Like all other procedures Anuvāsana Basti Vidhi is also explained in detail under three main headings

• Pūrva Karma
• Pradhāna Karma
• Paścāt Karma

PŪRVAKARMA

The various things included in the Pūrva Karma can be summarised as follows

• Sambhāra Saṅgraha– Collection of necessary items needed for the treatment
• Roga – Rogī Parīkṣā – Examination of the disease and the patient
• Mātrā and Kāla Nirṇaya– Determining suitable Anuvāsana dosage and time for administration
• Food regimen to be followed before giving Anuvāsana Basti
• Ātura Siddhata – Preparation of the patient

Sambhāra Saṅgraha

• Sneha Dravya – Suitable Anuvāsana Basti Sneha Dravya like Taila or Ghṛta should be selected by the doctor depending on the patient and the Rogavasthā. It should be collected well in advance so as to cover the whole course of the treatment.
• Basti Yantra / Rubber Catheter / Disposable Anuvāsana Basti Plastic Enema Syringe – Classical Basti Netra and Puṭaka or the present-day modifications can be used like Plastic disposable Anuvāsana Basti Netra / Rubber catheter.
• Saindhava – enough quantity
• Yavānyadi Kalka Cūrṇa / Śatapuṣpa Kalka (QS)
• Tīkṣṇa Basti Dravya / Doṣa Śamana basti Dravya
• Āvāpa Dravya– पिप्पलींमदनंकुष्ठंशताह्वांमधुकंवचाम्|

योजयेन्मात्रयापिष्ट्वाआवापमनुवासने||                                                                                        (Cha. Si.10/17, Cakrapāni commentary)

Paste of appropriate quantity of Pippali, Madana, Kuṣṭha, Śatāhvā, Madhuka and Vaca added as Āvāpa for Anuvāsana Basti.

• Other Medicines for treating Vyāpat.

ROGA – ROGĪ PARĪKṢĀ

• Assessing Anuvāsana Yogya – Ayogya – This has been explained in detail already
• Aṣṭa sthāna parīkṣā and Daśa Vidha Parīkṣā – The Vaidya should make use of all these Parīkṣā for examination of the Roga and Rogī

Nava Parīkṣya Viṣaya

समीक्ष्य दोषौषधदेशकालसात्म्याग्निसत्त्वादिवयोबलानि|

बस्तिः प्रयुक्तो नियतं गुणाय स्यात् सर्वकर्माणि च सिद्धिमन्ति||[i]                  (Cha. Si. 3/6)

Basti has to administered after considering the Doṣa, Auṣadha, Deśa, Kāla, Sātmya, Agni, Satva, Oka, Vaya, and Bala. By considering these only the effective results can be attained.

Basti Kalpana: it is the preparation of Basti Dravya, which has been explained in detail previously.

Doṣa: –

The number of Basti, schedule of Basti and the spacing of therapies are all dependent on the involved Doṣas.

त्रीन्पञ्चवाऽऽहुश्चतुरोऽथषड्वावातादिकानामनुवासनीयान् ||

स्नेहान्प्रदायाशुभिषग्विदध्यात्स्रोतोविशुद्यर्थमतोनिरूहान् |                  (Cha. Si. 1/ 49-50)

After giving three, five, four or six Anuvāsana Bastis for the purpose of oleation to patients suffering from diseases caused by Vāta, Pitta and Kapha, the physician should thereafter administer Nirūha Basti for cleansing the obstructed Srotases. This is followed for the purpose of oleation as a preparatory therapy for Nirūha Basti.

एकं त्रीन् वा बलासे तु स्नेहबस्तीन् प्रकल्पयेत् ||

पञ्च वा सप्त वा पित्ते, नवैकादश वाऽनिले|

पुनस्ततोऽप्ययुग्मांस्तु पुनरास्थापनं ततः||                      (A. H. Su. 19/54-55)

In Kaphaja Vikāra – 1 or 3 Anuvāsana Basti

In Paithika Vikāra – 5 or 7 Anuvāsana Basti

In Vatika Vikāra – 9 or 11 Anuvāsana Basti

The term Punarva indicates that Anuvāsana Basti can be given after 11^th day but only on odd days intervened with Nirūha Basti. This is followed when Anuvāsana Basti is given as Pradhāna karma for the purpose of alleviation of Vātadi Doṣas.

Other considerations in Doṣa include Kṣaya- Vṛddhi- Samatva / Ūrdhva – Adho – Tiryak gati / Śākhā – Koṣṭha – Marmasraya Rogamārga/ Svasthānagata – Anyasthāna Gata Doṣatva / Svatantra – Paratantra Doṣa / Sāma – Nirāma Avasthā of Doṣa / Alpa – Madhyama – Bahu Doṣa Avasthā / Aṃśāṃśa Parīkṣā.

Auṣadha: –

न त्वामं प्रणयेत् स्नेहं स ह्यभिष्यन्दयेद्गुदम्|                  (Cha. Si. 4/48)

The Taila used for Anuvāsana Basti should be Pakva Taila. Otherwise it will produce Gudābhiṣyanda.

