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Now we shall expound the chapter upon management of complications due to enema nozzle. Thus said Lord Atreya, henceforth listen to the description of defects in enema nozzles, their complications if used for ''basti'' and their management. [1-3]
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Now we shall expound the chapter "Netrabastivyapat Siddhi" (Management of complications due to enema nozzle). Thus said Lord Atreya. henceforth listen to the description of defects in enema nozzles, their complications if used for ''basti'' and their management. [1-3]
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==== Eight defects of nozzle and its harmful effect ====
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=== Eight defects of nozzle and its harmful effect ===
 
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[4-5]
 
[4-5]
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==== ''Basti putaka'' (defects of bladder/enema holding bag) ====
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=== ''Basti putaka'' (defects of bladder/enema holding bag) ===
 
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[6-7]
 
[6-7]
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==== Errors by ''basti'' administrator ====
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=== Errors by ''basti'' administrator ===
 
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Defects related to ''pranetru'' (administrator or attendant who applies procedure) are ''savata'' (''basti'' filled with air), ''atidruta'' (very fast), ''utkshipta'' (raised/upwards), ''tiryak'' (oblique/sideways/transverse), ''ullupta'' (taken out), ''kampita'' (trembling/shaking), ''ati'' (excess/too far), ''bahyaga'' (outside/diverging from), ''mandavega'' (slow) and ''ativega'' (speedy) administration of ''basti'' and they cause harm to the body. [8]
 
Defects related to ''pranetru'' (administrator or attendant who applies procedure) are ''savata'' (''basti'' filled with air), ''atidruta'' (very fast), ''utkshipta'' (raised/upwards), ''tiryak'' (oblique/sideways/transverse), ''ullupta'' (taken out), ''kampita'' (trembling/shaking), ''ati'' (excess/too far), ''bahyaga'' (outside/diverging from), ''mandavega'' (slow) and ''ativega'' (speedy) administration of ''basti'' and they cause harm to the body. [8]
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==== Effect of ''savata dosha'' (air entry during ''basti'' administration) ====
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=== Effect of ''savata dosha'' (air entry during ''basti'' administration) ===
 
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Administration of medication from an improperly filled and/or tied ''basti'' and complete emptying of ''basti'' will cause entry of air into the rectum. ''Vata dosha'' gets vitiated inducing ''shoola'' (sharp, acute pain) and ''toda'' (pricking pain). ''Abhyanga'' (inunction), ''sveda'' (fomentation) to ''guda'' and consumption of diet comprising of ''vata dosha'' pacifying items are to be done as management.[9-10]
 
Administration of medication from an improperly filled and/or tied ''basti'' and complete emptying of ''basti'' will cause entry of air into the rectum. ''Vata dosha'' gets vitiated inducing ''shoola'' (sharp, acute pain) and ''toda'' (pricking pain). ''Abhyanga'' (inunction), ''sveda'' (fomentation) to ''guda'' and consumption of diet comprising of ''vata dosha'' pacifying items are to be done as management.[9-10]
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==== ''Atidruta'' and ''utkshipta dosha'' (fast insertion and withdrawal) ====
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=== ''Atidruta'' and ''utkshipta dosha'' (fast insertion and withdrawal) ===
 
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In case of very fast insertion and withdrawal of ''netra'' and introduction of ''netra'' in upward direction, ''arti'' (pain) occurs in waist, rectum and calf along with thighs. Consumption of diet comprising of ''vata dosha'' pacifying items, unction, fomentation and ''basti'' are to be advised as management.[10-11]
 
In case of very fast insertion and withdrawal of ''netra'' and introduction of ''netra'' in upward direction, ''arti'' (pain) occurs in waist, rectum and calf along with thighs. Consumption of diet comprising of ''vata dosha'' pacifying items, unction, fomentation and ''basti'' are to be advised as management.[10-11]
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==== ''Tiryak dosha'' (improper direction of insertion) ====
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=== ''Tiryak dosha'' (improper direction of insertion) ===
 
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#some material like thread knot occluding the aperture from inside. Here, the ''netra'' should be withdrawn, either re-inserted in proper direction or obstruction removed and re-inserted.[12]
 
#some material like thread knot occluding the aperture from inside. Here, the ''netra'' should be withdrawn, either re-inserted in proper direction or obstruction removed and re-inserted.[12]
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==== ''Ullupta'' and ''kampita dosha'' (improper squeezing of basti putaka and trembling while administration ) ====
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=== ''Ullupta'' and ''kampita dosha'' (improper squeezing of basti putaka and trembling while administration ) ===
 
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In case of trembling of hands while introduction of ''netra'', burning sensation, ''davathuḥ'' (pain heat/inflammation) and swelling occur in ''guda''. ''Seka'' (pouring) and ''basti'' has to be dome with medicines having astringent and sweet taste and in cold state. [13-15]
 
