Ashtanga Hrudaya Sutra Sthana Chapter 19: Basti Vidhim Adhyayam (Procedure of Basti Treatment)

The 19th chapter of Sutrasthanam of Ashtanga Hridayam is named as Basti Vidhi Adhyayam. This chapter explains the types, indications, contra indications and procedure of Basti treatment. Basti in general means enema therapy.

अथातो बस्तिविधिमध्यायं व्याख्यास्याम: इति ह स्माहुरात्रेयादयो महर्षय:॥
Atreya and other sages pledge that henceforth they will be explaining the chapter named Basti vidhimadhyaya (pertaining to therapeutic enema therapy).

Patients suitable for Anuvasana Basti

Anuvasana Arha – Anuvasya
आस्थाप्या एव चान्वास्या विशेषादतिवह्नयः ॥ ६ ॥
रूक्षाः केवलवातार्ता
Person suitable for Asthapana are suitable for Anuvasana (fat enema).
Especially those who have strong digestion power, who are dry, not undergone Snehana therapy and those suffering from diseases of vata.

Patients not suitable for Anuvasana

नानुवास्यास्त एव च ।
येऽनास्थाप्यास्तथा पाण्डुकामलामेहपीनसाः ॥ ७ ॥
निरन्नप्लीहविड्भेदिगुरुकोष्ठकफोदराः ।
अभिष्यन्दिभृशस्थूलकृमिकोष्ठाढ्यमारुताः ॥ ८ ॥
पीते विषे गरेऽपच्यां श्लीपदी गलगण्डवान् ।
Persons unsuitable for Anuvasana (fat enema) are all those unsuitable for Niruha basti, those suffering from
Pandu – anaemia,
Kamala – Jaundice,
Meha – diabetes, urinary tract disorders
Peenasa – rhinitis
Niranna on empty stomach
Pleeha – disease of the spleen, Splenomegaly
Vid bhedi – diarrhoea,
Guru koshta – hard bowels – constipated,
Kaphodara – Kapha type of Ascites
Abhishyandi – a type of eye disorder (conjunctivitis)
Bhrusha Sthula – profound obesity,
KrumiKoshta – Intestinal worm infestation
Adhyamaruta – gout;
Who have consumed poison, those suffering from artificial poison, goitre, filariasis and scrofula.

Bastinetra – enema nozzle

तयोस्तु नेत्रं हेमादिधातुदार्वस्थिवेणुजम् ॥ ९ ॥
गोपुच्छाकारमच्छिद्रं श्लक्ष्णर्जु गुलिकामुखम् ।
Enema nozzle should be made from metals like gold, silver, wood, bone or bamboo;
Gopuchhakara – resembling the tail of the cow in shape,
Achidra – without holes (except at the ends), smooth, straight and with
Gulikamukha – tip shaped like a pill.

Measurements for children

ऊनेऽब्दे पञ्च पूर्णेऽस्मिन्न् आसप्तभ्योऽङ्गुलानि षट् ॥ १० ॥
सप्तमे सप्त तान्यष्टौ द्वादशे षोडशे नव ।
द्वादशैव परं विंशाद्वीक्ष्य वर्षान्तरेषु च ॥ ११ ॥
वयोबलशरीराणि प्रमाणमभिवर्धयेत् ।
For children less than 1year of age, nozzle should be five angula– fingers breadth of patient’s own finger in length;
1 – 7 years of age, it should be 6 angula;
7 year it should be 7 Angula,
12 years – 8 Angula
16 years – 9 Angula
20 years and onwards it should be 12 Angulas only.
These measurements may be slightly increased for those of other age groups based on age, strength and body build.

Diameter of the orifice (Basti netra)

स्वाङ्गुष्ठेन समं मूले स्थौल्येनाग्रे कनिष्ठया ॥ १२ ॥
पूर्णेऽब्देऽङ्गुलमादाय तदर्द्धार्द्धप्रवर्धितम् ।
त्र्यङ्गुलं परमं छिद्रं मूलेऽग्रे वहते तु यत् ॥ १३ ॥
मुद्गं माषं कलायं च क्लिन्नं कर्कन्धुकं क्रमात् ।
Its orifice at its root should be 1 Angula in diameter for children of one year of age.
Diameter of the orifice should be increased by ½ angula for different age groups and its maximum is 3 Angula diameters.
At its tip, the orifice should allow free movement of soaked Mudga (green gram), Masha (black gram), Kalaya (round pea) and seed of Karkandhu (Jujube) respectively.

Karnika – Ridges

मूलच्छिद्रप्रमाणेन प्रान्ते घटितकर्णिकम् ॥ १४ ॥
वर्त्याग्रे पिहितं मूले यथास्वं द्व्यङ्गुलान्तरम् ।
कर्णिकाद्वितयं नेत्रे कुर्यात्
Near the orifice at its root, a Karnika– ear–like ridge of the same size of the orifice should be constructed – at the time of preparing the nozzle, another Karnika– ridge should be made at a distance of two Angula– towards its tip. The orifice at the tip should be kept closed with a plug of cloth.

