Anuvasana Basti: Method, Benefits, Mode Of Action, Contra Indications

Article by Dr Raghuram Y.S. and Dr Manasa
Anuvasana Basti is a specialized Ayurvedic Panchakarma treatment. Here, fats or oils are administered as enema. It is especially indicated in Vata imbalance disorders.

Basti therapy is classified basically as
Anuvasana basti – wherein oils and fats are administered.
Niruha Basti – wherein a decoction mix is administered.
Both the above can be administered through urethral, vaginal, anal routes or directly over wounds and ulcers.

Anuvasana Vasti

The Vasti in which Sneha (medicated oils and or ghee) is used as the main liquid medicine is called Anuvasana Basti. Sushruta has named it as ‘Snaihika Vasti’ (Sneha = Medicated fats, mainly ghee and oil). Anuvasana Basti is said to be a type of Sneha Vasti.

Anuvasan api na dushyati anu dinam vaa deeyata iti anuvaasanaha (Ref – Sushruta Chikitsa 35/18)
Anuvasana means to stay. In Anuvasana Basti, the administered medicines stay for a longer duration inside the intestine (bladder, uterus) but still do not cause any untoward problem. They neither aggravate the Dosha’s nor cause any complication. They in fact cure many diseases stayng inside our system for a longer duration. They can also be administered on a daily basis. Therefore it is called Anuvasana Basti. Depending on the quantity (dosage) of Sneha administered, Anuvasana Vasti is divided into 3 types.
1. Sneha Vasti – 6 Prasruta medicines is given
2. Anuvasana Vasti – ½ of Sneha Vasti, i.e. 3 Prasruta medicines is given
3. Matra Vasti

Sneha Basti

The maximum dosage of Niruha Vasti (decoction enema) is said to be 12 Prasruta quantity (96 tola or 1152 grams approximately). This is not a fixed dosage of Niruha. It will carry a different dosage in accordance with age. The dosage of Sneha Basti will be ¼ of the dosage of Niruha for a given age.
Thus if 12 Prasruta is the standard adult dosage of Niruha, ¼ of 12 Prasruta i.e. 3 Prasruta (24 tola or 288 grams approximately) will be the stand adult dosage of Sneha Basti.
According to Dalhana, commentator of Sushruta Samhita,

– The Uttama Matra (standard and highest dosage) of Sneha Basti is 6pala or 24 tola or 3 Prasruta (288 grams approximately). Chakrapani, commentator of Charaka Samhita calls this dosage of Sneha Vasti as ‘Sneha Basti’.
– The Madhyama Matra (moderate or intermediate dosage) of Sneha Vasti is 3 pala or 12 tola or 1 ½ Prasruta (144 grams approximately). Chakrapani, commentator of Charaka Samhita calls this dosage of Sneha Vasti as ‘Anuvasana Basti’.
– The Kaniyasi Matra (lowest dosage) of Sneha Vasti is 1 ½ pala or 6 tola or ¾ Prasruta (72 grams approximately). Chakrapani, commentator of Charaka Samhita calls this dosage of Sneha Vasti as ‘Matra Basti’.

Thus according to Chakrapani Sneha, Anuvasana and Matra Vasti are all types of Oil enema. The dosage of each of these Vasti’s will be half of its precursor. The subtypes and dosage of Sneha Vasti are –

Sneha Vasti – 6 Prasruta medicines is given
Anuvasana Vasti – ½ of Sneha Vasti, i.e. 3 Prasruta medicines is given
Matra Vasti – ½ of Anuvasana Vasti, i.e. 1 ½ Prasruta medicines is given

Anuvasana Vasti

Anuvasana Vasti is a type of Vasti in which the medicated fats are administered in a dose of ½ of that of Sneha Vasti (i.e. ½ of 6 pala i.e. 3 pala). Its dose is 3 pala (144 grams approximately)

Matra Vasti

The Vasti in which the medicines are used in a dose equal to that of Hrusva Sneha Matra (lowest dose of intake of medicated fats) is called Matra Basti (According to Charaka, Charaka Siddhi Sthana 4/53). According to Sushruta, Matra Vasti is a type of Anuvasana Vasti. In Matra Vasti, the medicated fats are administered in a dose of ½ of that of Anuvasana Vasti (i.e. ½ of 3 pala i.e. 1 ½ pala). Its dose is 1 ½ pala (72 grams approximately).

