Chikitsaa Prakaara: Nirooha Basti / Aasthaapana Basti

Prakaara Paribhaashaa:

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• The procedure in which medicine is administered inside the rectum with the help of bladder of any animal is termed as Basti. The type of Basti in which the medicine is predominantly decoction is termed as Nirooha Basti.
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• Since this procedure helps expulsion of Dosha out of the body it is termed as Nirooha Basti and since itgives relief from diseases and prolongs life and stabilizes all the Dhaatu it is termed as Aasthaapana Basti.

Description:Kaala/Vaya/Ahoraatra/Ritu/Bhukta

• Nirooha Basti should be administered in S`hukla Paksha / phase of ascending moon on an auspicious day. It should be administered after complete digestion of food and before next meal. This ensures the presence of the three Dosha in their sites in the alimentary canal and the Basti can exhibit its effect on them.
• If Nirooha Basti is to be administered after Virechana it should be administered after on the 15^th day after Virechana i.e. it should be administered after Anuvaasana Basti.
• Nirooha Basti can be administered to a patient of any age.

Poorvakarma (Prerequisites):

Patient Preparation:

• Abhyanga (Oil massage) – whole body massage particularly at S`hron`i, Ooru, Kat`ee, Sphig and Pakvaas`haya (lower back, thighs, buttocks and abdomen)
• Application of local fomentation by Taapa Sveda or Pot`t`ali Sveda over above mentioned regions. These are mild fomentation and result in increasing circulation to the area and relaxing the abdominal wall and low back postural muscles. This ensures the stay of the Basti in the colon for a longer period.
• If Anuvaasana Basti isalso indicated it should also be administered before.

Pradhaanakarma:

• Basti Pran`idhaana – ­The Bastiput`aka should be attached to the Basti Netra tightly. The Bastiput`aka should be filled with the lukewarm prescribed medicine. The amount of medication should be enough to tie the bladder to the applicator easily and should leave no extra space within. The applicator is plugged securely with a cotton swab till administration to prevent leaks.
• Yantran`aa (position of the patient) – The patient is asked to lie down on his left side. He should keep his left hand below his head as pillow to support the head. His left leg should be stretched and right leg should be flexed at the knee and hip joint and should be in front of the abdomen, this relaxes the abdominal wall and the intestinal coils are in their natural position. 
• The anal opening and Basti Netra Mukha should be lubricated with ghee or oil.
• Instead of the classical metal or wooden Basti Netra now-a-days rubber flatus tube is used.
• The flatus tube or the Basti Netra should be inserted slowly and steadily in the direction parallel to the vertebral column. If flatus tube is used then the Basti Netra should be connected to the tube. In that case a little more medicine than indicated is taken to counter the loss in the flatus tube and Basti Netra.
• Then the Bastiput`aka should be held in left hand below with the thumb facing the patient and right hand above. Both together they should form a cup.
• The patient should be advised to inhale deeply through mouth throughout the procedure.
• The plug in the applicator should be deftly removed and re placed with left thumb.
• Then the physician should squeeze the Bastiput`aka evenly and administer the medicine inside the Pakvaas`haya (rectum) steadily with a moderate speed in one stroke, there should be no strokes, tremors to the hand as it results in movement of the applicator in the rectum and might cause local injury.
• Some of the medicine should be left in the bladder as it prevents entry of free air in the body which may aggravate the condition.
• Then the physician should immediately remove the tube or Netra gently.
• Then the patient is asked to lie down in a supine position with a pillow below his head for 30 Maatraa (nearly ½ minute).
• Then the patient should sit in a position of Utkat`aasana (squatting position) when he gets the urge to pass stools.
• It is desired for the Basti to stay in the colon as long as possible in Balya, Vaajeekaran`a and Brimhan`a type of Basti. As colon is the site wherein maximum absorption takes place in shortest period of time.To facilitate this patient should be given a pillow under his lower back and buttocks. Head low position is given by raising the foot side of the bed, mild patting on the buttocks with legs flexed should also done. They help in retaining the Basti for a longer period.
• The Basti medicine should normally return within 1 Muhoorta (48 minutes).
• Following are some types of Nirooha Basti used in day to day practice

