पञ्चकर्म Part B

पञ्चकर्म
PART B
CHAPTER VI: basti karma
 Introduction
 Nirukti:
The word Basti is derived from the root Vas.
Vas = To dwell, inhabit, stay, reside
Basti karma is the therapeutic procedure in which Auṣadha Dravya is administered

and stays inside the body for a certain period of time until it gets discharged.
Basti as an organ is the structure in which Mūtra is collected and resides until it
gets discharged. It is situated below the Nābhī.
Traditionally, Basti of animals was used as Bastipuṭaka for the purpose of
administering Basti Auṣadha Dravya.
 Paribhāṣā:
नाभिप्रदेशं कभिपार्श्मकुभषं गत्वा शकृ द्दोषचयं भवलोड्य ॥ ४० ॥
सस्ं नेह्य कायं सपरु ीषदोषः सम्यक् सख
ु ने ैभि कृ िः स बभस्िः । (च - भस - १)
Basti karma is the therapeutic procedure in which Basti Dravya moves in Nābhī
pradesha, Kaṭi, Pārshva and Kukṣi, churns up the Shakṛt and other impurities which
are located in these areas, appropriately eliminates them, and provides Snehana to
the body.
 Mahatva:
Basti karma is the best treatment for the alleviation of Vāta Doṣa.
Vāta is responsible for manifestation of all diseases originating in Shākhā, Koṣṭha,
Marma, Ūrdhajatru pradesha, Sarva Avayava and Aṅga.
Vāta is responsible for Vikṣepa (separation/scattering) and Saṅghatā (compactess)
of Vit, Mūtra, Pitta, etc., including Dhātu.
When it gets highly aggravated, there is no better remedy than Basti karma.
Therefore, Basti is considered as Ardha Chikitsā. Some even consider it as Sarva
Chikitsā. Similarily, Sirāvyadha has the same importance in Shalyatantra.
Vāta Doṣa has greater importance compared to Pitta and Kapha. The other
Doṣa depend on Vāta for performing their functions. There are 80 Roga described
which are only due to Vāta Doṣa, whereas only 40 due to Pitta, and 20 due to
Kapha. Additionally, Vāta Doṣa is Yogavaha and can therefore easier worsen the
diseases which are predominant in Pitta or Kapha Doṣa.
Because of its Chala Guṇa, Vāta is responsible for all movements in the body, but it
can also get easily disturbed.
Therefore, Basti karma has great importance in management of diseases,
specifically if Vāta is predominantly involved.
Basti is superior among all therapies because it can be prepared with a wide
variety of combinations of Auṣadha Dravya. It produces Saṁshodhana,
Saṁshamana and Saṁgrahaṇa of Doṣa. It causes Vājīkaraṇa in case of Shukrakṣīṇa,
Bṛṁhana in case of Kṛsha, Karshana in case of Sthaulya. It promotes Cakṣu,
prevents and removes Valī (wrinkles) and Palita (grey hair), and is Vayaḥ Sthāpana.
If Basti is properly administered, it provides Sharīropachaya, Varṇa, Bala, Ārogya
and Āyuṣa.
Basti is the most important therapy because it destroys diseases by cleansing the
Srotas, and increases Oja, Teja, Shukra, Agni and Medhā.
 Basti Yantra
1) Traditional Basti Yantra
The traditional Basti Yantra conists of Bastinetra and Bastipuṭaka.
a) Bastinetra:
Bastinetra (nozzle) should be made from metals like Suvarṇa, Rūpya,
Vaṅga, Tāmra, Kāṁsya, Asthi, Veṇu, etc., It should be tapering like a
cow’s tail, without pores on the sides (achidra), smooth (Shlakṣṇa),
straight (Ṛju) and have a rounded tip.
The diameter at the root should be equal to the patient’s thumb, and the
diameter at the tip should be equal to the patient’s little finger.
A ridge should be made towards the tip, leaving a distance equal to the
diameter of Mūlachidra from the tip. The orifice at the tip should be
plugged, using a Varti (a piece of cloth). At the base, there should be two
ridges, with a distance of 2 aṅgula in between.
Age Length (aṅgula)

<1 5
1-6 6
12 8
20 12
Between age 6-12, every year, length of Bastinetra is increased by 1/3.
Between age 12-20, every year, length of Bastinetra is increased by 1/2.
b) Bastipuṭaka / Bastikosha:
Basti (urinary bladder) of Aja, Āvi, Mahiṣa, etc. The selected Basti should
be devoid of pores or tears, nodules, foul smell and blood vessels. It
should be brownish-red (Kaṣāyarakta), thin, strong, and softened (by
twirling after soaking in water). It should be cleaned by keeping and
washing it with Triphalā Kvātha. Basti is squeezed to remove air, filled
with Auṣadha Basti Dravya and fastened tightly with a thread in between
the ridges at the base.
If Basti of animals is not available, leather or a thick cloth may be used

instead.
2) Alternative Basti Yantra
Nowadays, alternative instruments are used for administration of Basti karma.
a) Bastinetra
Instead of the traditional Bastinetra, rubber catheter is used. It can be
easily attached to the nozzle of enema pot or syringe. It can easily be
sterilized before use and safely disposed after use. It is available in
various sizes and the chance of occurrence of Bastinetra Doṣa is less.
The rubber catheter is soft compared to the traditionally used materials
like gold, silver, copper, etc. Therefore, injury to Guda is less likely.
b) Bastipuṭaka
Instead of the traditional Bastipuṭaka, enema can/pot, enema syringe,
modified plastic/rubber bag are used. These instruments are easily
available in various sizes, can easily be stored, cleaned and reused.
The traditional described Bastipuṭaka Doṣa do not occur.
The enema can/pot with capacity of 1200 ml is commonly used for

administering Nirūha Basti as it can hold larger quantity of Basti Dravya.
Enema can is attached with a plastic tube. A nozzle is inserted into the
other end which will be fitted with the rubber catheter.
It does not require manual compression as the enema can is kept at a
higher level and Basti Dravya flows due to the gravitational force.
Enema syringe is commonly used for administering Sneha Basti.

Sneha Basti does not require as much quantity of Basti Dravya as for
Nirūha Basti. Hence, enema syringe is preferably used because it is even
easier to handle than enema can.
 Bastinetra, Bastipuṭaka & Praṇetṛta Doṣa
1) Bastinetra Doṣa: - 8
ह्रस्वदीर्मिनुस्थूलजीर्मभशभथलबन्धनर्् ।
पार्श्मभछिद्रं िथा वक्रर्ष्टौनेत्राभर्वजमयेि् ॥ ४ ॥ (च - भस - ५)
Bastinetra Doṣa Nozzle Defect Upadrava
1) Hrasva Too short Aprāpti (enema fluid does not reach its destination)
2) Dīrgha Too long Atigati (enema fluid penetrates too far)
3) Tanu Too thin Kṣobha (irritation due to instability)
4) Sthūla Too thick Karṣaṇa (bruising of rectal wall)
5) Jīrṇa Too old Kṣaṇana (injury of rectal wall)
6) Shithila Bandhana Loosely tied Srava (leaking of enema fluid)
7) Pārshva Chidra Hole at the side Gudapīḍā (pain in rectum)
8) Vakra Curved Jihmā Gati (slow/false/crooked movement of enema fluid)
2) Bastipuṭaka Doṣa: - 8
भवषर्र्ासं लभछिन्नस्थूलजाभलकवािलाः ।
भस्नग्धः भललन्नश्चिानष्टौबस्िीन्कर्मसुवजमयेि् ॥ ६ ॥ (च - भस - ५)
Bastipuṭaka Doṣa Bladder Defect Upadrava
1) Viṣama Irregular formed Gati Vaiṣamya (irregular flow of enema fluid)
2) Māṁsala Fleshy/Bulky Visratva/Āmagandhā (makes enema fluid smell fleshy)
3) Chinna Perforated/Cut/Torn Srava (leaking of enema fluid)
4) Sthūla Too thick Daurgrāhya (difficult to handle/use)
5) Jālika Having many pores Nisrava (exudation of enema fluid from the bladder)
6) Vātala Containing air Phenilatva (frothiness of enema fluid)
7) Snigdha Oily/Greasy/Slippery Chyuti (slipping while use)
8) Klinna Putrefied/Rotten Adhāryatva (inability to hold the bladder; inability of
the bladder to hold the enema fluid)
3) Praṇetṛta Doṣa: - 10 (Defects during administration of Basti)
सवािाभिद्रुिोभत्षप्तभियमगुल्लप्तु कभम्पिाः ।
अभिबाह्यगर्न्दाभिवेगदोषाः प्रर्ेििृ ः ॥ ८ ॥ (च - भस - ५)
Praṇetṛta Doṣa Administration Defect Upadrava Chikitsā

