Changes

Here the Acharya detail mode of action of medicated enema which points toward various sites for proper evacuation. Medicated enema when given properly crosses the rectum and reaches the colon, where maximum possible limit is up to cecum as ileaocecal valve prevents further movement.  Proper evacuation of enema is also an important phenomenon as enema retaining for longer duration may cause abdominal discomfort, loss of osmotic balance etc. and early removal of enema may not produce desired clinical effect.

Here the Acharya detail mode of action of medicated enema which points toward various sites for proper evacuation. Medicated enema when given properly crosses the rectum and reaches the colon, where maximum possible limit is up to cecum as ileaocecal valve prevents further movement.  Proper evacuation of enema is also an important phenomenon as enema retaining for longer duration may cause abdominal discomfort, loss of osmotic balance etc. and early removal of enema may not produce desired clinical effect.

Sign and symptoms of proper, improper and excess use of evacuating type of medicated enema: [verse 41-43]

==== Sign and symptoms of proper, improper and excess use of evacuating type of medicated enema (verse 41-43) ====

 

Properly administered enema causes cleansing of colon and rectum but in proportionate manner causing less harm to the mucosal membrane and nourishing the bacterial flora of colon. This may improve the process of proper formation of feces & gives sense of lightness in lower abdomen. Agni i.e. digestion is improved due to regularisation of vata that ignites digestive fire.

Properly administered enema causes cleansing of colon and rectum but in proportionate manner causing less harm to the mucosal membrane and nourishing the bacterial flora of colon. This may improve the process of proper formation of feces & gives sense of lightness in lower abdomen. Agni i.e. digestion is improved due to regularisation of vata that ignites digestive fire.

Improper enema or retention of enema gives symptoms that mimic bowel obstruction and hypervolemia. Especially symptoms like edema and dyspnea are produced as a result of excess fluid load, primarily salt and water, that builds up in various locations in the body and leads to an increase in weight, swelling in the legs and arms (peripheral edema), and/or fluid in the abdomen (ascites). Eventually, the fluid enters the air spaces in the lungs (pulmonary edema) reduces the amount of oxygen that can enter the blood, and causes shortness of breath (dyspnea).   

Improper enema or retention of enema gives symptoms that mimic bowel obstruction and hypervolemia. Especially symptoms like edema and dyspnea are produced as a result of excess fluid load, primarily salt and water, that builds up in various locations in the body and leads to an increase in weight, swelling in the legs and arms (peripheral edema), and/or fluid in the abdomen (ascites). Eventually, the fluid enters the air spaces in the lungs (pulmonary edema) reduces the amount of oxygen that can enter the blood, and causes shortness of breath (dyspnea).   

Excess enema is nothing but purgation produced by overdose of evacuating enema thus the symptoms are same as that of excessive purgation.

Excess enema is nothing but purgation produced by overdose of evacuating enema thus the symptoms are same as that of excessive purgation.

Sign and symtoms of proper, improper and excess use of unctuous type of medicated enema: [verse 44-47]

 

==== Sign and symtoms of proper, improper and excess use of unctuous type of medicated enema (verse 44-47) ====

 

Unctuous enema though considered as a dosha pacifying enema it acts as a cleansing therapy because it cleanses the colon & rectum to remove adhered fecal matter. Moreover, the unctuousness makes colonic & rectal lining more slippery so that no feces remains and quantity of defecation increases. It brings about proper sleep as vata is responsible for insomnia and it takes care of vata.   

Unctuous enema though considered as a dosha pacifying enema it acts as a cleansing therapy because it cleanses the colon & rectum to remove adhered fecal matter. Moreover, the unctuousness makes colonic & rectal lining more slippery so that no feces remains and quantity of defecation increases. It brings about proper sleep as vata is responsible for insomnia and it takes care of vata.   

Improper administration of unctuous enema cannot meet the extent of oleation needed in colon, rectum and whole body thus causes dryness. Vitiated vata thus leads to the symptoms stated as in verse.

Improper administration of unctuous enema cannot meet the extent of oleation needed in colon, rectum and whole body thus causes dryness. Vitiated vata thus leads to the symptoms stated as in verse.

Excess unctuous enema gives symptoms somewhat similar to that of excess oleation. However local symptom like griping pain may be due to excess motions is more prominent.

