Changes

==== Characteristics of Three types of emesis and purgation (verse 13-15) ====

==== Characteristics of Three types of emesis and purgation (verse 13-15) ====

Yellowish-greenish vomiting along with bitter taste in mouth indicates that the pyloric valve is open and bile is flowing into the stomach from the duodenum.  This is considered as end point of emesis and called pittanta vamana. In case of virechana, mucosal layer gets removed partially at the end point that can be considered as kaphanta virechana. Continuing cleansing beyond these endpoints may cause deleterious effects on the health.

Yellowish-greenish vomiting along with bitter taste in mouth indicates that the pyloric valve is open and bile is flowing into the stomach from the duodenum.  This is considered as end point of emesis and called ''pittanta vamana''. In case of ''virechana'', mucosal layer gets removed partially at the end point that can be considered as ''kaphanta virechana''. Continuing cleansing beyond these endpoints may cause deleterious effects on the health.

 

 

Properly administered cleansing processes causes lightness in the body, feeling of happiness, clarity of heart region and sense organs etc. Both ''vamana'' and ''virechana'' clear digestive tract that is filled of morbid matter and bulky food, fluid etc. Hence causes feeling of lightness. Sense organs respond to the stimuli either internal or external thus any adherence of morbid matter in these organs is responsible for ill functioning. Especially in ''vamana'' cleansing of nasal cavity, oral cavity is directly evident whereas skin is affected during oleation and fomentation. Removal of ''dosha'' causes blood purification which is responsible for health and proper functioning of skin.

Improper administration of emesis causes itching, urticaria etc. which can be considered as allergic reaction in response to the allergen in the form of emetic drug. The protein in the food is the most common allergic component. Some proteins or fragments of proteins are resistant to digestion and those that are not broken down in the digestive process are tagged by the Immunoglobulin E (IgE) causing allergic reaction.  Possibility cannot be ruled out that the drug administered for emesis may irritate gastric mucosa, increases intracellular space due to transient inflammation thereby escaping into circulation directly without digestion and acts as a trigger for allergy.

Improper administration of emesis causes itching, urticaria etc. which can be considered as allergic reaction in response to the allergen in the form of emetic drug. The protein in the food is the most common allergic component. Some proteins or fragments of proteins are resistant to digestion and those that are not broken down in the digestive process are tagged by the Immunoglobulin E (IgE) causing allergic reaction.  Possibility cannot be ruled out that the drug administered for emesis may irritate gastric mucosa, increases intracellular space due to transient inflammation thereby escaping into circulation directly without digestion and acts as a trigger for allergy.

Similarly in case of purgation if drug fails to give proper effect of evacuation then it remains inside the body and gives an allergic reaction which is evident in the form of coryza.  

Similarly in case of purgation if drug fails to give proper effect of evacuation then it remains inside the body and gives an allergic reaction which is evident in the form of coryza.  

In Ayurvedic parlance, the probable reason for these symptoms is that when drug fails to attain desired cleansing and it is not removed from the body it act as a trigger for aggravation or excitement of dosha but is unable to throw them outside the body; thus either the disease gets aggravated or symptoms of dosha vitiation are evident.  

In Ayurvedic parlance, the probable reason for these symptoms is that when drug fails to attain desired cleansing and it is not removed from the body it act as a trigger for aggravation or excitement of dosha but is unable to throw them outside the body; thus either the disease gets aggravated or symptoms of dosha vitiation are evident.  

Time to anuvasana (unctuous enema) or oleation after cleansing process: [verse 20-22]

 

==== Time to anuvasana (unctuous enema) or oleation after cleansing process (verse 20-22) ====

 

Anuvasana or snehapana therapy is indicated on ninth day after cleansing processes. This duration of gap includes seven days of post therapeutic measures and one day of rest. Immediately after cleansing, the digestive power is reduced and it improves gradually in seven days. This gap of total eight days is very much necessary to regain the normal functioning of digestive components in the gastrointestinal tract. Mucosal membrane is one such component of digestive tract that establishes a barrier between external environments and the internal milieu. Normal well formed healthy mucosa is responsible for nutrient absorption and waste secretion, which require a selectively permeable barrier. These functions place the mucosal epithelium at the centre of interactions between the mucosal immune system and luminal contents, including dietary antigens and microbial products.  Thus in view of regeneration of new healthy mucosal barrier this duration of gap may play a prime role.