1) Savāta Bladder filled with Vāta duṣṭi, Shūla, Toda Abhyaṅga & Svedana in
air/enema fluid with Gudapresha,
air bubbles Vātashāmaka Āhāra
2) Atidruta Fast insertion of Kaṭi-Guda-Jaṅgha Arti Vātashāmaka Āhāra,
Bastinetra Sneha, Svedana, Basti
3) Utkṣipta Upward insertion of Same as Atidruta Same as Atidruta
Bastinetra
4) Tiryak Oblique/Sideward Obstruction of Withdrawal of
insertion of Bastinetra Bastinetra opening Bastinetra, and
reintroduction in proper
direction
5) Ullupta Fast removal of Same as Atidruta Same as Atidruta
Bastinetra
6) Kampita Trembling/shaking Dāha, Davathu, Shopha; Seka and Basti with
while inserting or obstruction of Vāta Kaṣāya and Madhura
removing Bastinetra; Doṣa, leading to Uraḥ- Dravya; Auṣadha should
or interrupted Shirorti, Ūru sadana be Shīta
compression of
Bastipuṭaka
7) Ati Excessive introduction Injury to Gudavali, Arti, Pichu with Sarpi, Kṣīra
of Bastinetra Dāha, Nistoda, Picchā Basti
Gudabhraṁsha, Varcha
pravartana
8) Bāhyaga Insufficient or non- Auṣadha is expelled Sneha Basti
insertion of Bastinetra faster and therefore will
not be effective.
9) Mandavega Too slow compression Auṣadha does not reach Sneha Basti
of Bastipuṭaka Pakvāshaya and
therefore will not be
effective.
10) Ativega Too fast compression Auṣadha stays in Koṣṭha Basti, Virechana,
of Bastipuṭaka or ascends up to Gala. Stambhana,
Chardinigrahaṇa,
compression of Kaṇṭha
 Basti Vargīkaraṇa
A) On the basis of administration procedure:
1) Nirūha / Asthāpana Basti
2) Sneha / Anuvāsana Basti
3) Uttara Basti
B) On the basis of administration site:

1) Pakvāshayagata Basti (administered in male or female through anal route)
a) Sneha Basti (Uttama, Madhyama, Hrasva Mātrā)
b) Nirūha Basti (Prasṛta Basti, Kṣīra Basti, Gomūtra Basti, Yāpana Basti,
Mādhutailika Basti, etc.)
2) Mūtrāshayagata Basti
(Uttara Basti administered in male or female through urethral route)
3) Garbhāshayagata Basti
(Uttara Basti adminsitered in female through vaginal route into uterus)
4) Vraṇa Basti
(Vraṇa pūraṇa with Kaṣāya for Shodhana and Ropana)
C) On the basis of administration schedule:

1) Karma Basti (30-day schedule = 1S + 12S & 12N alternately + 5S)
2) Kāla Basti (16-day schedule = 1S + 6S & 6N alternately + 3S)
3) Yoga Basti (8-day schedule = 1S + 3N & 3S alternately + 1S)
S = Sneha Basti
N = Nirūha Basti
D) Miscellaneous Classifications:
1) Uṣṇa Basti
2) Shīta Basti
1) Mṛdu Basti
2) Madhyama Basti
3) Tīkṣṇa Basti
1) Madhura Rasa Skandha Dravya Basti

2) Amla Rasa Skandha Dravya Basti
3) Lavaṇa Rasa Skandha Dravya Basti
4) Kaṭu Rasa Skandha Dravya Basti
5) Tikta Rasa Skandha Dravya Basti
6) Kaṣāya Rasa Skandha Dravya Basti
 General Precautions:
- Neither Nirūha Basti nor Anuvāsana Basti should be given continuously in excess.
Continuous Nirūha Basti casues Vāta prakopa.
Continuous Sneha Basti causes Doṣa Utklesha and Agnimāndya.
Thus, Nirūha and Sneha Basti should be given alternately. By administering these
therapies appropriately, even diseases due to Tridoṣa can be cured.
- Unprocessed Sneha Dravya should not be used for Anuvāsana Basti as it produces
Abhishyanda in Guda pradesha.
- Administration of Snehapāna and Sneha Basti should not be done simultaneously
as it vitiates Vāta and Agni.
- Uṣṇa Basti should be given in case of Roga due to Shīta Guṇa. It contains Uṣṇa
Vīrya Dravya and the Basti Drava Dravya should be warm.
Shīta Basti should be given in case of Roga due to Uṣṇā Guṇa. It contains Shīta Vīrya
Dravya and the Basti Drava Dravya should not be much warm.
Basti Auṣadha should always contain ingredients having attributes opposite to that
of the etiological factors of the disease.
- The interval between two courses of any Basti should be double the period
required for administration of that therapy.
- Apathya Vihāra during the course of Pañchakarma:

अत्यासनस्थानवचाभं स यानं स्वप्नं भदवा र्ैथुनवेगरोधान् ॥ ५४ ॥
शीिोपचारािपशोकरोषास्ं त्यजेदकालाभिििोजनं च । (च - भस - १)
 Dvadasha Basti Pranidhāna Doṣa:
1) If Bastinetra is inserted obliquely, then the Basti Dravya will not flow into Guda
because its opening will be obstructed.
2) If Bastinetra is shifted from one place to the other, it may lead to injury.
3) If Bastipuṭaka is compressed too slowly, the Basti Dravya may not reach the
proper place; Nābhī, Kaṭi, Pārshva, Kukṣi.
4) If Bastipuṭaka is compressed too strongly, the Basti Dravya may reach even up
to the throat.
5) If Basti Dravya is Atishīta, it may cause Deha Stambha.
6) If Basti Dravya is Atyuṣṇa, it may cause Dāha and Mūrcchā.
7) If Basti Dravya is Atisnigdha, it may cause Jāḍyatā (numbness) in the body.
8) If Basti Dravya is Atirūkṣa, it may cause Vāyu prakopa.
9) If Basti Dravya is Tanu (thin) or contains low quantity of Lavaṇa, it may lead to
Ayoga Lakṣaṇa.
10) If Basti Dravya is administered in Atimātrā, it may lead to Atiyoga Lakṣaṇa.
11) If Basti Dravya is Sāndra (viscid), it moves very slowly inside the patient and
may cause emaciation.
12) If Basti Dravya contains excessive Lavaṇa, it may cause Dāha and Atisāra.
 Karmukta:
Basti karma is the therapeutic procedure in which Basti Dravya moves in Nābhī
pradesha, Kaṭi, Pārshva and Kukṣi, churns up the Shakṛt and other impurities which
are located in these areas, appropriately eliminates them, and provides Snehana to
the body. After providing Snehana, Basti Dravya spreads throughout the body and
eliminates waste products, vitiated Doṣa and nourished the body.
If properly administered, Basti remains in Pakvāshaya, Shroṇi and Nābhī Adha; the
potency of Basti spreads through Srotas over the whole body. It draws the Doṣa
from head to foot and expels them.
The Basti Dravya is a combination of various medicinal drugs including Sneha,

Madhu, Lavaṇa, Kalka, Kvātha, etc.
Sneha: It lubricates the colon, softens the faecal material and helps to eliminate
them without strain. The oil helps in protecting the intestinal mucosa from
irritating substances, thus helping an easy and smooth elimination of Basti Dravya
and waste material without causing wear and tear to mucosa. Adding Sneha with
decoction aims to provide a dual base of the preparation for trans-mucosal and
intercellular absorption.
Madhu & Lavaṇa:

Honey is composed primarily of fructose and glucose but also contains 4-5%
fructooligosaccharides which serve as prebiotic agents. It contains more than 180
substances, including amino acids, vitamins, minerals and enzymes. Honey has
simulative effect on colonic probiotic bacteria. It is involved in formation as well as
inactivation of carcinogens in the gut lumen and may be altered in a positive way
by the presence of colonic probiotic bacteria.
Honey is a natural emulsifying agent which helps in binding the liquids together.
The antitoxic effect of honey neutralizes hydrogen peroxide which is found
extensively in mammalian tissues.
Fatty acids present in honey stimulate peristaltic digestion. Honey along with salts
makes a homogenous mixture to form a solution having properties to permeable
the water easily thus absorbing quickly and acting as an instant energizer. Honey
has hygroscopic properties which promote healing of tissue. Honey and salt also
have Chedana karma, specifically for Kapha, and therefore help in disintegration
and expulsion of waste material.
Kalka: It also helps to disintegrate waste material. It increases osmotic permeability

of the solution. It helps in retention of Basti Dravya; if too little Kalka is in the Basti
Dravya, it becomes too liquid and gets expelled quickly. The specific action of Kalka
depends on the Dravya which are used to prepare it.
Kvātha: This is the main ingredient of Nirūha Basti Dravya. The drugs used for
decoction are mainly according to disease and stage of disease. It brings
homogeneousity to the mixture.
 Nirūha Basti
 Nirukti:
स दोषभनिमरर्ाछिरीरनीरोिर्ाद्वा भनरूिः
वयःस्थापनादायुःस्थापनाद्वा आस्थापनर्् । (सु - भच - ३५)
It is called Nirūha because it expels Doṣa and relieves the body from diseases.
It is called Āsthāpana because it prevents aging and support/prolongs the lifespan.
It is called Kaṣāya Basti because decoction is the main ingredient of Nirūha Dravya.
 Paribhāṣā:
The Basti karma which eliminates the vitiated Doṣa from the body and increases
strength of the body is called Nirūha Basti.
 Paryāya: Nirūha Basti, Nairūhika Basti, Āsthāpana Basti, Kaṣāya Basti
 Bheda:
- Mādhutailika Basti is a form of Āsthāpana Basti. It is also known as Yāpana Basti,
Siddha Basti or Yuktaratha Basti.
- Depending upon the therapeutic effect of Nirūha Basti, it is named differently:

1) Vātahara Basti
2) Pittahara Basti
3) Kaphahara Basti
4) Shoṇita Doṣahara Basti
5) Doṣa Saṁsargahara Basti
6) Utkleshana Basti
7) Shodhana Basti
8) Shamana Basti
9) Doṣahara Basti
- Depending upon specific indication of Nirūha Basti, it is named differently:

1) Pramehahara Basti
2) Visarpahara Basti
3) Raktapittahara Basti
4) Kuṣṭhahara Basti
5) Vātaraktahara Basti
6) Gulmahara Basti
7) Abhiṣyandahara Basti
8) Kṛmihara Basti
9) Dāhahara Basti
10) Mūtrakṛcchrahara Basti
11) Parikartikāhara Basti
- Depending upon the basis of main Dravya of Nirūha Basti, it is named differently:
1) Kṣīra Basti
2) Māṁsarasa Basti
3) Gomūtra Basti
4) Rakta Basti
5) Kṣāra Basti
6) Dadhimastu Basti
7) Amlakāñjī Basti
8) Surākṛta Basti
9) Āsavakṛta Basti
- Depending upon the dose of Nirūha Basti, it is named differently:

1) Chatu Prasṛta Basti
2) Pañcha Prasṛta Basti
3) Shad Prasṛta Basti
4) Sapta Prasṛta Basti
5) Aṣṭa Prasṛta Basti
6) Nava Prasṛta Basti
7) Ekadasha Prasṛta Basti
8) Dvadasha Prasṛta Basti
 Yogya:
- Vātavyādhi, Daruṇa Anila Roga, Sarvāṅga roga, Ekāṅga roga, Kukṣi roga, Bala
kṣaya, Varṇa kṣaya, Māṁsa kṣaya, Retasa kṣaya, Aṅga supti, Kṛmikoṣṭha, Udāvarta,
Parvabheda, Abhitāpa, Gulma, Ānāha, Khuḍa, Plīhāroga, Shuddhātisāra, Shūla,
Shiroshūla, Karṇashūla, Jīrṇa Jvara, Pratishyāya, Hṛdroga, Hṛdaya graha, Pārshva
graha, Pṛṣṭha graha, Kaṭi graha, Shukra graha, Anila/Adhovāta graha, Mala graha,
Vṛddhi, Ashmarī, Rajonāsha, Vepana, Ākṣepaka, Gaurava, Atilāghava, Viṣamāgni,
Bhagandara, Parikartika, Unmāda
- Alpālpa Uttana (frequent evacuation of stool in small quantity)
Sashabdha Utthāna, Ugragandha Utthāna
- Shūla Shoṣa Stambha located in Sphika, Jānu, Jaṅgha, Uru, Gulpha, Pārṣṇi, Pada,
Yoni, Bahu, Aṅguli, Stana, Danta, Nakha, Parva, Asthi
 Ayogya:
- Saṁshudda (who has undergone Shodhana; Vamana & Virechana),
Datta-Nāvana (who has undergone Nasya), Bhukta (who has just eaten a meal),
Pītodaka (who has just drunk water)
- Ajīrṇa, Atisnigdha, Pīta Sneha, Utkliṣṭa Doṣa, Alpāgni, Yānaklānta (exhaustion due
to travelling), Krodha, Bhaya, Mūrcchita, Atidurbala, Kṣudha, Tṛṣṇā
- Atikṛsha, Uraḥkṣata, Āmātisāra, Chardi, Shvāsa, Kāsa, Hikkā, Niṣṭhīvikā, Praseka,
Arsha, Ādhmāna, Agnimāndya, Baddhodara, Chidrodara, Udakodara, Kuṣṭha,
Madhumeha, Alasaka, Visūchikā
- Āmaprajātā (premature birth), Garbhinī (up to 7th month)
 Lābha:
बभस्िवमयः स्थापभयिा सुखायुबमलाभग्नर्ेधास्वरवर्मकृछच ।
सवामथमकारी भशशवु द्धृ यनू ां भनरत्ययः सवमगदापिश्च ॥ २७ ॥
भवि्लेष्र्भपत्ताभनलर्ूत्रकषी दार््मयाविः शुक्रबलप्रदश्च ।
भवर्श्भलस्थिं दोषचयं भनरस्य सवामन् भवकारान् शर्येभन्नरूिः ॥ २८ ॥ (च - भस - १)
 Mātrā:
1 Pala = 48 ml
1 Prasṛta = 96 ml
Age Mātrā
1 ½ Prasṛta / 1 Pala
6 3 Prasṛta / 6 Pala
Nirūha Basti Dravya Mātrā is increased by ½ Prasṛta / 1 Pala each year from age 1-12.
Nirūha Basti Dravya Mātra is increased by 1 Prasṛta / 2 Pala each year from age 13-18.
12 Prasṛta / 24 Pala is the maximum quantity of Nirūha Basti, which generally should be used
for the age group of 18-70 years.Above 70 years, Nirūha Basti Mātrā should be 20 Pala.
 Contents and Method of preparation of Nirūha Basti Dravya:

Madhu & Saindhava Lavaṇa should be mixed in Khalva Yantra till Saindhava is
dissolved. Then Sneha, Kalka, Avāpa and Kvātha are added in successive order while
continuously churning the Dravya. The homogenous mixture should be slightly
warmed before administration.
General quantity of Nirūha Basti ingredients:

Ingredients Vāta Roga Pitta Roga / Svastha Kapha Roga
Saindhava Lavaṇa 1 kola 1 kola 1 kola
Madhu ½ prasṛta 2 prasṛta 3 prasṛta
Avāpa 1 ½ prasṛta 2 prasṛta 1 ½ prasṛta
Sneha 3 prasṛta 2 prasṛta 1 ½ prasṛta
Kalka 1 prasṛta 1 prasṛta 1 prasṛta
Kvātha 5 prasṛta 5 prasṛta 5 prasṛta
--- 12 prasṛta 12 prasṛta 12 prasṛta
 Āsthāpanopaga Mahākaṣāya:
Trivṛt, Bilva, Pippalī, Kuṣṭha, Sarṣapa, Vachā, Kuṭaja phala, Shatapuṣpā, Madhuka,
Madanaphala
 Vidhi:
1) Pūrvakarma
- Sneha Basti on the previous day is generally indicated before Nirūha Basti
- Abhyaṅga & Svedana on the day just before Nirūha Basti procedure
- Preparation of Nirūha Basti Dravya
- Preparation of Bastinetra (rubber catheter) & Bastipuṭaka (enema can)
2) Pradhānakarma
- The client is made to lie down on the table in the left lateral position, with
the left leg extended and the right leg flexed at the hip and knee. The buttocks
and anal region should be exposed.
- The anal orifice of the client is smeared with with the help of a cotton swab.
The tip of the rubber catheter is also lubricated.
- The therapist should hold the enema can with Basti Dravya in the left hand,
while keeping the rubber catheter in the right. The catheter should be bent to
prevent leakage of Basti Dravya.
- Then the rubber catheter is gently inserted into Guda in the direction of Pṛṣṭa
Vaṁsha (vertebral column). While inserting, hands should be steady, and it
should neither be done too fast nor too slow.
- Then the Bastipuṭaka is elevated, and rubber catheter is straightened. Thus,
the Basti Dravya can easily flow by the gravitational force. A little quantity of
Basti Dravya should remain in Bastipuṭaka to prevent Vāta from entering.
If during the administration of Basti Dravya, the patient gets the urge to pass
feaces and flatus, the Bastinetra should be removed and one should wait till
the urge has passed. Then the remaining Auṣadha should be administered.
The rubber catheter is again removed and bent.
- After removal, the buttock of the patient should gently be struck. The patient
should turn to supine position. After some time, he/she should turn to left
lateral, prone and right lateral positions respectively.
Afterwards, the patient should lie again in supine position while keeping the
lower part of the body elevated to retain the Basti Dravya and allow it to
spread. In this position, the patient is asked to rub the palms against each
other, while at the same time the therapist rubs the sole of the patient
vigorously. Further, the therapist should flex and extend the client’s legs at the
hip and knee for several times. Then the patient is asked to raise the legs by
flexing the hip several times.
3) Pashchātkarma
When the urge of defecation is strongly manifested, the patient is allowed to
expulse the medicine.
Pratyāgamana Kāla
In most cases, Nirūha Basti Dravya is expelled within a few minutes after
administration. Preferably, Auṣadha should be retained for about 7-15
minutes.
If evacuation does not occur even after 48 minutes, it becomes harmful.
Following measures should be adopted:
- Administration of Tīkṣṇa Basti consisting of Yavakṣāra, Gomūtra or Amla Rasa
Skandha Dravya Basti.
- Phalavarti
- Application of heat to the abdomen, buttocks and pelvic region with a hot
water bag.
- Oral administration of laxatives like Trivṛt chūrṇa or Harītakī chūrṇa.
Pathya:
For all purposes, such as drinking, bathing, etc., the patient should use boiled
and warm water.
Laghu Āhāra should be consumed. Māṁsarasa is indicated in Vāta duṣṭi.
Kṣīra is indicated in Pitta duṣṭi. Yūṣa is indicated in Kapha duṣṭi.
Parihāra Viṣaya & Kāla:

Parihāra Viṣaya are specific regimens which should be avoided during the
whole course of Basti karma as well as for a time period twice as long as the
time of the Basti course.
अत्यासनस्थानवचांभस यानं स्वप्नं भदवा र्ैथुनवेगरोधान् ॥ ५४ ॥
शीिोपचारािपशोकरोषांस्त्यजेदकालाभिििोजनं च । (च - भस - १)
 Samyak Yoga Lakṣaṇa:

प्रसृष्टभवण्र्ूत्रसर्ीरर्त्वं रुछयभग्नवृद्् याशयलार्वाभन ॥ ४१ ॥
रोगोपशाभन्िः प्रकृ भिस्थिा च बलं च िि् स्याि् सुभनरूर्भलङ्गर्् । (च - भस - १)
 Ayoga Lakṣaṇa:
स्याद्रुभलिरोहृद्गदु बभस्िभलङ्गे शोफः प्रभिश्यायभवकभिमके च ॥ ४२ ॥
हृल्लाभसका र्ारुिर्ूत्रसङ्गः र्श्ासो न सम्यक् च भनरूभििे स्युः । (च - सु - १)
 Atiyoga Lakṣaṇa:
भलङ्गं यदेवाभिभवरेभचिस्य िवेत्तदेवाभिभनरूभििस्य ॥ ४३ ॥ (च - भस - १)
कफास्रभपत्तषयजाभनलोत्थाः सुप्त्यङ्गर्दमललर्वेपनाद्ाः ॥ १९ ॥
भनद्राबलािाविर्ः प्रवेशाः सोन्र्ादभिलकाश्च भवरेभचिेऽभि । (च - भस - १)
 Nirūha Basti Vyāpat: - 12
Basti Vyāpat Nidāna Lakṣaṇa Chikitsā

1) Ayoga Krūra Koṣṭha, Mala Gurukoṣṭha, Vāta-Vit-Mūtra Pramāthya pāna, Svedana,
pūrṇa Koṣṭha, Rūksha, graha, Nābhi-Basti ruja, Dāha, Phalavarti, Virechana, Nirūha Basti
Vātolbaṇa; Shīta Basti, Hṛllepa, Guda Shvayathu,
Alpalavaṇa, Kaṇḍū, Gaṇḍāni Vaivarṇya,
Alpasneha, Alpadrava, Aruchi, Vahni Mārdava
Ghana, Alpamātrā
2) Atiyoga Uṣṇa Tīkṣṇa Basti, Excessive elimination of Vit, Shīta Parisheka, Avagāha, Shīta-
Mṛdu Koṣṭha Pitta, Kapha, Drava Dhātu; Kaṣāya-Madhura Annapāna,
Balakṣaya, Svarakṣaya, Dāha, Raktapitta-Atisāra-Jvara Chikitsā
Kaṇṭhashoṣa, Bhrama, Tṛṣṇā
3) Klama Āmasheṣa, Mṛdu Klama, Dāha, Hṛtshūla, Moha, Rūkṣa Svedana, Pāchana, Kvātha
Nirūha Veṣtana, Gaurava, Agnimāndya (Pippalī, Katruna, Ushīra, Devadāru,
Mūrva, Sauvarchala Lavaṇa), Peya,
Kṣāra, Basti with Dashamūla Kvātha
& Gomūtra
4) Ādhmāna Alpavīrya Dravya, Ādhmāna, Marma pīḍa, Vidāha, Snehana, Svedana, Varti, Nirūha
Mahādoṣa, Rūkṣa, Apāna Vāyu duṣṭi, Gurukoṣṭha, Basti with Pīlu, Sarṣapa & Gomūtra,
Krūra Koṣṭha Muṣka-Vaṅkṣaṇa Vedanā, Sneha Basti with Sarala & Devadāru
Hṛdayarodha, Hṛtshūla
5) Hikkā Atitīkṣṇa Basti Hikkā Hikkānigrahaṇa Dravya, Bṛmhaṇa,

administered in Mṛdu Hikkā Chikitsā
Koṣṭha, Abala Rogī Sneha Basti with Taila (Balā,
and causes Dashamūla, Triphalā, Guḍa,
Atinirharana, leading Saindhava), Prasanna & Amla
to Hikkā Aranala
6) Hṛtprāpti Atitīkṣṇa Basti, Savāta Hṛtprāpti Nirūha Basti (Kasha, Kusha, Utkata,
Basti, Mandavega Amla Dravya, Lavaṇa, Karavīra,
Badara)
Sneha Basti (Vātashāmaka Dravya;
Dashamula, etc.)
7) Ūrdhvatā Vāta-Vit-Mūtra Ūrdhva Gamana, Basti Dravya Shīta Mukha seka, Rubbing the
veganigrahaṇa after may be expelled from Mukha, flanks, abdomen and lower body,
administration of Mūrcchā Keep head elevated, Vātānulomana,
Basti, Ativega Virechaka, Compression of Kaṇṭha,
Basti with Uṣṇa Tīkṣṇa Dravya /
Dashamūla & Gomūtra, Nasya,
Dhūma, Sarṣapa Kalka Shiropralepa
8) Pravāhikā Mṛdu Vīrya Basti in Doṣa are expelled in Alpamātrā, Abhyaṅga, Svedana, Nirūha Basti,
case of Bahu Doṣa, Shopha, Jaṅgha-Uru Sadana, Shodhana Dravya, Anulomana
leading to Doṣa Niruddha Māruta, Atisāra Dravya, Laṅghana, Peyādi krama
Utklesha lakṣaṇa
9) Shiroarti Tanu, Mṛdu, Shīta Vāta gets further vitiated and Abhyaṅga Salavaṇa, Shirovirechana
Basti Dravya, moves in all directions of the (Pradhamana Nasya & Dhūmapāna),
Alpamātrā given in body, especially upwards Snigdha Tīkṣṇa Anulomaka Bhojana,
case of Durbala, Krūra affecting the head – Shiroarti. Anulomana Dravya, Sneha Basti
Koṣṭha, Tīvra Doṣa Grīva-Manyā graha, Shira- (Tīkṣṇa & Anulomaka)
Kaṇṭha bhedana, Bādhirya,
Karṇanāda, Pīnasa, Netra
vibhrama
10) Aṅgārti Atidoṣa Nirharana due Gatra veṣtana, Nistoda, Bheda, Abhyaṅga Salavaṇa, Uṣṇa Parisheka,
to Guru Tīkṣṇa Basti Sphuraṇa, Jṛmbhana Prastara Sveda (Eraṇḍapatra Kvātha),
given to a patient who Nirūha Basti (Yava, Kulattha, Kola,
has not undergone Dashamūla – Kvātha, Bilva Taila,
proper Pūrvakarma; Lavaṇa), Avagāha Sveda, Sneha Basti
or non at all (Bilva Taila / Yaṣṭīmadhu Taila)
11) Parikarta Rūkṣa Tīkṣṇa Atimātrā Parikartikā, Trika-Vaṅkṣaṇa- Kṣīrabasti with Madhura & Shīta
Basti given to a Basti Toda, Nābhī Adharuja, Dravya (E.g.: Ikṣurasa, Yaṣṭīmadhu
patient with Mṛdu Vibandha, Alpa Utthāna Kalka & Taila), Kṣīra Bhojana, Mṛdu
Koṣṭha and Alpa Doṣa Bhojana
12) Parisrava Amla Uṣṇa Tīkṣṇa Vidāha, Raktasrava, Pittasrava, Basti (Ardraka, Shālmalī, Vṛnta with
Atilavaṇa Basti given Atipravṛtti, Moha Ajā Kṣīra and Gḥrta; boiled and
in case of Pitta Roga admnistered when cooled down),
leads to Lekhana of Seka / Pradeha on Guda pradesha
Guda with Madhura & Shita Guṇa Dravya,
Raktapitta & Atisāra Chikitsā
 Anuvāsana Basti
 Nirukti:
It is called Anuvāsana Basti because it does not produce harm even though it stays
inside the body for a long time and can be administered day after day.
It is called Sneha Basti because Sneha Dravya is the main ingredient.
 Paribhāṣā:
Anuvāsana Basti is a type of Basti karma in which Sneha Dravya is administered
through the anal route and stays inside the body for a long time.
 Paryāya: Anuvāsana Basti, Sneha Basti
 Bheda: - 3
1) Uttama 24 Karṣa / 6 Pala (288 ml)
2) Madhyama 12 Karṣa / 3 Pala (144 ml)
3) Kanīyasī/Hrasva 6 Karṣa / 1 ½ Pala (72 ml) = Mātrābasti
 Yogya: Same as for Nirūha Basti

