Basti in Panchakarma (पंचकर्मसु बस्तिः )

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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 (Su.Chi 35/38).
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. Siddhi. 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 too based on the selected ingredients in basti preparation. Therefore basti is called as a supreme line of treatment.

Basti is commonly used along with Ayurveda medications. In some instances it can be administered alone. 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
7. Diseases of any body part causing stiffness or spasm or restricted range of movements

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 niruha basti is recommended. These are follows,

1. Diseases having generalised or all overthe body presentation
2. Diseases restricted to 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

शेषास्त्वास्थाप्याः; विशेषतस्तु सर्वाङ्गैकाङ्गकुक्षिरोगवातवर्चोमूत्रशुक्रसङ्गबलवर्णमांसरेतःक्षयदोषाध्मानाङ्गसुप्तिक्रिमिकोष्ठोदावर्तशुद्धातिसार- पर्वभेदाभितापप्लीहगुल्मशूलहृद्रोगभगन्दरोन्मादज्वरब्रध्नशिरःकर्णशूलहृदयपार्श्वपृष्ठकटीग्रहवेपनाक्षेपकगौरवातिलाघव- रजःक्षयार्तविषमाग्निस्फिग्जानुजङ्घोरुगुल्फपार्ष्णिप्रपदयोनिबाह्वङ्गुलिस्तनान्तदन्तनखपर्वास्थिशूल- शोषस्तम्भान्त्रकूजपरिकर्तिकाल्पाल्पसशब्दोग्रगन्धोत्थानादयो [१] वातव्याधयो विशेषेण महारोगाध्यायोक्ताश्च; एतेष्वास्थापनं प्रधानतममित्युक्तं वनस्पतिमूलच्छेदवत्||१६|| Cha si 2.16

Indications for Anuvasana basti

The diseases where niruha basti is recommended are also fit for Anuvasana type. However, those who have excessive dryness, strong agni and diseases caused due to vata alone, and not associated with ama.

य एवास्थाप्यास्त एवानुवास्याः; विशेषतस्तु रूक्षतीक्ष्णाग्नयः केवलवातरोगार्ताश्च; एतेषु ह्यनुवासनं प्रधानतममित्युक्तं मूले द्रुमप्रसेकवत्||१९|| cha si 2

Unfit for basti or contraindications

Unfit for Niruha basti

अनास्थाप्यास्तुअजीर्ण्यतिस्निग्धपीतस्नेहोत्क्लिष्टदोषाल्पाग्नियानक्लान्तातिदुर्बलक्षुत्तृष्णाश्रमार्तातिकृशभुक्तभक्तपीतोदकवमितविरिक्तकृतनस्तःकर्मकुद्धभीतमत्तमूर्च्छितप्रसक्तच्छर्दिनिष्ठीविकाश्वासकासहिक्काबद्धच्छिद्रोदकोदराध्मानालसकविसूचिकामप्रजातामातिसार- मधुमेहकुष्ठार्ताः||१४||

तत्राजीर्ण्यतिस्निग्धपीतस्नेहानां दूष्योदरं मूर्च्छाश्वयथुर्वा स्यात्, उत्क्लिष्टदोषमन्दाग्न्योररोचकस्तीव्रः, यानक्लान्तस्य क्षोभव्यापन्नो बस्तिराशु देहं शोषयेत्, अतिदुर्बलक्षुत्तृष्णाश्रमार्तानां पूर्वोक्तोदोषः स्यात्, अतिकृशस्य कार्श्यं पुनर्जनयेत्, भुक्तभक्तपीतोदकयोरुत्क्लिश्योर्ध्वमधो वा [१] वायुर्बस्तिमुत्क्षिप्य क्षिप्रं घोरान् विकाराञ्जनयेत्, वमितविरिक्तयोस्तु रूक्षं शरीरं निरूहः क्षतं क्षार इव दहेत्, कृतनस्तःकर्मणो विभ्रंशं भृशसंरुद्धस्रोतसः [२] कुर्यात्, क्रुद्धभीतयोर्बस्तिरूर्ध्वमुपप्लवेत्, मत्तमूर्च्छितयो र्भृशं विचलितायां सञ्ज्ञायां चित्तोपघाताद् व्यापत् स्यात्, प्रसक्तच्छर्दिर्निष्ठीविकाश्वासकासहिक्कार्तानामूर्ध्वीभूतो वायुरूर्ध्वं बस्तिं नयेत्, बद्धच्छिद्रोदकोदराध्मानार्तानां भृशतरमाध्याप्य बस्तिः प्राणान् हिंस्यात्, अलसकविसूचिकामप्रजातामातिसारिणामामकृतो दोषः स्यात्, मधुमेहकुष्ठिनोर्व्याधेः पुनर्वृद्धिः; तस्मादेते नास्थाप्याः||१५|| Cha si 2.15

Unfit for Anuvasana Basti

य एवानास्थाप्यास्त एवाननुवास्याः स्युः; विशेषतस्त्वभुक्तभक्तनवज्वरपाण्डुरोगकामलाप्रमेहार्शःप्रतिश्यायारोचकमन्दाग्निदुर्बलप्लीहकफोदरोरुस्तम्भवर्चोभेद- विषगरपीतपित्तकफाभिष्यन्दगुरुकोष्ठश्लीपदगलगण्डापचिक्रिमिकोष्ठिनः [१] ||१७||

