Module on “Clinical Application of Kashaya Basti” Talk By- Dr. Rajkala P. Patil

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   NIRUHA BASTI KARMA   

  Dr. Rajkala P. Patil  
Head & Associate Professor,
Department of Panchakarma,
Faculty of Ayurveda, IMS, BHU, Varanasi

 

Basti is a therapeutic procedure carefully designed to facilitate comprehensive bio-purification, with a primary focus on addressing Vata dosha-related imbalances through the ano-rectal route. It is revered as a potent remedy for a wide spectrum of ailments. Basti can be strategically incorporated into a treatment plan, either following seven days after Virechana karma or as a standalone therapeutic intervention. In the classical texts of Ayurveda, Basti is esteemed as the cornerstone of Ayurvedic therapeutics. 

  What is Basti?      

बस्तिना दीयते इति बस्तिः।
(A.H.Su.19/1)

Administration of liquid medicines through the rectal, urethral, or vaginal route is collectively called Basti.

तत्र द्धिवधो बस्तिः नैरुहिको स्नैहिकश्च।
स दोषं निर्हरणात्‌ शरीर दोषहरणाद्वा निरुहः।
(Su. chi. 35/18)

Elimination of dosha and cures the disease.

वयः स्थापनात्‌ आयुः स्थापनात्‌ या आस्थापनम्‌॥
(A.S.Su.28/6)

Refers to maintenance and prolongation of life

अनुवसन्‌ अपि न दुष्यत्यनुदिवसं वा दीयत इत्यनुवासनः।
(Su. chi. 35/18)

Can be given every day regularly with no risk of complications

  Importance of Basti:          

बस्ति वातहराणाम्‌ श्रेष्ठम्‌।

Almost all the Acharya consider Basti as half or whole of the entire therapeutic measures and advocated best and quickest way to provide strength and immunity to even children and old peoples So this is the time to provide attention to Basti in present research era and to develop current advance modalities for Basti.

  Classification of Basti:     

1A) Based on Adhishtana:

  1. Pakwashaya Gata
  2. Garbhashaya Gata
  3. Mutrashaya Gata
  4. Vranagata

B) Based on action:

Susruta-
1. Sadhana
2. Lekhana
3. Snehana
4. Brimhana

Vagbhata: 

  1. Utkleshana
  2. Doshahara
  3. Shamana

C) According to Anushangika bheda

  1. Yapana Basti
  2. Yukhtharatha Basti
  3. Siddha Basti
  4. Madhutailika Basti
  5. Prasrityogiki Basti
  6. Dvadashprasrita Basti
  7. Padahina Basti

D) Based on composition: 

  1. Anavasana / Sneha Basti
    The Basti Dravya is Taila / Gritha / Majja
  1. Nirooha / Asthapana Basti
    Decoction is the major component

On the basis of specific indications

  1. Pramehahara Basti
  2. Visarpahahara Basti
  3. Raktapittahara Basti
  4. Kusthahara Basti
  5. Vataraktahara Basti
  6. Gulmahara Basti
  7. Abhisyndahara Basti
  8. Krimihara Basti
  9. Dahaghna Basti
  10. Mutrakrcchahara Basti
  11. Parikartikahara Basti.

Based on the nature of the Basti Dravya

  1. Mridu Basti
  2. Madhyama Basti
  3. Tikshna Basti

Based on Number: 

Karma Basti: 30 basti
Kala Basti: 15 basti
Yoga Basti- 7 basti 

Nirooha Basti: is the procedure where, combinations of medicaments are administered through rectal route, for local as well as systemic effects. Depending on the dose and nature of ingredients, Nirooha is of several types like Ksheera Basti, Yapana, Vaitarana Basti, etc.

  Indications of Nirooha   

  • Sarvanga Roga: Neurological disorders involving whole body – Paralysis, Parkinsonism
  • Ekanga Roga: Neurological disease in one part of the body
  • Vatasanga: Obstruction to the passage of flatus
  • Mutrasanga
  • Malasanga
  • Shukrasanga
  • Mudhagarbha
  • Pregnancy (in 9th month)
  • Balakshaya – ↓ physical strength
  • Mamsakshaya – Emaciation
  • Shukrakshaya
  • Angasupti – Numbness in body parts
  • Hridroga 
  • Katishula
  • Rajakshaya
  • Vatarakta 
  • Ashmari

  Practical indications of Nirooha Basti:      

  • Neurological diseases
  • Rheumatoid syndrome, and other arthropathy
  • Low back ache of varied aetiology
  • Peripheral vascular disorders
  • Ulcerative colitis
  • IBS
  • Infertility (Male and female)

  Contraindications of Nirooha Basti:        

