Mode Of Action Of Basti Panchakarma Treatment

Article by Dr Raghuram Y.S. and Dr Manasa.
Vasti or Basti is a broad spectrum Panchakarma treatment. It is not limited to cleanse the bowel and evacuate the stagnant faeces. It is a highly valued treatment and is much more than the modern term ‘enema’ though the method of administration is the same. 

When it is administered in various combinations, Vasti serves the purposes of Shodhana (cleansing, detoxification), shaman (palliation), lekhana (scraping), brimhana (nourishing, bulk promoting), vajikarana (aphrodisiac), vaya sthapana (life span enhancing, longevity promoting) etc.

Mode of action of Basti

Mode of action of Vasti, Ayurveda perspective:
While appraising the significance and utility of Vasti, Charaka enumerates the below mentioned gunas (qualities) and karmas (functions) of Vasti –

• Vaya sthapana – stabilizes, fortifies and strengthens the tissues of the body and hence enhances the life span of an individual by postponing or delaying the process of ageing
• Ayushya – enhances the life span (quality and quantity of life)
• Sukha – provides comfort and happiness by establishing good health
• Bala krit – provides strength, endurance and immunity
• Agni krit – stabilizes the digestion and metabolism
• Medha krit – enhances the intelligence
• Svara krit – provides good voice
• Varna krit – enhances colour
• Sarvartha kari – can be readily administered at all ages
• Niratyaya – free of complications
• Sarva gada apaha – remedy for all the diseases
• Vit shleshma, pitta, anila mootra karshi – eliminates stools, morbid kapha, pitta and vata and urine
• Dhaardyakrit – makes the body strong and stable
• Shukrabala prada – strengthens the shukra (semen, reproductive fluid)
• Vishvak sthitam doshascha nirasya – eliminates all the morbid doshas accumulated in the body

Similarly while appraising the benefits of Anuvasana vasti, Charaka enumerates the below said qualities and functions:

Varna prada – provides and enhances colour
Bala prada – provides and enhances strength and vigour
Vatahara – best remedy to tackle and eliminate Vata disorders from their roots

Taila or sneha (medicated oil or lipids) administered in the Anuvasana Vasti is totally antagonistic to the qualities of Vata. The snigdhata (unctuousness), guruta (heaviness), ushnata (heat) qualities of sneha are antagonistic to the ruksha (dry), laghu (lightness) and sheeta (cold) qualities of Vata.
After getting rid of morbid vayu, Anuvasana Basti restores health. It causes pleasantness of the mind and nourishes (enriches) veerya (potency, sexual potency), bala (strength and immunity), varna (colour) and agni (metabolism)
Kashyapa tells that Vasti is equal to the amrita (nectar of life) to the kids and also the old aged people

All these functions and benefits of Vasti are obtained by its ‘vata mitigating property’. We all know that Vata is the master of the orchestra of body functions and is responsible for all the normal and abnormal activities (physiological and pathological activities) taking place in our system. This means to tell that all the activities, good or bad, are under the control of the Vayu.

तत्र आस्थापन अनुवासनं तु खलु सर्वत्र उपक्रमेभ्यो वाते प्रधानतमं मन्यते भिषजः।(च.सू.२०/१५)
Tatra aasthaapana anuvaasanam tu khalu sarvatra upakramebhyo vaate pradhaanatamam manyate bhishajaha (Ref – Charaka Sootra 20/15)

Charaka gives an opinion that ‘Asthapana and Anuvasana are the best choices of treatments to control the Vata’.

Treatment of Vata in Pakvashaya

Destruction of aggravated Vata Dosha

Destruction of Vata in its root place i.e. Pakwashaya by Niruha Vasti –
The Vasti (Niruha) on entering the Pakwashaya (colon) terminates the morbid Vata by roots. When the Vata is controlled in the Pakwashaya, which is the centre of administration of Vata, the other subtypes of Vata located in all the parts of the body will be automatically controlled. When the Vayu is controlled all the other elements and activities which are under the control of Vayu fall into rhythm and get to become normal.

Example, Just as the flowers, fruits, leaves and branches of a tree get destroyed when the roots of the tree are cut off, the Vata too gets destroyed when it is cut at its roots located in Pakwashaya. Thus, Vasti is the numero-uno treatment for Vata disorders and all the other diseases.