Anuvasanopaga Gana

Anuvasanopaga Gana (Medicines which act as helpers to herbs used for Anuvasana Vasti) –

• Rasna – Pluchea lanceolata
• Devadaru – Cedrus deodara
• Madanaphala – Randia dumetorum
• Shatapushpa – Anethum sowa
• Rakta punarnava – Boerhavia diffusa
• Shweta punarnava – Trianthema portulacastrum
• Gokshura – Tribulus terrestris
• Agnimantha – Premna integrifolia / Clerodendrum phlomidis)
• Bilwa – Aegle marmelos
• Shyonaka – Oroxylum indicum

Anuvasana basti contraindications

Contra indications for Anuvasan Basti: Ananuvasya
(Reference – Charaka Siddhi 2/17)

• Anasthapya – all those conditions in which asthapana vasti is contra-indicated
• Abhukta bhukta – on empty stomach (in a person who has not consumed food)
• Nava jwara – acute fever
• Pandu roga – anaemia
• Kamala – jaundice
• Prameha – diabetes, stubborn urinary diseases
• Arsha – piles
• Pratishyaya – coryza, cold congestions
• Arochaka – anorexia
• Manda agni – low digestion
• Durbala – weakness
• Pleeha udara – splenomegaly (enlargement of spleen)
• Kapha udara – abdominal diseases caused by vitiated kapha
• Urustambha – stiffness of thigh
• Varcho-bheda (atisara) – diarrhoea
• Visha peeta – poisoning
• Gara peeta – consumption of artificial added poisons
• Kapha abhishyanda – conjunctivitis caused by morbid kapha
• Guru koshta – heavy abdomen (hard bowel movement)
• Shleepada – filariasis
• Gala ganda – goitre
• Apachee – cervical lymphadenopathy
• Krimi koshta – worms in intestine
• Prameha –urinary disorders, diabetes
• Kushta – skin diseases, leprosy
• Sthoulya – obesity
• Peenasa – nasal block
• Krisha – emaciation

Reasons for Contra-indication:
When anuvasana vasti is administered in the contra-indicated conditions, it causes exacerbation of the diseases, these diseases then become impossible to cure (asaadhya).
On empty stomach:
Anuvasana Basti should never be administered on an empty stomach. If administered, the medicine quickly travels towards upper parts of the body (to the throat and stomach) which is not desired. As a result of this quick movement, the medicine causes distension of the abdomen, tightness in the chest and feeling of stiffness in the heart, hiccough and vomiting. Therefore Sneha Basti or anuvasana vasti should as a rule be administered after the patient has consumed food. After having consumed the food, the food present in the stomach and intestine will block the passages due to their occupancy. This doesn’t allow the sneha vasti to move beyond the colon. The medicine stays back in the colon for the desired period and imparts beneficial results.

Anuvasana Basti should not be administered in conditions of nava jwara (acute fever), kamala (jaundice), pandu (anaemia), prameha (diabetes, urinary disorders). If administered it causes provocation of doshas leading to manifestation of udara rogas (abdominal disorders). These diseases are accompanied by srotorodha (obstruction to the channels of transportation) in the body. Due to this, the movement of administered sneha gets blocked and this blocked sneha causes exacerbation of doshas.
When administered in arsha (piles), anuvasana vasti causes distension of abdomen.
When administered in arochaka (anorexia), the anuvasana vasti causes more anorexia or tastelessness.
When administered in conditions of agnimandhya (low digestion) and dourbalya (debility), the anuvasana vaasti worsens the metabolism or digestion capacity.
In krimi koshta (worm infestation), the administered anuvasana vasti increases the quantity of worms. These krimis move upward and damage the heart.
Anuvasana vasti when administered in adyavata (urustambha) causes increase in ama (endotoxins)
In rest of the enlisted diseases, the anuvasana causes dosha utklesha (exacerbation or vitiation or provocation) of doshas leading to worsening of the diseases.

Anuvasana basti indications

Anuvasya (indications for Anuvasana Vasti) –
All the conditions which are mentioned in the indications of Asthapan Basti are also the indications of Anuvasan Basti. This means to tell that all the conditions which can be cured by Asthapana Vasti can be cured by Anuvasana Vasti also. But Anuvasana Basti is specifically beneficial in patients having excessive rukshata (dryness) in the body, those in whom the agni (digestion, metabolism) is severe and patients suffering from Vata Vyadhis (disorders caused due to vitiated vata).

