Changes

According to the condition, ''hinguvachadi, shaddharana, vaishvanara churna'' can also be used.

According to the condition, ''hinguvachadi, shaddharana, vaishvanara churna'' can also be used.

Preparation of kalka:

===== Preparation of ''kalka'' =====

Very fine powder of the prescribed drug are taken in khalva and combined one by one with the pestle. Add warm water to the powder and do mardana with pestle for 1-2 minutes. Now kalka is ready for adding.   

 

Dose of kalka:

Very fine powder of the prescribed drug are taken in ''khalva'' and combined one by one with the pestle. Add warm water to the powder and mash the mixture with pestle for 1-2 minutes. Now ''kalka'' is ready for use.

• Caraka has not mentioned the dose of kalka

   

===== Dose of ''kalka'' =====

 

• Charaka has not mentioned the dose of kalka

• Sushruta mentions it as 1 prasruta

• Sushruta mentions it as 1 prasruta

• According to Vriddha Vagbhata, 1/8th of 12 prasruta=1.5 prasruta  

• According to Vriddha Vagbhata, 1/8th of 12 prasruta=1.5 prasruta  

• Jatukarna, Vrinda Madhava, Chakrapani told 2 Pala  

• Jatukarna, Vrinda Madhava, Chakrapani told 2 Pala  

Utility of kalka:

 

===== Utility of ''kalka'' =====

 

• Kalka confers the viscosity (sāndratā) to the basti dravya and will not change the volume.

• Kalka confers the viscosity (sāndratā) to the basti dravya and will not change the volume.

• Kalka helps in retension of enema  

• Kalka helps in retension of enema  

• Prevents ayoga (insufficient action), adhmāna (flatulence) etc. upadrava

• Prevents ayoga (insufficient action), adhmāna (flatulence) etc. upadrava

Verse 24  

==== Verse 24 ====

 

Rationale for mixing sequence of basti:

Rationale for mixing sequence of basti:

Madhu- mangalakāraka auspicious  

Madhu- mangalakāraka auspicious  

Mūtra- increases the action & potency basti.8  

Mūtra- increases the action & potency basti.8  

Verse 24-25  

==== Verse 24-25 ====

 

When the patient lies on his left side, both the grahaņi and guda remain in normal position. Basti administered in this position gets absorbed properly and distributed easily. In this position, the sphincters remain relaxed. Therefore, the enema fluid enters into rectum easily without any obstruction and impregnates the grahaņi to produce the desired therapeutic effect.9  

When the patient lies on his left side, both the grahaņi and guda remain in normal position. Basti administered in this position gets absorbed properly and distributed easily. In this position, the sphincters remain relaxed. Therefore, the enema fluid enters into rectum easily without any obstruction and impregnates the grahaņi to produce the desired therapeutic effect.9  

Basti drug reaches first to the pakvāśaya and then to the grahaņī. Pakvāśaya is the site of purīshadharā kalā and grahaņī is the site of pittadharā kalā. So basti directly acts on Purīshadharā kalā and Pittadharā Kalā. Commentator Ďalhaņa has commented that Purīshadharā and asthidharā kalā are same and pittadharā kalā and majjādharā kalā are one and same.10 So from these evidences it is clear that basti has direct action on asthi and majjā dhātu. Majjā is present in the asthi. Also mastulunga is considered as mastaka majjā.11 Vāta nāďi are also made by majjā which is the seat of vāta dosha. So in this way, basti is useful in the disorders of central nervous system.

Basti drug reaches first to the pakvāśaya and then to the grahaņī. Pakvāśaya is the site of purīshadharā kalā and grahaņī is the site of pittadharā kalā. So basti directly acts on Purīshadharā kalā and Pittadharā Kalā. Commentator Ďalhaņa has commented that Purīshadharā and asthidharā kalā are same and pittadharā kalā and majjādharā kalā are one and same.10 So from these evidences it is clear that basti has direct action on asthi and majjā dhātu. Majjā is present in the asthi. Also mastulunga is considered as mastaka majjā.11 Vāta nāďi are also made by majjā which is the seat of vāta dosha. So in this way, basti is useful in the disorders of central nervous system.