Nourishment of Vata Dosha

Nourishing of root place of Vayu (Guda and Pakwashaya) by Anuvasana Vasti –
The tree is nourished when the water is regularly sprinkled at its roots. The tree always remains healthy and green. It will be enriched with attractive green leaves, and timely appearance of flowers and fruits. Similarly when the Guda (anus and large intestine, colon) is sprinkled with anuvasana vasti, all the siras (veins or vessels carrying the nutrition) will get nurtured and the body as a whole will be nourished. All the dhatus (tissues) including shukra or semen will be nourished with enriched qualities. People who don’t have progeny will be blessed with kids following the nourishment of shukra tissue by Anuvasana Vasti.

Basti is said to be the best treatment for Vata Vyadhis (diseases occurring due to vitiation of Vata). Vasti is an unparalleled remedy in many conditions including stiffness of the limbs, lame and limp, pains occurring due to vata in various parts of the body, distension of abdomen, hard bowel movements and impaction of faeces in the intestines, pain in the viscera, anorexia, and many more pathological conditions. Basti is also the best remedy for impotence and infertility.

This multidimensional action of Basti keeps us puzzled regarding how Vasti is capable of bestowing so many benefits and how does it expel many types of morbidity and diseases from the body and mind!

The Vasti administered in the Pakwashaya imparts its beneficial action on the entire body and mind. If it palliates and pacifies the morbid doshas somewhere in the body, it destroys and expels the doshas somewhere in the body. This shows the selective action, tissue and organ specific action of Basti. According to Sushruta, the administered Vasti stays in the pakwashaya (colon), shroni (pelvic region) and below nabhi (navel) regions of the body. From here the Vasti works on the basis of its veerya (potency or functional capacity). The veerya of the medicines of Vasti spreads throughout the body through the means of multiple srotas’s (channel or duct system or transportation system of the body). The veerya of the medicines brings about the desired actions like palliation, elimination, nourishment etc depending on the purpose of which the Basti has been administered. Just as the veerya (potential part) of water sprinkled at the roots of a tree reaches all the parts of the tree, the Vasti sprinkled at the root of the body i.e. Guda or anal orifice (guda is said to be the root of the body by Acharya Parashara as quoted by Chakrapani, the commentator of Charaka Samhita) will reach all the parts of the body.
Most of the administered Vasti gets eliminated within quick time. Now a question arises so as to how the Vasti medicine in its short duration of stay within the colon imparts such healing effect?

Actually the given medicine (through Basti) will flush off the faeces and comes out in quick time along with the excreta by the action of Apana Vayu (the subtype of vayu which governs the functions of the lower parts of the body). But the Basti acts on the virtue of its Veerya (as already said). By the virtue of its Veerya, the Vasti reaches every corner of the body from the toes to head, drags the morbid doshas from every part of the body and expels them from the body.

Just as the Sun being located lacks of miles away from is capable of sapping off the fluids of living beings on earth by the virtue of the effect (virya, prabhava) of its heat and intensity, the Vasti medicine administered into the Pakwashaya by the virtue of its veerya will dissolve in it all the impurities and morbidity located at all the places of the body and expel them from the system.

Among all the 3 doshas, the vitiation of Vayu presents as the strongest morbidity and causes highest damage at all levels. Vata will also control the vitiation of other 3 doshas. It is said that nothing tolerates the strength and intensity of vitiated Vayu like Basti. Only the waves of the sea or ocean can tolerate the tsunami caused by the high winds or Vayu. Just like that, it is only the Vasti which can tolerate the aggravation of Vayu, destroy the morbid vayu and expel it out of the system.

Summarizing the above said material, it is understood that the Vasti and its effect is not limited to the Pakwashaya but in fact reaches to every minute part of the body. The veerya of the Vasti gets digested and assimilated by Agni, the digestive fire. Later the veerya of the vasti getting admixed with blood and plasma (rasa-rakta) circulates all through the body and reaches the target sites (where its utility is needed). On reaching various parts of the body, Vasti renders the functions of shamana (palliation), shodhana (cleansing) etc.

Modern understanding of Vasti action

Mode of action of Vasti, modern view (in comparison to Ayurvedic concepts) –
Even modern studies have shown the action of vasti vis-à-vis enema beyond the level of colon (large intestine). According to studies, the enema reaches to the level of stomach, duodenum and ileum (parts of small intestine) wherein the active principles of the enema medicines are absorbed and made use of.

The Vasti explained in Ayurveda is a combination of many healing medicines like honey, rock salt, herbal decoctions, jaggery, milk, medicinal pastes, medicated ghee and oil etc. Sneha or medicated lipids (oil and ghee) have anu pravana guna (deep penetrating quality or crossing the barriers or percolating nature).