Below mentioned are the indications for Anuvasana Basti –

• Sarvanga roga – diseases afflicting the whole body
• Ekanga roga – diseases afflicting part of the body
• Kukshi roga – diseases afflicting the abdominal viscera
• Vata sanga – obstruction to passage of flatus
• Mutra sanga – obstruction of urine
• Mala sanga – obstruction of stools / constipation
• Shukra sanga – obstruction of ejaculation of semen (seminal passages)
• Bala kshaya – decrease of strength
• Mamsa kshaya – wasting of muscles
• Dosha kshaya – deterioration of doshas
• Shukra kshaya – diminution of quantity of semen
• Aadhmaana – distension of abdomen
• Anga supti – numbness of the body
• Krimi koshta – worms in the gut
• Udavarta – upward movement of vayu
• Shuddha atisara – diarrhoea
• Parva bheda – pain in the inter-phalangeal joints
• Abhitaapa – rise of internal heat
• Pleeha dosha – contamination of spleen
• Gulma – abdominal tumours
• Shoola – colic
• Hrid-roga – heart diseases
• Bhagandara – fistula in anus
• Unmada – insanity, lunacy
• Jwara – fever
• Braghna – hernia
• Shira shula – headache
• Karna shula – ear ache
• Hridaya shula – heart pain
• Paarshva shula – pain in flanks
• Prushta shula – back ache
• Kati shula (trika) – low back or sacral pain
• Vepaga or kampa – tremors
• Aakshepa – convulsions
• Anga gourava – heaviness of the body
• Ati laghava – excessive lightness of the body
• Raja kshaya – oligo-menorrhoea (less menstrual blood)
• Vishama agni – fluctuating digestion capacity
• Spik shula – butt pain
• Jaanu shula – knee pain
• Jangha shula – leg pain
• Uru shula – thigh pain
• Gulma shula – pain due to abdominal tumours
• Pani bhuta – hand pain
• Prapada shula – pain in the fore-foot
• Yoni shula – vaginal pain
• Bahu shula – arm pain
• Anguli shula – finger pain
• Stana shula – breast pain
• Danta shula – tooth ache
• Nakha shula – nail pain
• Parva-asthi-shula – bone and inter-phalangeal pain
• Shosha – dryness of the body
• Stambha – stiffness of the body
• Aantra kujana – gurgling sounds in the abdomen
• Parikartika – cramps in the calf muscles (muscles on the back of the leg)
• Vata vyadhi – all diseases caused by vitiated vayu
• Jwara – fever
• Timira – darkness in front of the eyes
• Pratishyaya – cold, running nose
• Adhimantha – glaucoma
• Ardita – facial paralysis
• Pakshaghata – paralysis, hemiplegia
• Sharkara shula (ashmari) – gravel, stones in urinary passages
• Upadamsha – sexually transmitted diseases
• Vata rakta – gout
• Arsha – piles
• Stanya kshaya – less production of breast milk
• Manya graham – gripping pain and stiffness of nape of the neck
• Hanu graham – lock jaw
• Ashmari – stones in the kidney
• Moodha garbha – impacted foetus, breech presentation
• Mutra krichra – dysuria (difficulty in passing the urine or painful urination)

Important points about Anuvasana Vasti:
Charaka and Vagbhata have called Sneha Vasti (enema given with oils and ghee) as Anuvasana Basti i.e. both these terms Sneha and Anuvasana have been used synonymously.
Though Sushruta has named it as Snaihika Vasti, the description is no different from Anuvasana Vasti.
Charaka on the other hand named the chapter in which he describes the vyapat (complications) of Anuvasana Basti as ‘Sneha Vyapadiki Siddhi’ i.e. chapter dealing with management of complications caused due to Sneha Vaypat.
Commenting on this Chakrapani tells ‘this chapter deals with complications of anuvasana’ wherein the name of the chapter says ‘sneha vyapat’. Here too we can see the terms Anuvasana and Sneha being interchangeably used.

Vagbhata has mentioned the quantity of Sneha Vasti as ¼ of Niruha Vasti. Sushruta too after giving a similar opinion as that of Vagbhata tells that Anuvasana Vasti is a type of Sneha Vasti. He tells that the dose of Anuvasana vasti is ¼ of Sneha Vasti and Matra Basti (type of Anuvasana vasti) is ½ of Anuvasana vasti.
Dalhana, the commentator of Sushruta Samhita has mentioned 3 doses of Sneha Vasti. He named them as Uttama matra (6pala or 288 grams approximately), Madhyama matra (3 pala or 144 grams approximately) and Heena matra (1 ½ pala or 72 grams approximately).

Chakrapani, the commentator of Charaka Samhita also has expressed almost same opinion. There arises no controversy in the explanation of the 3 types of sneha vasti explained by Charaka, Sushruta and Vagbhata.

Factors to be assessed

Factors to be accessed before the administration of Anuvasana Vasti –
The Doshadi factors – In the context of Niruha Vasti (cleansing enemas or decoction enemas) it has been explained that the factors including Dosha (morbidity), Oushadha (medicine), desha (geography of the patient and the body nature of the patient), kala (time factor), saatmya (compatibility), oka (compatibility due to constant practice), agni (digestion capacity), satva (status of mind), vaya (age factor) and bala (strength and endurance of the patient) should be thoroughly examined and accessed. The same factors should be considered and examined before the administration of Anuvasana Basti (and Uttara Vasti – enema given through urinary and genital passages) also.

Fitness of the patient – First of all, the patient should be thoroughly examined and decided if he or she fits into the category of undergoing anuvasana vasti.

Anuvasana is basically nurturing – Anuvasana Basti is basically a nurturing and nourishing type of vasti (enema). Therefore wherever shodhana (cleansing and depleting treatments) are indicated, anuvasana vasti or brimhana vasti (nourishing, strengthening, bulk promoting) enemas should not be administered.
Example, anuvasana vasti should be avoided in diseases like prameha (urinary diseases, diabetes) etc manifested due to santarpana (excessive nutrition), kapha predominance and kapha predominant diseases, meda (fat) predominance in the body and diseases occurring due to disturbance in fat metabolism (fat storage diseases or diseases caused due to excessive stagnation of fat tissue in the body) etc.

