Niruha Basti (Kashaya Basti) Panchakarma Method, Uses, Side Effects

Article by Dr Raghuram Y.S. and Dr Manasa
Niruha Basti is an Ayurvedic Panchakarma therapy wherein herbal decoction mixed with honey, rock salt etc are administered through anal route, like enema. It is also called Asthapana basti. 

Introduction

Basti therapy is classified basically as
Anuvasana basti – wherein oils and fats are administered.
Niruha Basti / Asthapana basti – wherein a decoction mix is administered.
Both the above can be administered through urethral, vaginal, anal routes or directly over wounds and ulcers.
Read related: Basti Chikitsa: Benefits, Routes, Types, Indications, Equipment

Niruha Vasti

Niruh Vasti or Kashaya Vasti or Asthapana Vasti –
Niruha Vasti is a type of Vasti wherein Kashaya or herbal decoction is used as a medication.
It is also called Kashaya Vasti

Since this Vasti eliminates (expels) the morbid Doshas and or diseases from the body, it is called Nirooha Vasti (Niruha = To eliminate).

Since this Vasti also establishes life span (Vaya) and age, it is called Asthapana Vasti. Establishing age means enhancing the age, by enhancing the life span of each and every cell in the body. By expelling the morbidity, Basti establishes unparalleled health and immunity in all the cells in the body. All the functions of the body will be carried out in a smooth way. A new life element is created in each and every cell enabling them to live more and live healthy. This Vasti enhances longevity and establishes youthfulness.

Contraindications

Who should not undergo Niruha Basti:
Patients indicated for Anasthapya (Contra-indications for Asthapana Vasti) –
Charaka Siddhi 2/14

The below mentioned conditions are contra-indicated for administration of Asthapana or Nirooha Vasti –

• Ajeerna – indigestion
• Ati snigdha – person who has been subjected to excessive oleation (administered with excessive medicated oils and or ghee orally)
• Peeta sneha – person who has consumed sneha (medicated lipids in the form of oil and or ghee as a part of snehana or oleation treatment)
• Utklishta dosha – doshas having exacerbated and ready to be expelled
• Alpa agni – low digestion
• Yana klanta – person who is tired due to excessive travelling
• Ati durbala – severely debilitated person
• Kshudaarta – in presence of hunger
• Trishnarta – in presence of thirst
• Shramaarta – in presence of fatigue
• Ati krusha – severely emaciated person
• Bhuktabhakta – after having consumed food
• Peeta udaka – after drinking water
• Vamita – after vomiting or to a person who has been administered with therapeutic emesis treatment
• Virikta – to a person who has been administered with therapeutic purgation treatment
• Kruta nasya karma – to a person who has been administered with nasal medicines
• Kruddha – to a angry person
• Bheeta – person in panic
• Matta – intoxicated person
• Moorchita – in condition of fainting and unconsciousness
• Prasakta chardi – nausea
• Prasakta nishteeva – in presence of excessive salivation or expectoration (impending)
• Shwasa prasakta – breathing trouble (impending)
• Kasa prasakta – severe cough (impending)
• Hikka prasakta – impending hiccough
• Baddha guda udara – intestinal obstruction
• Chidra udara – intestinal perforation
• Dakodara – ascitis
• Aadhmana – distension of abdomen
• Alasaka – slow clearance of intestines, reduced peristalsis (natural intestinal movements to propel its content ahead)
• Visuchika – throbbing pain in the abdomen, cholera
• Ama dosha – in presence of intermediate products of digestion (improperly processed nutritional juices in circulation) in circulation
• Ama atisara – diarrhoea caused by ama
• Madhumeha, Prameha – Diabetes, urinary disorders
• Kushta – skin disorders
• Arsha – piles
• Pandu – anaemia
• Bhrama – giddiness
• Arochaka – anorexia
• Unmada – insanity
• Shoka grasta – grief
• Sthoulya – obesity
• Kantha shosha – dryness of throat
• Kshata ksheena – wasting disorders caused due to excessive bleeding (internal) due to injury
• Sapta masa garbhini – to a 7 month pregnant
• Baala – child
• Vruddha – old aged people
• Alpa varcha – in those who have less production of stools
• Shuna payu (guda shotha) – numbness of anus, swelling of anus
• Aama prajata – women who had abortion
• Shopha – swelling, anasarca

Reasons for Basti Contra-indication:

When Asthapana Basti is given in conditions like indigestion, to a person who has consumed medicated fats, or saturated with fats – causes dooshi udara (contaminated abdomen, ascitis etc), murcha (unconsciousness), shotha (swelling) etc. There is no objection for using medicated oils or ghee externally. Anyhow oil massage is an essential part of pre-treatment procedure of Asthapana Basti (Purvakarma of Asthapana Vasti).

When Asthapana Vasti is administered to Yana Klanta (those tired of riding or travelling) Basti medicine immediately causes deha shosha (destruction of body by depletion of tissues). Similar effect is seen when the enema is administered in those in whom the doshas have been exacerbated or heavily vitiated, those having mandagni (low digestion capacity), arochaka (anorexia, tastelessness) etc conditions

When Asthapana Basti is administered to people who are debilitated (weak), and in presence of hunger, thirst and fatigue, the vasti medicines will produce further irritation and cause threat to life (prana uparodha) by producing severe pain or hampering circulation and oxygenation to the cells. Difficulty in breathing leads to death or suffering equal to death.

Asthapana Vasti administered in thin (emaciated) persons will cause further emaciation. Brimhana Basti (strengthening and bulk promoting enemas) can be given to the emaciated people.

Asthapana Vasti should never be administered to a person who has consumed food, water and other liquids. If given, the Basti causes exacerbation (provocation) of doshas (dosha utklesha) and causes severe life-threatening complications.

Asthapana Vasti should not be administered to a person who has been subjected to cleansing treatments like Vamana (therapeutic emesis) and Virechana (therapeutic purgation). These cleansing treatments will produce excessive dryness in the body. The Basti will further enhance the dryness and cuase complications. The condition is compared to the ‘application of alkali over the wound’.

If Asthapana Vasti is administered after Nasya or nasal medication, it causes srotorodha (obstruction to the channels of the body).
When administered to a person in anger and panic, the medicines of Asthapana Basti will quickly reach high up in the body (up to the throat) which is not desired.
When administered to an intoxicated or fainted person, the Asthapana Vasti causes sangna-nasha (loss of consciousness) and hrudaya upaghata (obstruction of heart functioning, heart failure).

Asthapana Basti should not be administered to the patient’s sufferieng from vomiting, expectoration, dyspnoea or breathlessness and cough. If administered, the Vayu moving upwards carries the medicines to the upper parts of the body which is not desired.
Asthapana Basti should not be administered in the conditions of intestinal obstruction (badda guda udara), perforation of intestine (chidra udara), ascitis (udaka udara) and aadhmaana (distension of abdomen). If administered, it causes severe distension of abdomen leading to death or life threatening complications.

When administered in Alasaka (absolute constipation or lazy abdomen), the asthapana vasti causes severe distension of abdomen by obstructing the expulsion of doshas through vomiting and diarrhoea (upper and lower direction).
When administered to a person suffering from visuchika (cholera), the asthapana vasti causes severe ama dosha (toxicity due to immature essence of food in circulation) by causing excessive vomiting and diarrhoea.
Asthapana vasti when administered to the person suffering from madhumeha (diabetes, urinary disorders) and kushta (skin disorders) further worsens and complicates these diseases.

Indications

Indications for Asthapan Basti (Niruh Basti) – Aasthapya:
Charaka Siddhi 2/16

• 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)

Read related: Mode Of Action Of Basti Panchakarma Treatment
Briefly the above said conditions in which Asthapana Vasti is indicated can be included in the below said categories:

• Vata rogas or Vata pradhana rogas – diseases caused due to vitiated vayu or diseases in which Vata morbidity is severe
• Diseases located in or occurring in the sites, organs and tissues which are abodes of vayu (vata ashraya sthanas)
• Diseases in which Shodhana (cleansing) should be administered
• The diseases which can be cured by the different types of vastis (as seen in the above said classification of vasti)
• The diseases occurring in the site of malashodhana (colon)

Procedure of Niruh Basti

Administration of Niruha Vasti (Asthapana Vasti or evacuation enema) –
Like any other treatment process in Ayurveda, Vasti too is conducted methodically in different stages.

Purva karma

Purva Karma (Pre-treatment procedures)
Like any other treatment, the success of Basti treatment also lies on the preparation done in the Purvakarma (pre-treatment procedures). The below mentioned points should be seriously viewed and reviewed to obtain successful results.

Dosha analysis

Vasti is a dosha specific treatment, but can also be administered in pitta and kapha vitiation. Before administering Vasti, the minute aspects of dosha vitiation, its pathological stages and mode of manifestation should be thoroughly inspected and understood. The below mentioned aspects with respect to dosha should be noticed i.e.

• Kshaya – pathological decreaasae
• Vriddhi – pathological increase
• Samata – equilibrium
• Urdhwa desha gamana – upward movement of doshas
• Adho desha gamana – downward movement of doshas
• Tiryak gamana – oblique and sideward movement of doshas
• Shaka ashrayitva – movement and lodgement of doshas in the tissues
• Koshta ashrayitva – lodgement of doshas in the visceral organs
• Madhyama marga ashrayitva – lodgement of doshas in the vital areas of the body, bones and joints
• Swadesha gamana – vitiation of doshas in its own place
• Paradesha gamana – encroachment of doshas into other organs
• Swatantra paratantratva – primary and secondary vitiation of doshas
• Amsha amsha vikalpana – micro analysis of qualitative vitiation of doshas
• Dhatu vishesha ashrayitva – lodgement of doshas in specific dhatus or tissues etc

In dosha kshaya (depletion of doshas) the normal functions of the body will be disturbed. In such cases – Brimhana (bulk promoting), balya (strength promoting), utkleshana (provoking or stimulating) enemas should be administered.

