अथातो बस्तिव्यापत्सिद्धिं व्याख्यास्यामः ।
इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter Basti vyapat siddhi successful management of complications of enema therapy; thus said Atreya and other great sages.
Niruha basti vyapat – complications of decoction enema
अस्निग्धस्विन्नदेहस्य गुरुकोष्ठस्य योजितः । शीतोऽल्पस्नेहलवणद्रव्यमात्रो घनोऽपि वा ॥ १ ॥
बस्तिः सङ्क्षोभ्य तं दोषं दुर्बलत्वादनिर्हरन् । करोत्ययोगं तेन स्याद्वातमूत्रशकृद्ग्रहः ।। २ ।।
नाभिबस्तिरुजा दाहो हल्लेपः श्वयथुर्गुदे । कण्डूर्गण्डानि वैवर्ण्यमरतिर्वह्निमार्दवम् ॥ ३ ॥
क्वाथद्वयं प्राग्विहितं मध्यदोषेऽतिसारिणि ।
उष्णस्य तस्मादेकस्य तत्र पानं प्रशस्यते ॥ ४ ॥
फलवर्त्यस्तथा स्वेदाः कालं ज्ञात्वा विरेचनम् ।
बिल्वमूलत्रिवृद्दारुयवकोलकुलत्थवान् सुरादिमूत्रवान् बस्तिः सप्राक्पेष्यस्तमानयेत् । ॥५॥
Enema administered to the person who has not been administered oleation and sudation therapies, who has hard bowels, the enema material being cold, containing little quantity of fats, salt and drugs (decoction and paste) or the liquid being thick in consistence-aggravates that dosa (for elimination of which it is administered) and not expelling it out because of its poor strength produces Ayoga (inadequacy of elimination of enema liquid) giving rise to no non-expulsion of flatus, urine and faeces, pain in the umbilicus and urinary bladder, burning sensation, feeling of the heart being coated, swelling of the rectum, itching, appearance of enlarged nodes, discolouration, restlessness and weakness of digestive fire. The treatment for this is, the administration of one of the two decoctions prescribed for diarrhoea of moderate increase of the dosas described earlier ( chapter 9 of cikitsitasthana) to be consumed warm. Use of rectal suppositories prepared from fruits, different kinds of sudations, and administration of purgative therapy appropriate to the season, enemas with the decoction of root of bilva, trivrt, daru, yava, kola and kulattha added with sura etc. ( fermented liquids) cow’s urine and paste of drugs mentioned earlier (chapter 4 of kalpasthana) should also be administered. 1-6a.
युक्तोऽल्पवीर्यो दोषाढ्ये रूक्षे क्रूराशयेऽथवा ॥ ६ ॥
बस्तिर्दोषावृतो रुद्धमार्गो रुन्ध्यात्समीरणम् । स विमार्गोऽनिलः कुर्यादाध्मानं मर्मपीडनम् ॥ ७ ॥
विदाहं गुदकोष्ठस्य मुष्कवड्ङ्क्षणवेदनाम् । रुणद्धि हृदयं शूलैरतिश्चेतश्च धावति ॥ ८ ॥
स्वभ्यक्तस्विन्नगात्रस्य तत्र वर्तिं प्रयोजयेत् । बिल्वादिश्च निरूहः स्यात्पीलुसर्षपमूत्रवान् ॥ ९ ॥
सरलामरदारुभ्यां साधितं चानुवासनम् ।
Enema of mild potency administered to the person who has great increase of the dosas, who has dryness (inside the alimentary tract) or who has hard bowels, the enema liquid getting surrounded by the dosas and obstructed in its channels from going out, produces obstruction of samirana ( vata ). Then anila (vata ), begins to move in wrong directions, gives rise to flatulence, pain in vital organs, burning sensation, of the rectum and alimentary tract, pain in the scrotum and groins, grips the heart, and moves here and there causing pain. The treatment for this is-administration of rectal suppositories, after giving oleation and sudatian therapies, niruha (decoction enema) with decoction of bilva etc. (mentioned in verse no-5) added with paste of pilu and sarsapa and cow’s urine), anuvasana (lubricating / fat enema) prepared with sarala and amaradaru. 6b-10a.