Basti Putaka– Enema bag

तत्र च योजयेत् ॥ १५ ॥
अजाविमहिषादीनां वस्तिं सुमृदितं दृढम् ।
कषायरक्तं निश्छिद्रग्रन्थिगन्धशिरं तनुम् ॥ १६ ॥
ग्रथितं साधु सूत्रेण सुखसंस्थाप्यभेषजम् ।
वस्त्यभावेऽङ्कपादं वा न्यसेद्वासोऽथवा घनम् ॥ १७ ॥
Urinary bladder of goats, sheep, buffalo or other animals was used as enema bag. The bladder should be sturdy, well beaten, made red by tanning with astringent substances.
The bladder should be devoid of holes, hard spots.
It should not be torn.
To such a bladder, the big end of the nozzle is adjusted and tied with threads.
If the bladder is not available, skin of thigh and legs of animals or thick cloth may be utilized for making the bag.

Niruha Matra (quantity of medicine for decoction enema)

निरूहमात्रा प्रथमे प्रकुञ्चो वत्सरे परम् ।
प्रकुञ्चवृद्धिः प्रत्यब्दं यावत् षट् प्रसृतास्ततः ॥ १८ ॥
प्रसृतं वर्द्धयेदूर्ध्वं द्वादशाष्टादशस्य तु ।
आसप्ततेरिदं मानं दशैव प्रसृताः परम् ॥ १९ ॥
For a child up to 1 year age, the quantity of Niruha basti is 1 prakuncha = 1 Pala = 48 g.
For each succeeding year it should be increased by 1 pala (48 g) till it becomes six Prasruta– 12 pala = 576 g;
So for a 12 year old, the quantity is 12 Pala = 576 g.
Further on, it should be increased by one Prasruta (2 Palas= 96 g). Each year till it becomes twelve Prasta– 24 Palas = 1,152 g.
At 18 years, it is 24 Pala.
18 – 70 years – 24 Pala.
After 70 years, 10 Prasruta = 20 Pala = 960 grams / ml

Anuvasana Matra– quantity for oil enema

यथायथं निरूहस्य पादो मात्राऽनुवासने ।
The quantity for oil enema should be one fourth of the quantity of that of decoction enema, as prescribed for each age group.

Anuvasana Vidhi procedure of fat Enema: Preparation and position of patient

आस्थाप्यं स्नेहितं स्विन्नं शुद्धं लब्धबलं पुनः ॥ २० ॥
अन्वासनार्हं विज्ञाय पूर्वमेवानुवासयेत् ।
शीते वसन्ते च दिवा रात्रौ केचित्ततोऽन्यदा ॥ २१ ॥
अभ्यक्तस्नातमुचितात् पादहीनं हितं लघु ।
अस्निग्धरूक्षमशितं सानुपानं द्रवादि च ॥ २२ ॥
कृतचङ्क्रमणं मुक्तविण्मूत्रं शयने सुखे ।
नात्युच्छ्रिते न चोच्छीर्षे संविष्टं वामपार्श्वतः ॥ २३ ॥
The person suitable for Niruha (Asthapana) Basti should be administered Snehana (oleation) and Swedana (sweating therapy) followed by Vamana and Virechana.
After he regains strength, determining that he is fit, he is given Sneha Basti.
Then, the following procedure is adopted.
During cold seasons (Hemanta and Shishira Rutus) and Vasanta (spring) it should be given during day time, in other seasons during night.
He should be given Abhyanga and bath, then accustomed food, less by one fourth of the usual quantity; satiable, light, easily digestible, neither with too oily nor very dry, followed by an after–drink of appropriate liquid.
Next he should walk for some time, eliminate faeces and urine and lie on a comfortable cot, neither too high nor too low, on his left side, folding his right thigh, and extending the left thigh.

Administration of Sneha basti

सङ्कोच्य दक्षिणं सक्थि प्रसार्य च ततोऽपरम् ।
अथास्य नेत्रं प्रणयेत् स्निग्धे स्निग्धमुखं गुदे ॥ २४ ॥
उच्छ्वास्य वस्तेर्वदने बद्धे हस्तमकम्पयन् ।
पृष्ठवंशं प्रति ततो नातिद्रुतविलम्बितम् ॥ २५ ॥
नातिवेगं न वा मन्दं सकृदेव प्रपीडयेत् । सावशेषं च कुर्वीत वायुः शेषे हि तिष्ठति ॥ २६ ॥
Next, the enema nozzle is lubricated. The air inside the bag is expelled out and well fastening of the nozzle is confirmed.
It should be pressed without shaking the hands, in the direction of the vertebral column, neither too fast nor too slow, neither with great force nor with low pressure but in one attempt, a little quantity of liquid material be allowed to remain in the bag.