Similarly in Dosha vriddhi (pathological increase in doshas) – dosha hara (dosha alleviating), shodhana (evacuation, cleansing), tikshna (strong) vastis should be administered

In the urdhwagamana of doshas – the doshas tend to move and lodge in the upper parts of the body like in head, sense organs etc. in these conditions shaman (dosha pacifying), anulomana (pushing doshas downwards) vasti should be administered

In the adhogamana of doshas the doshas tend to move downwards and get lodged in the lower parts of the body and produce diseases therein. Example, Urusthambha (stiffness of thighs) is a disease caused by accumulation of doshas i.e. ama and vata in the thighs. In this condition, ama, vata and visha (poison) alleviating vastis should be administered.

In shakhagata doshas – the doshas tend to get lodge in weak and susceptible dhatus (tissues) and cause disease therein. The vasti should be in accordance to the dosha and dushya (tissue) combination in the pathology.

• In Raktagata doshas (doshas lodged in blood tissue) wherein the Rakta gets vitiated shaman vasti (dosha pacifying vasti), varnya vasti (colour enhancing or cosmetic vasti), balya (strengthening vasti), rakta vasti (blood enema) etc should be administered
• In mamsa gata doshas (doshas lodged in muscle tissue) brimhana vastis (bulk promoting or muscle strengthening enemas should be administered)
• In meda gata doshas (doshas lodged in fat tissue) lekhana vasti (scraping or fat depleting enemas), karshana vasti (thinning or emaciating or weight reducing enemas) should be administered
• In asthigata doshas (doshas lodged in bone tissue) tikta ksheera vasti or enemas with milk and ghee processed with bitter medicines should be given
• In majjagata doshas (doshas lodged in bone tissue) shaman vasti (dosha pacifying or palliative enemas) and brimhana vasti (nourishing or bulk promoting enemas) prepared using bitter and sweet medicines should be administered
• In shukragata doshas (doshas lodged in semen or reproductive tissue), vajikarana vasti (aphrodisiac enemas) should be administered

Koshtagata – In pakwashayagata doshas (doshes lodged in large intestine) vasti is an ideal choice, since vasti is the main treatment for vayu and pakwashaya (large gut) is the primary site of vata or vayu

Madhyama roga marga gata doshas (doshas lodged in madhyama roga marga i.e. in marmas or vital areas of the body, bones and joints) – When the doshas get lodged in madhyama roga marga, organs and tissues like heart, urinary bladder, brain, bones, joints, tendons, nerves etc are involved. In these cases, the basti should be administered with the medicines prepared with specific disease modifying medicines, keeping in consideration the organs and tissues involved. Target specific or tissue specific herbs can also be chosen to prepare the vasti medication.

Sthanastha dosha (doshas getting aggravated in their own sites) – Amashaya or stomach is a predominant kapha site but in Amashayagata vata (vitiated vata moving into the kapha site i.e. amashaya and causing diseases therein) vamana treatment (therapeutic emesis) should be administered taking Amashaya into consideration but basti should not be administered (vasti is a vata specific treatment but in this condition though vata is invading dosha it is not handled as first option instead the organ which is invaded is attended and made strong, vamana is the best treatment for diseases and morbidity located in amashaya and also for kapha which is the local dosha of amashaya).

But in Pakwashaya gata Kapha (kapha morbidity in large intestine which is reverse condition of amashaya gata vata, the regional dosha of large intestine or pakwashaya is vata), vasti is administered following the same principles explained in amashaya gata vata. Even here, the agantu dosha (invading dosa i.e. kapha is not handled initially). basti is administered with medicines having hot potency (ushna virya) and mixed with gomutra (urine of cow).

If pitta predominant doshas are afflicting Vata site i.e. large intestine, Niruh basti with pitta alleviating herbs processed in milk (ksheera vasti) and Anuvasana vasti (oil enemas) with oil or ghee or both prepared with medicines having sweet taste should be administered
Read related: Anuvasana Basti: Method, Benefits, Mode Of Action, Contra Indications

Swatantra-Paratantra dosha dushti (primary and secondary vitiation of doshas) – In the primary and or secondary manifestations of dosha vitiation, the possibility of Avarana (enveloping or masking of functions of vata or its subtypes by another subtype of vayu, other doshas, dhatus, malas i.e. excreta, food etc) should be considered. Example, in Pranavruta Samana (functions of samana vayu blocked by Prana Vayu) the symptoms are jadatva (stiffness of he body parts), gadgadatva (stammering of speech), mukatva (dumbness). In this condition, Vasti should be given with Chatu sneha (4 fats mixed together i.e. ghee, oil, bone marrow and muscle fat) and Yapana vasti (nourishing enemas) should be administered. Here Prana is blocking the functions of Samana vayu, therefore Prana vayu is swatantra dushti (independent vitiation) and Samana Vayu is paratantra dushti (the afflicted or passive and suppressed vata subtype).

Similarly in Udanavruta Apana (functions of Apana vayu blocked by the dominant Udana vata) the symptoms are chardi (vomiting), shwasa (dyspnoea) etc. Basti (enemas) and anulomana (medicines pushing the vitiated vata downwards) are desired treatments.

Sama-niramata of dosha (association of ama or disassociation of ama with doshas) – In the predominance or association of ama with the doshas, Vasti should not be given. Ama means the immature essence of digestion obtained after the digestion in the stomach. Actually the essence of digestion which goes into circulation to nourish all the tissues of the body should be formed properly. But if the agni or metabolic fire in the stomach is weak (indigestion, anorexia etc conditions), the essence is formed in immature form, this doesn’t satisfy the rules of proper nutrition. Owing to its sticky nature it blocks all the channels of circulation, and depletes all the tissues and organs of their nutrition.

When doshas get associated with this ama they are called sama doshas. These sama doshas are highly pathological in nature. They too become sticky in nature and start damaging the tissues and organs leading to many diseases. When vasti is given in sama dosha condition, the medicines administered through vasti due to intense nature try to pull the sama doshas which are sticking in the tissues out of the body. This further damages the tissues and causes serious problems because the cells will be severely damaged.

Thus vasti should not be administered in sama dosha condition. It can be given after the ama has been digested with pachana medicines and after ama has been detached from the association with doshas. In these conditions, antara peya or antara pana should be administered. This is a specially prepared medicated gruel. (Peya or thin gruel prepared with deepana or appetizer and pachana i.e. digestant medicines like trikatu i.e. 3 pungent herbs – pepper, long pepper and ginger along with lavana – salt should be given)

According to dosha predominance:
In Vata predominance – Sneha vasti (oil or ghee enemas) with medicines predominant in sweet, sour and salt tastes, 9-11 vastis can be given, 1 Niruha (decoction enema) vasti with hot and oily medicines (ushna, snigdha) and meat soup should be given
In Pitta predominance – Basti with medicines having sweet, bitter and astringent tastes can be given, 5-7 vastis with medicines having cold potency and processed in milk shall be given, 2-2 Vastis are given
In Kapha predominance – Vasti with medicines having astringent, pungent and bitter tastes, 1-3 vastis with pungent, alkalis, strong and intense acting medicines mixed with cows urine should be given, 3-3 vastis are given

Aushadha

Aushadhas (medicines) –
The medicines need to be checked for their compliance. They are the most important ones in the business. Dryness, wetness, freshness, oldness, its interactions with other medicines, taste, potency, post-digestion effect, overall effect etc of the medicines should be considered.
Below said are the qualities, which when present in the medicines are considered to be unfit to be used in Basti –

Aamata – medicines should be devoid of aamata i.e. unprocessed or unripe part (the medicines and herbs used in the preparation of vasti liquids should have grown to full maturity and they should not comprise of immature and unripe part). Similarly the medicines which are combined to form vasti liquid also should be properly processed and prepared i.e. kwatha (decocitons), mamsa rasa (meat soup), sneha (oils, ghee) etc are the components of vasti dravya (vasti medicine), they should be processed and prepared properly without having unprocessed parts in them. This means to tell that the final products should be tested for their excellence.

Heenata or inadequacy – the medicines advised to be used should be taken in their full quantity. If less quantity of medicines are taken than what has been advised, it causes ayoga (symptoms of insufficiency) because the medicine will not be effective. When the medicine is not effective we do not get desired results. Similarly, the final medicine which is given as enema also should not be in small quantity.

Ati-maatrata or excessive quantity – the medicinal herbs advised to be taken for preparing the enema should not cross the limits of the advised quantity. If this is done, the medicine might become too stronger to tolerate and may produce symptoms of excessive evacuation. Similarly administering the enema liquid or medicine in higher quantity, encroaching maximum quantity prescribed will produce symptoms like klama (tiredness), admana (distension), atisara (diarrhoea) etc.