कुर्वतो वेगसंरोधं पीडितो वाऽतिमात्रया ॥ १० ॥
अस्निग्धलवणोष्णो वा बस्तिरल्पोऽल्पभेषजः । मुदुर्वा मारुतेनोर्ध्वं विक्षिप्तो मुखनासिकात् ॥ ११॥
निरेति मूर्च्छाहल्लासतृड्दाहादीन् प्रवर्तयन् । मूर्च्छाविकारं दृष्ट्वाऽस्य सिञ्चेच्छीताम्बुना मुखम् ॥ १२ ॥
व्यजेदाक्लमनाशाच्च प्राणायामं च कारयेत् । पृष्ठपार्श्वोदरं करैरुष्णैरधोमुखम् ॥ १३ ॥
मृज्यात् केशेषूत्क्षिप्य धुन्वीत भीषयेद्व्यालदंष्ट्रिभिः ।
शस्त्रोल्काराजपुरुषैर्बस्तिरेति तथा पाणिवस्त्रैर्गलापीडं कुर्यान्न म्रियते तथा ।
प्राणोदाननिरोधाद्धि अपान: पवनो बस्तिं कुष्ठक्रमुककल्कं औष्ण्यात्तैक्ष्ण्यात्सरत्वाच्च बस्तिं सोऽस्यानुलोमयेत् । ह्यधः ॥ १४ ॥
सुप्रसिद्धतरायनः ॥ १५ ॥ तमाश्वेवापकर्षति । पाययेताम्लसंयुतम् ॥ १६ ॥
गोमूत्रेण त्रिवृत्पथ्याकल्कं पक्वाशयस्थिते स्विन्ने निरूहो वाऽधोनुलोमनम् ॥ १७ ॥
दाशमूलिकः । मूत्रसाधितैः ॥ १८ ॥
यवकोलकुलत्थैश्च विधेयो बस्तिर्गोमूत्रसिद्धैर्वा पूतीकरञ्जत्वक्पत्रशठीदेवाह्वरोहिषैः सतैलगुडसिन्धूत्थो विरेकौषधकल्कवान् ।
बिल्वादिपञ्चमूलेन सिद्धो बस्तिरुरःस्थिते ॥ २० ॥
सर्षपैः शिरः | सामृतावंशपल्लवैः । ॥१९॥ शिरःस्थे नावनं धूमः प्रच्छायं
Enema administered to the person who is habituated to suppression of the urges, the enema liquid being more in quantity, not added with fats and salts, not being warm or the liquid being less in quantity and with less of drugs or of mild potency-gets pushed upwards by vata and comes out through the mouth and nose, giving rise to fainting, oppression in the chest, thirst and burning sensation. Observing, fainting and other symptoms, the face of the patient should be sprinkled with cold water and fanned, till the fatigue is relieved, pranayama (artificial breathing with long inspiration) should be made, the black, flanks, and abdomen of the patient should be massaged with warm hands (of the physician) in the downward direction, his hairs should be plucked, he should be shaken with force ( holding him inverted), threatened by wild animals, snakes, sharp weapons, fire crackers, palace officials (policemen etc); his throat should be pressed hard either with the hands or a band of cloth but not making him die. By obstructing the prana and udana (divisions of vata) only the apana vata functioning in the well known channels (passages of urine, faeces and flatus), quickly pulls the enema liquid down. The patient should be made to drink any sour liquid added with the paste of kustha and kramuka, which by its hot, penetrating and laxative properties makes for the downward movement of the enema liquid; or the paste of trivrt, and pathya added cow’s urine makes for downward movement. When the dosas are localised in the pakvasaya (large intestine) the patient should be given sudation therapy (preceded by oleation) and then administered decoction enema with decoction of dasamula; or decoction of yava, kola and kulattha added with cow’s urine, oil (of sesame), jaggery (treacle), saindhava and paste of any purgative drug. When the dosas are localised in the head, administration of nasal medication, inhalation of smoke and application of the paste of sarsapa over the head should be done.
