Changes

|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.

|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

|description=Siddhi Sthana Chapter 2. Successful administration of [[Panchakarma]] therapies

|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image_alt=charak samhita

|image_alt=charak samhita

|type=article

|type=article

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Mangalasseri P., Auti S.

|data7  = Mangalasseri P., Auti S.

|label8 = Editor

|label8 = Editors

|data8  = Thakar A. B., Mangalasseri P.

|data8  = Thakar A. B., Mangalasseri P., Deole Y.S., Basisht G.

|label9 = Date of publication  

|label9 = Year of publication  

|data9 = December 17, 2018

|data9 = 2020

|label10 = DOI

|label10 = Publisher

|data10  =  

|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

|header3 =  

|label11 = DOI

 

|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s08.003 10.47468/CSNE.2020.e01.s08.003]

}}

}}

<big>'''Abstract </big>'''

<big>'''Abstract </big>'''

<div style="text-align:justify;">

<div 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.

[[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.

'''Keywords''':  Asthapana-basti, Anuvasana-basti, Panchakarma, Siddhi, Shirovirechana, Vamana, Virechana, indications, contra-indications, therapeutic enema, therapeutic purgation, therapeutic emesis, therapeutic intra-nasal administration.

'''Keywords''':  Asthapana-basti, Anuvasana-basti, [[Panchakarma]], Siddhi, Shirovirechana, [[Vamana]], [[Virechana]], indications, contra-indications, therapeutic enema, therapeutic purgation, therapeutic emesis, therapeutic intra-nasal administration.

</div>

</div>

== Introduction ==

== Introduction ==

<div style="text-align:justify;">

<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 ''doshas'' 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]].   

''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.

[[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>

</div>

== Sanskrit text, Transliteration and English Translation ==

== Sanskrit text, Transliteration and English Translation ==

|-

|-

! scope="col"| Serial No.

! scope="col"| Serial No.

! scope="col"| Disease or State in which ''vamana'' is contraindicated

! scope="col"| Disease or State in which ''[[vamana]]'' is contraindicated

! scope="col"| Translation in English

! scope="col"| Translation in English

|-

|-

|-

|-

| 17

| 17

| ''Vyayama-prasakta-kshaama''

| ''[[Vyayama]]-prasakta-kshaama''

| Exhaustion due to excessive physical exercise

| Exhaustion due to excessive physical exercise

|-

|-

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 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 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 ''[[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 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 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 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 ''[[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 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 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.

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 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 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.                                                                                                                                           

''[[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]

[9]

</div>

</div>

| 34

| 34

| ''Shelshmavyadhayo Visheshena Maharogadhyayoktah''

| ''Shelshmavyadhayo Visheshena Maharogadhyayoktah''

| All ''Kapha-dosha'' disorders mentioned in the [[Maharoga Adhyaya]] of [[Charaka Samhita]] [[Sutra Sthana]]

| All ''[[Kapha dosha]]'' disorders mentioned in the [[Maharoga Adhyaya]] of [[Charaka Samhita]] [[Sutra Sthana]]

|}

|}

<div style="text-align:justify;">

<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]

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>

</div>

=== Contra-indications of ''virechana karma'' ===

=== Contra-indications of ''[[virechana]] karma'' ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

|-

|-

! scope="col"| Serial No.

! scope="col"| Serial No.

! scope="col"| Disease or State (in which ''virechana'' is contraindicated)

! scope="col"| Disease or State (in which ''[[virechana]]'' is contraindicated)

! scope="col"| Translation in English

! scope="col"| Translation in English

|-

|-

[11]

[11]

=== Adverse effects of ''virechana karma'' administered in contra-indicated conditions ===

=== Adverse effects of ''[[virechana]] karma'' administered in contra-indicated conditions ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

</div></div>

</div></div>

<div style="text-align:justify;">

<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).

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]]'' 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).

''[[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.  

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''.

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]]'' 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]]'' 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]]'' 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 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]]'' 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]]'' 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.

''[[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]

Therefore, above mentioned persons should not be treated with ''[[virechana]] karma''.                    [12]

</div>

</div>

=== Indications of ''virechana karma'' ===

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

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

</div></div>

</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:

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;

{| class="wikitable" style="text-align: center;

|-

|-

! scope="col"| Serial No.

! scope="col"| Serial No.

! scope="col"| Disease or State (in which ''virechana'' is indicated)

! scope="col"| Disease or State (in which ''[[virechana]]'' is indicated)

! scope="col"| Translation in English

! scope="col"| Translation in English

|-

|-

|-

|-

| 2

| 2

| ''Jwara''

| ''[[Jwara]]''

| Fever

| Fever

|-

|-

|}

|}

<div style="text-align:justify;">

<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]

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>

</div>

=== Contra-indications of ''asthapana basti'' ===

=== Contra-indications of ''asthapana [[basti]]'' ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

</div></div>

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

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

{| class="wikitable" style="text-align: center;

{| class="wikitable" style="text-align: center;

|-

|-

! scope="col"| Serial No.