तत्राभुक्तभक्तस्यानावृतमार्गत्वादूर्ध्वमतिवर्तते स्नेहः, नवज्वरपाण्डुरोगकामलाप्रमेहिणां दोषानुत्क्लिश्योदरञ्जनयेत्, अर्शसस्यार्शांस्यभिष्यन्द्याध्मानं कुर्यात्, अरोचकार्तस्यान्नगृद्धिं पुनर्हन्यात्, मन्दाग्निदुर्बलयोर्मन्दतरमग्निं कुर्यात्, प्रतिश्यायप्लीहादिमतां भृशमुत्क्लिष्टदोषाणां भूय एव दोषं वर्धयेत्; तस्मादेते नानुवास्याः||१८||

How basti is given in today's times

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.

How basti is absorbed in body

  Lipid soluble drugs 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. As per Ayurvedic classics Basti works as plant watered at its root & then root circulate it in all branches (su.ch.35/24-25). It has also been described as Ardha Chikitsa (Ch.si.1/39). i.e. half treatment for management of diseases.

Mode of Action of Basti

Ayurveda is having its 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. Similes were used, because the objective parameters were not developed to an extent as they are today. 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. A) Eliminative or purificative action of the Basti Acharya Charaka explained in Siddhi Sthana (7/64) that the Basti administered to the Pakvashaya draws the Dosha/Mala from all over the body from the foot to the head by virtue of its Virya, just as the sun situated in the sky draws the moisture from the earth by virtue of its heat. Why only the waste substance (Mala) is eliminated. This is explained by another simile in Charaka Siddhi (7/65). 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. B) Systemic action of the Basti Acharaya Sushruta explained in Chikitsa Sthana (36/25) that the Virya of the drugs administered through the Basti into the Pakvasaya reaches the whole body through the channels (Srotas), as the active principles in the water when poured at the root of the tree reaches the whole plant.

Basti have been categorised into various types according to type of ingredients action of Basti & number of Basti. Medicines/ ingredients used in Basti Karma are selected as per the condition of disease & condition of the patient.

शाखागताः कोष्ठगताश्च रोगा मर्मोर्ध्वसर्वावयवाङ्गजाश्च|

ये सन्ति तेषां न हि कश्चिदन्यो वायोः परं जन्मनि हेतुरस्ति||३८||

विण्मूत्रपित्तादिमलाशयानां [१] विक्षेपसङ्घातकरः स यस्मात्|

तस्यातिवृद्धस्य शमाय नान्यद्बस्तिं विना भेषजमस्ति किञ्चित्||३९||

तस्माच्चिकित्सार्धमिति ब्रुवन्ति सर्वां चिकित्सामपि बस्तिमेके|४०| Cha si 1

नाभिप्रदेशं कटिपार्श्वकुक्षिं गत्वा शकृद्दोषचयं विलोड्य [१] ||४०||

संस्नेह्य कायं सपुरीषदोषः सम्यक् सुखेनैति च यः स बस्तिः [२] |४१|

Basti - A Supreme Line Of Treatment

It is the Best threapy 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. (Cha. Su.12/8, 17/118, 25/40,

Cha.Si. 1/38- 39, 10/17, 18).

It performs 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. (Cha.Si.11/16, 3/6 ).

It acts as both Samsodhana and Samsamana (Su. Ci. 35/3,4) It provides immediate strength; hence it is a supreme line of treatment, particularly in children and aged persons (Cha.Si 11/36).

It can be used in almost all the diseases by using specific drugs indicated in that disease condition (Ca. Si. 10/4, Su. Ci. 38/111)

कर्मान्यद्बस्तिसमं न विद्यते शीघ्रसुखविशोधित्वात्|

आश्वपतर्पणतर्पणयोगाच्च निरत्ययत्वाच्च||५|| (Char.Samh. Siddhi 10.5)

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 (Cha. Si. 9/7).

It eliminates the Doshas/Mala accumulated in the whole body; in turn alleviates the disease (Cha. Si. 1/28).

Benefits of different types of basti

Niruha samyak yoga signs- प्रसृष्टविण्मूत्रसमीरणत्वं रुच्यग्निवृद्ध्याशयलाघवानि||४१||

रोगोपशान्तिः प्रकृतिस्थता च बलं च तत् स्यात् सुनिरूढलिङ्गम्|४२| (Char. Samh. Siddhi 1. 42) Anuvasana samyak yoga - प्रत्येत्यसक्तं सशकृच्च तैलं रक्तादिबुद्धीन्द्रियसम्प्रसादः ^[१] |

स्वप्नानुवृत्तिर्लघुता बलं च सृष्टाश्च वेगाः स्वनुवासिते स्युः||४४|| (Char. Samh. Siddhi 1. 44)

Do's and Dont's For basti and other panchakarmas

Parihara kala

कालस्तु बस्त्यादिषु याति यावांस्तावान् भवेद्द्विः परिहारकालः|५४| Cha Si 1.54

Things to avoid

अत्यासनस्थानवचांसि यानं स्वप्नं दिवा मैथुनवेगरोधान्||५४||

शीतोपचारातपशोकरोषांस्त्यजेदकालाहितभोजनं च|५५|