अथातो बस्तिविधिं नामाध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥ १॥
We will now expound the chapter called as Bastividhi – procedure of enema therapy; thus and said atreya and other great sages. (1)
Basti nirukti – definition of enema
बस्तिरनिलप्रधानेषु दोषेषु प्रयुज्यते । बस्तिना दीयते बस्तिं वा पूर्वमन्वेत्यतो बस्तिः ॥२॥
Basti ( enema therapy ) is made use of for the treatment of the (increased) doshas, dominated by Vata. It is called as “basti” because it is administered with a basti (urinary bladder) or medicines used will reach the basti (urinary bladder) first. (2)
Notes: In ancient time the urinary bladder of ox, goat, sheep etc., was being used as enema can, to hold the liquid to be introduced into the rectum. Hence the first definition. The second one meaning that “it reaches the bladder first” is applicable only to uttarabasti or urethral enema.
सच सर्वोपक्रमाणां प्रधानतमः शीघ्रं
बृंहणादिकारित्वाद्विकृतानिलोच्छेदित्वाच्च ॥३॥
It is the best among all kinds of therapies because it provides the body with quick nutrition etc., and mitigates the abnormal vata. (3)
अनिलो हि दोषाणां नेता । सर्वशरीरचेष्टैककारणम् । पञ्चात्मतया अङ्गप्रत्यङ्गव्यापी | विधाता विविधबाह्याध्यात्मिक भावानां सर्गस्थितिप्रलयाना हेतुः मार्गत्रयजानामपि रोगा णामिति ॥४॥
Vata, alone is the purveyor of the doshas, the chief cause for all the activities of the body. Divided into five kinds it pervades the whole body. It is the controller of creation, sustainance and destruction of all external and internal things, and also the cause for production of diseases in the three pathways. (4)
Notes: The five divisions of Vata are prana, udana, samana, vyana and apana. External things means mud, stone, trees, animals, water, rivers etc. Internal things are the doshas, dhatus, malas, Indriyas, Manas etc., of human body. The three pathways of diseases are the internal (or alimentary tract). the external (or all the tissues) and the middle (or bony joints and vital organs).(Bahya,Madhyama & Abhyantara)
सुखत्वादेव च बस्तिर्बालवृद्धकृशस्थूलक्षीणधात्विन्द्रियेषु च स्त्रीषु चानिलोपसर्गादप्रजासु कृछ्रप्रजासुचोपदिश्यते । तथाग्निबलवर्णमेधास्वरायुः सुखप्रदो वयः स्थापनः पङ्गरुस्तम्भभग्न सङ्कुचितानिलाध्मानशूलारोचकोदावर्तपरिकर्तिकादिषु हित इति ॥५॥
Because of its easy administration it is useful for children, the aged, the emaciated, the obese; to those whose tissues have been depleted, whose sense organs are weak; for women, who by predominance of vata are either sterile, or deliver the child with difficulty. It improves, digestion strength, colour (complextion), intelligence, voice, span of life and happiness, it maintains youth and is also beneficial in diseases like lameness, stiffness of the legs, fractures, contractures, distension of abdomen with gas, colic, loss of appetite, upward movement of vata, cutting pain in the rectum and such others.( 5 )
Trividha basti – three kinds of enema
स तु बस्तिस्त्रिविधः । आस्थापनमनुवासनमुत्तरबस्तिश्च । तत्रास्थापनं दोषदूष्याद्यनुसारेण नानाद्रव्यसंयोगादिनिर्वृत्तम् । तस्य भेदाः । उत्क्लेशनं संशोधनं संशमनं लेखनं बृंहणं बाजीकरणं पिच्छाबस्तिर्माधुतैलिकमित्यादयः । माधुतैलिकस्य पर्यायाः यापनो युक्तरथो दोषहरः स्निग्धबस्तिरिति । तेषां नामभिरेव स्वरूपमाख्यातम् ॥६॥
Enema therapy is of three kinds Asthapana (decocton of drugs being used), Anuvasana (oil or other fatty materials being used) and Uttara basti (enema into the urinary bladder or into the uterus). (6)
Asthapana basti – decoction enema
The material for Asthapana basti (the decoction enema) is prepared from the combination of different drugs appropriate to the doshas, dusyas etc., involved.
The different kinds of Asthapana basti (decoction of enema) are: Utklesana ( exciting), Samsodhana (purificatory ), Sansamana (mitigating ), Lekhana ( scarifying), Brimhana ( Stoutening, nourishing, Vajikarana (aphrodisiac ), Piccaabasti (enema liquid containing slimy materials), Madhutailika (enema with honey and oil), etc. The other synonyms of madhutailika basti are yapana (which can be continued for long period of time), Yuktaratha (which can be given even while travelling), doshahara (which mitigates or expels the doshas which have been increased) and singdha basti (which contains fatty materials to lubricate the interior of the body); their nomenclature itself suggests their characteristics. (6)
तद्वयः स्थापनाद्दोषस्थापनाद्वाऽऽस्थापनमित्युच्यते शरीरारोहणाद्दोषनिर्हरणादचिन्त्यप्रभा वतया यस्मिन्नूहासम्भवान्निरूह इति ॥७॥
It is named ‘asthapana’ because it with holds the (advancing of the) age or the doshas, it is also called as ‘Niruha’ because it ascends up the body eliminates the doshas and also because it is impossible to guess its special effects as it is very powerful. (7)
Anuvasana basti – enema with fatty materials, lubricating enema
अनुवासनं यथार्हौषधसिद्धः स्नेहनार्थः स्नेहः स्नेहविधौ सचतुर्धाभिहितः । तस्य भेदो मात्राबस्तिः । स पेयस्त्रेह्रस्वमात्रातुल्यः ॥८॥
Anuvasana is another kind of enema in which any one of the four fatty materials mentioned in the chapter on oleation therapy, is used processed with appropriate drugs and is intended for producing lubrication. Its other kind is Matra basti; its dose is equivalent to the minimum dose of fatty material prescribed for drinking (acchapana the first method of oleation therapy). (8)
सेव्यः सदाच माधुतैलिकवत् । बालवृद्धाध्वभारयानव्यायामचिन्तास्त्रीनित्यस्त्रीनृपेश्वरसुकुमा रदुर्बलानिलभग्नाल्पाग्निभिर्निष्परिहारतया सुखो बल्यो वर्ण्यः सृष्टमलोदोषघ्नश्च । तथापि तौ नाजीर्णे योज्यौ न च दिवास्वप्नः सेव्यः । यतश्च सोऽन्नमनुवसन्नपि न दुष्यत्यनुवासरमपि वा दीयत इत्यनुवासनम् ॥९॥
It can be resorted to always just as Madhutailika basti. As it does not cause any bad effects it can be used for children, the aged, to those who daily indulge in walking long distances, lifting weights, physical exercises, too much of worry and sexual intercourse; to women, kings, lords (wealthy persons), the tender, those in whom the functions of vata are weak, who have fractures of bones and who have poor digestive capacity; it gives them happiness, strength, complexion, easy elimination of wastes, and also the doshas. Even then, it should not be administered to those who have indigestion and those who sleep during day.
It is called as Anuvasana because it does not cause any harm even if there is food inside (in the alimentary tract) or because it can be administered even after the day (that is even it nights ). (9)
Note: This verse has another rendering and so another meaning also as follow: it is called anuvasana because it does not cause any harm even if it remains inside (for long time) or because it can be administered day after day (for long duration).
