapters that whatever has been discussed is as per the preaching of his teacher Lord Punarvasu Atreya. The title ''Bhagavana'' (lord) itself reveals that Punarvasu Atreya was an extraordinary personality who could completely discuss the medical science without any mistake and lacunae<ref>Chakrapani, Charak.  In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita. Varanasi:Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No-1-4 </ref>.

=== Success of treatment ===

''Chikitsa'' is indicated in curable disease <ref>Chakrapani, Charak.In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita. Varanasi:Chaukhamba Surbharati Prakashan, reprint edition-2000, Page No.-17.</ref> and another important concept of [[Ayurveda]] in this regard is that ''chatushpada upapatti'' (desired qualities of four limbs of treatment) are one of the important cause in the success of treatment<ref>Chakrapani, Charak.In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita. Varanasi:Chaukhamba Surbharati Prakashan, reprint edition-2000,Page No-66.</ref>. In the above mentioned verses the desired qualities of patients are lacking and patient is one of the important components among ''chatushpada''. In such situations chances of complications are also high.< ref name= chakra> Chakrapani, Charak.In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita. Varanasi:Chaukhamba Surbharati Prakashan, reprint edition-2000, Page No.-687</ref>

=== Contraindications of ''[[vamana]]'' ===

The above mentioned contra-indications are as per general rule but in specific conditions exceptions are also found such as generally ''[[vamana]]'' is contra-indicated in ''gulma roga'' but when ''[[kapha]]'' is increased and causing diminution of digestive fire, anorexia, nausea etc. in ''vatika gulma'', ''[[vamana]]'' is indicated exceptionally.<ref>Chakrapani, Charak.In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.1st ed. Varanasi:Chaukhamba Surbharati Prakashan, reprint edition-2000,Page No.-437 </ref>. Similarly ''[[vamana]]'' is advised in vomiting and heart disease according to condition <ref>Chakrapani, Charak.In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.1st ed. Varanasi:Chaukhamba Surbharati Prakashan, reprint edition-2000,Page No.- 690</ref> which is the exception of the general instruction. In all the above mentioned states of contra-indications, ''[[vamana]]'' is not contra-indicated in the conditions of poisons, artificial poisons, incompatible food, intake of food during indigestion and ''ama'' (ailment caused by the product of improper digestion and metabolism) because these conditions are of emergent nature. <ref name= chakra />

Vagbhata has added following contra-indications for [[vamana]]:

krimikoshtha, ashthila, arsha, bhrama, parshwaruk, Vatavyadhi

=== Indications of ''[[vamana]]'' ===

''[[Vamana]] karma'' is mainly indicated in the diseases caused by ''[[kapha dosha]]'' reason being it is considered the best therapy among all causing elimination of ''[[kapha dosha]]''.<ref>Chakrapani, Charak.  In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.reprint edition. Varanasi: Chaukhamba Surbharati Prakashan;2000.p.4.Page No.-131</ref><ref>Indu. Vagbhata. In:Dr. Shivprasad Sharma,Editor,Ashtanga-Sangraha, 2nd edition, Varanasi: Chaukhamba Sanskrit Series Office, Varanasi (India),2008 Page No.-9</ref><ref>Arunadatta,Hemadri,Vagbhata. In:Bhishagacharya  Harishastri Paradakar Vaidya,9th edition,Varanasi: Chaukhambha Orientalia,2005, Page No.-16</ref>. Vagbhatta says that ''vamana'' is indicated in the ''[[kapha dosha]]'' as well as in the combination of ''[[dosha]]'' where ''[[kapha]]'' is dominant. In the commentary of the view of Vagbhata, Arunadatta in his Sarvangasundara commentary says that here combination of ''[[dosha]]'' should be understood as ''[[kapha]]-[[pitta]]'' association.<ref> Arunadatta,Hemadri,Vagbhata, In:Bhishagacharya  Harishastri Paradakar Vaidya,Editor,9th ed,Varanasi; Chaukhambha Orientalia,2005,Page No.-260</ref>   
    
