Basti treatment procedure, Benefits- Astangahrudayam Sutrasthana 19

This chapter explains the procedure of Basti treatment. Basti in general means enema therapy. This is the 19^th chapter of Ashtanga Hrudaya Sutrasthana, called as Basti Vidhi Adhyaya, written by Sri Vagbhata, son of Sri Vaidyapathi Simhagupta. 

Shloka recitation video

Basti is described for diseases with
imbalanced Doshas having predominance of Vata or
for diseases with Vata imbalance alone,
It is the best among all treatments.
It is of three kinds- viz
Niruha also known as Asthapana Basti  – Decoction enema – decoction mixed with salt, honey, ghee etc is administered.
Anuvasana also known as Snehabasti  ghee, oil, fat etc are administered. Herbal oils such as Narayana Taila, Herbal ghritas are more commonly used for this purpose.
Uttarabasti  administered through urethral route. 1

Notes- Basti  means urinary bladder. In ancient times urinary bladder of animals like buffalo etc were used as a bag to hold the enema material like decoctions, oil etc.

Persons suitable for decoction enema

Persons suitable for decoction enema -Asthapya  Asthapana Arha

Patients suffering from
Gulma – Tumors of the abdomen
Anaha – bloating, fullness
Khuda – gout,
Pleeha – Disease of the spleen, Splenomegaly
Shuddha atisara – Diarrhoea unassociated with other diseases
Shula – pain abdomen
Jeernajwara –  Chronic fever
Pratishyaya – rhinitis
Shukra, Anila, Mala Graha –  obstruction of semen, flatus and constipation,
Vardhma – enlargement of the scrotum,
Ashmari  Urinary calculi,
Rajonasha – Amenorrhoea and
Grievous diseases of vata origin. 2-3

Persons unsuitable for decoction enema

Unsuitable for Niruha – Asthapana Anarha – Anasthapyah
Atisnigdha – who have had excess of oleation therapy;
Urakshata –  Chest injury,
Krusha – highly emaciated,
Ama Atisara – diarrhoea, dysentery due to Ama or diarrhea of recent onset,
Vami – vomiting,
Samshuddha – who have undergone purification therapies (Panchakarma),
Datta Navana – who have been administered nasal medication
Shvasa –  COPD, Asthma, Dyspnoea
Kasa – cough, cold
Praseka –  excessive salivation
Arsha – Hemorrhoids
Hidhma – Hiccups
Adhmana –  Abdominal bloating
Alpavahni – low digestion strength
Shunapayu – Swelling in the rectum
Kruta Ahara –  Who have just taken food
Badhodara – intestinal obstruction
Chidra Udara –  Intestinal rupture
Udakodara –  Ascites
Kushta – skin diseases
Madhumeha –  diabetes
Pregnant woman in the seventh month. 4-5

Persons suitable for oil enema

Patients suitable for Anuvasana Basti  Anuvasana Arha – Anuvasya
Person suitable for Asthapana are suitable for oil enema (Anuvasana).
Especially those who have strong digestion power, who are dry not undergone Snehana therapy and those suffering from diseases of vata. 6

Persons unsuitable for oil enema

Patients not suitable for Anuvasana – Nanuvasyah  Anuvasana Anarha
Persons unsuitable for oil enema are all those unsuitable for decoction enema, those suffering from
Pandu – anemia,
Kamala – Jaundice,
Meha – diabetes, urinary tract disorders
Peenasa – rhinitis
Niranna –  on empty stomach
Pleeha – Disease of the spleen, Splenomegaly
Vid bhedi – diarrhea,
Guru koshta – hard bowels- constipated,
Kaphodara – Kapha type of Ascites
Abhishyandi – a type of eye disorder
Bhrusha Sthula – profound   obesity,
Krumi Koshta – Intestinal worm infestation
Adhyamaruta – gout;
Who have consumed poison, those suffering from artificial poisoning, goiter, filariasis and scrofula. 7-8

