Charaka Siddhisthana Chapter 2 – Panchakarmiya Siddhi

This article explains the second chapter of siddhisthana of Charaka samhita called ‘Panchakarmiya Siddhi Adhyaya’. In this chapter, indications, contra-indications and adverse effects of Vamana, Virechana, Niruha, Anuvasana and Dhumapana are explained.

Prologue
अथातः पञ्चकर्मीयां सिद्धिं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
We shall now expound the chapter dealing with the “Indications and contra-Indications for Panchakarma Therapy’. Thus, said Lord Atreya [1-2]

Dialogue
येषां यस्मात् पञ्चकर्माण्यग्निवेश न कारयेत्|
येषां च कारयेत्तानि तत् सर्वं सम्प्रवक्ष्यते||३||
yeṣāṃ yasmāt pañcakarmāṇyagniveśa na kārayet|
yeṣāṃ ca kārayettāni tat sarvaṃ sampravakṣyate||3||
O! Agnivesa, we shall now describe all the patients for whom Panchakarma therapies are contra indicated, reasons for which these are contraindicated, and for which type of patients these therapies are indicated. [3]

Prohibition for Panchakarma

Persons in whom panchakarma is prohibited:

चण्डः साहसिको भीरुः कृतघ्नो व्यग्र एव च|
सद्राजभिषजां द्वेष्टा तद्द्विष्टः शोकपीडितः||४||
यादृच्छिको मुमूर्षुश्च विहीनः करणैश्च यः|
वैरी वैद्यविदग्धश्च श्रद्धाहीनः सुशङ्कितः||५||
भिषजामविधेयश्च नोपक्रम्या भिषग्विदा|
एतानुपचरन् वैद्यो बहून् दोषानवाप्नुयात्||६||
एभ्योऽन्ये समुपक्रम्या नराः सर्वैरुपक्रमैः|
अवस्थां प्रविभज्यैषां वर्ज्यं कार्यं च वक्ष्यते||७||
caṇḍaḥ sāhasiko bhīruḥ kṛtaghno vyagra eva ca|
sadrājabhiṣajāṃ dveṣṭā taddviṣṭaḥ śokapīḍitaḥ||4||
yādṛcchiko mumūrṣuśca vihīnaḥ karaṇaiśca yaḥ|
vairī vaidyavidagdhaśca śraddhāhīnaḥ suśaṅkitaḥ||5||
bhiṣajāmavidheyaśca nopakramyā bhiṣagvidā|
etānupacaran vaidyo bahūn doṣānavāpnuyāt||6||
ebhyo’nye samupakramyā narāḥ sarvairupakramaiḥ|
avasthāṃ pravibhajyaiṣāṃ varjyaṃ kāryaṃ ca vakṣyate||7||
The wise physician should not give Panchakarma therapies to the following types of patients –
Those who are forceful, rash, cowardly, ungrateful and fickle minded
Those who hate good persons, kings and physicians, and in turn hated by them
Those who are afflicted by grief
Those who does not believe in God (Yadrcchika = Nastika)
Those who are in the terminal stage of the disease, and are destined to die
Those who are unable to arrange the essential items (Karana) for the treatment
Those who are inimical to the physician
One who is an imposter and considers himself to be a physician
One who is skeptical and
Those not having faith in the physician
Those who do not carry out the instructions given by the physician
The physician who administers Panchakarma therapy to the above-mentioned types of patients invites many difficulties upon himself.
Persons other than those mentioned above should be treated with all the different types of Panchakarma therapies.
Hereafter, we shall explain the indications and contraindications of each of the different types of Panchakarma therapies. [4-7]
Ayurvedic Panchakarma Treatment: Introduction, Benefits, Dosha Relation

Contraindications of Vamana

अवम्यास्तावत्- क्षतक्षीणातिस्थूलातिकृशबालवृद्धदुर्बलश्रान्तपिपासित क्षुधितकर्मभाराध्वहतोपवासमैथुनाध्ययनव्यायामचिन्ता- प्रसक्तक्षामगर्भिणी सुकुमारसंवृतकोष्ठदुश्छर्दनोर्ध्वरक्तपित्तप्रसक्तच्छर्दिरूर्ध्ववातास्थापितानुवासित हृद्रोगोदावर्तमूत्राघात- प्लीहगुल्मोदराष्ठीलास्वरोपघाततिमिरशिरशङ्खकर्णाक्षिशूलार्ताः||८||
avamyāstāvat- kṣatakṣīṇātisthūlātikṛśabālavṛddhadurbalaśrāntapipāsita kṣudhitakarmabhārādhvahatopavāsamaithunādhyayanavyāyāmacintā- prasaktakṣāmagarbhiṇī sukumārasaṃvṛtakoṣṭhaduśchardanordhvaraktapittaprasaktacchardirūrdhvavātāsthāpitānuvāsita hṛdrogodāvartamūtrāghāta- plīhagulmodarāṣṭhīlāsvaropaghātatimiraśiraśaṅkhakarṇākṣiśūlārtāḥ||8||

Emetic therapy is contra- indicated for the following:
The patient suffering from Ksata (phthisis)
The patient who is Ksina (suffering from consumption),
Ati-sthula (excessively obese), atikrsa (excessively emaciated), Bala (infant), Vriddha (old) and Durbala (weak)
One who is sranta (fatigue), Pipasita (thirsty) and Ksudhita (hungry);
One who is broken down because of hard work, carrying heavy weight and long walks;
Those who have become weak by excessive fasting, sexual indulgence, study, exercise and worry,
Pregnant woman
One having tender health
One whose gastrointestinal tract is occluded by Vayu and
Those who does not respond easily to emetic therapy;
One suffering from aliments characterized by bleeding from upward tract;
One who is suffering from incessant vomiting
Those suffering from upward movement of Vayu or wind;
Those who have taken evacuative type of medicated enema and
Those who have taken unctuous type of medicated enema
One suffering from heart-diseases
One suffering from mis-peristalsis
One suffering from suppression of urination, pleeha, gulma, udara, enlarged prostate, choked voice and cataract; and
One suffering from pain in the head, temporal region, ears and eyes [8]
Read: Vamana Therapy – Right Method, Side Effects, Management