In case of trembling of hands while introduction of ''netra'', burning sensation, ''davathuḥ'' (pain heat/inflammation) and swelling occur in ''guda''. ''Seka'' (pouring) and ''basti'' has to be dome with medicines having astringent and sweet taste and in cold state. [13-15]
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==== ''Ati dosha'' (excessive deep insertion) ====
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=== ''Ati dosha'' (excessive deep insertion) ===
 
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Extensive deep insertion of ''netra'' into ''guda'' inflicts injury to ''gudavali'' and results in pain, burning sensation, pricking pain, prolapse of ''guda'' and abrupt / unexpected defecation. ''Picu'' with cow’s ghee and milk and ''picchabasti'' are to be done here.[15-16]
 
Extensive deep insertion of ''netra'' into ''guda'' inflicts injury to ''gudavali'' and results in pain, burning sensation, pricking pain, prolapse of ''guda'' and abrupt / unexpected defecation. ''Picu'' with cow’s ghee and milk and ''picchabasti'' are to be done here.[15-16]
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==== ''Manda vega'' and ''ativega dosha'' (slow and fast administration) ====
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=== ''Manda vega'' and ''ativega dosha'' (slow and fast administration) ===
 
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In case of speedy administration, either medicine stays in ''koshtha'' or ascends up to ''gala'' (throat). There, ''basti'', ''vireka'' (purgation) and tight gripping of neck are to be done. [17-18]
 
In case of speedy administration, either medicine stays in ''koshtha'' or ascends up to ''gala'' (throat). There, ''basti'', ''vireka'' (purgation) and tight gripping of neck are to be done. [17-18]
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==== Summary ====
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=== Summary ===
 
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Research works have proved the importance of instruments and technique of administration which influences the total procedure and thereby its effect on the body. Usage of proper ''netra'' and ''basti'' in the procedure had influenced the time taken for administration by the maintenance of uniform pressure and gradual squeezing of the content during administration of ''niruha''  (decoction type of enema)<ref>Gundeti MS, Raut AA, Kamat NM. Basti: Does the equipment and method of administration matter?. J [[Ayurveda]] Integr Med 2013;4:9-12</ref>. Also, it influenced the extent of reach of medication in the colon and its quantity. Usage of animal bladder for preparation of ''bastiputaka'' (bag or vessel) was possible and justified in earlier days, however, is not feasible and practical today. As an alternative, a plastic bag of 50 microns thickness and having 1.5 l capacity has been reported recently and is disposed of after single use.<ref>Nampoothiri MR, Mahadevan L. Principles and Practice of Vasti. 1st ed. Derisanamcope: Y. Mahadeva Iyer’s Sri Sarada Ayurvedic Hospital; 2007. p. 49</ref>
 
Research works have proved the importance of instruments and technique of administration which influences the total procedure and thereby its effect on the body. Usage of proper ''netra'' and ''basti'' in the procedure had influenced the time taken for administration by the maintenance of uniform pressure and gradual squeezing of the content during administration of ''niruha''  (decoction type of enema)<ref>Gundeti MS, Raut AA, Kamat NM. Basti: Does the equipment and method of administration matter?. J [[Ayurveda]] Integr Med 2013;4:9-12</ref>. Also, it influenced the extent of reach of medication in the colon and its quantity. Usage of animal bladder for preparation of ''bastiputaka'' (bag or vessel) was possible and justified in earlier days, however, is not feasible and practical today. As an alternative, a plastic bag of 50 microns thickness and having 1.5 l capacity has been reported recently and is disposed of after single use.<ref>Nampoothiri MR, Mahadevan L. Principles and Practice of Vasti. 1st ed. Derisanamcope: Y. Mahadeva Iyer’s Sri Sarada Ayurvedic Hospital; 2007. p. 49</ref>
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==== Defects of ''basti'' nozzle ====
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=== Defects of ''basti'' nozzle ===
    
Defect in ''netra'' are eight in number and each of them affects the proper administration of ''basti'' procedure. Recommendable ''netra'' according to Charak, should have the following attributes:  apertures(at the tip, i.e outlet aperture and at the base (inlet aperture) of the ''netra'') equal to little and thumb in circumference (यथावयोऽङ्गुष्ठकनिष्ठिकाभ्यां मूलाग्रयोः स्युः परिणाहवन्ति), straight (ऋजूनि), alike tail of a cow in shape (गोपुच्छसमाकृतीनि), smooth (श्लक्ष्णानि), curved in tip/round or circular (र्गुडिकामुखानि) and two round protuberances – one at the distal ¼ and other at the proximal end (कर्णिकैकाऽग्रचतुर्थभागे मूलाश्रिते बस्तिनिबन्धने द्वे). (Ca.Si-3/3)
 
