Charaka Siddhisthana Chapter 7 – Basti Vyapat Siddhi

This article explains the 7th chapter of siddhisthana of Charaka samhita called ‘Basti vyapat Siddhi Adhyaya’. In this chapter, complications of basti and their treatment, importance of Basti etc. have been explained.

Prologue
अथातो बस्तिव्यापत्सिद्धिं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athāto bastivyāpatsiddhiṃ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātreyaḥ||2||
Now we shall explore chapter on “Basti vyapat siddhi”. Thus said Lord Atreya [1-2]

Topics discussed
धीधैर्यौदार्यगाम्भीर्यक्षमादमतपोनिधिम्| पुनर्वसुं शिष्यगणः पप्रच्छ विनयान्वितः||३||
काः कति व्यापदो बस्तेः किंसमुत्थानलक्षणाः| का चिकित्सा इति प्रश्नाञ्छ्रुत्वा तानब्रवीद्गुरुः||४||
dhīdhairyaudāryagāmbhīryakṣamādamataponidhim| punarvasuṃ śiṣyagaṇaḥ papraccha vinayānvitaḥ||3||
kāḥ kati vyāpado basteḥ kiṃsamutthānalakṣaṇāḥ| kā cikitsā iti praśnāñchrutvā tānabravīdguruḥ||4||
Punarvasu, the veritable storehouse of wisdom, fortitude, large heartedness, profundity, forgiveness, self control and penance was asked with humility by the group of disciples about the following topics:
Which complications arise out of basti administration ?
What is the number of these complications?
What are their causes?
What are their signs and symptoms? and
What is the treatment of these complications?
Having heard these questions, the teacher said as follows [to be discussed in the subsequent verses]. [3-4]
Read: Basti Chikitsa: Benefits, Routes, Types, Indications, Equipment

Complications of Improper Basti administration

Complications, Their Number and Etiology in General
नातियोगौ क्लमाध्माने हिक्का हृत्प्राप्तिरूर्ध्वता| प्रवाहिका शिरोङ्गार्तिः परिकर्तः परिस्रवः||५||
द्वादश व्यापदो बस्तेरसम्यग्योगसम्भवाः| आसामेकैकशो रूपं चिकित्सां च निबोधत||६||
nātiyogau klamādhmāne hikkā hṛtprāptirūrdhvatā| pravāhikā śiroṅgārtiḥ parikartaḥ parisravaḥ||5||
dvādaśa vyāpado basterasamyagyogasambhavāḥ| āsāmekaikaśo rūpaṃ cikitsāṃ ca nibodhata||6||
Twelve complications arising out of the improper administration (Asamyak Yoga) of Basti or enema are as follows:
Ayoga (under action or absence of any action),
Atiyoga (overaction),
Klama (mental fatigue),
Adhmana (flatulence),
Hikka (hiccup),
Hrt Prapti (cardiac disorders),
Urdhvata (excessive upward movement),
Pravahika (gripping pain),
Siro arti (headache),
Anga arti (body ache),
Parikartika (sawing pain) and
Parisrava (excessive discharge)

Signs (including aetiology) and treatment of each one of them will be described thereafter which you may hear (addressed to Agnivesha) [5-6]

Ayoga

Etiology, signs and Treatment of Ayoga:
गुरुकोष्ठेऽनिलप्राये रूक्षे वातोल्बणेऽपि वा| शीतोऽल्पलवणस्नेहद्रवमात्रो घनोऽपि वा||७||
बस्तिः सङ्क्षोभ्य तं दोषं दुर्बलत्वादनिर्हरन्| करोति गुरुकोष्ठत्वं वातमूत्रशकृद्ग्रहम्||८||
नाभिबस्तिरुजं दाहं हृल्लेपं श्वयथुं गुदे| कण्डूगण्डानि वैवर्ण्यमरुचिं वह्निमार्दवम्||९||
तत्रोष्णायाः प्रमथ्यायाः पानं स्वेदाः पृथग्विधाः| फलवर्त्योऽथवा कालं ज्ञात्वा शस्तं विरेचनम्||१०||
बिल्वमूलत्रिवृद्दारुयवकोलकुलत्थवान्| सुरादिमूत्रवान् बस्तिः सप्राक्पेष्यस्तमानयेत्||११||
gurukoṣṭhe’nilaprāye rūkṣe vātolbaṇe’pi vā| śīto’lpalavaṇasnehadravamātro ghano’pi vā||7||
bastiḥ saṅkṣobhya taṃ doṣaṃ durbalatvādanirharan| karoti gurukoṣṭhatvaṃ vātamūtraśakṛdgraham||8||
nābhibastirujaṃ dāhaṃ hṛllepaṃ śvayathuṃ gude| kaṇḍūgaṇḍāni vaivarṇyamaruciṃ vahnimārdavam||9||
tatroṣṇāyāḥ pramathyāyāḥ pānaṃ svedāḥ pṛthagvidhāḥ| phalavartyo’thavā kālaṃ jñātvā śastaṃ virecanam||10||
bilvamūlatrivṛddāruyavakolakulatthavān| surādimūtravān bastiḥ saprākpeṣyastamānayet||11||

Causes for Ayoga

The enema, while exciting the morbid matter does not help in their elimination because of its weak actions as a result of the following:
• Guru Koshta – If the patient is of costive bowel;
• Anila Praya – If the colon of the patient is dominated by vata
• Rooksha – If the body of the patient is un-unctuous, dry
• Vata Ulbana – If there is aggravation of vata in the body
• Sheeta – If the enema recipe is cold
• Alpa Lavana, Sneha Drava – If the recipe of enema contains less of salt, unctuous material and liquid
• Ghana – If the enema recipe is dense
• If the enema recipe is of small dose.