Complications of Vamana

तत्र क्षतस्य भूयः क्षणनाद्रक्तातिप्रवृत्तिः स्यात्, क्षीणातिस्थूलकृशबालवृद्धदुर्बलानामौषधबलासहत्वात् प्राणोपरोधः, श्रान्तपिपासितक्षुधितानां च तद्वत्, कर्मभाराध्वहतोपवासमैथुनाध्ययनव्यायामचिन्ताप्रसक्तक्षामाणां
रौक्ष्याद्वातरक्तच्छेदक्षतभयं स्यात्, गर्भिण्या गर्भव्यापदामगर्भभ्रंशाच्चदारुणा रोगप्राप्तिः, सुकुमारस्य हृदयापकर्षणादूर्ध्वमधो वा रुधिरातिप्रवृत्तिः, संवृतकोष्ठदुश्छछर्दनयोरतिमात्रप्रवाहणाद्दोषाः समुत्क्लिष्टा अन्तःकोष्ठे जनयन्त्यन्तर्विसर्पं स्तम्भं जाड्यं वैचित्त्यं मरणं वा, ऊर्ध्वगरक्तपित्तिन उदानमुत्क्षिप्य प्राणान् हरेद्रक्तं चातिप्रवर्तयेत्, प्रसक्तच्छर्देस्तद्वत्, ऊर्ध्ववातास्थापितानुवासितानामूर्ध्वं वातातिप्रवृत्तिः, हृद्रोगिणोहृदयोपरोधः, उदावर्तिनो घोरतर उदावर्तः स्याच्छीघ्रतरहन्ता, मूत्राघातादिभिरार्तानां तीव्रतरशूलप्रादुर्भावः, तिमिरार्तानां तिमिरातिवृद्धिः, शिरःशूलादिषु शूलातिवृद्धिः; तस्मादेते न वम्याः|
सर्वेष्वपि तु खल्वेतेषु विषगरविरुद्धाजीर्णाभ्यवहारामकृतेष्वप्रतिषिद्धं शीघ्रतरकारित्वादेषामिति ||९||
tatra kṣatasya bhūyaḥ kṣaṇanādraktātipravṛttiḥ syāt, kṣīṇātisthūlakṛśabālavṛddhadurbalānāmauṣadhabalāsahatvāt prāṇoparodhaḥ, śrāntapipāsitakṣudhitānāṃ ca tadvat, karmabhārādhvahatopavāsamaithunādhyayanavyāyāmacintāprasaktakṣāmāṇāṃ
raukṣyādvātaraktacchedakṣatabhayaṃ syāt, garbhiṇyā garbhavyāpadāmagarbhabhraṃśāccadāruṇā rogaprāptiḥ, sukumārasya hṛdayāpakarṣaṇādūrdhvamadho vā rudhirātipravṛttiḥ, saṃvṛtakoṣṭhaduśchachardanayoratimātrapravāhaṇāddoṣāḥ samutkliṣṭā antaḥkoṣṭhe janayantyantarvisarpaṃ stambhaṃ jāḍyaṃ vaicittyaṃ maraṇaṃ vā, ūrdhvagaraktapittina udānamutkṣipya prāṇān haredraktaṃ cātipravartayet, prasaktacchardestadvat, ūrdhvavātāsthāpitānuvāsitānāmūrdhvaṃ vātātipravṛttiḥ, hṛdrogiṇohṛdayoparodhaḥ, udāvartino ghoratara udāvartaḥ syācchīghratarahantā, mūtrāghātādibhirārtānāṃ tīvrataraśūlaprādurbhāvaḥ, timirārtānāṃ timirātivṛddhiḥ, śiraḥśūlādiṣu śūlātivṛddhiḥ; tasmādete na vamyāḥ|
sarveṣvapi tu khalveteṣu viṣagaraviruddhājīrṇābhyavahārāmakṛteṣvapratiṣiddhaṃ śīghratarakāritvādeṣāmiti ||9||

Complications caused by Vamana administered in contraindicated Conditions:

Emetic therapy given to	Effect
a person suffering from Ksata (Phthsis)	it further aggravates the injury [to the lungs], and causes excessively haemoptysis
to a person who is Ksina (suffering from consumption), Ati-Sthula (excessively obese), ati-Krisa (excessively emaciated), Bala (infant),  Vrddha (old) and Durbala (weak),	this endangers their life because such patients are incapable of tolerating the effects of drugs which are used for emesis
to a person who is fatigued, thirsty and hungry	similar effect is produced (as explained above)
to a person who is broken down by doing hard work, carrying excessive weight and long wayfaring, and is weakened by incessant fasting, sexual indulgence, study, exercise and worry	because of excessive dryness caused by these, the vayu in his body gets aggravated, he may get haemorrhage or injury to his lungs
to a pregnant woman	this may give rise to complications of pregnancy and occurrence of serious diseases because of the abortion of immature foetus
person having tender health	because of the strain in his heart, this may give rise to haemorrhage through the upward and downward tracts
a person whose gastro–intestinal tract is occluded or who does not respond to emetic therapy easily,	excessive bouts of urges for vomiting leading to the excitation of Doshas causing internal erysipelas, stiffness, numbness, mental perversion or death
to a person suffering from Urdhvaga- Rakta-Pitta (a diseases characterize by bleeding from the upward tracts)	it provokes Udana-vayu leading to death or excessive bleeding
a person who is already suffering from incessant vomiting	similar effects (as mentioned above)
a person suffering from Urdhva-Vata (upward movement of the wind), and who has already taken Asthapana or anuvasana types of medicated enema,	this causes upward movement of the wind in excess
a person suffering from heart-diseases	it leads to cardiac arrest
person suffering from Udavarta (mis-peristalsis)	this leads to severe mis-peristalsis which is serious nature, and which results in quicker death of the patient
patients suffering from Mutraghata (Suppression of urination) etc,	leads to the manifestation of colic pain of more acute nature
a patient suffering from Timira (cataract)	leads to excessive increase of this ailment
a patient suffering from headache etc.	leads to the excessive aggravation of pain

Therefore, emetic therapy is contraindicated for the above types of patients.
However, administration of emetic therapy is not prohibited even in the above mentioned (contraindicated) ailments if the person is suffering from
Visa (ailments caused by natural poisons),
Gara (ailments caused by artificially prepared poisons),
Viruddhahara (ailments caused by the intake of mutually contradictory ingredients), Ajirna Abhyavahara (intake of foods which cause indigestion) and Ama (ailments caused by the product of improper digestion and metabolism), because these ailments produce their effects instantaneously. [9]
Read: Vamana Virechana – Emesis and Purgation – Ashtanga Hridayam Sutrasthana 18

Indications of Vamana

शेषास्तु वम्याः; विशेषतस्तु पीनसकुष्ठनवज्वरराजयक्ष्मकासश्वासगलग्रहगलगण्डश्लीपदमेहमन्दाग्निविरुद्धाजीर्णान्न विसूचिकालसकविषगरपीतदष्टदिग्धविद्धाधःशोणितपित्तप्रसेक (दुर्नाम) हृल्लासारोचकाविपाकापच्यपस्मारोन्मादातिसारशोफपाण्डुरोगमुखपाकदुष्टस्तन्यादयः श्लेष्मव्याधयो विशेषेण महारोगाध्यायोक्ताश्च; एतेषु हि वमनं प्रधानतममित्युक्तं केदारसेतुभेदे शाल्याद्यशोषदोषविनाशवत्||१०||
śeṣāstu vamyāḥ; viśeṣatastu pīnasakuṣṭhanavajvararājayakṣmakāsaśvāsagalagrahagalagaṇḍaślīpadamehamandāgniviruddhājīrṇānna visūcikālasakaviṣagarapītadaṣṭadigdhaviddhādhaḥśoṇitapittapraseka (durnāma) hṛllāsārocakāvipākāpacyapasmāronmādātisāraśophapāṇḍurogamukhapākaduṣṭastanyādayaḥ śleṣmavyādhayo viśeṣeṇa mahārogādhyāyoktāśca; eteṣu hi vamanaṃ pradhānatamamityuktaṃ kedārasetubhede śālyādyaśoṣadoṣavināśavat||10||

Emetic therapy is indicated for the remaining aliments especially for –
Pinasa (Coryza), Kustha (skin diseases),
Nava Jvara (freshly occurring fever), Rajayaksma (tuberculosis),
Kasa (cough), Svasa (Asthma), Galagraha (spasm in the throat),
Galaganda (Enlargement of thyroid gland),
Slipada (elephantiasis), Meha,
Mandagni (suppression of the power of digestion),
Viruddhanna (ailments caused by the intake of mutually contradictory food ingredients), Ajirnaanna (ailments caused by indigestion of food),
Visucika (cholera), Alasaka (flatulence / tympanitis),
Visa-Pita (ailments caused by the intake of artificially prepared poisons), Visa-Dasta (poisonous bites),
Visa-digdha-Vidddha (ailments caused by injury with weapons smeared with poisons material), Adhah-sonitapitta (an ailment characterized by bleeding from downward tracts),
Praseka (Ptyalism), Durnama (piles),
Hrllasa (nausea), Arocaka (anorexia), Avipaka (indigestion),
Apaci (cervical adenitis), Apasmara (epilepsy), Unmada (insanity),
Atisara (diarrhoea), Sopha (Oedema), Pandu-roga (anemia),
Mukha-Paka (stomatitis), Dusta-stanya (polluted breast-milk), etc
The emetic therapy is especially useful for diseases caused by Kapha which are described in Sutra 2): 17.

