Latest Trends in Basti Management

Dr. Yadaiah Polepally.
M.D., Ph.D

Ayurveda considers fats, medicated oils as tissues-protectors. The advice of applications of such material is spread all over the texts. Instead of application to the skin, only the warm oils and decoctions are allowed to dwell in hollows of the body for a stipulated period. By dwelling in they come in contact with the specific mucous membrane, improvise the structure and thus function in that locality. So the method of making a material to dwell in the hollow, facility to be in and such interventivematerial is called Basti. The majority of such push-to-dwell in are through the rectum in the large intestines, and they are mistranslated as enema. The intention of enema is mostly of introduction of some irritant / secretogogue, volume to hasten movement of obstructed contents outside; the intention in administering Basti is to dwell inside for a much longer spell, so that absorption of the interventive material can augment the capacity of the organ. The entry is mainly through three orifices:

• Pakvaas`haya (Large intestines) through rectum; or
• Into Garbhaas`haya (Uterus) through vagina or
• Into Mootraas`haya (Bladder) through urethra. It is done with the help of Basti Yantra andit can be called as intra-rectal.

According to modern science enema is said to be the cleaning of the large intestines and rectum with the help of soap water or warm water whenever a patient gets constipation. In Basti there are many food items rather than only irritants introduced into the body. The dominant mixture ingredients are mainly of two varieties of I.R. (2).

1. Anuvaasana (Predominance of oils or ghee) and
2. Nirooha (less oil and more decoction of herbs)

Maatraa Basti is one of the varieties of Anuvaasana Basti and it is one of the safest and least uncomplicated. Its volume is very small, equal to 60 ml approximately. It is indicated in all clinical conditions, where building of tissues is the need arising out of less nourishment (Apatarpan`ajanya Vyaadhi) (3)

MAATRAA BASTI INDICATIONS: –

• Vaataavyaadhi_s
• Paks`haaghaata
• Sandhivaata
• Balaapahata
• Kat`is`hoola
• Gridhrasee
• Manyaashoola
• Osteoporosis
• Avascular Necrosis
• Pseudomuscular hypertrophy.
• Muscular emaciation.
• Apasmaara (Epilepsy).

MATERIALS: –

1. 100 ml of metal or plastic syringe.
2. Rubber catheter according to the age.
3. Medicine

• Medicated oil, fat.
• Medicated ghee

Dose: 15 to 30 ml – children
        30 to 60 ml – adults

Duration: 8 days or 16 days.

PROCEDURE: –

Poorva Karma (Preparatory)

• The Patient should be asked to pass urine and stools to avoid chance of uncontrolled evacuation or undue holding.
• Oil massage should be done to the whole body or locally i.e. back, abdomen and buttocks for 10 to15 minutes.
• Hot fomentation should be given with controlled medicated steam by a tube or with a hot water bag for 10 to 15 minutes.

Pradhaana Karma (Main procedure): –

• The patient should lie down on the table on his left side, flexing the righthip and knee, and putting on his left leg.
• Warm medicated oil mixed with 1 gram of rock salt.
• Warm medicated oil should be taken into a syringe and the catheter must be fixed by removing the air completely from it by pressing the piston of the syringe.
• After applying oil to the anus insert oil-smeared catheter, slowly into anus up to 3″ length, and then slowly and gently push the oil in to the rectum without jerk.
• Slowly remove the catheter and do a light massage and give gentle jerks on the buttocks.

Paschaata Karma (last procedure): –

1. After every five minutes ask the patient to change the postures from left lateral to prone posture and from prone to right lateral and from right lateral to supine relaxed posture.
2. If the patient is below 5 years, the parent should be asked to hold, him so as to avoid harmful movements.
3. Encourage the patient to take complete rest for 2 to 3 hours, and as far as possible he should be advised not to pass stools up to 2 hours. After 2 hours he can be allowed to pass stools OPD patient should be allowed to go home and take rest.
4. When the patient gets a good appetite, he should be given hot and fresh lentil-rice (Khichad`i) combination.
5. Hot water should be given throughout the treatment period.
6. For O.P.D. patients, however, care should be taken to avoid physical as well as mental strain.
7. The patient should be advised to sleep early.
8. Patient should be advised about the principles of the treatment and asked to follow throughout the course to obtain maximum results.