Excess unctuous enema gives symptoms somewhat similar to that of excess oleation. However local symptom like griping pain may be due to excess motions is more prominent.

Karma, kala and yoga basti: [verse 47-49]

 

==== Karma, kala and yoga basti (verse 47-49) ====

 

The concept of karma, kala and yoga basti denotes the use of basti therapy as per the severity of the disease. Generally diseases of vital organs like brain, heart, kidney etc. are considered more serious in nature and dosha vitiation is so severe that repeated medicated enema for long duration is a must hence karma basti is used in such instances. Another view suggests that 18 unctuous enema cause oleation of semen (Su. Chi. 37/71-74) Thus karma basti is meant for body elements which are far apart for the unctuousness to reach like shukra (semen), majja (bone marrow) etc. Yogabasti is the smallest duration or schedule that is required generally for healthy individuals doing cleansing according to particular season or in patients having disease newly diagnosed or of less severe nature. Kala basti is used in conditions which are in between the highly severe, chronic and less severe, newly diagnosed category.

The concept of karma, kala and yoga basti denotes the use of basti therapy as per the severity of the disease. Generally diseases of vital organs like brain, heart, kidney etc. are considered more serious in nature and dosha vitiation is so severe that repeated medicated enema for long duration is a must hence karma basti is used in such instances. Another view suggests that 18 unctuous enema cause oleation of semen (Su. Chi. 37/71-74) Thus karma basti is meant for body elements which are far apart for the unctuousness to reach like shukra (semen), majja (bone marrow) etc. Yogabasti is the smallest duration or schedule that is required generally for healthy individuals doing cleansing according to particular season or in patients having disease newly diagnosed or of less severe nature. Kala basti is used in conditions which are in between the highly severe, chronic and less severe, newly diagnosed category.

Shirovirechana: [verse 50-53]

 

==== Shirovirechana (verse 50-53) ====

 

Shirovirechana comes in sequence of shodhana after vamana-virechana etc. It has direct cleansing effect on the part above the clavicle hence termed shirovirechana. As head is a vital part and eyes are to be avoided during any fomentation, only fomentation with the help of the palm is an ideal procedure before shirovirechana. Inappropriate administration may cause only irritation and not the removal of morbid matter that leads to increase in secretions as result of allergic reaction causing adhesion of sticky material in the throat, heaviness of the head etc. Excessive administration of shirovirechana may cause rupture of certain capillaries in the Little's area, lying in antero-inferior part of the nasal septum having rich vascularisation.  This may results in cutting type of pain. Due to sudden entry of foreign bodies in the nasal cavity fainting occurs rarely which may be due to vagal shock.

Shirovirechana comes in sequence of shodhana after vamana-virechana etc. It has direct cleansing effect on the part above the clavicle hence termed shirovirechana. As head is a vital part and eyes are to be avoided during any fomentation, only fomentation with the help of the palm is an ideal procedure before shirovirechana. Inappropriate administration may cause only irritation and not the removal of morbid matter that leads to increase in secretions as result of allergic reaction causing adhesion of sticky material in the throat, heaviness of the head etc. Excessive administration of shirovirechana may cause rupture of certain capillaries in the Little's area, lying in antero-inferior part of the nasal septum having rich vascularisation.  This may results in cutting type of pain. Due to sudden entry of foreign bodies in the nasal cavity fainting occurs rarely which may be due to vagal shock.

Do’s and don’ts in panchakarma procedures:[verse 54-55]

 

==== Do’s and don’ts in panchakarma procedures (verse 54-55) ====

 

All the procedures involved in cleansing therapies act on the common principles, as follows:

All the procedures involved in cleansing therapies act on the common principles, as follows:

• Stimulation of certain receptors

• Stimulation of certain receptors

• Establishing body homeostasis by exchange between nutritive and morbid matters across the various membranes including gastric, intestinal or cell membrane.

• Establishing body homeostasis by exchange between nutritive and morbid matters across the various membranes including gastric, intestinal or cell membrane.