If we place sneha in a container, close the lid and invert it, the sneha dribbles from the junction of the lid and vessel or from the pores of the lid and escapes. This is called as anu pravana guna or percolation. Similarly, the vasti medicine can percolate and cross the barrier of ileo-caecal valve which is a door between (lid) the end of ileum (last part of small intestine, where it enters the large intestine) and caecum (first part of colon or large intestine). The salt, milk, meat soup, veerya of medicines etc dissolved in sneha also crosses this barrier and reaches their target tissues and or organs. Sneha is an important solvent.

In the book named ‘The Physiological basis of medical practice’, the authors Best and Taylor quote ‘Materials introduced by enema, in some instances pass through the walls into the illium; such incompetence may permit the enema fluid to reach the duodenum’

If due to the pressure of the medicines of Basti and provocation by the same, if the valve dilates, there is a good chance of the medicines moving quickly towards the duodenum. They can also reach the stomach and mouth.

In one of the modern references we get to read ‘The possibility of materials even the lower bowel, reaching the mouth is strongly suggested by the fact that lycopodium sporce, introduced into the colon by enema, have been recovered some hours later from washing of the stomach’. This shows that the enema can reach the stomach also.

While explaining the positioning of the patient, Charaka states that when the Vasti is administered with patient sleeping on his left lateral side, the medicines easily reach the level of grahani or duodenum. Jejjata, the commentator of Charaka Samhita further clarifies by telling that the agni-sthana or site of agni (digestive fire) is located on the left side of the body, above the level of the nabhi (navel region). This is also called as Grahani (duodenum).

Similarly, on the left side of the body itself the sthulantra (large intestine, descending and sigmoid colon with rectum) is continuous with guda (anus and rectum). Thus, when the patient sleeps on the left lateral side, the medicine easily reaches the Sthulantra and agni sthana because they both are placed at the same level, in line with each other. On reaching the agni sthana or grahani, the vasti dravya strengthens and fortifies the agni. In turn, the agni digests (transforms into usable form) the vasti medicine and helps in its absorption and utilization.

The Vasti medicines will have various forms of sneha (medicated oils, ghee etc) and they will be absorbed and utilised in the body. Scientific studies and research works have proved this fact. On giving vasti (brimhana vasti or strengthening or bulk promoting enemas) the quantity of fatty acids and proteins were found to be increased in the blood. This fortifies the concept of ‘action of brimhana vasti’. It increases the sneha (fat proportions) and proteins of the body. The body weight also has been seen to be enhanced after administration of brimhana vasti. All these help in recovery from Vata diseases.

The action of Vasti is also seen to have beneficial effects on Asthivaha srotas (channels helping in nourishing and forming bone tissue) and Majjavaha srotas (channels helping in nourishing and forming bone marrow tissue). Tikta Ksheera Bastis (enemas prepared with bitter medicines processed in milk) are the best in getting rid of asthigata vata (osteopenia, osteoporosis) and asthi shula (bone pain). Tikta dravyas or bitter herbs are predominant in Akasha (ether, sky) and Vayu (air) elements. By the virtue of these elements, they tend to reach the places (tissues and organs) rich in akasha and vayu elements. Asthi or bone is the seat of Vayu. All srotas (channels of transportation or duct system of the body) are made up of akasha mahabhuta. Therefore the tikta ksheera vasti has maximum affinity towards the bone tissues and the channels of the bone. By the virtue of tissue specificity and target tissue, the vasti reaches the bones and destroys the diseases and morbidity therein. Lot of snehas are included in the vasti. Some ingredients or portions of the sneha (phospholipids) take an important role in the formation of bone and bone marrow. Pakwashaya or large intestine (colon) is said to be the adhishtana (location in which vasti is administered) of vasti. Pakwashaya is Pureeshadhara kala (layers which form the faeces). According to Dalhana, the Pureeshadhara kala is itself Asthidhara kala. This establishes a relationship between the large intestines and bones.

The medicines administered into large intestine reach the bones and help in nourishing and healing the bones. According to the modern science the calcium which is essential ingredients of bones are excreted through the stools. If the ingredients of bone are excreted through the stools, the medicines implanted into the colon could reach the bone. Practically we can see that the bone pain of asthigata vata quickly subsides on administration of tikta ksheera vasti (bitter milk enemas).

