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Understanding of Basti, An Important Treatment Procedure of Panchkarma

Dr. Usha Rani B. J., Lecturer, A.L.N. Rao Memorial Ayurvedic Medical College, Koppa.
Dr. Nikhil Narayanan, P.G. Scholar, A.L.N. Rao Memorial Ayurvedic Medical College, Koppa.
Dr. Prashant Kumar Jha, Reader, A.L.N. Rao Memorial Ayurvedic Medical College, Koppa.

Introduction:
Basti is one of important procedure practiced in Panchakarma for the treatment of Vata dosha. It is in use since the Veda-period. Kaushik Sutra of Atharvaveda has mentioned this as substitute for minor operation while Agni Purana details this as a principle treatment in complaints predominance with Vayu. Samhitas like Charaka, Sushruta, Ashtanga Sangaraha etc. also well deal with this procedure of Panchakarma.
Basti is derived from “vas nivase” which literally means “shelter”. In Ayurveda basti denotes urinary bladder since it is a pouch where “mutra” or “urine” is given shelter while in panchakarma treatment “basti” is called so as the urinary bladder of animals like goat, sheep, cow, buffalo etc. are used to administer the medicine into the body.
Basti is a treatment whose horizon is not confined to shodhana chikitsa only but, it also brings about different actions in the body like shamana, karshana, lekhana, brihmana, vrishya, varnya, snehana, rasayana, vajikara etc. based on the drugs administered as well the form in which these drugs are administered. In short, it can be said that basti is not just a treatment aimed at particular disease but can be administered to get beneficial results.
Many learned saints emphasize the use of basti chikitsa and exaggerates it as “AMRITA- a potion which makes a person immortal”. Basti is also considered as ‘ardha chikitsa’ because it does the ‘vayu nigrahana’ which is responsible for the movement of any doshas in the body.
Classification:
Basti is been classified into different categories based on various criteria as follows :-
1. Based in Site of Application:
a. Pakwashayagata basti: Administered to pakwasaya through rectum
b. Uttara basti: Administered to mutrashaya/urinary bladder
c. Garbhashayagata basti: Administered to garbhashaya (uterus)
d. Vrana basti: Administered to vranas (injuries/ulcers)
2. Based on Type of Formulation:
a. Kashaya basti/Asthapana basti/Niruha basti
b. Sneha basti/Anuvasana basti/Matra basti
Sneha Basti: On the basis of quantity of oil/ghrita administered, Sneha basti is subdivided as:
· Sneha Basti
· Anuvasana Basti
· Matra Basti
The quantity of Sneha basti is ¼ of the total dose of Niruha Basti i.e., 6 pala. The dose Anuvasana Basti is half of the dose of Sneha basti i.e., 3 pala. The dose of Matra basti is ¼ of the dose of Sneha basti i.e., 1.5 pala. It is also said that the quantity of matra basti is equal to the quantity of hrasva matra of abhyantara sneha.
3. Based on Duration:
a. Karma basti

b. Kala basti
c. Yoga basti
4. Based on Quantity
a. Dwadasha prasruti basti
b. Padaheena basti
c. Pancha prasrutika basti
5. Based on Mode of Action
a. Shodhana basti
b. Shaman basti
c. Brihmana basti
6. Other types
a. Lekhana basti
b. Vaitarana basti
c. Vrishya basti
d. Vajeekarana basti
e. Rasayana basti
f. Varnya basti etc.
                                                                         Anuvasana Basti
Anuvasana basti is a simple but important type of basti, most commonly used in practice. It is used either independently in various vatavyadhi or alternatively with Niruhabasti. The type of basti which remains inside the body for a day without causing any harm or which is administered everyday is called as Anuvasana basti.
Guna Karma:
It is mentioned that srothas are cleansed by the Niruha Basti whereas Snehana imparts vrana and bala. In case of vitiation of Vata, it is claimed that no remedy is more beneficial than the administration of Taila. The number of Basti applied has different actions as:
· 1st Basti does snehana of vankshana
· 2nd Basti pacifies the sirogatavata
· 3rd Basti increases bala and varna
· 4th, 5th, 6th, 7th, 8th, and 9th Basti does snehan of rasa, raktha, mamsa, meda, asthi, majja respectively
· After giving 18 basti, Shukra dhatu gets nourished
Anuvasana Yogya For Anuvasya (Indication): Same as asthapya specially tikshnagni, ruksha, only vatarogarth.
Anuvasana Ayogya Or Ananuvasya (Contraindication): Ansthapya, abhuktha, navajvara, pandu, kamala, prameha, arsa, pratisyaya, arochaka, mandagni, durbala, pliha, kphodara, urusthambha, visapitta, garpitta, kapharoga, abisyandha, gurukosta, slipadha, galaganda, apach, krimikosta, pinasa, kusta, sthaulya.
Consideration before Anuvasana Basti:
Dosha: Contraindicated in samadosha, vridhakapha, uthklistadosha
Kala:
· In vata, pitta dosha and season of sharad, varsa, grishma: Night time
· In kapha dosha and season of sheeta, vasantha: Day time.