2) Maadhu Tailika Basti
Maadhu Tailika a combine of honey and oil is one of the varieties of S`hodhana Basti and the safest among all. It can be used for VIPS, Business executives, Old persons etc. (4)

NIROOHA BASTI:
Due to the more absorbable ingredients, Anuvaasana is to dwell in the body for a longer period. With repetitionof these, there is the necessity to clear the extra oily component. For this the medicated decoctions, administered in between; cleanse, Dosha_s and Mala_s from the body. This is known as Nirooha – one responsible for doing away extra oiliness, due to continued Basti_s. Care must be taken that Anuvaasana should be given before and after the Nirooha Basti. The Basti, which is dominant in decoction, instead of oils, fats; is also known as Kashaaya Basti. Due to its beneficial effect on a longer span of life, it has been called, Aasthaapana Basti.

INDICATIONS: –

• All Vaatavyadhi_s.      
• Sandhivaata
• Aamavaata
• Pakshaaghaata
• Gridhrasee
• Madhumeha
• Malabaddhataa
• Aadhmaana
• UTI infection
• All Dhaatu Vikaara_s
• Osteoporosis.
• Avascular necrosis.

MATERIALS: –

1. Powders of Das`hamoola
2. Triphal`aa
3. Erand`a Moola
4. Rock salt
5. Honey
6. Cows urine, all these remove the oily material, so a little sesame oil is added.

Poorva Karma (Preparatory procedure): 25gms. of the above mentioned powder, add 400 ml. of water. On the slim flame reduce it to 100 or 50 ml. Strain and use the decoction in required proportion.

50gms of honey, 10gms of rock salt, churn along with chutney. After mixing, pour 50ml of sesame oil slowly and at the end add 300ml to 400ml decoction. After mixing properly keep in hot water-bath, to maintain warmth, for use.

Before administration of S`hodhana the patient should have had Anuvaasana earlier.

Pradhaana Karma (Main procedure): – be sure that the patient comes with an empty stomach.
The procedure as advised earlier is to be followed.

Paschaata Karma (end procedure): –

Reassure the patient, inquire about any pain, and advise rest, at least for two hours. With proper appetite, rice munga preparation, freshly cooked along with warm water to drink, should be advised throughout the treatment. In the evening, a hot and light diet is advised. In the situation of no passage of stools, once again he is administered S`hodhana in larger quantity. The next day morning the patient should continue Anuvaasana Basti.

Uses: –

By improvising the area responsible for absorption, by proper separation of sticky layers, there is cleansing of all the channels, fluid exchange mechanism gets toned up; extra Dosha_s are propagated outside, whereby the strength of tissues is improved. It results in rejuvenation, which improves longevity and memory and complexion too.

By nature it is antiVaata procedure, and by maximizing tissue wear tear it normalizes other components too.

Basti is the choicest remedy to compensate the effects of Vaata exacerbation as termed Vaataharaan`aam Shresht`ham” (6) and therefore it is the best therapy to treat all Vaata Vyaadhi_s and Aachaarya Sus`hrita aptly described that, it is useful not only for Vaata, but also for Pitta, Kapha, Rakta and in complex combination of two, three (Samsarga and Sannipaata) Dosha_s (7)

Basti is not similar to enema, because of its nourishing potential; hence it should not to be misunderstood as enema. Basti, management is labeled as total (for Kaaya Chikitsaa) and of entire management in Ayurveda.