Deśa: –

Factors to be considered here areDeha Deśa and Bhūmi Deśa

Bhūmi Deśa helps to find out the predominance of Doṣa in those areas and the diseases caused by the same. It also helps to finalise the medicines against that. In Deha Deśa the prevalence of the Gunas in the patient’s body can be assessed and the Auṣadha can be selected exactly opposite to that.

उष्णाभिभूतेषु वदन्ति शीताञ्छीताभिभूतेषु तथा सुखोष्णान्|

तत्प्रत्यनीकौषधसम्प्रयुक्तान् सर्वत्र बस्तीन् प्रविभज्य युञ्ज्यात्[ii]                (Cha. Si. 1/35)

Śīta vīrya Auṣadha Yukta Basti should be given to the patients suffering from diseases caused by Uṣṇa ingredients. Uṣṇa Vīrya Auṣadha Yukta Basti should be given to the patients suffering diseases caused by śīta ingredients. In all the cases, different types of Bastis containing ingredients having attributes opposite to the attributes of the Nidāna of Roga should be administered.

Kāla: –

Factors to be considered here include Ṛtu Kāla and Vyādhi Avasthā Kāla; Usually Basti is indicated in Prāvrit Ṛtu. Kāla is explained in detail below.

Sātmya: –

Factors to be considered here are Ṛtu, Deśa, Vyādhi, Kāla, Prakṛti, Abhyāsa Sātmya

न बृंहणीयान् विदधीत बस्तीन् विशोधनीयेषु गदेषु वैद्यः|
कुष्ठप्रमेहादिषु मेदुरेषु नरेषु ये चापि विशोधनीयाः||                               (Cha. Si. 1/36)

Patients suffering from diseases like Kuṣṭa and Prameha and those having adiposity need elimination therapy. To such patients, Bṛṃhaṇa or Anuvāsana Basti should not be given because they are Sneha Sātmya.

Agni: –

Anuvāsana Basti should not to be given in Mandāgni.

Satva: –

Depending on the Sattva of the Rogī i.e.; Pravara, Madhyama or Avara  Mātrā of the medicine and its dose should be finalized.

Bala: – Sahaja, Kālaja, Yuktikrita / Pravara, Madhyama, Avara Bala should be considered while selectin drugs and dose

Vaya: – Selection ofBasti Netra and Mātrā of Auṣadha finalized according to Vaya.

Age told for giving Basti in children according to the opinion of different Ācāryas

• Gārgya – from birth
• Mātara – After 1 month
• Ātreya Punarvasu – After 4 months
• Anya Ācārya (No name)- After 1 year
• Pārāśara – After 3 years
• Bhela – After 6 years
• Kaśyapa – When the child is ready to take Anna or weans from breast milk.

MĀTRĀ AND KĀLA NIRNAYA

MĀTRĀ

According to Suśruta – Dose according to Vaya

यथावयो निरूहाणां या मात्राः परिकीर्तिताः |

पादावकृष्टास्ताः कार्याः स्नेहबस्तिषु देहिनाम् ||[iii]              (Su. Chi. 37/4)

The 1/4^th dose of Nirūha Basti for a particular age should be considered as the Mātrā of the Anuvāsana for that age.

स्नेहबस्तिविकल्पोऽनुवासनः पादाव(प)कृष्टः|[iv]                 (Su. Chi. 35/18)

Anuvāsana Basti is a variety of Sneha Basti which possesses quarter Pramāṇa of Nirūha.

• Acc. To Kaśyapa Sneha Basti Mātrā is as follows

• • Baby who is not on milk only diet– 2 Karṣa
  • Up to 3 yrs – 3 Karṣa (36 g)
  • Up to 4 yrs – 1 Pala (50g)
  • Up to 6 yrs – 1 Prasṛta (100 g)
  • Up to 12 yrs – 2 Prasṛta (200 g)
  • Up to 16 yrs (Madhyamavasthā) – 4 Prasṛta (400 g)
  • Vṛddhavasthā – Depending on Doṣa, Deha, Agni, Bala, Prakṛti

• Acc to Bhela

• • Uttama Mātrā – 2 Prasṛta (200 g)
  • Madhyama Mātrā – 1 Prasṛta (100 g)
  • Kanīyasī Mātrā – 1/2 Prasṛta (50 g)

• Acc. To Śāraṅgadhara, Bhāvaprakāsha and Cakradatta
  • Uttama Mātrā – 6 Pala (300 g)
  • Madhyama Mātrā – 3 Pala (150 g)
  • Kanīyasī Mātrā – 1.5 Pala (175 g)

हीनमात्रावुभौबस्तीनातिकार्यकरौमतौ |
अतिमात्रौतथाऽऽनाहक्लमातीसारकारकौ ||[v]                                (Su. Chi. 37/18)

Anuvāsana Basti doesn’t cause the desired action if given in Hīna Mātrā and if given in Atimātrā it causes Anāha, Klama, Atisāra etc…

Kāla – Season / Time

• Bhojanottara Kāla (आर्द्र पाणिना)

सदाऽनुवासयेच्चापिभोजयित्वाऽऽर्द्रपाणिनम्|                      (Su. Chi. 37/54)

Sneha Basti should  be given always after the patient consume his meal and before his hands dries up (in other words immediately after food).