1. Yaapana Basti – This type of Basti cause Yaapana (prolongation of life and support life).This can be administered any time. The effect of this type of Basti is Balya, S`hukravardhaka and Maamsavardhaka. These Basti are Rasaayana as well as Vaajeekarn`a.
2. Siddha Basti – The Basti which cures particular disease is termed as Siddha Basti.
3. Prasrita Yaugiki Basti – The Basti which should be administered in the dose of one Prasrita is termed as Prasrita Yaugiki Basti.
4. Dvaadas`ha Prasritiki Basti – The Basti which should be administered in the dose of twelve Prasrita is termed as Dvaadas`ha Prasritiki Basti. Maadhutailika Basti is also an example of this type of Basti.
5. Paadaheena Basti – The Basti which should be administered in the dose of nine Prasrita is termed as Paadaheena Basti.
6. Teekshn`a Basti – The Basti which contains Kshaara, Mootra or hot and penetrating Dravya. These Basti can be included in S`hodhana type of Basti. This Basti should be administered when Basti Pratyaagama does not occur.
7. Mridu Basti – This type of Basti contains Ghrita, Maamsarasa, Dugdha or Dravya from Madhura Skandha. These can be administered to children and aged people.
8. Pichchhaa Basti – This Basti contains Pichchhila Dravya (slimy). These Basti stop the passage of blood or Pichchhila Sraava outside the body. Act as Sangraahee.
9. Utkles`hana Basti – These Basti cause Dosha Utkles`hana (precipitation).
10. Doshahara Basti – These Basti are Dosha pacifying.
11. Brimhan`a Basti – These Basti are strengthening to the body.

Pas`hchaatkarma:

• If the Basti returns immediately without signs of adequacy and feeling of fullness of abdomen persists another Basti then it is to be administered immediately which could be repeated till the signs of adequacy appear. As the Basti medicine is greater in volume and the condition for which Basti is given is occluding in nature there is chance that it would be aggravated, hence it is absolutely essential to ensure the return of Basti within 48 minutes.
• After Pratyaagama of Basti the patient is asked to rest for a while.
• Then the patient is asked to take bath with lukewarm water.
• Then the patient is advised to consume food containing Dhanvamaamsa Rasa (meat soup of animals from dry and arid region), milk and Yoosha considering the strength of Agnee and Dosha.
• Anuvaasana Basti should be administered in the evening, if signs of adequate Nirooha Basti Karma are seen.
• Following things should be avoided during administration of Basti Karma

1. Atyaasana (sitting in one position for a long time.)
2. Avasthaana (travelling for a long time in a fast moving vehicle.)
3. Talking in high pitch persistently
4. Sleeping in day time
5. Indulgence in sexual act
6. S`heetopachaara (contact with substances cold to touch and in effect e.g. drinking cold water. Staying in air conditioned climate etc.)
7. Bathing with cold water
8. Prolonged exposure to sun
9. S`hoka (grieving)
10. Rosha  (anger)

Chikitsaa Karma (Benefits):