Niruha basti dose

In this context let us discuss about the proper quantity of Vasti medicine which should be administered as advised by Ayurveda –

Quantity of Niruha Vasti according to the age:
For a child of 1 year – ½ prasruti (48 grams)
For 2 year – 1 prasruti (96 grams)
For 3 year old – 1 ½ prasruti (144 grams)
For 4 year old – 2 prasruti (192 grams)
For 5 year – 2 ½ prasruti (240 grams)
For a child of 6 year – 3 prasruti (288 grams)
For a child of 7 year – 3 ½ prasruti (336 grams)
For a child of 8 year – 4 prasruti (384 grams)
For a child of 9 year – 4 ½ prasruti (432 grams)
For a child of 10 year – 5 prasruti (480 grams)
For a child of 11 year – 5 ½ prasruti (528 grams)
For a child of 12 year – 6 prasruti (576 grams)
At 13^th year of age – 7 prasruti (672 grams)
At 14^th year of age – 8 prasruti (768 grams)
At 15^th year of age – 9 prasruti (864 grams)
At 16^th year of age – 10 prasruti (960 grams)
At 17^th year of age – 11 prasruti (1056 grams)
At 18^th year of age – 12 prasruti (1152 grams)
From 19^th to 70^th year of age – 12 prasruti (1152 grams)
Above 70 years of age – 10 prasruti (960 grams)

By the above said explanation it is clear that the maximum dosage of Niruha or Asthapana Basti is 12 prastha or 96 tola or 1152 grams approximately.

Dose of Niruh Basti as per Sushruta –
Heena matra (least dosage) of Niruha Vasti is 2 prasruti (as measured by the patient’s hands)
Madhyama matra or moderate quantity is 4 prasruti
Uttama matra (adequate dosage or quantity) is 8 prasruti
Parama Pramana or matra (maximum dosage or quantity) is 12 prasruti

According to Sharangadhara and Bhava Prakasha texts –
Uttama matra (maximum dosage) is 1 ½ prastha or 80 tola i.e. 960 grams approximately
Madhyama matra (moderate or medium dosage) is 1 prastha or 64 tola i.e. 768 grams approximately
Heena matra (minimum dosage) is 1 kudava or 48 tola i.e. 576 grams approximately
Sneha matra in Vasti dravya (quantity of oil and ghee to be used in Vasti medicine) –
Sneha (oil or ghee or both) is added as one of the components of Niruha Vasti dravya

In Vata predominant doshas the quantity of sneha added should be ¼ that of the Kwatha or decoction i.e. 3 prastha or 24 tola quantity (288 grams approximately)
In pitta predominant doshas and in healthy people – the quantity of sneha added should be 1/6 of Kwatha or decoction i.e. 2 prastha or 16 tola (192 grams approximately)
In Kapha predominant doshas the quantity of sneha added should be 1/8 of kwatha or decoction i.e. 1 ½ prastha or 12 tola (144 grams approximately)
In healthy people the quantity of sneha added should be 1/5 of kwatha or decoction i.e. 2 ½ prastha or 18 tola (216 grams approximately)
(The above said quantity of sneha is said with respect to 12 prastha niruha vasti dosage taken as standard)

Qualities of ideal Niruha basti

Qualities of an ideal Niruha basti liquid mix:
Ati sheeta – ati ushna –
Vasti medicine should neither be too cold nor too hot. If the medicine is too cold (ati sheeta), it causes vitiation of vata, causes vibandha (constipation), stambha (stiffness of body parts) and adhmana (distension of abdomen). If the vasti medicine is too hot (ati ushna), it causes murcha (fainting), daha (burning sensation), atisara (diarrhoea) and pitta vitiation.

Ati teekshna, ati mrudu –
The vasti medicine should neither be too strong nor too mild in nature. If the medicine is too strong (ati teekshna), it causes daha (burning sensation), atisara (diarrhoea), murcha (unconsciousness, fainting) etc. if the medicine is too mild (ati mrudu) it causes vibandha (constipation), adhmana (distension) etc symptoms.

Ati snigdha, ati ruksha –
The vasti medicine should neither be too oily or unctuous nor too dry in nature. If the vasti medicine is too oily in nature (ati snigdha), it causes jaadhya (stiffness and immobility of body parts). If the vasti medicine is too dry (ati ruksha), it causes vitiation of Vata.

Ati Sandra, ati drava –
The vasti medicine should neither be too thick, dense and concentrated (ati Sandra) nor too dilute (ati drava) in nature. If the vasti medicine is too thick and concentrated (ati Sandra), it stays in the intestines for a longer time than intended and doesn’t come out easily. This may cause complications. If the vasti medicine is too dilute (ati drava), it causes ayoga i.e. the medicine doesn’t stay in the intestines for the desired time so as to impart good effect, in fact it comes out very quickly without causing proper cleansing.

Other rules (points of interest) about the medicines –
In the diseases which need Shodhana (cleansing or evacuation), example, prameha (urinary disorders or diabetes) medo roga (obesity, excess body weight, diseases caused due to errors of fat metabolism) etc Brimhana Basti (nourishing or bulk promoting enemas) should not be administered.

Shodhana vasti (cleansing or evacuation enemas) should not be given in conditions like Shosha (emaciation or consumption or tissue depletion), murcha (fainting), ati dourbalya (excessive weakness or chronic fatigue) etc

Method of mixing

Method of mixing and preparing the Niruha Vasti dravyas or medicines
Basti dravya or enema medicine is prepared by combining many things. Interesting thing is that many things which basically are not easily miscible and having different densities are mixed so as to make a homogenous liquid.

The basic ingredients needed to prepare Vasti medicine are:
Saindhava lavana – rock salt
Makshika or madhu – honey
Sneha – medicated oil or ghee or both
Kalkam – herbal paste
Kashayam or kwatham – decoction of herbs
(In some vasti dravyas milk, meat soup etc are mixed, the quantity of which is summed up in the quantity of kashaya taken)

First, the honey is mixed with rock salt and grinded in a mortar until they mix up properly. Later the oil or ghee or both is added to the mixture and thoroughly mixed. Later kalka is added and mixed and finally Kashaya is added to the mixture and grinded well until they form a homogenous mixture. The whole mixture should be put in a transparent container and left for few minutes. The contents should not be settled in different layers. This is the test for homogeneity.
Now the vasti dravya is ready to be administered.

Kalka: The paste of herbs to be mixed in the vasti medicine is explained and mentioned in the context of preparing specific vasti medicines. Generally the soft powder of the Kashaya churna (course powder used to prepare the decoction for niruha vasti) itself is taken, mixed with water and made into paste. If the kalka has not been specified, ‘Puto Yavanyadi Kalka’ is to be used. . It is a paste made up of Yavani (Trachyspermum ammi), Madana (Randia dumetorum), Bilwa (Aegle marmelos), Kushta (Saussurea lappa), Vacha (Acorus calamus), Shatahva (Anethum sowa), Musta (Cyperus rotundus), Pippali (Long pepper) mixed with honey, ghee, oil, jaggery and salt

Desha

Desha (land and body) –
Desha is basically of two types or it is wise to tell that the term desha is understood in 2 senses i.e. Bhumi desha (geography or the land in which the patient lives) or atura bhumi desha (human body, which itself is a land on which the seeds of treatment are sown when the body gets contaminated or diseased).

Bhumi desha – is of 3 types, they are as below said:
Jangala desha – desert land, vata predominant
Anupa desha – marshy land, kapha predominant
Sadharana desha – moderate land, sama dosha (doshas are in equilibrium)

The diseases are manifested according to the dosha predominance in specified lands. The medicines having qualities antagonistic of the qualities of the land producing the diseases should be used to prepare vasti medicines.

Atura desha – The body and mind of the patient is also a land on which the medicine and treatment is administered. Examining of atura desha includes the complete procedure of patient preparation done in the purva karma (pre-treatment procedure) of vasti treatment. In this context we shall discuss about the patient preparation for niruha vasti.

Atura Siddhata

Atura siddhata (preparation of the patient)
Snehana and Swedana – Before administering vasti, the patient should be subjected to snehana i.e. abhyanga (massage using herbal oils) and swedana (fomentation, steaming, sudation or sweat inducing treatment) should be done.

Generally, Abhyanga when related to Vasti is limited to the abdominal region followed by tapa sweda (hot water bag fomentation) over the same area. Total body massage and steaming can also be done giving special emphasis to the abdominal area (area of large intestine into which the vasti medicine is pushed). Swedana can alternatively be given with valuka sweda (sand filled cloth bolus fomentation) or with sterile cloth dipped in hot water.

Anuvasana vasti – After snehana and swedana, anuvasana vasti is the next purva karma (pre-treatment procedure) of Niruha or Asthapana Vasti. If the patient is fit enough to take Anuvasana Basti (oil or ghee enema), it should be given. Here, Anuvasana vasti becomes purva karma for niruha vasti. If the patient is of rukhsa shareera (extreme dryness of the body), the patient should be administered with 2-3 Anuvasana Bastis on same number of days (one vasti on each day) and eventually prepare him or her for Asthapana Vasti Atha anuvaasitam aasthaapayet (Ref – Sushruta Chikitsa 38/1)

Sushruta has specifically indicated Anuvasana Vasti to be given before Asthapana Basti (Niruha Vasti), as a rule. This makes Anuvasana Vasti a mandatory Purva Karma for Niruha Basti. We generally follow this rule in Vasti procedures unless Anuvasana is strongly and strictly contraindicated in a given condition. Anyhow, every Niruha Basti medicine will have sneha (medicated oil or ghee or both) as an important ingredient in the total composition.