In all the above-mentioned conditions, emesis is the best therapy. As paddy, etc., in a field full of water are likely to get spoiled, but an outlet made through its wall to take out water saves the crop, similarly, emetic therapy cures diseases caused by aggravated kapha by eliminating these Doshas from the body. [1)]

Contraindications of Virechana

अविरेच्यास्तु सुभगक्षतगुदमुक्तनालाधोभागरक्तपित्तिविलङ्घितदुर्बलेन्द्रियाल्पाग्निनिरूढकामादिव्यग्राजीर्णिनवज्वरि- मदात्ययिताध्मातशल्यार्दिताभिहतातिस्निग्धरूक्षदारुणकोष्ठाः क्षतादयश्च गर्भिण्यन्ताः||११||
avirecyāstu subhagakṣatagudamuktanālādhobhāgaraktapittivilaṅghitadurbalendriyālpāgninirūḍhakāmādivyagrājīrṇinavajvari- madātyayitādhmātaśalyārditābhihatātisnigdharūkṣadāruṇakoṣṭhāḥ kṣatādayaśca garbhiṇyantāḥ||11||

Purgation therapy is contra-indicated for the following:
Subhaga (persons having tender health / delicate nature),
Ksata-Guda (persons having anal injury),
Mukta-Nala (prolapse rectum),
Adhobhaga rakthapitta (an ailment characterized by bleeding through downward tracts),
Vilanghita (person who is on fasting),
Durbalalendriya (person having weak sensory and motor organs), Alpagni (person having less power of digestion),
Nirudha (person who has undergone evacuative type of enema therapy), Kamadi vyagra manasa (person whose mind is agitated by passion etc),
Ajirni (Person suffering indigestion),
Madatyayita (person suffering from alcoholism),
Adhmata (person suffering from abdominal distension),
Salyardita (person afflicted with foreign bodies),
Abhihata (person with bodily injury),
Ati-snigdha (person who is over-unctuous),
Ati-Ruksa (person is excessively un-unctuous),
Daruna-Kostha (person having hard bowel) and Other persons having ailments beginning from Ksata (phthisis) and ending with Garbhini (pregnancy) as described in Paragraph no. 8[11]
Read: Virechana Therapy – Right Method, Side Effects, Management

Adverse effects of Virechana administered in contraindicated conditions

तत्र सुभगस्य सुकुमारोक्तो दोषः स्यात्, क्षतगुदस्य क्षते गुदे प्राणोपरोधकरीं रुजां जनयेत्, मुक्तनालमतिप्रवृत्त्या हन्यात्, अधोभागरक्तपित्तिनं तद्वत्, विलङ्घितदुर्बलेन्द्रियाल्पाग्निनिरूढा औषधवेगं न सहेरन्, कामादिव्यग्रमनसो न प्रवर्तते कृच्छ्रेण वा प्रवर्तमानमयोगदोषान् कुर्यात्, अजीर्णिन आमदोषः स्यात्, नवज्वरिणोऽविपक्वान् दोषान् न निर्हरेद् वातमेव च कोपयेत्, मदात्ययितस्य मद्यक्षीणे देहे वायुः प्राणोपरोधं कुर्यात्, आध्मातस्याधमतो वा पुरीषकोष्ठे निचितो वायुर्विसर्पन् सहसाऽऽनाहं तीव्रतरं मरणं वा जनयेत्, शल्यार्दिताभिहतयोः क्षते वायुराश्रितो जीवितं हिंस्यात्, अतिस्निग्धस्यातियोगभयं भवेत्, रूक्षस्य वायुरङ्गप्रग्रहं कुर्यात्, दारुणकोष्ठस्य विरेचनोद्धता दोषा हृच्छूलपर्वभेदानाहाङ्गमर्दच्छर्दिमूर्च्छाक्लमाञ्जनयित्वा प्राणान् हन्युः, क्षतादीनां गर्भिण्यन्तानां छर्दनोक्तो दोषः स्यात्; तस्मादेते न विरेच्याः||१२||
tatra subhagasya sukumārokto doṣaḥ syāt, kṣatagudasya kṣate gude prāṇoparodhakarīṃ rujāṃ janayet, muktanālamatipravṛttyā hanyāt, adhobhāgaraktapittinaṃ tadvat, vilaṅghitadurbalendriyālpāgninirūḍhā auṣadhavegaṃ na saheran, kāmādivyagramanaso na pravartate kṛcchreṇa vā pravartamānamayogadoṣān kuryāt, ajīrṇina āmadoṣaḥ syāt, navajvariṇo’vipakvān doṣān na nirhared vātameva ca kopayet, madātyayitasya madyakṣīṇe dehe vāyuḥ prāṇoparodhaṃ kuryāt, ādhmātasyādhamato vā purīṣakoṣṭhe nicito vāyurvisarpan sahasā”nāhaṃ tīvrataraṃ maraṇaṃ vā janayet, śalyārditābhihatayoḥ kṣate vāyurāśrito jīvitaṃ hiṃsyāt, atisnigdhasyātiyogabhayaṃ bhavet, rūkṣasya vāyuraṅgapragrahaṃ kuryāt, dāruṇakoṣṭhasya virecanoddhatā doṣā hṛcchūlaparvabhedānāhāṅgamardacchardimūrcchāklamāñjanayitvā prāṇān hanyuḥ, kṣatādīnāṃ garbhiṇyantānāṃ chardanokto doṣaḥ syāt; tasmādete na virecyāḥ||12||

If purgation therapy is given to a person in Subhaga (persons having tender health), then he will suffer from the same disorders as described for emetic therapy administered to sukumara (person having tender health) in para no. 9a
When administered to persons having anal injury it causes ulcers in the anal / rectum region which further causes severe and intolerable pain causing threat to life.
If purgation medicine is given to those having prolapse of rectum there will be excessive defecation which leads to death.
When administered to those having bleeding through downward passages, purgative medicine causes excessive bleeding leading to death.
When purgation medicine is administered to people who have fasted, those having weak sense organs, those having less digestion power and those who have undergone evacuative enema, they cannot tolerate the intensity of medicine i.e., they would suffer from severe purgation.
If purgation recipes are administered to those whose mind is agitated with passion etc the medicine would not produce purgation or the purges (motions) happen with difficulty which in turn causes complications which would be caused by deficit administration of purgation medicine.
When purgation is administered to those having indigestion it causes ama dosha.
When purgation medicine is administered to those who are suffering from alcoholism, the vayu gets severely aggravated in the body which has been emaciated and depleted causes threat to life (can cause death)
When purgation is administered to those suffering from abdominal distension, the vayu accumulated in the colon wanders throughout the gut in all directions and causes severe flatulence or death.
When purgation is administered to those who are afflicted by foreign bodies, the vayu accumulated in the site of foreign body will cause death.
When purgation is administered to those who are over unctuous it may cause atiyoga i.e., symptoms of excessive administration of purgation therapy (symptoms of excessive purgation).
When purgation is administered in people who have excessive dryness of the body, the vayu gets aggravated and causes gripping pain in the body parts
When administered to people having hard bowel, purgation medicine causes severe aggravation of doshas which in turn cause pain in heart, pain in the small joints of the fingers, flatulence, pain in body parts, vomiting, fainting (unconsciousness), fatigue etc. which can lead to death.
When purgation medicine is given to a patient who is having ailments beginning from phthisis and ending with pregnancy it will cause the same complications which are mentioned in the context of giving emesis therapy in the same cases.
Therefore, purgation therapy is contra- indicated in the above-mentioned cases. [12]