Similarly the sneha and majja (bone marrow) has nutritive relation with each other. Sneha is an essential ingredient of majja. Majja is in fact made up of sneha. Mastaka (brain) which is an abode of indriyas (sense organs) is said to be the sneha (fat) located in the shira (head). It is also called mastulunga. Mastulunga is in the form of consolidated ghee and is an ingredient which supports and provides strength to the head. Mastulunga is also called as mastishka gata majja. It is formed by the transformed part of meda or fat.

Thus we can find the combination of sneha, meda and majja within the shira (head). All the vata nadis (nerves) are formed by majja dhatu. According to Kashyapa, Majja is an abode of Vata. Thus sneha takes an important role in nourishing the Majja. This gives us a clarity so as to how Vasti has an impact and healing effect over the nerve centres of the brain, spinal cord and all parts of the body.

The medicines administered through Vasti reach Grahani and gets absorbed there. Grahani is also called Pittadhara kala (the layers which form the pitta are located in Grahani). Pitta formed in pittadhara kala or grahani has an important role in digestion of sneha. Pittadhara kala is also the majjadhara kala i.e. layers or membranes helping in formation of majja or marrow (pittadhara and majjadhara kalas are functionally said to be one and the same). The sneha which reaches Grahani will have a gross impact on all the majjas of the body.

In Grahani roga (disease caused in the duodenum due to metabolic errors, sprue syndrome, mal-absorption, IBS etc) we can find parva ruja or pain in inter-phalangeal joints (caused by majja), pain in flanks, heart, head (due to affliction of majja forming the nerves) and also some mental symptoms. All these justify the use of sneha vasti in vata diseases.

Studies have shown that there will be decrease in pyruvic acid, an ingredient of keto-acids after the administration of Vasti. Increase in pyruvic acid levels in the blood leads to decrease of Vitamin B1 and its decrease causes increase of Vitamin B1  levels. This vitamin has an important role in the health of nervous system. When this vitamin decreases inflammation occurs in the cells of the nerves. It also causes degeneration of myelin sheath leading to many diseases. This vitamin also has its influence on heart, circulatory and digestive systems. When its levels are decreased it causes symptoms like indigestion, constipation, tastelessness, sluggish digestion, etc. Vasti rectifies these conditions by reducing pyruvic acid levels and in turn increasing the Vitamin B1 levels.

Pakwashaya is an abode of Krimis (intestinal bacteria or bacterial flora). According to Ayurveda, Pureeshaja krimis or microorganisms taking their origin from faeces are located which are harmful. Similarly there are kaphaja krimis (microorganisms caused by morbid kapha) in the amashaya (stomach). The vasti will destroy and expel these krimis. The useful bacteria of intestinal flora are thought to be producing some strains of Vitamin B and Vitamin K. They help in proper maintenance of intestinal health. The ingredients of Vasti like milk, jaggery, sesame etc will help in increasing the quantity of these natural and helpful bacteria (provide a suitable environment wherein the useful bacteria are formed).

Basti also helps in formation of Vitamin B in the intestines which helps in recovery of many neurological diseases (vata vyadhi) and also helps in causing brimhana (enhancing strength, promoting bulk). Similarly deficiency of certain vitamins lead to skin disorders, eye diseases, burning sensation etc symptoms. The twachya (beneficial for skin), chakshushya (beneficial for eyes) and Varnya (colour enhancing) Bastis will help in destroying these diseases.

Vasti will have a soothing effect over the peripheral and local nerves. This will help in reduction of pains caused by nerve irritation (vitiation of vata). The shodhana (cleansing effect) effect of Vasti will reduce pressure over the colon, pelvis, flanks and viscera and also pacify vata. The pains caused by vitiated vayu will immediately pacify on administration of shodhana vasti.

Since the vasti reaches the grahani, the ksheera vastis (milk enemas processed with medicines) impart healing effect over the peptic ulcers occurring in stomach and duodenum and reduces pain and other symptoms associated with peptic ulcers.

All the above said versions of explanations from Ayurveda and modern perspectives prove and justify the role of Vasti and its probable mode of action.

Mode of action of Uttara Vasti

Vasti or Basti is predominantly a treatment oriented towards the correction of Vata morbidity.
Uttara Basti is administered into the urinary tract (through urethra) or into the genital tract (through vagina). Thus the target organs of Uttara Vasti will be Basti (urinary bladder) and Garbhashaya (uterus).