Pharmaco Dynamics of Basti

Using the simple examples of daily life easily does the explanations of actions. Intra Rectal, dominate in food items rather than medicinals. The tissues on the verge of weakness are refreshed / rejuvenated by courses of intra-rectals. It is compared to watering of a dry plant, to have the recovery of the turgid cells once again. As the actions are noted at so many levels of tissues regeneration, broad spectrum is probably the most appropriate term. It acts as Rasaayana (to rejuvenate,) Vrishya (Aphrodisiac); Brimhan`a (Anabolic) because of its capacities to contribute to the building of tissues; and it is indicated in a (Kris`ha) or emaciated persons to increase the quality and quantity of Dhaatu_s; and in (Sthaulya) obesity to streamline the unwanted obesity components (9). The clinically observed effects at times surprise the scientists, especially in background of prevalently accepted medical sciences. A volume of fat, with or without herbal decoction, with temperatures around 38-43 degree Celsius, allowed to dwell in the lower zone of gastro-intestinal tract; for a stipulated bearable period, produces a spectrum of actions. But the area of Apaana–Vaata by its controlling capacity of rest Vaata types, does so. Here it is the distinct concept is to be digested, rather than pharmacological action of the substance dwelling in. Basti_s show significant results in almost all diseases, by its very distinct actions on Vaata zone. The fact is therefore explained with suitable analogies. :

Trees are irrigated at its root level, and in due course of time, develop branches rich with beautiful tender leaves, flowers and fruits. So the administered decoction in the rectum, due to the main absorbing area, (Guda) produces results positive from head to toe 10) (11). (See illustration)

Basti eliminates the vitiated Dosha_s. Medicines, which are administered through the rectal route, are absorbed in the rectum and large intestines. The rectum has rich blood and lymph supply and drugs can cross through the rectal mucosalike other lipid membranes. Aachaarya Paaras`haraopined long ago, anus (Guda) is the main route of the body having blood vessels in it, nourishes the whole body. The technical term for this part of the track is Paayu. i.e. one which is capable of absorbing oil through its layers, is the grammatical derivation of the term; the most appropriate.

        The superior haemorrhoidalveins in the portal circulation carry the portion, which is absorbed from the upper rectal mucosa, whereas the middle and inferior haemorrhoidalveins absorb from the lower rectal mucosa, and thus enters directly into the Systemic Circulation.

        The rectum with its vascularityand venous plexus provides a good circulation, producing the effects more quickly without affecting the liver where they may be differently metabolized.

Soon after the intake, to facilitate digestion at proximal part, the pyloric sphincter contracts for proper digestion. The Kapha`s transient dominance, in Kapha–Prapaaka stage extends due to Anuvaasana particularly and enhances the (Brimhan`a) tissue – building effect.

The alimentary canal is open on both sides. With any intake automatically the pyloric sphincter tightly closes, and by intra-rectal at the same time the chances of dwelling in are increased to achieve tissue building.

Pharmacodynamics of S`hodhana Basti: –

The decoction predominant Basti enters into the large intestine, and gets absorbed a little earlier, as the contents are less thick. The medicine component enhances elimination of waste materials, from tissue level and brings to the hollow area to throw out from the body.

In other words it can be hypothetically explained that, being a hyper tonic solution (Nirooha Basti) after entering the large intestines, the fluids may traverse because of osmosis from hypo tonic to hyper tonic solutions i. e.fluid along with the unwanted pathological material, dragged from intracellular and extra cellular level into the large intestines and thrown out from the body. The choice of an empty stomach for this is specific of S`hodhana Basti. Expected to come out with in (one Muhurta) 45min.to avoid many complications. S`hodhana Basti should be given on empty stomach as explained in Aasthaapana Basti.

With Ayurvedaic and other rationales so perused, the statements about, half or total management, by intra-rectal, solely or only can be appreciated with certain clinical evaluations.

Maatraa Basti: –

Clinically Maatraa Basti has shown different properties in various diseases.

1. In polio Balaataila Maatraa Basti and Snehana Svedana with Vitous nirgudocrushed leaves restored the muscle power. Girths and the total weight increased significantly after treatment.

In the present study the Polio cases were selected from the 0.P.D & I.P.D. and kept under the following treatment groups.