Indications of Virechana

शेषास्तु विरेच्याः; विशेषतस्तु कुष्ठज्वरमेहोर्ध्वरक्तपित्तभगन्दरोदरार्शोब्रधप्लीहगुल्मार्बुदगलगण्डग्रन्थिविसूचिकालसकमूत्राघातक्रिमिकोष्ठविसर्प- पाण्डुरोगशिरःपार्श्वशूलोदावर्तनेत्रास्यदाहहृद्रोगव्यङ्गनीलिकानेत्रनासिकास्यस्रवणहलीमकश्वासकासकामला- पच्यपस्मारोन्मादवातरक्तयोनिरेतोदोषतैमिर्यारोचकाविपाकच्छर्दिश्वयथूदरविस्फोटकादयः पित्तव्याधयो विशेषेण महारोगाध्यायोक्ताश्च; एतेषु हि विरेचनं प्रधानतममित्युक्तमग्न्युपशमेऽग्निगृहवत्||१३||
śeṣāstu virecyāḥ; viśeṣatastu kuṣṭhajvaramehordhvaraktapittabhagandarodarārśobradhaplīhagulmārbudagalagaṇḍagranthivisūcikālasakamūtrāghātakrimikoṣṭhavisarpa- pāṇḍurogaśiraḥpārśvaśūlodāvartanetrāsyadāhahṛdrogavyaṅganīlikānetranāsikāsyasravaṇahalīmakaśvāsakāsakāmalā- pacyapasmāronmādavātaraktayoniretodoṣataimiryārocakāvipākacchardiśvayathūdaravisphoṭakādayaḥ pittavyādhayo viśeṣeṇa mahārogādhyāyoktāśca; eteṣu hi virecanaṃ pradhānatamamityuktamagnyupaśame’gnigṛhavat||13||
In all the other conditions (other than the above), purgation therapy is indicated.
Especially it is indicated for the patients suffering from –
Kustha (skin diseases), Jvara (fever),
Meha,
Urdhvaga- Raktapitta (bleeding from the upward tracts),
Bhagandara (fistula- in-ano), Udara (obstinate abdominal diseases including ascites),
Arsas (piles), Bradhna (inguinal swelling), Pliha (splenic disorders),
Gulma (phantom tumour), Arbuda (tumour),
Gala-Ganda (thyroid enlargement), Granthi (lymphadenitis),
Visucika (choleric diarrhoea), Alasaka (intestinal torpor),
Mutraghata (suppression of urination),
Krimi-Kostha (parasitic infestation of intestines),
Visarpa (erysipelas), Pandu-roga (anaemia),
Sirah-sula (headache), Parsva-Sula (pain in the sides of the chest), Udavarta (upward movement of wind in the abdomen),
Netra-daha (burning sensation in the eyes),
Asya-Daha (burning sensation in mouth / face),
Hrd-roga (heart diseases), Vyanga (freckles),
Nilika (bluish black moles),
Netra –Sravana (excessive discharge from eyes),
Nasika-sravana (excessive discharge from the nose),
Asya-srvana (excessive salivation), Halimaka (a serious type of Jaundice),
Svasa (asthma), Kasa (cough), Kamala (jaundice),
Apaci (cervical adenitis), Apasmaara (epilepsy),
Unmada (insanity), Vata-Rakta (gout),
Yoni-dosa (gynaecological disorders),
Reto-Doshas (seminal morbidities),
Timira (cataract), Arocaka (anorexia),
Udara (obstinate abdominal disorders including ascites; this appears to be a repetition), Visphotajka (pustular eruptions) etc.
Purgation therapy is also especially useful for Paittika type of diseases described in Sutra 2):14.
For the above-mentioned ailments, purgation therapy is the foremost remedy.
As the extinguisher of fire normalizes Agni-Grha (a house on fire), similarly, purgation therapy, by eliminating aggravated Pitta, cures all the above-mentioned diseases. [13]

Prohibitions for Niruha Basti

अनास्थाप्यास्तु अजीर्ण्यतिस्निग्धपीतस्नेहोत्क्लिष्टदोषाल्पाग्नियानक्लान्तातिदुर्बल क्षुत्तृष्णाश्रमार्तातिकृशभुक्तभक्तपीतोदकवमितविरिक्तकृतनस्तः कर्मकुद्धभीतमत्तमूर्च्छितप्रसक्तच्छर्दिनिष्ठीविकाश्वास कासहिक्काबद्धच्छिद्रोदकोदराध्मानालसकविसूचिकामप्रजातामातिसार- मधुमेहकुष्ठार्ताः||१४||
anāsthāpyāstu ajīrṇyatisnigdhapītasnehotkliṣṭadoṣālpāgniyānaklāntātidurbala kṣuttṛṣṇāśramārtātikṛśabhuktabhaktapītodakavamitaviriktakṛtanastaḥ karmakuddhabhītamattamūrcchitaprasaktacchardiniṣṭhīvikāśvāsa kāsahikkābaddhacchidrodakodarādhmānālasakavisūcikāmaprajātāmātisāra- madhumehakuṣṭhārtāḥ||14||
Administration of asthapana or Niruha (evacuation type of medicated enema) is prohibited for the following:
Person who is suffering from Ajirna (indigestion),
Person who is administered with excessive oleation or the one to whom oleation has just been administered
Persons in whom Doshas are excited (Utklista-Dosa) and those suffering from mandagni (suppression of the power of digestion);
To a person fatigued due to excessive riding of vehicle
Persons who are excessively weak, excessively hungry, excessively thirsty and excessively tired due to indulgence in hard (strenuous) work,
Excessively emaciated persons
Persons who have just taken the meal and has just consumed water
Persons who have just taken emetic therapy and those who have just undergone purgation therapy or those who have just taken inhalation therapy
Persons who are angry and fearful
Persons who are intoxicated and those who have fainted
Those suffering from incessant vomiting, ptyalism, asthma, cough and hiccup;
Those suffering from intestinal obstruction, intestinal perforation, ascites associated with meteorism
Those suffering from intestinal torpor, cholera, miscarriage and first stage of diarrhoea and
Those suffering from diabetes mellitus, all pramehas or skin diseases. [14]
Read: Niruha Basti (Kashaya Basti) Panchakarma Method, Uses, Side Effects