Effects for Ayoga

As a result of these factors, the patient suffers from the following;
• Guru Koshta – Heaviness in the gastro-intestinal tract
• Vata, Mutra, Shakrut Graha – Retention of flatus, urine and stool
• Nabhi, Basti Ruja, Pain in the umbilical region and urinary bladder
• Daha – Burning sensation
• Hrut Lepa (Hrullepa) – A feeling as if the heart is adhered with/enveloped by sticky material)
• Guda Shvayathu – Oedema in the rectum
• Kandu, Ganda – Itching and abscesses
• Vaivarnya – Discoloration of the skin
• Aruchi – Anorexia and
• Vahni Mandya – Decreased digestion strength

Treatment for Ayoga

The above-mentioned ailments can be treated with the following therapies and measures:
• Intake of hot Pramathya (warm digestive decoctions which are described in the treatment of Atisara – vide Charaka Chikitsa 19:20-21)
• Administration of different types of fomentation therapy
• Administration of Phala-Varti (medicated suppository)
• Administration of purgation therapy in appropriate time and
• Administration of enema recipe prepared of the root of Bilva, Trivrt, Devadaru, Yava, Kola, Kulattha, Sura etc., (Sauviraka, Tusodaka, etc.) and cow’s urine by adding the paste of drugs described earlier, (viz, Bala etc., described in Siddhi 3:13) [7-11]
Read: Niruha Basti (Kashaya Basti) Panchakarma Method, Uses, Side Effects

Ati Yoga

Etiology, signs and Treatment of AtiYoga
स्निग्धस्विन्नेऽतितीक्ष्णोष्णो मृदुकोष्ठेऽतियुज्यते|तस्य लिङ्गं चिकित्सा च शोधनाभ्यां समा भवेत्||१२||
पृश्निपर्णीं स्थिरां पद्मं काश्मर्यं मधुकं बलाम्| पिष्ट्वा द्राक्षां मधूकं च क्षीरे तण्डुलधावने||१३||
द्राक्षायाः पक्वलोष्टस्य प्रसादे मधुकस्य च| विनीय सघृतं बस्तिं दद्याद्दाहेऽतियोगजे [२] ||१४||
snigdhasvinne’titīkṣṇoṣṇo mṛdukoṣṭhe’tiyujyate|tasya liṅgaṃ cikitsā ca śodhanābhyāṃ samā bhavet||12||
pṛśniparṇīṃ sthirāṃ padmaṃ kāśmaryaṃ madhukaṃ balām| piṣṭvā drākṣāṃ madhūkaṃ ca kṣīre taṇḍuladhāvane||13||
drākṣāyāḥ pakvaloṣṭasya prasāde madhukasya ca| vinīya saghṛtaṃ bastiṃ dadyāddāhe’tiyogaje [2] ||14||
Ati-Yoga (over-action) is caused by the administration of excessively sharp and hot recipes as enema to a person who is oleated and fomented, and who has a lax bowel. The signs and treatment are similar to those prescribed for the treatment of atiyoga (over action) of emetic and purgative therapies.
The recipe for Basti is prepared by adding the paste of Prsniparni, Sthira, Padma, Kasmarya, Madhuka, Bala, Draksa and Madhuka to milk, Tandulodaka (rice-water) and sita-Kasaya (cold infusion) of Draksa, baked earth and Madhuka.
This basti when administered with ghee cures Daha (burning sensation) caused by Ati-Yoga (over action) of Niruha. [12-14]