Group	Intervention	Duration
Balaa Taila Maatraa Basti	30 ml continuously	15 days in Acute cases
Balaa Taila Maatraa Basti	30 ml	Alternate day.
Tila Taila Maatraa Basti.	30 ml dose continuously
Balaa Taila Maatraa Basti	30 ml	Chronic polio
Tila Taila Maatraa Basti	30 ml dose continuously
Pin`d`a Sveda		15 days regularly chronic polio
Balaa Taila Abhyanga with Nirgundo		2 months. Acute
Balaa Taila Abhyanga with Nirgundo		2 months Chronic

1. To assess the individual muscle power before and after the treatment, all the patients were examined and graded according to the Medical Research Council (0-5)
2. Measurements of all the muscles were noted before and after the treatment.
3. Body weight was recorded before as well as after the treatment.

Conclusion:

1. The study has established that continuous Balaa Taila Maatraa Basti is superior to other treatments for acute patients. The statistical and even clinical results have indicated that the recovery is faster than from other treatments.
2. The study has indicated that the muscles of the left knee extensors have gained significant muscle power with continuous Balaa Taila Maatraa Basti in acute cases.
3. The clinical study revealed that the continuous Balaa Taila Maatraa Basti in acute cases is superior to the other treatments, particularly in the improvement of hip extensors of left side affected cases.
4. All the treatments considered in this study have shown statistical significance by 5%, increase in body weight.
5. Statistically it has been proved that, all patients have gained the muscle power at 5% level.
6. Maatraa Basti has not shown any complications and side effects during and after the treatment (Yadaiah1985).

II. In Pakshaaghaata (paralysis) , there were significant results with courses of Bastis of As`hvagandhaa Ghrita and Vaata Naas`haka Taila, muscle power significantly increased and many patients become independent .

III As`hvagandhaa Ghrita Basti has shown significant results in Sandhivaata (osteoArthritis).

IV. Brihat Saindhavaadi Taila has shown encouraging results in Aamavaata (Rheumatism) patients and laboratory investigations were reported negative for R.A. and ASO titrein number of cases.

Lekhana Basti has shown significant reduction in body weight and lipid profile. In this study, patients who possessed the signs and symptoms of Medoroga mentioned in Charaka Samhitaa as well as having a body mass index more than 24 were selected for research trials. Following investigations were done for every obesity patient before and after treatment i.e. blood for Hb%, blood sugar, serum cholesterol, and lipid profile and urine examination. These patients were divided randomly into three groups:

Group I

1. Baahya Snehana
2. Baashpa Svedana
3. Lekhana Basti
4. Navaka Guggulu 500 mgs TDS
5. Restricted Aahaara
6. Daily exercises and precautions.

Apart from the present day prevalent managements for various conditions, addition or alone use of textually indicated intra-rectal has number of benefits. All scientific details cannot be included for want of place. Certain claims about shifting of pathological values or texts to physiological ones are indicative of therapeutic efficacy. Lekhana for control of obesity; Maadhu Tailika for control of neuro-muscular stroke, situations; medicated milk administration by Basti for antacid potential; intra-rectal of volume of churned gum-olio-resin of S`haalmaeei, in ulcerative irritationalmalabsorbtiveconditions are a few taken from a long list.

Group ‑ II: In this group the patients were kept on Navaka Guggulu 500mgs TDS for 90 days along with a restricted diet and Vihaara.

Group ‑ III: In this group patients were kept on placebo for 90 days along with restricted diet and Vihaara.

It is observed from the clinical study, that the group I (Lekhana Basti) therapy is most effective with respect to body mass index (1% level of significance), body weight (1% level), subjective symptoms such as Daurbalya (5% level), Anga Gaurava (1% level) Sandhi S`hoola (1% level) and Trishn`aadhikya (5% level), bio-chemical investigation serum Cholesterol(1% level) and did not produce any significant changes in blood pressure or the respiratory rate

Table showing the mean reduction of body weightin-group I, II, III.

S. Treatment Body wt.         Body wt. After treatment

No. Group  B.T. 15 Days       30     45     60     75    90

1.             I       77.7          75.3  74.5 74.0         73.3  73.0 72.3

2.             II      78.7          78.0  77.0 76.6 75.8  75.8 75.4

3.             III     76.5          76.1  75.7 75.8 75.8  75.9 75.1

Mean Deference in Lipid Profile after treatment in three groups.