Defect in ''netra'' are eight in number and each of them affects the proper administration of ''basti'' procedure. Recommendable ''netra'' according to Charak, should have the following attributes:  apertures(at the tip, i.e outlet aperture and at the base (inlet aperture) of the ''netra'') equal to little and thumb in circumference (यथावयोऽङ्गुष्ठकनिष्ठिकाभ्यां मूलाग्रयोः स्युः परिणाहवन्ति), straight (ऋजूनि), alike tail of a cow in shape (गोपुच्छसमाकृतीनि), smooth (श्लक्ष्णानि), curved in tip/round or circular (र्गुडिकामुखानि) and two round protuberances – one at the distal ¼ and other at the proximal end (कर्णिकैकाऽग्रचतुर्थभागे मूलाश्रिते बस्तिनिबन्धने द्वे). (Ca.Si-3/3)
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This explanation of Sushruta seems to be more apt to the context. Also, the number of ''netra dosha'' varies in Sushruta and eleven are considered there viz. ''atisthoola, avanata, karkasha, anubhinnam, sannikrushtakarnika'' (round protuberance designed close to the outlet aperture), ''viprakrushtakarnika'' (round protuberance designed far from outlet aperture), ''sookshmachidra'' (subtle aperture), ''atichhidra'' (wider aperture), ''atideergha, atihrasva'' and ''asrimat''<ref>Suśruta, Suśrutasamhita Cikitsāsthāna chapter 35. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas [[Ayurveda]] series 51)</ref> (Verse 4- 5)
 
This explanation of Sushruta seems to be more apt to the context. Also, the number of ''netra dosha'' varies in Sushruta and eleven are considered there viz. ''atisthoola, avanata, karkasha, anubhinnam, sannikrushtakarnika'' (round protuberance designed close to the outlet aperture), ''viprakrushtakarnika'' (round protuberance designed far from outlet aperture), ''sookshmachidra'' (subtle aperture), ''atichhidra'' (wider aperture), ''atideergha, atihrasva'' and ''asrimat''<ref>Suśruta, Suśrutasamhita Cikitsāsthāna chapter 35. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas [[Ayurveda]] series 51)</ref> (Verse 4- 5)
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==== Defects of ''basti putaka'' (enema pot) ====
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=== Defects of ''basti putaka'' (enema pot) ===
    
Defective ''basti putaka'' are eight in number and each of them affects the proper appliance in the procedure. When ''basti'' was used in olden times, a ''basti'' devoid of veins was selected from a dead animal (natural death/healthy and butchered) and it was processed prior by soaking in ''kashaya'', (decoctions) gently rubbed and dried (दृढस्तनुर्नष्टसिरो विगन्धः कषायरक्तः सुमृदुः सुशुद्धः)<ref>Agnivēśa, Carakasamitha Sidhisthāna chapter 3</ref>
 
Defective ''basti putaka'' are eight in number and each of them affects the proper appliance in the procedure. When ''basti'' was used in olden times, a ''basti'' devoid of veins was selected from a dead animal (natural death/healthy and butchered) and it was processed prior by soaking in ''kashaya'', (decoctions) gently rubbed and dried (दृढस्तनुर्नष्टसिरो विगन्धः कषायरक्तः सुमृदुः सुशुद्धः)<ref>Agnivēśa, Carakasamitha Sidhisthāna chapter 3</ref>
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''Praasteerna'' causes leakage of medication and ''alpa'' in less effective due to less amount of medication getting administered<ref>Suśruta, Suśrutasamhitha Cikitsāsthāna chapter 35. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas [[Ayurveda]] series 51)</ref> (Verse 6-7)
 
''Praasteerna'' causes leakage of medication and ''alpa'' in less effective due to less amount of medication getting administered<ref>Suśruta, Suśrutasamhitha Cikitsāsthāna chapter 35. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas [[Ayurveda]] series 51)</ref> (Verse 6-7)
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==== Errors during administration and management of complications ====
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=== Errors during administration and management of complications ===
    
The probable errors committed by the person who administers ''basti'' are 10 in number.  Charak in 3rd chapter of ''siddhi'' has laid down the standard operative procedure of administration as follows:
 
The probable errors committed by the person who administers ''basti'' are 10 in number.  Charak in 3rd chapter of ''siddhi'' has laid down the standard operative procedure of administration as follows:
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As discussed earlier, with the knowledge of ''siddhi'' one acquires not only routine practice but expertise in prevention, identification, rectification and management of complications related to the respective ''karma''.(Verse 19)
 
As discussed earlier, with the knowledge of ''siddhi'' one acquires not only routine practice but expertise in prevention, identification, rectification and management of complications related to the respective ''karma''.(Verse 19)
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=== Glossary ===
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#''Basti netra'' (बस्तिनेत्र) – Nozzle made of various metals designed for administering ''basti'' in anal route
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#''Basti'' (बस्ति) – Enema / Also some time used to mention the bladder used for ''Bastikarma'' for filling the ingredients 
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#''Vapadah'' (व्यापदः) – Complications
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#''Netra dosha'' (नेत्रदोषा) – Defects of enema nozzle
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#''Basti doshah'' (बस्तिदोष) – Defects enema bladders
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#''Pranetru doshah'' (प्रणेतृदोषाः) – Administration errors
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=== References ===
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== References ==
 
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