As per the view of Charaka, one predominant in ''[[kapha]]'' vomits easily.<ref>Chakrapani,Charak,In: Vaidya Yadavji Trikamji Acharya,Editor,repint edition,Varanasi : Chaukhamba Surbharati Prakashan,2000, Page No.-678</ref> This should be accepted as an ideal condition for ''[[vamana]] karma''. Therefore, either it is the diseased or healthy condition, predominance of ''[[kapha]]'' should be observed or produced (by the application of ''[[snehana]]'' and ''[[swedana]]''), then one should administer ''[[vamana]] karma''. In the context of [[Jwara Chikitsa]], Charaka has given the specific view for the application of ''[[vamana]]'' which can be accepted in all the cases if ''[[kapha dosha]]'' is dominant with tendency to come out and situated in ''amashaya'' (stomach). <ref>Chakrapani,Charak,In: Vaidya Yadavji Trikamji Acharya,Editor,reprint edition,Varanasi : Chaukhamba Surbharati Prakashan,2000, Page No.-410</ref>

Vagbhata has added following indications as suitable for [[vamana]]: 
 
Granthi, arbuda, medoroga, vidarika, hridroga, chittavibhrama, visarpa, vidradhi, putinasa, kanthapaka, adhijivhika, galashundika

=== Contraindications of ''[[virechana]]'' ===

''[[Virechana]]'' is not advised in the conditions when ''[[kapha dosha]]'' is increased because ''manda'' (''alpa'') ''[[kapha]]'' is considered as an ideal condition for proper administration of ''[[virechana]] karma''.<ref> Chakrapani, Charak. In: Vaidya Yadavji Trikamji Acharya,Editors, Charak Samhita, Reprint Ed.,Varanasi; Chaukhamba Surbharati Prakashan,2000, Page No.-678</ref>.[[Panchakarma]] is not administered in the state of indigestion.<ref>Arunadatta, Hemadri,In: Bhishagacharya  Harishastri Paradakar Vaidya,editor, Ashtanga Hridayam, 9th edition,Varanasi:Chaukhambha Orientalia,2005, Page No.-261</ref>
Chakrapani, the commentator of [[Charaka Samhita]] has interpreted the term ''subhaga kshata guda'' as ''subhaga guda'' (one who has delicate anus) and ''kshata guda'' (one who has anal injury). He has also mentioned ''subhagam'' means ''sukhasamvardhita'' (those who has never faced any hardship) according to the view of other scholars in his commentary. ''[[Virechana]]'' applied in the person having injury to anus or delicate anus causes harm to the patients. In the person who has taken the ''niruha'' type of enema, at least seven days gap is essential to perform ''[[virechana]] karma'' and vice-versa. ''[[Virechana]]'' in pregnant woman is contra-indicated up to seventh month except in emergency. In eighth month if disease is curable by ''[[vamana]]'' or ''[[virechana]]'', then ''mridu [[vamana]]'' (mild emesis) or ''mridu [[virechana]]'' (mild purgative) can be given.<ref>Chakrapani, Charak. In: Vaidya Yadavji Trikamji Acharya,Editors, Charak Samhita, Reprint Ed.,Varanasi; Chaukhamba Surbharati Prakashan,2000, Page No.-344</ref>

Vagbhata added following conditions in the list of contraindications: 

Navaprasuta, navapratishyaya, Rajyakshma, Atisara, nityadukkhi, hridrogi, bhayabhita

=== Indications of ''[[virechana]]'' ===

''[[Virechana]]'' is considered the best therapy to purify ''[[pitta dosha]]'' especially. <ref>Chakrapani, Charak. In: Vaidya Yadavji Trikamji Acharya,Editors, Charak Samhita, Reprint Ed.,Varanasi; Chaukhamba Surbharati Prakashan,2000, Page No.-131</ref><ref>Indu, Vagbhata, In: Dr. Shivprasad Sharma,Editor, Ashtanga Sangraha, 2nd edition,Varanasi: Chaukhamba Sanskrit Series Office,2008,Page No.-9</ref> <ref>Arunadatta,Hemadri,Vagbhata. In: Bhishagacharya  Harishastri Paradakar Vaidya,Editors,Ashtanga Hridaya,reprint ninth edition,Varanasi; Chaukhambha Orientalia,2005, Page No.-16</ref>

''[[Virechana]]'' eliminates ''[[pitta]]'' or ''[[kapha pitta]]'' situated in ''pittashaya''. <ref name= chakra>Chakrapani, Charak. In: Vaidya Yadavji Trikamji Acharya,Editors, Charak Samhita, Reprint Ed.,Varanasi; Chaukhamba Surbharati Prakashan,2000, Page No.-431</ref>

''[[Virechana]]'' treatments are of many types such as ''mridu virechana'', ''sukha virechana'' and ''tikshṇa virechana''.<ref name= chakra />