The eligibility of the patient to undergo Niruha Vasti shall be checked and confirmed. For this, thorough examination of the patient should be done to check if he or she is fit and eligible to receive Niruha Vasti or not (See indications for Niruha Vasti). Niruha Basti shall not be administered in the cases which are contraindicated.

Fixing an auspicious day

After learning that the patient is fit to receive Niruha Vasti, the treatment should be carried out on the pre-fixed auspicious day. The vasti shall be given on any auspicious date and time (following the star constellation of the patients horoscope to be be specific or by randomly fixing a good day according to the Hindu calendar if the patients horoscope is not available) of Shukla Paksha (between new moon and full moon). It should not be carried out on a cloudy day.
The food taken on the previous day should have been properly digested.
Inquire for signs of proper digestion like feeling of lightness in the body, freshness of mind, feeling of timely appetite and interest in food, proper elimination of stools and urine, absence of burping, bloating or distension etc.

Niruha Basti should be given on empty stomach (before the food has been consumed.

Note – The rules relating to the auspicious day etc are written with a purpose of providing holistic and comprehensive healing to the patient. But they can be ignored in cases of emergency. When Niruha Basti is being done as Purva Karma (pre-treatment procedure) before conducting Rasayana (immune modulator, anti-ageing medicines) and or Vajikarana (aphrodisiacs) treatments, these rules shall be followed religiously for better results. It will provide mental and physical strength, assurance and immunity to the patient.

Kala

Kala – Time factor
This is also of 2 types. In fact, it is wise to say that we need to understand the term Kala in 2 different senses.

1. Rutu bheda – Season and seasonal changes also have an impact on the treatment. There are no specific seasonal restrictions mentioned with respect to Niruha Basti.
2. Vyadhi avastha – Different stages of a disease also will denotes the time period elapsed and time period available to tackle a disease, its acute and chronic phases and prognosis.

All these factors should be taken into consideration before administering Niruha Basti.

Apart from this we also need to understand when and where the Niruha Vasti should be given in the sequence of Pancha Karma (5 cleansing treatments), keeping in view the ‘Kala’ factor. according to rules, Virechana is conducted on the 15^th day after the administration of Vamana (therapeutic emesis). Niruha should be given 7 days after Virechana. On the 9^th day after Virechana, Anuvasana Vasti (oil or ghee enema) should be given. Niruha Basti can be given on the same evening or the following day (10^th day).

Vagbhata has suggested Niruha Vasti to be given on 15^th day. According to him, on the 7^th day after Virechana, Anuvasana Vasti should be given. Later Anuvasana Bastis should be given on every alternative day i.e. on the 9^th, 11^th and 13^th day. On the 15^th day (after the administration of Virechana), Niruha Basti should be administered.

Satmya

Satmya (compatibility)
The suitability and compatibility of diet, lifestyle etc should be analyzed before Niruha Vasti. Planning suitable diet and lifestyle for the patient is called satmya.
Niruha Basti should be given before taking the food on empty stomach (after the previously taken food has been digested), but care should be taken to see that it should not be administered when the patient is hungry (empty stomach is not equal to hungry stomach). Basti given after food will cause chardi (vomiting), Vishuchika (gastro-enteritis) and other complications.

Agni

Agni (capacity to digest)
Niruha Vasti should not be given to the patients who are having Mandagni (weak digestion). In these people, first of all, Deepana (appetizers or fire kindling) and Pachana (digestants) medicines should be given to kindle the weak agni (digestive fire). Once the digestion increases, Niruha Basti shall be given.

Satva

Satva (status of mind)
Niruha Basti is a cleansing process wherein not only the gut but also the entire range of body tissues will be cleansed and detoxified with the treatment. In the process it becomes difficult for the patients to tolerate the strength of the treatment. Example, if the disease has bahu dosha (severe and excess morbidity) and if strong niruha vasti has to be given but if the patient is timid (mentally weak) we cannot administer strong treatment in spite of the situation and condition of the disease demanding it to be done. The intensity of th treatment should be modified as per the status of mind of the patient.

Strength of the medicines, the number of sittings which need to be planned and duration of treatment shall be determined on the basis of knowing the satva of the patient properly.

Person having avara satva (low mental strength)may exaggerate things. Therefore even normal observations will look abnormal. Doctor may be misguided to think that the patient has developed complications. Similarly, the pravara satwa (high mental strength) person can tolerate all the hardships of the treatment, including complications. In these cases, the complications might remain concealed without being diagnosed. Thus it is important to know the mind strength of the patient before commencing the Niruha Basti. It is always wise to explain the treatment method and pattern to the patient to keep them mentally ready for what they would be undergoing.

Oka

Oka (compatibility which comes with constant practice)
Anything which gets compatible with constant practice is called oka satmya. We need to examine regarding the compatibility of the patient, what suits him, what not and lot more. Example, it need to be judged if the Basti medicines consisting of Mamsa rasa (meat soup) be given to a vegetarian patient or not. The need for adding mamsa rasa in the vasti medicine may be stronger, but the patient’s body is not used to the mamsa rasa, i.e. it is not oka satmya for him or her. It also gives us an idea to judge which type of vasti is suitable for people taking lots of fats including oils and ghee in their foods, especially to judge if sneha vasti should be given or not to them. Sneha Basti consists of large amount of fats in the form of medicated oils and or ghee but the patient’s body already has oka satmya to sneha or fats by practice. In such cases, the sneha vasti (oil or ghee enema) may increase snigdhata (oiliness of the body) beyond normal limits, which is not intended.

Vaya

Vaya (age factor)
No age group has been contra-indicated to undertake Vasti. The quantity of Basti medicines to be administered, the length, breadth and lumen size of Vasti netra (nozzle of enema apparatus) have been explained with minute details taking age of the patient into consideration. It is said that Vasti can be administered right from the birth but we can find the difference of opinions regarding this concept.

Acharya Matar tells that Niruha Basti should be given after 1 month of age
Atreya Punarvasu is of the opinion that Niruha Vasti shall be administered after the age of 4 months
Bhela opines that Niruha shall be given after 6 years of age

Acharya Kashyapa, the Ayurvedic paediatrician of ancient times tells that Niruha Vasti can be given once the child starts crawling on the ground and starts consuming some solid food. This fits somewhere into the age group of kids between 8 months and 1 year of age.
On an average, all the authors have explained Niruha Basti to be administered from 1 year of age

Bala

Bala (strength factor)
Niruha Basti is contra-indicated in ati durbala (too weak persons). In these people, initially the physical strength and stamina should be enhanced by judicious administration of Rasayanas (immune modulators, anti-ageing, rejuvenators) or balya medicines (strengthening) or administering Brimhana Vasti (bulk promoting enemas) etc. Once the person gains strength, Niruha Basti shall be administered.

By knowing the bala of the patient we can plan the type of Vaasti to be administered accordingly. Example, Teekshna vasti (strong and fast acting enemas) can be readily given to those having sahaja bala. Mrudu vasti can be given to those having moderate strength and tolerance. Snigdha vasti can be administered in those who are weak and emaciated. According to the rule of Kalakruta Bala, strength naturally enhances in some seasons like Hemanta ritu (early winter). In this season, any person will have good strength to tolerate any hardships of treatment. Therefore in durbala or weak patients Niruha Basti scan be given once the Kala krita bala increases in the concerned season.

Pradhana karma

Actual procedure of Niruha Basti:
Pradhana Karma (Treatment proper – Method of administration of Niruha Vasti)
The main procedure of administration of Niruha Vasti is called Pradhana Karma and it includes 3 steps.
Vasti pranidhana – The method of administering Vasti
Vasti Pratyagamana and Nireekshana – The return of Vasti medicine, observations related to it
Yoga, Ayoga, Atiyoga lakshana nireekshana – Observation of the symptoms of properly administered, inadequately administered or excessively administered Vasti medicines and management of complications if any

Vasti pranidhana

Vasti pranidhana – The method of administering Vasti –
The Vasti dravya or medicine should be prepared as explained above i.e. Saindhava lavana (rock salt), Makshika (honey), Sneha (medicated oil or ghee or both), Kalka (herbal paste of medicines) and Kwatha or Kashaya (Herbal decoction) should be mixed in that order and a homogenous liquid prepared.

The Vasti netra (nozzle) and Vasti putaka (can or container) of the Basti apparatus should be assembled and tied properly.
The patient should be advised to evacuate his bowel and bladder before administration of enema.

Following this, the patient is made to sleep on a table specially designed for Vasti treatment. Abhyanga or herbal oil massage should be given over the abdominal area, pelvis, hips, low back, buttocks and thighs. Chandanabala lakshadi tailam oil, Dhanwantaram oil, Ksheerabala oil or Panchaguna oil should be used for Abhyanga. Full body massage also can be done. Later swedana or fomentation should be given using potali (bolus of medicines) or tapa sweda (cloth dipped in hot water).

The prepared medicines are now filled in the Vasti putaka. If urinary bladder is used following the traditional method, medicines should be filled to ¾ level of bladder, leaving the upper portion vacant so that it can be tied tightly with the help of thread, so that the medicine doesn’t spill while giving vasti. If we are using the enema can of modern times, the mentioned quantities of medicines are filled in the can.

In either case, the tip of the Vasti netra should be blocked with sterile cotton so that the medicines do not rush out of the nozzle (catheter) while the putaka is being filled. In the modern catheter if there is a provision for a tap, the tap should be turned off until the container is filled. While administering vasti, the tap can be turned open. Now, the Basti apparatus is ready to be used.