Dose: According to Charaka, dose is 1/4th of Niruhabasti, while commenting upon matrabasti chakrapani has des-
cribed that the snehan basti contains 6 pala of sneha, anuvasana contains 3 pala of sneha and matrabasti contains 1.5 pala of sneha. Dalhana also commented the same.
Procedure of Anuvasana Basti:
Purva Karma:
1. Sambhara Sangraha: Bastiyantra, saindhava lavana, kalka, sneha etc. as per the disease should be procured.
2. Rogi Pareeksha:
· Assessing patient for yogya and ayogya
· Assessment Of rogibala and doshabala by dasavidhapariksha
· Doshadipariksha
3. Preparation of Snehabasti: Required quantity of sneha is taken and saindhava lavana and kalka are added together and they are triturated well until the mixture turns homogenous. It is then heated indirectly in to lukewarm. Later the sneha is filled up in basti putaka and netra is attached and is tied well. These days glycerin syringe is commonly used to administer sneha basti than the putaka.
4. Athursiddhanta:
· Laghu bhojana which is na ati snigdha, na ati rooksha and is of ushna veerya
· Chankramana or walking 100 steps
· Sthanika abhyanga and sweda (mridu)
Pradhana Karma: Anuvasana Basti is given after meal when the patient is having aardra-pani (wet hands). Here ardra paani denotes time immediately after taking meal. According to Charaka Chi. 3/28, the procedure of administration is same as that of Niruha basti except some modifications, which are as follows:
· After giving basti, gluteal region is gently stroked with palm
· Both lower limbs are lifted for 3 times
· Mardana of soles and palms is done
· Abyanga over the painful areas is done
Paschata Karma:
· Basti pratyagamana (expulsion of Basti): Unlike niruha basti the anuvasana dravya doesn’t or should not come out in less time since purpose will not be served. Basti is desired to remain in the body for 3 yamas i.e., 12 hours. If the basti dravya is expelled out immediately another dose of anuvasana basti should be given. Incase basti remains inside body for more than 12 hours, then it has to be observed for next 12 hours; development of complication calls for introduction of phalavarti or teekshna niruha basti to remove anuvasana dravya. If with no complications occur then has to be ignored.
Pathya and anya basti vichara (diet and planning of other Basti):
1. Yusha, mamsaras etc. should be given
2. Usnajala or dhanyanagarasiddha jala for drinking
3. If severe vata prakopa then, anuvasna should be given on the same day evening
4. If moderate vataprakopa, anuvasna should be given on alternate days
5. In case of kaphaprakopa on 3rd or 5th day anuvasana should be given
6. If niruhabasti is to be given, then it should be given on the next day