Klama

Etiology, signs and Treatment of Klama
आमशेषे निरूहेण मृदुना दोष ईरितः|मार्गं रुणद्धि वातस्य हन्त्यग्निं मूर्च्छयत्यपि||१५||
क्लमं विदाहं हृच्छूलं मोहवेष्टनगौरवम्|कुर्यात् स्वेदैर्विरूक्षैस्तं पाचनैश्चाप्युपाचरेत्||१६||
पिप्पलीकत्तृणोशीरदारुमूर्वाशृतं जलम्|पिबेत् सौवर्चलोन्मिश्रं दीपनं हृद्विशोधनम्||१७||
वचानागरशट्येला दधिमण्डेन मूर्च्छिताः|पेयाः प्रसन्नया वा स्युररिष्टेनासवेन वा||१८||
दारु त्रिकटुकं पथ्यां पलाशं चित्रकं शटीम्|पिष्ट्वा कुष्ठं च मूत्रेण पिबेत् क्षारांश्च दीपनान्||१९||
बस्तिमस्य विदध्याच्च समूत्रं दाशमूलिकम्|समूत्रमथवा व्यक्तलवणं माधुतैलिकम्||२०||
āmaśeṣe nirūheṇa mṛdunā doṣa īritaḥ|mārgaṃ ruṇaddhi vātasya hantyagniṃ mūrcchayatyapi||15||
klamaṃ vidāhaṃ hṛcchūlaṃ mohaveṣṭanagauravam|kuryāt svedairvirūkṣaistaṃ pācanaiścāpyupācaret||16||
pippalīkattṛṇośīradārumūrvāśṛtaṃ jalam|pibet sauvarcalonmiśraṃ dīpanaṃ hṛdviśodhanam||17||
vacānāgaraśaṭyelā dadhimaṇḍena mūrcchitāḥ|peyāḥ prasannayā vā syurariṣṭenāsavena vā||18||
dāru trikaṭukaṃ pathyāṃ palāśaṃ citrakaṃ śaṭīm|piṣṭvā kuṣṭhaṃ ca mūtreṇa pibet kṣārāṃśca dīpanān||19||
bastimasya vidadhyācca samūtraṃ dāśamūlikam|samūtramathavā vyaktalavaṇaṃ mādhutailikam||20||
If a mild recipe is used for NiruhaBasti, when there is residual Ama (product of improper digestion) in the gastrointestinal tract, then the Doshas (Pitta and Kapha along with Ama) excited by enema obstruct the channel of vata that causes perversion and suppression of the power of digestion, further aggravation of vata, mental fatigue, burning sensation, cardiac pain, stupefaction, cramps and heaviness.

Such a patient is treated by fomentation with un-unctuous (dry) ingredients, and Pachana (carminatives).
The patient should drink water boiled with Pippali, kattrna, Usira, Devadaru and Murva by adding sauvarcala salt which stimulates the power of digestion and cleanses the heart.
The powder of Vacha, Nagara, Shati and Ela is added with whey. This recipe is taken along with Prasanna, Arista or Asava (a type of alcoholic preparations).
The patient should take the paste of Devadaru, Sunthi, Pippali, Marica, Pathya, Palasa, Citraka, Sati and Kustha along with the cow’s urine.
He may also take alkali preparations which are digestive stimulants (described in Charaka Chikitsa 15: 168:193)
He is given Basti prepared of Bilva, Shyonaka,Gambhari, Patala, Gani-Karika, Salaparni, Prsniparni, Brhati, Kantakari and Goksura along with cow’s urine. [The enema recipe containing this Dashamula is described in siddhi 3:35-36]
Alternatively, he may also take Madhu Tailika Basti (to be described later in Siddhi 12:18:13) added with cow’s urine and adequate quantity of salt. [15-20]

Adhmana

Etiology, signs and Treatment of adhmana
अल्पवीर्यो महादोषे रूक्षे क्रूराशये कृतः|बस्तिर्दोषावृतो रुद्धमार्गो रुन्ध्यात् समीरणम्||२१||
स विमार्गोऽनिलः कुर्यादाध्मानं मर्मपीडनम्|विदाहं गुरुकोष्ठस्य मुष्कवङ्क्षणवेदनाम्||२२||
रुणद्धि हृदयं शूलैरितश्चेतश्च धावति|श्यामाफलादिभिः कुष्ठकृष्णालवणसर्षपैः||२३||
धूममाषवचाकिण्वक्षारचूर्णगुडैः कृताम्|कराङ्गुष्ठनिभां वर्तिं यवमध्यां निधापयेत् ||२४||
अभ्यक्तस्विन्नगात्रस्य तैलाक्तां स्नेहिते गुदे|अथवा लवणागारधूमसिद्धार्थकैः कृताम्||२५||
बिल्वादिना निरूहः स्यात् पीलुसर्षपमूत्रवान्|सरलामरदारुभ्यां सिद्धं चैवानुवासनम्||२६||
alpavīryo mahādoṣe rūkṣe krūrāśaye kṛtaḥ|bastirdoṣāvṛto ruddhamārgo rundhyāt samīraṇam||21||
sa vimārgo’nilaḥ kuryādādhmānaṃ marmapīḍanam|vidāhaṃ gurukoṣṭhasya muṣkavaṅkṣaṇavedanām||22||
ruṇaddhi hṛdayaṃ śūlairitaścetaśca dhāvati|śyāmāphalādibhiḥ kuṣṭhakṛṣṇālavaṇasarṣapaiḥ||23||
dhūmamāṣavacākiṇvakṣāracūrṇaguḍaiḥ kṛtām|karāṅguṣṭhanibhāṃ vartiṃ yavamadhyāṃ nidhāpayet ||24||
abhyaktasvinnagātrasya tailāktāṃ snehite gude|athavā lavaṇāgāradhūmasiddhārthakaiḥ kṛtām||25||
bilvādinā nirūhaḥ syāt pīlusarṣapamūtravān|saralāmaradārubhyāṃ siddhaṃ caivānuvāsanam||26||

If enema of mild potency is given to a person who has excessively aggravated Doshas, whose body is un-unctuous and who has costive bowel, then it gets occluded by Doshas, and gets clogged in the channel thereby causing obstruction to the movement of vata. This vata then moves through a diverted path thereby causing exceedingly painful Adhmana (flatulence), Vidaha (burning sensation), Guru Kosthata (heaviness of the gastro- intestinal tract) and pain in the testicles as well as groins. It causes impediment in the functioning of the heart by causing cardiac pain, and moves about irregularly in different directions.