All the persons are not treated by the same medicines. So the application depends upon the nature of ''koshtha'', nature of the disease, strength of the person, age, season and many other considerable issues. ''Mridu [[virechana]]'' is not appropriate for the person having ''krurakoshtha'' and ''tikshna [[virechana]]'' is not suitable for ''mridu koshtha''. ''Tikshna [[virechana]]'' is advised in ''mrittika bhakshanajanya pandu roga'' and ''baddhodara'' in [[Charaka Samhita]] but it cannot be given to the patient suffering from the heart disease. ''Mridu [[virechana]]'' is advised in ''kamala roga'' .<ref>Chakrapani, Charak. In: Vaidya Yadavji Trikamji Acharya,Editors, Charak Samhita, Reprint Ed.,Varanasi; Chaukhamba Surbharati Prakashan,2000, Page No.-528</ref> ''[[Virechana]]'' given to the patients suffering from ''paittika'' disorders cannot be given to those suffering from ''pitta shlaishmika'' disorders. Again ''[[virechana]]'' medicines are of two types i.e. ''snigdha virechana'' and ''ruksha virechana''. ''Snigdha [[virechana]]'' is used in the person having dryness in the body and ''ruksha [[virechana]]'' is used in the persons who have unctuousness in the body. For example ''snighdha [[virechana]]'' is advised in ''vatodara''. <ref>Chakrapani, Charak. In: Vaidya Yadavji Trikamji Acharya,Editors, Charak Samhita, Reprint Ed.,Varanasi; Chaukhamba Surbharati Prakashan,2000, Page No.-494</ref> 

''Tikshna [[vamana]]'' and ''[[virechana]]'', and other painful procedures are generally not advised in children and old, if required then ''mridu [[vamana]]'' and ''[[virechana]]'' should be administered .<ref> Dalhana,Gayadasa, Sushruta. Nidana Sthana In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 7th ed. Varanasi: Chaukhambha Orientalia; 2002. page N-155.</ref>  ''[[Virechana]] karma'' should be administered in ''Sharad ritu'' (autumn season) in healthy individuals because the aggravation of ''[[pitta dosha]]'' takes place in this season naturally. Generally it should not be administered in peak of summer and peak of winter season as it may lead to ''atiyoga'' and ''ayoga'' respectively.<ref>Chakrapani,Charak. In:Vaidya Yadavji Trikamji Acharya,Editor, Charaka Samhita, reprint edition, Varanasi: Chaukhamba Surbharati Prakashan,2000, Page No.-281</ref>

Vagbhata added following conditions in the list of indications: 

Garavisha, pakwashayaruja, vibandha, Vidradhi, dushtavrana, akshipaka, abhishyanda, kacha, gudadaha, medhradaha, nasadaha, anaha, stanyadosha

=== Contraindications of ''asthapana [[basti]]'' ===

''Asthapana [[basti]]'' is contra-indicated in the stage of ''ajeerna''<ref>Chakrapani, Charak. In:Vaidya Yadavji Trikamji Acharya,Editor, Charak Samhita, reprint edition, Varanasi: Chaukhamba Surbharati Prakashan,2000, Page No.-692</ref> or ''ama''.  ''Asthapana'' and ''anuvasana [[basti]]'' are indicated in the treatment of ''baddhodara''<ref>Chakrapani, Charak. In:Vaidya Yadavji Trikamji Acharya,Editor, Charak Samhita, reprint edition, Varanasi: Chaukhamba Surbharati Prakashan,2000, Page No.-496</ref>, so ''baddhodara'' mentioned in the contra-indications of ''asthapana'' should be read as ''baddhodaradhmana'' means it is contraindicated in ''adhmana'' due to ''baddhodara''<ref>Chakrapani, Charak. In:Vaidya Yadavji Trikamji Acharya,Editor, Charak Samhita, reprint edition, Varanasi: Chaukhamba Surbharati Prakashan,2000, Page No.-689</ref> ''Asthapana [[basti]]'' is contraindicated in ''kushtha roga'' but in a particular stage of the disease, Charaka has exceptionally indicated the ''asthapana'' and ''Anuvasana [[basti]]'' <ref>Chakrapani, Charak. In:Vaidya Yadavji Trikamji Acharya,Editor, Charak Samhita, reprint edition, Varanasi: Chaukhamba Surbharati Prakashan,2000, Page No.-452</ref>.[14]

Vagbhata added following conditions in the list of contraindications:

Pandu, bhrama, arochaka, unmada, shokagrasta, sthaulya, kanthashosha, kshatakshina, pregnant woman upto 7th month of gestation, gudashotha