• शीतेवसन्तेचदिवारात्रौकेचित्ततोऽन्यदा|| (A. H. Su. 19/21)

• शीतेवसन्तेचदिवाऽनुवास्योरात्रौशरद्ग्रीष्मघनागमेषु||[vi]             (Cha. Si. 1/22)

During cold season and Vasanta season, it should be given during day and in other seasons, during night.

• In Vāta – Pitta Doṣa pradhāna avasthā and in Śarat, Varṣa, Grīṣma Ṛtu, Anuvāsana Basti should be administered during night (सायंकाल – चक्रपाणि, ie; 1^st Prahara of Ratrikāla)
• In Kapha Doṣa Pradhāna Avasthā and in Śīta Kāla – Vasanta Ṛtu, Anuvāsana basti should be administered during day time.

रात्रौ बस्तिं न दद्यात्तु दोषोत्क्लेशो हि रात्रिजः

स्नेहवीर्ययुतः कुर्यादाध्मानं गौरवं ज्वरम् [vii]                                           (Su. Chi. 37/47)

Anuvāsana Basti should not be administered at night because aggravation of Doṣas happen at nights; so the Doṣas along with the Vīrya of sneha produce flatulence, feeling of heavyness and fever.

• After Virecana on 9^th day

संसृष्टभक्तं नवमेऽह्नि सर्पिस्तं पाययेताप्यनुवासयेद्वा||

तैलाक्तगात्राय ततो निरूहं दद्यात्र्यहान्नातिबुभुक्षिताय|

प्रस्यागते धन्वरसेन भोज्यः समीक्ष्य वा दोषबलं यथार्हम्||

नरस्ततो निश्यनुवासनार्हो नात्याशितः स्यादनुवासनीयः[viii]            (Cha. Si. 1/20)

For seven days starting from the day of Vamana the patient should be given Saṃsarjana Krama and on the 8^th day he should be given normal food. So, after Saṃsarjana Krama on the ninth day after Vamana, the patient should be given ghee for Snehana if Virecana is intended to be given subsequently. Similarly on the 9^th day after Virecana, Anuvāsana Basti should be given if Nirūha type of Basti is intended to be given subsequently.

For three days, there after abhyanga should be done and then Nirūha should be given when the person is not hungry. After Basti Pratyāgamana, Jāngala Māmsarasa or any other appropriate diet depending upon the nature of Doṣas and the power of Agni should be given. Thereafter, when the patient has not taken a heavy meal in the night, Anuvāsana Basti should be given to him if he is fit for the same.

In Bhadra – Śaunaka Saṃhita, Anuvāsana is suggested to be given after one month.

• शोधनानन्तरं नवमेऽह्नि स्नेहपानमनुवासनं वा [ix] (Jatūkarṇa)

• विरेचनात् सप्तरात्रे गते जातबलाय च| कृतान्नायानुवास्याय सम्यग्देयोऽनुवासनः [x]                                          (Su. Chi. 37/3)

Anuvāsana Basti should be administered seven days after purgation therapy, after the person has obtained strength and after he has partaken food.

Arohana Krama Sneha Basti (Vṛnda Mādhava)

Frequency of Anuvāsana Basti

प्रत्यागते चाप्यनुवासनीये दिवा प्रदेयं व्युषिताय भोज्यम्||२३||
सायं च भोज्यं परतो द्व्यहे वा त्र्यहेऽनुवास्योऽहनि पञ्चमे वा |
त्र्यहे त्र्यहे वाऽप्यथ पञ्चमे वा दद्यान्निरूहादनुवासनं च||[xi]              (Cha. Si. 1/23-24)

After Anuvāsana Basti has come out, the patient should avoid any food at night. During next day, food should be taken in day time and in evening. Thereafter, on the second, third or fifth day Anuvāsana Basti should be given. On every third or fifth day Anuvāsana Basti should be given while giving Nirūha type of medicated enema.

The patient should be again given Anuvāsana Basti on 2^nd day if Vāta is excessively aggravated, on 3^rd day if Pitta and Kapha are excessively aggravated.