• Rearrangement of gastrointestinal bacterial flora

• Rearrangement of gastrointestinal bacterial flora

Reason for failure of basti to cure curable diseases and importance of dose in cleansing therapies: [verse 57-60]

 

==== Reason for failure of basti to cure curable diseases and importance of dose in cleansing therapies (verse 57-60) ====

 

Acharya has attracted the attention to an important concept of avarana i.e. occlusion of one dosha by other causing its vitiation. In such instances treatment of the dosha or dhatu that is the reason for occlusion must be treated first then the one which is occluded (Ch.Chi.28/239). Otherwise the symptoms get aggravated as occlusion is potentiated.  

Acharya has attracted the attention to an important concept of avarana i.e. occlusion of one dosha by other causing its vitiation. In such instances treatment of the dosha or dhatu that is the reason for occlusion must be treated first then the one which is occluded (Ch.Chi.28/239). Otherwise the symptoms get aggravated as occlusion is potentiated.  

Similarly, though one cannot measure the exact quantity of dosha, still on basis of symptoms, koshtha, agni etc. one need to decide the dose of drug to be given for cleansing. If dose calculation or the treatment is administered is wrong, then even if the drug is proper then also results may be adverse.

Similarly, though one cannot measure the exact quantity of dosha, still on basis of symptoms, koshtha, agni etc. one need to decide the dose of drug to be given for cleansing. If dose calculation or the treatment is administered is wrong, then even if the drug is proper then also results may be adverse.

Procedures followed practically for vamana & virechana are as follows:

 

==== Procedures followed practically for vamana & virechana are as follows ====

 

• After proper deepana and pachana, 30-40 ml of the fat is given empty stomach in the morning around 6.00 to 7.00 a. m. This dose is considered as test dose.

• After proper deepana and pachana, 30-40 ml of the fat is given empty stomach in the morning around 6.00 to 7.00 a. m. This dose is considered as test dose.

• Depending upon time taken for complete digestion of this dose, the dose required as per disease severity is calculated. Generally the dose which can be digested in 12 hours is considered as moderate.

• Depending upon time taken for complete digestion of this dose, the dose required as per disease severity is calculated. Generally the dose which can be digested in 12 hours is considered as moderate.

• Post therapeutic measures are followed in both virechana and vamana.

• Post therapeutic measures are followed in both virechana and vamana.

Procedure followed practically for medicated enema is as follows:

==== Procedure followed practically for medicated enema is as follows ====

 

• Evacuating type of medicated enema is given at around 10.00-10.30 a.m. in the morning when the food taken on earlier day is digested and patient is not too hungry. Unctuous type of enema is given immediately after meal.  

• Evacuating type of medicated enema is given at around 10.00-10.30 a.m. in the morning when the food taken on earlier day is digested and patient is not too hungry. Unctuous type of enema is given immediately after meal.  

• Initially local massage with suitable oil is done at stomach, abdomen and buttocks & fomentation is given on the same part.

• Initially local massage with suitable oil is done at stomach, abdomen and buttocks & fomentation is given on the same part.

• After evacuating type of enema classics advise to give unctuous enema in the evening but practically unctuous enema is given on next day after having food. This alternate use of evacuating and unctuous enema avoids any possible vata vitiation.

• After evacuating type of enema classics advise to give unctuous enema in the evening but practically unctuous enema is given on next day after having food. This alternate use of evacuating and unctuous enema avoids any possible vata vitiation.

Procedure followed practically for shirovirechana:

==== Procedure followed practically for shirovirechana ====

 

• Before administering shirovirechana local massage with suitable oil and mild fomentation is given on parts above the clavicles.  

• Before administering shirovirechana local massage with suitable oil and mild fomentation is given on parts above the clavicles.  

• Then patient is made to lie supine with neck slightly lifted and head tilted down. This position allows easy entry of drug to the intracranial organs.

• Then patient is made to lie supine with neck slightly lifted and head tilted down. This position allows easy entry of drug to the intracranial organs.

• After instillation of drug patient is made to lie in supine position for 3-5 minutes. During this time palms and soles of the patient are massaged which stimulates the absorption of nasal drug.

• After instillation of drug patient is made to lie in supine position for 3-5 minutes. During this time palms and soles of the patient are massaged which stimulates the absorption of nasal drug.