It is thought that an enema introduced would never ascend so high as the stomach. There is a referance from the Best and Taylor that “materials introduced by enema, in some instances pass through the walls into the ilium, such incompetence may permit the enema fluid to reach the duodenum.” Also the possibility of materials from even the lower bowel, reaching the mouth is strongly suggested by the fact that lycopodium sporce, introduced into the colon by enema, has been recovered some hours later from washing of the stomach.12  

It is thought that an enema introduced would never ascend so high as the stomach. There is a referance from the Best and Taylor that “materials introduced by enema, in some instances pass through the walls into the ilium, such incompetence may permit the enema fluid to reach the duodenum.” Also the possibility of materials from even the lower bowel, reaching the mouth is strongly suggested by the fact that lycopodium sporce, introduced into the colon by enema, has been recovered some hours later from washing of the stomach.12  

Verse 26  

==== Verse 26 ====

 

For vāta prakopa 1 basti, for pitta prakopa 2 basti and for kapha prakopa 3 basti should be given. It is not that 3 basti prayoga for tridosha Prakopa, the 1st basti eliminates the vāta, second pitta and third, kapha. The author himself will explain the need of giving one basti for vāyu, 2 for pitta and 3 for kapha in verse no. 69. Thus, the one basti eliminates the aggravated vāta from its location, two of them (given on after the other) eliminate the pitta from its location and three of them (given on after the other) eliminate kapha from its location.

For vāta prakopa 1 basti, for pitta prakopa 2 basti and for kapha prakopa 3 basti should be given. It is not that 3 basti prayoga for tridosha Prakopa, the 1st basti eliminates the vāta, second pitta and third, kapha. The author himself will explain the need of giving one basti for vāyu, 2 for pitta and 3 for kapha in verse no. 69. Thus, the one basti eliminates the aggravated vāta from its location, two of them (given on after the other) eliminate the pitta from its location and three of them (given on after the other) eliminate kapha from its location.

Basti is given to eliminate the aggravated vāta from pakvāshaya. But as specific effect, this basti is also capable of eliminating the aggravated dosha even from the locations of pitta and kapha. Thus, in general basti eliminates the vāta from pakvāshaya. But by the application of special methods, this basti becomes capable of eliminating the dosha from other parts.

Basti is given to eliminate the aggravated vāta from pakvāshaya. But as specific effect, this basti is also capable of eliminating the aggravated dosha even from the locations of pitta and kapha. Thus, in general basti eliminates the vāta from pakvāshaya. But by the application of special methods, this basti becomes capable of eliminating the dosha from other parts.

Basti is, no doubt, not the most effective therapy for aggravated pitta and kapha. But it is very effective only when these two dosha are associated with aggravated vāta.13  

Basti is, no doubt, not the most effective therapy for aggravated pitta and kapha. But it is very effective only when these two dosha are associated with aggravated vāta.13  

Verse 27-29  

 

==== Verse 27-29 ====

 

The patient is instructed to take the thin meat soup etc. after niruha basti to protect his agni which is slightly reduced due to therapy. Peyadi krama is not necessary after niruha.   

The patient is instructed to take the thin meat soup etc. after niruha basti to protect his agni which is slightly reduced due to therapy. Peyadi krama is not necessary after niruha.   

Niruha basti does not cause agnimandya, bala kshaya, prana kshaya like virechana, so peyadi krama is not needed. Bhoja stated that the virechana causes agnimandya by adhisthana samplavat whereas basti does not decrease the agni instead kindles it.14  

Niruha basti does not cause agnimandya, bala kshaya, prana kshaya like virechana, so peyadi krama is not needed. Bhoja stated that the virechana causes agnimandya by adhisthana samplavat whereas basti does not decrease the agni instead kindles it.14  

Verse 30-31  

 

==== Verse 30-31 ====

 

The above-mentioned ratio of decoction and sneha should be adopted even if the niruha basti is administered in minimum quantity. Apart from the decoction and sneha, the niruha kalpana also contains madhu, kalka, and saindhava etc. The quantity of these ingredients is variable according to the dosha, prakruti etc. of the patient. However, the quantity of the ingredients should be such that it should make the kalpana equal to 12 prasruta in total.  

The above-mentioned ratio of decoction and sneha should be adopted even if the niruha basti is administered in minimum quantity. Apart from the decoction and sneha, the niruha kalpana also contains madhu, kalka, and saindhava etc. The quantity of these ingredients is variable according to the dosha, prakruti etc. of the patient. However, the quantity of the ingredients should be such that it should make the kalpana equal to 12 prasruta in total.  

Jatukarna has prescribed two pala of paste to be added to the basti kalpana. According to him, 6 pala of sneha for vata roga and for healthy persons; four pala of ghee should be added for pitta roga and 3 pala of taila for kapha roga. Saindhava should be added in 1 tola dose.

Jatukarna has prescribed two pala of paste to be added to the basti kalpana. According to him, 6 pala of sneha for vata roga and for healthy persons; four pala of ghee should be added for pitta roga and 3 pala of taila for kapha roga. Saindhava should be added in 1 tola dose.