- Tīkṣṇāgni, Rūkṣa, Kevala Vāta Roga (diseases only due to Vāta Doṣa)
- Anuvāsana Basti can be given on daily basis in conditions such as Rūkṣa Nitya,
Diptāgni, Vyāyāma Nitya, Mārutāmaya, Udāvarta.
In others, Sneha generally digests in three days, so it should not be given on daily
basis for a long period. In the following manner, Sneha Basti does not cause any
complications:
1st day = Anuvāsana Basti
2nd day = Pathya Annapāna & Vihāra
3rd 4th or 5th day = Anuvāsana Basti is given again.
 Ayogya: Same as for Nirūha Basti

- Abhukta (without having eaten)
- Navajvara, Plīhodara, Kaphodara, Pāṇḍu, Kāmalā, Pīnasa, Pratishyāya, Viḍbheda,
Gurukoṣṭha, Kṛmikoṣṭha, Abhiṣyandi (Pittaja, Kaphaja), Kārshya, Sthaulya,
Ūrustambha, Viṣha pīta, Gara Viṣa, Apachī, Shlīpada, Galagaṇḍa, Arochaka
 Lābha:
देिे भनरूिेर् भवशुद्धर्ागे संस्नेिनं वर्मबलप्रदं च ।
न िैलदानाि् परर्भस्ि भकभञ्चदद्र् व्यं भवशेषेर् सर्ीरर्ािे ॥ २९ ॥
स्नेिने रौक्ष्यं लर्ुिां गुरूत्वादौष्ण्याछच शैत्यं पवनस्य ित्वा ।
िैलं ददात्याशु र्नःप्रसादं वीयं बलं वर्मर्थाभप पुभष्टर्् ॥ ३० ॥ (च - भस - १)
व्याभधव्यायार्कर्ाम्वषीर्ाबलभनरोजसार्् ।
षीर्शुक्रस्य चािीव स्नेिबभस्िबमलप्रदः ॥ २३ ॥
पादजङ्र्ोरुपृष्ासं किीनां भस्थरिां परार्् ।
जनयेदप्रजानां च प्रजां स्त्रीर्ां िथा नृर्ार्् ॥ २४ ॥ (च - भस - ४)
1st Sneha Basti acts on Basti and Vaṅkṣaṇa.
2nd Sneha Basti alleviates Vāta localized in Mūrdha.
3rd Sneha Basti bestows Bala and Varṇa.
4th Sneha Basti acts on Rasa Dhātu.
5th acts on Rakta Dhātu.
6th acts on Māṁsa Dhātu.
7th acts on Meda Dhātu.
8th acts on Asthi Dhātu.
9th acts on Majjā Dhātu.
After administration of 18 Sneha Basti, all types of Shukra Doṣa get alleviated.
The person who has taken 18x18 Sneha Basti (324) obtains the strength of an
elephant, speed of a horse, brilliance like the Gods, gets rid of sins, becomes
capable of retaining knowledge for a long time, and lives a long life.
 Mātrā:
The quantity of Anuvāsana Basti should be ¼ of Nirūha Basti Mātrā.
1 Pala = 48 ml 1 Karṣa = 12 ml
1 Prasṛta = 96 ml 1 Shukti = 24 ml
Age Nirūha Basti Mātrā Sneha Basti Mātrā

1 ½ Prasṛta / 1 Pala ½ Shukti / 1 Karṣa
6 3 Prasṛta / 6 Pala 1 ½ Pala / 3 Shukti / 6 Karṣa
12 6 Prasṛta / 12 Pala 1 ½ Prasṛta / 3 Pala / 6 Shukti / 12 Karṣa
18 12 Prasṛta / 24 Pala 3 Prasṛta / 6 Pala / 12 Shukti / 24 Karṣa
Sneha Basti Dravya Mātrā is increased by ½ Shukti / 1 Karṣa each year from age 1-12.
Sneha Basti Dravya Mātra is increased by 1 Shukti / 2 Karṣa each year from age 13-18.
3 Prasṛta / 6 Pala is the maximum quantity of Sneha Basti, which generally should be used
for the age group of 18-70 years. Above 70 years, Sneha Mātrā should be 5 Pala.
Types of Anuvāsana Basti according to Mātrā:
i) Uttama 24 Karṣa / 6 Pala (288 ml)
ii) Madhyama 12 Karṣa / 3 Pala (144 ml)
iii) Kanīyasī/Hrasva 6 Karṣa / 1 ½ Pala (72 ml) = Mātrābasti
 Mātrābasti:
Basti with Hrasva Sneha Mātrā is known as Mātrābasti.
It can always be used, even in Bāla, Vṛddha, Alpabala, Alpāgni, Sukhātma, Vātaroga,
after long walks or carrying heavy weight, Vyāyāma, Maithuna, Madyapāna.
No specific regimens must be followed during the course of Mātrābasti; also it can
be administered in any season and without specific Pūrva- and Pashchātkarma.
It provides strength and nourishment. It eliminates Mala, is simple to administer
and comfortable. It cures Vātaroga and generally does not cause complications.
It provides strength and nourishment. It eliminates Mala, is simple to administer
and comfortable. It cures Vātaroga and generally does not cause complications.
 Contents of Sneha Basti Dravya:

Most commonly, Siddha Sneha Dravya is used as single ingredient.
If indicated, Saindhava Lavaṇa and Kalka may also be added.
Kalka Mātrā:
i) Uttama 6 Māṣa (45 gm)
ii) Madhyama 4 Māṣa (30 gm)
iii) Alpa 2 Māṣa (15 gm)
 Anuvāsanopaga Mahākaṣāya:
Rāsnā, Devadāru, Bilva, Madana, Shatapuṣpā, Vṛshchīra, Punarnavā, Kaṇṭakārī,
Agnimantha, Shyonaka
 Anuvāsana Basti Kāla:

- In the morning during Hemanta, Shishira, Vasanta Ṛtu.
- In the evening during Grīṣma, Varṣa, Sharada Ṛtu.
 Vidhi:
1) Pūrvakarma
- Snehana, Svedana, Shodhana (Vamana, Virechana) can be performed before
Sneha Basti procedure. Sneha Basti should be administered 7 days after
Virechana. If the disease is caused by Vāta alone, Sneha Basti can be
administered without performing Shodhana previously.
- On the day of Sneha Basti procedure:
Snāna (Uṣṇodakena), Āhāra bhojana (less than ¼ than the usual quantity);
Hita, Laghu, Asnigdha, Arūkṣa
- Chaṅkramana, Vit-Mūtra pravṛtti
- Abhyaṅga, Svedana
- Preparation of Sneha Basti Dravya
- Preparation of Bastinetra (rubber catheter) & Bastipuṭaka (enema syringe)
2) Pradhānakarma
Same as for Nirūha Basti.
3) Pashchātkarma
Pratyāgamana Kāla
In general, Sneha Dravya should be expelled in 3 yāma (9 hours).
If it is not expelled within 9 hours, one should wait for one Ahorātra (24 hours).
After that, if Sneha Dravya is still retained, it should be expelled by using
Phalavarti or Tīkṣṇa Basti (strong decoction enema).
If Sneha does not come out due to Rūkṣa and if it does not cause any
complications, then it should be ignored. But the patient should not take any
food at night.
If Basti Dravya comes out immediately, then another Anuvāsana Basti should
be administered because the previous one did not produce any Snehana.
Pathya: Drava, Uṣṇa, Laghu, Pathya, Mātravat Āhāra

In the next morning, the patient should drink warm water boiled with Nāgara
and Dhānyaka or only Uṣṇodaka.
Uṣṇodaka helps in digestion of Apakva Sneha, disintegrates Kapha and does
Vātānulomana. Therefore, it should be given to the patient after Vamana,
Virechana, Nirūha and Anuvāsana Basti.
Parihāra Vishaya & Kāla:

Parihāra Viṣaya are specific regimens which should be avoided during the
whole course of Basti karma as well as for a time period twice as long as the
time of the Basti course.
अत्यासनस्थानवचाभं स यानं स्वप्नं भदवा र्ैथुनवेगरोधान् ॥ ५४ ॥
शीिोपचारािपशोकरोषास्ं त्यजेदकालाभिििोजनं च । (च - भस - १)
 Samyak Yoga Lakṣaṇa:

प्रत्येत्यसक्तं सशकृ छच िैलं रक्ताभदबुद्धीभन्द्रयसंप्रसादः ।
स्वप्नानवु भृ त्तलमर्िु ा बलं च सृष्टाश्च वेगाः स्वनवु ाभसिे स्यःु ॥ ४४ ॥ (च - भस - १)
 Ayoga Lakṣaṇa:
अधःशरीरोदरबािुपष्ृ पार्श्ेषु रूग्रूषखरं च गात्रर्् ।
ग्रिश्च भवण्र्त्रू सर्ीरर्ानार्सम्यगेिान्यनवु ाभसिे िस्य ॥ ४५ ॥ (च - भस - १)
 Atiyoga Lakṣaṇa:
हृल्लासर्ोिललर्सादर्ूछिाम भवकभिमका चात्यनुवाभसिस्य । (च - भस - १)
 Sneha Vyāpat: - 6
1) Vātāvṛta Occlusion of Basti Dravya by Vāta Doṣa
2) Pittāvṛta … by Pitta Doṣa
3) Kaphāvṛta ... by Kapha Doṣa
4) Annāvṛta ... by Āhāra
5) Purīṣāvṛta ... by Shakṛt
6) Abhukte Praṇīta Administration of Sneha Basti without having eaten.
Sneha Vyāpat Nidāna Lakṣaṇa Chikitsā

1) Vātāvṛta Shīta or Alpa Basti Dravya Aṅgamarda, Jvara, Nirūha Basti prepared with Kalka
given in a patient with Ādhmāna, Shīta, which is Sneha, Amla, Kṣāra and Uṣṇa.
excessive Vāta Stambha, Ūrupīḍana, Anuvāsana Basti on the same evening
Pārshvaruk with same Dravya.
2) Pittāvṛta Uṣṇa Basti given in Pitta Dāha, Rāga, Tṛṣṇā, Nirūha Basti with Madhura and
predominance Moha, Tamaka, Jvara Tikta Dravya.
3) Kaphāvṛta Mṛdu Basti given in Tandrā, Shīta, Jvara, Nirūha Basti prepared with Surā and
Kapha predominance Ālasya, Praseka, Gomūtra, Madanaphala taila, Kaṣāya,
Aruchi, Gaurava, Kaṭu, Tīkṣṇa, Uṣṇa and Amla Dravya.
Mūrcchā, Glāni
4) Annāvṛta Basti prepared with Guru Chardi, Mūrcchā, Pāchana with Kaṭu and Lavaṇa Kvātha
Dravya given to a patient Aruchi, Glāni, Shūla, or Chūrṇa.
who has overeaten prior Nidrā, Aṅgamarda, Mṛdu Virechana
to the procedure Āma, Dāha Āma Chikitsā
5) Purīṣāvṛta Alpabala Basti given to a Vāta-Vit-Mūtra Saṅga, Sneha Sveda, Guda varti, Nirūha Basti
patient with Varcha Shūla, Gurutva, prepared with Shyāma Trivṛt and Bilva,
Saṅchaya (accumulated Ādhmāna, Hṛdaya followed by Anuvāsana Basti.
faeces) graha Udāvarta Chikitsā
6) Abhukte Sneha Basti given Sneha Dravya comes Stambhana Dravya, Virechana Dravya,
Praṇīta forcefully to a patient out of Mukha or other Chardinigrahaṇa Dravya, pressure
who has not eaten orifices of the head. should be applied over the throat.
anything prior to the Nirūha and Anuvāsana Basti should be
procedure given with Taila; cooked with Gomūtra,
Shyāma Trivṛt, Yava, Kola, Kulattha
 Mādhutailika Basti
Mādhutailika Basti is a form of Nirūha Basti.
According to Āchārya Ḍalhaṇa, 5 types of Basti are included under Mādhutailika Basti:
1) Mādhutailika Basti
2) Yuktaratha Basti
3) Doṣahara Basti
4) Siddha Basti
5) Mustādi Yāpana / Rājayāpana Basti
Yuktaratha and Siddha Basti are also considered synonyms of Mādhutailika Basti.
यस्र्ान्र्धु च िैलं च प्राधान्येन प्रदीयिे ॥

र्ाधिु ैभलक इत्येवं भिषभग्िबमभस्िरुछयिे ॥ ११४ ॥ (सु - भच - ३८)
Since Madhu and Taila are added in large quantity, the physicians call these types
Mādhutailika Basti.
It is also known as Yuktaratha Basti because it can ne administered without any

prohibition.
It is also known as Siddha Basti because it promotes strength, growth and complexion,
and can be used in hundreds of diseases.
There is no specific restriction regarding travelling, copulation, food and drinks, etc.
The possibility of complications is less and it can be easily administered.
 Karma: Doṣa nirharaṇa, Balya, Varṇya

 Yogya: Sukumāra, Bāla, Vṛddha, Alpadoṣa, Mṛdu Koṣṭha, Svastha, Vandhyatva
1) Mādhutailika Basti
 Ingredients: Eraṇḍmūla Kvātha 2 pala
Madhu 1 pala
Tila Taila 1 pala
Shatapuṣpa Kalka ½ pala
Saindhava Lavaṇa ¼ pala
2) Yuktaratha Basti
 Ingredients: Eraṇḍamūla Kvātha, Madhu, Tila Taila, Vachā, Madhuka, Pippalī,
Māṁsarasa, Saindhava Lavaṇa
3) Doṣahara Basti
 Ingredients: Kvātha (Suradāru, Triphalā, Rāsnā, Shatapuṣpa, Vachā), Madhu, Taila,
Hinġu, Saindhava Lavaṇa
4) Siddha Basti
 Ingredients: Kvātha (Yava, Kola, Kulattha), Magādhika, Madhuka, Madhu, Taila,
Saindhava Lavaṇa
5) Mustādi Yāpana Basti / Rājayāpana Basti

 Ingredients:
Kvātha Dravya:
Musta, Pāṭhā, Amṛtā, Tiktā, Balā, Rāsnā, Punarnavā, Mañjiṣṭha, Āragvadha, Ushīra,
Trāyamāṇa, Hrasva Pañchamūla - 1 pala each
Madana phala - 8
Jala - 1 āḍhaka
Boiled until reduced to one fourth, and filtered.