Considering Ama – Sneha vasti or anuvasana vasti should not be administered when the doshas are in sama avastha (doshas associated with ama). Ama is a metabolic intermediate product. It is the improperly formed or immature essence of nutrition which due to the sticky nature tends to block all the channels in the body leading to depletion of nutrition and essentials to the tissues and organs of the body. Thus ama getting stagnated in the channels and tissues of the body gradually gets converted into toxins and disturb all the body functions, especially when they get associated with the functional components of the body i.e. doshas (vata, pitta or kapha). This association of ama gives doshas too a sticky nature and all their normal functioning will get hampered. The oils and ghee administered in sneha vasti or anuvasana vasti will further vitiate this ama and sama doshas and produce guda klinnata (excessive moistening of anal region) and other systemic complications.

Kala or time factor – is another important thing which needs to be accessed before administering anuvasana vasti. Anuvasana vasti, as a rule should be given during the day time in cold season, shishira ritu (late winter), hemanta ritu (early winter) and vasanta ritu (spring season). Anuvasana vasti should be given during night (evening) time in other seasons i.e. sharad (autumn), greeshma (summer) and varsha (monsoon) seasons.

As a rule, it is not wise to administer anuvasana vasti in the evening or night time unless it is mandatory. Due to the prevailing cold during the night, the kapha will be on a rise. When anuvasana vasti is given at night it further aggravates kapha and causes complications like adhmana (distension of abdomen), gourava (heaviness of the body), jwara (fever) etc. Still, in pitta predominant conditions or diseases, in presence of kapha kshaya lakshanas (symptoms of kapha deterioration), in people having ati-ruksha shareera (excessive dryness of the body) and in those suffering from Vata vyadhis (diseases caused due to vitiated vata), anuvasana vasti can be administered at night.

Basti, as a rule can be readily given during day time. In the day time, the doshas will be much settled in their own places, the digestion of food also takes place properly, the channels of the body will be clear with their open orifices so as to facilitate easy transportation and distribution of the administered sneha.

The anuvasana vasti which should be given after niruha (asthapana) vasti i.e. decoction enema should be given on the same night, after food. In emergency conditions and in presence of severe pain in vata vyadhis (vata predominant diseases) anuvasana can be either given during day time or night time after the patient has consumed food.

Scheduling Anuvasan Vasti

We also should access where in the schedule of vasti treatment, anuvasana vasti fits. In the chronology of vamanadi chikitsa (vamana etc panchakarma treatment measures), it is said that anuvasana vasti should be administered on the 9^th day after Virechana. Sushruta is of the opinion that anuvasana vasti should be givne on the 7^th day after virechana (therapeutic purgation) after the patient would have gained energy and strength after virechana process and is consuming normal food having completed the samsarjana krama. (Note – Samsarjana krama is a special type of dietetic regimen advised for people who have undergone cleansing treatments especially vamana i.e. therapeutic emesis and virechana i.e. therapeutic purgation. After Vamana and virechana, the patient would be having low digestion capacity and low appetite due to cleansing process. In order to kindle the fire, the normal food is not given instantly. The liquid food in the form of gruels will be given on the first day and gradually the consistency of food will be shifted from liquid to semi-solid to normal over a period of 3-7 days depending on the nature of cleansing done).

In the chronology of Bastis, anuvasana should be given after asthapana or niruha vasti (cleansing enemas). In fact, the anuvasana vasti will be highly effective when administered after niruha vasti. The medicines administered in the form of medicated oils and or ghee in anuvasana vasti will be better absorbed and distributed when administered after niruha vasti because the niruha would have cleansed the body and channels of the body.

Relation to food – Anuvasana Basti should never be administered before food or on empty stomach. When on empty stomach, all the passages (digestive tract) will be open. Anuvasana Basti when administered before food will find the pathway easy to travel and quickly move towards the upper parts of the body which is not intended. This will cause lot of complications. Therefore anuvasana vasti should be administered to a person who has just consumed food. It is said that anuvasana vasti should be administered in ardra-pani condition (wet hands, i.e. the patient has just washed his hands after taking food).

Considering Doshas – According to the doshas 1-3 anuvasana vastis can be administered in kaphaja diseases, 5-7 anuvasana vastis in diseases caused due to vitiated pitta and 9-11 anuvasana vastis in vata predominant diseases. It is not specified if these anuvasana vastis should be given on daily basis or should be alternated with niruha vastis. Since it is not wise to administer either anuvasana or niruha in excess, we should follow the method of administering anuvasana and niruha vastis on alternative days. Even today, this method is in practice in hospitals and clinics.

Tissue impact – Sushruta has specified that either 6 or 7 or 8 or 9 sneha vastis should be administered along with Niruha Basti. According to him, the first sneha vasti will produce unctuousness or oiliness (snigdhata) in the region of vasti (urinary bladder) and vankshana (groin). 2^nd sneha vasti compats vitiated vata in the head. 3^rd sneha vasti enhances strength and colour. 4^th sneha vasti will nourish and produce unctuousness of rasa (first tissue i.e. lymph or plasma). 5^th sneha vasti will cause unctuousness of rakta (blood tissue). 6^th sneha vasti will cause unctuousness of mamsa dhatu (muscle tissue). 7^th sneha vasti will cause unctuousness of meda dhatu (fat tissue). 8^th sneha vasti will cause unctuousness of asthi dhatu (bone tissue). 9^th sneha vasti will cause unctuousness of majja dhatu (bone marrow tissue).