  • Ajirna – Dushyodara
  • Pitasneha – Shotha, Murccha
  • Alpagni
  • Atidurbala
  • Utklishta dosha
  • Khudharta
  • Vamita
  • Murchhita
  • Kasaprasakta
  • Shvasaprasakta
  • Kushtha
  • Arsha
  • Shunapayu: swelling in anus 

  Materials required      

  1. Mortar and pestle
  2. Basti Netra
  3. Polythene cover of at least 1&1/2 litre capacity/ traditional Basti Putaka
  4. Hot water
  5. Utensils
  6. Good quality fine sieve
  7. Cotton towel
  8. Measuring apparatus
  9. Cotton thread-1/2 meter
  10. Cotton
  11. Sterile glove.
  12. Oil for Abhyanga
  13. Medicaments as per prescription in the required quantity
  14. Churner

  Basti Netra:    Classically brass basti Netra with three karnika tied to basti Dravya filled polythene bag is used for administration of Basti. 

  Preparation of Basti Dravya       

Initially, Saindhava is put in the Khalwa Yantra and it is powdered well. Madhu is added in a thin stream triturating properly to ensure a homogenous mixture. It is followed by the mixing of appropriate Tailam in the required quantity mentioned in the mixture slowly by the side of the mortar and it is continuously stirred until it attains a uniform consistency. 

The Kalka, which is the fine paste of drugs mentioned in the Yoga is added little by little along with proper grinding with pestle. Then appropriate Kwatha in required amount as per yoga is added slowly and properly mixed. The Avapa, if mentioned in the Yoga/if needed, is added at last followed by proper stirring.  The mixture is filtered through a fine sieve and finally made lukewarm (Sukoshna) by keeping over a hot water bath. This mixture is churned well with the help of a churner.  When it is lukewarm, and comfortable for the patient, it is transferred to a  plastic cover  (Basti Putaka) having sufficient thickness and then Basti Netra of bronze or plastic is tied to it very well with plugging the other tip with a cotton Varti.

Time of administration

मध्यान्हे किन्चित आवर्ते, नातिबुभुक्षिता।

This time varies depending on Desha and Kala and is generally  in between 9am -11am

  Poorvakarma of Nirooha        

The procedure is usually done in empty stomach
Those who are Sukumara and Ksheena are asked to take very light food in early morning.
Abhyanga and Sweda done over lower abdomen and lower back i.e. Kati, Parshwa, etc.
Sarvanga Abhyanga and Sveda can be done before the procedure. 

  Pradhanakarma      

Position of the patient: The patient is asked to lie on a cot of knee height, in the left lateral position. His left lower limb extended and his right lower limb flexed at knee and hip. His left upper limb is kept folded under his head. 

Procedure: A small amount of plain ghee/medicated oil is smeared over the tip of Basti Netra as well as the anus of the patient for lubrication. Wearing the hand gloves, per rectal examination is carried out to rule out loaded rectum, or any other obstruction. Hold the Basti Netra in the left hand and Putaka in the right hand. Remove the plug from the tip of Basti Netra and evacuate the air and close the tip with left index finger. Basti Netra is then gently introduced into the anus and Putaka is pressed slowly and steadily to push the Basti Dravya into the patient’s rectum. Patient is asked to count up to 30 and to breathe deeply through the mouth during introduction.  Basti Netra is withdrawn with a little amount of medicament remained in the Putaka to avoid the entry of air. If the patient feels the urge for defecation during the procedure, he is allowed to pass stools after removing Basti Nethra and the remaining medicine is administered later.

  Paschatkarma      

The patient is asked to lie in supine position till the urge for defecation occurs. He is asked to clear the bowels as many times he feels Vega and advised to take bath in luke warm water. 

Then diet according to dosha vitiation and Satmya is given (preferably rice with Mudgayoosha or Mamsarasa). 

Blood pressure, pulse rate, time of retention, number of evacuations and if discomforts any are observed. He is asked to take rest and light food is given at night.

  Complications & their management       

  1. Abdominal discomfort and pain – after careful evaluation about the cause appropriate management can be adopted. General measures like Abyanga, Sweda, Deepana Anulomana drugs are advised.
  2. Immediate evacuation without retention – Another Basti with less Lavana, Ushna and quantity should be administered immediately after ruling out sphincteral incontinence.
  3. Giddiness, low pulse, cold extremities, delirium: – Console the patient, foot end elevation, hot drinks, warming extremities. Drugs like Sidhamakaradhwaja, Drakshadi Kashaya, Dhanwantharam Gulika, etc. can be given.
  4. Vomiting: – Usually subsides without specific management. Drugs like Chandrakalarasa, Dhanwantharam Gulika, Drakshadi Kashaya, Mayoorapichabhasma, etc. can be given.
  5. Anaphylatic reaction: – Skin eruptions, itching, urticaria, dyspnoea, etc. Careful history taking to identify known allergents and avoiding them. Haridrakhanda, Thrikatu with Sita, Chandanasavam, Draksharishtam, etc. can be given.
  6. Long retention: – Known causes like obstruction of anal canal by pile mass, enlarged prostrate, fecal matter etc should be excluded. Rubber tube or specific Guda Vartis can be introduced into anal canal for evacuation.

