Changes

==== Selection of type of enema (verse 35-37) ====

==== Selection of type of enema (verse 35-37) ====

Disease specific medicine is to be given through the enema because when medicated enema is given it brings about multiple actions at a time that includes evacuation which is a local action, affects certain receptors which need a specific molecule that acts as a stimulant over gut receptors for secretion of particular chemical messenger for disease attenuation besides cleansing. ''Dosha'' pacification is also evident due to action of absorbed active principles from drug specific to disease. ''Acharya'' has quoted a condition where life depends upon the morbid matter. This particular condition can be seen in the patient who is bed ridden, not consuming food and highly emaciated. Generally nutrition comes from the food that we consume and if food is not available then energy is produced from optional processes of metabolism like gluconeogenesis, lipolysis etc.  This can be termed in Ayurvedic parlance as use of ''dhatu'' (body elements) for nutrition. But if patient is so emaciated that gluconeogenesis is also not possible then the life supports comes from absorption of nutrients from fecal matter. Precursor of fecal matter i.e. chyme in the colon contains some electrolytes like sodium, magnesium, and chloride which are left as well as undigestible parts of ingested food (e.g., a large part of ingested amylose, starch which has been shielded from digestion, and dietary fiber, which is largely undigestible carbohydrate in either soluble or insoluble form). The bacteria break down some of the fiber for their own nourishment and create acetate, propionate, and butyrate as waste products, which in turn are used by the cell lining of the colon for nourishment. Perhaps 10% of the undigested carbohydrate thus becomes available, through this last but an important part of digestion. Hence in such patients giving enema may prove fatal as no nutrition will be available if colon is cleansed. Since it is explained that ''mala'' is responsible for ''bala'' in the context of ''rajayakshnma''.

Disease specific medicine is to be given through the enema because when medicated enema is given it brings about multiple actions at a time that includes evacuation which is a local action, affects certain receptors which need a specific molecule that acts as a stimulant over gut receptors for secretion of particular chemical messenger for disease attenuation besides cleansing. ''Dosha'' pacification is also evident due to action of absorbed active principles from drug specific to disease. ''Acharya'' has quoted a condition where life depends upon the morbid matter. This particular condition can be seen in the patient who is bed ridden, not consuming food and highly emaciated. Generally nutrition comes from the food that we consume and if food is not available then energy is produced from optional processes of metabolism like gluconeogenesis, lipolysis, etc <ref>

Rui L. Energy Metabolism in the Liver. Comprehensive Physiology. 2014;4(1):177-197. doi:10.1002/cphy.c130024 </ref>.  This can be termed in Ayurvedic parlance as use of ''dhatu'' (body elements) for nutrition. But if patient is so emaciated that gluconeogenesis is also not possible then the life supports comes from absorption of nutrients from fecal matter. Precursor of fecal matter i.e. chyme in the colon contains some electrolytes like sodium, magnesium, and chloride which are left as well as undigestible parts of ingested food (e.g., a large part of ingested amylose, starch which has been shielded from digestion, and dietary fiber, which is largely undigestible carbohydrate in either soluble or insoluble form). The bacteria break down some of the fiber for their own nourishment and create acetate, propionate, and butyrate as waste products, which in turn are used by the cell lining of the colon for nourishment. Perhaps 10% of the undigested carbohydrate thus becomes available, through this last but an important part of digestion. Hence in such patients giving enema may prove fatal as no nutrition will be available if colon is cleansed. Since it is explained that ''mala'' is responsible for ''bala'' in the context of ''rajayakshnma''.

==== Importance of ''basti'' therapy (verse 38-40) ====

==== Importance of ''basti'' therapy (verse 38-40) ====