A varti (medicated suppository) of the size of thumb, and sharp of barley seed is prepared of Shyama, etc. (nine drugs viz Shyama, Trivrt, Chaturangula, Tilvaka, Mahavrksa, Saptala, sankhini, Danti and Dravanti-vide kalpa 1: 6),Phala etc., (six drugs, viz, Phala, Jimutaka, Iksvaku, Dhamargava, Kutaja and Salt, Sarsapa, powder of dhuma (kitchen soot), Masa, Vacha, Kinva (yeast) and Ksara (alkali) and jaggery.

Alternatively, this Varti (suppository) can be prepared by adding salt, kitchen soot and Siddharthaka (to Shyama, etc., and Phala etc. described above).
These suppositories may be smeared with oil and inserted into the lubricated anus of the patient who is precisely given massage and fomentation therapies.
The patient may be given Niruha with a recipe containing bilva etc., (vide verse no. 11) and added with pilu, sarsapa and cow’s urine.
Oil cooked with Sarala and Devadaru may be used for giving anuvasana basti or unctuous types of enema to the patient. [21-26]
Read: Anuvasana Basti: Method, Benefits, Mode Of Action, Contra Indications

Hikka

Etiology, signs and Treatment of Hikka
मृदुकोष्ठेऽबले बस्तिरतितीक्ष्णोऽतिनिर्हरन्|कुर्याद्धिक्कां, हितं तस्मै हिक्काघ्नं बृंहणं च यत्||२७||
बलास्थिरादिकाश्मर्यत्रिफलागुडसैन्धवैः|सप्रसन्नारनालाम्लैस्तैलं पक्त्वाऽनुवासयेत्||२८||
कृष्णालवणयोरक्षं पिबेदुष्णाम्बुना युतम् |धूमलेहरसक्षीरस्वेदाश्चान्नं च वातनुत्||२९||
mṛdukoṣṭhe’bale bastiratitīkṣṇo’tinirharan|kuryāddhikkāṃ, hitaṃ tasmai hikkāghnaṃ bṛṃhaṇaṃ ca yat||27||
balāsthirādikāśmaryatriphalāguḍasaindhavaiḥ|saprasannāranālāmlaistailaṃ paktvā’nuvāsayet||28||
kṛṣṇālavaṇayorakṣaṃ pibeduṣṇāmbunā yutam |dhūmaleharasakṣīrasvedāścānnaṃ ca vātanut||29||

If a very strong recipe of Basti is administered to a person having laxed bowel and weakness, then it causes elimination of morbid matter in excess quantity as a result of which the patient suffers from Hikka (hiccup).
For this is given Anuvasana Basti or unctuous types of medicated enema with oil cooked by adding Bala, Sthira etc., Kasmarya, Haritaki, Bibhitaka, Amalaki, Guda, Saindhava, Prasanna and sour Aranala.
The patient may take one Aksha (12 g) of powder of Krishna (pippali) and rock-salt along with hot water.
He is given vata-alleviating dhuma (smoking therapy), linctus, meat-soup, medicated milk, fomentation therapy and suitable food. [27-29]

Hrit prapti

Aetiology, signs and treatment of Hrt-Prapti
अतितीक्ष्णः सवातो वा न वा सम्यक् प्रपीडितः| घट्टयेद्धृदयं बस्तिस्तत्र काशकुशेत्कटैः||३०||
स्यात् साम्ललवणस्कन्धकरीरबदरीफलैः| शृतैर्बस्तिर्हितः सिद्धं वातघ्नैश्चानुवासनम्||३१||
atitīkṣṇaḥ savāto vā na vā samyak prapīḍitaḥ| ghaṭṭayeddhṛdayaṃ bastistatra kāśakuśetkaṭaiḥ||30||
syāt sāmlalavaṇaskandhakarīrabadarīphalaiḥ| śṛtairbastirhitaḥ siddhaṃ vātaghnaiścānuvāsanam||31||

If the enema recipe is of exceedingly strong nature, if the enema fluid is injected along with air, or if appropriate pressure is not applied over the receptacle of enema-fluid during administration, then this afflicts the heart.
In this case the decoction of Kasa, Kusa, Itkata, drugs belonging to Amla (sour) and Lavana (saline) Skanadha (group) Karira and fruit of Badari is used for enema (Niruha). The patient may also be given Anuvasana or an unctuous type of enema prepared with vata-alleviating drugs (like Dashamula). [30-31]