Added with:
Kṣīra ½ āḍhaka
Māṁsarasa ¼ āḍhaka
Madhu ¼ āḍhaka
Ghṛta ¼ āḍhaka
Kalka Dravya:
Shatāvarī, Phalinī, Yaṣṭī, Vatsaka, Rasāñjana, Saindhava - 1 karṣa each
 Karma: Balya, Jīvana, Vṛṣya, Chakṣuṣya, Shūlanāshana

 Āmāyika Prayoga: Vātarakta, Meha, Shopha, Arsha, Gulma, Mūtra-Vit saṅga,
Visarpa, Jvara, Raktapitta
 Yāpana Basti
Yāpana Basti is a variety of Basti karma which promotes life and prolongs the life span.
Yāpana Basti are Avirodhi (not contraindicated) for healthy persons, patients or old
persons. They promote Shukra, Māṁsa, and are indicated in case of Ativyavāya.
They promote fertility of women and men.
Yāpana Basti provide Snehana & Shodhana Karma / Bṛṁhaṇa & Lekhana.
Sarva Roga Prashamana, Sarva Ṛtu Yogya, Nāti-Rūkṣa Nāti-Snigdha, Dīpana, Balya, Vṛṣya,
Rasāyana, Vibandha nāshaka.
There is no need for specific Pathyāpathya.
Yāpana Basti generally do not cause complications.
 Kṛmighna Basti / Kṛmināshaka Basti

 Ingredients: Kvātha Dravya: Viḍaṅga, Triphalā, Shigru, Musta, Akhuparṇī
Kalka Dravya: Viḍaṅga, Pippalī
 Indications: Kṛmi
 Ardhamātrika Basti
 Ingredients: Dashamūla Kvātha 5 pala
Shatāvarī Kalka 1 tolā
Saindhava Lavaṇa 1 tolā
Madhu 2 pala
Tila Taila 2 pala
Madana 1 phala
 Karma: Shukrajanana, Balya, Varṇya, Vṛṣya, Puṁsavana

 Āmāyika Prayoga: Vātaroga, Shūla, Kṛmi, Vātarakta
 Eraṇḍamūlādi Basti
 Ingredients: Saindhava Lavaṇa
Madhu
Tila Taila
Gomūtra
Kvātha Dravya
Eraṇḍamūla 3 pala
Palāshā, 1 pala each
Hrasvapañchamūla (Shālaparṇī, Pṛshniparṇī, Bṛhatī, Kaṇṭkārī,
Gokṣura), Rāsnā, Ashvagandhā, Atibalā, Guḍūchī, Punarnavā,
Āragvadha, Devadāru
Madana kalka 8 bīja
Jala 2 āḍhaka / kāṁsha
Kalka Dravya
Kalka of… 1 tola each
Shatāvarī, Hapuṣa, Priyaṅgu, Pippalī, Madhuka,
Balā, Rasāñjana, Vatsaka, Musta
 Preparation:
Eraṇḍamūla and Palāshādi Dravya are mixed together with Madana kalka and Jala,
and boiled until the liquid reduces to 1/8 of the quantity. The decoction is filtered.
Basti Dravya should be prepared as per the general preparation procedure.
Saindhava Lavaṇa & Madhu -> Sneha -> Kalka -> Kvātha & Gomūtra
 Karma: Dīpanīya, Lekhanīya
 Āmāyika Prayoga:
जङ्र्ोरुपादभत्रकपृष्शल ू ं कफावृभिं र्ारुिभनग्रिं च ॥ ४१ ॥
भवण्र्ूत्रवािग्रिर्ं सशल
ू र्ा्र्ानिार्श्र्ररशकम रे च ।
आनािर्शोग्रिर्ीप्रदोषानेरण्डबभस्िः शर्येि् प्रयुक्तः ॥ ४२ ॥ (च - भस - ३)
 Lekhana Basti
Basti prepared mainly with Lekhana Dravya is known as Lekhana Basti.
Lekhana refers to scrapping or removing adhered Doṣa, Dhātu Mala or excessive Medas
from the body. Lekhana Dravya are Vāyu-Agni Mahābhūta pradhāna.
Guṇa of Lekahan Dravya: Laghu, Tīkṣṇa, Vishada, Sūkṣma, Khara, Sara, Kaṭhīna, Uṣṇa
Examples of Lekhana Dravya:
- Musta, Kuṣṭha, Haridrā, Dāruharidrā, Vachā, Ativiṣā, Kaṭurohiṇī, Chitraka, Karañja,
Haimavatī, Triphalā Kvātha, Gomūtra, Yavakṣāra, Lavaṇa, Madhu
 Kṣāra Basti
 Ingredients: Amlikā 2 pala
Gomūtra 8 pala
Guḍa 2 pala
Shatāvarī 1 tolā
Saindhava 1 tolā
 Indications: Shūla, Purīṣa saṅga, Ānāha, Mūtrakṛcchra, Kṛmi, Udāvarta, Gulma
 Dashamūla Kṣāra Basti

 Ingredients: Dashamūla Kvātha 8 pala
Amlikā 2 pala
Gomūtra 2 pala
Guḍa 1 pala
Shatāvarī 1 tolā
Saindhava 1 tolā
Bṛhat Saindhavādi Taila 2 pala
 Indications: Āmavāta, Ankylosing spondylitis, Fibromyalgia
 Picchā / Picchila Basti

Basti prepared mainly with Picchila Dravya is kown as Picchila Basti
Picchila refers to slimy quality of Dravya. It Picchila Dravya are Jala Mahābhūta pradhāna.
Guṇa of Picchila Dravya: Picchila, Guru, Manda, Shlakṣṇa, Mṛdu, Shīta
In Sushruta Saṁhitā, Picchila Basti described as:

Badarī, Nāgabalā, Shleṣmātaka, Shālmalī, Dhanvana boiled in Kṣīra, added with Madhu
and Rakta (fresh blood) from boar, buffalo, camel, deer, goat, etc.
 Kṣīra Basti
Kṣīra Basti is a form of Nirūha Basti in which Kṣīra is used along with Kvātha as main
ingredients.
Examples:
Yaṣṭīmadhu Kṣīra Basti

 Ingredients: Yaṣṭīmadhu Kaṣāya Siddha Kṣīra 500 ml
Kalka made from: 30 gm
Yaṣṭīmadhu, Shatapuṣpa, Pippalī, Rāsnā
Yaṣṭīmadhu Taila 40 ml
Ashvagandhā Ghṛta 40 ml
Madhu 80 ml
Saindhava Lavaṇa 3 gm
 Indications: Disc prolabpse, Lumbar spondylosis, Disc desiccation
Ashvagandhādi Kṣīra Basti

 Ingredients: Kṣīrapāka made from: 500 ml
Ashvagandhā, Balā, Nāgabalā, Shatāvarī, Māṣa
Kalka made from: 30 gm
Ashvagandhā, Balā, Shatapuṣpa, Pippalī, Yaṣṭī
Ashvagandhā Gḥrta 80 ml
Madhu 80 ml
 Indications: Kārshya, Vātavyādhi, Māṁsa kṣaya
Tiktaka Kṣīra Basti / Pañchatikta Kṣīra Basti

Pañchatikta = Vāsā, Nimba, Paṭola, Guḍūchī, Kaṇṭakārī
 Ingredients: Pañchatikta Kṣīrapāka 500 ml

Pañchatikta Kalka 30 gm
Tiktaka Ghṛta 80 ml
Madhu 80 ml
 Indications: Vātavyādhi, Vātarakta, Asthisauṣirya
For Vātavyādhi specifically, various other Dravya may be added, such as:
Dashamūla Kvātha, Rāsnādi Kvātha, Ashvagandhā, Gomūtrārka, Kṣāra, Trikaṭu,
Eraṇḍa Taila, etc.
 Prasṛta Basti
Prasṛta Basti is a mild form of Nirūha Basti. It is specifically indicated for delicate persons
and patients suffering from complications as a result of therapies. These type of Basti
karma provide nourishment, strength and alleviate Vāta Doṣa.
Pañcha Prasṛtika Basti

 Ingredients: Kṣīra 2 prasṛta
Madhu 1
Taila 1
Gḥrta 1
 Karma: Vātaghna, Balakara, Varṇakara
Aṣṭa Prasṛtika Basti

 Ingredients: Taila 1 prasṛta
Prasanna 1
Madhu 1
Ghṛta 1
Bilvādimūla Kvātha 2
Kulattha Kvātha 2
 Indication: Vātaroga
Nava Prasṛtika Basti

 Ingredients: Bṛhata Pañchamūla Kvātha 5 prasṛta
Taila 2
Madhu 1
Madhu 1
 Karma: Snehana, Anilāpaha
 Vaitaraṇa Basti
 Ingredients: Amlikā 1 pala
Guḍa ½ pala
Saindhava 1 karṣa
Gomūtra 1 kuḍava
Taila Alpa Mātrā
 Indications: Shūla, Ānāha, Āmavāta