• Vayasthaapana (retard aging and stabilize the effects of age comparable to the chronological age)
• Ayuvardhaka (prolong the life span)
• Agneevardhaka (improve digestive capacity so that digestion is better and chances of Aama formation are reduced to a minimum)
• Medhya (improves mental faculties and the intellect, grasp, memory, decision making etc.)
• Svarya (beneficial for the voice improves quality, timber, pitch etc)
• Varn`ya (beneficial for the skin colour, lustre, complexion etc.)
• Sarvavyaadhihara (is indicated in almost all types of diseases and is beneficial in them to control, cure etc)
• Vit`, S`hleshma, Pitta, Anila and Mootra S`hodhaka (it beneficial in cleansing the faecal matter, sticky Kapha, Pitta, Vaata and Urine.)
• S`hareera Daard`hyakara (imparts stability and firmness to the body constituents as it gets rid of the excess fluid and Aama form them.)
• S`hukra Vardhaka (improves reproductive tissue substantially)
• Balya (tones up the muscle tissue and improves physical power and efficiency.)
• Doshachaya Nirasana (if administered in the accumulative stage of vitiated Dosha it successfully eliminates them and nips the impending disease in the bud.)
• Vaata Niyamana (as colon is the main site of Vaata it controls the abnormal activity of it.)
• S`hamana (it is palliating in those persons who are not suited for purification processes by increasing digestive capacity, it renders the Dosha harmless.)
• S`hodhana (it has purificatory action on Vaata predominant Dosha combinations.)
• Lekhana (it can cause weight loss and depletion in Kapha and Pitta due to the medicines uses in it.)
• Vaajeekaran`a ((improves sexual performance, erectile dysfunction, impotence etc)
• Vayasthaapana
• S`hareera Upachaya (it can act as tissue builder and cause weight gain.)
• Netrya (beneficial to the eyes.)

Samyak Yoga:

• Prasrisht`a Vit`kataa (complete and easy evacuation of stool.)
• Prasrisht`a Mootrataa (easy and complete voiding of urine)
• Prasrisht`a Vaata (easy passage of flatus.)
• Kramas`hah Visarjana of Mala, Pitta, Kapha and Vaata (sequential passage of stool, Pitta ( multi coloured stool), Kapha ( sticky stool with mucus, strand or frank mucus)
• Ruchi (imparts / improves taste of mouth and gustatory perception)
• Agnee Vriddhi (improved digestive capacity and digestion.)
• Aas`haya Laaghava (feeling of lightness especially in the abdomen and whole body)
• Rogopas`hama
• Prakritisthataa (reestablishment of normal functional equilibrium of Dosha and other constituents.)
• Balya (improved strength and physical power, efficiency.)
• S`hareera Laaghava (lightness of the body.)

Atiyoga:

• Anga Supti (lack of touch sensation in the body, part gone to sleep.)
• Angamarda (body ache)
• Klama (with reluctance to any activity)
• Kampa (tremor on attempted movement or even at rest due mainly to weakness.)
• Nidraa (sleepiness due to fatigue.)
• Daurbalya (weakness due to excessive fluid loss.)
• Tamapraves`ha (syncope due to weakness and loss of fluid.)
• Unmaada (mood disorder.)
• Hikkaa (hiccough)

Heenayoga:

• Guru Kosht`hatva (heaviness in the abdomen due to inadequate elimination of stool, Dosha.)
• Vaata Graha  (obstructed flatus)
• Mootra Graha (obstructed urine output and flow.)
• Mala Graha (constipation)
• Naabhee Rujaa (peri umbilical pain due to adverse effect on Agnee.)
• Basti Rujaa (pain in the bladder region due to obstructed passage.)
• Daaha (subjective feeling of burning.)
• Hrillepa (discomfort in the cardiac region with feeling of binding with a wet cloth.)
• Guda S`hotha (rectal anal swelling.)
• Guda Kan`d`oo (anal itching, pruritis.)
• Pid`akaa (blisters on the body as the non eliminated Dosha mix in the main stream circulation and reach the skin to manifest as blisters.)
• Vaivarn`ya (discoloration of the skin as the non eliminated Dosha mix in the main stream circulation and reach the skin layers to manifest as discoloration)
• Aruchi (tastelessness )
• Agneemaandya (hypo function of Agnee, leading to generation of Aama.)
• S`hira Rujaa (headache)
• Hridaya Rujaa (pain in the cardiac region.)
• Yoni Rujaa (vaginal pain.)
• Pratis`hyaaya (with sneezing and watery secretions.)
• S`hvaasakrichhra (breathlessness.)
• Hrillaasa (nausea with excessive salivation.)