! scope="col"| Serial No.

! scope="col"| Disease or State (in which ''asthapana basti'' is contraindicated)

! scope="col"| Disease or State (in which ''asthapana [[basti]]'' is contraindicated)

! scope="col"| Translation in English

! scope="col"| Translation in English

|-

|-

|-

|-

| 4

| 4

| ''Utklishtha dosha''

| ''Utklishtha [[dosha]]''

| (A person who has) excited ''dosha''

| (A person who has) excited ''[[dosha]]''

|-

|-

| 5

| 5

[14]

[14]

=== Adverse effects of ''asthapana basti'' administered in contra-indicated persons ===

=== Adverse effects of ''asthapana [[basti]]'' administered in contra-indicated persons ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

</div></div>

</div></div>

<div style="text-align:justify;">

<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]

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]

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=== Indications of ''asthapana basti'' ===

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

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

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;

{| class="wikitable" style="text-align: center;

|-

|-

! scope="col"| Serial No.

! scope="col"| Serial No.

! scope="col"| Disease or State (in which ''asthapana basti'' is indicated)

! scope="col"| Disease or State (in which ''asthapana [[basti]]'' is indicated)

! scope="col"| Translation in English

! scope="col"| Translation in English

|-

|-

|-

|-

| 4

| 4

| ''Vata sanga''

| ''[[Vata]] sanga''

| Retention of flatus

| Retention of flatus

|-

|-

|-

|-

| 7

| 7

| ''Shukra sanga''

| ''[[Shukra]] sanga''

| Retention of semen

| Retention of semen

|-

|-

|-

|-

| 10

| 10

| ''Mamsa kshaya''

| ''[[Mamsa]] kshaya''

| Diminution of muscle tissue

| Diminution of muscle tissue

|-

|-

|-

|-

| 25

| 25

| ''Jwara''

| ''[[Jwara]]''

| Fever

| Fever

|-

|-

|}

|}

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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]

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]

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=== Contra-indications of ''anuvasana basti'' ===

=== Contra-indications of ''anuvasana [[basti]]'' ===

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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:

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>

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{| class="wikitable" style="text-align: center;

{| class="wikitable" style="text-align: center;

|-

|-

! scope="col"| Serial No.

! scope="col"| Serial No.

! scope="col"| Disease or State (in which ''anuvasana basti'' is contraindicated)

! scope="col"| Disease or State (in which ''anuvasana [[basti]]'' is contraindicated)

! scope="col"| Translation in English

! scope="col"| Translation in English

|-

|-

| 12

| 12

| ''Kaphodara''

| ''Kaphodara''

| Obstinate abdominal disease caused by aggravation of kapha

| Obstinate abdominal disease caused by aggravation of [[kapha]]

|-

|-

| 13

| 13

| 17

| 17

| ''Pittaabhishyanda''

| ''Pittaabhishyanda''

| Conjuctivitis caused by aggravated ''pitta''

| Conjuctivitis caused by aggravated ''[[pitta]]''

|-

|-

| 18

| 18

| ''Kaphaabhishyanda''

| ''Kaphaabhishyanda''

| Conjuctivitis caused by aggravated ''kapha''

| Conjuctivitis caused by aggravated ''[[kapha]]''

|-

|-

| 19

| 19

[17]

[17]

=== Adverse effects of ''anuvasana basti'' in contra-indicated conditions ===

=== Adverse effects of ''anuvasana [[basti]]'' in contra-indicated conditions ===

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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]

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]

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=== Indications of ''anuvasana basti'' ===

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

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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:

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:

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{| class="wikitable" style="text-align: center;

{| class="wikitable" style="text-align: center;

|-

|-

! scope="col"| Serial No.

! scope="col"| Serial No.

! scope="col"| Disease or State (in which ''anuvasana basti'' is indicated)

! scope="col"| Disease or State (in which ''anuvasana [[basti]]'' is indicated)

! scope="col"| Translation in English

! scope="col"| Translation in English

|-

|-

| 3

| 3

| ''Kevalavata rogaartah''

| ''Kevalavata rogaartah''

| A person suffering from diseases caused due to ''vata'' alone, and not associated with ''ama''.

| 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]

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'' ===

=== Contra-indications of ''shirovirechana'' ===

| 21

| 21

| ''Anuvasita''

| ''Anuvasita''

| A person who has undergone ''Anuvasana Basti''

| A person who has undergone ''Anuvasana [[Basti]]''

|-

|-

| 22

| 22

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<div style="text-align:justify;">

<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]

''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]

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=== Indications of ''shirovirechana'' ===

=== Indications of ''shirovirechana'' ===

|38

|38

|''Urdhvajatrugatashcha vatadi vikarah paripakvashcha''

|''Urdhvajatrugatashcha vatadi vikarah paripakvashcha''

|Diseases of the part above clavicle caused by aggravation of ''vatadi dosha'' and which are free from ''ama dosha''

|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;">

<div style="text-align:justify;">

#Indications of each of the ''karma'' (therapy) of [[Panchakarma]].