Regimen after administration of Sneha Basti

दत्ते तूत्तानदेहस्य पाणिना ताडयेत् स्फिजौ ।
तत्पार्ष्णिभ्यां तथा शय्यां पादतश्च त्रिरुत्क्षिपेत् ॥ २७ ॥
ततः प्रसारिताङ्गस्य सोपधानस्य पार्ष्णिके ।
आहन्यान्मुष्टिनाङ्गं च स्नेहेनाभ्यज्य मर्दयेत् ॥ २८ ॥
वेदनार्तमिति स्नेहो न हि शीघ्रं निवर्तते ।
योज्यः शीघ्रं निवृत्तेऽन्यः स्नेहोऽतिष्ठन्नकार्यकृत् ॥ २९ ॥
दीप्ताग्निं त्वागतस्नेहं सायाह्ने भोजयेल्लघु ।
After the administration and removing the nozzle, the person should be placed with his face upwards, his buttocks beaten gently by the hands of the physician, then by patients own heels;
the foot of the cot should be lifted up thrice;
Next he must lie extending the entire body, with a pillow under his heels, oil should be smeared all over the body and all the parts of it beaten with fist or massaged, concentrating on the painful areas of the body, so that the fat enema liquid inside the rectum does not come out soon.
If it comes out soon, another oil enema should be administered immediately because Sneha which does not remain inside does not serve the purpose. If the person has good digestion strength and if the fat comes out after the stipulated time, he can be given light food in the evening.

Time for retaining of Sneha within colon

निवृत्तिकालः परमस्त्रयो यामास्ततः परम् ॥ ३० ॥
अहोरात्रमुपेक्षेत परतः फलवर्तिभिः ।
तीक्ष्णैर्वा वस्तिभिः कुर्याद्यत्नं स्नेहनिवृत्तये ॥ ३१ ॥
The maximum time for the fat to come out is 3 Yama– nine hours; after that, it can be awaited for one day and night; later on, after 24 hours after administration, attempt should be made to remove it by force, with the help of Phalavarti (rectal suppositories) made from fruits or with the help of Teekshna Basti (strong decoction enema).

Severe dryness

अतिरौक्ष्यादनागच्छन्नचेज्जाड्यादिदोषकृत् ।
उपेक्षेतैव हि ततोऽध्युषितश्च निशां पिबेत् ॥ ३२ ॥
If it does not come out due to severe dryness inside and does not produce any troubles like lassitude etc., it should be neglected and allowed to remain inside for the night;

Drink for next morning

प्रातर्नागरधान्याम्भः कोष्णं केवलमेव वा ।
अन्वासयेत्तृतीयेऽह्नि पञ्चमे वा पुनश्च तम् ॥ ३३ ॥
यथा वा स्नेहपक्तिः
Next morning he is made to drink warm water either processed with ginger and coriander or plain.
Again he should be given fat enema on the third or fifth day, or till the fat gets well–digested.

People eligible to take unctuous enema daily – Nitya Sneha basti Sevaneeya

स्यादतोऽत्युल्बणमारुतान् ।
व्यायामनित्यान् दीप्ताग्नीन् रूक्षांश्च प्रतिवासरम् ॥ ३४ ॥
For people having an intense increase of vata, who do exercise every day, who have good digestive power and those who are very dry can be given sneha basti daily.

Sneha basti as preparation for decoction enemas

इति स्नेहैस्त्रिचतुरैः स्निग्धे स्रोतोविशुद्धये ।
निरूहं शोधनं युञ्ज्यादस्निग्धे स्नेहनं तनोः ॥ ३५ ॥
After administering 3–4 such sneha bastis, if the body is found to be well lubricated, Shodhana Niruha basti should be administered next, to clear the channels, if the body is not well lubricated, the fat enemas only should be continued.

Procedure of decoction enema – Niruha basti Vidhi

पञ्चमेऽथ तृतीये वा दिवसे साधके शुभे ।
मध्याह्ने किञ्चिदावृत्ते प्रयुक्ते बलिमङ्गले ॥ ३६ ॥
अभ्यक्तस्वेदितोत्सृष्टमलं नातिबुभुक्षितम् ।
अवेक्ष्य पुरुषं दोषभेषजादीनि चादरात् ॥ ३७ ॥
वस्तिं प्रकल्पयेद्वैद्यस्तद्विद्यैर्बहुभिः सह ।
On the 3rd or 5th day after completion of Sneha basti, at an auspicious day decided as per astrology, sometime after the passage of mid–day, after performing auspicious rites and rituals, after Abhyanga and Swedana, after the elimination of urine and faeces, after making sure that the patient has not taken a heavy meal, after carefully considering the person, dosha status, drugs and dose etc.; the physician, accompanied by many experts of enema therapy, should administer Asthapana Basti to the patient.