• According to Hārīta, second Anuvāsana Basti is administered on the same day
• According to Ācārya Suśruta, if Vāta is excessively aggravated – administer Anuvāsana Basti daily

रूक्षनित्यस्तुदीप्ताग्निर्व्यायामीमारुतामयी|
वङ्क्षणश्रोण्युदावृत्तवाताश्चार्हादिनेदिने||४६||
एषांचाशुजरांस्नेहोयात्यम्बुसिकतास्विव|

अतोऽन्येषांत्र्यहात्प्रायःस्नेहंपचतिपावकः|[xii]                     (Cha. Si.4/46)

Persons who are Rūkṣa, who have a strong Agni, who perform Vyayāma regularly, who have Vātika Rogas, who’s pelvic, hip region are afflicted with Vāta and those suffering from Udāvarta should be given Anuvāsana Basti daily. As the water falling over sand gets absorbed immediately, similarly the Sneha given to these Rogīs gets digested immediately. In other cases, the Agni generally digests this Sneha in three days. In short, the persons who are habituated to Sneha need higher dose of Snehana through Anuvāsana.

ANUVĀSANA PŪRVA ĀHĀRA VYAVASTHĀ

अभ्यक्तस्नातमुचितात्पादहीनं हितं लघु|

अस्निग्धरूक्षमशितं सानुपानं द्रवादि च||२२||       (A. H. Su. 19/22)

The patient should have done Abhyaṅga and Snāna in Sukhoṣṇa Jala and then he should consume food. The food should be Pādahīna than the usual Mātrā, Hita, Laghu, not too much unctuous or not too much dry and should be followed by Anupāna

यूषक्षीररसैस्तस्माद्यथाव्याधि समीक्ष्य वा | यथोचितात् पादहीनं भोजयित्वाऽनुवासयेत् ||

                                                                                  (Su. Chi. 37/57)

Yūṣa, Kṣīra and Māmsarasa or Vyādhi according food should be given in Pādahīna Mātrā ie; 3/4^th of the usual quantity of food should be administered.

न चाभुक्तवतः स्नेहः प्रणिधेयः कथञ्चन | शुद्धत्वाच्छून्यकोष्ठस्य स्नेह ऊर्ध्वं समुत्पतेत् ||

सदाऽनुवासयेच्चापि भोजयित्वाऽऽर्द्रपाणिनम् | ज्वरं विदग्धभुक्तस्य कुर्यात् स्नेहः प्रयोजितः ||

न चातिस्निग्धमशनं भोजयित्वाऽनुवासयेत् | मदं मूर्च्छां च जनयेद् द्विधा स्नेहः प्रयोजितः ||

रूक्षं भुक्तवतो ह्यन्नं बलं वर्णं च हापयेत् | युक्तस्नेहमतो जन्तुं भोजयित्वाऽनुवासयेत् ||

                                                                                              (Su. Chi. 37/53-57)

Anuvāsana Basti should not be administered without giving food because since the Śārīra is Śuddha and the Koṣṭha is empty the Sneha will spread upwards fastly. Immediately after taking the food and just washing the hands the patient should be given Anuvāsana Basti. If the Basti is given when the food is undergoing the Pāka or given in Vidagdāvasthā it will produce Jvara.

If we give Atisnigdha Bhojana and Anuvāsana Basti then due to the administration of Sneha through both the Mārga it will cause Mada and Mūrchā. Rūkṣa anna Sevana causes destruction Of Bala and Varna, hence the Bhojana administered should be mixed with a little Sneha.

Method of preparation of Anuvāsana basti dravya

सतुसैन्धवचूर्णेनशताह्वेनचयोजितः|
देयःसुखोष्णश्चतथानिरेतिसहसासुखम्||               (Su. Chi. 37/63)

The Taila for Anuvāsana Basti may be added with Saindhava and Śatāhvā and administered comfortably warm. This will facilitates its proper and better return.

पिप्पलींमदनंकुष्ठंशताह्वांमधुकंवचाम् |

योजयेन्मात्रयापिष्ट्वाआवापमनुवासने ||                         (Cha. Si.10/17, Cakrapani commentary)

Paste of appropriate quantity of Pippali, Madana, Kuṣṭha, Śatāhvā, Madhuka and Vaca added as Āvāpa for Anuvāsana Basti.

ĀTURASIDDHATA

अभ्यक्तस्नातमुचितात्पादहीनं हितं लघु|

अस्निग्धरूक्षमशितं सानुपानं द्रवादि च||२२||

कृतचङ्क्रमणं मुक्तविण्मूत्रं शयने सुखे| [xiii]                               (A. H. Su. 19/22)

The patient should have done Abhyaṅga and Snāna in Sukhoṣṇa Jala and then he should consume food. The food should be Pādahīna than the usual Mātrā, Hita, Laghu, not too much unctuous or not too much dry and should be followed by Anupāna. Then he should walk for some time and void faeces and urine if get the Vegas and should lie in a comfortable Śayana or couch for the administration of Anuvāsana Basti.

[i]Cha. Si 3/6

[ii] Cha. Si 1/35

[iii] Su. Chi 37/4

[iv] Su. Chi 35/18

[v] Su. Chi 36/18

[vi] Cha. Si 1/22

[vii] Su. Chi 37/47

[viii] Cha. Si 1/20

[ix] Jatukarna

[x] Su. Chi 37/3

[xi] Cha. Si 1/14

[xii] Cha. Si 4/46

[xiii] A.H. Su 19/22

The following is being discussed under Pradhāna Karma.