Bastinetra enema nozzle

Enema nozzle should be made from metals like gold, silver, wood, bone or bamboo;
Gopuchhakara – resembling the tail of the cow in shape,
Achidra – without holes (except at the ends), smooth, straight and with
Gulikamukha – tip shaped like a pill. 9

For children less than 1 year of age, nozzle should be five angula- fingers breadth of Patients own finger in length;
1 – 7years – 6 angula;
7 years – 7 Angula,
12 years – 8 Angula
16 years – 9 Angula
20 years and above – 12 Angulas only.
These measurements may be slightly increased for those of other age groups based on age, strength and body build. 10-11

Its orifice at its root should be 1 Angula in diameter for children of one year of age.
Diameter of the orifice should be increased by ½ angula for different age groups and its maximum is 3 Angula diameter.
At its tip, the orifice should allow free movement of soaked Mudga (green gram), Masha (black gram), Kalaya (round pea) and seed of Karkandhu Jujube respectively. 12-13

Near the office at its root, a Karnika- ear-like ridge of this same size of the orifice should be constructed –  at the time of preparing the nozzle, another second Karnika- ridge should be made at a distance of two Angula- towards its tip, the orifice at the tip should be kept closed- with a plug of cloth.14-15.

Basti Putaka-  Enema bag

Urinary bladder of goat, sheep, buffalo or other animals was used as enema bag. The bladder should be sturdy, well beaten, made red by tanning with astringent substances.
The bladder should be devoid of holes, hard spots.
It should not be torn.
To such a bladder, big end of the nozzle is adjusted and tied with threads.
If the bladder is not available, skin of thigh and legs of animals or thick cloth may be utilized for making the bag. 15-17

Quantity of medicine for decoction enema

Niruha Matra (quantity of medicine for decoction enema):-
For a child upto 1 year age, the decoction enema quantity is 1 prakuncha = 1 Pala = 48g.
For each succeeding year it should be increased by 1 pala till it becomes six Prasruta- 12 pala =576g;
So for a 12 year old, the quantity is 12 Pala.
Further on it should be increased by one Prasruta (2 Palas= 96 g). Each year till it becomes twelve Prasta- 24 Palas=1152g.
At the age of 18 years, it is 24 Pala.
18 – 70 years – 24 Pala.
After 70 years, 10 Prasruta = 20 Pala = 960 grams / ml. 18-19

Quantity of medicine for oil enema

 Anuvasana Matra– quantity for oil enema:-
The quantity for oil enema should be one fourth of the quantity of that of decoction enema, as prescribed for each age group. 20

Oil enema procedure

 Anuvasana Vidhi procedure of fat Enema:-
The person suitable for decoction enema should be administered Snehana (oleation) and sweating therapy followed by purification therapy- emesis or purgation.
After he regains strength, determining that he is fit for oil enema, he should be given an oil enema first. The following procedure is adopted.
During cold season (Hemanta and Shishira Rutus) and Vasanta (spring) it should be given during day and in other seasons during night.
He should be given oil massage and bath, then accustomed food, less by one fourth of the usual quantity; satiable, light- easily digestible neither with more of fats nor very dry, followed by an after-drink of appropriate liquid.
Next he should walk for some time, eliminate faeces and urine and lie on a comfortable cot, neither too high nor too low, on his left side, folding his right thigh, and extending the left thigh. 20-23

Next, the enema nozzle which is lubricated, after the air inside the bag is expelled out, confirming that it is well fastened to the nozzle, should be pressed without shaking the hands, in the direction of the vertebral column, neither too fast nor too slow, neither with great force nor with low pressure but in one attempt, a little quantity  of liquid  material be allowed to remain in the bag. 24-26

After the administration and removing the nozzle the person should be placed with his face upwards, his buttocks beaten gently by the hands of the physician, then by patients own heels;
the foot of the cot should be lifted up thrice;
Next he must lie extending the entire body, with a pillow under his heels, oil should be smeared all over the body and all the parts of it beaten with fist or massaged, concentrating on the painful areas of the body, so that the fat  enema liquid inside the rectum does not come out soon.