Samyakyoga, ayoga, atiyoga lakshana
Samyakyoga
1. Administered drug comes out along with the faeces
2. Nourishment of raktadi dhatus
3. Clarity in senses
4. Sound sleep
5. Lightness, healthy feeling
6. Proper elimination of the excretory urges
Ayoga
1. Excruciating pain in abdomen, arms, vertebral region and flanks
2. Dryness and coarseness in the body
3. Retention of the urges like urine, flatus and faeces
Atiyoga
1. Nausea
2. Delusion
3. Fatigue
4. Malaise
5. Unconsciousness
6. Cutting pain in rectum
Sneha Basti vyapat and chikitsa (Complications of Sneha Basti and their treatments): Ch.Chi 4/25 deals with complications of Sneha basti and their treatments. It is mentioned that they arise due to avarana of sneha due to vata, pitta, kapha, or by excess of mala or food. They may be of various types and accordingly, they are treated.
Vatavrutha Sneha: If the administered sneha is cold and is administered when the person is affected with vata dosha, the sneha gets obstructed by vata dosha causing retention of vata and manifests symptoms like angamarda, jwara, aadhmana, stambha, sheeta and pain in thighs.
Treatment: Niruha basti with snigdha, amla, lavana, ushna drugs should be given. They are prepared by sauviraka, surakola, kulatha, yava, gomutra, brihat panchamula kvatha and rasanataila. At evening anuvasanbasti should be given with rasana and pitadru taila after taking meal.
Pittavrutha Sneha: If excessive Ushna basti is given in the condition of excess pitta, it produces Daha, raga, trshna, mohatamaka, jvara.
Treatment: Niruha basti prepared with madhura and tikta dravya should be given.
Kaphavrutha Sneha: If mridu basti is given in condition of excess kapha, it causes tandra, sheeta jvara, alasya, praseka, aruchi etc.
Treatment: Niruha basti made by kashaya, katu, tikshna, ushna dravya with sura, gomutra and phala taila.
Annavritha Sneha: If the basti dravya is guru or given after heavy meals, it causes annavrita sneha vyapat and develops symptoms chhardi, murchha, aruchi, glani, sula, nidra, angamarda, aamalakshana with daha.
Treatment:This condition should be treated by stimulating digestion with decoction and powders of katu and lavana dravya.

Basti is an amazing way of administration of required drugs normally through rectal administration. It provides rapid and extensive absorption of the active ingredient. The body is well prepared before Basti administration with abhyanga (massage) and swedana (sudation). These purva karma processes prepare our muscles of specific region around the application as pelvic, hip, duodenum etc. to get ready and for better response. Exactly in Basti, rectal administration of various medicines depending upon the desired result of specific problems is done. The type of Basti and medicine used in those Basti changes with the purpose.
We know that the rectum consists of the last few inches of the large intestine, terminating at the anus and the wall of gastro-intestinal tract is composed of mucosa, submucosa, tunica muscularis and the visceral peritoneum. The rectal dosage forms are usually applied in region of mucous membrane of the rectum. This portion is made up of a layer of cylindrical epithelial cells and villi of intestines are absent here. Other than that the rectum is having three types of hemorrhoidal veins as superior hemorrhoidal vein, middle hemorrhoidal vein and inferior hemorrhoidal vein. These three hemorrhoidal veins form anastomosis network. They transport the absorbed constituents of drugs to blood system. Such transportation may occur either by means of iliac veins and the vena cava (inferior and middle hemorrhoidal veins) or by means of the portal vein and the liver (superior hemorrhoidal vein).
As the exact location of application in rectum is not predicted, transportation of active constituents may be by one pathway or another or in combination. It is general acceptance that 50-70% of ingredients are absorbed directly. Chances of absorption through lymphatic vessels are also possible as abundant vascularization of the submucosal region of the rectum wall with blood and lymphatic vessels is there. In both these cases the administered drugs will bypass the liver. There are various factors inheriting with drugs which may affect the absorption of drugs as:
1. Physical state and particle size of drugs
2. Nature and form of active constituents (as fatty acid, esters etc.)
3. Type of solution used to dissolve the constituents (vehicle)
4. Type of dosage forms
5. Viscosity: As higher the viscosity, slower is release of drugs
6. Stability of drugs
7. Specific gravity of drug (solution)
8. Temperature of dosage forms etc.
There are following advantages of rectal administration of drugs as:

Advantages to Rectal Administration:
The advantages to rectal administration include the following:
1. Non-required breakdown of drugs with gastric degradation can be avoided.
2. First pass metabolism of oral administration is quashed.
3. Unpleasant (taste and smell) drugs can be administered.
4. Irritating drugs can be administered.
5. Large quantity of drugs can be administered.
6. In terminal care, it is better.
7. pH of drugs: As the rectal fluids are having pH 7-8 and have negligible buffer capacity, hence the chances of chemical change in formulation or substance given as drug will not change by rectal environment.