• Basti Pranidhāna Vidhi -Administration of basti
• Immediate Paścāt Karma after Basti Pranidhāna
• Basti Pratyāgamana – Observations till basti dravya comes out
• Samyak – Ayoga – Atiyoga Lakṣaṇa

The points to be discussed under Basti Pranidhāna Vidhi includes

• Śayana Vidhi – How to lie on the bed while administering Basti?
• How to fill Auṣadha in Basti Puṭaka?
• Basti Dāna / Basti Pranidhāna – Administering the Basti
• Basti Pīḍana Kāla

Śayana Vidhi

नात्युच्छ्रितेनचोच्छीर्षेसंविष्टंवामपार्श्वतः||

सङ्कोच्यदक्षिणंसक्थिप्रसार्यचततोऽपरम्|                                              (A. H. Su. 19/23)

The patient should lie on a comfortable cot, neither too high nor too low, on his left side, folding his right thigh, and extending the left thigh.

वामाश्रये हि ग्रहणीगुदे च तत् पार्श्वसंस्थस्य सुखोपलब्धिः

लीयन्त एवं वलयश्च तस्मात् सव्यं शयानोऽर्हति बस्तिदानम्|[i]                   (Cha. Si. 3/25)

As Grahaṇī and Guda are located in the left side of the body, administration of Basti in the left lateral position helps the Basti Dravya to reaches the site of action easily. Lying on left lateral side keeps the sphincters submerged in surrounding musculature. Therefore, Basti should be administered when the patient is lying in his left side.

In this position both Grahaṇī and Guda remain in their natural position. Basti administered in this position gets absorbed properly and spreads easily.

Since the sphincters remain submerged into the surrounding musculature fluid enters into the rectum smoothly and then to Grahaṇī.

All Ācāryas have followed the same Śayana Vidhi.

How to fill Auṣadha in Basti Puṭaka?

पुर्वमेव तु वैद्यो वर्त्त्या सुपिहिताग्रच्छिद्रं नेत्रं भाजन स्योपरि कृत्वा दक्षिणपादाङ्गुष्ठाङ्गुलीभ्यां कर्णिकायाउपरिष्टन्निष्पीड्याविबन्धाय शताह्वसैन्धवचूर्णावचूर्णितं प्रागेव नेत्रस्पर्शात् पूर्ववदभिमन्त्रितं यथार्हं यथार्हौषधा-विपक्वं सुख़ोष्णं बस्तौ स्नेहमासिच्यावलीकोच्छ्वासं निःसारितवातबुद्बुदमौषधान्ते सूत्रेण द्विस्त्रिर्वा बस्तिमुख़मावेष्ट्य दक्षिणपाणौ नेत्रमुपनिधाय तिष्ठेत्|[ii]                          (A. S. Su. 28/31)

Before telling the patient to lie down on the bed, the Vaidya should close the Agrabhāga of the Netra with a cotton Varti to prevent the leakage of Basti Dravya. Śatahva / Saindhava should be mixed with Sneha Dravya in required quantity. The Auṣadhas Dravya should be Mantrābhimantrita. The Auṣadha Dravya should be Sukhoṣṇa and it should be filled in the Puṭaka completely, no Vayu should be there in the Puṭaka. If there is Vayu it should be removed. Place Basti Netra into the Puṭaka till the Dravya is present and do Bandhana at the Moolabhāga Kārṇika.

Basti Dāna / Basti Pranidhāna

अथास्य नेत्रं प्रणयेत्स्निग्धे स्निग्धमुखं गुदे||२४||

उच्छ्वास्य बस्तेर्वदने बद्धे हस्तमकम्पयन्|

पृष्ठवंशं प्रति ततो नातिद्रुतविलम्बितम्||२५||

नातिवेगं न वा मन्दं सकृदेव प्रपीडयेत्|

सावशेषं च कुर्वीत वायुः शेषे हि तिष्ठति| [iii]                                (A. H. Su. 19/24)

The enema nozzle which is lubricated should be gently pushed in to the lubricated Guda after the air inside the Basti Puṭaka is expelled out and it is well tied to the nozzle. The Netra should be pushed into the Guda in the direction of Pṛṣṭhavaṃśa with steady hands; neither too fast nor too slow. Then the Basti Puṭaka should be pressed, not with excessive pressure or insufficient pressure but in a single attempt. A little quantity of the Basti Dravya should be allowed to remain in the Basti Puṭaka to preventthe entering of air into the body / intestine.

स्निग्धे गुदे नेत्रचतुर्थभागं स्निग्धं शनैरृज्वन पृष्ठवंशम्|

अकम्पनावेपनलाघवादीन् पाण्योर्गुणांश्चापि विदर्शयंस्तम्

प्रपीड्य चैकग्रहणेन दत्तं नेत्रं शनैरेव ततोऽपकर्षेत्|[iv]                  (Cha. Si. 3/19)

According to Ācārya Caraka, after lubricating the Guda, the lubricated nozzle should be inserted into it up to 1/4^th part from the top slowly and straight following the position of the vertebral column. The physician should not shake or tremble his hand and he should easily compress the bladder so that the Dravya goes inside at one stretch. Thereafter, he should take out the nozzle slowly.