Clinical Case discussions of basti: Niruha is done in following clinical cases and got good results to physician. 

  1. Renal calculi of 8 mm
  2. Spinal injury 
  3. Backache  
  4. Renal failure- 
  5. Pancreatitis chronic 
  6. Diabetes- Pramehahar Basti
  7. Rheumatoid Arthritis
  8. Vaitarana- Amavatastha 

  10 multiple-choice questions (MCQs) based on the Nirooha Basti topic:     

  1. What is the primary focus of the therapeutic procedure known as Basti?
    A. Addressing Pitta dosha imbalances
    B. Facilitating comprehensive bio-purification
    C. Stimulating hair growth
    D. Treating skin conditions
    Answer: B. Facilitating comprehensive bio-purification
  2. When can Basti be strategically incorporated into a treatment plan?
    A. Immediately after Virechana karma
    B. Anytime during the treatment process
    C. Following seven days after Virechana karma
    D. Only as a standalone therapy
    Answer: C. Following seven days after Virechana karma
  1. According to classical Ayurvedic texts, what is the significance of Basti in Ayurvedic therapeutics?
    A. It is considered a minor therapy.
    B. It is the primary treatment for skin disorders.
    C. It is esteemed as the cornerstone of Ayurvedic therapeutics.
    D. It is only relevant for children and the elderly.
    Answer: C. It is esteemed as the cornerstone of Ayurvedic therapeutics.
  1. Which of the following is NOT a classification of Basti based on its action?
    A. Sodhana
    B. Lekhana
    C. Brimhana
    D. Prasrityogiki
    Answer: D. Prasrityogiki
  1. What is the primary purpose of Abhyanga and Sweda before the Basti procedure?
    A. To cleanse the digestive system
    B. To prepare the patient mentally
    C. To relax the patient’s mind
    D. To prepare the lower abdomen and lower back
    Answer: D. To prepare the lower abdomen and lower back
  1. What is the recommended position for the patient during the administration of Basti?
    A. Supine position
    B. Right lateral position
    C. Left lateral position
    D. Prone position
    Answer: C. Left lateral position
  1. What is the purpose of wearing hand gloves during the Basti procedure?
    A. To protect the patient from infections
    B. To maintain hygiene
    C. To prevent allergic reactions
    D. To keep the patient’s hands warm
    Answer: B. To maintain hygiene
  1. What is the time frame generally recommended for the administration of Basti?
    A. 06 am – 08 am
    B. 09 am – 11 am
    C. 12 pm – 02 pm
    D. 03 pm – 05 pm
    Answer: B. 09 am – 11 am
  1. Which of the following is NOT a practical indication for Nirooha Basti?
    A. Rheumatoid syndrome
    B. Neurological diseases
    C. Low backache
    D. Common cold
    Answer: D. Common cold
  1. What is the primary material used for Basti Netra in traditional practice?
    A. Stainless steel
    B. Brass
    C. Plastic
    D. Wood
    Answer: B. Brass

  References:     

  1. Agnivesha; Charaka Samhita; redacted by Charaka and Dridabala with Ayurveda Dipika Commentary by Chakrapanidutta; English translation edition 1997; by Ram Karan Sharma and Vaidya Bhagwan Dash; Chaukhambha Sanskrit Series Office, Varanasi, Uttar Pradesh. Pp 738 pg 699-700
  2. Vagbhatacharya; Ashtanga Hridaya with commentaries Sarvangasundara of Arunadutta and Ayurveda Rasayana of Hemadri, ed. by Pandit Bhishak Acharya, Hari Shastri Paradkar Akola; 8th edition, 2000; Chaukhambha Orientalia, Varanasi, Uttar Pradesh. Pp 956 pg 769
  3. Sushruta, Sushruta Samhita with commentary of Sri Dalhanacharya edited by Aryan Ram Acharya “Kavyatirtha”, published by Chaukhamba Orientalia, Varanasi, Reprint 2009
  4. Dravyaguna Vijnana by Dr. J. L. N Shastri, Vol. 2, 3rd Edition, Chaukhamba Orientalia, Varanasi, 2008

 

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