Sushruta further tells that 9 more vastis given in similar way will remove the morbidity from shukra dhatu (reproductive tissue i.e. semen), fortify and strengthen it.

Any person taking these 18 sneha vastis in the mentioned way will become as strong as an elephant and as powerful as a horse.

The Vasti apparatus

The apparatus of administering anuvasana vasti is almost similar to that of niruha vasti (already discussed in the introduction part of Vasti). The instrument has a vasti netra (nozzle) fit to a vasti putaka (can or container). The netra now days is connected to a catheter fitted with another nozzle with a control mechanism (in the form of a tap) for monitored flow of medicines. This nozzle is pushed into the anal canal.
For the sake of convenience we use disposable syringes made up of metal (stainless steel, brass etc) or disposable plastic accommodating a minimum of 100 ml of medicine (medicated oil or ghee).

No oral sneha during Anuvasana Vasti – Whenever anuvasana vasti is administered, no sneha (fats in the form of oil and or ghee, medicated oils and or ghee) should be administered through oral route. If the sneha is given through both routes (oral and anal) will definitely aggravate vata and agni (metabolic fire).

Anuvasana with Niruha basti

Anuvasana, an excellent combo with Niruha or Asthapana Vasti – Anuvasana or Niruha should not be given individually in excess. Excess of anuvasana vasti causes agnimandhya (errors of digestion or metabolism, mainly deficit digestion) and excess of niruha vasti will vitiate vata. Therefore it is always wise to administer niruha and anuvasana alternating with each other. Anuvasana should be given after niruha and niruha should be given after anuvasana.

But there are few exemptions for the above said rules. Anuvasana Basti can be administered everyday as in those people who have ati ruksha shareera (excessive dryness of the body), teekshna agni (severe appetite or rapid digestion), those who are indulged in ati vyayama (excessive physical exercises), those suffereing from vata vyadhi (diseases caused due to vitiated vata), those having severe pain in hip, pelvis due to severe vitiation of vata and in those who are suffering from udavarta (upward movement of vayu). The sneha administered through anuvasana (sneha) vasti in these people gets utilised quickly just like the water dropped on the sand quickly disappears.

The sneha (fats in the form of oil and or ghee) administered through anuvasana or sneha vasti gets digested and used up. The sneha forms a coating in the interiors of pakwashaya (large intestine) and gets digested in a time span of 24-72 hours by the agni (fire) present in the pakwashaya (large intestine).
method of administration of anuvasana vasti – Anuvasana vasti vidhana:
Anuvasana Basti too, just like other treatments explained in Ayurveda is carried in 3 different steps. They are as explained below.

Purvakarma

Purva karma (pre-treatment procedures)
Abhyanga and Swedana (herbal oil massage and sudation) –
The patient should be given a thorough abhyanga (herbal oil massage) before administration of Anuvasana vasti. Generally the massage is given so as to cover the abdominal area, the pelvis, low back area, hips and thighs. General massage can also be given to the full body with special emphasis to the abdominal area (tummy).
After abhyanga, swedana should be done. The swedana (fomentation, sudation, steaming or sweat inducing treatment) can be given in either of the Parisheka (sprinkling or showering or stream pouring of hot herbal liquids) or avagaha (hot water tub bath) or tapa sweda (steaming with hot water bag or cloth dipped in hot water) methods.
Bhojana (food planning) –
Since anuvasana vasti or sneha vasti should be given after the food, the planning of food before anuvasana falls into the pre-treatment procedure. Below said are some of the rules and regulations related to food.
The food should not be too oily. Oil and ghee should be avoided as part of food because even the medicine given in anuvasana vasti is in the form of medicated ghee or oil. Anuvasana Basti administered after intake of oily food will cause mada (intoxication) and murcha (fainting / loss of consciousness).
The food taken before anuvasana vasti should not be too dry. The anuvasana vasti administered after ruksha ahara (dry food) will cause destruction of bala (strength) and varna (colour)
The food given before anuvasana vasti should have been cooked and prepared thoroughly. The anuvasana vasti administered after the intake of improperly cooked food causes jwara (fever).

Mamsarasa (meat soup), Yoosha (soups) and dugdha (milk) should be given as food. To be specific, in vata predominance mamsarasa (meat soup), in pitta predominance milk and in kapha predominance yusha (soups) should be served as food. Or else the diet should be disease specific. The quantity of food served before administration of anuvasana vasti should be ¼ quantity lesser than the normal food intake of a given person.

Chankramana adi (walking etc procedures) –
It is said that the anuvasana or sneha vasti should be given in ardra pani condition (wet hands after washing them post food consumption). This means to tell that the physician should not wait for a longer duration to administer vasti once the patient has taken the food. Before administering vasti the patient is advised chankramana (slow walking for about 100 steps in the treatment room itself). After this, the patient is advised to void urine and stools. Following this, anuvasana vasti is administered.