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 enema container of modern days, we only need to hold the can or container high up so that the medicines flow towards gravity and enter the intestines in uniform speed.

The complete Basti 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). 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. 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 will help the movement of medicine into the intestine and to stay there for few minutes, which is intended. Since the quantity of niruha vasti is large, it doesn’t stay in the intestines for long duration. But still attempts to make the medicine to stay longer in the gut should be made. The patient should also be advised to hold the enema medicine in the gut as longer as possible, especially if Brimhana vasti (bulk promoting enemas), balya vasti (strengthening enemas), Vajikarana vastis (aphrodisiac enemas) etc are given, because longer the medicine stays in the gut, more will be the effect. Alternatively, a pillow or couple of pillows shall be placed beneath the lower back, with which the abdomen will be raised to a higher level. This makes the medicine to stay in the gut for a longer duration.
Immediately when the patient feels bowel movements, he or she is advised to go to the loo and evacuate their bowel.

Vasti Pratyagamana, Nireekshana

Vasti Pratyagamana and Nireekshana – (The return of Vasti medicine, observations related to it)
The time in which the Basti medicine comes out of the gut is called ‘Pratyagamana Kala’ or time of return of medicine. The pratyagamana kala for Niruha Basti is said to be 1 muhurta (48 minutes approximately). This is the maximum ‘time of stay’ of medicine in the gut. The vasti medicine should not stay in the gut for a time period beyond 1 muhurta. If the medicine happens to stay in the gut for more than 1 muhurta, it might cause serious complications. Vagbhata has said that if Basti doesn’t return back within 1 muhurta time, it can cause death (we should understand the word death as pain equal to death). The shodhana vasti (evacuation or cleansing enema) causes severe adhmana (distension of abdomen), pakwashaya shula (intestinal colic), mutra shula (pain in urinary passages), vata pratilomata (reverse movement of vayu), hrut peeda (pain in cardiac region) etc if the medicine doesn’t return within stipulated time. Sushruta also has said that the vasti medicine which has not returned back in stipulated time causes vata pratiloma (reverse movement of vata), vishtambha (constipation), shula (colic), jwara (fever), arati (tiredness) and mrutyu (death).

The below said remedies should be attempted if the vasti dravya (medicine) doesn’t come out in proper time –

Another Basti prepared using Yava kshara (alkali prepared from whole plant of barley), amla dravya (sour herbs), teekshna-ushna aushadha (medicines having strong, intense and hot nature) like Trikatu etc (3 pungent herbs i.e. black pepper, long pepper and ginger)

Phalavartis (suppositories) should be inserted into the anal canal and the enema medicine and excreta should be forcibly expelled
Swedana (fomentation or sudation) should be administered over the pelvis, buttocks, groins, abdomen etc.
Utrasana – means generating fear. Fear should be generated in the patient by suddenly shocking him by showing sword, gun, or any material which can cause shock and fear. Fear will cause motility and the enema medicine along with stools will be excreted out.

Shodhana – Purgation should be given by administering medicines like Triphala, Medicated castor oil (eranda sneha), Trivrut churna etc. the patient should be kept under observation until the enema medicines are expelled.
Yoga, Ayoga, Atiyoga lakshana nireekshana – (Observation of the symptoms of properly administered, inadequately administered or excessively administered Vasti medicines and management of complications if any)

Samyak lakshana

Symptoms of proper administration of Niruh basti –
According to Charaka – ‘The vasti medicine which reaches to the level of abdomen, pelvis, flanks and navel region, compile all the waste substances and excreta, create oiliness (unctuousness) of stools, body and intestines and gets expelled admixed with all the morbidity of the body is called as Samyak datta vasti or vasti which has been properly administered).

If the vasti has caused proper shodhana (cleansing), the below said signs and symptoms will be manifested:

• Prasrushta vitkata – spontaneous excretion of stools
• Prasrushta mutrata – spontaneous excretion of urine
• Prasrushta vaatataa – spontaneous excretion or expulsion of flatus
• Kramashaha mala pitta kapha vayu pravrutti – expulsion of stools and excreta, pitta, kapha and vayu in that order
• Laghutaa – lightness of the body
• Ruchi – appreciation of taste of food
• Agni deepana – kindling of digestive fire
• Ashaya laghuta – lightness in the organs like pakwashaya (large intestine)
• Roga upashamana – destruction of the disease for which the vasti had been administered
• Prakrutishtha – regaining health
• Bala vruddhi – increase in strength

Ayoga lakshana

Ayoga lakshanas (symptoms of inadequately administered niruha vasti) –

• Rujaa – pain in head, region of heart, umbilicus, urinary bladder, anus, penis and vagina
• Shotha – inflammation and swelling
• Pratishyaya – stuffy nose
• Parikartika – splitting (cutting) pain in the anus
• Hrillasa – excessive salivation
• Vata sanga – obstruction to movement of vayu
• Mutra sanga – urinary obstruction
• Shwasa krichchrata – dyspnoes, shortness of breath (difficulty to breathe)
• Alpa vega – elimination of stools and enema medicine in less quantity (than what is intended)
• Aruchi – anorexia, tastelessness
• Gourava – heaviness of the body

In this condition, suitable treatment to bring out the residue enema medicine and stools should be done

Atiyoga lakshana

Ati-yoga lakshanas (symptoms of excessively administered niruha vasti) –

• Anga supti – pricking or throbbing pain in the body
• Anga marda – pain as if somebody is hitting
• Klama – tiredness
• Kampa – tremors
• Nidraa – sleep
• Dourbalya – weakness
• Tamaha pravesha – feeling of darkness in front of the eyes
• Unmade – insanity, instability of mind
• Hikka – hiccough

In these conditions medicines which are grahi (create constipation or stop passage of excess stools, anti-diarrhoeals), deepana (appetizer), pachana (digestants) should be given

Paschat Karma

Paschat Karma (Post treatment procedures)
All the measures taken after the administration of Basti falls under the category of Paschat Karma or post treatment procedures. This includes taking an account of vasti pratyagamana and making note of it (return of vasti medicine), planning proper diet and lifestyle protocol for the patient, follow up etc.

The paschat karma of niruha vasti can be covered under the below mentioned headings –

Vasti uttara vichaaraneeya vishaya

Vasti uttara vichaaraneeya vishaya (immediate measures to be taken after the administration of vasti): After the administration of Niruha Basti, we should wait for vasti pratyagamana (return of vasti medicine). Many times the medicine which has been administered will return back in quick time but will not have performed proper evacuation. This will not produce samyak nirudha lakshanas (symptoms of properly administered niruha vasti). It is observed that in these conditions only the medicine which has been administered will come out without flusing out the waste substances or excreta from the gut. In such cases another Niruha Basti should be administered. In fact 2-5 vastis can be administered until proper cleansing has occurred. Care should be taken not to administer more than 2 niruhas on the same day (2^nd one can be given). If done, they will produce pakwashaya kshobha (irritation of large intestine and pain). In spite of all attempts if Samyak lakshanas are not obtained, anuvasana or matra vasti (oil or ghee enemas) should be given and niruha vasti should be administered once again.
Read related: Matra Basti: Indications, Benefits, Contra Indications

Pathyadi vichara

Plan of diet, lifestyle changes and the follow up vastis if needed should be planned in paschat karma. After the proper elimination of vasti dravya and excreta and on observing samyak nirudha lakshanas, the patient should be allowed to take rest. After some time he or she shall be given a hot water bath. After analysing the strength of the doshas, food with any of the milk, yusha (soup), mamsarasa (meat soup) or jangala mamsarasa (meat soup of animals living in desert areas) etc should be given. The food should follow the appetite and digestive capacity of the patient according to their constitution.

Sushruta has advised milk in pitta predominant conditions, yusha in kapha predominant conditions and mamsa rasa in vata predominant conditions. If compatible, mamsa rasa and rice can readily be administered for everyone.
If the patient is vegetarian soups (yusha) prepared using mudga (green gram), shali (rice), masha (black gram), etc should be administered and milk can readily be given.

The food should not be too heavy to digest. One serving should be 1/3 of the regular consumption (at one serving) of the given patient. If possible and if the patient can tolerate, the quantity of food can be still minimised.
After administering light food, anuvasana vasti (oil and or ghee enema) should be administered to the patient in the same evening.

After niruha vasti, anuvasana vasti has to be administered as a rule. Ayurvedic texts tell that it should be given the same evening. But in practise we give it the following day (morning). It is said that during the cold season and in spring (vasanta ritu) season, anuvasana should be administered the same evening. If the niruha vasti has produced irritation of intestines, anuvasana has to be given the same evening.

According to Dalhana, commentator of Sushruta samhita, Anuvasana vasti should be given only after obtaining samyak nirudha lakshana (symptoms of properly administered niruha vasti). This means to tell that anuvasana works the best on the backdrop of excellent cleansing effected by Niruha vasti. In presence of ama lakshanas and signs of indigestion anuvasana should not be administered (Chakrapani, commentator of Charaka Samhita).

Parihara kala

Parihara kala – Recovery period
Pathya (stringent diet and lifestyle practices) should essentially be followed after the completion of course of vasti. Pathya should be followed for double the number of days as the number of days the Vasti has been given (course of Vasti). Example, if Basti has been given for 15 days then the duration of pathya or parihara kala should be for 30 days.