Urdhwa gamana

Aetiology, signs and treatment of urdhva-Gamana (Upward movement)
वातमूत्रपुरीषाणां दत्ते वेगान्निगृह्णतः|अति वा पीडितो बस्तिर्मुखेनायाति वेगवान्||३२||
मूर्च्छाविकारं तस्यादौ दृष्ट्वा शीताम्बुना मुखम्| सिञ्चेत् पार्श्वोदरं चाधः प्रमृज्याद्वीजयेच्च तम्||३३||
केशेष्वालम्ब्य चाकाशे धुनुयात्त्रासयेच्च तम्| गोखराश्वगजैः सिंहै राजप्रेष्यैस्तथोरगैः||३४||
उल्काभिरेवमन्यैश्च भीतस्याधः प्रवर्तते| वस्त्रपाणिग्रहैः कण्ठं रुन्ध्यान्न म्रियते यथा||३५||
प्राणोदाननिरोधाद्धि प्रसिद्धतरमार्गवान् | अपानः पवनो बस्तिं तमाश्वेवापकर्षति||३६||
ततः क्रमुककल्काक्षं पाययेताम्लसंयुतम्| औष्ण्यात्तैक्ष्यात् सरत्वाच्च बस्तिं सोऽस्यानुलोमयेत्||३७||
पक्वाशयस्थिते स्विन्ने निरूहो दाशमूलिकः| यवकोलकुलत्थैश्च विधेयो मूत्रसाधितः||३८||
बिल्वादिपञ्चमूलेन सिद्धो बस्तिरुरःस्थिते| शिरःस्थे नावनं धूमः प्रच्छाद्यं सर्षपैः शिरः||३९||
vātamūtrapurīṣāṇāṃ datte vegānnigṛhṇataḥ|ati vā pīḍito bastirmukhenāyāti vegavān||32||
mūrcchāvikāraṃ tasyādau dṛṣṭvā śītāmbunā mukham| siñcet pārśvodaraṃ cādhaḥ pramṛjyādvījayecca tam||33||
keśeṣvālambya cākāśe dhunuyāttrāsayecca tam| gokharāśvagajaiḥ siṃhai rājapreṣyaistathoragaiḥ||34||
ulkābhirevamanyaiśca bhītasyādhaḥ pravartate| vastrapāṇigrahaiḥ kaṇṭhaṃ rundhyānna mriyate yathā||35||
prāṇodānanirodhāddhi prasiddhataramārgavān | apānaḥ pavano bastiṃ tamāśvevāpakarṣati||36||
tataḥ kramukakalkākṣaṃ pāyayetāmlasaṃyutam| auṣṇyāttaikṣyāt saratvācca bastiṃ so’syānulomayet||37||
pakvāśayasthite svinne nirūho dāśamūlikaḥ| yavakolakulatthaiśca vidheyo mūtrasādhitaḥ||38||
bilvādipañcamūlena siddho bastiruraḥsthite| śiraḥsthe nāvanaṃ dhūmaḥ pracchādyaṃ sarṣapaiḥ śiraḥ||39||

If after the administration of enema the patient suppresses the natural urges for voiding flatus, urine and stool, and if excessive pressure is applied over the Basti Putaka during the administration of this therapy, then because of forceful flow the enema fluid comes out through the oral cavity.

If on account of this there is fainting, the following remedial measures are undertaken:
• In the beginning the face of the patient is sprinkled with cold water.
• His sides of the chest and abdomen are squeezed downwards;
• He is fanned;
• He is pulled up to the mid-air by holding his hair, and shaken;
• He is frightened by means of infuriated bull, ass, horse, elephant, lion, and executions of the king, serpents, fire-works and such other fearful objects. Being terrified in this manner, the enema fluid will start flowing downwards.
• The throat of the patient is squeezed with the help of a piece of cloth or by hand, taking care not to asphyxiate the patient, which may otherwise lead to his death. By the obstruction to the path of prana and udana caused in the above said manner, the Apana vata becomes predominant in the passage, and instantaneously draws the fluid downwards to the normal course.
• Thereafter, one Aksa (12 g) of the paste of Kramuka (Puga phala) added with sour juice is given to the patient to drink, because of hot, sharp and mobile attributes, the recipe helps in the downward movement of the enema-fluid.
• If the enema fluid is located in the Pakvasaya (colon), then the patient is given fomentation therapy and thereafter, Niruha type of enema is given with a recipe containing Dashamula, Yava, Kola and Kulattha cooked by adding cow’s urine;
• If the enema- fluid is located in the chest region, then Niruha Basti prepared by cooking Panacamula (Bilva, Shyonaka, Gambhari, patala and ganikarika) is administered and
• If the enema fluid gets located in the head (upper part of the body) then the patient is given Navana (inhalation therapy) and Dhuma (smoking therapy) after anointing his head with the mustard paste. [32-39]

Pravahika

Etiology, signs and Treatment of Pravahika (gripping Pain)
स्निग्धस्विन्ने महादोषे बस्तिर्मृद्वल्पभेषजः|उत्क्लिश्याल्पं हरेद्दोषं जनयेच्च प्रवाहिकाम्||४०||
स बस्तिपायुशोफेन जङ्घोरुसदनेन वा|निरुद्धमारुतो जन्तुरभीक्ष्णं सम्प्रवाहते||४१||
स्वेदाभ्यङ्गान्निरूहांश्च शोधनीयानुलोमिकान्| विदध्याल्लङ्घयित्वा तु वृत्तिं कुर्याद्विरिक्तवत्||४२||
snigdhasvinne mahādoṣe bastirmṛdvalpabheṣajaḥ|utkliśyālpaṃ hareddoṣaṃ janayecca pravāhikām||40||
sa bastipāyuśophena jaṅghorusadanena vā|niruddhamāruto janturabhīkṣṇaṃ sampravāhate||41||
svedābhyaṅgānnirūhāṃśca śodhanīyānulomikān| vidadhyāllaṅghayitvā tu vṛttiṃ kuryādviriktavat||42||