Basti Pīḍana Kāla

त्रिंशन्मात्रामित: काल: बस्तेस्तु पीडने [v]                (Sha. Sam. Utt. 5/27)

30 Mātrā (Su.)

• According to Ācārya Pārāśara,
  • Krūra Koṣṭha – 100 Mātrā
  • Madhyama Koṣṭha – 70 Mātrā
  • Mridu Koṣṭha – 30 Mātrā

• According to Ācārya Ḍalhaṇa – Time required to get up, sit in Utkuṭakāsana etc. Including Pīḍana Kāla it becomes 100 Mātrā.

[i] Cha. Si 3/25

[ii] A. S. Su 28/31

[iii] A.H. Su 19/ 24

[iv] Cha. Si 3/19

[v] Sha. Sam U 5/27

दत्तेतूत्तानदेहस्यपाणिनाताडयेत्स्फिजौ|
तत्पार्ष्णिभ्यांतथाशय्यांपादतश्चत्रिरुत्क्षिपेत्||[i]                                            (Cha. Su. 3/28)

After Basti Pranidhāna, the patient should lie on his back and his buttocks beaten by the hands of physician and then by patient’s own heels. The foot end of Śayyā should be lifted thrice.

ततःप्रसारिताङ्ह्गस्यसोपधानस्यपार्ष्णिके|

आहन्यान्मुष्टिनाऽङ्ह्गंचस्नेहेनाभ्यज्यमर्दयेत्||

वेदनार्तमितिस्नेहोनहिशीघ्रंनिवर्तते|

योज्यःशीघ्रंनिवृत्तेऽन्यःस्नेहोऽतिष्ठन्नकार्यकृत्||[ii]                            (A. H. Su. 19/28)

• After the administration of Anuvāsana Basti, patient should lie in relaxed position by extending the entire body and with a pillow under his heels.
• The physician shall hit the painful body parts with fist or massaged with oil.
• By doing all these Sneha will not expelled out soon and will be retained for more time.
• If expelled soon another Anuvāsana Basti should be administered immediately because Sneha which is expelled out soon does not serve the purpose.

ततःप्रणिहितस्नेहउत्तानोवाक्शतंभवेत् |

प्रसारितैःसर्वगात्रैस्तथावीर्यंविसर्पति ||

ताडयेत्तलयोरेनंत्रींस्त्रीन्वाराञ्छनैःशनैः |

स्फिचोश्चैनंततःशय्यांत्रीन्वारानुत्क्षिपेत्ततः ||

एवंप्रणिहितेबस्तौमन्दायासोऽथमन्दवाक् |

स्वास्तीर्णेशयनेकाममासीताचारिकेरतः ||                                            (Su. Chi. 37/ 60-62)

After administering oil enema the patient should be made to lie with his face upfor a period of uttering hundred letters, stretching his entire body so that the power of the oil spreads to all places; his body and buttocks should be patted thrice with the palm slowly, the bed should be lifted up and lowered down thrice; oil enema given in this way will be less tiresome, the person should talk less, lie comfortably in bed for as much time as he desires, adhering to the regimen.

[i] Cha. Su 3/28

[ii] A.H. Su 19/28

निवृत्तिकालः परमस्त्रयो यामास्ततः परम्||

अहोरात्रमुपेक्षेत, परतः फलवर्तिभिः|

तीक्ष्णैर्वा बस्तिभिः कुर्याद्यत्नं स्नेहनिवृत्तये||[i]                     (A. H. Su. 19/30)

यस्येहयामाननुवर्ततेत्रीन्स्नेहोनरःस्यात्सविशुद्धदेहः||[ii]                    (Cha. Si. 1/46)

The maximum time for the Sneha to come out is 3 Yāma i.e., 9 hours. Even if it is not expelled within this time, we may wait for one Ahorātra i.e., one day and night or 24 hours. After that the retained Sneha should be expelled using Phala Varti or Tīkṣṇa Basti if it does not produce any complications within 24 hours.

अतिरौक्ष्यादनागच्छन्न चेज्जाड्यादिदोषकृत्|
उपेक्षेतैव हि ततोऽध्युषितश्च निशां पिबेत्||
प्रातर्नागरधान्याम्भः कोष्णं, केवलमेव वा|[iii]                      (A. H. Su. 19/32)

If the Sneha doesn’t come out because of severe Rūkṣata in Koṣṭha and if it doesn’t produce any complications like Jaḍatā then it should be ignored but the patient should not take food at night. In the next morning he should drink warm water or water boiled with Nāgara and Dhānyaka Jala.