If it comes out soon, another oil enema should be administered immediately because fat which does not remain inside does not serve the purpose. If the person has good digestive activity, and if the fat comes out after the stipulated time he can be given light food in the evening. 27- 29 ½.

The maximum time for the fat to come out is three Yama- nine hours; after that, it can be awaited for one day and night; later on, after 24 hours after administration, attempt should be made to remove it by force, with the help of rectal suppositories made from fruits or strong decoction enema. 30-31

If it does not come out due to severe dryness inside and does not produce any troubles like lassitude etc. it should be neglected and  allowed to remain inside for the night;
Next morning he is made to drink warm water either processed with ginger and coriander or plain. 32
 Again he should be given fat enema on the third or fifth day, or till the fat gets well digested;
To whom fat enema can be given daily?
Those who have profound increased of vata, who do exercises- Physical activities daily, who have good digestive power and those who are very dry can be given fat enema daily. 33-34

After 3 – 4 such fat enemas if the body is found to be well lubricated, purification decoction enema should be administered next, to clear the channels, if not well lubricated, fat enema only should be continued. 35

Decoction enema procedure

Niruha Basti Vidhi– Procedure of decoction enema:-
On the fifth or third day- after fat enema, at an Auspicious time, some time after midday, after performing auspicious rites, after oleation and sweating, after elimination of wastes- urine, faeces, after a light meal, after carefully considering the nature of the patient, the dose, drugs etc, the physician, accompanied by many experts of the enema therapy, should administer  decoction enema to the patient. 36- 37 ½

Preparation of enema decoction

 Nirahadraya Kalpana  preparation of enema decoction:-
20 Pala- (960 g) of Drugs- enumerated in the prescription and
8 Madana Phala fruits should be made into a decoction with 16 parts of water (15.360 liters) and boiled down to 1/4^th quantity; Thus, 3.840 liters of decoction will be obtained.
To the decoction, is added fat- oil, ghee etc in
1/4^th quantity = 960 g, for treatment of Vata,
1/6^th quantity = 640 g for the treatment of Pitta,
1/8^th quantity = 480 g for healthy person and for the treatment of Kapha disorders.
The quantity of Kalka (Paste) of some Drugs to be added to the decoction for all Doshas and the healthy person shall be 1/8^th part of the decoction (480 g) neither too thin nor too thick  after mixing.
Next one pala (48 g) of Guda- Molasses/ jaggery and appropriate quantity of honey and salt are also added.

All these are then mixed together, churned well with a churner and made warm by keeping its container either in hot water or by steam from a pot.
It should then be filled into the enema bag in that condition, which is neither too hot nor too cold, neither too fatty nor too dry, neither too strong nor mild, neither too thick nor too thin, neither too much nor too less in quantity, neither with too much of salt nor too less is then pushed into the rectum. 41-43

Some other experts of enema therapy say that the quantity of fats- oil, ghee and honey should be three pala (144 g) individually;
Quantity of Manimantha (Saindhava salt) for healthy will be half a Karsha – 6 grams, the Kalka- paste of drugs be two Pala 96 g and of all the other liquids put together shall be 10 Pala- 480  g. 44-44 ½

Honey, salt, fat, paste and decoction are to be mixed in successive order, one after the other;
This shall be the method of mixing the materials for decoction enema. 45 ½

After receiving the enema, the patient should lie with his face upward with a pillow under his head, mentally intent of the enema; after getting the urge he should eliminate the faeces sitting on his heels. 46

Time of retention for decoction enema

The maximum time for decoction enema material to come out is one Muhurta- 48 minutes, after that period it may be fatal;
Hence another purgative enema prepared with fats, Alkalies, Urine of animals like the cow and sour substances and possessing unctuous, Penetrating and hot properties should be administered immediately; or a rectal suppository prepared from fruits should be made use of;
Sweating therapy and frightening should also be resorted to, to induce defecation. 47-48 ½

If the materials comes out on its own accord, then second, third or fourth enema can be given or as many as required till he developed symptoms of proper enema therapy. 49

The symptoms of bouts of decoction enema therapy are similar to those of purgation therapy. 49 ½

After the appearance of the decided symptoms, the patient should take a bath with warm water, and eat rice mass along with juice of animals of desert- like land. The complications of decoction enema caused by the circulating Malas  Doshas will subside by warm water bath and food.