Preparation of decoction for enema – Niruha dravya kalpana

क्वाथयेद्विंशतिपलं द्रव्यस्याष्टौ फलानि च ॥ ३८ ॥
ततः क्वाथाच्चतुर्थांशं स्नेहं वाते प्रकल्पयेत् ।
पित्ते स्वस्थे च षष्ठांशमष्टमांशं कफेऽधिके ॥ ३९ ॥
सर्वत्र चाष्टमं भागं कल्काद्भवति वा यथा ।
नात्यच्छसान्द्रता वस्तेः पलमात्रं गुडस्य च ॥ ४० ॥ मधुपट्वादिशेषं च युक्त्या
The drugs / herbs (mentioned in the prescription for preparation of Kashaya) should be taken in 20 pala (960 grams) quantity and madana phala i.e. fruits of Randia dumetorum should be taken in 8 numbers the above mentioned ingredients should be made into a Kashaya .
(Note – the decoction is prepared with 16 parts water i.e. 15.360 litres and the contents boiled until ¼ quantity remains. Thus, 3.840 litres of decoction will remain roughly)
To this Kashaya, sneha dravya i.e. oil, ghee etc are added in ¼ quantity as that of kashaya for treatment of vata conditions / disorders (i.e. 960 grams), in 1/6 quantity as that of kashaya for treatment of pitta conditions / disorders and in healthy persons (i.e. 640 grams) and 1/8 quantity as that of kashaya for treatment of kapha disorders, the quantity of kalka of some drugs / herbs to be added to the kashaya for all the doshas and for healthy persons shall be 1/8 part of the decoction (i.e. 480 grams). The decoction should neither be too thin nor too thick after mixing all the above said ingredients.
Next, 1 pala (48 grams) of jaggery / molasses and appropriate quantity of honey and salt are also added.

Administration of decoction enema – Kashaya basti pranidhana

सर्वं तद् एकतः । उष्णाम्बुकुम्भीबाष्पेण तप्तं खजसमाहतम् ॥ ४१ ॥
प्रक्षिप्य वस्तौ प्रणयेत् पायौ नात्युष्णशीतलम् । नातिस्निग्धं न वा रूक्षं नातितीक्ष्णं न वा मृदु ॥ ४२ ॥
नात्यच्छसान्द्रं नोनातिमात्रं नापटु नाति च । लवणं तद्वद् अम्लं च
All these are then mixed together, churned well with a churner and made warm by keeping its vessel either in hot water or by steam from a pot, it should then be filled into the basti putaka (enema bag). The medicine or basti dravya should neither be too hot or too cold, neither too fatty nor too dry, neither too strong nor mild, neither too thick nor too thin, neither too much nor too less in quantity, neither with too much salt nor without it, similarly the sour substances too (neither too much nor without their inclusion) is then pushed into the rectum.

Difference of opinion on quantity of fats, honey, salt, paste and liquids to be added to the enema liquid

पठन्त्यन्ये तु तद्विदः ॥ ४३ ॥
मात्रां त्रिपलिकां कुर्यात् स्नेहमाक्षिकयोः पृथक् ।
कर्षार्धं माणिमन्थस्य स्वस्थे कल्कपलद्वयम् ॥ ४४ ॥
सर्वद्रवाणां शेषाणां पलानि दश कल्पयेत् ।
Some others, who are well versed in basti or enema therapy opine that the quantity of sneha dravya or fats i.e., oil, ghee and honey should be 3 pala (144 grams) individually, quantity of rock salt for healthy will be ardha karsha (6 grams), the paste of the drugs should be 2 pala (96 grams) and of all the other liquids put together should be 10 pala (480 grams).

Order of mixing enema substances basti dravya mishrana krama

माक्षिकं लवणं स्नेहं कल्कं क्वाथमिति क्रमात् ॥ ४५ ॥
आवपेत निरूहाणां एष संयोजने विधिः ।
Honey, salt, fat (oil, ghee etc), paste of drugs / herbs and decoction are to be grinded and mixed in successive order this shall be the method of mixing the materials for Niruha basti.

After–care following the completion of decoction enema

उत्तानो दत्तमात्रे तु निरूहे तन्मना भवेत् ॥ ४६ ॥
कृतोपधानः सञ्जातवेगश्चोत्कटकः सृजेत् ।
After receiving the enema, the patient should lie with his face upwards with a pillow under his head, focussing on (mentally intent) on the enema, after getting the urge (to evacuate), he should eliminate the faeces sitting on his heels.