During the parihara kala, the below said should be strictly avoided –

• Ati asana – constantly sitting at a place for longer duration
• Asthana asana – sitting in prohibited places, excessive riding etc
• Vachaamsi – speaking in excess
• Yaanam – travelling
• Diva-svapnam – excessive sleeping during daytime
• Maithuna – excessive indulgence in sexual activities
• Vega avarodha – forcibly avoiding the natural urges or reflexes
• Sheeta upachara – cold comforts
• Aatapa – exposure to heat of sun
• Shoka – excessive grief
• Rosham – anger
• Akala bhojana – eating at wrong times (untimely consumption of food)
• Ahita bhojana – incompatible food (unwholesome food)

Vasti vyapad evam pratikara

Vasti vyapad evam pratikara (complications arising due to niruha vasti and their management) –

Vasti netra vyapat

Vasti netra vyapad (complications arising due to errors of enema nozzle) – This aspect has been dealt in detail in the discussion of vasti netra. To sum up, complications arising due to errors of vasti netra are as mentioned below –

• Ati hrusva netra – too short netra or nozzle causes aprapti (insufficient medicine entering the gut)
• Ati deergha netra – too long netra or nozzle will cause ati gati (medicines quickly entering the gut)
• Tanu netra – thin netra or nozzle causes guda kshobha (anal irritation)
• Sthula netra – too stout netra or nozzle causes ati karshana (too much friction of anus and injury)
• Jeerna netra – too old or broken / damaged netra or nozzle will cause guda kshanana (injury of anal canal)
• Shithila bandhana – loose binding of vasti netra and putaka (can or container) causes srava (leakage or spilling of medicines)
• Paarshwa chidra – opening on the side of nozzle instead of the tip causes guda peeda (pain in anal canal)
• Vakra netra – crooked netra or nozzle causes vakra gati of dravya (crooked flow of medicines)

Remedies

In aprapti – caused due to too short netra, the netra should be changed and vasti should be given once again

In ati gati caused due to long netra, one need to wait till the medicines are expelled. If the medicines get expelled it is well and good. If it doesn’t return back, it might cause complications. In such conditions, shodhana (purgation), phalavarti (suppositories), teekshna vasti (strong enemas) etc should be administered and the vasti medicines should be forcibly expelled.

In kshobha or anal irritation (caused by thin netra), ati karshana or friction (caused by thick netra), kshanana or injury (caused by damaged netra) and guda peeda or anal pain / rectal pain (caused by lateral opening on netra) medicines and ointments (pastes) like padhmakadi taila, jatyadi taila, padhmakadi ghrita, shuddha ghrita, jatyadi ghruta, shata dhauta ghrita, arshaghna malahara (ointments used for healing piles, fissures etc) should be applied to enable quick healing.

If there is leakage or spilling of medicines due to shitila bandhana (loose binding), the netra should be detached from putaka and tied tightly once again. Or else, new apparatus shall be used.

Checking the netra before administration of vasti is a wise idea. Netra which is crooked in shape, damaged and having lateral opening should be discarded.

Vasti putaka vyapat

Vasti putaka vyapad (complications arising due to errors of enema can or container) – This aspect has been dealt in detail in the discussion of vasti putaka. To sum up, complications arising due to errors of vasti putaka are as mentioned below –

• Vishama vasti putaka (crooked bladder) causes gati vaishamya (crooked flow of medicines)
• Maamsala vasti putaka (fleshy bladder) – causes visra gandhata (imparts foul smell to the vasti medicine)
• Chidrayukta vasti (perforated bladder) – causes srava (leakage of medicines)
• Stuoola vasti (stout or large bladder) – causes daurgrahya (difficulty to hold)
• Jaala yukta vasti (bladder with networks) – drava srava (causes perforation or leakage of medicines)
• Vatala vasti (air filled bladder) – causes phenila drava (froth or foam in the medicine)
• Ati snigdha vasti (oily bladder) – causes chyuta dharyatva (slipping of putaka) and difficulty to administer vaasti
• Ati klinna vasti (too wet bladder) – causes agrahyata (difficult to hold)

Remedies –
Mamsala (fleshy), chidra yukta (perforated), sthula (large), jala yukta (bladder with network), ati snigdha (too unctuous or oily) and ati klinna (too wet) vasti putaka should be discarded.
In gati vaishamya caused due to vishama vasti, one should wait for the expulsion of medicine and treated accordingly.
If vata vitiation takes place due to presence of too much air in the bladder, vata should be treated with anti-vata remedies and medicines.

Praneta vyapat

Praneta vyapat (complications caused by the attendant or therapist) –
The attendant or therapist administering the vasti should have mastered over the technique of administration and should be perfect. If the praneta (attendant) is not trained properly he can commit the below said mistakes. The complications caused by praneta are as below mentioned –

Sa vata vasti

Sa vata vasti (administration of enema along with air) –
Air should not enter the gut along with medicines. The vayu or air can enter the pakwashaya (colon or large intestine) and cause shula (colic) and toda (pricking pain) in the below mentioned conditions:

If the patient is not instructed to breathe in properly
If the vasti netra has not been tightly and perfectly tied to the vasti putaka
If ashesha vasti is given i.e. if the vasti medicine is given in totality (as per rule a small amount of medicine should be left out in the container after administering vasti).

Remedy –
Massage (abhyanga) of guda (anus) and pakwashaya (colon, abdomen) should be done using either of Chandanabala lakshadi taila, Ksheerabala taila, Panchaguna taila etc medicated oils. Followed by abhyanga, swedana (fomentation, sudation) should be given using ishtika (bricks made hot and tied in a bolus), vastra (cloth dipped in hot water) etc.

Druta praneeta vasti vyapad

Druta praneeta vasti vyapad (forcibly pushing or removing the vasti netra quickly into the anal canal) –
When the vasti netra is forcibly pushed in the anal canal or pulled quickly out of the canal, it causes pain in anus, groins, legs (calf), thigh and pelvis, vasti stambha (stiffness of urinary bladder) or obstruction of urine.

Remedy –
Vataghna ahara (vata alleviating food), yusha (soups), mamsarasa (meat soup), madhura-snigdha bhojana (food rich in sweet taste and oily substances), milk, ghee, krushara (thick gruel) etc should be administered
Abhyanga (herbal oil massage) and swedana (fomentation) should be given followed by vasti (enema)
Anuvasana vasti (oil or ghee enema) or pichcha vasti (enema with medicines prepared using slimy herbs) should be administered to overcome the irritation or pain caused in anal canal

Tiryak pranidhana

Tiryak pranidhana (oblique insertion of enema nozzle) –
When the Vasti netra is obliquely inserted into the anal canal the tip (opening) of the nozzle will get blocked by the walls of the anal canal. As a result the medicine will not enter properly into the colon. Same thing happens when something gets stuck in the lumen of the nozzle blocking the flow of medicine.

Remedy –
In such condition, the vasti netra or nozzle should be slowly removed from the anal canal, cleansed, sterilized, blocks removed and properly inserted parallel to the spine so as to enable proper flow of medicines

Ullupta data vasti

Ullupta data vasti (repeated squeezing of enema bladder) –
The vasti putaka should be uniformly pressed and the medicines should be pushed into the colon in one squeeze. Squeezing the bladder repeatedly and pushing the medicines in intervals is called ullupta dosha. By doing so, it causes vata vitiation in the anal region.
Remedy –
In such conditions, vasti should be given with the vasti dravya prepared using bilwa (Aegle marmelos), madana phala, trivritetc medicines and gomutra (urine of cow)

Sa kampa vasti dana

Sa kampa vasti dana (administration of enema with trembling hands) –
If the attendant or therapist is not well trained or newly trained and not experienced or is low in confidence, his hands will tremble while administering vasti. This will cause wrong entry of vasti netra and improper squeezing of vasti putaka. As a consequence pain, inflammation, swelling and burning sensation is caused in the anal canal.
Remedy –
In such conditions another enema prepared with medicines enriched with sweet and astringent taste (madhura-kashaya siddha vasti) should be administered. This enema will include medicinal herbs like Lodhra (Symplocos racemosa), triphala, aaragwadha (Cassia fistula), mocharasa (Gum exudates of Silk Cotton Tree), dhataki (Woodfordia fruticosa), badara (Ziziphus jujube), khadira (Acacia catechu) etc.

Parisheka (stream pouring or sprinkling or showering) should be done over the anus using decoctions prepared using herbs having sweet and astringent taste (example, drakshadi kashayam).

Ati praneeta vasti

Ati praneeta vasti (pushing the vasti netra deep in the anal canal) –
When the vasti netra or nozzle is pushed deep inside the anal canal, it causes damage and wounds in the anal muscles (walls). It also causes pain, burning sensation, pricking pain and prolapsed of the rectum during defecation.
Remedy –
Piccha vasti (enemas with liquid prepared using slimy herbs), ksheera vasti (enema with medicated milk) should be administered. Pichu (plugging) of anus with sterile cotton wicks dipped in medicated oils (example, jatyadi taila, chandanabala lakshadi taila, padhmakadi taila etc) and medicated ghee (jatyadi ghrita etc) should e done for healing of wounds.

Ati bahya, Ati manda data vasti

Ati bahya – Ati manda data vasti (complications of enema given on the surface or in a slow manner) –
If the vasti netra is not inserted properly along the length of the anal canal and if enema is administered with the tip of the nozzle very near to the orifice (small portion of the nozzle into the anal canal), the given medicine will immediately be expelled because it has not entered the desired depth. When the enema is given very slowly, the medicine will not reach up to the pakwashaya (colon).
Remedy –
In these conditions, immediately another vasti should be administered with proper precautions.