If the patient becomes troubled by increased Vata he should be given a fat enema immediately on the Same day. 50-52
The symptoms of proper, inadequate and excess- decoction enema therapy are the same as those of Snehana (drinking of fat) therapy.

Signs of good Anuvasana basti procedure

Enema material – fat coming out along with faeces after staying inside for a short time, followed by flatus moving down are the symptoms of proper fat enema therapy .53

1 – 3 fat enema (Anuvasana) should be administered for the treatment of Kapha dominant diseases.
5 – 7 for Pitta,
9 – 11 for Vata.
Again on uneven alternative days- third, fifth, seventh etc. decoction enema should be given. 54-55

Note – Always, Niruha Basti = decoction enema is given in empty stomach.
Anuvasana basti – fat enema is given soon after taking food, when the palms of the patient is still wet due to hand wash, after food intake. (Ardra Pani Avastha)

Food should be given along with
Anna Yusha (Soup prepared with rice, grains)  in case of Kapha disorder,
Milk in case of Pitta disorder and
Meat juice / Meat soup in case of Vata disorder. 55 ½

In case of increased Vata, one enema consisting of decoction of drugs which mitigate Vata, Trivrt, Saindhava mixed with fats, liquids of sweet and sour taste, made warm and administered  will be ideal. 56

In case of increase of Kapha, three enemas consisting of decoction of drugs of Aragwadhadi gana and Vatsakadi gana mixed with honey, cow urine, possessing penetrating, hot and pungent properties is ideal. 58

In case of increase of all the Doshas together, these three kinds of enema will bring down the Doshas for which another enema need to be given with drugs of all the above mentioned qualities. 60

Yet others say that only three kinds of enema are to be prepared,
Utkleshana – that causing increase of the Doshas,
Shodhana – that causing purification, by expelling the Doshas and
Shamana – that causing mitigation  subsiding them inside the body. 61

All these are to be justified on the basis of strength of the Doshas, drugs etc.  Administration of enemas should be continued till symptoms of proper enema are obtained.

Karma Basti – treatment with 30 enemas

A course of 30 enemas with one fat enema at the beginning and five at the end, with twelve decoction enema and twelve fat enema alternately in the middle is called as Karma basti. 63
Here, each day, one enema is usually given. Some expert doctors may give two enemas per day. But one enema per day is the common standard
F = Fat enema = Anuvasana = Snehabasti
D = Decoction enema = Niruha = Asthapana

Kala Basti – 15 enema regimen

A course of 15 enemas, with one fat enema at the beginning and three at the end, with six decoction enemas and five fat enema alternately in the middle- is known as Kala Basti. 64

 Yogabasti  – 8 day enema regimen

A course of eight enemas, with one fat enema both at the beginning and at the end, with three decoction enema and three fat enema alternately in the middle is known as- yoga basti.

Either fat enema or decoction enema alone should not be administered.
More of fat enema may cause nausea and loss of digestion strength.
More of decoction enema may cause fear of increase of Vata.
Hence those who are given decoction enema should also be given fat enema and those who are given fat enema should also be given decoction enema;
Enema therapy will balance the three Doshas only when it is both lubricating and  purifying. 65-661/2

Matra Basti – Low dose fat enema

Fat enema consisting of fat quantity equivalent to the minimum quantity of fat used for Snehakarma is known as Matra Basti.
In practice, a very low dose of medicated oil or ghee – 50 – 75 ml is administered as Matra Basti.