Uttarabasti – urethral and uterine enema
उत्तरबस्तिरपि स्नेहोनुवासनवच्छोधनं निरूहवदपि केचिदाहुः स निरूहादुत्तरमुत्तरेण वा मार्गेण दीयत इत्युत्तरबस्तिः ॥१०॥
Though Uttarabasti (urethral and uterine enema) is lubricating, just as anuvasana and purificatory just as niruha, some say it is called Uttarabasti beacuse it is administered after niruha basti or because it is administered through another route (urethral or vaginal passage). (10)
Asthapyah – persons suited for decoction enema – Niruha Basti Yogya
तत्रास्थाप्या गुल्मप्लीहानाहशूलशूद्धातीसारजीर्णज्वरप्रतिश्यायाढ्यरोगहृदयकुक्षिपार्श्वग्रहपर्वा भितापपार्श्वयोनिशूलाङ्गसुप्तिशोषकम्पगौरवातिलाघवान्त्रकूजनवातवर्चोमूत्रशुक्र सङ्गाश्मरीश करावृद्धिशुक्रार्तवस्तन्यनाशरजः क्षयोन्मादरेतोदोषक्रमिणकोष्ठविषमाग्निसशब्दाल्पाल्पोग्रग न्धोत्थानादयो दोषभेदीयोक्ताश्च वातव्याधयो विशेषेणैते हि परं बस्तिना नाशमुपयान्ति मूलच्छेदेन वृक्षवत् ॥११॥
The following persons are eligible (fit) for Asthapana basti; those who are suffering from abdominal tumors, splenic diseases, enlargement of the abdomen. colic, pure diarrhoea ( without the association of ama visa etc.), longstanding fevers, nasal catarrh, adhyaroga (gout) catching pain in the heart (region), lower abdomen, flanks, pain in the joints, and sides, vaginal pain, loss of tactile sensation, consumption, tremors, feeling of heaviness or too much of lightness; intestinal gurglings, obstruction of flatus, faeces, urine and semen; urinary calculus and gravel, scrotal enlargement, loss of semen, menstrual fluid and breast-milk, decrease of menstrual fluid (loss of ovum) insanity, disorders of reproductive elements, intestinal parasites, erratic digestive activity, diseases caused by sound which are mild, by strong smell inhaled little by little often and such others, and also all the diseases caused by (increased) vata enumerated in the Doshabhediya chapter (Ch. 20) especially; these (disorders) get cured completely by enema therapy just as the tree (is destroyed) by cutting of its roots. (11)
Anasthapyah – persons unsuited for decoction enema – Niruha Basti Ayogya
निरन्नाः कृतवमनविरेचननस्यप्रसक्त सकविषूचिकामातीसारारोचका अनास्थाप्यास्त्वस्निग्धोत्क्लिष्टदोषक्षतोरस्कातिकृशा च्छर्दिनिष्ठीविकाकासश्वासहिक्कार्शोबद्धच्छिद्रदकोदराध्मानाल ल्पाग्निगुदशोफकुष्ठमधुमेहार्ता:। गर्भिणी चाप्रवृत्तेष्टममासा। तत्रातिस्निग्धोत्क्लिष्टदोषयोर्दोषा नुत्क्लेश्योदरं मूर्च्छा श्वयथुं वा निरूहो जनयेत् । क्षतोरस्कस्यातिकृशस्य च क्षोभमापन्नः शरीरमाशु पीडयेत् । अनिरन्नस्य वक्ष्यते । कूतवमनविरेकयोस्तु रिक्तं देहं क्षतं क्षार इव दहेत् स्नेहबस्तिस्तु सद्योऽग्निमवसाद्यश्लेष्मामयाय स्यात् ॥१२॥
The following persons should not be given Asthapana (decoction enema) :those who have too much of lubrication in their body, in whom the doshas are slightly increased, who have injury in their chest, the very emaciated, those who have no food, those who have undergone emesis, purgation, nasal medication therapies, who are having bouts of vomiting, expectoration, cough, dyspnoea, hiccup; those suffering from haemorrhoids, abdominal enlargement due to intestinal obstruction, perforation and accumulation of fluid; flatulance, long stasis of food inside the stomach withouth digestion, vomiting and diarrhoea concurrently, diarrhoea caused by undigested materials, loss of appetite, indigestion, swelling of rectum, leprosy (and other skin diseases), diabetes and the pregnant woman who is not in her eight month.
Niruha basti (dectection enema) administered to those who have too much of lubrication, in whom doshas are increased slightly, will produce enlargment of abdomen, fainting or dropsy by further increase of the doshas. It will cause many troubles to the body in person who have injury in the chest and who very emaciated; of the person who is not having food will be described later; in person who had emesis and purgation therapies, it causes burning sensation in the empty organs just like alkalies cause burning in the wounds; in those who had a decoction enema, administration of another oleation enema (on the same day) will decrease the digestive activity and gives rise to diseases of kapha origin. (12)
कृतनस्यस्यास्यविभ्रशं विवृतोर्ध्वस्त्रोतस्तया कुर्यात् । अनुवासनं तु दोषोत्क्लेशम् । प्रसक्तच्छ दीनां वायुर्निरूहमूर्ध्व नयेत् । अनुवासनं च अर्शसस्यावृतमार्गत्वादनागच्छन्बस्तिः प्राणान् हिंस्यात् । स्नेहः पुनरर्शांस्यभिष्यन्द्याध्मानाय स्यात् । बद्धोदराद्याध्मानान्तानां भृशतरमाध्मा नान्मृत्युः । अलसकार्तादीनां चामदोषात् । अरोचकार्तादीनां यथास्वमामयवृद्धिः । गभिण्याः पूर्वोक्तो दोषः ॥१३॥
In persons who have undergone nasal medication it (decoction enema) will cause disease of the mouth by the expansion of the upward channels, lubrication enema in such people will cause mild increase of the doshas. In those who have bouts of vomitting etc., vata brings the decoction in the upward direction, so also the materials of the lubrication enema will cause exudations from the pile (mass).
In those suffering from diseases commencing with intestinal obstruction and ending with flatulence (enumerated above), enemas will cause death producing profound distension of the adbomen. In those suffering from loss of appetite etc. they will cause exacerbation of respective disease; in case of pregnant women, the same trouble will be caused as described earler (under contra indications of emesis therapy). (13)
Anuvasyah – persons suited for lubrication enema – Anuvasana Yogya
य एवास्थाप्यास्त एवानुवास्याः । रूक्षातिदीप्ताग्नयः केवलानिलार्ताश्च विशेषेण । एते परमनुवासनेनाप्याय्यन्ते । मूलसेकेन वृक्षवत् । य एवानास्थाप्यास्त एवाननुवास्याः ।
Ananuvasya – persons unsuited for lubrication enema – Anuvasana Ayogya
तथा निरन्ननवज्वरपाण्डुरोगकामलाप्रमेहप्रतिश्यायप्लीहकफोदराढ्यवातवर्चो भेदार्तपीतविषगर पित्तकफाभिष्यन्दगुरूकोष्ठातिस्थूलश्लीपदगलगण्डापचीक्रिमिणकोष्ठाः । तत्राति•स्निग्धादीनां यथास्वमुक्ताः पृथग्दोषाः । अपि च ॥१४॥
Those who are eligible for decoction enema are also eligible for lubrication enema and especially those who are very dry, who have very powerful digestion and those suffering from diseases of vata origin. Just as the entire tree gets nourished by satisfying its roots with water, so also the above kinds of patients by the administration of lubrication enema.