Maximum time required for exit of decoction enema and measures to be taken when the decoction enema doesn’t come out on its own

आगतौ परमः कालो मुहूर्तो मृत्यवे परम् ॥ ४७ ॥
तत्रानुलोमिकं स्नेहक्षारमूत्राम्लकल्पितम् ।
त्वरितं स्निग्धतीक्ष्णोष्णं वस्तिमन्यं प्रपीडयेत् ॥ ४८ ॥
विदद्यात् फलवर्तिं वा स्वेदनोत्त्रासनादि च
स्वयमेव निवृत्ते तु द्वितीयो वस्तिरिष्यते ॥ ४९ ॥
तृतीयोऽपि चतुर्थोऽपि यावद्वा सुनिरूढता ।
The maximum time for return of administered basti dravya is one muhurta (48 minutes). If it doesn’t return by itself after the mentioned time period, it is said to be fatal. Hence, another Anulomana basti (purging enema) prepared with fats, alkalis, urine of animals like cow and sour substances, which possess unctuous, penetrating and hot properties should be administered immediately or a phala varti (rectal suppository) should be introduced. Swedana karma and frightening should also be resorted to, if the enema liquid comes out on its own accord, then second, third or fourth enemas can be given or as many enemas as required until he develops symptoms of proper enema therapy.

Measures to be done after proper elimination of enema liquid

विरिक्तवच्च योगादीन् विद्यात् योगे तु भोजयेत् ॥ ५० ॥
कोष्णेन वारिणा स्नातं तनुधन्वरसौदनम् ।
विकारा ये निरूढस्य भवन्ति प्रचलैर्मलैः ॥ ५१ ॥
ते सुखोष्णाम्बुसिक्तस्य यान्ति भुक्तवतः शमम् ।
The symptoms of bouts of kashaya basti i.e., signs of proper and improper elimination are similar to those of virechana after the appearance of the symptoms of proper elimination (proper administration of kashaya basti), the patient should take a warm water bath and eat rice mass along with the juice of meat of animals living in deserts. The complications of kashaya basti caused by the circulating doshas will subside by warm water bath and prescribed food.

Measures to be taken in those troubled by increased vata

अथ वातार्दितं भूयः सद्य एवानुवासयेत् ॥ ५२ ॥
If the patient becomes troubled by increased vata, he should be given Anuvasana basti immediately once again on the same day itself.

Signs of proper, less and excessive administration of decoction enema

सम्यग्घीनातियोगाश्च तस्य स्युः स्नेहपीतवत्|
The symptoms of samyak (proper), heena (inadequate) and ati (excessive) administration of decoction enema therapy are the same as those of snehana (drinking of fat) therapy.

Signs of properly done unctuous (oil, lubricating) enema therapy

किञ्चित्कालं स्थितो यश्च सपुरीषो निवर्तते ॥ ५३ ॥
सानुलोमानिलः स्नेहस्तत् सिद्धमनुवासनम् ।
The sneha (oil, ghee etc.) given through enema coming out along with faeces after staying inside for a short time, followed by flatus moving down are the symptoms of properly given anuvasana basti.

Number of unctuous enemas in relation to the doshas

एकं त्रीन् वा बलासे तु स्नेहवस्तीन् प्रकल्पयेत् ॥ ५४ ॥
पञ्च वा सप्त वा पित्ते नवैकादश वाऽनिले ।
पुनस्ततोऽप्ययुग्मांस्तु पुनरास्थापनं ततः ॥ ५५ ॥
1–3 anuvasana bastis should be administered for the treatment of kapha predominant diseases, anuvasana bastis for pitta predominant diseases and 9–11 anuvasana bastis for vata predominant diseases again on uneven alternative days, i.e., 3rd, 5th, 7th etc days, kashaya bastis should be administered.

Diet arrangement for different doshas in enema after–care

कफपित्तानिलेष्वन्नं यूषक्षीररसैः क्रमात् ।
In kapha, pitta and vata disorders, food should be given along with soup prepared with rice, grains etc., milk and meat soup respectively (with soup in kapha, with milk in pitta and with meat soup in vata).

Enema for increased vata

वातघ्नौषधनिःक्वाथत्रिवृतासैन्धवैर्युतः ॥ ५६ ॥
वस्तिरेकोऽनिले स्निग्धः स्वाद्वम्लोष्णो रसान्वितः ।
In case of vata vruddhi, one enema consisting of decoction of herbs which pacify vata, trivrit (Operculina turpethum), rock salt, mixed with fats, liquids of sweet and sour taste, made warm and administered will be ideal.

Enema for increased pitta

न्यग्रोधादिगणक्वाथपद्मकादिसितायुतौ ॥ ५७ ॥
पित्ते स्वादुहिमौ साज्यक्षीरेक्षुरसमाक्षिकौ ।
In case of pitta vruddhi, two enemas consisting of decoction of herbs of Nyagrodhadi gana and Padmakadi gana of herbs made sweet by adding sugar and cold and mixed with ghee, milk, sugarcane juice and honey will be ideal.

Enema for increased kapha

आरग्वधादिनिःक्वाथवत्सकादियुतास्त्रयः ॥ ५८ ॥
रूक्षाः सक्षौद्रगोमूत्रास्तीक्ष्णोष्णकटुकाः कफे ।
In case of kapha vruddhi, three enemas consisting of decoction of herbs of Aragwadhadi gana and Vatsakadi gana of herbs, dry in nature, mixed with honey, urine of cow, possessing penetrating, hot and pungent properties is ideal.