If a mild recipe of enema is administered in a small dose to patient who is oleated and fomented, and whose body is afflicted with excessively aggravated Doshas, then after excitation this enema eliminates morbid material (Doshas) only in small quantity thereby causing Pravahika (dysentery).
The patient having obstructed vata passes stool frequently because of the inflation of the bladder (basti) and anus, and asthenia of calf region as well as thighs.
In such cases, after fasting, the patient is given fomentation, massage and Niruha type of enema with recipes containing drugs which are Shodaniya or purificatory (like Trivrt etc.), and Anulomaniya or inducing downward movement of vata (like milk, sugarcane juice) in nature. He should resort to regimens as prescribed for a person who has undergone purgation therapy. [40-42]

Shiro arti

Aetiology, signs and treatment of shirorti (headache)
दुर्बले क्रूरकोष्ठे च तीव्रदोषे तनुर्मृदुः| शीतोऽल्पश्चावृतो दोषैर्बस्तिस्तद्विहतोऽनिलः||४३||
मार्गैर्गात्राणि सन्धावन्नूर्ध्वं मूर्ध्नि विहन्यते| ग्रीवां मन्ये च गृह्णाति शिरः कण्ठं भिनत्ति च||४४||
बाधिर्यं कर्णनादं च पीनसं नेत्रविभ्रमम्| कुर्यादभ्यञ्जनं तैललवणेन यथाविधि||४५||
युञ्ज्यात् प्रधमनैर्नस्यैर्धूमैरस्य विरेचयेत्| तीक्ष्णानुलोमिकेनाथ स्निग्धं भुक्तेऽनुवासयेत् [६] ||४६||
durbale krūrakoṣṭhe ca tīvradoṣe tanurmṛduḥ| śīto’lpaścāvṛto doṣairbastistadvihato’nilaḥ||43||
mārgairgātrāṇi sandhāvannūrdhvaṃ mūrdhni vihanyate| grīvāṃ manye ca gṛhṇāti śiraḥ kaṇṭhaṃ bhinatti ca||44||
bādhiryaṃ karṇanādaṃ ca pīnasaṃ netravibhramam| kuryādabhyañjanaṃ tailalavaṇena yathāvidhi||45||
yuñjyāt pradhamanairnasyairdhūmairasya virecayet| tīkṣṇānulomikenātha snigdhaṃ bhukte’nuvāsayet [6] ||46||

If the enema recipe which is thin, mild and cooling in nature is administered in a small dose to a patient who is weak, who has costive bowel and who is afflicted with exceedingly aggravated Doshas, then the enema fluid gets occluded by doshas. The vata, thus pressed, moves fast through the channels to different parts of the body, causes stiffness of the neck and temples and gets stuck up in the head and throat, causing deafness, tinnitus, coryza and agitation of the eyes.

The patient is given following therapies:
• Massage with oil mixed with salt in appropriate manner
• Elimination of Doshas by Pradhamana nasya (inhalation therapy given by blowing drugs into the nostrils) and vairechanika dhuma (dosha purging smoking therapy)
• Enema prepared with drugs which are Tikshna (sharp) and Anulomika (causing downward movement of vata) is given after food to the patient who has been oleated [43-46]
Read: Mode Of Action Of Basti Panchakarma Treatment

Anga arti

Aetiology, signs and treatment of Angarti (Pain in Limbs)
स्नेहस्वेदैरनापाद्य गुरुस्तीक्ष्णोऽतिमात्रया| यस्य बस्तिः प्रयुज्येत सोऽतिमात्रं प्रवर्तयेत्||४७||
स्रुतेषु तस्य दोषेषु निरूढस्यातिमात्रशः| स्तब्धोदावृतकोष्ठस्य वायुः सम्प्रतिहन्यते||४८||
विलोमनसमुद्भूतो रुजत्यङ्गानि देहिनः| गात्रवेष्टननिस्तोदभेदस्फुरणजृम्भणैः ||४९||
तं तैललवणाभ्यक्तं सेचयेदुष्णवारिणा| एरण्डपत्रनिष्क्वाथैः प्रस्तरैश्चोपपादयेत्||५०||
यवान् कुलत्थान् कोलानि पञ्चमूले तथोभये| जलाढकद्वये पक्त्वा पादशेषेण तेन च||५१||
कुर्यात् सबिल्वतैलोष्णलवणेन निरूहणम्| तं निरूढं समाश्वस्तं द्रोण्यां समवगाहयेत्||५२||
ततो भुक्तवतस्तस्य कारयेदनुवासनम्| यष्टीमधुकतैलेन बिल्वतैलेन वा भिषक् ||५३||
snehasvedairanāpādya gurustīkṣṇo’timātrayā| yasya bastiḥ prayujyeta so’timātraṃ pravartayet||47||
sruteṣu tasya doṣeṣu nirūḍhasyātimātraśaḥ| stabdhodāvṛtakoṣṭhasya vāyuḥ sampratihanyate||48||
vilomanasamudbhūto rujatyaṅgāni dehinaḥ| gātraveṣṭananistodabhedasphuraṇajṛmbhaṇaiḥ ||49||
taṃ tailalavaṇābhyaktaṃ secayeduṣṇavāriṇā| eraṇḍapatraniṣkvāthaiḥ prastaraiścopapādayet||50||
yavān kulatthān kolāni pañcamūle tathobhaye| jalāḍhakadvaye paktvā pādaśeṣeṇa tena ca||51||
kuryāt sabilvatailoṣṇalavaṇena nirūhaṇam| taṃ nirūḍhaṃ samāśvastaṃ droṇyāṃ samavagāhayet||52||
tato bhuktavatastasya kārayedanuvāsanam| yaṣṭīmadhukatailena bilvatailena vā bhiṣak ||53||