Those who are not eligible for decoction enema are also not eligible for lubrication enema. And also those who are suffering from want of food, fevers of recent origin, anaemia, jaundice, diabetes, nasal catarrh, diseases of the spleen, enlargement of abdomen due to increased kapha adhyavata (urusthambha or stiffness of the limls), diarrhoea, poison, homicidal poison, ophthalmia due to kapha and pitta, constipation, severe obesity, filariasis, enlarged glands in the neck, scrofula and intestinal parasites. The same (bad) effects as described earlier ( commencing from those having too much of lubrication etc., para no. 12) will also. manifest in these people. (14)
अभुक्ते रिक्तकोष्ठस्य प्रयुक्तमनुवासनम् । सरदूरगसूक्ष्मत्वैः क्षिप्रमूर्ध्व प्रपद्यते ॥ १५ ॥ तेन वायोर्जयो न स्याद्धातस्थाने ह्यतिष्ठता । कायाग्नेराशु नाशश्च विशेषादनिवर्तनात् ॥१६॥ • स्नेहः सद्योशिताहाररूद्धे त्वामाशयेऽनिलम् । पक्वस्थं हन्ति पक्वस्थश्चवते चान्नपाकतः ॥१७॥ निरूहश्च समीरश्च तीक्ष्णवेगावुभावपि। तावन्नमूर्च्छितौ तीक्ष्णावधोऽन्नेन सहागतौ ॥ १८ ॥ ऊर्ध्व वा शकृता सार्द्ध संस्थितौ कोष्ठ एव वा । समलाहारविष्टब्धौहरेतामाशु जीवितम् ॥१९॥ भुक्तवाननुस्यो ऽस्मान्न निरूह्यस्तु भुक्तवान् ।
The material of the anuvasana (lubrication enema) administered to the person who has no food in the stomach, quickly moves upwards, because of its mobile, far reaching and subtle properties. From this vata does not get controlled but the digestive activities become greatly weakened because of the enema material not coming out of the body.
If it is administered when the person has taken food, the full stomach obstructs the vata (controls it), then the fatty substances (of the lubrication enema), will be able to mitigate vata, vata if localised in the pakwasaya (colon) enema expels it out after the digestion of food.
Niruha basti (decoction enema ) and vata both have powerful bouts. If they are mixed by food, they move downwards along with food or move upwards along with feces or might even get obstructed in the alimentary tract and remain there (causing distention, pain etc.) along with the doshas and food and may cause death quickly.
Hence Anuvasana (lubricating enema) should be given to a person who has taken food whereas Niruha (decoction enema) should not be given to him, who has taken food. (15-192).
पाण्डुरोगार्तादीनां दोषानुत्क्लेश्य स्नेहबस्तिरुदरं जनयेत् । प्रतिश्यायादिमतां भूय एव दोषं वर्धयेत् ॥२०॥
In person suffering from anemia etc. lubrication enema will produce enlargement of abdomen by increasing the doshas mildly and in those suffering from nasal catarrh etc., it will cause profound increase of the doshas. ( 20 )
Bastinetra – enema nozzle
तयोस्तु नेत्रं सुवर्णादिधातुमणिशङ्खशृङ्गदन्तास्थिवेणुनलखदिरकदरतिनिशतिन्दुकादि दारु सारमय मृज्वकर्कशंगोपुच्छाकृतिगुलिकामुखमूनवर्षवार्षिकसप्तद्धादशषोडशवर्षाणां विंशतिप्र भृतिषु च क्रमात्पञ्चषट्सप्ताष्टनवद्धादशाङ्गुलप्रमाणम् । मूलेऽग्रे चातुराङ्गुष्ठकनिष्ठिकापरि णाहमर्धाङ्गुलात् प्रभृत्यर्धाङ्गुलप्रवृद्धव्यङ्गुलपर्यन्तप्रवेशमूलच्छिद्रमवनमुद्गमुद्गमाषक लयाक्लिन्नकलायकर्कन्धुवाह्याग्रच्छिद्रम् मूलछिद्रप्रमाणाङ्गुलैरग्रे यथास्वं सन्निविष्टकर्णिकं कर्णिकान्तप्रतिबद्धसूत्रान्तगृहीताग्रपिधानघनचैलवर्तिम् । मूले व्यङ्गुलान्तराले कर्णिकाद्वयं कारयेत् । वर्षान्तरेषु च वयोबलशरीराण्यवेक्ष्यनेत्रप्रमाणमुत्कर्षयेत् ॥२१॥
For both of these (decoction and lubricating enemas to be administered) the enema nozzle is to be made from gold and other metals, gems, conch shell, horn, tusk or bones of animals, bomboo and hallow reeds, pith of khadira, kadara, tinisa, tinduka and other trees, it should be straight, smooth, without corners or bends, resembling the tail of the cow in shape, its lower tip resembling a round pill; varying in length from five, six, seven, eight, nine and twelve anguils (fingers breadth) for use in persons of the age of less than a year, one year, seven, twelve sixteen and twenty years and above respectively. Its circumference at the upper and lower ends should be equal to the circumfernce of the thumb and little finger of the patient respectively, its upper orifice having diameters ranging from half anguli, increasing by half anguli to reach a maximum of three anguli; its lower orifice ranging in diameter to permit a vanamudga (wild green gram), mudga (ordinary green gram), masa (blackgram), kalaya (pea), soaked pea and seed of karkandhu. It should have two karnikas (rims-small protuberance of ridges) all around resembling a ear; the calibre of the upper orifice arranged suitably in its body; the open end of the enema bag being fastened tightly with strong lubricated threads in between two such rims). These rims two angulis apart are to be made from the top (bigger end). The size of the nozzle can be increased depending upon the age, strength and physique of the patient. (21)
ततो जाविवराहहरिणगोमहिषान्यतमजं स्नेहमुद्गरविमृदितं विगतच्छिद्रसिराग्रन्थिस्कन्धं नातिवर्तुलं मृदु दृढं कषायरक्तं सुखसंस्थाप्यौषधप्रमाणं न्युब्जंविवृताननं निवेश्य बस्तिं कर्णिकयोर्हृढेन सूत्रेण घनं समं चबध्वा परिवर्त्त्य पुनश्चान्यद्धस्तिमुखबन्धनार्थ सूत्रमुपधायानु गुप्तं निधापयेत् ॥ २२ ॥
The urinary bladder of a goat, sheep, boar, deer, cow, buffalo or any other animal is prepared by tanning with lubricants, removed of its veins, glands and joints, small holes closed; made not very round but made soft, tough, blackish red in colour and accommodative. The decoction is filled into it, the (wider end of) the nozzle is introduced into it and the edges of the bladder tied firmly between upper two ridges with strong threads, and kept ready with the tip of the nozzle pointing upwards. Another one is also prepared like wise and kept ready. (22)
बस्त्यभावे प्लवनीच्छागलाङ्कपादमधूच्छिष्टोपदिग्धघनसूक्ष्मतान्तवान्यतमं निवेशयेत् ॥ २३॥
In the absence of the urinary bladder, a bag made out of the tendons of plavani (a kind of water bird) the thigh (muscle) of the goat or a bag made of thick cloth prepared with strong, fine threads, lubricated with bees wax, may be made use of as enema can. (23)
Bastidravya matra – quantity of enema fluid
आस्थापनमात्रा तु प्रथमे वर्षे प्रकुञ्चः । ततः परं प्रतिवर्षं प्रकुञ्चमभिवर्धयेदाषट्प्रसृतात् । ततश्चोर्ध्वं प्रसृताभिवृद्धिः । प्राप्तानतीताष्टादशसप्ततेस्तु द्वादश प्रसृताः । परं चातो दशैव । अन्येपुनर्द्धादशप्रसृतस्याप्यष्टाविच्छन्ति ॥ २४॥
The quantity of liquid for Asthapana (decoction enema) to be given to a child of one year of age shall be one prakunca. This quantity should be increased by one prakunca for each successive year till the quantity becomes six prasrtas. Further it is to be increasd by one prasrti till it becomes twelve prasrtis at the age of eighteen years. That will be the quantity for persons betwen eighteen to seventy years of age. Further on, it shall be ten prasrtis only. Some authorities prescribe eight prasrtis instead of twelve. (between eighteen to seventy years). (24)
Note: Prakunca is the synonym of ‘pala‘ which is equivalent to 48 ml. and prasyta is 2 ‘palas’ equivalent to 96 ml. approximately. commencing from one prakunca and increasing it by one more each year till six prasrta (576 ml.) will be at the age of twelve years. Further on it should be one prasrti more each year till it reaches twelve preasrtis (1152 ml.) at the eighteenth year. The dose is same from eighteen to seventy years of age, after which it is reduced to ten prasitis (960 ml.).