Sushruta has described one tola saindhava and 2 prasruta madhu for basti kalpana.15

Sushruta has described one tola saindhava and 2 prasruta madhu for basti kalpana.15

Hārita has prescribed one prasruta of honey and one tola of saindhava.  

Hārita has prescribed one prasruta of honey and one tola of saindhava.  

Use of these avapa is also described in Hārita Samhita.

Use of these avapa is also described in Hārita Samhita.

In the exact quantity of these ingredients are told as follows - saindhava-1 tolā, madhu-2 prasruta, sneha-3 prasruta, kalka-1 prasruta, kashāya-4 prasruta and avapa-2 prasruta. Thus, the total quantity becomes 12 prasruta ½ which is rounded to 12 prasruta. This kalpanā is meant for vāta  roga.16

In the exact quantity of these ingredients are told as follows - saindhava-1 tolā, madhu-2 prasruta, sneha-3 prasruta, kalka-1 prasruta, kashāya-4 prasruta and avapa-2 prasruta. Thus, the total quantity becomes 12 prasruta ½ which is rounded to 12 prasruta. This kalpanā is meant for vāta  roga.16

Caraka told 5 prasruta of kashāya to be added. Suśruta told 4 prasruta. This change in the quantity of kashāya is not acceptable.18  

 

Charaka told 5 prasruta of kashāya to be added. Suśruta told 4 prasruta. This change in the quantity of kashāya is not acceptable.18  

Basti kalpanā according to dosha:19

Basti kalpanā according to dosha:19

In case of a healthy person (marked by an equilibrium of vāta, pitta and kapha), the solution to be administered should be composed of four parts of the decoction of drugs and one part (a fifth part of the basti) of the sneha (any oleaginous substance). In any case marked by a preponderance of the deranged vāta, the sneha should measure a quarter part of the whole, one-sixth in a case of a preponderance of the deranged pitta and an eighth part in a case of the deranged kapha. In a case of aggravation of all the (three) dosha, the kalka should measure an eighth part (of the entire quantity of basti dravya), and the following drugs, viz.y salt, honey, cow's urine, phala (madana), milk, avāpa (additives) such as kānjika, etc. and soup of meat. In formulating niruha basti the dosage should be determined by a due consideration of the requirements in each case. When the kalka, the sneha, and the decoction would be well mixed together, the solution for administration should be considered to have been well prepared. The application of such a solution would be supposed to produce the desired results. Ďalhaņa says that of the whole mixture measuring 12 prasruta (twenty-four Palas), there should be 4 prasruta of the decoction, and so on.19  

In case of a healthy person (marked by an equilibrium of vāta, pitta and kapha), the solution to be administered should be composed of four parts of the decoction of drugs and one part (a fifth part of the basti) of the sneha (any oleaginous substance). In any case marked by a preponderance of the deranged vāta, the sneha should measure a quarter part of the whole, one-sixth in a case of a preponderance of the deranged pitta and an eighth part in a case of the deranged kapha. In a case of aggravation of all the (three) dosha, the kalka should measure an eighth part (of the entire quantity of basti dravya), and the following drugs, viz.y salt, honey, cow's urine, phala (madana), milk, avāpa (additives) such as kānjika, etc. and soup of meat. In formulating niruha basti the dosage should be determined by a due consideration of the requirements in each case. When the kalka, the sneha, and the decoction would be well mixed together, the solution for administration should be considered to have been well prepared. The application of such a solution would be supposed to produce the desired results. Ďalhaņa says that of the whole mixture measuring 12 prasruta (twenty-four Palas), there should be 4 prasruta of the decoction, and so on.19  

Vrinda Madhava has given different formula as follows-20

Vrinda Madhava has given different formula as follows-20

Total 24 Pala or 12 Prasruta 24 pal 24 Pala

Total 24 Pala or 12 Prasruta 24 pal 24 Pala

Verse 34 -

==== Verse 34 ====

After the manifestation of samyak nirudha  symptoms, the patient should be advised to take bathe (in hot water) and to take meat-soup (rasa), milk and pulse-soup (yūsha) in diseases due to the action of the deranged vāta, pitta and kapha respectively. The essence (rasa) of the meat of any jāngala animal may, however, be prescribed in all cases under the circumstances, since it would produce no harm. Only a quarter, a half or three-quarter part of the usual diet should be prescribed according to the digestive capacity of the patient, and the nature and intensity of the Dosha involved in each case.21  