Adverse Effects of Niruha

तत्राजीर्ण्यतिस्निग्धपीतस्नेहानां दूष्योदरं मूर्च्छाश्वयथुर्वा स्यात्, उत्क्लिष्टदोषमन्दाग्न्योररोचकस्तीव्रः, यानक्लान्तस्य क्षोभव्यापन्नो बस्तिराशु देहं शोषयेत्, अतिदुर्बलक्षुत्तृष्णाश्रमार्तानां पूर्वोक्तोदोषः स्यात्, अतिकृशस्य कार्श्यं पुनर्जनयेत्, भुक्तभक्तपीतोदकयोरुत्क्लिश्योर्ध्वमधो वावायुर्बस्तिमुत्क्षिप्य क्षिप्रं घोरान् विकाराञ्जनयेत्, वमितविरिक्तयोस्तु रूक्षं शरीरं निरूहः क्षतं क्षार इव दहेत्, कृतनस्तःकर्मणो विभ्रंशं भृशसंरुद्धस्रोतसः कुर्यात्, क्रुद्धभीतयोर्बस्तिरूर्ध्वमुपप्लवेत्, मत्तमूर्च्छितयो र्भृशं विचलितायां सञ्ज्ञायां चित्तोपघाताद् व्यापत् स्यात्, प्रसक्तच्छर्दिर्निष्ठीविकाश्वासकासहिक्कार्तानामूर्ध्वीभूतो वायुरूर्ध्वं बस्तिं नयेत्, बद्धच्छिद्रोदकोदराध्मानार्तानां भृशतरमाध्याप्य बस्तिः प्राणान् हिंस्यात्, अलसकविसूचिकामप्रजातामातिसारिणामामकृतो दोषः स्यात्, मधुमेहकुष्ठिनोर्व्याधेः पुनर्वृद्धिः; तस्मादेते नास्थाप्याः||१५||
tatrājīrṇyatisnigdhapītasnehānāṃ dūṣyodaraṃ mūrcchāśvayathurvā syāt, utkliṣṭadoṣamandāgnyorarocakastīvraḥ, yānaklāntasya kṣobhavyāpanno bastirāśu dehaṃ śoṣayet, atidurbalakṣuttṛṣṇāśramārtānāṃ pūrvoktodoṣaḥ syāt, atikṛśasya kārśyaṃ punarjanayet, bhuktabhaktapītodakayorutkliśyordhvamadho vāvāyurbastimutkṣipya kṣipraṃ ghorān vikārāñjanayet, vamitaviriktayostu rūkṣaṃ śarīraṃ nirūhaḥ kṣataṃ kṣāra iva dahet, kṛtanastaḥkarmaṇo vibhraṃśaṃ bhṛśasaṃruddhasrotasaḥ kuryāt, kruddhabhītayorbastirūrdhvamupaplavet, mattamūrcchitayo rbhṛśaṃ vicalitāyāṃ sañjñāyāṃ cittopaghātād vyāpat syāt, prasaktacchardirniṣṭhīvikāśvāsakāsahikkārtānāmūrdhvībhūto vāyurūrdhvaṃ bastiṃ nayet, baddhacchidrodakodarādhmānārtānāṃ bhṛśataramādhyāpya bastiḥ prāṇān hiṃsyāt, alasakavisūcikāmaprajātāmātisāriṇāmāmakṛto doṣaḥ syāt, madhumehakuṣṭhinorvyādheḥ punarvṛddhiḥ; tasmādete nāsthāpyāḥ||15|

Administration of Niruha basti in contra-indicated conditions produces adverse effects as follows:

Therefore, Niruha basti is prohibited for the above-mentioned type of patients. [15]

Indications of Niruha Basti

शेषास्त्वास्थाप्याः; विशेषतस्तु सर्वाङ्गैकाङ्गकुक्षिरोगवातवर्चोमूत्रशुक्रसङ्गबलवर्णमांसरेतःक्षयदोषाध्मानाङ्गसुप्तिक्रिमिकोष्ठोदावर्तशुद्धातिसार- पर्वभेदाभितापप्लीहगुल्मशूलहृद्रोगभगन्दरोन्मादज्वरब्रध्नशिरःकर्णशूलहृदयपार्श्वपृष्ठकटीग्रहवेपनाक्षेपकगौरवातिलाघव- रजःक्षयार्तविषमाग्निस्फिग्जानुजङ्घोरुगुल्फपार्ष्णिप्रपदयोनिबाह्वङ्गुलिस्तनान्तदन्तनखपर्वास्थिशूल- शोषस्तम्भान्त्रकूजपरिकर्तिकाल्पाल्पसशब्दोग्रगन्धोत्थानादयो वातव्याधयो विशेषेण महारोगाध्यायोक्ताश्च; एतेष्वास्थापनं प्रधानतममित्युक्तं वनस्पतिमूलच्छेदवत्||१६||
śeṣāstvāsthāpyāḥ; viśeṣatastu sarvāṅgaikāṅgakukṣirogavātavarcomūtraśukrasaṅgabalavarṇamāṃsaretaḥkṣayadoṣādhmānāṅgasuptikrimikoṣṭhodāvartaśuddhātisāra- parvabhedābhitāpaplīhagulmaśūlahṛdrogabhagandaronmādajvarabradhnaśiraḥkarṇaśūlahṛdayapārśvapṛṣṭhakaṭīgrahavepanākṣepakagauravātilāghava- rajaḥkṣayārtaviṣamāgnisphigjānujaṅghorugulphapārṣṇiprapadayonibāhvaṅgulistanāntadantanakhaparvāsthiśūla- śoṣastambhāntrakūjaparikartikālpālpasaśabdogragandhotthānādayo vātavyādhayo viśeṣeṇa mahārogādhyāyoktāśca; eteṣvāsthāpanaṃ pradhānatamamityuktaṃ vanaspatimūlacchedavat||16||
In all the other conditions Niruha basti (evacuative type of medicated enema) is indicated. It is especially useful in treating the below mentioned conditions –
Sarvanga-Roga (paralysis of the whole body),
Ekanga- Roga (paralysis of one of the limbs), Kuksi-Roga (diseases of pelvic region), Vata-Sanga (retention of flatus),
Varcah-Sanga (retention of stool), Mutra-Sanga (retention of urine),
Sukra-Sanga (retention of semen),
Bala-Ksaya (diminution of strength),
Varna Ksaya (diminution of complexion),
Mamsa-Dosa (morbidity of muscle tissue),
Reto-Dosa (morbidity of semen),
Adhmana – bloating, gaseous distension of abdomen (meteorism), Anga- Supti (numbness of limbs), Krimi Kostha (worm infestation / parasitic infestation of the intestine), Udavarta (upward movement of the wind in the abdomen),
Suddhatisara (diarrhoea without the association of ama – a product of indigestion and altered metabolism), Parva- bheda (joint pain, pain in the interphalangeal joints), Abhitapa (feeling of burning sensation), Pliha (splenic disorder),
Gulma – tumours of the abdomen (phantom tumour),
Sula (colic pain), Hrd-roga (heart diseases),
Bhagandara (anal fistula), Unmada – Schizophrenia (Insanity), Jvara – fever (fever), Bradhna – prolapsed rectum (inguinal swellings),
Sirah- Sula (headache), Karna-Sula (earache),
Hrdaya- Graha (cardiac spasm),
Parsva graha (stiffness in the sides of the chest),
Prstha graha (stiffness of the back), Kati- graham (stiffness of the lumbar region), Vepathu (tremor), Aksepaka- Arti (convulsions),
Gaurava- Arti (excessive heaviness of the body), Atilaghava- arti (excessive lightness of the body), Rajah Ksaya (amenorrhoea),
Visamagni (irregular power of digestion),
Sphik sula sosa stambha – stiffness, pain, atrophy and stiffness of the buttocks,
Janu Sula Sosa Stambha – pain, atrophy and stiffness of knee-joints,
Jangha Sula Sosa Stambha – pain, atrophy and stiffness of the thighs,
Gulpha Sula Sosa Stambha – pain, atrophy and stiffness of ankles,
Parsni Sula Sosa stambha – pain, atrophy and stiffness of heels,
Prapada Sula Sosa stambha – pain, atrophy and stiffness of feet, Yoni sula sosa stambha – pain, atrophy and stiffness of female reproductive organs,
Bahu sula sosa stambha – pain, atrophy and stiffness of arms,
Anguli Sula Sosa Stambha – pain, atrophy and stiffness of fingers,
Stananta Sula sosa stambha – pain, atrophy and stiffness at the end of the breasts or nipples, Danta sula Sosa stambha – pain, atrophy and stiffness of teeth,
Nakha Sula sosa stambha – pain, atrophy and stiffness of nails,
Parva Sula sosa stambha – pain, atrophy and stiffness of bones,
Antra-Kujana (intestinal gurgling),
Parikartika (sawing pain in the abdomen),
Alpalpa-utthana (voiding stools in small quantities, frequently), Sasabdotthana (voiding stools with noise),
Ugra-Gandha-utthana (voiding of foul-smelling stool) and such other ailments Niruha- basti is especially useful in Vatika diseases described in Sutra 2):11
For the above-mentioned ailments, Niruha basti is the foremost medication. As a tree gets destroyed by cutting its roots, similarly the above-mentioned diseases get cured by the administration of Niruha basti. [16]