यथास्वमास्थापनमात्रा पादहीना माधुतैलिके प्रयोज्या | अनुवासने त्वेवमेवास्थापनस्य पाद इति ॥ २५ ॥
In case of Madhutailika basti the quantity will be less by one-fourth (that is three-fourth) of the quantity of Asthapana of the corresponding age. In case of Anuvasana (oleation enema) also it is one fourth of the quantity of Asthapana. (25)
Notes: For a person between eighteen and seventy years of age, the quantity for Madhutailika basti will be nine pasrtis (864 ml.) and for Anuvasana basti will be three prasytis only (288 ml.).
Asthapana vidhi – procedure of decoction enema – Basti Vidhi
अथास्थापनीयमातुरं स्नेहस्वेदोपपन्नं कृतवमनविरेकमासेवितपेयादि संसर्गक्रममुपजातबलम नुवासनार्हं पूर्वमेवानुवासयेत् । शीतवसन्तयोर्दिवा अन्यथा रात्राववेक्ष्य वा दोषादीन् । अन्यथा हि स्नेहोक्तामयप्रादुर्भावः ॥२६॥
The patient who is to be treated with Asthapana (decoction enema) should have undergone lubrication, sudation, emesis and purgation therapies earlier and gained strength by following the regimen of liquid diet.(Snehana,Swedana,Vamana,Virechana,Sansarjanakrama) He should be the one eligible for administration of lubrication enema also. To such a person a anuvasana (lubrication enema) is to be given first. It (Anuvasana basti) should be given during day time in winter and spring seasons and during nights in others or during such time suitable to the doshas involved. Otherwise it will give rise to diseases mentioned under oleation therapy. (26)
धन्वन्तरीयाः पुनराहुः ।
न रात्रौ प्रणयेद्वस्तिं स्नेहोत्क्लेशो हि रात्रिजः । अह्नि स्थानस्थिते दोषे वह्नौचान्नरसान्विते ॥२७॥
The followers of Dhanwantari, opine as follows enemas should not be administered at nights because the troubles of lubrication arise at nights only. During day the lubricating materials will be able to circulate all over the body because the doshas will be in their normal places, digestive activity will be good, the body will be nourished by the essence of food and the openings of all the channels will be clear.
स्फुटस्त्रोतोमुखं देहं स्नेहो यत् परिसर्पति । अल्पपित्तकफं रूक्षं भृशं वातरुजार्दितम् ॥ २८ ॥ भुक्तं जीर्णाशनं कामं रात्रावप्यनुवासयेत् ।
In cases of mild increase of pitta and kapha, the inside of the body if dry, persons suffering from severe diseases of vata origin, anuvasana (lubricating enemas) can be given even at nights, if found necessary after the food has been digested. (27-28)
Anuvasana vidhi – procedure of lubricating enema
केवलानिलनिपीडितं त्वशुद्धमप्यनिरूपितबलं चाप्य नुवासयेदात्ययिकत्वात् व्याधेः । तस्य विधिर्वमनादधिकतरं कृतमङ्गलमनुसुखमभ्यक्त मुष्णाम्बुस्नातं युक्तस्नेहमुचितात् पादहीनं द्रवपूर्वं लघूष्णं सानुपानमशनमशितवन्तं कृतचङ्क्रम णमुत्सृष्टविण्मूत्रमशनार्द्रहस्तमशङ्कनीयपरिचारकं निवातेवेश्मनि प्रतत शयने नात्युच्छ्रिते स्वास्तृते ईषदुन्नमितपाददेशे वामपार्श्वन प्राक्शिरसं संवेशयेत् । अतिस्निग्धाशिनो ह्यभयमार्ग संसर्गात् स्नेहो मदमूर्च्छाग्निसादहल्लासान् जनयति । रूक्षशिनोविष्टम्भं बलवर्णहानिं वा । अल्पमात्रद्रवाशिनोविसृष्टविण्मूत्रस्य चानावृतेन तदावृतात् व्यापदम् । चिरमशितवतो विदाहाभिमुखभक्तस्य ज्वरं कुर्यात् । यतश्च वामपार्श्वाश्रयाणि वह्निग्रहणीगुदवलीमुखानि तानि तत्पार्श्वशायिनो निम्नानि भवन्त्यतस्तदौषधमस्खलितमाप्नोति प्रवेशनिर्गमाविति। संविष्ठं चैनमृजुस्थितदेहं स्वबाहूपधानं प्रसारितवामसक्थिमाकुञ्चितेतरं तस्यैव चोपरिप्रसारित दाक्षणबाहुं कारयेत् ॥ २९ ॥
In case of patients suffering from diseases of vata alone, they can be administered lubrication enema even though they have not undergone purificatory therapies, in view of the emergency of such diseases. Its procedure is, more rigid than that of emesis therapy.
After the usual auspicious ceremony, the patient should be anointed with oil comfortably and given a bath in hot water. He should then take food less by onefourth quantity of the usual, liquid in nature, easily digestible, warm, added with suitable fat (ghee) and followed by an appropriate after-drink. Afterwards he is made to walk leisurely for a short while, then void the urine and feces. He should then be made to lie on a cot inside a room devoid of breeze; the cot being not very high, not very broad, and slightly raised at its foot end. He should lie on his left side placing his head first. Attendants who are soft and tender in their activities and possessing reliable character, should be available nearby, inside the room. If the patient eats too much of fatty foods the lubrication enema will produce toxicity, fainting, weakness of digestive activity, and nausea because of presence of fatty substance at both ends; in case of dry foods, it causes stasis of enema material, loss of strength or complexion; with little quantity of liquid foods and non-elimination of urine and feces, the person will develop complications caused by such obstruction; if the food has been partaken long earlier and the food being in the stage of digestion, lubrication enema at the time will produce fever.