Vyapad:

These are a set of situations that can lead to potential complications of Basti at various stages of administration

• Basti Netra Vyaapad:
• Ati Hrasva Netra (too short applicator)
• Ati Deergha Netra (too long applicator)
• Tanu Netra (too thin applicator)
• Sthoola Netra (too thick applicator)
• Jeern`a Netra (old applicator)
• S`hithila Bandhana (loose applicator)
• Paars`hva Chhidra (applicator with opening in the side instead of in front)
• Vakra Netra (bent applicator)

• Basti Put`aka Vyaapad (complications due to the bladder):

1. Vishama Basti (malformed, irregularly shaped bladder)
2. Maamsala Basti (muscular bladder)
3. Chhinna Basti (broken, frail bladder)
4. Sthoola Basti (thick bladder)
5. Jaalika Basti (bladder with dense venation)
6. Vaatala Basti (thin bladder)
7. Snigdha Basti (oily, greasy bladder)
8. Klinna Basti (wet bladder)

• Bastipran`etri Vyaapad ( complications due to administrator):

1. Savaata Basti (given with air in the end)
2. Druta Pran`eeta Basti (fast administration)
3. Tiryag Pran`idhaana (administering when the applicator is not is alignment with the vertebral column.)
4. Ullupta Basti (administering with unsteady, tremulous hand.)
5. Sakampa Basti (administering with unsteady, tremulous hand.)
6. Atipran`eeta Basti (excess medicine)
7. Atibaahya Datta basti (administration before completely inserting the applicator in the anus)
8. Atimanda Datta Basti (very slow administration this may induce evacuation before the procedure is complete.)
9. Ativega Datta Basti (fast administration)

• S`hayana Vidhi Pramaadajanya Vyaapad (complications due to mal positioning):

1. Klama (fatigue, exhaustion)
2. Adhmaana (abdominal distension)
3. Hikkaa (hiccough)
4. Hritpraapti (vitiated Dosha reaching the heart through mainstreamcirculation)
5. Urdhvapraapti (induction of vomiting, eructation, salivation, headache etc.)
6. Pravaahikaa (straining during passing stool, mucus colitis)
7. S`hirorti (headache)
8. Angaarti (body ache)
9. Parikartikaa (cutting type of pain in the anus )
10. Parisrava (persistent oozing from rectum and wetness.)

Other Description:

• Now a days enema pot is used instead of Bastiput`aka and Basti Netra.
• The dose of Nirooha Basti should be according to the age of the patient.i.e.  For a child of one year it should be half Prasriti and it should be increased by half Prasriti each year till twelve years of age. Then it should be increased by one Prasriti till eighteen years of age. This dose should be continued till seventy years of age. Then the dose should be tapered till similar to the dose at the age of sixteen.
• The dose of Sneha in the Nirooha Basti medicine should be according to following method:

Dosha Praadhaanya	Sneha Maatraa	Maatraa
Vaata Praadhaana	One fourth of decoction	3 Prasriti
Pitta Praadhaana	One sixth of decoction	2 Prasriti
Kapha Praadhaana	One eighth of decoction	1 and 1/2 Prasriti
Svastha Avasthaa	One fifth or sixth of decoction	2 and 1/4 Prasriti

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• If and when more than one Basti are indicated Nirooha and Anuvaasana should always be administered alternately and never alone. It is essential to counter the effect on another and to establish state of equilibrium in the internal environment.
• It might be confusing to a casual observer as the range and indications of Basti are conflicting and diagonally opposed in some instances. This is due to the medicines that go in the individual Basti. Vaata is the conveyer in the internal environment; it can reach all the tissues and affect their functions adversely when vitiated. Hence in hands of a competent Vaidya Basti can work diverse functions. There is no confusion or ambiguity whatsoever.

Last updated on April 29th, 2021 at 10:29 am