Pradhana karma

Pradhana Karma (treatment proper or administration of anuvasana vasti)
The vasti pranidhana karma (method of administration of vasti) is same as in Niruha Basti.

Positioning of patient –
Before administering Basti, the positioning of the patient is very essential. The patient should be made to sleep on his left lateral side, i.e. turning towards his or her left hand side. The left upper limb folded (flexed) in such a way that his or her hand goes beneath the side of the head forming the pillow. This means to tell that, the patient should lie on his lift side resting his head on his hand. The left lower limb should be stretched straight. The right lower limb should be folded (flexed) at the knee joint and hip joint over the left lower limb such that the right knee dips down across the left lower limb and touches the table. In this position the anal orifice, butts and pelvis would be facing the physician or nurse (or therapist) who would be administering enema.
Taking a sterile pad of cotton dipped in medicated oil or ghee (example, Jatyadi taila oil, padhmakadi taila oil, and other medicated ghee or plain ghee), the anal orifice should be smeared to make it unctuous and lubricated. This facilitates easy entry of vasti netra (nozzle or catheter).

The Vasti netra or enema catheter now should gently be inserted into the anal canal, parallel to the spinal column. Before doing so, the cotton with which the tip of the netra is blocked should be removed. Now with both hands the Vasti putaka should be squeezed. While squeezing the putaka (when bladder is used) care should be taken to see that it should be gently pressed evacuating the vasti dravya or medicine in a single push. The hands of the physician or therapist should not tremble or shake while pressing the vasti putaka.

While administering vasti, the patient is asked to take deep breath in so that the medicine enters the intestines easily. The physician closely observes if the medicine is properly entering the intestine or not. If the nozzle or catheter is pushed in an oblique or crooked way, the medicines do not enter easily. If the therapist shakes his hands while administering vasti, the netra injures the anal canal and causes pain.

Care should be taken not to press the vasti putaka quickly or slowly. If the putaka is pressed hard or quickly, the medicines enter the intestines in a rush and there is a possibility that it reaches high up and moves towards the throat or mouth. The movement of medicines high up is not intended in vasti treatment. If the putaka is squeezed slowly, the medicines enter the intestines very slowly and will be ineffective.

If we are using the modern day enema apparatus, i.e. syringe, the medicine should be filled in the container and the piston is pushed so as to evacuate the air in the nozzle, the tip of the nozzle is blocked with sterile cotton. After making the anal orifice unctuous by applying oil or ghee, the cotton from the tip of the nozzle is removed and the nozzle is slowly inserted into the anal canal parallel to the spinal column.

The complete Vasti medicine should not be pushed into the intestine. Some part of it should remain in the putaka because if the medicine is totally pushed into the intestine, the air in the can also will enter the intestine and create pain.

After the administration of vasti, the vasti netra should be slowly and gently removed from the anal canal. The patient should be advised to stay in that position for 30 matra kala (approximately ½ minute). The butts should be lightly tapped with closed fists. The patient is made to sleep on his back (supine) and should be instructed to be in that position for a time period till a count of 100 is finished. Gentle massage is given over the abdomen from left to right in circles, in the reverse direction of large intestine so as to help the medicines to move up into the large intestine. The patient is asked to gradually take breathe in and breathe out.

The soles of the foot are massaged and the butts are tapped. Holding the toes of the patient, both his lower limbs should be lifted to 90 degrees and bent at the knees such that the heels touch the butts and again the limbs are extended.  This process is done 8-10 times.

All these procedures will enable the medicine to stay inside the intestine for a longer time without getting expelled. The longer the sneha remains in the pakwashaya (intestines), the better will be its benefits. The patient who has taken anuvasana vasti should restrain from all physical activities. The physician meanwhile should wait for samyak anuvasita lakshanas (symptoms of properly administered anuvasana vasti).

The anuvasana vasti is said to be properly administered if the sneha is expelled in the desired time along with stools and flatus without producing burning sensation or any other untoward complications.

The dose of sneha fixed or decided to be given as per the disease and morbidity should be mixed with saindhava lavana (rock salt) in a dose of 3 grams and powder of saunf (fennel seeds) in a dose of 1 gram and administered after making the medicine warm. The vasti given in the said method will come out in proper time.
If the Vasti medicine being too hot in nature (ushna), too intense and fast acting in nature i.e. too strong medicine (ati teekshna), due to the pressure of vata, or when administered along with air, being too large in quantity or being heavy in nature comes out (expelled) in quick time, another anuvasana vasti should be administered in a lower dose.
After the administration of anuvasana vasti, mild tapping with closed fists should be given on the painful parts as if pampering. The patient should be allowed to either relax on the bed or allow him or her to sleep.

Paschat karma

Paschat Karma (post-treatment procedures):
Vasti Pratyagamana (expulsion or return of administered Vasti):
Just as in niruha vasti, the medicine administered in anuvasana vasti also should come back after a scheduled time of its stay in the pakwashaya (colon). The maximum limit for the anuvasana vasti medicine to return back is 3 yama i.e. 12 hours from the time of administration. The maximum benefits of anuvasana vasti can be obtained only if the medicine stays in the pakwashaya for 12 hours. If the sneha (medicine) returns before this scheduled time, another anuvasana vasti should be immediately administered.