The lower part of the body is governed by a subtype of Vayu called as Apana Vayu. This Vayu or vata helps in controlling and governing all the activities taking place in the lower parts of the body. Its centres of control are Colon, pelvis, urinary bladder, uterus and lower limbs. If the Apana Vayu is at its functional best and is not vitiated all the activities related to the above mentioned organs take place easily and effortlessly. But if the Vata gets vitiated or moves in opposite direction i.e. upward direction (generally Apana vata tends to move in downward direction, expelling and excreting things being its primary functions) or gets obstructed functionally by other subtypes of Vayu or Pitta or Kapha (Avarana) or gets weak in functions, the functions related to the above mentioned organs and parts of the body will be disturbed.

This disturbance will be manifested in terms of excessive discharge or premature or immature elimination of the body contents as in premature ejaculation (PME), abortion, miscarriage, diarrhoea, etc or blocks caused by Apana vayu in these regions leading to various deformities and diseases like PCOS, BPH, impotence, sterility, amenorrhoea, constipation, back pain, pain in the joints of the lower limb, vesical calculi (stones in urinary bladder), etc

So the primary line of action in the diseases afflicting the urinary and genital systems will be to control and balance the Apana Vata. This goal will be achieved by Uttara Vasti because the medicinal ingredients in Niruha (decoction) and Anuvasana (oil or ghee) enemas given into the bladder or uterus will control Vayu. We know that Vasti is the best treatment to control Vayu. The vitiated Vayu when controlled by Uttara Vasti will be restored to its normal status. Healthy Apana Vayu will help in the activities at these sites to take place normally and will once again have its movements in the downward direction. With the regression of deformities and diseases all the diseases related to uro-genital system mentioned above will be cured.

The Uttara Vasti will also have a cleansing action especially Niruha Vasti. By cleansing action of Uttara Vasti in the urinary bladder and uterus and other genital passages, the process of urination and menstruation and sexual functions will be restored. The organs will be clean and sterile and will get rid of inflammation, irritation, stagnation and infections.

The sneha vasti administered in Uttara Vasti will be having a supportive role. They are nutritive in function and will improve the blood circulation, nerve conduction and immunity of the organs. Anuvasana vasti given in the form of uttara vasti is highly effective in cases of sterility and impotence and will bestow the progeny to those anticipating it.

Vasti or urinary bladder is said to be one of the important Marma sthana or vital organ. Its health can be maintained to its optimum with the help of Utara Vasti.

Conclusion

Basti is said to be ‘ardha chikitsa’ or half the treatment of all the treatments put on the other side of the balance. This is not exaggeration. I have not only handled but also have seen many complicated and rejected medical conditions being cured and healed by Vasti. The beauty of Vasti is its multi-dimensional nature. It can be highly useful in preventing many diseases and thus can be administered in healthy individuals. Its role in healing many psycho-somatic disorders is unparalleled by any other medicines or treatments. Basti can be administered at all ages and its variants like Matra Vasti can be administered on daily basis. Basti enhances immunity and postpones ageing, thus promoting longeivity of life in terms of quality and quantity.

No condition seems to be hopeless nor declared as ‘impossible to cure’ as long as Vasti has not been tried.
Click to Consult Dr Raghuram Y.S. MD (Ayu)

Fecal Transplant Therapy vs. Ayurvedic Basti

Fecal transplant is a therapy wherein fecal matter from a healthy individual is implanted into the colon of the patient. The idea is that, many diseases such as  inflammatory bowel disease, irritable bowel syndrome (IBS), diabetes, multiple sclerosis, thyroid disorders, obesity, etc., are caused due to the lack of healthy gut bacteria. Implanting helps the patient to develop these healthy bacteria that the his colon is lacking. 

Ayurveda does not mention such a treatment, though Gomaya – filtered cow dung water is part of panchagavya and droppings of the pigeon are used in the management of stroke, to remove the clot. These cannot be compared with the modern fecal microbiota transplantation (FMT). 
Ayurveda relies heavily upon Basti treatment to correct the health of the colon environment. 

In the Basti treatment, herbal oil, herbal ghee, decoction mixed with rock salt, honey, dill seed paste and oil / ghee are advised through the anal route. 
Thus administered Basti is useful to – 
cleanse and detoxify colon 
create a healthy environment in the colon to develop healthy gut bacteria 
directly absorb certain medicinal qualities without getting medicines metabolized by the liver (It is called bypassing the hepatic first pass effect) 

local healing of disease pathology – like healing the inflammation in case of colitis, healing the local ulcers in case of ulcerative colitis etc. 
Read: Basti Chikitsa: Benefits, Routes, Types, Indications, Equipment
Basti therapy is explained as Ardha Chikitsa – half of the effectiveness of entire therapies of Ayurveda lies in Basti treatment.