Sr. Name of After Treatment (Groups)

No. Values                 I       II     III

1      Sr.cholesterol     16.625 mg/dl      10.308 mg/dl -1.09 mg/dl

2      Triglycerides      11.244 mg/dl 4.258 mg/dl    1.75 mg/dl

3      HDL –        7.524 mg/dl       – 1.9 mg/dl        1.9 mg/dl

4      LDL           16.759 mg/dl      15.315 mg/dl      – 0.406 mg/dl

In Group-I, a remarkable decrease in the values of serum cholesterol and Triglyceridevalues was noticed, which was 16.625 mg/dl and 11.244 mg/dl respectively, in average. The HDL values were increased by -7.524 in average. The LDL values were changed slightly.

Group‑I therapy is the best with respect to Triglyceridevalue (1% level of significance) and HDL value (1% level of significance). (Kulkarni& Yadaiah1996).

Clinical trials of Maadhu Tailika Basti in Pakshaaghaata .
In this study 38 Pakshaaghaat patients were selected from I.P.D.&O.P.D. Kaayachikitsaa
Dept. Ayurvedaic Hospital Akola (1983-1985) divided them randomly into three groups. Maadhu Tailika Basti in Madhyam Maatraa (648ml) has been kept for a period of 8 days for 12 Pakshaghaata Patients (G‑1 group). In Avara maatraa (424ml) Maadhu Tailika Basti has been administered to 11 Pakshaaghaata Patients (G ‑2group) and 15 Basti course has been kept for 11 patients (G‑3 group) in the dose of Pravara Maatraa.

Investigations: ‑
The following investigations were carried out on all the patients before and after the treatment:

• Urine examination
• Blood for Hb%. ESR, TLC, DLC, Serum protein, Serum Cholesterol, Blood Sugar and VDRL etc.

Conclusion: –

From the above study the following conclusions were drawn:

1. Statistically significant results have been observed in all the three groups.
2. Maadhu Tailika Basti has been proved to be an effective medicine for Pakshaaghaata.
3. In present mechanical era the Maadhu Tailika Basti is a safest, uncomplicated and time saving method of Basti and it is free from untoward effects.
4. It has also seen that, this Basti can be administered in OPD level.
5. In G1 group, the significant raise in protein levels (t+‑ 16.48 P<0.10) and significant reductions in ESR levels (t+_ 1.68;P<0.10) were seemed.
6. In G2 group, significant reduction was seen in Blood sugar levels (t+_2.193; P<0.05) and ESR levels (t+3.268; P<0.01)
7. Significant increase in Hb% (t+_1.97; P<0.05) was seen in G3 group.
8. Serum cholesterol levels have not shown any significant change in any group.
9. Grading scale has shown statistically significant improvement in all the symptoms of three groups.
10. Marked improvement was seen in 38.23% patients, 50% patients were moderately relieved and mild relief was observed in 11.7%. Cases.
11. In the improvement and response, there is no difference have been noted in relation to the effect of the side (right or left)
12. Blood sugar is significantly reduced in G2 group, it suggests that, further study is required is this direction.
13. From above study it is very clear that, Maadhu Tailika Basti is very useful uncomplicated and the safest variety of Basti. It can be administered to any body at any time and in all walks of life, as said by Aachaarya Sus`hruta (Yadaiah1983).
14. In this clinical study 125 polio cases were selected from Ayurveda Hospital, KaayachikitsaaDept. Akola(1985 to 1990)

Polio cases were divided randomly in to three groups:

1. Group I: – 68 polio cases were kept under the management of Snehana Svedana (Vaata S`haamaka Taila and Nirgun`d`i Patra Svedana) for a period of 2 months.
2. Group II: ‑ 23 cases were kept under the Pin`d`a svedena for a period of 15 to 21 days continuouslyafter application of Vaata S`haamaka Taila.
3. Group III: ‑ 34 cases were received Vaata S`haamaka Taila Maatraa Basti for a period of 8 days continuously along with Snehana and Svedana.

