Basti in Panchakarma (पंचकर्मसु बस्तिः )

Basti (बस्तिः) is the samskrit term which means urinary bladder. Ayurveda considers basti as one of the 3 chief vital organs of humans. When the term basti is used in reference to Panchakarma procedures of Ayurveda, it refers to the procedure of giving medicated enema. In this panchakarma procedure, medicated oils or decoctions or combination of multiple medicated ingredients is done and the fluid is administered per rectally. In this article a brief account on the panchakarma procedure basti has been given.

Introduction

Ayurveda has categorized the chikitsa (treatment) into 2 main types. Pacification of aggravated doshas with the help of medicines means Shamanam (शमनम्) while eliminating the excessively aggravated doshas out of the body through Panchakarma procedures is called as shodhanam (शोधनम्). Basti, the prime treatment in shodhana is considered as one of the most important treatments for many diseases according to Ayurvedic classical literature. It is the best treatment modality for all types of vata diseases. The route of administration of basti ensures the entry of medicines directly into the pakwashaya (part of large intestine) which is believed to be the chief site of Vata dosha in body. Thus the basti directly acts on the site of vata and facilitates easy control or pacification of vitiated vata. Thus classically it is advocated in the diseases of vata. According to the classical texts basti administration is done with the help of animal urinary bladder and specially prepared metal/wooden nozzle/catheter, the whole assembly is called as basti-yantra i.e. Tool for basti. As basti is basically a receptacle having soft and elastic nature, it was used as an instrument for drug administration with a constant pressure.

Etymology

According to Vachaspathyam the word “Basti” is derived from the root “Vas” by adding “Tich” Pratyaya and it belongs to masculine gender.

If the function of basti in the body is observed, it is understood that, bladder is that organ which collects waste liquid from all over the body up to certain capacity and then throws it all at one time not continuously. Thus basti has capacity to store and then expel out in a particular fashion which makes it suitable organ for giving basti. In the basti procedures, multiple ingredients are mixed in a specific manner, stored for little time and then the resultant mixture is administered.

Types

Basti is categorized into 3 main types by Acharya Vagbhata. In Ashtanga hrudayam, 3 types of basti have been mentioned as below,

1. Niruha basti : The type of basti where decoction is the major part is called as asthapana basti or niruha basti. In Niruha Basti/ Aasthaapana Basti, decoction of medicinal plants is the main content wherein other ingredients like honey, salt, lipids & other drugs are incorporated to form a colloid or a suspension. Word Niruha, indicates “To eliminate” or eliminate morbid Doshas or Disease from body, & its synonym word “Asthapan” indicates “establish life span & age..
2. Anuvasana basti : Basti in which major part of plain or medicated oil is used is called as anuvasana. The word Anuvasan indicates “To stay”, the administrated medicines stay inside for a longer duration, but still do not cause any untoward problem
3. Uttar basti : The basti administered through different route (Uttara:next) i.e. through urethral opening in males and vaginal orifice in females is called as uttara basti. In this type of basti also chiefly oil or ghee is used as a drug.

Other common basti types include following bastis,

1. Yapana basti: Basti indicated for strengthening, longevity, maintenance of health etc. Milk, broth, ghee, oil etc are common ingredients.
2. Ksheera basti: Milk is the major ingredient. ALong with milk, ghee, oil, honey can be used.
3. Matra basti: Type of anuvasana basti wherein medicated or plain oil is administered like anuvasana basti but the quantity of the oil is very less as compared to it.

What factors are considered before planning Basti for a patient?

Your Vaidya will examine you thoroughly and make assessment on the basis of Ayurveda's parameters. Usually Dashavidha pariksha (10 fold assessment) is done and only then it will be decided whether the patient needs basti therapy and all other details of basti treatment e.g. type, total period, ingredients, dose, do's and dont's etc. Acharya charaka has briefly listed the basic parameters a vaidya will consider before planning basti. Those are as follows,

समीक्ष्य दोषौषधदेशकालसात्म्याग्निसत्त्वादिवयोबलानि|

बस्तिः प्रयुक्तो नियतं गुणाय स्यात् सर्वकर्माणि च सिद्धिमन्ति||६|| (Char. Samh. 3.6)