Enema for all three Doshas

त्रयस्ते सन्निपातेऽपि दोषान् घ्नन्ति यतः क्रमात् ॥ ५९ ॥
In case of tridosha vruddhi (increase of all the three doshas together), these three kinds of enemas (mentioned above for vata, pitta and kapha) will bring down the doshas when given in that order.

Superiority of the above mentioned three dosha mitigating enemas

त्रिभ्यः परं वस्तिमतो नेच्छन्त्यन्ये चिकित्सकाः ।
न हि दोषश्चतुर्थोऽस्ति पुनर्दीयेत यं प्रति ॥ ६० ॥
Other physicians do not desire any enema other than these three enemas because there is no fourth dosha for which another enema needs to be given.

Three other kinds of enema

उत्क्लेशनं शुद्धिकरं दोषाणां शमनं क्रमात् ।
त्रिधैव कल्पयेद्वस्तिमित्यन्येऽपि प्रचक्षते ॥ ६१ ॥
दोषौषधादिबलतः सर्वमेतत् प्रमाणयेत् ।
Yet others say that only three kinds of enema are to be prepared, (they are) utkleshana basti – that which causes exacerbation of doshas, shodhana basti – that which causes purification, by expelling the doshas and shamana basti – that which causes mitigation of doshas by subsiding them inside the body, without expelling them. In that order all these are to be justified on the basis of strength of the doshas, drugs, etc.

Limits of doing basti therapy

सम्यङ्निरूढलिङ्गं तु नासम्भाव्य निवर्तयेत् ॥ ६२ ॥
The administration of kashaya basti should not be stopped until the symptoms of proper enema are not obtained.

Karma Basti – treatment with 30 enemas

प्राक् स्नेह एकः पञ्चान्ते द्वादशास्थापनानि च ।
सान्वासनानि कर्मैवं वस्तयस्त्रिंशदीरिताः ॥ ६३ ॥
A course of 30 enemas in which one Anuvasana basti is given at the beginning and five Anuvasana bastis at the end (of the course), with twelve kashaya bastis and twelve anuvasana bastis alternatively in the middle (in between the above said unctuous enemas at the beginning and end) is called karma basti.
Pattern of Karma basti –
Anuvasana basti days –
1st day, 2nd, 4th, 6th, 8th, 10th, 12th, 14th, 16th, 18th, 20th, 22nd and 24th days
Kashaya basti days –
3rd, 5th, 7th, 9th, 11th, 13th, 15th, 17th, 19th, 21st, 23rd, 25th days
26th, 27th, 28th, 29th, 30th days – anuvasana basti

Kala Basti – treatment with 15 enemas

कालः पञ्चदशैकोऽत्र प्राक् स्नेहोऽन्ते त्रयस्तथा ।
षट् पञ्चवस्त्यन्तरिताः
A course of 15 enemas in which 1 anuvasana basti is given at the beginning and three anuvasana bastis at the end (of the course), with 6 kashaya bastis and 5 anuvasana bastis alternatively in the middle (in between the first and last anuvasana bastis) is known as kala basti.
Pattern of Kala basti –
1st day – anuvasana basti
2nd, 4th, 6th, 8th, 10th and 12th days – Niruha basti
3rd, 5th, 7th, 9th and 11th days – anuvasana basti
13th, 14th, 15th days – anuvasana basti

Yoga Basti – treatment with 8 enemas

योगोऽष्टौ वस्तयोऽत्र तु ॥ ६४ ॥
त्रयो निरूहाः स्नेहाश्च स्नेहावाद्यन्तयोरुभौ ।
A course of 8 enemas in which 1 anuvasana basti is given at the beginning and 1 anuvasana basti at the end (of the course), with 3 kashaya bastis and 3 anuvasana bastis alternatively in the middle (in between the first and last anuvasana bastis) is known as yoga basti.
Pattern of Yoga basti –
Anuvasana basti – 1st day, 3rd, 5th & 7th days and on 8th day
Niruha basti – 2nd, 4th & 6th days

Unctuous or decoction enemas should not be administered alone, in excess

स्नेहवस्तिं निरूहं वा नैकमेवातिशीलयेत् ॥ ६५ ॥
उत्क्लेशाग्निवधौ स्नेहान्निरूहान्मरुतो भयम् ।|
तस्मान्निरूढः स्नेह्यः स्यान्निरूह्यश्चानुवासितः ॥ ६६ ॥
स्नेहशोधनयुक्त्यैवं वस्तिकर्म त्रिदोषजित् ।
Either anuvasana basti or kashaya basti alone should not be administered (in excess and continuously) more of anuvasana basti – unctuous (oil, lubricating, fat) enema may cause nausea and loss of digestion strength, more of kashaya basti may cause fear of increase of vata hence those who are given kashaya basti should also be given with anuvasana basti and those who are given anuvasana basti should also be given with kashaya basti will balance the three doshas only when it is both lubricating and purifying / cleansing (as caused by anuvasana basti and kashaya basti respectively).