From this study it has been observed that the lower limb (LL) affected cases have shown good improvement whereas both LL affected cases have not shown encouraging results. However in these cases one limb (either left or right) has got improvement in their muscle power up to3‑4 grade and another LL has got 1‑2 grade muscle power.

1. Children affected with UL have not shown encouraging results.
2. Maatraa Basti has shown comparatively encouraging results than other treatments (Yadaiah1989).

Ksheera Basti

Ksheera Basti in Amlapitta patients

In this study 24 Amlapitta the patients were kept on Ksheera Basti. The patients who hadthe symptoms of vomiting, belching, hotness, headache, loss of appetite anxiety, constipation, general weakness and abdominal pain were kept on Ksheera Basti treatment. The patients were divided into three groups according to the intensity and duration of disease.

Group I: In this group 12 patient were kept on Ksheera Basti for 8 days duration.

Group II: In this group 6 patients were kept on 16 days Ksheera Basti continuously.

Group III: In this group 6 Amlapitta patients were kept on 2 courses of 16 days. Ksheera Basti 2nd group (another 16 days) was similarly treated but after a 2 months gap.

Results: ‑

1. Maximum (86.38%) Cases of Amlapitta were observed in 21 to 50 year groups.
2. From the study in has been observed that all the symptoms were significantly reduced.
3. The body weight was increased significantly.
4. Vomiting, belching hotness, abdominal pain, were negated completely (Yadaiah1998).

Pichchhaa Basti:
In the present study 23 Grahan`i patients were administered the Pichchhaa Basti after Detailedclinical examination.

Duration of the treatment: ‑ 6 patient were given 8 days of Pichchhaa Basti, 6 patients were given 16 days and 11 patients were given more than 16 Pichchhaa Basti to get complete relief.

The signs and symptoms like abdominal pain, mucus stool, loose motions, palpitation, indigestion belching, anxiety and disturbed sleep were relieved significantly and their body weight increased statistically significant at 5% level.

References:

1) A.H.Su.19/1            2) S.Chi.35/18

3) C. S.4/53                4) S.Chi.38/96

5) S.Chi.35/26            6) C.Su.25/40

7) S.Chi.35/3              8) C.Si.1/40,41

9) S.Chi.35/12            10) S.Chi.35/25

11) C.Si.1/31              12) S.Chi.35/26

13) S.Chi.35/29

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20. Nayana Giram and Yadaiah.P (Supervisor): Studies on Parin`aama Shoola (Duodenal Ulcer) and its Management with Ksheera Basti (1999), M.D. Thesis, Post Graduate Dept. of Kaayachikitsaa, R.T. Ayurvedic College Akola. Amaravati University, Amaravati.
21. Sonal Gududhe and Yadaiah.P. (Supervisor): Studies on Vaataja Grahan`i and its Management with PichchhaaBasti (2001), M.D. Thesis, Post Graduate Dept. of Kaayachikitsaa, R.T. Ayurvedic college Akola. Amaravati University, Amaravati
22. Prajakta Kapate and Yadaiah.P. (Supervisor) Studies on Madhumeha and its Management with Maadhu Tailika Basti (2001) M.D. Thesis, Post Graduate Dept. of Kaayachikitsaa, R.T. Ayurvedic College Akola. Amaravati University, Amaravati
23. Tripti Laddha and Yadaiah.P. (Supervisor): Clinical Trials of Vaitaran`a Basti and Pippalee Rasaayana in Amavaata (2001), M.D. Thesis, Post Graduate Dept. of Kaayachikitsaa ,R.T. Ayurvedic college Akola. Amaravati University, Amaravati
24. Jayabaya and Yadaiah.P. (Supervisior). Comparative study of Kati Basti and Vaitarna Basti. (2000), M.D. Thesis, Post Graduate Dept. of Kaayachikitsaa, R.T. Ayurvedic college Akola. Amaravati University, Amaravati.

Dr. Yadaiah Polepally.
I/C Prof. & HOD Post Graduate Department of Kayachikitsa,
R.T.Ayurvedic College Akola, Maharashtra-444005.

Last updated on February 18th, 2021 at 07:18 am