Because the orifices of the seats of digestive fire (duodenum) and the folds of the rectum are all located on the left side, they will be facing downwards when the person is lying on his left side, hence the enema material can get in or get out without hinderance. The person should lie straight making his arm as pillow for the head, fully extending his left leg and bending his other leg over it and keeping his right arm extended over it. ( 29 )
पूर्वमेव तु वैद्यो वर्त्त्या सुपिहिताग्रच्छिद्रं नेत्रं भाजनस्योपरि कृत्वा दक्षिणपादाङ्गुष्ठाङ्गुलीभ्यां कर्णिकाया उपरिष्टानिष्पीड्याविबन्धाय शताह्रासैन्धवचूर्णावचूर्णितं प्रागेव नेत्रस्पर्शात् पूर्ववदभिमन्त्रितं यथार्हं यथार्हौषधाविपक्क सुखोष्णं बस्तौ स्नेहमासिच्यावलीकोच्छ्वासं निस्सारितवातबुद्बुदमौषधान्ते सूत्रेण द्विस्त्रिर्वा बस्तिमुखमावेष्ट्य दक्षिणपाणौ नेत्रमुपनि धाय तिष्ठेत् । ततो घृताभ्यक्ते पायौ वामहस्तप्रदेशिन्याभ्यक्तप्रवेशप्रदेशमपनीतवर्युत्तानवाम हस्ताङ्गुष्ठोदरपिहिताग्रं मध्यमाप्रदेशिन्युपगृहीतकर्णिकमृज्वनुपृष्ठवंशमनुसुखमेकमना लाघवेन निष्कम्पमद्रुतमविलम्बितं नेत्रमाकर्णिकं प्रवेशयेत् । आतुरोऽपि तदनुलोमयन्नवलम्बेत । ततश्च वैद्यो बस्तिमुखं दक्षिणहस्ताङ्गुष्ठप्रदेशिनीभ्याममुञ्चन्नेत्रमचालयन् हस्तद्वयेनो त्तानेनैकग्रहणेनैवानिलाधिष्ठानभूतं किञ्चिदवशेषयन् शनैश्शनैरवेगमनुपीडयेत् । अन्यथा हि व्यापदो भवन्ति । ताः ससाधनाः सिद्धिषु वक्ष्यन्ते ॥३०॥
The physician should, before hand, keep ready the enema bag, its front orifice closed with bits of threads, then squeeze it under the toes of his right foot to drive out air. Then covering the orifice with paste of satahwa, saindhava nad slaked lime. Then the decoction of appropriate drugs and mixed with other ingrediants, is made warm and filled till the lubcricated bag gets removed of all its folds. The upper end (bigger end) of the nozzle is inserted into the bag, the edges of the bag are drawn up and fastened tightly to the nozzle in between the two upper ridges (rims) making sure that liquid does not come out at that joint. Holding the bag and nozzle together, the tip of the nozzle facing upwards the bag should be squeezed slightly to remove air, froth etc. from inside and the small opening at the tip of the nozzle kept closed by the fingers of the right hand.
The physician should lubricate the index finger of his left hand and also the place of insertion (anus and rectum of the patient), slowly insert his index finger first followed closely by the tip of the nozzle, holding the nozzle and the bag at the same level coinciding with vertebral column and then push the nozzle up to the level of its lower rim into the rectum, slowly without shaking, neither too fast nor too slow and with an attentive mind. The patient should be instructed to allow the entry of the nozzle inside. The physician should, then squeeze the bag with the thumb and fingers of his right hand, slowly and steadily, pushing the liquid little by little and retaining a little quantity inside the bag at the end of the act. Otherwise many complications will arise; they and their management will be described in Siddisthana. (chapter 6) (30)
अन्ये तु त्रिंशन्मात्राः पीडनकालमाहुः । न च बस्तौ दीयमाने क्षवकासहासजृम्भास्पन्दनान्या चरेत्विणमूत्रानिलवेगे तु नेत्रमाकृष्य वेगान्ते शेषं प्रणयेत् । अन्ते चोत्तानस्य स्फिजौ पाणितलेन त्रिचतुरो वारांस्ताडयेत् । तथा तत्पार्ष्णिभ्याम् । पादतश्च शय्यां त्रिरुत्क्षिपेत् । सोपधानस्य च प्रसारितसर्वाङ्गस्य पार्णिके मुष्टिना हन्यात् । तथा पार्ण्यङ्गुलिपादतलपिण्डिकाः । सरुजं चाङ्गं स्नेहेन प्रतिलोमं वाक्शतमात्रं शनैर्विमृनीयात् । एवमाशु स्नेहो न निवर्तते । समनुगच्छति चासमन्तात्सिराः । ततः परं तु स्नेहोक्तामाचारमनुवर्तते ॥ ३१ ॥
Others say, that the duration of time for squzeezing the enema bag shall be thirty matras. During the administration the patient should not sneeze, cough, laugh, yawn or shake his body. If he gets the urge of faeces, urine, or flatus, the nozzle should be removed and after attending to the urges, the remaining portion of enema material pushed in. After the administration, the buttocks are patted by the palms of the hand three or four times, next the heels; the legs should be raised from the cot three times.
The patient lieing straight on a pillow, his heels should be stroked with the fist, next the toes, soles and the calves. If there is pain in any part of the body it should be given mild massage in the reverse direction after anointing it with oil for a period of hundered matras. By these methods the fatty materials of the enema will not be expelled out quickly, travels through all the vessels of the body.
Afterwards the patient should follow the regimen described under oleation therapy. (31)
दीप्ताग्निं च सायं लघ्वन्नं भोजयेत् । नैव चानागतस्त्रेहं द्वितीयेऽहनि । न च तमनुवासयेत् । आगमन कालस्तु परो यामत्रयम् । ततः परमनागच्छन्तमहोरात्रमुपेक्षेत । तदाप्यनिवर्तमाने फलवर्तिभिर्लवणारनालप्रायैर्वा तीक्ष्णबस्तिभिः शोधयेत् । स्नेहव्यापत्सिद्धिं चावेक्षेत । अतिरौक्ष्यादनागच्छन्नचेज्जाड्यद्युपद्रवाय स्यात् तथाप्युपेक्ष्यः । शीघ्रनिवृत्ते तु विना मलेन केवले स्नेह स्नेहमन्यं पुनर्योजयेत् । न ह्यसावतिष्ठन् कार्यकरो भवति । सुखोषितं चैनं तथाकृतवमनविरेकास्थापनान्यतमं प्रातः शुण्ठीधान्यक्वथमितरच्चोष्णोदकं वाहशेषजरणाय वातकफोपशान्तये च पाययेत् ॥ ३२॥
If the digestion is good, he can be given light diet in the evening. If the lubricating material does not come out, he should be given food the next day only and another lubricating enema should not be given the next day. The maximum time for oil to come out is three yamas (nine hours). If it does not come out after that time, it should be awaited for one full day and night. If it does not come even after this period, the patient should be given purificatory therapies with rectal suppositories prepared from fruits or by strong enema containing rice-wish and salt predominantly. The complications are to be treated on the same lines as those of treatment of complications of oleation therapy. If the material does not come out due to severe dryness inside and does not cause lassitude and other complications, it should be neglected. If the lubricating material only comes out quickly without the feces (or doshas) another lubricating enema should be given because fatty material not remaining inside will be useless.