Matra Basti – Low dose fat enema

ह्रस्वया स्नेहपानस्य मात्रया योजितः समः ॥ ६७ ॥
मात्रावस्तिः स्मृतः स्नेहः
The anuvasana basti consisting of fat/oil quantity equivalent to the minimum quantity of fats used for oral consumption (sneha pana) is known as matra basti.

Indications and benefits of Matra Basti

शीलनीयः सदा च सः ।
बालवृद्धाध्वभारस्त्रीव्यायामासक्तचिन्तकैः ॥ ६८ ॥
वातभग्नाबलाल्पाग्निनृपेश्वरसुखात्मभिः ।
दोषघ्नो निष्परीहारो बल्यः सृष्टमलः सुखः ॥ ६९ ॥
It (matra basti) should always be administered in children, the aged, who are habituated to long walking, carrying heavy weights, excessive sexual activity, excessive exercise, who think too much, who are suffering from diseases of vata, fractures, debility, those having poor digestive activity, for kings, wealthy persons and persons who live happily. Matra Basti conquers the doshas, does not need strict regimen, gives strength, eliminates the wastes (urine, faeces etc.), easily and is comfortable (to undergo).

Uttara basti – urethral and vaginal enema (douche)

वस्तौ रोगेषु नारीणां योनिगर्भाशयेषु च ।
द्वित्रास्थापनशुद्धेभ्यो विदध्याद्वस्तिमुत्तरम् ॥ ७० ॥
In diseases of urinary bladder and diseases of vagina and uterus in women, Uttara basti (enema administered through urethral route for both men and women or vaginal route for women) should be administered, to those who have purified by two or three kashaya bastis given through the rectal route.

Enema nozzle for Uttara basti

आतुराङ्गुलमानेन तन्नेत्रं द्वादशाङ्गुलम् ।
वृत्तं गोपुच्छवन्मूलमध्ययोः कृतकर्णिकम् ॥ ७१ ॥
सिद्धार्थकप्रवेशाग्रं श्लक्ष्णं हेमादिसम्भवम् ।
कुन्दाश्वमारसुमनःपुष्पवृन्तोपमं दृढम् ॥ ७२ ॥
The basti netra or nozzle for administering uttara basti should be of 12 angula in length, in terms of patients own fingers, rounded (tubular), which looks like a cow’s tail at its end, should have ridges at the root and middle should have an orifice of mustard seed size, it should be smooth and made up of gold, silver etc. metals, resembling the stalk of flowers such as kunda, ashwamara and sumanas, it should be strong in consistency.

Enema liquid for Uttara basti

तस्य वस्तिर्मृदुलघुर्मात्रा शुक्तिर्विकल्प्य वा ।
The enema liquid meant for uttara basti should be mild in strength light (easily acting) its quantity should be one sukti i.e. 24 grams .

Proceduee of urethral / vaginal enema – Uttara basti Vidhi

अथ स्नाताशितस्यास्य स्नेहवस्तिविधानतः ॥ ७३ ॥
ऋजोः सुखोपविष्टस्य पीठे जानुसमे मृदौ ।
हृष्टे मेढ्रे स्थिते चर्जौ शनैः स्रोतोविशुद्धये ॥ ७४ ॥
सूक्ष्मां शलाकां प्रणयेत्तया शुद्धेऽनुसेवनि ।
आमेहनान्तं नेत्रं च निष्कम्पं गुदवत्ततः ॥ ७५ ॥
पीडितेऽन्तर्गते स्नेहे स्नेहवस्तिक्रमो हितः ।
वस्तीननेन विधिना दद्यात् त्रींश्चतुरोऽपि वा ॥ ७६ ॥
अनुवासनवच्छेषं सर्वमेवास्य चिन्तयेत् ।
Next, the patient who has been given bath and food according to the regimen prescribed for anuvasana basti, the person should be stable and steadily placed, should be seated comfortably on soft seat of one’s knee height, the erect penis should be held straight by the physician and a thin probe should be inserted gently (by the physician) to clear the channel (urinary or vaginal tract), after thus cleansing the passage, the enema nozzle should be inserted along the line of the suture, to the entire length of the urethral passage, till the cavity of the urinary bladder is reached, without shaking and the enema bag should be pressed gently as explained in rectal enema, pushing the fat (oil, ghee etc.) into the urinary bladder, this is the ideal method for administering urethral enema in this manner, three or four enemas should be given, all other procedures including after–care, diet etc. are planned (and implemented) similar to that of fat enema therapy.

When to administer Uttara Basti in women, during or after menstrual period in women?