#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]

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]

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== Tattva Vimarsha (Fundamental Principles) ==

== 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.  

*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.  

*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.  

*''[[Vamana]]'' (therapeutic emesis) is mainly indicated in ''[[kapha]]'' dominant diseases.  

*''Virechana''( therapeutic purgation) is mainly indicated in ''pitta'' 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.

*''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.

*''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.

*''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 ) ==

== Vidhi Vimarsha (Applied Inferences ) ==

=== Success of treatment ===

=== 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>

''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'' ===

=== 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/>

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:

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

krimikoshtha, ashthila, arsha, bhrama, parshwaruk, Vatavyadhi

krimikoshtha, ashthila, arsha, bhrama, parshwaruk, Vatavyadhi

=== Indications of ''vamana'' ===

=== 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>   

''[[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>

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:  

Vagbhata has added following indications as suitable for [[vamana]]:  

   

   

Granthi, arbuda, medoroga, vidarika, hridroga, chittavibhrama, visarpa, vidradhi, putinasa, kanthapaka, adhijivhika, galashundika

Granthi, arbuda, medoroga, vidarika, hridroga, chittavibhrama, visarpa, vidradhi, putinasa, kanthapaka, adhijivhika, galashundika

=== Contraindications of ''virechana'' ===

=== 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>

''[[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>

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:  

Vagbhata added following conditions in the list of contraindications:  

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

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

=== Indications of ''virechana'' ===

=== 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]]'' 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]]'' 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 />

''[[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>  

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>

''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:  

Vagbhata added following conditions in the list of indications:  

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

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

=== Contraindications of ''asthapana basti'' ===

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

''Asthapana basti'' is contra-indicated in the stage of ''ajeerna''<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.-692</ref> or ''ama''.  ''Asthapana'' and ''anuvasana basti'' are indicated in the treatment of ''baddhodara''<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-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>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika”commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-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>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika”  commentary by Chakrapanidatta

''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]

and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi

(India), reprint edition-2000, Page No.-452

</ref>. [14]

Vagbhata added following conditions in the list of contraindications:

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

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

=== Indications of ''asthapana basti'' ===

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

''Asthapana basti'' is considered the best therapy in ''vatika'' disorders.<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi (India), reprint edition-2000, Page No.- 114</ref><ref>Vagbhata, Ashtanga -Hridaya, with the commentaries “Sarvanׂgasundara” of Arunadatta

''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.

and “[[Ayurveda]]-Rasayana” of Hemadri Edited by Bhishagacharya  Harishastri Paradakar  

Vaidya, Chaukhambha Orientalia, Varanasi (India), reprint ninth edition-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>Sushruta, Sushruta-Samhita, with the “Nibandha-Sangraha” commentary of Dalhana and

of Chikitsasthana) by Vaidya Yadavji Trikamji Acharya and the rest by Narayan Ram Acharya

“Kavyatirth”, Chaukhambha Orientalia,Varanasi (India), seventh edition- 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>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika”commentary by Chakrapanidatta

and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi

(India), reprint edition-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>Sushruta, Sushruta-Samhita, with the “Nibandha-Sangraha” commentary of Dalhana and

</ref> 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:  

Vagbhata added following conditions in the list of indications:  

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

[[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>

</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>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta

and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi

(India), reprint edition-2000, Page No.-259</ref>

Vagbhata added following conditions in the list of contraindications:

Vagbhata added following conditions in the list of contraindications:

Prameha, Kushtha, Sthaulya, Pinasa, Krisha

Prameha, Kushtha, Sthaulya, Pinasa, Krisha

=== Indications of ''anuvasana basti'' ===

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

 

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]

</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'' ===

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

''Shirovirechana'' type of ''nasya'' is mainly beneficial in ''kaphaja'' disorders.<ref>Vriddha Vagbhata, Ashtanׂga-Samgraha with “Shashilekha” commentary by Indu, Edited by Dr. Shivprasad Sharma, Chaukhamba Sanskrit Series Office, Varanasi (India), 2nd edition-2008, Page No.-223</ref>

''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>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika”commentary by Chakrapanidatta

''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]

and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi

(India), reprint edition-2000, Page No.-690

</ref>  ''Pinasa roga'' mentioned in the indications should be accepted as ''pakva pratishyaya'' (chronic coryza)<ref>Agnivesha, Charaka-Samhita, with the “[[Ayurveda]]-Dipika” commentary by Chakrapanidatta

</ref> as ''shirovirechana'' is contraindicated in the patients suffering from ''nava pratishyaya'' (acute coryza).  [22]

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

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

=== Current researches ===

=== 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>

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 ===

=== 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.  

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.

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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== References ==

== References ==