Ati vega data vasti

Ati vega data vasti (enema given very quickly) –
If the enema medicines are administered too quickly by squeezing the bladder very quickly and hardly, the medicine which has entered the gut will remain there itself and does not return, or it may move quickly and reach as high as throat and mouth. In either case, it creates a complication. This may cause severe vomiting of medicine along with stomach contents.

Remedy –
In these conditions, immediately another vaasti should be given after having taken proper precautions. If the conditions demands, virechana (purgation) or abhyanga (oil massage) over the throat should be administered. Virechana is preferred in comparison to 2^nd vasti. Virechana pulls down the medicines which have reached too high. Sheeta udaka parisheka (cold water shower), utraasana (generating fear), upaghraanana (asking the patient to smell perfumed things) etc can alternatively be done.

If necessary (and if the symptoms caused due to the above said errors do not come down in quick time), Sutashekara rasa and Shanka bhasma should be mixed together and given along with honey twice or thrice daily. Shankha vati tablets, 2 numbers should be kept in the mouth and sucked twice or thrice in a day. For virechana (purgation), Avipatikara churna, Trivrit churna or Panchasakaara churna should be used.

Shayana vidhi janya vyapad

Shayana vidhi janya vyapad (complications caused due to improper positioning of patient) –
In the discussion of Purva Karma we have seen how to position the patient. The patient should eb positioned in left lateral position with his left hand beneath his head, left lower limb extended and the right limb flexed at the knee and hip and crossed across the extended left lower limb. If the patient doesn’t follow this position and sleep in any undesired or awkward position, it causes complication.

Immediately after administration of vaasti, the patient should be positioned in the same position for 30 matra kala (at least ½ minute). If the patient sleeps supine (on the back) immediately after administering vasti, the medicine instead of entering the pakwashaya (colon) will enter in urinary bladder and penis. This causes Medhra samunnaha (swelling of penis).

Remedy – Mridu swedana (mild fomentation) and uttara vasti (enema given through penis) should be given.
If the patient is positioned with head low position, the vasti medicine reaches the stomach and creates complications
If the patient is positioned in prone position (face down, lying on stomach), the medicine doesn’t reach Pakwashaya (colon), instead it moves in wrong direction and reaches the region of heard and imparts pressure on heart and anal canal, causes vata vitiation and subsequent visceral pain.

If the patient lies on his back (supine), the administered vasti medicine doesn’t go into the anal canal being against the gravity; in fact it quickly gets expelled.
If the patient keeps rotating his eyes while administering vasti, it causes vata vitiation
If the body or both knees are bent (flexed) while administering vasti, the medicine gets obstructed and doesn’t get expelled.
If vasti is administered in a sitting or standing posture, the medicine will get expelled immediately
If the patient is positioned in right lateral position, the medicines do not reach the pakwashaya (colon)

Remedy –
The only remedy for all the above said abnormal positions is to avoid them and just follow the left lateral positioning.

Other complications –
Some complications occur in spite of all the above said factors acting in proper synchronization (i.e. netra, putaka and praneta). They may occur due to improper judgement or decision taken by the physician or due to some untoward and unexpected event occurring in the patient’s body during the course of treatment. They are as described below –

Ayoga

Ayoga (inadequate evacuation of doshas or morbidity due to low strength of administered medicines) –
Vasti, cold in nature having less amount of salt, oils or ghee, liquid (too much concentrated) and excess of solid material, and has deficit medicinal properties given to a patient having guru koshta (hard bowel movement), vata bahula (excess vitiation of vata), ati ruksha shareera (excessive dryness of the body) and vata pradhana (basically vata predominant constitution), the medicine will exacerbate the doshas but will not be able to expel them due to its weak medicinal property. This is called ayoga vyapat (ayoga complication)

Symptoms of ayoga –

• Guru koshtata – heaviness in the belly or abdomen
• Vata, mutra, shakrut graham – obstruction to passage of flatus, urine and stools
• Nabhi – vasti ruja – pain in the navel region and urinary bladder
• Daham – burning sensation
• Hrut lepam – feeling of coating over the heart
• Gude svayathu – swelling in anal canal and rectum
• Gude kandu – itching in the anal region
• Vaivarnyam – discolouration especially over the cheeks
• Aruchi –anorexia
• Vahni maardavam – weak digestion

Treatment –
Ushna pramathya – decoctions which are appetizers and digestants (deepana-pachana kashayas)
Swedana – fomentation or sudation
Phalavarti – placing suppositories in the anal canal and enabling the expulsion of vasti medicine which has got
stagnated in the colon

Enema with medicine prepared with decoction of bilwa mula (Root of Aegle marmelos), trivrit (Operculina turpethum), devadaru (Cedrus deodara), yava (barley), kola (Ziziphus jujuba), kulattha (horse gram) mixed with sura (fermented medicinal liquid) and gomutra (urine of cow) should be administered

Atiyoga

Atiyoga (excessive discharges or elimination of doshas) –
Administering ati tikshna (too strong and intense acting), ushna (hot), ksharadi (including alkalis etc) vasti in a patient having mrudu koshta (natural easy bowel movements) who has been administered with snehana (internal consumption of medicated ghee or oil) and swedana (sudation of fomentation) will cause atiyoga vyapad (complication).

Symptoms of atiyoga –
Diarrhoea and its complications are manifested as a result of ayoga.
Treatment –
Enema with tandulodaka (rice water), milk and ghee mixed with paste of Prishniparni (Uraria picta), Sthiraa (Desmodium gangeticum), kamala (lotus), draksha (Raisins), gambhari (Gmelina arborea), bala (Sida cordifolia), Yashtimadhu (Liquorice) should be administered
Treatment should be on the lines of atisara chikitsa (treatment principles of diarrhoea)

Klama

Klama (exhaustion or extreme tiredness) –
Administration of mrudu niruha (evacuation enema having less strength) in the presence of ama will cause insufficient expulsion of doshas (morbidity). The movement of vata will be obstructed by ama, pitta and kapha with consequential manifestation of agnimandhya (sluggish metabolism, weak digestion, errors of digestion). This is called Klama.
Note: Ama means immature nutritional essence which by the virtue of its sticky nature tends to clog the channels of the body and deplete the tissues and organs of nutrients and other essentials]

Symptoms of klama vyapat –

• Klama – severe exhaustion or weakness
• Vidaaha – burning sensation
• Hrit shula – pain in the heart
• Moha – confusion
• Pindika udweshtana – cramps in calf muscles
• Gourava – heaviness of the body

Treatment –
Pachana (administering medicines which can digest ama), virukshana (medicines which bring about dryness) and Swedana (fomentation, steaming, sudation)

Water processed and strained with Pippali (long pepper), gandhatrina (Lemon grass), ushira (Vetiveria zizanioides), devadaru (Cedrus deodara), Murva (Marsdenia tenacissima), mixed with Sauvarchala lavana (Sochal salt) should be given for drinking

Asava or arishta (fermented medicinal drinks) mixed with devadaru (Cedrus deodara), Trikatu (black pepper, long pepper and ginger), haritaki (Terminalia chebula), palasha (Butea monosperma), chitraka (Plumbago zeylanica), karpoora (camphor), kushta (Saussurea lappa), kshara (alkali) and gomutra (urine of cow) should be given to drink

For Virukshana decoction of dashamula (10 roots) should be given mixed with gomutra (urine of cow)
Madhutailika vasti – Enema having rich quantities of honey and oil mixed with large quantities of salt or cows urine should be administered

For Swedana – Tapa sweda (with cloth dipped in hot water or hot sand bolus) should be given over Pakwashaya (large intestine), i.e. abdomen

Adhmana

Adhmana (distension of abdomen) –
Enema having less strength when administered to a patient having bahu dosha (excessive morbidity), krura koshta (hard bowel movement) and ruksha sharira (dry body) will cause vitiation of vata. Due to the obstruction in its pathways, vata moves in abnormal directions (upwards) and cause adhmana (distension of abdomen).

Symptoms of adhmana vyapat –

• Adhmana – distension of abdomen
• Marma peeda (guda marma) – excessive pain in the anal region
• Vidaha – burning sensation
• Vrushana shula – pain in testicles
• Vankshana shula – pain in groin
• Hridaya shula – pain in the heart

Treatment –
Phalavarti (suppositories) – Trivritadi phalavarti or lavanadi phalavarti should be used
Niruha vasti – once the distension comes down after the insertion of suppositories, niruha vasti should be given using vilwadi niruha (same enema explained in the context of ayoga vyapat) should be administered
Anuvasana vasti – oil enema with oil prepared and processed with sarala (Pinus roxburghii) and devadaru (Cedrus deodara)

Hikka

Hikka (Hiccough) –
When ati teekshna aushadhi (very strong enema) is administered to the patient having mrudu koshta (natural easy movements of bowel) and alpa shareera bala (less physical strength and endurance), the medicine causes excessive cleansing leading to hiccough. This is called Hikka vyapat

Treatment –
Medicines and other approaches following the line of treatment of hiccough
Brimhana – strengthening and bulk promoting treatments and medicines
Anuvasana Basti with oil prepared from bala (Sida cordifolia), shalaparni (Desmodium gangeticum), gambhari (Gmelina arborea), triphala (Terminalia chebula, Terminalia bellirica and Emblica officinalis), Guda (jaggery), saindhava (rock salt), amla (sour medicines), prasanna and aranala (fermented medicinal liquids).