• धान्यनागरसिद्धं हि तोयं दद्याद्विचक्षणः| व्युषिताय निशां कल्यमुष्णं वा केवलं जलम्||
  स्नेहाजीर्णं जरयति श्लेष्माणं तद्भिनत्ति च| मारुतस्यानुलोम्यं च कुर्यादुष्णोदकं नृणाम्||[iv]

(Cha. Si. 4/43)

• वमने च विरेके च निरूहे सानुवासने|

           तस्मादुष्णोदकं देयं वातश्लेष्मोपशान्तये||[v]                                 (Cha. Si. 4/44)

This warm water helps the patient in the digestion of undigested Sneha and it disintegrates Kapha. Therefore after Vamana, Virecana, Nirūha and Anuvāsana Karma, warm water is to be given to the patient for the alleviation of Vāyu.

The reason for Basti coming out immediately

यस्यानुवासनोदत्तःसकृदन्वक्षमाव्रजेत् |
अत्यौष्ण्यादतितैक्ष्ण्याद्वावायुनावाप्रपीडितः ||
सवातोऽधिकमात्रोवागुरुत्वाद्वासभेषजः |
तस्यान्योऽल्पतरोदेयोनहिस्निह्यत्यतिष्ठति ||[vi]                               (Su. Chi. 37/64)

If oil does not come out quickly, due to either being very hot, very strong in potency, obstructed by Vāta, combined with air, being more in quantity or medicated oil being heavy, then another oil enema with less quantity should be administered because if the oil does not stay inside for some time, the person does not become lubricated.

The reason for Basti retaining inside for long

अस्विन्नस्याविशुद्धस्य स्नेहोऽल्पः सम्प्रयोजितः |
शीतो मृदुश्च नाभ्येति ततो मन्दं प्रवाहते ||                                           (Su. Chi. 37/93)

Oil enema administered to persons who are not given sudation and purification earlier and if the oil less in quantity, cold and with mild potency, then it will come out slowly.

Other Precautions

नत्वामंप्रणयेत्स्नेहंसह्यभिष्यन्दयेद्गुदम्|
सावशेषंचकुर्वीतवायुःशेषेहितिष्ठति||[vii]                 (Cha. Si. 4/48)

Uncooked oil should not be used for Anuvāsana Basti as it produces stuffiness in the rectum. Some portion of the oil should be allowed to remain in the Basti Puṭaka because in attempt to give complete oil, some portion of Vāta also enter into the body / intestine.

[i]A. H. Su 19/30

[ii]Cha. Si 1/46

[iii] A. H. Su 19/32

[iv] Cha. Si 4/43

[v] Cha. Si 4/ 44

[vi] Su. Chi 37/64

[vii] Cha. Si 4/48

Samyak Anuvāsita Lakṣaṇa

प्रत्येत्यसक्तंसशकृच्चतैलंरक्तादिबुद्धीन्द्रियसम्प्रसादः
स्वप्नानुवृत्तिर्लघुताबलंचसृष्टाश्चवेगाःस्वनुवासितेस्युः||

                                                                                                (Cha. Si. 1/44)

Proper administration of Anuvāsana Basti give rise to the following signs and symptoms

Return of the Sneha with Purīṣa without any obstruction. Nourishment of Raktadi Dhātus, clarity of intellect and senses, good and continuous sleep, lightness and strength in the body and proper elimination of natural urges without any obstruction.

Anuvāsana Ayoga Lakṣaṇa

अधःशरीरोदरबाहुपृष्ठपार्श्वेषुरुग्रूक्षखरंचगात्रम्
ग्रहश्चविण्मूत्रसमीरणानामसम्यगेतान्यनुवासितस्य ||                    (Cha. Si. 1/45)

Improper administration of Anuvāsana Basti give rise to the following signs and symptoms

Pain in the lower part of the body, abdomen, arms, back and flanks, dryness and roughness of the body and obstruction in the passage of stool, urine and flatus.

Anuvāsana Atiyoga Lakṣaṇa

हृल्लासमोहक्लमसादमूर्च्छाविकर्तिकाचात्यनुवासितस्य|                (Cha. Si. 1/46)

Excessive administration of Anuvāsana Basti gives rise to nausea, unconsciousness, physical fatigue, mental fatigue, exhaustion, fainting and gripping pain in the anus.

दत्तेतूत्तानदेहस्यपाणिनाताडयेत्स्फिजौ|
तत्पार्ष्णिभ्यांतथाशय्यांपादतश्चत्रिरुत्क्षिपेत्||[i]                                            (Cha. Su. 3/28)

After Basti Pranidhāna, the patient should lie on his back and his buttocks beaten by the hands of physician and then by patient’s own heels. The foot end of Śayyā should be lifted thrice.