Basti Atiyoga – excess enema therapy
बस्तिरत्युष्णतीक्ष्णाम्लघनोऽतिस्वेदितस्य वा ॥ २१ ॥
अल्पे दोषे मृदौ कोष्ठे प्रयुक्तो वा पुनः पुनः । अतियोगत्वमापन्नो भवेत्कुक्षिरुजाकरः ॥ २२ ॥
विरेचनातियोगेन स तुल्याकृतिसाधनः ।
Enema liquid which is very hot, very penetrating, very sour and thick in consistence, administered to the person who has undergone excess of sudation therapy or administered when there is mild increase of the dosas, or for a person of soft bowel movements or administered again and again leads to Atiyoga (excess bouts) producing pain in the abdomen, it is similar to excess bouts of purgation therapy both in its features and management. 21b-23a.
बस्ति: क्षाराम्लतीक्ष्णोष्णलवणः पैत्तिकस्य वा ॥ २३ ॥
गुदं दहन् लिखन् क्षिण्वन् करोत्यस्य परित्रवम् । स विदग्धं स्त्रवत्यस्त्रं वर्णैः पित्तं च भूरिभिः ॥ २४ ॥
बहुशश्चातिवेगेन मोहं गच्छति सोऽसकृत् । रक्तपित्तातिसारघ्नी क्रिया तत्र प्रशस्यते ॥ २५ ॥
दाहादिषु त्रिवृत्कल्कं मृद्वीकावारिणा पिबेत् । तद्धि पित्तशकृद्वातान् हृत्वा दाहादिकान् जयेत् ॥ २६ ॥
विशुद्धश्च पिबेच्छीतां यवागूं शर्करायुताम् । युञ्ज्याद्वाऽतिविरिक्तस्य क्षीणविटकस्य भोजनम् ॥ २७ ॥
माषयूषेण कुल्माषान् पानं दध्यथवा सुराम् । सिद्धिर्बस्त्यापदामेवं
Enema liquid which has more of ksara (alkalies), sour, penetrating, hot and salt ( properties ), administered to a person of pitta prakriti (pitta predominant constitution) gives rise to burning sensation, pain such as scraping and cutting in the rectum and discharge of blood which is over cooked having the colour of pitta; or more quantity of pitta often and with great force; by this the patient loses consciousness often. In such a condition treatments advocated for raktapitta (bleeding disease) and atisara ( diarrhoea) are best suited. For burning sensation etc. paste of trivrt added to water of mrdvika (water in which dry grapes are squeezed) be consumed, it expels out the pitta, faeces and flatus and cures burning sensation etc. After purification (elimination of pitta etc.) the patient should drink yavagu ( gruel) mixed with sugar and in cold state. The patient who had too many purgations and consequent loss/depletion/decrease of faeces should be made to eat kulmasa (pulses baked in steam) along with soup of masa, as food and then drink either dadhi (curds /yoghart) or sura (beer ). In this manner the complica tions of decoction-enema therapy should be manged.
Notes: Astanga sangraha enumerates twelve Vyapats (complications) of Niruha basti (decoction-enema); they are
1. vibandha-constipation, 2. gaurava-feeling of heavyness of the body, 3. adhmana-flatulence, 4. siroruk – headache, 5 urdhvagati-upward movement of the enema liquid, 6. vahana-straining at stools / tenesmus, 7. kuksisula-pain in the abdomen, 8. angaruk-pain in the body parts, 9. hidhma-hiccup, 10. hrtpida-discomfort/pain in the heart, 11. kartana-cutting pain in the rectum, 12. sravana-discharge of slimy material from the rectum-the first six from ayoga (inadequacy) and the second six from atiyoga (excess).