Contraindications of Anuvasana

य एवानास्थाप्यास्त एवाननुवास्याः स्युः; विशेषतस्त्वभुक्तभक्तनवज्वरपाण्डुरोगकामलाप्रमेहार्शः प्रतिश्यायारोचकमन्दाग्निदुर्बलप्लीहकफोदरोरुस्तम्भवर्चोभेद विषगरपीतपित्तकफाभिष्यन्दगुरु कोष्ठश्लीपदगलगण्डापचिक्रिमिकोष्ठिनः ||१७||
ya evānāsthāpyāsta evānanuvāsyāḥ syuḥ; viśeṣatastvabhuktabhaktanavajvarapāṇḍurogakāmalāpramehārśaḥ pratiśyāyārocakamandāgnidurbalaplīhakaphodarorustambhavarcobheda viṣagarapītapittakaphābhiṣyandaguru koṣṭhaślīpadagalagaṇḍāpacikrimikoṣṭhinaḥ ||17||

Anuvasana Basti is prohibited in all the conditions for which Niruha basti is contra- indicated. It is especially contraindicated in the following conditions:
Abhukta- Bhakta (a person who has not taken food) and
The persons suffering from –
Nava-Jvara – fever (freshly occurring fever / acute fever),
Pandu Roga (anaemia),
Kamala – Jaundice, Liver diseases, Prameha – Urinary tract disorders, diabetes and
Arsas (piles),
Pratisyaya (coryza)
Arocaka (anorexia),
Mandagni – low digestion strength (suppression of the power of digestion), Daurbalya (weakness),
Plihodara (splenic disorders),
Kaphodara – Kapha type of Ascites (obstinate abdominal ailments caused by aggravated Kapha),
Uru-Stambha – stiffness / spasticity of thighs,
Varco-Bheda (ingestion of natural poison),
Pittabhisyanda (conjunctivitis caused by aggravated pitta),
Kaphabhisyanda (conjunctivitis caused by aggravated Kapha),
Guru Kostha (hard bowel),
Slipada (elephantiasis),
Galaganda (enlargement of thyroid gland),
Apaci (cervical adenitis) and
Krimi Kostha (intestinal parasites) [17]
Read: Anuvasana Basti: Method, Benefits, Mode Of Action, Contra Indications

Adverse Effects of Anuvasana basti in contraindicated conditions

तत्राभुक्तभक्तस्यानावृतमार्गत्वादूर्ध्वमतिवर्तते स्नेहः, नवज्वरपाण्डुरोगकामलाप्रमेहिणां दोषानुत्क्लिश्योदरञ्जनयेत्, अर्शसस्यार्शांस्यभिष्यन्द्याध्मानं कुर्यात्, अरोचकार्तस्यान्नगृद्धिं पुनर्हन्यात्, मन्दाग्निदुर्बलयोर्मन्दतरमग्निं कुर्यात्, प्रतिश्यायप्लीहादिमतां भृशमुत्क्लिष्टदोषाणां भूय एव दोषं वर्धयेत्; तस्मादेते नानुवास्याः||१८||
tatrābhuktabhaktasyānāvṛtamārgatvādūrdhvamativartate snehaḥ, navajvarapāṇḍurogakāmalāpramehiṇāṃ doṣānutkliśyodarañjanayet, arśasasyārśāṃsyabhiṣyandyādhmānaṃ kuryāt, arocakārtasyānnagṛddhiṃ punarhanyāt, mandāgnidurbalayormandataramagniṃ kuryāt, pratiśyāyaplīhādimatāṃ bhṛśamutkliṣṭadoṣāṇāṃ bhūya eva doṣaṃ vardhayet; tasmādete nānuvāsyāḥ||18||
Administration of Anuvasana Basti in contraindicated conditions produces adverse effects as follows:
Sl No Anuvasana Basti (unctuous enema) therapy given to Effect
1 person who has not taken any food, Anuvasana Basti spreads upwards due to the absence of any obstruction in the alimentary tract
2 person suffering from
Nava-Jvara (fever of recent origin), anaemia,
Jaundice, and
Prameha – Urinary tract disorders, diabetes, causes excitation of Doshas leading to the manifestation of Udara – ascites, enlargement of the abdomen (obstinate abdominal diseases including ascites)
3 person suffering from piles, administration of Anuvasana Basti produces stickiness in the piles leading to Adhmana – bloating, gaseous distension of abdomen (abdominal distension)
4 person suffering from anorexia,
administration of Anuvasana Basti further impairs the desire for food
5 person suffering from
mandagni – low digestion strength (suppression of the power of digestion) and debility, administration of Anuvasana- basti further reduces the power of digestion
6 person suffering from coryza, splenic disorder (and such other ailments described in the no. 7 of the para-17 above), then the administration of Anuvasana Basti causes excessive aggravation of the already aggravated Doshas
So Anuvasana Basti must not be administered to the above category of patients.

Indications of Anuvasana Basti

य एवास्थाप्यास्त एवानुवास्याः; विशेषतस्तु रूक्षतीक्ष्णाग्नयः केवलवातरोगार्ताश्च; एतेषु ह्यनुवासनं प्रधानतममित्युक्तं मूले द्रुमप्रसेकवत्||१९||
ya evāsthāpyāsta evānuvāsyāḥ; viśeṣatastu rūkṣatīkṣṇāgnayaḥ kevalavātarogārtāśca; eteṣu hyanuvāsanaṃ pradhānatamamityuktaṃ mūle drumaprasekavat||19||
Anuvasana –Basti is indicated in the very conditions for which Niruha- Basti is indicated (vide para no. 16). It is especially indicated for –
the person having un-unctuousness (dryness),
Tiksnagni (sharp power of digestion) and
Kevala- Vata-Roga (diseases caused by Vayu alone, i.e., not associated with Ama – A product of indigestion and altered metabolism),
In these conditions, Anuvasana Basti is the foremost therapy.
As sprinkling of water at the root prevents withering out of the tree. Similarly, administration of Anuvasana – basti cures diseases in the body of the person. [19]