=== Indications of ''asthapana [[basti]]'' ===

''Asthapana [[basti]]'' is considered the best therapy in ''vatika'' disorders.<ref>Chakrapani, Charak. In: Vaidya Yadavji Trikamji Acharya,Editor, Charaka Samhita,reprint edition, Varanasi; Chaukhamba Surbharati Prakashan,2000, Page No.- 114</ref> <ref>Arunadatta,Hemadri, Vagbhata. In:Bhishagacharya  Harishastri Paradakar Vaidya,editors, Ashtangahridayam, 9th ed, Varanasi; Chaukhambha Orientalia,2005, Page No.-16</ref> It is given in disorders caused by other ''[[dosha]]''. ''[[Basti]]'' can be administered in the vitiation of ''[[vata]], [[pitta]], [[kapha]], samsarga'' (vitiation of two ''[[dosha]]''), ''sannipata'' (vitiation of all the three ''[[dosha]]'') and even in vitiation of ''[[rakta]]'' (blood) also.<ref name=dal>Dalhana,Gayadasa, Sushruta.Nidana Sthana.In: Vaidya Yadavji Trikamji Acharya, Narayan Ram Acharya,Editors, Sushruta Samhita, 7th ed., Varanasi; Chaukhambha Orientalia, 2002, Page No.-525</ref>  Application of first ''asthapana [[basti]]'' removes or purifies ''[[vata]]'', second ''[[basti]]'' removes or purifies ''[[pitta]]'' and third to ''[[kapha dosha]]'' <ref>Chakrapani, Charak. In: Vaidya Yadavji Trikamji Acharya,Editor, Charaka Samhita,reprint edition, Varanasi; Chaukhamba Surbharati Prakashan,2000, Page No.-693</ref>, purification of three ''[[dosha]]'' should be understood of either occlusion or association of ''[[vata]]'' with other ''[[dosha]]''. Different applications of ''asthapana [[basti]]'' show that by processing and combination with different medicines, it exerts many effects such as ''samshodhana'', ''samshamana'', ''samgrahana'', ''[[vajikarana]], [[brimhana]], karshana, vayahsthapana''<ref name=dal />etc. Type of ''[[basti]]'' depends upon the nature of disease such as ''[[basti]]'' given in the condition of ''[[vata]]-[[mala]] sanga'' will be different in comparison to ''[[basti]]'' given in ''shuddhatisara, [[basti]]'' applied in the case of ''bala kshaya, [[mamsa]] kshaya'' and ''retas kshaya'' will be of different composition in comparison to ''[[basti]]'' administered in ''krimikoshhtha''. In ''vatika'' disorders also, only ''asthapana [[basti]]'' is not given for longer duration that’s why ''karma basti, kala basti'' and ''yoga basti'' have been discussed by ancient sages for the rational use of the therapy. In all these types, ''asthapana'' and ''anuvasana [[basti]]'' are administered in a particular sequence for the better efficacy.

Vagbhata added following conditions in the list of indications: 

[[Jwara]], ashmari, upadamsha, vatarakta, arsha, stanyakshaya, mudhagarbha, mutakrichhra

=== Contraindications of ''anuvasana [[basti]]'' ===

''Anuvasana [[basti]]'' is not advised in ''kaphaja'' disorders, ''medo vriddhi'' and ''ama dosha''. Contraindications given in the text are as per general rule. Exceptional instructions are also found in the text considering the need of therapy in particular stage of disease such as in the patient suffering from piles if patient comes with associated symptoms like ''udavarta'', excessive dryness of the body, abnormal movement of ''[[vata]]'' and pain, then ''anuvasana [[basti]]'' is advised.<ref>Chakrapani, Charak. In:Vaidya Yadavji Trikamji Acharya,Editor,Charaka Samhita, ?ed., Varanasi;Chaukhamba Surbharati Prakashan,2000, Page No.-507</ref>

''Anuvasana'' is contraindicated in the patients suffering from ''krimikoshtha'' also because initially he should not be treated with this type of ''[[basti]]'' as it will increase the disease.  In the patient of ''krimikoshtha'', initially ''asthapana [[basti]]'' followed by ''[[vamana]]'' and ''[[virechana]]'' should be applied and when ''koshtha'' is completely purified, ''anuvasana [[basti]]'' with ''vidanga'' oil can be administered.<ref>Chakrapani, Charak. In:Vaidya Yadavji Trikamji Acharya,Editor,Charaka Samhita, ?ed., Varanasi;Chaukhamba Surbharati Prakashan,2000, Page No.-259</ref>