These factors are-

• Doshas: Which doshas are aggrvated, vitiated, reduced etc needs to be decided first.
• Aushadha: Whether the drug is having desired gunas (properties) to balance the disturbed state of doshas an dhatus in presented health condition
• Desha: Usually agni is weak in Anupa desha (humid and hot regions) in such cases the dose and ingredients of basti need to be carefully selected to balance all the desha related conditions too.
• Kala: Kala affects dosha status in body. Thus certain kala may aggravate or reduce existing dosha status.
• Satmya: Intolerance and allergies for certain ingredients should be looked after and such ingredients can be avoided.
• Agni: Types of basti, ingredients, dosage may change with agni status
• Satva: Those having low tolerance
• Vaya: Dosage of basti, dimensions of the basti instrument, ingredients change as per the age.
• Bala: Dosage of basti, ingredient selection, type of basti etc change as per balam.
• other relevant factors like bowel habits, comorbities etc

When all these factors are considered, one can attain maximum benefits, desired outcomes and prevent adverse effects of basti therapy.

Common indications of basti

Basti is the chief treatment for aggravated or vitiated vata dosha. Although it chiefly acts on vata, it does help to balance vitiated pitta and kapha dosha as well due to appropriately selected ingredients in basti preparation. Therefore basti is called as a supreme line of treatment.

Basti is commonly administered along with Ayurveda medications. In some instances it can be recommended alone. In Charaka Samhita, medical conditions in which basti can be used as an emperical treatment are mentioned. Grossly these indications can be grouped in 4 categories.

1. Vata predominant conditions (muscular, neurological,neuro-mascular, orthopedic condiitons etc) leading to pains and aches in limbs
2. Gut related conditions arising from severe constipation and bowel discomfort
3. Genral conditions where Vata dosha plays key role viz. fertility related issues in women, certain gynaecological conditions, weakness of sensory and motor organs etc

Along with these Sushruta Samhita also specifically mentions few medical conditions where basti treatment is beneficial. Therefore, general indications for basti treatment can be compiled as below,

Various health conditions in which basti is recommended are listed below,

1. Vata related disorders in extremities like spasms, sprains, stiffness, pains, fracture etc.
2. Constipation, bloating, fissure like pain in ano,
3. In heat imbalances within body- to reduce excessive heat or to generate heat whenever required
4. Gulma - tumour like growths causing pain in abdomen
5. Atisara- diarrhoea
6. Udawarta - Reflux like disorders due to forceful suppression of excretion of urine, stools or flatus
7. Diseases of any body part causing stiffness or spasm or restricted range of movements
8. Head , neck diseases- Pratishyaya (rhinitis or sinusitis), Shirorogas (various types of headaches or migraine like condiitons), ardita (similar to facial paralysis or bell's palsy), adhimantha (an eye disease)
9. Neurological conditions- ardita (facial paralysis or bell's palsy), akshepaka (convulsion like disorder), pakshaghata (similar to paralysis or hemiparesis), generalized neurological conditions
10. Gynecological conditions- menstrual pain or pain associated with other gynecological conditions, scanty menses, low fertility, scanty breastmilk etc,
11. Colicky pain associated with renal calculi, hernia, bloating

In addition to this, there could be many other illnesses that are not mentioned here, but, after assessment, a vaidya may feel that basti would be beneficial. In such cases basti helps to balance aggravated vata which could be possibly exacerbating the actual illness.

Ayurveda scholars have also described the states specifically suitable for different types of bastis. The indications for 2 different types of basti are listed below.

Indications for niruha basti

There are certain conditions in which specifically niruha basti is recommended. These are follows,

1. Diseases having generalized (all over the body) presentation OR paralysis
2. Diseases restrictedto a certain part of the body
3. Diseases related to the organs in flanks and abdomen
4. Obstruction in the flow of flatus, feces, urine or semen
5. Emaciation resulting from depletion of mamsa dhatu, shukra dhatu, balam and varnam.
6. Abdominal bloating
7. Numbness in body parts
8. Worm infestation
9. Reflux like diseases
10. splenic disorder
11. abdominal lump
12. Fistula in ano
13. psychotic diseases
14. Headaches
15. tremors
16. convulsions
17. Scanty menses
18. Pain in back, knee, thighs, ankle, heels, foot, pelvis, arms, fingers, breasts, teeth, nails, bones, joints etc
19. Emaciation or atrophy
20. Stiffness
21. Fissure in ano
22. Various vata related diseases

Indications for Anuvasana basti

The diseases wherein niruha basti is recommended are also fit for Anuvasana type of basti. However, those who have excessive dryness in the body, strong agni and when the diseases are caused due to vata alone i.e not associated with ama require anuvasana type of basti chiefly.