Next, after satisfactory administration of lubrication enema, emesis, purgation, decoction enema or any other purificatory therapy, the patient should be given a warm drink prepared from sunthi and dhanyaka or even hot water to facilitate digestion of residue of fatty materials and mitigation of vata and kapha. (32)
ततोऽन्नकाले यथोक्तमन्नमश्नीयात् । न चानुवासितं पेयां पाययेत् । सा हि सस्नेहकोष्ठमेनमभि ष्यन्दयति । पुनश्च तृतीयेऽहन्यनुवासयेत् पञ्चमे वा । यदा वा स्नेहपक्तिः स्यादतश्च दीप्ताग्निरूक्षवातोल्बणव्यायामनित्यान् प्रत्यहम् । एवममुना कम्रेण दोषाद्यनुसारतस्त्रिचतुरैः स्नेहबस्तिभिरुपस्निग्धंशोधनेनास्थापनेन स्त्रोतोविशुद्ध्यर्थमास्थापयेत् । वाताधिक्यादस्निग्धं तु स्नेहनेन ॥३३॥
Next, at each time of meals appropriate diet should be given; peya (thin gruel ) should not be given after lubrication enema, for it causes exudation of secretion from the already lubricated alimentary tract. Again on the third or fifth day, lubrication enema should be given. After the digestion of the lubrication material the patient should indulge in dry foods, and exercises daily to activate vata. In this manner he should be given three or four lubrication enemas depending upon the doshas etc., and then given one decoction enema to clear the channels and produce purification. If the patient is very dry due to predominance of vata, decoction enema should be given after a lubrication therapy. (33)
Asthapana vidhi – procedure for decoction enema
अथैनं तृतीये पञ्चमे वाहनि किञ्चिदावृत्ते माध्याह्ने कृतमङ्गलस्वस्त्ययनमभ्यक्तदेहं स्वेदितमुत्सृष्टमलमनाशितं नातिक्षुधितमवेक्ष्यातुरमार्यावलोकितं नाथमार्यतारामात्मभुवं धातारमश्विना विन्द्रमात्रेयं सप्तर्षीन काशिराजं विदेहपतिप्रभृतीनग्निवेशादींश्च तन्त्रकारान् दीपगन्धफलबलि धूर्णैर्यज्ञ इव प्रकल्पितभागान् कृत्वौषधीवृद्धवैद्यद्विजातींश्च संपूज्य तद्विद्यसहितो दोषौषधादिबलेन यथार्हमुपकल्पयेद्वस्तिम् ॥ ३४॥
On the third or fifth day after lubrication enema, the patient should be given a decoction enema, in the afternoon of a bright day, after performing the auspicious rites, anointing the body with oil, and sudation therapy; he should have eliminated the wastes of the body; not taken any food but not severely hungry, he should then worship the divine beings such as Lord Avalokita, Arya Tara, the self-born Brahma, the Aswini twins, Indra, the sage atreya, the seven rsis (sages), the kasiraja (Divodasa), the king of videha etc., authors of treatises like Agnivesa and others by offering them lighted wicks, fragrance, fruits, oblations, incence etc. Just as being done during a yajna (sacrificial ceremony); then gifting the portions of the offering and also the medicines to elder physicians and the twice born, obtain their blessings, with the help of which and also that of the medicines, he will obtain the full benefits (of enema therapy). (34)
तत्र विंशतिमात्राणि पलान्यौषधानां मदनफलाष्टकं च क्काथकल्पेन विपचेत् । क्काथाच्चतुर्थांशं स्नेहमनिले षष्ठांशं पित्ते स्वस्थवृत्ते चाष्टमांशं तु कफे। सर्वस्य चाष्टमांशं कल्कस्य स्याद्यावता नात्यच्छसान्द्रता भवेत् । गुडस्य पलं युक्त्या मधुसैन्धवे यथायोग्यं चशेषाणि कल्पयेत् ॥ ३५ ॥
Twenty palas of drugs and fruits of madana, eight by count are prepared into a decoction in the prescribed method. To this decoction is added lubricating material (fats) one-fourth, one-sixth and one-eighth the quantity of the decoction for the treatment of vata, pitta and kapha and also the healthy person respectively. A paste of drugs equal to one-eighth the total quantity or as much as required to make the solution, neither too thin nor too thick, is added, one pala of jaggery (molasses) and suitable quantity of honey and saindhava salt are also added. (35)
सर्वाणि चैकध्यमुष्णोदककुम्भीबाष्पाभितप्तानि खजमथितानि बस्तौ प्रक्षिप्यानुवासनवन्निरूहं प्रणयेत् । नात्युष्णशीतं नातिमृदुतीक्ष्णं नातिस्निग्धरूक्षं नातितनुसान्द्रं न हीनातिमात्रं नालवणातिलवणं नात्यम्लं च । तत्र बाष्पमात्रानुतापादौषधस्य विदाहो न भवति । खजप्रमथनात्तु क्वाथस्त्रेहादयः सम्यक् सम्प्रयुक्ताः सम्यगेव योगमारभन्ते । अन्यथा पुनः क्काथादीनामुल्बणोन्यतमं यथास्वं दोषमीरयेत् । अत्युष्णादीनां तु पृथग्व्यापद: साधनानि च सिद्धिषूत्तरकालमुपदेक्ष्यन्ते ॥३६॥
All are mixed together, churned with a churner, slightly warmed in steam and filled into the enema bag (tied to the nozzle and) administered in the same way as of lubrication enema. The decoction (solution) should neither be very hot nor very cold, neither too mild nor too strong, neither too oily nor too dry, neither too thin nor very thick, neither very little in quantity nor too large, neither salt-less nor too much salty and not too much sour also. It will not produce burning sensation inside because it is warmed by steam; churning makes a homogeneous mixture of decoction, oil paste etc., initiate their combined action in the proper way concurrently, otherwise decoction and others remaining separately will excite the doshas depending on their strength.
The complications arising from the solution being very hot etc., and management of such troubles will be described later in the Siddhisthana (chapter 4). (36)
अपि च ।
तिर्यप्रणीते हि न याति धारा गुदे व्रणः स्याच्चलिते च नेत्रे । दत्तः शनैर्नाशयमेति बस्तिः कण्ठं प्रधावेदतिपीडितस्तु ॥३७॥
स्तम्भं विधत्तेऽतिमृदुर्हिमश्च तप्ताम्लतीक्ष्णो भ्रमदाहमोहान् । स्निग्धोऽतिजाड्यं पवनं तु रूक्षस्तन्वल्पमात्रालवणस्त्वयोगम् ॥३८॥
करोति मात्राभ्यधिकोऽतियोगं क्षोभं तु सान्द्रः सुचिरेण चैति । दाहातिसारौ लवणोऽति कुर्यात्तस्मात्सुयुक्तं सममेव दद्यात् ॥३९॥
Further
If the bag is not held in straight position the enema material will not go inside in a continuous stream; if the nozzle is shaken, it may cause wound to the rectum; given very slowly the enema will not reach the colon and by pressing the bag quickly the material may go up to the throat.
Decoction prepared with mild drugs or solution being cold will cause obstruction; that which is sour and containing strong drugs, will cause giddiness, burning sensation and delusion. If it is very unctous it causes profound lassitude; if very dry it causes increase of vata; that which is very thin, little in quantity and with very little or no salt will make for inadequate bouts of evacuation.
Large quantity of solution will produce excessive bouts, that which is very thick causes discomfort and delayed evacuation, too much of salt in it will cause burning sensation and diarrhoea. Hence the enema solution should be prepared properly and administered carefully. (37-39)
अन्येपुनराहुः
मात्रां त्रिपलिकां कुर्यात् स्त्रेहमाक्षिकयोः पृथक् । कर्षार्धं मणिमन्थस्य स्वस्थे कल्कपलद्वयम् ॥४०॥ सर्वद्रवाणां शेषाणां पलानि दश कल्पयेत् । माक्षिकं लवणं स्नेहंकल्कं क्वाथमिति क्रमात् ॥४१॥ आवपेत निरूहाणामेष संयोजने विधिः ॥४२॥
Some other authorities say
The quantity of lubricating material (fats) honey should be three palas (144 ml.) each; that of manimantha (saindhava salt), half of a karsa (6gms.) and that of the paste shall be two palas (9.6gms.) all the remaining drugs shall be ten palas (480 gms.) in total. Honey, salt, lubricating material (oil), paste and decoction are to be mixed in this order of succession only and this will be the procedure of preparing the solution of decoction enema. (40-42)
Notes: First honey and saindhava salt are put into a vessel and grinded nicely with a pestle, oil is added next and then the decoction poured into the vessel and churned with a churner, adding the paste of drugs, little by little, to reach the required consistence, continuing the churning till a homogenous solution is formed. This is filled into the enema bag and administered. Now-a-day Satapuspa is being used for preparing the paste.