Contraindications of Dhoomapana

अशिरोविरेचनार्हास्तु अजीर्णिभुक्तभक्तपीतस्नेहमद्यतोयपातुकामाः स्नातशिराः स्नातुकामः क्षुत्तृष्णाश्रमार्तमत्तमूर्च्छितशस्त्रदण्डहतव्यवायव्यायामपानक्लान्तनवज्वरशोकाभितप्तविरिक्तानुवासितगर्भिणीनवप्रतिश्यायार्ताः, अनृतौ दुर्दिने चेति||२०|
aśirovirecanārhāstu ajīrṇibhuktabhaktapītasnehamadyatoyapātukāmāḥ snātaśirāḥ snātukāmaḥ kṣuttṛṣṇāśramārtamattamūrcchitaśastradaṇḍahatavyavāyavyāyāmapānaklāntanavajvaraśokābhitaptaviriktānuvāsitagarbhiṇīnavapratiśyāyārtāḥ, anṛtau durdine ceti||20|
Shiro- virecana (inhalation therapy) is prohibited for the following:
The person who has indigestion or to a person who has already taken food
The person who has already taken oleation therapy
The person who has taken alcohol or water
The person who has taken head-bath or who desires to take bath
The person who is hungry and thirty
The person who is suffering from fatigue, intoxication or fainting;
The person afflicted by injury with a weapon or a stick;
The person who is fatigued because of sexual intercourse, physical exercise or intake of alcohol:
The person afflicted with freshly occurring fever and grief;
The person who has taken purgation therapy or Anuvasana –Basti;
A pregnant woman;
The person who is suffering from freshly occurring coryza; and
In inappropriate season or on a cloudy day

Adverse effects of Dhoomapana in Prohibited Conditions

तत्राजीर्णिभुक्तभक्तयोर्दोष ऊर्ध्ववहानि स्रोतांस्यावृत्य कासश्वासच्छर्दिप्रतिश्यायाञ्जनयेत्, पीतस्नेहमद्यतोयपातुकामानां कृते च पिबतां मुखनासास्रावाक्ष्युपदेहतिमिरशिरोरोगाञ्जनयेत्, स्नातशिरसः कृते च स्नानाच्छिरसः प्रतिश्यायं, क्षुधार्तस्य वातप्रकोपं, तृष्णार्तस्य पुनस्तृष्णाभिवृद्धिं मुखशोषं च, श्रमार्तमत्तमूर्च्छितानामास्थापनोक्तं दोषं जनयेत्, शस्त्रदण्डहतयोस्तीव्रतरां रुजं जनयेत्, व्यवायव्यायामपानक्लान्तानां शिरःस्कन्धनेत्रोरःपीडनं, नवज्वरशोकाभितप्तयोरूष्मा नेत्रनाडीरनुसृत्य तिमिरं ज्वरवृद्धिं च कुर्यात्, विरिक्तस्य वायुरिन्द्रियोपघातं कुर्यात्, अनुवासितस्य कफः शिरोगुरुत्वकण्डूक्रिमिदोषाञ्जनयेत्, गर्भिण्या गर्भं स्तम्भयेत् स काणः कुणिः पक्षहतः पीठसर्पी वा जायते, नवप्रतिश्यायार्तस्य स्रोतांसि व्यापादयेत्, अनृतौ दुर्दिने च शीतदोषान् पूतिनस्यं शिरोरोगं च जनयेत्; तस्मादेते न शिरोविरेचनार्हाः||२१||
tatrājīrṇibhuktabhaktayordoṣa ūrdhvavahāni srotāṃsyāvṛtya kāsaśvāsacchardipratiśyāyāñjanayet, pītasnehamadyatoyapātukāmānāṃ kṛte ca pibatāṃ mukhanāsāsrāvākṣyupadehatimiraśirorogāñjanayet, snātaśirasaḥ kṛte ca snānācchirasaḥ pratiśyāyaṃ, kṣudhārtasya vātaprakopaṃ, tṛṣṇārtasya punastṛṣṇābhivṛddhiṃ mukhaśoṣaṃ ca, śramārtamattamūrcchitānāmāsthāpanoktaṃ doṣaṃ janayet, śastradaṇḍahatayostīvratarāṃ rujaṃ janayet, vyavāyavyāyāmapānaklāntānāṃ śiraḥskandhanetroraḥpīḍanaṃ, navajvaraśokābhitaptayorūṣmā netranāḍīranusṛtya timiraṃ jvaravṛddhiṃ ca kuryāt, viriktasya vāyurindriyopaghātaṃ kuryāt, anuvāsitasya kaphaḥ śirogurutvakaṇḍūkrimidoṣāñjanayet, garbhiṇyā garbhaṃ stambhayet sa kāṇaḥ kuṇiḥ pakṣahataḥ pīṭhasarpī vā jāyate, navapratiśyāyārtasya srotāṃsi vyāpādayet, anṛtau durdine ca śītadoṣān pūtinasyaṃ śirorogaṃ ca janayet; tasmādete na śirovirecanārhāḥ||21||
Administration of inhalation therapy in contra-indicated conditions gives rise to adverse effects as follows:
Sl No Shiro Virechana – nasal medication therapy given to Effect
1 person suffering from indigestion or he who has already taken food, causes occlusion of the channels of circulation moving upwards causing therapy cough, asthma, vomiting and coryza
2 person who has already taken oleation therapy or he who desires to take oleation therapy, alcohol or water or if he takes water after the therapy, gives rise to ptyalism, discharge from the nose, stickiness of eyes, cataract and head diseases
3 person who has taken head-bath or takes head-bath after the therapy, gives rise to coryza
4 a hungry person aggravates vayu
5 a thirsty person intensifies thirst, and causes dryness of the mouth
6 a person afflicted with fatigue, intoxication or fainting
produces the same adverse effects as mentioned in respect of Niruha- Basti
7 a person injured by weapon or beaten by a stick produces excruciating pain
8 a person fatigued because of sexual indulgence, physical work or taking alcohol (even after a day) causes pain in the head, shoulders, eyes and chest
9 a person suffering from Nava-Jvara (fever of recent origin) and grief, causes the heat to spread into the channels of the eyes resulting in Timira (cataract) and further aggravation of the fever
10 a person who has already taken the purgation therapy
the Vayu in his body gets aggravated leading to the injury to his sense organs
11 a person who has already taken Anuvasana Basti
kapha in his body gets aggravated leading to heaviness of head, itching and parasitic infestation
12 a pregnant woman,
the growth of the foetus gets arrested, and she gives birth to and offspring who may be Kana (blind by one eye), Kuni (with deformity of upper limbs), Paksahata (hemiplegic) or Pitha-Sarpi (with deformity of the lower limbs)
13 a person who is suffering from nava pratisyaya (freshly occurring coryza), may cause morbidity of the channels of circulation
14 on a cloudy day or during inappropriate seasons may cause ailments due to cold, Puti- nasya (putrefied rhinitis) and Shiro-Roga (head –diseases)
Therefore, in the above-mentioned conditions inhalation therapy is prohibited. [21]
Read: Dhumapana Vidhi Adhyaya Ashtanga Hridaya Sutrasthana 21