The key point to be noted is that, the anuvasana vasti given in excessive dose will obviously come out quickly. Therefore it should be given in proper dose. If the vasti is administered without the patient having voided his stools and urine, the medicine will come out in quick time due to the pressure of stools and urine. These points should be taken care of during the treatment.

If the medicine doesn’t return within 12 hours i.e. even after 12 hours, we need not worry. We should wait for the next 12 hours (total of 24 hours) for the sneha to return. If the sneha doesn’t return even after 24 hours, phala varti (suppositories) and teekshna vastis (strong cleansing enemas) should be administered and the sneha should be flushed out. If the vasti medicine doesn’t return after 24 hours and has not caused any complications or troublesome symptoms, it should be neglected.

Pathya

Pathya (dietetic planning and other measures) –
After the vasti pratyagamana (return of vasti medicines), good digestible, light food should be administered on the next afternoon. On the same evening properly cooked yusha (soups) or mamsa rasa (meat soup) should be given according to once compatibility. After the food, once again anuvasana vasti should be given. If consecutive vastis (3^rd, 4^th, 5^th etc) anuvasana vastis are planned to be given, the y should be given alternatively with niruha vastis (decoction enemas).

In apravrutta (not expelled) and anupadruta (uncomplicated) sneha vastis, proper rest should be given to the patients. After proper sleep at night, the patient should be administered water processed with coriander seeds and ginger for drinking (next day). Alternatively only hot water should be given to drink. The above said hot drinks will help in digesting the residual sneha in the body, to break the morbid kapha and to mobilize the vata in a downward direction.

Niruha Vasti – If the Niruha vasti needs to be given after anuvasana vasti, it should be given on the next day. Niruha Basti should be administered to a patient who has not consumed food i.e. on empty stomach.

Since anuvasana vasti should be given before and after niruha vasti (when niruha vasti is planned), anuvasana vasti forms a purva karma (pre-treatment procedure) and pashchat karma (post-treatment procedure) of niruha vasti. Anuvasana vasti can also be administered independently. Therefore it is an independent treatment also.

Sneha Vasti Vyapat, Chikitsa

Sneha vasti vyapad and chikitsa (complications arising due to erratically administered sneha vasti or anuvasana vasti and methods of managing the complications) –
When sneha vasti is erratically given, it will cause 6 types of vyapat or complications. They are as below mentioned –

Vata avrita sneha

Vata avrita sneha (sneha being enveloped and blocked by vata) –
In the predominance of vata if excessively cold vasti is administered or if less quantity of vasti is administered, the vata gets vitiated and blocks the sneha. This sneha is not expelled in proper time. This is called vata avrita sneha vyapat.

Symptoms of Vata avrita sneha vyapat –

• Apratyagamana – the medicine is not expelled properly in right quantities and in proper time
• Angamarda – pain in the body parts as if someone is hitting
• Jwara – fever
• Adhmana – distension of abdomen
• Stambha – stiffness of the body parts
• Uru vedana – pain I the thighs
• Parshva vedana – pain in the flanks
• Veshtana – feeling of body being enveloped
• Kashaya asyata – feeling of astringent taste in the mouth
• Jrimbha –yawning
• Kampa – tremors

Treatment –
Hot niruha vasti prepared with Rasnadi kwatha (decoction) mixed with souveera, sura (fermented medicinal drinks), kulattha (horse gram), yava (barley), lavana (salt) amla kanji (sour fermented drinks), medicated oil or ghee should be administered.
Vasti prepared with amla dravyas (sour medicines), rasnati taila oil, panchamula kwatha (decoction) and gomutra (urine of cow) should be administered
When proper cleansing takes place after the administration of either of the above said niruha vastis, properly prepared food should be given in the evening. Later anuvasana vasti should be given with rasnadi taila oil.

Pitta avrita sneha (sneha being enveloped and blocked by pitta) –
In the predominance of pitta if excessively hot sneha vasti is administered, the medicines get enveloped and blocked by pitta. This is called pitta avrita sneha vyapat.

Pitta avrita sneha

Symptoms of pitta avrita sneha:

• Sarvanga daha – burning sensation in the whole body
• Trishna – thirst
• Kotha – red coloured eruptions all over the body
• Moha – confusion
• Tama pravesha – feeling of darkness in front of the eyes
• Jwara – fever
• Tikta asyata – feeling of bitter taste in the mouth
• Ati sweda – excessive sweating
• Peeta netrata – yellowish discolouration of the eyes

Treatment –
Niruha vasti with medicine prepared from madhura skanda (group of sweet tasting medicines) and tikta skanda (group of medicines tasting bitter)
Pitta shaman niruha (niruha or cleansing enema with pitta alleviating medicines)

Kapha avrita sneha

Kapha avrita sneha (sneha being enveloped and blocked by kapha) –
If mrudu vasti (enema with slow acting medicines or weak enema) is administered in the presence of kapha predominance, the sneha will get enveloped and blocked by kapha. This is called kapha avrita sneha vyapat. The obstructed sneha doesn’t come back in proper time.
Symptoms of kapha avrita sneha vyapat –