Anuvasana or snehapana therapy is indicated on ninth day after cleansing processes. This duration of gap includes seven days of post therapeutic measures and one day of rest. Immediately after cleansing, the digestive power is reduced and it improves gradually in seven days. This gap of total eight days is very much necessary to regain the normal functioning of digestive components in the gastrointestinal tract. Mucosal membrane is one such component of digestive tract that establishes a barrier between external environments and the internal milieu. Normal well formed healthy mucosa is responsible for nutrient absorption and waste secretion, which require a selectively permeable barrier. These functions place the mucosal epithelium at the centre of interactions between the mucosal immune system and luminal contents, including dietary antigens and microbial products.  Thus in view of regeneration of new healthy mucosal barrier this duration of gap may play a prime role.

After niruha type of medicated enema the unctuous enema is indicated on the same day in the evening for the pacification vata that is remained in the gut even after removal by niruha or to pacify vata that is produced due to possible overdose of niruha. Also as per modern perspectives it is possible that due to niruha type of medicated enema the colon gets cleared providing minimal barrier for absorption and due to increased permeability on virtue of transient inflammation, the transmucosal entry of fats of unctuous enema is facilitated.   

After niruha type of medicated enema the unctuous enema is indicated on the same day in the evening for the pacification vata that is remained in the gut even after removal by niruha or to pacify vata that is produced due to possible overdose of niruha. Also as per modern perspectives it is possible that due to niruha type of medicated enema the colon gets cleared providing minimal barrier for absorption and due to increased permeability on virtue of transient inflammation, the transmucosal entry of fats of unctuous enema is facilitated.   

Number and sequence of unctuous and niruha type of enema [verse 23-25]

 

==== Number and sequence of unctuous and niruha type of enema (verse 23-25) ====

 

After niruha, unctuous enema is indicated.  Also the minimum unctuous enema required for a patient also depends upon aggravated dosha.  

After niruha, unctuous enema is indicated.  Also the minimum unctuous enema required for a patient also depends upon aggravated dosha.  

Thus,

Thus,

• If kapha is agravated then 1-3 unctuous enema & if pitta is aggravated then 5-7 unctuous enema are indicated along with niruha in between. In such condition continuous three niruha type of medicated enema can be given so as to remove the vitiated kapha-pitta and then unctuous enema can be administered to combat vata aggravation.

• If kapha is agravated then 1-3 unctuous enema & if pitta is aggravated then 5-7 unctuous enema are indicated along with niruha in between. In such condition continuous three niruha type of medicated enema can be given so as to remove the vitiated kapha-pitta and then unctuous enema can be administered to combat vata aggravation.

Benefits of niruha type of medicated enema: [verse 27-28]

==== Benefits of niruha type of medicated enema (verse 27-28) ====

 

Ageing is a process that causes aggravation of vata due to loss of body’s vital elements gradually and aggravated vata also fastens the ageing. Thus being best treatment for vata, basti proves to be an anti-ageing therapy. Moreover, it has a cleansing spectrum in the lower part of gut. This portion is surrounded by vital organs like liver, spleen, pancreas, kidneys. Thus, the effect of cleansing is more marked for these organs. Liver and kidney plays an important role of detoxification thus maintaining body homeostasis that is helpful to avoid ageing.

Ageing is a process that causes aggravation of vata due to loss of body’s vital elements gradually and aggravated vata also fastens the ageing. Thus being best treatment for vata, basti proves to be an anti-ageing therapy. Moreover, it has a cleansing spectrum in the lower part of gut. This portion is surrounded by vital organs like liver, spleen, pancreas, kidneys. Thus, the effect of cleansing is more marked for these organs. Liver and kidney plays an important role of detoxification thus maintaining body homeostasis that is helpful to avoid ageing.

Basti is considered as a harmless treatment mainly because in this treatment unlike that of purgation the fluid is supplied from outside for cleansing process and the amount of evacuation is also very less as compared to purgation. It acts in the colon and rectum which has a dominant function of excretion rather than absorption of nutrients. Thus, enema hardly alters the process of digestion; on the contrary it supports body’s natural process of excretion. Whereas in case of emesis the treatment goes in opposite direction of peristalsis and it mainly affects process of digestion. This is the reason for which no post therapeutic measures (samsarjana krama) are indicated in Medicated enema.

Basti is considered as a harmless treatment mainly because in this treatment unlike that of purgation the fluid is supplied from outside for cleansing process and the amount of evacuation is also very less as compared to purgation. It acts in the colon and rectum which has a dominant function of excretion rather than absorption of nutrients. Thus, enema hardly alters the process of digestion; on the contrary it supports body’s natural process of excretion. Whereas in case of emesis the treatment goes in opposite direction of peristalsis and it mainly affects process of digestion. This is the reason for which no post therapeutic measures (samsarjana krama) are indicated in Medicated enema.

Vata is responsible for movement of pitta and kapha. Hence it plays main role in the production of all diseases. Thus, being remedy for vata, basti is said to cure all diseases.