After the manifestation of samyak nirudha  symptoms, the patient should be advised to take bathe (in hot water) and to take meat-soup (rasa), milk and pulse-soup (yūsha) in diseases due to the action of the deranged vāta, pitta and kapha respectively. The essence (rasa) of the meat of any jāngala animal may, however, be prescribed in all cases under the circumstances, since it would produce no harm. Only a quarter, a half or three-quarter part of the usual diet should be prescribed according to the digestive capacity of the patient, and the nature and intensity of the Dosha involved in each case.21  

After anuvāsana, yūsha, kshīra and māmsa rasa yūsha, kshīra and māmsa rasa should be given along with anna in kapha, pitta and vāta respectively. Peyā should not be given as it causes abhishyandana of koshţha because of sneha in koshţha.22  

After anuvāsana, yūsha, kshīra and māmsa rasa yūsha, kshīra and māmsa rasa should be given along with anna in kapha, pitta and vāta respectively. Peyā should not be given as it causes abhishyandana of koshţha because of sneha in koshţha.22  

Verse 35 –

==== Verse 35 ====

 

This basti is also highlighted in Ashtanga Hridaya which is detailed below for a practical understanding.

This basti is also highlighted in Ashtanga Hridaya which is detailed below for a practical understanding.

DVIPANCAMŪLĀDI (A.H.Ka.4/4):

DVIPANCAMŪLĀDI (A.H.Ka.4/4):

Guņa- Sarva vātavyādhihara

Guņa- Sarva vātavyādhihara

Verse 39  

==== Verse 39 ====

 

In the same method, the skilled physician should administer 2nd, 3rd or 4th niruha basti or till samyak niroodha & then stop.23 Ďalhaņa while commenting has justified that, in kroora koshtha if improperly administered or if suniroodha lakshana not observed and dosha to be eliminated are present, in such condition 4thbasti should be used judiciously.24  

In the same method, the skilled physician should administer 2nd, 3rd or 4th niruha basti or till samyak niroodha & then stop.23 Ďalhaņa while commenting has justified that, in kroora koshtha if improperly administered or if suniroodha lakshana not observed and dosha to be eliminated are present, in such condition 4thbasti should be used judiciously.24  

Some other considered 4th basti is advocated for rakta. Some other considered that the 4th basti with madhura and sheeta dravya for daha nirvapana.25  

Some other considered 4th basti is advocated for rakta. Some other considered that the 4th basti with madhura and sheeta dravya for daha nirvapana.25  

Some others opine that the utkleshana, shodhana and shamana basti should be formulated sequentially.26  

Some others opine that the utkleshana, shodhana and shamana basti should be formulated sequentially.26  

In case of sannipata dosha also three basti are enough as mentioned in order of dosha above. Hence, some other physicians do not desire a fourth basti as there is no fourth dosha for which basti is to be given.27

In case of sannipata dosha also three basti are enough as mentioned in order of dosha above. Hence, some other physicians do not desire a fourth basti as there is no fourth dosha for which basti is to be given.27

The physicians regard that there is no more than three basti should be given because there is no 4th dosha to give basti.28  

The physicians regard that there is no more than three basti should be given because there is no 4th dosha to give basti.28  

Vāgbhaţa another context in the same chapter told that after self returning (svayam nivritti) 2nd , 3rd or 4th basti should be given or till samyak nirudha  lakshaņa.29  

Vāgbhaţa another context in the same chapter told that after self returning (svayam nivritti) 2nd , 3rd or 4th basti should be given or till samyak nirudha  lakshaņa.29  

Aruņadatta commenting on above verse, told that svayameva means, without stimulation by phalavarti etc. If by stimulus i.e. phalavarti, tīkshņa virechana etc. are used, then subsequent basti should not be given. Fourth, fifth basti etc. can be given till samyak niroodha lakshaņa are observed.30  

Aruņadatta commenting on above verse, told that svayameva means, without stimulation by phalavarti etc. If by stimulus i.e. phalavarti, tīkshņa virechana etc. are used, then subsequent basti should not be given. Fourth, fifth basti etc. can be given till samyak niroodha lakshaņa are observed.30  

Vaidya Kasture referring to the Suśruta’s view told that, one should not administer more than 4 basti in a day; otherwise it causes pakvashaya kshobha (irritation of colon).  

 

Vaidya Kasture referring to the Suśruta’s view told that, one should not administer more than 4 basti in a day; otherwise it causes pakvashaya kshobha (irritation of colon).  

So the above discussion may be concluded that the 2nd, 3rd or 4th basti can be given after assessing the doshadi factors31 in following conditions-

So the above discussion may be concluded that the 2nd, 3rd or 4th basti can be given after assessing the doshadi factors31 in following conditions-

• After the self returning of 1st basti without any stimulation.

• After the self returning of 1st basti without any stimulation.