ततःप्रसारिताङ्ह्गस्यसोपधानस्यपार्ष्णिके|

आहन्यान्मुष्टिनाऽङ्ह्गंचस्नेहेनाभ्यज्यमर्दयेत्||

वेदनार्तमितिस्नेहोनहिशीघ्रंनिवर्तते|

योज्यःशीघ्रंनिवृत्तेऽन्यःस्नेहोऽतिष्ठन्नकार्यकृत्||[ii]                            (A. H. Su. 19/28)

• After the administration of Anuvāsana Basti, patient should lie in relaxed position by extending the entire body and with a pillow under his heels.
• The physician shall hit the painful body parts with fist or massaged with oil.
• By doing all these Sneha will not expelled out soon and will be retained for more time.
• If expelled soon another Anuvāsana Basti should be administered immediately because Sneha which is expelled out soon does not serve the purpose.

युक्तस्नेहं द्रवोष्णं च लघुपथ्योपसेवनम्|

भुक्तवान् मात्रया भोज्यमनुवास्यस्त्र्यहात्त्र्यहात्||४२||

धान्यनागरसिद्धं हि तोयं दद्याद्विचक्षणः|

व्युषिताय निशां कल्यमुष्णं वा केवलं जलम्||४३||

स्नेहाजीर्णं जरयति श्लेष्माणं तद्भिनत्ति च|

मारुतस्यानुलोम्यं च कुर्यादुष्णोदकं नृणाम्||४४||

वमने च विरेके च निरूहे सानुवासने|

तस्मादुष्णोदकं देयं वातश्लेष्मोपशान्तये||४५||[iii]                          (Cha. Si. 4/42-45)

After appropriate administration of Anuvāsana Basti the patient should be given liquid, hot, light and wholesome food. After intake of this in appropriate quantity the patient may be repeatedly given Anuvāsana Basti every third day.

If the Sneha doesn’t come out because of severe Rūkṣata in Koṣṭha and if it doesn’t produce any complications like Jaḍatā then it should be ignored but the patient should not take food at night. In the next morning he should drink warm water or water boiled with Nagara and Dhānyaka Jala.

This warm water helps the patient in the digestion of undigested Sneha and it disintegrates Kapha. Therefore, after Vamana, Virecana, Nirūha and Anuvāsana Karma, warm water is to be given to the patient for the alleviation of Vāta.

After Anuvāsana Basti has come out, the patient should avoid any food at night. During next day, food should be taken in day time and in evening. Thereafter, on the second, third or fifth day Anuvāsana Basti should be given. On every third or fifth day, Nirūha Basti should be done followed by Anuvāsana Basti.

The patient should again be given Anuvāsana on the second day if there is excessively aggravated Vāyu, on the third day if Vāyu is moderately aggravated and on the fifth day if Pitta and Kapha are aggravated.

[i] Cha. Su 3/28

[ii] A.H. Su 19/28

[iii] Cha. Si 4/42-45

Parihārya Viṣaya after Anuvāsana Basti

अत्यासनस्थानवचांसि यानं स्वप्नं दिवा मैथुनवेगरोधान् ||

शीतोपचारातपशोकरोषांस्त्यजेदकालाहितभोजनं च | [i]                              (Cha. Si. 1/54)

Here Caraka advises to avoid Excessive sitting, standing, speaking and travelling, day sleep, sexual intercourse, suppression of manifested natural urges, cooling regimens, exposure to sun, grief and anger and intake of untimely and unwholesome food after doing Pañcakarma.

एतां प्रकृतिमप्राप्तः सर्ववर्ज्यानि वर्जयेत्|
महादोषकराण्यष्टाविमानि तु विशेषतः||
उच्चैर्भाष्यं रथक्षोभमविचङ्क्रमणासने|
अजीर्णाहितभोज्ये च दिवास्वप्नं समैथुनम्||
तज्जा देहोर्ध्वसर्वाधोमध्यपीडामदोषजाः|
श्लेष्मजाः क्षयजाश्चैव व्याध्यः स्युर्यथाक्रमम्||                       (Cha. Si. 12/10-12)

The Aṣṭa Mahā Doṣakara Bhāvas are the eight factors which are Apathya during Śodhana procedures. They are Ucchairbhāṣya, Rathakṣobha, Aticaṅkramaṇa, Atyaśana, Ajīrṇa, Adyaśana or Ahita Bhojana, Divāsvapna and Maithuna. As Ucchairbhāṣya leads to Ūrdhva Bhāga Deha Rogas. Rathakshobha leads to Sarva Deha Rogas. Aticaṅkramaṇa leads to Adho Deha Rogas, Atyaśana leads to Madhya Deha Rogas. Ajīrṇa and Ahita Bhojana leads to Āma doṣa. Divāsvapna leads to Kaphaja Rogas and Maithuna leads to Kṣayaja Rogas.

Parihāra Kāla

कालस्तुबस्त्यादिषुयातियावांस्तावान्भवेद्विपरिहारकालः|                 (Cha. Si. 1/54)

One should follow the restrictions and diet, double the duration taken for the treatment.

यान्यहानिपिबेत्तानितावन्त्यन्यान्यपित्यजेत्|                               (A. H. Su. 16/28)  

The restrictions should be followed for same number of days taken for the treatment.    

[i] Cha. Si 1/54