Vata is responsible for movement of pitta and kapha. Hence it plays main role in the production of all diseases. Thus, being remedy for vata, basti is said to cure all diseases.

Body strength and all kapha dominant body elements like semen are inversely related with vata. Thus, if vitiated vata is evacuated, the strength, sturdiness are enhanced bringing a new essence to body elements.  

Body strength and all kapha dominant body elements like semen are inversely related with vata. Thus, if vitiated vata is evacuated, the strength, sturdiness are enhanced bringing a new essence to body elements.  

Benefits of unctuous type of medicated enema: [verse 29-31]

==== Benefits of unctuous type of medicated enema (verse 29-31) ====

 

Evacuating type of enema cleanses the gut thus facilitating the absorption of fats. Oil is considered to be the best for vata on virtue of its properties. The example given by acharya points towards the colonic and rectal absorption of fats given through unctuous enema and also it specifies the superiority of rectal route over oral consumption of fats. This may be because of the fact that vata is nothing but increase in some properties like dryness, lightness, cold, movement etc. in the body and these properties are introduced in human gut in the last part of digestion that occurs in colon. Unctuous enema directly oleates the colon and after absorption affects whole body by properties like unctuousness, heaviness and warmth. As site of production of vata is treated, no new vata formation occurs in the body bringing about the phenomena of vata-nigraha that is responsible for movement of all dosha from shakha (extremities) to koshtha (gut). Even proper function of agni (digestive strength) is dependent upon normal activity of vata as it has a vital function of igniting the digestive fire. Other functions like mental harmony, strength, vitality, complexion etc. are taken care of by unctuous enema as pacification of vata affects positively on mind, improves production of new body elements and gives health to the skin as it is also a site of residence for vata.

Evacuating type of enema cleanses the gut thus facilitating the absorption of fats. Oil is considered to be the best for vata on virtue of its properties. The example given by acharya points towards the colonic and rectal absorption of fats given through unctuous enema and also it specifies the superiority of rectal route over oral consumption of fats. This may be because of the fact that vata is nothing but increase in some properties like dryness, lightness, cold, movement etc. in the body and these properties are introduced in human gut in the last part of digestion that occurs in colon. Unctuous enema directly oleates the colon and after absorption affects whole body by properties like unctuousness, heaviness and warmth. As site of production of vata is treated, no new vata formation occurs in the body bringing about the phenomena of vata-nigraha that is responsible for movement of all dosha from shakha (extremities) to koshtha (gut). Even proper function of agni (digestive strength) is dependent upon normal activity of vata as it has a vital function of igniting the digestive fire. Other functions like mental harmony, strength, vitality, complexion etc. are taken care of by unctuous enema as pacification of vata affects positively on mind, improves production of new body elements and gives health to the skin as it is also a site of residence for vata.

Effects of unctuous and evacuating type of medicated enema in general: [verse 32-34]

 

==== Effects of unctuous and evacuating type of medicated enema in general (verse 32-34) ====

 

All the disease quoted by acharya are exclusively vata disorders and thus basti seems to be the best remedy for them. Especially in females not conceiving despite their mating with male partner and in men’s having seminal debility basti acts potentially because both the abnormalities are related to apana vata. Apana is well regulated to the downward direction and its site of production is cleansed by basti bringing about the optimum therapeutic effect.

All the disease quoted by acharya are exclusively vata disorders and thus basti seems to be the best remedy for them. Especially in females not conceiving despite their mating with male partner and in men’s having seminal debility basti acts potentially because both the abnormalities are related to apana vata. Apana is well regulated to the downward direction and its site of production is cleansed by basti bringing about the optimum therapeutic effect.

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 faecal 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

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

Importance of basti therapy: [verse 38-40]

 

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 faecal 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) ====

 

Ayurveda states only two types of therapies i.e. samshamana (dosha pacifying) and samshodhana (cleansing). Vata is responsible for all diseases as beside its own hazards it moves other vitiated dosha also. Basti has duel nature of action i.e. cleansing with dosha pacification. It acts mainly on vata hence basti can be considered as a single remedy for all the diseases; however, its formulation needs to vary as per disease.

Ayurveda states only two types of therapies i.e. samshamana (dosha pacifying) and samshodhana (cleansing). Vata is responsible for all diseases as beside its own hazards it moves other vitiated dosha also. Basti has duel nature of action i.e. cleansing with dosha pacification. It acts mainly on vata hence basti can be considered as a single remedy for all the diseases; however, its formulation needs to vary as per disease.

Mode of action of  basti: [verse 41]

 

==== Mode of action of  basti (verse 41) ====

 

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

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

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

 

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

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

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

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

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