Sneha basti vyapat – complications of fat enema
स्नेहबस्तेस्तु वक्ष्यते ॥ २८ ॥
शीतोऽल्पो वाऽधिके वात पित्तेऽत्युष्णः कफे मृदुः ।
अतिभुक्ते गुरुर्वर्चः दत्तस्तैरावृतः स्नेहो स्तम्भोरुसदनाध्मानज्वरशूलाङ्गमर्दनैः सञ्जयेऽल्पबलस्तथा ॥ २९ ॥
नायात्यभिभवादपि । ॥३०॥
पार्श्वरुग्वेष्टनैर्विद्याद्वायुना स्निग्धाम्ललवणोष्णस्तं सौवीरकसुराकोलंकुलत्थयवसाधितैः
निरूहैर्निर्हरेत्सम्यक् समूत्रैः ताभ्यामेव च तैलाभ्यां सायं भुक्तेऽनुवासयेत् । स्नेहमावृतम्। रास्त्रापीतद्रुतैलिकैः ॥ ३१ ॥ पाञ्चमूलिकैः ॥ ३२
And now, the complications of fat enema/oil enema will be described. Enema liquid which is cold and little in quantity administered when there is great increase of vata; liquid which is very hot administered when there is great increase of pitta; liquid which is very mild administered when there is great increase of kapha; enema liquid more in quantity administered to the person who has consumed large quantity of food; enema liquid which is poor strength administered when there is great accumulation of faeces; these kinds of oil enema become enveloped by the respective dosas, get lost inside and do not come out. By the appearance of symptoms such as rigidity and weakness of the thighs, flatulence, fever, colic, body aches, pain and twisting ( pain) of the flanks, it should be understood that fat (enema-liquid) is enveloped by vata. In this condition, the oil remaining inisde should be removed by administering a niruha basti (decoction enema) prepared with decoction of pancamula added with drugs which are unctous, sour, salts and hot potency); oil boiled with rasna, and pitadaru, sauviraka, sura, kola, kulattha, yava, and cow’s urine; in the same evening after the patient has taken his food another anuvasana basti (oil enema) should be administered with the same oils (oil of rasna and pitadaru). 28b-33a.
तृड्दाहारागसम्मोहवैवर्ण्यतमकज्वरैः
विद्यात्पित्तावृतं स्वादुतितैस्तं बस्तिभिर्हरेत् । ॥३३॥
By the appearance of symptoms such as thirst, burning sensation, red colour ( of the skin etc ) , delusion, discolouration, darkness before the eyes ( loss of consciousness) and fever it should be understood that the enema liquid is enveloped by pitta. It should be removed out by administration of decoction enema prepared from drugs of sweet and bitter taste.
तन्द्राशीतज्वरालस्यप्रसेकारुचिगौरवैः सम्मूर्च्छाग्लानिभिर्विद्याच्छ्लेष्मणा स्नेहमावृतम् ।
कषायतिक्तकटुकै: ‘सुरामूत्रोपसाधितैः ॥३४॥
फलतैलयुतैः साम्लैर्बस्तिभिस्तं विनिर्हरेत् ।
By the appearance of stupor, cold and fever, lassitude, excess of salivation, loss of taste / appetite, feeling of heavyness, fainting and exhaustion it should be understood that the fat (enema liquid) is enveloped by slesman (kapha). It should be removed out by the administration of decoction enema prepared with (decoction of) drugs of astringent, bitter and pungent taste, added with sura (beer), cow’s urine, phala (madana phala), taila (oil of sesame) and sour liquids. 34b-36a.