Niruha basti shows more of cleansing and purifying action whereas anuvasana type of basti is nourishing type. Thus basti is chosen depending upon the desired action. When both the types of basti are used in succession or alternatively, cleansing and tonic both the actions are performed at a time. One type of basti works better when paired with the other type also. Therefore many a times niruha and anuvasana bastis are administered in alternate manner or one after the other.

Unfit for basti or contraindications

Basti is a type of Panchakarma which is known as detoxification or cleansing therapy. Since such therapies include administration of strong medicines and immediate elimination of body wastes through different routes of body, it needs careful observation. Therefore it is also extremely important to screen patients for their fitness before undergoing these procedures. Ayurveda scholars have listed certain conditions when the basti should not be given because then it might lead to serious adverse effects. These are called as contraindications for basti and are listed below.

Unfit for Niruha basti

The person should not receive niruha basti if he/she is having following conditions,

• Indigesiton
• Excessive snigdhata (Unctuousness) in body
• Ingested fatty substances like ghee or oil etc
• Weak agni ( digestive fire)
• anorexia
• Fatigue due to travelling
• Extreme weakness
• Hungry or thirsty
• Tired
• Very lean or frail
• Who has taken food or drink and is full stomach
• Continuous vomiting, breathlessness, coughing, hiccoughs
• Many other illnesses where administering large amount of decoction or suspension of multiple liquids might aggravate the already existing disease like intestinal perforation, obstruction etc.

Unfit for Anuvasana Basti

All those conditions where niruha basti is contraindicated, anuvasana basti is also contraindicated. In addition to that, certain other specific conditions where anuvasana basti is contraindicated are listed below,

• Empty stomach (Anuvasan basti is always given after food intake)
• Acute fevers
• Various diseases like- Pandu, Kamala, Prameha, Arsha, Pratishyaya, Arochaka, Pliha,
• Weak agni and balam (weak digestive strength and physical strength)
• Poisoning
• other medical conditions where purification or cleansing is recommended and not nourishing e.g worm infestation

How basti is given in today's times (Niruha basti or anuvasana basti)

Basti is known as the procedure there is rectal administration of medicated liquids. Thus technically it is somewhat similar to the enema procedure. However the instruments or tools used to administer basti have been described in depth in Ayurveda literature. Dimensions of catheter tube, quantity of total fluid to be administered have been described as per age and basti type. As described earlier the basti obtains its name from the fact that urinary bladders of animals (thoroughly cleaned and processed) were used as the bags to hold the fluid and push it through catheter inside the rectum. Nowadays, except in some of the Vaidya traditions in Kerala, basti administration is often done using enema-can or douche-set. In the aforesaid classical procedure active pressure is expected to be given on the bastiputaka whereas, in conventionally used enema-can only passive or gravitational force plays a role. It can also be used in children as well but with utmost care under physician’s supervision. The procedure of administering basti has been described in brief here.