दत्तमात्रे तूत्तानः सोपधानो निरूहवीर्येण देहव्याप्तये तन्मनास्तिष्ठेत् । उदीर्णवेगश्चोत्कुटिको विसृजेत् । आगमनकालस्तु परो मुहूर्तः । तदा ह्यनागच्छान्नाशु मृत्यवे स्यात् अतस्तत्रानुलोमिकं स्नेहक्षारमूत्राम्लं स्त्रिग्धतीक्ष्णोष्णमन्यं प्रयोजयेत् । फलवर्तिस्वेदभयोत्त्रसादींश्च । बस्तिव्यापत्सिद्धिं चावेक्षेत् ॥४३॥
After receiving the enema, the patient should lie on his back with a pillow under his head and be attentive to the movement (action) of the enema material spreading to all the parts of the body. After getting the urge of evacuation, he should sit on his heels and void the material. The maximum time for the material to come out is one muhurta (48 minutes), if it does not come out within this time it may lead to death soon. So it should be brought out by administration of laxative oils, alkalies, urine (of animals) and other drugs possessing properties such as sour, unctous, strong and hot potency, or by rectal suppositories prepared from fruits, sudation therapy, creating fear etc. The complication that may arise should also be managed effectively. (43)
स्वयं निवृत्ते तु पूर्ववद् द्वितीयं तृतीयं चतुर्थं च दद्याद्यावद्वा सुनिरूढ: स्यात् ॥४४॥
After the enema material comes out of its own accord easily, the second, third, fourth enema should be administered till the patient gets the satisfactory effects of the decoction enema therapy. (44)
तत्राद्योऽनिलंस्वमार्गादपर्षति । द्वितीयः पित्तम् । तृतीयः श्लेष्माणमिति ॥ ४५ ॥
तस्य हीनसम्यगतियोगास्तु विरिक्तवत् ।
The first enema brings down vata to its normal passage, the second enema, the pitta and the third the kapha.
The inadequate, improper and excessive bouts of (effects of) decoction enema are similar to those of the purgation therapy. (45)
सम्यनिरूढं तु कोष्णसलिलावसिक्तं तनुना जाङ्गलरसेन भोजयेत् । स्नाताशितस्यास्य चला दोषशेषाः स्वस्थानमाश्रयन्ते ॥४६॥
After a properly done decoction enema therapy the patient should be given a bath in warm water and then the soup prepared with the meat of animals living in desert-like regions. By taking bath and diet the residual and circulating doshas will come back to their normal places. (46)
ततः पुनर्वातार्तमातुरं बृंहणीयमन्यं वा तद्विधमशितानन्तरं सायं वा पुनरल्पलध्वशितं यथास्वमनिलादिषु दशमूलादिसाधितेन तैलेनानुवासयेत् । तस्य हीनसम्यगतियोगाः स्नेहपीतवत् ॥४७॥
Next, the patient-who is suffering from any diseases (symptoms) of vata origin should be given a nutritious food.
Then either after taking such a diet or in the evening after a diet of easily digestible food he should be given anuvasana (lubrication enema); the oil or other lubricant to be used having been processed with either dashamulas or other drugs mitigating vata, Its inadequate, proper and excessive bouts (effects) being similar to those of lubrication (drinking of oil) therapy. (47)
विशेषस्तु सम्यगनुवासिते किञ्चित्कालं स्थित्वा स्नेहः सपुरीषोनिलानुगतः प्रवर्तत इति भवति चात्र ॥४८॥
Properly administered lubrication enema material will remain inside for a short time and then comes out followed by fecal matter and flatus. ( 48 )
एवं कफे स्नेहबस्तिमेकं त्रीन् वा प्रयोजयेत् । पञ्च वा सप्त वा पित्ते नवैकादश वानिले ॥४९॥
Further on :
In this manner, lubrication enema, one or three in number, can be given in case of (increase of) kapha;
five or seven in case of (increase of) pitta; and
nine or eleven in case of (increase of) vata. (49)
पुनस्ततोप्ययुग्मांस्तु पुनरास्थापनं ततः । कफपित्तानिलेष्वन्नं यूषक्षीररसैः क्रमात् ॥५०॥
Again, decoction enema should be given in odd numbers after lubrication enema (in the treatment of all the three doshas). Soup of pulses, milk and meat soup are the diet for patients of kapha, pitta and vata respectively. (50)
वातघ्नौषधनिष्क्राथत्रिवृतासैन्धवैर्युतः । बम्तिरेकोऽनिलेस्निग्धः स्वाद्वम्लोष्णो रसान्वितः ॥५१॥
One enema containing the decoction of drugs which mitigate vata, trvrt, saindhava mixed with oil, sweet and sour substances and hot meat soup will be ideal for the (treatment of ) vata. (51)
न्यग्रोधादिगणक्वाथपद्मकादिसितायुतौ । पित्ते स्वादुहिमौ साज्यक्षीरेक्षुरसमाक्षिकौ ॥५२॥
Two enemas containing the decoction of drugs of nyagrodhadi gana alongwith padmakadi gana (vide chapter 16) mixed with sugar, made sweet and cold; added with ghee, milk, sugar-cane juice and honey is ideal for (ther treatment) of pitta. (52)
आरग्वधादिनिष्काथवत्सकादियुतास्त्रयः । रूक्षाः सक्षौद्रगोमूत्रास्तीक्ष्णोष्णकटुकाः कफे ॥५३॥
Three enemas containing the decoction of drugs of aragwadhadi and vatsakadi ganas, (vide chapter 16 ) without fatty substances but mixed with honey, cow’s urine, substances which have penetrating action, hot in potency and pungent in taste are ideal for the treatment of kapha. (53)
त्रयश्च सन्निपातेऽपि दोषान् ध्रन्ति यतः क्रमात् ।
नाचार्यचरकस्यातो बस्तिस्त्रिभ्यः परं मतः । न हि दोषश्चतुर्थोऽस्ति पुनर्दीयेत यं प्रति ॥५४॥
Even in case of sannipata (increase of all the doshas together) the above three enemas are sufficient to mitigate each one of the doshas. Even Acarya Caraka has not advised more, because there is no fourth dosha for the sake of which, enemas are to be given again. (54)
उत्क्लेशनं शुद्धिकरं दोषाणां शमनं क्रमात् । त्रिधैव कल्पयेद्वस्तिमित्यन्येऽपि प्रचक्षते । दोषौषधादिबलतः सर्वमेतत् प्रमाणयेत् ॥५५॥
Even other authorities opine that enemas should be of only three kinds; Utklesana (exciting the doshas) Suddhikara (eliminating the doshas) and Samana (mitigating the doshas). These are to be planned, depending upon the strength of the doshas, drugs and other factors. (55)
सम्यड्निरूढलिङ्गं तु नासंभाव्य निवर्तयेत् ॥५६॥
When the patient exhibits all the symptoms of proper decoction enema therapy further enemas should be discontinued. ( 56 )
Basti Prakarah – Types of enema
प्राक्स्नेह एकः पञ्चान्ते द्वादशास्थापनानि च । सान्वासनानि कर्मैवं बस्तयस्त्रिंशदीरिताः॥५७॥
कालः पञ्चदशैकोत्र प्रास्त्रेहोऽन्तेत्रयस्तथा ॥ ५८ ॥
षट् पञ्च बस्त्यन्तरिताः – योगोष्टौ बस्तयोऽत्र तु । त्रयो निरूहाः स्नेहाश्च स्नेहावाद्यन्तयोरुभौ ॥ ५९॥
A series of thirty enemas, commencing with one lubricating enema, followed by twelve decoction enemas and twelve lubricating enemas given alternately and ending with five lubricating enemas given continuously is known as Karma basti.
A series of fifteen enemas commencing with one lubricating enema, followed with six decoction enemas and five lubricating enemas given alternatively and three lubricating enemas continuous at the end is known as Kala basti.