छर्दिमूर्च्छारुचिग्लानिशूलनिद्राङ्गमर्दनैः ॥ ३६॥
आमलिङ्गः सदाहैस्तं विद्यादत्यशनावृतम् । कटूनां लवणानां च क्वाथैचूर्णैश्च पाचनम् ॥ ३७ ॥
मृदुर्विरेकः सर्वं च तत्रामविहितं हितम् ।
By the appearance of vomiting, fainting, loss of taste appetite exhaustion, colic, sleep, bodyache, symptoms accumilation of ama (vide chapter 13 of sutrasthana) and burning sensation, it should understood that the fat (enema liquid) is eveloped by excess of food. Then the excess of food should be got digested by administration of decoctions or powders of drugs which are pungent and salty, mild purgatives and all treatments which are good for removal of ama. 36b-38a.
विण्मूत्रानिलसङ्गार्तिगुरुत्वाध्मानहृद्ग्रहैः ॥ ३८
स्नेहं विडावृतं ज्ञात्वा स्नेहस्वेदैः सवर्तिभिः । श्यामाबिल्वादिसिद्धैश्च निरूहै: सानुवासनैः ॥ ३९
निहरे द्विधिना सम्यगुदावर्तहरेण च ।
By the appearance of obstruction of faeces, urine and flatus, pain, feeling of heavyness, flatulence, and catching pain in the region of the heart, it should be understood that the fat (enema liquid) is enveloped by faeces, It should be removed out by oleation and sudation therapies, use of rectal suppositories, administering decoction-enema and oil-enema prepared with syama and bilvadi pancamula and other treatments which remove udavarta (upward movement of vata inside the abdomen). 38b-40a.
अभुक्ते शूनपायौ वा पेयामात्राशितस्य वा ॥ ४० ॥
गुदे प्रणिहितः स्नेहो वेगाद्धावत्यनावृतः । ऊर्ध्वं कायं ततः कण्ठादूर्ध्वेभ्यः खेभ्य एत्यपि ॥ ४१ ॥
मूत्रश्यामात्रिवृत्सिद्धौ यवकोलकुलत्थवान् । तत्सिद्धतैलो देयः स्यान्निरूहः सानुवासनः ॥ ४२ ॥
कण्ठादागच्छतः स्तम्भकण्ठग्रहविरेचनैः । छर्दिघ्नीभिः क्रियाभिश्च तस्य कुर्यान्निबर्हणम् ॥ ४३ ॥
Oil-enama administered rectaly to the person who has not consumed his food, who has swelling of the rectum, or who has consumed peya (thin gruel) as food; the oil not getting enveloped, starts, moving upward and comes out of the channels above the throat. Then, decoction enema and enema both prepared with syama, trivrt, yava, kola, kulattha and added with cow’s urine, should be administered;
if it is coming out of the throat, it should be stopped by with holding (stopping ) the breath, pressing the throat, use of purgative and treatments which cure vomiting should be administered to expel out the fat. 40b-43.
नापक्कं प्रणयेत्स्नेहं गुदं स ह्यपलिम्पति । ततः कुर्यात्सरुजोहकण्डूशोफान्, क्रियाऽत्र च ॥ ४४ ॥
तीक्ष्णो बस्तिस्तथा तैलमर्कपत्ररसे शृतम् ।
Uncooked fat should not be used for retention enema/ oil enema; it adheres to the interior of the rectum and produces pain, delusion, itching and swelling. The treatment for this is administration of strong decoction enema and fat enema with oil boiled with juice of leaves of arka. 44-45a.
अनुच्छ्वास्य तु बद्धे वा दत्ते निःशेष एव वा ॥ ४५ ॥
प्रविश्य क्षुभितो वायुः शूलतोदकरो भवेत् । तत्राभ्यङ्गो गुदे स्वेदो वातघ्नान्यशनानि च ॥ ४६॥
Oil enema administered when the person is not taking expiration or when he is keeping his mouth closed or when the enema liquid is pushed in completely without retaining any residue (in the bag) such enema liquid aggravates vata and gives rise to pain and pricking sensation (in the rectum); the rectum should be bathed with oil and fomented, the person should be given foods which mitigate vata. 45b-46.