• Purvakarma & Asana- The patient is advised to evacuate the bowel and bladder and lie down on the basti table.
• Abhyanga- Usually local oil massage to abdomen and low back is given with specific medicated massage oil advised by a vaidya.
• Swedana- Then on the same area hot fomentation is done with hot water bag or steam.
• Basti danam- As per the type of basti (Niruha or Anuvasana) the medicine to be administered is prepared and made warm. The patient is asked to turn and sleep on the left side. The left leg is to be kept straight while the right leg to be flexed/folded in the knee and pulled near chest. In this position the anal opening is better visible to the therapist who would then insert the appropriate catheter inside the anus. While doing so the patient is asked to take deep breaths very slowly. This is painless and catheter tube made up of rubber doesnt cause any injury to the body parts. Once the therapist fixes the catheter upto appropriate length medication of basti may it be oil or a suspension containing oil, decoction etc is pushed inside slowly and gently in one stroke by active pressure on piston or passive gravitational force. Once the complete dose of medication is pushed inside, the catheter is gently removed. The low back region is gently and slowly tapped few times and the patient is advised to rest on back for few minutes.
• Basti pratyagama- This refers to the return of basti drug after some time of giving basti. In case of Niruha basti where ususally the large amount of fluid in administered, the basti returns mostly within an hour. Whereas, in case of anuvasana or matra type of basti where small amount of oil or fluid is administered, the basti may be retained in the intestines for few hours or in rare cases it may not ever return.
• Bath, food intake- There are certain rules regarding when should the food be taken, when one can take a bath after basti etc. The consulting vaidya instructs these to the patient and all these rules need to be followed strictly so as to get maximum benefits and least adverse effects of the basti treatment.

How basti is absorbed in the body

Basti is administered per rectally like an enema. According to Ayurveda, the administered basti reaches the pakwashaya (part of large intestine) of gut. This is known to be the chief site of vata dosha in body. Vata can perform the function of Shoshana (absorption) with its ruksha (dry) guna. Thus basti ingredients are absorbed by vata in pakwashaya. However Ayurveda scholars opine that the action of basti occurs due to its Veeryam irrespective of its retention inside body. This veeryam is circulated or transported all over the body by Apana vata, Vyana vata Udana vata etc which are among 5 types of vata doshas active in specific part of body and responsible for movements in specific direction inside body.

स चापि सहसा बस्तिः केवलः समलोऽपि वा |

प्रत्येति वीर्यं त्वनिलैरपानाद्यैर्विनीयते ॥ (Sush. Samh. 35.26)

वीर्येण बस्तिरादत्ते दोषानापादमस्तकात्” (सु.चि.अ.३५) इति

Basti contains decoction of herbs, oil, ghee, honey, salt and similar ingredients. Lipid soluble drugs in basti are absorbed by passive diffusion and some of the active ingredients are absorbed through active transport. The bioavailability of the drug i.e the part of the drug which is able to produce an active effect on the body, will be higher when given as Basti.

Mode of Action of Basti

Ayurveda was passed on through oral and then written tradition from thousands of years. In those times, the objective parameters and technology were not developed to the extent they are today. It is believed that the ancient scholars acquired knowledge about all the internal body processes through yogaja pratyaksha jnanam (innate superior intelligence developed through yogic nature). However in the lack of objective parameters it was difficult to show other disciples and teach them bodily processes. This limitation was overcome with the unique approach of explaining the complex subjects by giving the similes which are commonly seen in day to day life to understand the subject easily. Similies were used to explain complex mechanisms in the physiology, pathology (Symptomatology) and in the therapeutic measures. The same is true in the case of Basti also.

• The mechanism of action of basti in eliminative or purificative action is explained in siddhisthanam of charaka samhita. It is stated that disease causing doshas or malas from all over the body are drawn into the pakwashaya (part of large intestine or gut) through basti just like the sun situated in the sky drwas moisture from earth by virtue of its heat.
• Why only the waste substance (Mala) is eliminated. This is explained by another simile i.e. As the cloth sucks up the pigment only from the water dyed with flower, similarly Basti eliminates only the Mala (waste substances) from the body.
• Although the basti is administered in Pakwashaya it imparts action all over the body. The reason behind such widespread action of basti has been explained by Acharya Sushruta with the help of a simile again. It is stated that, basti in pakwashaya can reach whole body through strotasas (channels of transportation in body) just like the tree watered at the roots can reach every part of the tree.
• The steps involved in the action of basti inside the body are explained by Acharya Charaka. He explains,

नाभिप्रदेशं कटिपार्श्वकुक्षिं गत्वा शकृद्दोषचयं विलोड्य ॥ संस्नेह्य कायं सपुरीषदोषः सम्यक् सुखेनैति च यः स बस्तिः ॥ (Char. Samh. 1.40-41) Meaning: The therapy that while moving in umbilical region, lumbar region, sides of the chest and pelvic regions churns up stool including all the other morbid matter located there and appropriately eliminates them with ease after oleating the body is called basti

• The vata dosha present in this part controls all the activities in the body including movement of other 2 doshas namely kapha and pitta. Therefore basti which directly acts on vata at this site has the capacity to impart effect on all the activities in the body occurring under the control of all 3 doshas mainly vata. It is therefore said that Basti works as plant watered at its root & then root circulate it in all branches. It has also been described as Ardha Chikitsa i.e. half the treatment for management of diseases.