If without oleation and fermentation therapies, the patient is given enema, ingredients of which are Guru (heavy) and Tikshna (sharp) in large doses, and then there will be excessive elimination.
When the Dosha is eliminated in excessive quantity by Niruha Basti, then because of stiffness and occlusion in the gastro-intestinal tract vata gets impeded. By its upward movement, it causes pain in the limbs of a person in the form of cramps, pricking pain, breaking pain, throbbing pain and Jrmbhana (stretc.hing pain).

To this patient, a massage with oil added with salt is given, and his body is sprinkled with warm water. He is given fomentation with the decoction of the leaves of Eranda and Prastara type of fomentation (vide Sutra 14: 47: 48)
Yava, Kulattha, Kola and both the type of Panacamula (Dashamoola), is added with two adhakas (512 tolas) of water, and boiled till one fourth of the liquid remains. To this decoction, warm Bilva Taila and salt is added. This recipe may be used for NiruhaBasti. Thereafter, the patient is comforted and given a tub bath.
After he has taken food, the physician should be given anuvasana or unctuous types of enema with Yastimadhu Taila or Bilva Taila. [47-53]

Parikartika

Aetiology, Signs and Treatment of Parikartika (Sawing Pain)
मृदुकोष्ठाल्पदोषस्य रूक्षस्तीक्ष्णोऽतिमात्रवान्| बस्तिर्दोषान्निरस्याशु जनयेत् परिकर्तिकाम्||५४||
त्रिकवङ्क्षणबस्तीनां तोदं नाभेरधो रुजम्| विबन्धोऽल्पाल्पमुत्थानंबस्तिनिर्लेखनाद्भवेत्||५५||
स्वादुशीतौषधैस्तत्र पय इक्ष्वादिभिः शृतम्| यष्ट्याह्वतिलकल्काभ्यां बस्तिः स्यात् क्षीरभोजिनः||५६||
ससर्जरसयष्ट्याह्वजिङ्गिनीकर्दमाञ्जनम्| विनीय दुग्धे बस्तिः स्यात् व्यक्ताम्लमृदुभोजिनः||५७||
mṛdukoṣṭhālpadoṣasya rūkṣastīkṣṇo’timātravān| bastirdoṣānnirasyāśu janayet parikartikām||54||
trikavaṅkṣaṇabastīnāṃ todaṃ nābheradho rujam| vibandho’lpālpamutthānaṃbastinirlekhanādbhavet||55||
svāduśītauṣadhaistatra paya ikṣvādibhiḥ śṛtam| yaṣṭyāhvatilakalkābhyāṃ bastiḥ syāt kṣīrabhojinaḥ||56||
sasarjarasayaṣṭyāhvajiṅginīkardamāñjanam| vinīya dugdhe bastiḥ syāt vyaktāmlamṛdubhojinaḥ||57||
If enema with dry (un-unctuous) and sharp ingredients is given to a patient who has laxed bowel and who has less of aggravated Doshas, then it immediately eliminates Doshas to cause partikartika (sawing pain), pricking pain in the lumbar region, groins and the region of urinary bladder and pain in the lower abdomen below the umbilical region. Because of the scraping effect of enema, the patient suffers from constipation and frequent voiding of stool in small quantities.
Milk is boiled by adding sweet and cooling ingredients like sugarcane, etc. To this medicated milk, the paste of Yastimadhu and Tila is added. Enema is given with this recipe keeping the patient on a milk diet.
Milk is added with Sarjarasa, Yastimadhu, Jingini, Kardama (mud) and Anjana (solid extract of Daruharidra). This recipe is added with sour juice and used as enema for the patient who is on a soft diet. [54-57]