• Tandraa – drowsiness
• Sheeta purvaka jwara – fever with cold related symptoms in premonitory stages
• Aalasya – lethargy
• Praseka – excessive salivation
• Aruchi – anorexia tastelessness
• Anga gourava – heaviness of the body
• Murcha – unconsciousness, fainting
• Glani – tiredness
• Madhura asyata – feeling of sweet taste in the mouth

Treatment –
Niruha vasti prepared with decoction of madana phala (Randia dumetorum), kashaya skanda (group of medicines having astringent taste), katuka skanda (group of medicines having pungent taste) mixed with medicines having hot potency, intense in nature (strong or teekshna), kshara (alkalis) sura (fermented medicinal liquids) and gomutra (urine of cow) etc should be administered.
Kapha shaman vastis – enemas prepared with kapha alleviating medicines

Anna avrita sneha

Anna avrita sneha (sneha being enveloped and blocked by food) –
If sneha vasti is administered after feeding the patient with large amount of food, the sneha or medicine gets enveloped and blocked by food. This condition is called anna avrita sneha. The sneha blocked by sneha doesn’t return in proper time and causes the below said symptoms.

Symptoms of anna avrita sneha –

• Chardi – vomiting
• Murcha – fainting / unconsciousness
• Glani – troublesome weakness
• Anga shula – pain in different parts of the body
• Nidra – excessive sleep
• Angamarda – beating pain all over the body
• Daha – burning sensation
• Aama lakshanas – swelling, heaviness etc
• Amashaya shula – pain in the stomach
• Vayu avarodha – obstruction to the vayu
• Hrut shula – pain in the heart or cardiac region
• Mukha vairasya – feeling of abnormal tastes in the mouth
• Shwasa – dyspnoea or short of breath / breathlessness
• Bhrama – giddiness

Treatment –
Powder of medicines having katu (pungent) and lavana (salt) tastes for digestion, Ex – Lavanabhaskara churna, Hingvashtaka churna, Chitrakadi churna etc
Kwatha (decoctions) prepared from katu dravyas (herbs tasting pungent), Ex – Shunti kwatha (decoction of ginger) etc
Mrudu virechana (mild purgatives) should be given after the food has been digested properly, for this purpose Trivrit churna, Svadishta virechana or Avipattikara Churna powders shall be used

Pureesha avrita sneha

Pureesha avrita sneha (sneha being enveloped and blocked by stools or excreta) –
If the stools and urine are not voided by the patient before the administration of sneha vasti, the sneha gets enveloped and blocked by the stools. This is called pureesha avrita sneha vyapat.

Symptoms of pureesha avrita sneha –

• Mala-mutra avarodha – obstruction of stools and urine
• Pakwashaya gourava – heaviness in the colon
• Anga peeda – pain in various parts of the body
• Adhmana – distension of the abdomen
• Hrid-graha – stiffness or catch in the region of heart
• Shwasa – difficulty in breathing, shortness of breath (dyspnoea)

Treatment –
Abhyanga – herbal oil massage
Swedana – fomentation (sudation, steaming, sweat inducing treatments)
Phalavarti – suppositories
Niruha Basti – with kashaya (decoction) prepared using trivrit (Operculina turpethum), vilwa (Aegle marmelos) etc herbs should be administered. Following this anuvasana vasti should be given.
Udavarta chikitsa – treatment of udavarta (retrograde or upward movement of vayu) should be done

Abhukta praneeta sneha vyapat

Abhukta praneeta sneha vyapat (complication occurring due to administration of vasti on empty stomach) –
If the anuvasana vasti is administered on empty stomach (without having consumed food) the pathway from anal orifice to the colon will be wide open. Since there is no obstruction, the sneha medicine by the virtue of its rapid action moves quickly crossing the barrier of colon towards throat and mouth. This is called abhukta praneeta sneha vyapat.

Symptoms of abhukta praneeta sneha vyapat –

• Gaatra graham – stiffness in the body parts
• Indriya upalepa – feeling of coating over the sense organs (hypo-functioning of sense organs)
• Sneha gandha – smell of sneha in the mouth
• Kasa – cough
• Shwasa – dyspnoea (shortness of breath)
• Aruchi – anorexia (tastelessness)

Treatment –
Trivritadi niruha vasti mixed with barley, horse gram, urine of cow is administered
The throat is gently prssed with hands or with the help of a sterile cloth
Virechana – therapeutic purgation
Chardighna chikitsa – anti-emetic treatment and medicines
Mixture of sutasekara rasa and shanka bhasma with honey
Chitrakadi vati
Dashamularishta
Hemagarbha rasa etc

Matra Basti

Matra vasti is a type of sneha vasti. It has been highly praised for its extensive and multi-dimensional use. The dose of matra vasti is half that of anuvasana vasti i.e. half of 3 pala or 12 tola. Thus the dose of matra vasti is 1 ½ pala or 6 tola (72 grams approximately).
Click to Consult Dr Raghuram Y.S. MD (Ayu)