It should be used always for
Bala – children,
Vriddha – the aged,
Adhva, Bhara, Stri, Vyayama – who are habituated to long walking, carrying heavy weight, sexual activity and exercise
Chinta – who think too much,
who  are suffering from- diseases of vata, fractures, debility, poor who are digestive activity, for kings, wealthy persons and persons who live happily.
It conquers the Doshas, does not need strict regimen, gives strength, eliminates the wastes- faeces, urine etc. easily and is comfortable. 67-69

Uttarabasti- urethral and vaginal enema/ douche

In diseases of the urinary bladder and of vagina and uterus in women, Uttarabasti should be administered, to those who have purified by two or three decoction enemas, per rectum. 70

The nozzle should be 12 Angula in length, in terms of patients own fingers, round- tubular resembling a cow’s tail at its end should have an orifice of mustard size. It should be made of gold, silver etc metals, it should be smooth, resembling the stalk of flowers such as Kunda, Ashvamara and sumanas. It should be strong. 71-72

The enema liquid should be mild in strength, light- easily acting, its quantity one Sukti- 24 g or lesser.

Uttarabasti procedure

Uttarabasti Vidhi_ Procedure:-
The patient who has been given bath and food in accordance with the regimen prescribed for fat enema, should flex one’s knees, the penis should be held straight- by the physician and a thin probe should be slowly inserted the  by the physician into the  urethra to clear the channel; after thus clearing the passage, the enema nozzle should be inserted along the line of the Suture, to the entire length of the Urethral passage- till the cavity of the urinary bladder is reached, without shaking and the enema bag pressed just as described for rectal enema, pushing the fat- oil, ghee etc. into the urinary bladder; this is the ideal method- for a urethral enema. 73-75 ½

In this manner three or four enemas should be given; all other procedures- after care, food etc. are planned similar to that of fat enema therapy. 76-76 ½

For women, Vaginal/ Uterine enema- douche should be administered during the Menstrual period only. It is only then that the uterus is without its closure material; it can be  given even apart from the menstrual period, in emergency. In diseases such as prolapsed and pain of the uterus or Vagina, in other diseases of uterus and vagina and in menorrhagia. 77-78

The nozzle- for this enema  should be ten Angulas in length, permitting the entry of a grain of Mudga- green gram, it should inspected to a length of four Angula in case of  vaginal passage and to a length of two Angula in case of  urethral passage in diseases like Dysuria etc. and in case of children it shall be one Angulas. 79

The medium quantity of enema is one prakunca  Pala=48 g and for children one Sukti- half Pala=24 g only. 80

The women, who is lying on a cot with her face upwards, and legs folded at the knees and kept erect, should be administered, the Vaginal/ Urethral enema, three or four times in a day and night; it should be continued for three days only increasing the quantity of fat enema liquid daily;
After a gap of three days it should be administered again for another three days. 81-82

General period of enema administration

 Samanya Bastikala–  periods of administration of enema generally :-

Purgation therapy should be resorted to after a fortnight after emesis therapy
and decoction enema after a fortnight after purgation therapy,
Fat enema- therapy should be administered immediately after decoction enema but after seven days after purgation therapy. 83

Just as the cloth adsorbs the color from the water boiled with Kusumbha etc,  colouring materials, similarly, the enema, absorbs the Doshas from the moistened body. 84

Importance of enema therapy

Basti Chikitsa Sresthata- importance of enema therapy :-

For all the diseases which are localized in  the  Shakha (extremities), Koshta (alimentary tract), Marma (vital organs), all the organs above the shoulders, there is no other cause, more important than Vata.
Vata is the one responsible for transportation and destruction of the increased faeces, Kapha, Pitta and other Malas – wastes;
To balance the greatly increased Vata, there is no treatment more efficient other than enema therapy.
Hence it is described as half of the treatment (Ardha Chikitsa) – of all  diseases while some others authorities say, that it is the full treatment.

Similarly, Sira Vyadha – venesection treatment is considered to be effective in vitiated blood conditions. 87
Thus ends the chapter Basti Vidhi- the 19th in Sutrasthana of Astangahrdaya Samhita.