Parisrava

Aetiology, Signs and Treatment of Parisrava (Anal Exudation)
पित्तरोगेऽम्ल उष्णो वा तीक्ष्णो वा लवणोऽथवा|बस्तिर्लिखति पायुं तु क्षिणोति विदहत्यपि||५८||
स विदग्धः स्रवत्यस्रं पित्तं चानेकवर्णवत्|सार्यते बहुवेगेनमोहं गच्छति चासकृत्||५९||
आर्द्रशाल्मलिवृन्तैस्तु क्षुण्णैराजं पयः शृतम्|सर्पिषा योजितं शीतं बस्तिमस्मै प्रदापयेत्||६०||
वटादिपल्लवेष्वेष कल्पो यवतिलेषु च|सुवर्चलोपोदिकयोः कर्बुदारे च शस्यते||६१||
गुदे सेकाः प्रदेहाश्च शीताः स्युर्मधुराश्च ये| रक्तपित्तातिसारघ्नी क्रिया चात्र प्रशस्यते||६२||
pittaroge’mla uṣṇo vā tīkṣṇo vā lavaṇo’thavā|bastirlikhati pāyuṃ tu kṣiṇoti vidahatyapi||58||
sa vidagdhaḥ sravatyasraṃ pittaṃ cānekavarṇavat|sāryate bahuvegenamohaṃ gacchati cāsakṛt||59||
ārdraśālmalivṛntaistu kṣuṇṇairājaṃ payaḥ śṛtam|sarpiṣā yojitaṃ śītaṃ bastimasmai pradāpayet||60||
vaṭādipallaveṣveṣa kalpo yavatileṣu ca|suvarcalopodikayoḥ karbudāre ca śasyate||61||
gude sekāḥ pradehāśca śītāḥ syurmadhurāśca ye| raktapittātisāraghnī kriyā cātra praśasyate||62||

If a patient suffering from Paittika diseases is given enema with ingredients which are sour, hot, sharp or saline, then this causes seeping of the anus resulting in ulceration and burning sensation. From this inflamed anus there is exudation of blood and Pitta having variegated colour. Because of forceful exudation the patient faints frequently.
To this patient, cold enema of goat’s milk boiled by adding pounded green stalks of Salmali, and added with ghee is given.
This enema may also be prepared with the following recipes:
Leaves of vata, etc.:
Yava and Tila
Sauvarcala (Sunisannaka) and Upodika and
Karbudara (Kancanara)
The anal region of the patient is sprinkled or anointed with drugs which are cooling and sweet. Therapies prescribed for Raktapitta (vide Chikitsa 3) atisara (vide Chikitsa 19) are useful in this condition. [ 58-62]

Drugs for mild and strong enema

तीक्ष्णत्वं मूत्रपील्वग्निलवणक्षारसर्षपैः| प्राप्तकालं विधातव्यं क्षीराद्यैर्मार्दवं तथा||६३||
tīkṣṇatvaṃ mūtrapīlvagnilavaṇakṣārasarṣapaiḥ| prāptakālaṃ vidhātavyaṃ kṣīrādyairmārdavaṃ tathā||63||
When required, the recipe of enema can be made strong by adding ingredients like cow’s urine, Pilu (a fruit of Uttarapatha), Agni (Citraka), salt, Alkalies and mustard seed. By adding milk, etc., the enema recipe can be made milder in action when required. [63]

Importance of Basti

आपादतलमूर्धस्थान् दोषान् पक्वाशये स्थितः| वीर्येण बस्तिरादत्ते खस्थोऽर्को भूरसानिव||६४||
āpādatalamūrdhasthān doṣān pakvāśaye sthitaḥ| vīryeṇa bastirādatte khastho’rko bhūrasāniva||64||
Basti (medicated enema) lodged in the colon, by its potency, draws [and eliminates] morbid Doshas located in the entire body – extending right from the toes to the head, just like the sun situated in the sky absorbs all the moisture (lit. juice) from the earth. [64]

Elimination of Morbid Matter Excluding Nutrients

यद्वत् कुसुम्भसम्मिश्रात्तोयाद्रागं हरेत् पटः| तद्वद्द्रवीकृताद्देहान्निरूहो निर्हरेन्मलान्||६५||
yadvat kusumbhasammiśrāttoyādrāgaṃ haret paṭaḥ| tadvaddravīkṛtāddehānnirūho nirharenmalān||65||
Just like a piece of cloth soaked in the water mixed with the powder of Kusumbha (a vegetable dye) sucks up only the colour (the colour pigments), the Niruha (evacuative) type of medicated enema eliminates only the morbid material (faeces, doshas) from the body of a person in whom the morbid material has been liquefied following proper administration of oleation and fomentation therapies. [65]

तत्र श्लोकः-
इत्येता व्यापदः प्रोक्ता बस्तेः साकृतिभेषजाः| बुद्ध्वा कार्त्स्न्येन तान् बस्तीन्नियुञ्जन्नापराध्यति||६६||
tatra ślokaḥ-
ityetā vyāpadaḥ proktā basteḥ sākṛtibheṣajāḥ| buddhvā kārtsnyena tān bastīnniyuñjannāparādhyati||66||
To sum up: – Thus, the complications of Basti along with their signs and treatment are described. The physician administering Basti (medicated enema) after comprehension of this therapy does not commit any error. [66]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते सिद्धिस्थाने बस्तिव्यापत्सिद्धिर्नाम सप्तमोऽध्यायः||७||
ityagniveśakṛte tantre carakapratisaṃskṛte’prāpte dṛḍhabalasampūrite siddhisthāne bastivyāpatsiddhirnāma saptamo’dhyāyaḥ||7||
Thus, ends the seventh chapter of Siddhi- Sthana dealing with “the SuccessfulTreatment of Complications of Basti therapy” in Agnivesha’s work as redacted by Charaka, and because of its non availability, supplemented by Drdhabala.