Indications of Dhoomapana

शेषास्त्वर्हाः, विशेषतस्तु शिरोदन्तमन्यास्तम्भगलहनुग्रहपीनसगलशुण्डिकाशालूकशुक्रतिमिरवर्त्मरोगव्यङ्गो
पजिह्विकार्धावभेदकग्रीवास्कन्धांसास्यनासिकाकर्णाक्षिमूर्धकपालशिरोरोगार्दितापतन्त्रकापतानकगलगण्ड- दन्तशूलहर्षचालाक्षिराज्यर्बुदस्वरभेदवाग्ग्रहगद्गदक्रथनादय ऊर्ध्वजत्रुगताश्चवातादिविकाराः परिपक्वाश्च; एतेषु शिरोविरेचनं प्रधानतममित्युक्तं, तद्ध्युत्तमाङ्गमनुप्रविश्य मुञ्जादीषिकामिवासक्तां केवलं विकारकरं दोषमपकर्षति||२२||
śeṣāstvarhāḥ, viśeṣatastu śirodantamanyāstambhagalahanugrahapīnasagalaśuṇḍikāśālūkaśukratimiravartmarogavyaṅgo
pajihvikārdhāvabhedakagrīvāskandhāṃsāsyanāsikākarṇākṣimūrdhakapālaśirorogārditāpatantrakāpatānakagalagaṇḍa- dantaśūlaharṣacālākṣirājyarbudasvarabhedavāggrahagadgadakrathanādaya ūrdhvajatrugatāścavātādivikārāḥ paripakvāśca; eteṣu śirovirecanaṃ pradhānatamamityuktaṃ, taddhyuttamāṅgamanupraviśya muñjādīṣikāmivāsaktāṃ kevalaṃ vikārakaraṃ doṣamapakarṣati||22||
Inhalation therapy is indicated for the remaining ailments. It is especially useful in the below mentioned conditions –
Shiro-stambha (stiffness of the head),
Danta-Stambha (Stiffness of teeth),
Manya-stambha (torticollis),
Gala-Graha (spasm of the teeth),
Hanu-Graha (lock-jaw),
Pinasa (chronic coryza),
Gala-Sundika (tonsillitis),
Gala-Saluka (tumour in the throat),
Sukra (corneal ulcer),
Timira (cataract),
Vartma-Roga (diseases of eye-lids),
Vyanga (freckles),
Upa-Jihvika (Uvulitis),
Ardhavabhedaka (hemicrania),
Griva-roga (diseases of the neck),
Skandha-roga (diseases of the shoulders),
Amsa-roga (diseases of the scapula),
Asya-roga (diseases of the mouth),
Nasika-roga (diseases of the nose),
Karna-Roga (diseases of the ears),
Aksi roga (diseases of the eyes),
Murdha-Roga (diseases of the head),
Kapala-roga (diseases of the cranium),
Shiro-roga (diseases of the head),
Ardita (facial paralysis),
Apatantraka (convulsions with unconsciousness),
Apatanaka (convulsions with consciousness),
Galaganda (goitre),
Danta-Sula (toothache),
Danta-harsa (tingling of teeth),
Danta-cala (looseness of teeth)
Aksi-Raji (conjunctivitis),
Arbuda (tumour),
Svarabheda (hoarseness of the voice),
Vag-graham (loss of speech),
Gad-Gada (spasmodic speech),
Krathana (stammering) etc
and diseases of the head and neck which are caused by aggravated Vayu and which are fully matured (free from Ama-Dosa).
For the treatment of the above-mentioned maladies inhalation therapy is the foremost remedy. The recipe administered through inhalation therapy enters into the head (cerebrum), and draws out exclusively the morbid matter as the pith (Isika) is taken out after removing the fibrous coating of Munja (a type of Grass) adhered to it. [22]
Read: Herbal Smoking – Benefits, Rules, Side Effects, Blends To Try

Seasonal Propriety of Dhoomapana

प्रावृट्शरद्वसन्तेतरेष्वात्ययिकेषु रोगेषु नावनं कुर्यात् कृत्रिमगुणोपधानात्; ग्रीष्मे पूर्वाह्णे, शीते मध्याह्ने, वर्षास्वदुर्दिने चेति||२३||
prāvṛṭśaradvasantetareṣvātyayikeṣu rogeṣu nāvanaṃ kuryāt kṛtrimaguṇopadhānāt; grīṣme pūrvāhṇe, śīte madhyāhne, varṣāsvadurdine ceti||23||
In the case of an emergency, inhalation therapy can be given even in the seasons other than Pravrt (first part of the rainy season), sarat (autumn) and Vasanta (spring) by artificially creating the congenial environment. In the summer, inhalation therapy should be given in the morning. In the winter, it should be given during the mid-day. In the rainy season it should be given when the sky is free from clouds. [23]

Contents of chapter and Epilogue

तत्र श्लोकाः-
इति पञ्चविधं कर्म विस्तरेण निदर्शितम्|येभ्यो यन्न हितं यस्मात् कर्म येभ्यश्च यद्धितम्||२४||
न चैकान्तेन निर्दिष्टेऽप्यर्थेऽभिनिविशेद्बुधः| स्वयमप्यत्र वैद्येन तर्क्यं बुद्धिमता भवेत्||२५||
उत्पद्येत हि साऽवस्था देशकालबलं प्रति| यस्यां कार्यमकार्यं स्यात् कर्म कार्यं च वर्जितम्||२६||
छर्दिर्हृद्रोगगुल्मानां वमनं स्वे चिकित्सिते| अवस्थां प्राप्य निर्दिष्टं कुष्ठिनां बस्तिकर्म च||२७||
तस्मात् सत्यपि निर्देशे कुर्यादूह्य स्वयं धिया| विना तर्केण या सिद्धिर्यदृच्छासिद्धिरेव सा||२८||
tatra ślokāḥ-
iti pañcavidhaṃ karma vistareṇa nidarśitam|yebhyo yanna hitaṃ yasmāt karma yebhyaśca yaddhitam||24||
na caikāntena nirdiṣṭe’pyarthe’bhiniviśedbudhaḥ| svayamapyatra vaidyena tarkyaṃ buddhimatā bhavet||25||
utpadyeta hi sā’vasthā deśakālabalaṃ prati| yasyāṃ kāryamakāryaṃ syāt karma kāryaṃ ca varjitam||26||
chardirhṛdrogagulmānāṃ vamanaṃ sve cikitsite| avasthāṃ prāpya nirdiṣṭaṃ kuṣṭhināṃ bastikarma ca||27||
tasmāt satyapi nirdeśe kuryādūhya svayaṃ dhiyā| vinā tarkeṇa yā siddhiryadṛcchāsiddhireva sā||28||
To sum up: –
Thus, five elimination therapies taken together called Pancha-karma is explained above in detail with reference to their following aspects;
Contra-indications of these therapies for different categories of diseases.
The reasons for which these therapies are contraindicated and
the ailments for which these therapies are indicted.
A wise physician should not make a judgement exclusively on the suggestions made above in this chapter. He should use his own discretions and reasoning in arriving at the correct judgement.
Due to the nature of the habitat, time and strength of the patient, situations may arise because of which the therapy indicated for an ailment becomes ineffective, and a prohibited therapy may become useful.
In the chapters dealing with the treatment of Chardi (vomiting), Hrd-Roga (heart –diseases) and Gulma (phantom tumour), emetic therapy [though normally prohibited] is prescribed in certain stages of these diseases. Similarly, Basti or enema therapy is prescribed in the chapter dealing with the treatment of Kusthaa (thought is generally prohibited] depending upon the stage of this disease.
Therefore, despite the directions laid down in this chapter, the physician should determine the correct therapy for an ailment by the use of his own discretion. The success achieved without the exercise of the power of reasoning (tarka) is nothing but only the success per chance. [24-28]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते सिद्धिस्थाने पञ्चकर्मीयसिद्धिर्नाम द्वितीयोऽध्यायः||२||
ityagniveśakṛte tantre carakapratisaṃskṛte’prāpte dṛḍhabalasampūrite siddhisthāne pañcakarmīyasiddhirnāma dvitīyo’dhyāyaḥ||2||
Thus, ends the second chapter of siddhi- section dealing with “the Perfect administration of Pancha- karma” in Agnivesha’s work as redacted by Charaka, and because of its non-availability, supplemented by Drdhabala.