1 tola (12 grams approximately) each of pippali (long pepper) and lavana (salt) powdered and mixed in hot water is given for drinking
Dhumrapana – herbal smoking
Avaleha (confections or herbal jams like vasavaleha, kantakari avaleha etc), mamsarasa (meat soup), dugdha (milk) should be judiciously given
Yusha (soup) mixed with ginger and salt

Hrut prapti

Hrut-prapti (discomfort of heart) –
The vasti prepared with teekshna aushadhis (strong and quick acting herbs), vasti medicine having or carrying a lot of air along with it into the colon or the vasti which is administered with improper squeezing of vasti putaka (bladder) will cause stiffness or gripping pain in the region of heart. This is called Hritprapti vyapat.

Symptoms of Hrut prapti vyapat –
Hrit graham – gripping pain or stiffness in the heart
Treatment –
Enema (niruha) prepared with trunadi medicines or amla skanda (sour group of medicines) or lavana skanda (salt group of medicines) is administered
Anuvasana vasti is administered with vata alleviating dashamula taila

Urdhwa prapti

Urdhwa prapti (vasti medicine reaching too high) –
After the administration of vasti, if the patient forcibly holds the urge for defecation, urination and passing flatus or when the vasti is given very quickly by squeezing the vasti putaka (bladder) with enormous force, the medicine will quickly move upwards and reach throat and mouth. This complication is called urdhwa prapti.

Symptoms of urdhwa prapti vyapat –
Murchadi vikara – Fainting (loss of consciousness) and other serious complications

Treatment –
Sheeta parisheka – if the patient has fainted, cold water should be sprinkled over his face, sprinkling of cold water also should be done over the abdomen and flanks

Gentle tapping with closed fists (mardana) should be done over the abdomen and flanks, cold air should be provided by fanning
The hairs of the patient should be pulled so that the painful stimuli will get back the patient to consciousness
Fear should be created in the mind of the patient by suddenly bringing in front of him or her the cow, running horse, donkey etc or he should be told about the an elephant or lion or a police or snake approaching him to create fear in his mind. With fear, the patient will develop an urge to defecate and the doshas which have reached high up in the body will start moving downwards.

When the doshas are learnt to be choking in the throat, the throat of the patient should be gently pressed with a cloth (care should be taken not to strangulate the patient). Patient is advised to do Pranayama (breath control techniques as practised in Yoga).

Kramuka (betel nut) should be pounded.  1 tola (12 grams approximately) of its paste should be mixed in amla dravyas (sour drinks) and given to drink. Kramuka is hot and intense in nature. Being a good laxative, it pushes the doshas in a downward direction.

When the doshas get settle down in the pakwashaya (large intestine), another niruha vasti with decoction of dashamula mixed with yava (barley), badara (Ziziphus jujuba), kulattha (horse gram) and gomutra (cows urine) should be administered.

If the doshas are confined in the chest, vilwadi niruha vasti should be administered

If the doshas have moved towards the head and are confined to that zone, navana nasya (cleaning naal medication) and dhuma nasya (fumes of medicines through nasal route) should be given. Paste of sarshapa (mustard) should be applied on the forehead.

Pravahika

Pravahika (dysentery) –
When mrudu (less strength) and alpa aushadha yukta (having less medicines) vasti is given to a person having maha dosha (large quantity of morbidity)and who has been subjected to snehana (oleation) and swedana (sudation or fomentation), the enema provokes the doshas and expels them in small quantities repeatedly through anal route. This causes pravahika (dysentery) and is said to be one of the complications of niruha vasti.

Symptoms of pravahika vyapat –
Guda shotha – swelling in the anus
Jangha janu saada – weakness in the legs and knee
Vata avarodha – obstruction to vayu
Pravahana – repeaded straining on defecation
Treatment –
Abhyanga, swedana (sudation) should be fiven followed by shodana vasti (cleansing enemas)
Anulomana oushadhi – laxatives should be given
Langhana and samsarjana – treatments which produce lightness in the body (medicines too) should be given especially fasting or starvation. Liquid diets which act as appetizers and which aid better digestion should be administered.

Shiro arti

Shiro arti (head ache) –
Tanu (dilute), mrudu (soft natured i.e. less strong) and sheeta (cold in nature) vasti when administered to a patient who is weak, having krura koshta (hard and difficult bowel movements) and teevra dosha (severe morbidity), the vasti medicine will get blocked by the doshas which in turn blocks the movement of vayu. This vayu moving upwards reaches the head and causes stiffness of the whole body. It causes stiffness in the throat and neck and hoarseness of voice.

Symptoms of Shiro arti vyapat –

• Gala graha – stiffness of the throat
• Greeva graham – stiffness of the neck
• Kantha bheda – hoarseness of voice
• Shiro bheda – splitting pain in the head
• Karna badhirya – deafness
• Karna nada – tinnitus (abnormal sounds in the ear)
• Peenasa – stuffy nose
• Netra vibhrama – nystagmus

Treatment –
Abhyanga (massage) using lavana taila (salted oils)
Pradhamana nasya – nasal medication by blowing medicinal powders into the nose example, trikatu churna, katphala churna etc
Dhuma nasya – fumes of medicines through nose
Virechana – purgation
Anuvasana vasti – oil or ghee enema after having given snigdha bhojana (oily or unctuous foods)

Anga arti

Anga arti (body pains) –
When guru (high density, concentrated) and ati teekshna (intense or strong) vasti is administered in uttama matra (maximum dosage) without having conducted snehana (herbal oil massage) and swedana (steaming treatment)as a part of purva karma (pre treatment procedures), it will cause atiyoga (overdose) leading to severe body pains. This is called anga arti vyapat.

Symptoms of anga arti –
Excessive discharge of doshas leading to vata vitiation and udavarta (upward movement of vayu) is caused due to atiyoga.
Vayu moving in upward direction causes severe pain in the body parts along with stiffness of body parts.
Toda – pricking pain
Bheda – splitting pain
Sphurana – pulsating pain
Jrumbha – yawning etc

Treatment –
Abhyanga using lavana taila (salted oils)
Ushna udaka parisheka – sprinkling or showering with hot water
Swedana (fomentation) with eranda patra kwatha (decoction of leaves of castor plant)

In yavadi kwatha (decoction prepared using barley, horse gram and dashamula roots) bilwadi taila oil and salt are added. With this Niruha Vasti is given.
Avagaha – after niruha vasti, avagaha or tub bath is given
Anuvasana vasti – is given after avagaha with yashtimadhu taila or bilwa taila oils

Parikartika

Parikartika (splitting pain in the anus) –
When ruksha (having less oil or ghee), teekshna (intense or strong) vasti is given in atimatra (overdose) to a patient having mridu koshta (easy bowel movements) and alpa dosha (less morbidity), the vasti dravya will quickly expel the doshas and cause parikartika.

Symptoms of parikartika vyapat –

• Parikartika – splitting pain in the anus
• Trika shula – pain in sacral region
• Vasti shula – pain in the urinary bladder
• Vankshana shula – pain in the groin
• Adho nabhi shula – pain below navel region
• Alpa alpa dosha nirharana – repeated expulsion of doshas in small quantities due to constipation

Treatment –
Administering madhura and sheeta aushadhis (sweet and cold medicines)
Milk processed with sugarcane juice
Anuvasana vasti – with oil prepared from yashtimadhu (Liquorice) and tila kalka (paste of sesame)
Sarjarasadi ksheera vasti – milk enemas using milk processed with sarjarasa (resin of Vateria indica) etc medicines

Less food with sour food substances mixed with lot of salt

Parisraava

Parisraava (discharges) –
When vasti having hot (ushna), teekshna (intense and strong), lavana (salt) and amla (sour) medicines is administered in pitta roga (diseases caused due to vitiation of pitta), the vasti dravya will cause guda kshanana (injury or damage to the anus) and daha (burning sensation). Large amounts of liquid mixed with pitta and blood and having various colours will be discharged from the anus. This is called parisraava vyapat.

Symptoms of Parisraava vyapat –
Guda kshanana (injury to the anal canal)
Daha – burning sensation in the anal region
Srava – Large amounts of liquid mixed with pitta and blood and having various colours will be discharged from the anus

Treatment –
Sheeta vasti (cold enemas) with goat’s milk prepared using fresh stems of shalmali, mixed with ghee
Vatadi vasti (enema prepared with vata, yava, tila etc medicines)

Sheeta madhura parisheka – sprinkling or spraying or showering the anus and anal canal with liquids prepared from medicines having cold potency and sweet taste. The paste of the same medicines should be used for application.
Comforts with sweet medicines
Treatment and medicines on the lines of raktapitta chikitsa (treatment of bleeding disorders)
Click to Consult Dr Raghuram Y.S. MD (Ayu)

Basti with cold medicines

What happens if the enema contents are cold to touch, while giving Basti treatment? 
By rule, the enema contents should be lukewarm to touch. If they are too cold, then Acharya Charaka has explained that it leads to Ayoga, or depleted action of the enema medicines. 
Coldness quality is associated with blockage. This is clearly observed how cold packs soon after injury leads to temporary blockage of nerve conduction, leading to pain relief. 
Coldness causes blockage and hotness opens up the body channels. 
If the basti material is cold in nature, then the contents are not well received and absorbed by the colon and small intestine and hence, the basti will not give expected results. 
Read more about rules for basti and side effects of wrong administration here 
Charaka Siddhisthana Chapter 7 – Basti Vyapat Siddhi