Some Common Uses:
However specific type of Basti is suggested in specific alteration or for desired expected effect and ingredients used for that particular type of formulation in these individual cases also changes. But commonly overall uses of Basti application can be summarized as:
1. All intestinal and abdominal disturbances
2. Rheumatic problems like joint problems, chronic back pain etc.
3. Skin diseases like eczema, chronic neurodermatitis etc.
4. Neurological disorders like migraine, depression etc.
5. Immune deficiency
6. Lungs diseases etc.

Probable Mode of Action:
Different types of Basti involve different components and mechanisms for application. Accordingly, they carry the components which perform the desired action, once they are absorbed through the mucosa of colon or by other path of action like by causing irritation etc. to specific parts of body. As in case of Shodhana Basti, kwath of Amaltas, Trivrit, Dantimoola, Dantibeeja etc. are applied to cure the abdominal disorders. Amaltas pulp is having anthraquinone glycoside. With rectal administration anthraquinone glycosides are hydrolyzed by bacteria to release free anthraquinone. This helps to increase the peristalsis movement and thus in evacuation of feces. Excessive dose may bring colon discomfort by excessive loss of water and potassium salt. Trrivrit and Dantimoola are rich in resin contents and these resins are irritant to mucosa of colon and by this, they cause more movement, which brings eva-cuation. Similarly other mode of actions is applied with change in selection of drugs for this type of Basti. Combination of two or more of the mentioned drugs causes two or more paths of actions of these compounds.
Yavakshar, kwath or kalka of Maricha etc. katu drugs are used in Lekhana Basti along with gomutra and honey. Yavakshar and gomutra are rich in potassium and sodium salts while katu drugs are rich in terpene derivatives. The transport mechanism for sodium absorption is located on the luminal surface of the epithelial cells. An electrogenic sodium-specific channel in the distal colon and rectum is responsible for passive diffusion of sodium in to colonic epithelial cells along an electrochemical gradient. To avoid hypontremia, potassium salts are present with mentioned drugs which are coupled to exchange channels. This stimulates Na+/K+ ATPase pump on the basolateral membrane of the epithelial cell. Three sodium ions are expelled in exchange for two potassium ions. Aldosterone, a mineralocorticoid secreted by the adrenal gland in response to sodium depletion and dehydration, enhances fluid and sodium absorption in the colon. The absorption of sodium is further promoted by somatostatin, a2-adrenergic agents (e.g., clonidine), and the short-chain fatty acids. These ionic movement causes to enter more protein soluble contents and terpene derivatives of katu drugs in blood. They get attached with low density protein and make a complex and then it is resent to liver.Then endogenous triglyceride mainly synthesised in the liver is transported to peripheral tissues. The triglyceride is hydrolysed in the peripheral tissues by lipoprotein lipase, which is activated by apolipoprotein CII present in the lipoproteins. In Karshana Basti, Triphala is used. They are rich in tannin and its derivatives. They are not only precursor of various flavonoids (adaptogenic agents) but have also ability to combine with protein and fatty acids and by this way, they do the karshana.
Snehan drugs as oil, ghrita etc. are used in Snehan Basti for soothening effect in body. In the mucosal cells of colon, long-chain fatty acids are resynthesized by an ATP-dependent ligase to form acyl-CoA and then triacylglycerols. Then these fatty acids are released into the lymph in the form of chylomicrons and bypassing the liver, they are deposited in thoracic duct. In case of short chain fatty acids, they are absorbed and pass directly in to blood and reach the liver via the portal vein. This makes the smoothening of related part of body and thus strengthening. If these fatty acids carry other ingredients as stimulating metabolites (specific alkaloids, glycosides etc.), they perform the similar action like tone of related muscles etc. In all cases, they ultimately increase the working of related organs as in case of Brihan or Rasayan Basti, such component drugs as Shatavari, Ashwagandha etc. are included. In case of Kshirpaka, components soluble in water as well as fatty acids, both are brought to use for the expected purpose. If more pungent drugs or drugs which may cause the vasodilation are used in specific Basti, Vajeekaran action can be performed.
Hence, we find that Basti is purely scientific and logical process. An effort to understand the mode of action of few of them is made here in brief, however, it keeps option open for better understanding of these with more and pure pharmacological study. Application of Basti must be done with strict following of classical texts. Complications are suggested in these books and they must be handled accordingly.

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