Advanced researches:

==== Advanced researches ====

 

There are many research works carried out in field of panchakarma therapies, some published researches on procedural standardisation are as follows:

There are many research works carried out in field of panchakarma therapies, some published researches on procedural standardisation are as follows:

• Bharti Gupta, Physiological and biochemical changes with Vamana procedure, AYU, 2012, 33,3:348-355

• Bharti Gupta, Physiological and biochemical changes with Vamana procedure, AYU, 2012, 33,3:348-355

• Pharmacodynamics of Nasya Karma K.Y.,  Srikanth, V. Krishna murthy, M. Srinivasulu, International Journal of Research in Ayurveda & Pharmacy, 2011; 2(1):24-26.

• Pharmacodynamics of Nasya Karma K.Y.,  Srikanth, V. Krishna murthy, M. Srinivasulu, International Journal of Research in Ayurveda & Pharmacy, 2011; 2(1):24-26.

Scope for further research:

==== Scope for further research ====

• Beside yoga, karma and kala basti schedule the modified regimen can be prepared as per disease. For e.g. in case of kapha dominant disorders continuous three evacuating enema followed by one unctuous enema can be given.  

• Beside yoga, karma and kala basti schedule the modified regimen can be prepared as per disease. For e.g. in case of kapha dominant disorders continuous three evacuating enema followed by one unctuous enema can be given.  

Summary:

==== Summary ====

 

Acharya Atreya have described the successful administration of panchakarma in the form of answer to the twelve queries. Oleation and fomentation are the pre-treatment measure in cleansing processes that follows emesis and purgation. After cleansing post therapeutic measures (samsarjana krama) are necessary to bring digestion to its original state. Unctuous enema or oleation therapy can be started from ninth day. Unctuous enema should be followed by evacuating type of enema. Medicated enema cures all the diseases by removing accumulated dosha from entire body. Acharya have advised an ideal treatment schedule in the form of yoga, kala and karma basti as per disease severity. Shirovirechana (errhine) therapy acts over the things that need to be avoided during panchakarma includes excessive sitting, standing, speaking and riding, sleep during day time, sexual intercourse, suppression of natural urges, cooling regimens, exposure to sun, grief, anger and intake of untimely and unwholesome food. However after following all measure correct treatment is given but in low or excess doses, in inappropriate time or in wrong manner then it fails to cure diseases.

Acharya Atreya have described the successful administration of panchakarma in the form of answer to the twelve queries. Oleation and fomentation are the pre-treatment measure in cleansing processes that follows emesis and purgation. After cleansing post therapeutic measures (samsarjana krama) are necessary to bring digestion to its original state. Unctuous enema or oleation therapy can be started from ninth day. Unctuous enema should be followed by evacuating type of enema. Medicated enema cures all the diseases by removing accumulated dosha from entire body. Acharya have advised an ideal treatment schedule in the form of yoga, kala and karma basti as per disease severity. Shirovirechana (errhine) therapy acts over the things that need to be avoided during panchakarma includes excessive sitting, standing, speaking and riding, sleep during day time, sexual intercourse, suppression of natural urges, cooling regimens, exposure to sun, grief, anger and intake of untimely and unwholesome food. However after following all measure correct treatment is given but in low or excess doses, in inappropriate time or in wrong manner then it fails to cure diseases.

Glossary of technical terms

 

=== Glossary ===

 

• Snēha (sneha; स्नेह): Oiliness, unctousness, lubricity, Moisture, Oil  

• Snēha (sneha; स्नेह): Oiliness, unctousness, lubricity, Moisture, Oil  

• vamana (Vamana; वमन): Therapeutic emesis. Vamana is first of the Bio-cleansing series and consists in causing vomiting of the vitiated Dosha especially Kapha from the upper regions of the body, by means of consuming suitable drugs which are repulsive, nauseating, indigestible and tending to move upwards. Mainly used for diseases manifesting in upper part of body and caused by Kaphadosha.

• vamana (Vamana; वमन): Therapeutic emesis. Vamana is first of the Bio-cleansing series and consists in causing vomiting of the vitiated Dosha especially Kapha from the upper regions of the body, by means of consuming suitable drugs which are repulsive, nauseating, indigestible and tending to move upwards. Mainly used for diseases manifesting in upper part of body and caused by Kaphadosha.