द्रुतं प्रणीते निष्कृष्टे सहसोत्क्षिप्त एव वा । स्यात् कटीगुदजङ्घोरुबस्तिस्तम्भार्तिभेदनम् ॥ ४७ ॥
भोजनं तत्र वातघ्नं स्वेदाभ्यङ्गाः सबस्तयः ।
Enema administered very quickly, the nozzle pulled out suddenly, or the nozzle held sidewards and enema liquid pushed in-these give rise to rigidity (loss of movement) and pain of the waist, rectum, calves, thighs and area of the urinary bladder. In this condition the treatments are-foods which mitigate vata, fomentation and anointing oil (to the rectum etc.) and administration of enemas. 47-48a.
पीड्यमानेऽन्तरा मुक्ते गुदे प्रतिहतोऽनिलः ॥ ४८ ॥
सादमूर्वोश्च उरः शिरोरुजं जनयेद्वली । बस्तिः स्यात्तत्र बिल्वादिफलश्यामादिमूत्रवान् ॥ ४९ ॥
Enema bag left unpressed (incompletely pressed) during the administration of enema, anila ( vata) getting obstructed in the rectum produces pain in the chest and head and weakness of the thighs. In that condition administration of enema with the decoction of bilvadi pancamula, phala (madana) syama etc. added with cow’s urine should be done. 48b-49.
अतिप्रपीडितः कोष्ठे तिष्ठत्यायाति वा गलम् ।
तत्र बस्तिर्विरेकश्च गलपीडादि कर्म च ॥ ५० ॥
Enema bag pressed with great force and speed causes the enema liquid either to stay inside the abdomen or come out through the throat. The treatment then are enemas and purgatives, pressing the throat and such other remedial measures. 50.
Notes: Astanga sangraha enumerates the following eight as the vyapat-(complications) of sneha basti ( fat – enema ), 1. vatavarana-envelopment by vata, 2. pittavarana-envelopment by pitta, 3. kaphavarana envelopment by kapha, 4, annavarana-envelopment by food, 5 vida-varana-envelopment by faeces, 6. abhukta datta-enema administered before taking food, 7. sunapayu datta-enema given when there is swelling of the rectum, 8. amadatta-enema with raw / uncooked oil.
Basti Paschat karma – post enema therapy procedures
वमनाद्यैर्विशुद्धं च क्षामदेहबलानलम् । यथाऽण्डं तरुणं पूर्णं तैलपात्रं यथा तथा ॥ ५१ ॥ भिषक् प्रयत्नतो रक्षेत्सर्वस्मादपचारतः ।
The patient who has undergone emesis and other purifactory therapies will be having emaciated body and decrease of strength and digestive fire. He should be taken care of with all efforts just like and young (just laid) egg or a vessel filled with oil ( to its brim ) protecting him from all hazards / risk. 51-52a.
दद्यान्मधुरहृद्यानि ततोऽम्ललवणौ रसौ ॥ ५२ ॥
स्वादुतिक्तौ ततो भूयः कषायकटुकौ ततः । अन्योन्यप्रत्यनीकानां रसानां स्निग्धरूक्षयोः ॥ ५३ ॥
व्यत्यासादुपयोगेन क्रमात्तं प्रकृतिं नयेत् । सर्वसह: स्थिरबलो विज्ञेयः प्रकृतिं गतः ॥ ५४ ॥
First he should be given foods which are of sweet taste and pleasing to the mind; next foods of sour and salt tastes; next those of sweet and bitter tastes and then those of astringent and pungent tastes; he should be brought back to his normal health by judicious mixture of foods of similar and dissimilar tastes; unctous and non-unctous qualities. The person who can withstand all types of strain and whose strength has become stable should be considered as having regained his normalcy (health). 52b-54.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां
पञ्चम कल्पसिद्धिस्थाने बस्तिव्यापत्सिद्धिर्नाम पञ्चमोऽध्यायः ॥ ५॥
Thus ends the chapter Bastivyapat siddhi-the fifth in Kalpa-siddhi-sthana of Astangahrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