स्त्रीणामार्तवकाले तु योनिर्गृह्णात्यपावृतेः ॥ ७७ ॥
विदधीत तदा तस्मादनृतावपि चात्यये ।
योनिविभ्रंशशूलेषु योनिव्यापद्यसृग्दरे ॥ ७८ ॥
In women, the uterus (uterine passage) will be open only during the menstrual period, therefore, vaginal / uterine enema should be administered during the menstrual period only. It can be given even apart from the menstrual period in case of emergency, in diseases such as prolapsed and pain of uterus / vagina, in other diseases of uterus and vagina and in menorrhagia

Nozzle for vaginal / uterine enema & urethral enema in women

नेत्रं दशाङ्गुलं मुद्गप्रवेशं चतुरङ्गुलम् ।
अपत्यमार्गे योज्यं स्याद् द्व्यङ्गुलं मूत्रवर्त्मनि ॥ ७९ ॥
मूत्रकृच्छ्रविकारेषु बालानां त्वेकमङ्गुलम् ।
The length of basti netra or nozzle for administering vaginal / uterine enema should be 10 angulas, permitting the entry of a grain of green gram, it should be inserted to a length of four angula in case of vaginal passage and to a length of 2 angulas in case of urethral passage in diseases like dysuria etc. and in case of children, it shall be one angula.

Dosage of enema liquid for vaginal / uterine enema in women

प्रकुञ्चो मध्यमा मात्रा बालानां शुक्तिरेव तु ॥ ८० ॥
The medium quantity of enema is one prakuncha (48 grams) and for children the dose is 1 shukti (i.e., 24 grams).

Administering uttara basti in women

उत्तानायाः शयानायाः सम्यक् सङ्कोच्य सक्थिनी ।
ऊर्ध्वजान्वास्त्रिचतुरानहोरात्रेण योजयेत् ॥ ८१ ॥
वस्तींस्त्रिरात्रमेवं च स्नेहमात्रां विवर्द्धयन् ।
त्र्यहमेव च विश्रम्य प्रणिदध्यात् पुनस्त्र्यहम् ॥ ८२ ॥
The woman, who is lying on a cot with her face upwards, flexing the thighs and legs folded at the knees, should be administered with vaginal / urethral enema, 3–4 times in a day and night, it should be continued for 3 days only, increasing the quantity of unctuous enema liquid daily, after a gap of 3 days, it should be administered again for another 3 days.

General period of administration of enema and relation to other purification treatments in terms of time–gap

पक्षाद्विरेको वमिते ततः पक्षान्निरूहणम् ।
सद्यो निरूढश्चान्वास्यः सप्तरात्राद्विरेचितः ॥ ८३ ॥
Virechana should be administered after a fortnight after vamana and kashaya basti should be administered a fortnight after purgation therapy. Anuvasana basti should be administered immediately after kashaya basti but 7 days after virechana.

Simile to explain the mode of action of enema liquid

यथा कुसुम्भादियुतात्तोयाद्रागं हरेत्पटः ।
तथा द्रवीकृताद्देहाद्वस्तिर्निर्हरते मलान् ॥ ८४ ॥
Just as the cloth absorbs the color from the water boiled with kusumbha etc. coloring materials, the enema absorbs the doshas from the moistened body

Importance of enema therapy – Basti Chikitsa Shreshtata

शाखागताः कोष्ठगताश्च रोगा मर्मोर्ध्वसर्वावयवाङ्गजाश्च ।
ये सन्ति तेषां न तु कश्चिदन्यो वायोः परं जन्मनि हेतुरस्ति ॥ ८५ ॥
विट्श्लेष्मपित्तादिमलोच्चयानां विक्षेपसंहारकरः स यस्मात् ।
तस्यातिवृद्धस्य शमाय नान्यद्वस्तेर्विना भेषजमस्ति किञ्चित् ॥ ८६ ॥
तस्माच्चिकित्सार्ध इति प्रदिष्टः कृत्स्ना चिकित्साऽपि च वस्तिरेकैः ।
For all the ailments located in the shakha (extremities, tissues), koshta (alimentary tract, visceral organs) and marma (vital organs), all the organs above the shoulders, there is no other cause more important than vata dosha. Vata is the one responsible for transportation and destruction of the increased faeces, kapha, pitta and other wastes (excreta) of the body.
To balance this intensely increased vata, there is no treatment more efficient other than the enema treatment. Hence it is described as half of the treatment (of all other treatments in the world put together) of all diseases, while some others opine that it is full treatment by itself.

Importance of venesection – Siravyadha pradhanyata

तथा निजागन्तुविकारकारि रक्तौषधत्वेन सिराव्यधोऽपि ॥८९॥
Similarly, Sira Vyadha – venesection treatment is considered to be effective in vitiated blood conditions.

इति श्रीवैद्यपतिसिंहगुप्तप्रसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां सूत्रस्थाने बस्तिविधिर्नामैकोनविंशतितमोऽध्यायः॥१९॥
Thus ends the 19th chapter of Ashtangahridaya Samhita Sutrasthana, named Basti Vidhi Adhyayam, written by Shrimad Vagbhata, son of Shri Vaidyapati Simhagupta.