Vagbhata added following conditions in the list of contraindications:

Prameha, Kushtha, Sthaulya, Pinasa, Krisha

=== Indications of ''anuvasana [[basti]]'' ===

''Anuvasana [[basti]]'' and ''asthapana [[basti]]'' are considered the best therapy in ''vatika'' disorders.<ref>Chakrapani, Charak. In:Vaidya Yadavji Trikamji Acharya, editor, Charaka Samhita,reprint edition,Varanasi:Chaukhamba Surbharati Prakashan,2000, Page No.-114</ref>

It has been stated that patients suitable for ''asthapana [[basti]]'' are suitable for ''anuvasana [[basti]]'' is general instruction, because ''krimikoshthi'' and patient suffering from heaviness in the body are suitable for ''asthapana [[basti]]'' but not for ''anuvasana [[basti]]''. In ''krimikoshthi'', first of all ''asthapana [[basti]]'' is administered, then ''[[vamana]]'' and ''[[virechana]]'' to purify the ''koshtha''. When ''koshtha'' is purified, then ''anuvasana [[basti]]'' is advised as it is discussed in [[Vimana Sthana]]. So it should be accepted that instructions given in the text are applicable in most cases, but not in all cases.    [19]

=== Indications of ''Shirovirechana'' ===

''Shirovirechana'' type of ''[[nasya]]'' is mainly beneficial in ''kaphaja'' disorders.<ref>Indu, Vagbhata. In: Dr. Shivprasad Sharma, Editor, Ashtanga Sangraha,2nd edition, Varanasi; Chaukhamba Sanskrit Series Office, 2008, Page No.-223</ref>
                              
''Shirovirechana'' is mainly beneficial in ''kaphaja'' disorders where as Charaka says that it is beneficial in ''vatadi vikaras'' which are free from ''ama dosha''. Here ''vatadi vikaras'' means ''[[vata]] shleshmika vikara'' of the head region are cured by proper administration of ''shirovirechana''.<ref name=ch>Chakrapani, Charak.In:Vaidya Yadavji Trikamji Acharya, Editor, Charaka Samhita,reprint edition, Varanasi; Chaukhamba Surbharati Prakashan,2000, Page No.-690</ref>  ''Pinasa roga'' mentioned in the indications should be accepted as ''pakva pratishyaya'' (chronic coryza)<ref name=ch /> as ''shirovirechana'' is contraindicated in the patients suffering from ''nava pratishyaya'' (acute coryza).   [22]

=== Contra-indications of ''Shirovirechana'' ===

Vagbhata added the following conditions in list of contra-indications: 

Apatarpita, Pitadrava, Gararta, Kruddha, vegavarodhita, Raktasravita, Sutika, Shwasapidita, Kasapidita

=== Current researches ===

Prameha and Kushtha are considered as contraindications of Asthapana [[Basti]]. Thus the conditions of diabetes and skin diseases comes under this umbrella of contraindication. However, more precisely, if these conditions are associated with aggravated [[vata]], Asthapana [[Basti]] is used with good efficacy. The [[basti]] of gokshura and punarnava has shown good results in microalbuminuria in diabetic patients.<ref>Ramteke RS, Thakar AB, Trivedi AH, Patil PD. Clinical efficacy of Gokshura-Punarnava Basti in the management of microalbuminuria in diabetes mellitus. Ayu. 2012;33(4):537–541. doi:10.4103/0974-8520.110535</ref> Likewise [[basti]] has shown good results in skin condition like psoriatic arthritis.<ref>S. Shruthi, M Kumar Ashvini, Lohith B A, M Uday Shankar, Mishra Gaurav,  AyurvedicManagement of Psoriatic Arthritis: A Case Study, International Journal of Applied Ayurved Research,2017; 2(11):1472-77</ref>

=== Scope of further research ===

General indications and contraindications of all [[panchakarma]] are included in this chapter. Further it is needed to elaborate efficacy of these procedures in the specific stages of the disease. 
For e.g. Asthapana [[Basti]] is contraindicated in fatigue due to excess travelling (Yanaklanta). However in other reference Yuktaratha [[Basti]] is indicated in certain conditions with similarity of pathogenesis. Though [[basti]] is contraindicated in skin diseases (Kushtha),  a formulation for [[basti]] is prescribed in management of Kushtha. This is specific to the conditions associated with specific [[dosha]]. A study is required to elaborate and explain the reasons.
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