Basti - A Supreme Line Of Treatment

Basti is called as supreme line of treatment in Ayurveda. By virtue of its broad spectrum of action it is believed to be the most important among panchakarmas. Charaka Samhita praised Basti treatment as the half the treatment or even complete treatment for illnesses.

• Basti has potential to control Vata which actually controls the entire functioning of body. Even in the process of disease development, vata plays crucial role by carrying other 2 doshas at the affected place as per the disease theory of Ayurveda. It is the Best therapy to regulate the Vata Dosha which is the chief governing force behind all the physiological and pathological processes both in the body and the mind. Thus it is called as half the treatment of any disease.

शाखागताः कोष्ठगताश्च रोगा मर्मोर्ध्वसर्वावयवाङ्गजाश्च| ये सन्ति तेषां न हि कश्चिदन्यो वायोः परं जन्मनि हेतुरस्ति||३८||

विण्मूत्रपित्तादिमलाशयानां विक्षेपसङ्घातकरः स यस्मात्| तस्यातिवृद्धस्य शमाय नान्यद्बस्तिं विना भेषजमस्ति किञ्चित्||३९||

तस्माच्चिकित्सार्धमिति ब्रुवन्ति सर्वां चिकित्सामपि बस्तिमेके|४०| (Char. Samh. 1.38-40)

• Moreover, Basti is fast acting and quickly restores the balance by either nourishing or cleansing activity without any adverse effects. Thus is effective and safe at the same time. Therefore Basti holds special place in Panchakarma and all the treatment modalities in Ayurveda.

कर्मान्यद्बस्तिसमं न विद्यते शीघ्रसुखविशोधित्वात्| आश्वपतर्पणतर्पणयोगाच्च निरत्ययत्वाच्च||५|| (Char.Samh. Siddhi 10.5)

• Basti is versatile in action. It can perform both the Upakramas viz. Langhana and Brumhana and can provide the benefit of whole of the Panchakarma by virtue of its specific type and different drugs utilised in it.
• It acts as both Samsodhana and Samsamana, It provides immediate strength; hence it is a supreme line of treatment, particularly in children and aged persons.
• It can be used in almost all the diseases by using specific drugs indicated in that disease condition.
• There is no treatment equivalent to Basti in the protection of the Marmasthi and Sandhi in the management of their affliction, which are considered as vital parts in the body.
• It eliminates the Doshas/Mala accumulated in the whole body; in turn alleviates the disease.

Benefits of different types of basti

Various health benefit of different types of basti are described in brief below,

Niruha basti when done properly brings about following positive changes in body

• Sufficient and satisfactory evacuation of bowels, urinary bladder and release of accumulated gas takes place
• Since all wastes are properly evacuated, it generates appetite, increases interest in food, and lightness in stomach.
• The disease or medical condition for which the basti wad advised is well treated, and symptoms relived.
• The normal health state is achieved.
• Strength is gained.

Anuvasana basti consisting of medicated oils when done properly provides following benefits,

• Stools are passed with ease and smoothly with or without oil after administering basti
• All the dhatus, buddhi and indriyas are calmed and nourished.
• One gets sound sleep.
• Strength is increased.
• Bowel and bladder evacuation occurs smoothly. All other natural urges are properly manifested.

Special precautions after doing basti and other panchakarmas

Parihara kala is the term used in Ayurveda to indicate the time period which is double the time required for panchakarma procedure which starts after completion of Panchakarma procedure like vamana, virechana, basti etc. During this period the patient is advised to take following precautions and follow these rules,

• Long hours of sitting
• Excessive talking
• Excessive travelling
• Excessive sleeping,
• Daytime sleeping
• Coitus
• Suppression of natural urges
• Cold exposure, drinking/eating cold
• Exposure to sun/heat
• Greif, anger, anxiety
• Eating on irregular time