A series of eight enemas, with one lubricating enema both at the commencement and the end, with three decoction enemas and three lubricating enemas alternately in between is known as Yoga basti. (59)
स्नेहबस्तिं निरूहं वा नैकमेवातिशीलयेत् । उत्क्लेशाग्निवधौ स्नेहान्निरूहान्मरुतो भयम् ॥६० ॥ तस्मान्निरूढः स्नेह्यः स्यान्निरूह्यश्चानुवासितः । स्नेहशोधनयुक्त्यैवं बस्तिकर्म त्रिदोषजित् ॥ ६१ ॥
Neither lubricating enema nor decoction enema should be administered alone in greater number; for lubricating enemas will cause mild increase of the doshas and decrease of digestive activity.
Whereas decoction enemas create the fear (risk) of increase of vata. So, he who, should be given decoction enema should also be given lubricating enema and he who needs lubricating enema should also be given decoction enema. Enema therapy will be able to control the doshas when both lubrication and purification are done together. (60-61)
अष्टादशाष्टदशकान् बस्तीनां यो निषेवते । विधिना ना यथोक्तेन स भवेदजरोऽरुजः ॥६२॥
सहस्त्रायुः श्रुतधरो वीतपाप्मामरप्रभः । वाजिस्यदो नागबल: स्थिरबुद्धीन्द्रियानलः ॥६३ ॥
He who, undergoes a course of eighteen times of eighteen number (324) of enema in the prescribed manner will neither become old nor sick; lives for a thousand years, with keen sense organs, devoid of sins, shining like gods, like a stallion in matters of sex, like an elephant in strength, with steady mind, sense organs and digestive activity. (62-63)
Uttara basti – urethral and uterine enema / douche
बस्तौ रोगेषु नारीणां योनिगर्भाशयेषु च । द्वित्रास्थापनशुद्धेभ्यो विदध्याद्वस्तिमुत्तरम् ॥६४॥
‘आतुराङ्गलमानेन तन्नेत्रं द्वादशाङ्गलम् । वृत्तं गोपुच्छवन्मूलमध्ययोः कृतकर्णिकम् ॥६५॥
सिद्धार्थक प्रवेशाग्रं श्लक्ष्णं हेमादिसम्भवम् । कुन्दाश्वमारसुमनः पुष्पवृन्तोपमं दृढम् ॥६६॥
तस्य बस्तिर्मृदुलघुर्मात्रा शुक्तिर्विकल्प्य वा ॥६७ ॥
Uttara basti (urethral and uterine enemas) are indicated in diseases of the urinary bladder and those of vagina and uterus in women. It should be administered only after two or three decoction enemas. The nozzle for this enema should be of twelve anguli of the patient (fingers breadth of the patient’s hand), round, resembling the tail of a cow in shape, with rims (ridges) at its top and middle, its lower orifice permitting movement of a mustard seed; smooth, made from gold or other metals, resembling the stalk of flowers of kunda, aswamara and sumana and strong.
The enema material should be prepared from drugs which are soft and mild in action and its quantity should be one sukti (24 ml.) or as much as suitable to the doshas etc. (64-67)
Uttara basti vidhi – procedure of urethral and vaginal enema
अथ स्त्राताशितस्यास्य स्नेहबस्तिविधानतः । ऋजोः सुखोपविष्टस्य पीठे जानुसमे मृदौ ॥६८ ॥
हृष्टे मेढ्रे स्थिते चर्जु शनैः स्त्रोतोविशुद्धये । मालतीपुष्पवृन्ताग्रपरिणाहां घनामृजुम् ॥६९॥
श्लेक्ष्णां शलाकां प्रणयेत्तया शुद्धेऽनुसीवनीम् । आमेहनान्तं नेत्रं च निष्कम्पं गुदवत्ततः ॥ ७० ॥
पीडितेऽनुगते स्नेहे स्नेहबस्तिक्रमो हितः । बस्तीननेन विधिना दद्यात् त्रींश्चतुरोऽपि वा ॥७१ ॥
अनुवासनवच्छेषं सर्वमेवास्य चिन्तयेत् ॥७२॥
The patient should be given a bath and good food, as prescribed under lubrication enema. He should then be made to sit on a soft stool of the height of the knee. A thin, hard, straight, metal probe of the circumference of the stalk of malati flower, lubricated (with oil or ghee) is slowly introduced into the urethral canal along the line of the lower raphae (scrotal raphae), till it reaches the cavity inside. This is meant to make the passage clear. The probe is then pulled out and the hollow nozzle introduced slowly without shaking, in the same manner as of the lubricating enema, till it reaches the cavity of the urinary bladder. In this manner three or four enemas are to be given. All other regimen as prescribed for lubrication enema should be followed herein also. (68-72)
स्त्रीणामार्तवकाले तु योनिगृह्णात्यपावृतेः । विदधीत तदा तस्मादनृतावपि चात्यये ॥७३॥
योनिविभ्रंशशूलेषु योनिव्यापद्यसृग्दरे ॥७४॥
In case of women the ideal time for this type of enema is during their fertile period because the uterus and vagina will be in inverted position then. In emergencies it can be administered at any time and so also in prolapse of the uterus or vagina, pain, other diseases of the uterus and menorrhagia. (73-74)
नेत्रं दशाङ्गुलं मुद्गप्रवेशं चतुरङ्गुलम् । अपत्यमार्गे योज्यं स्याद्व्यङ्गुलं मूत्रवर्त्मनि ॥७५॥ मूत्रकृच्छ्रविकारेषु बालानां त्वेकमङ्गुलम् । प्रकुञ्चो मध्यमा मात्रा बालानां शुक्तिरेवतु ॥७६॥
The nozzle for this type of enema should be of ten angulis (fingers breadth) long and its lower orifice permitting movement of a mudga (green gram). It is introduced to a length of four angulis in case of uterus and only to two angulis in case of urinary bladder. In cases of difficulty of micturition and in children, to the length of only one angula. The enema material, one prakunca (48 ml.) in quantity is the moderate dose for adults and one sukti (24 ml.) for children. (75-76)
उत्तानायाः शयानायाः सम्यक् सङ्कोच्य सक्थिनी । ऊर्ध्वजान्वास्त्रिचतुरानहोरात्रेण योजयेत् ॥७७॥
बस्तींस्त्रिरामत्रेवं तु स्नेहमात्रां विवर्धयेत् । त्र्यहमेवं च विश्रम्य प्रणिदध्यात् पुस्त्र्यहम् ॥७८ ॥
The woman should be made to lie on a cot with her face upwards, folding both the legs at the knee and keeping both of them upright. Three or four enemas should be given within a day and night (24 Hrs). It should be continued in this manner for three days slightly increasing the quantity of lubricating material each successive day. After a rest of three days another course of three days may be started. (77-78)
पक्षाद्विरेकोवमिते ततः पक्षान्त्रिरूहणम् । सद्यो निरूढश्चान्वास्यः सप्तरात्राद्विरेचितः ॥७९॥
Purgation therapy should be started after a fortnight of emesis therapy, decoction enema therapy after a fortnight of purgation therapy; lubrication enema should be given immediately after decoction enema and seven days after purgation therapy. (79)
यथा कुसुम्भादियुतात्तोयाद्रागं हरेत् पटः । तथा द्रवीकृताद्देहाद्वस्तिर्निर्हरते मलान् ॥८० ॥
Just as the cloth absorbs only the colour from the solution of kusumbha and other colouring substances, so also the enema expels out from the body only the doshas which have been made moist. (80)
॥ इति अष्टाविंशोऽध्यायः ॥
Thus ends the twenty-eighth chapter.