Can be given after meals.
 Uttara Basti
 Nirukti:
The Basti administered through Uttaramārga and has Shreṣṭha Guṇa is known as
Uttara Basti.
 Paribhāṣā:
The Basti which is administered after Nirūha Basti and through the Uttara Mārga is
called Uttara Basti.
 Āmāyika Prayoga:
Shukra Duṣṭi, Ārtava Duṣṭi, Kaṣṭārtava, Atyārtava, Yoniroga, Aparāsaṅga,
Mūtrāghāta, Mutraroga, Ashmarī, Sharkarā, Bastiroga, Basti shūla, Vaṅkṣaṇa shūla,
Shukrotseka
 Samyak Lakṣaṇa & Vyāpat of Uttara Basti are similar to that of Sneha Basti.
 Bheda:
1) Puruṣa (Mūtra & Shukra Mārga)
2) Strī
a) Mūtra Mārga
b) Yoni Mārga
1) Snehana
2) Shodhana
 Uttara Basti Yantra:

1) Traditional Uttarabasti Yantra
a) Bastinetra / Puṣpanetra
Bastinetra should be made from gold, silver, etc.
For Males:
Its orifice should be the size of Sarṣapa bīja (mustard seed).
Length = 14 aṅgula (Ā. Sushruta)
12 aṅgula (Ā. Charaka)
For Females:
Its orifice should be the size of Mudga (green gram).
Length for Females = 10 aṅgula (Ā. Sushruta)
b) Bastipuṭaka = Urinary bladder of goat, camel or boar.
2) Alternative Uttarabasti Yantra

a) Bastinetra / Puṣpanetra
For Males: Rubber catheter
For Females: Rubber catheter / Stainless steel Cannula
b) Bastipuṭaka = Syringe
A) Uttara Basti for Males
Uttara Basti in males is administration of Auṣadha Dravya through Mūtra & Shukra
Mārga (urethral route).
 Uttara Basti Mātrā: Kvātha = 1 prasṛta

Sneha = ½ - 1 pala
 Uttara Basti Kāla:

There is no specific indicated time period for administration of Uttara Basti.
In one course, 3 Uttara Basti may be given; with a gap of 3 days between each.
Or 30 ml / day for 3 days consecutively. 50 ml for the following 4 days. Then a gap
of 7 days, and another 7 days of Uttara Basti.
 Vidhi:
1) Pūrvakarma
- Generally, 2-3 Āsthāpana Basti are done before administration of Uttara Basti
- Preparation of instruments
- Preparation of Auṣadha Dravya
- Mala pravṛtta
- Abhyaṅga, Paṭṭa Svedana
2) Pradhānakarma
- Supine position
- Prepuce is retracted and glans penis is cleaned with aseptic solution.
- Catheter is lubricated and slowly introduced into the urethra. It is sufficiently
pushed until it reaches into the urinary bladder.
- Auṣadha Dravya is administered, and catheter is slowly removed.
3) Pashchātkarma
Pratyāgamana Kāla:
If Kvātha is used for Uttara Basti, it gets evacuated within several minutes.
If Sneha is used for Uttara Basti, it may be retained for a longer period. If it
does not get expelled after 12-14 hours, Pippalyādi Varti should be introduced
into the urethra to induce voiding of urine and Sneha Dravya.
Pathya & Parihāra Vishaya are similar as for Sneha Basti.
B) Uttara Bast for Females

1) Mūtra Mārga
Uttara Basti through Mūtra Mārga in females is administration of Auṣadha Dravya
through urethral route.
 Mātrā & Vidhi: Similar as for males; patient should lie in lithotomy position.
2) Yoni Mārga
Uttara Basti through Yoni Mārga is administration of Auṣadha Dravya through vaginal
route into the uterus.
 अधिष्ठान = िृिीयाविम, भद्विीयाविम
 प्रयोग = वन््यत्व, कष्टािमव, नष्टािमव, आिमवषय, पुत्रभनन / जािननी योभनव्यापि्

PCOD (Poly-Cystic Ovarian Disease), POF (Premature Ovarian Failure)
 अयोग = प्रसावकाल, गिमकाल

Any inflammatory condition or infection in genital area or urinary tract.
 द्रव्य = िैल, र्ृि
 औषि = योग आर्ाभयक प्रयोग

फलर्ृि पुत्रभनन / जािननी योभनव्यापि्, POF
शिपस्ु प िैल वन््यत्व (Anovulation), PCOD, POF
दशर्ूल िैल कष्टािमव, नष्टािमव
अपार्ागमषार िैल वन््यत्व (Tubal blockage)
गुडूछयाभद िैल कष्टािमव, आिमवषय
 मात्रा = 5 ml; 1-2 ml only will be directly administered into uterine cavity.
 परिमाण = After cessation of menses: a) 3 days subsequently

b) 6 days subsequently
c) 3 days – 3 days break – 3 days
- Repetition: 3 cycles / 6 cycles / 9 cycles with break of 1 cycle after
each 3 cycles of treatment.
 काल = Morning
 क्रम = पव
ू क
म र्म, प्रधानकर्म, पश्चात्कर्म
1) पूवक
म र्म ▪ Required investigations to check the general health of the patient
and to rule out any inflammation or infection.
(TCDC, Hb, HIV, VDRL, HBsAg, Urinalysis)
▪ Patient should have empty stomach.
▪ अभ्यङ्ग (mainly on legs, lower abdomen & back)
▪ नाडीस्वेदन
▪ योभनप्रषालन (पञ्चवल्कल लवाथ)
▪ Separate procedure room, clean table
▪ Required instruments: Sponge-holding forceps, Sims’ speculum,
Anterior vaginal wall retractor, Vulsellum (Alli’s forceps), Bastinetra &
Bastipuṭaka (cannula & syringe), Cotton swap, Draping cloth
▪ िैल / र्ृि should be warmed.
2) प्रधानकर्म ▪ Early morning

▪ Patient should be in lithotomy position.
▪ Antiseptic measures (betadine)
▪ Draping of peripheral area
▪ Clean internal vagina with cotton swab.
▪ PS-examination
▪ Catch anterior lip of the cervix with vulsellum.
▪ Uterine sounding to know the position of uterus.
▪ Injection of Auṣadha Dravya (1-2 ml) in warm state into uterine cavity
with the help of Bastinetra.
▪ Remove Basti Netra carefull from external os and remaining Auṣadha
Dravya (3-4 ml) is injected into vagina.
▪ Pratyavartana (backward flow of Auṣadha Dravya) should be
observed.
▪ Puta-Pottali
▪ Remove speculum
3) पश्चािकर्म ▪ Head low position for 30 min - 1 h.

▪ Massage on lower abdomen for 10 min.
▪ Hot water bath fomentation for 30 min -1h.
▪ Removal of Pottali before micturition or latest after 2 hours to
prevent infection.
▪ Mild abdominal pain & slight vaginal bleeding may be normal.
▪ Precautions for the patient: Avoid spicy food, avoid heavy food, avoid
food which may cause constipation, avoid coitus, clean vaginal area
properly after micturition.
 उपद्रव = Uterine distension & severe pain if too much Basti Dravya is
administered directly into uterine cavity or if it is forcefully injected.
- Infection due to improper hygiene, white discharge, itching vulva,
burning sensation while urination.
- Lower abdominal pain for prolonged time.
- Oil embolism leading to Peritonitis -> Tenderness, pain, distension,
nausea, vomiting, diarrhea, constipation, minimal urine output,
anorexia, excessive thirst, fatigue, fever.
 धिधकत्सा = चन्द्रप्रिाविी / भत्रफला गुग्गुलु / गोषुराभद गुग्गुलु for 3 days, b.i.d.

शण्खविी for 3 days, 1-2/d in case of pain.
एरण्डिृष्ट िरीिकी 3-5gm at night with warm water in case of
constipation.
 कमुक्त
म
- िैल / र्ृि is used along with medicinal drugs to act as a carrier because the
endometrium, mucosa, etc. can absorb fat easier. Also, estrogen & progesterone are
lipid hormones, so Sneha Dravya have a stronger effect on them.
- After absorption of Auṣadha Dravya, it reaches the blood and is circulated & acts on the
genital organs.
- पूवक
म र्म is done to improve absorption & circulation of Auṣadha Dravya.
- फलर्ृि acts primarily on the uterus.
- शिपुस्प िैल acts primarily on the ovaries.
- अपार्ागमषार िैल does Lekhana Karma.
- उत्तरबभस्ि is useful in all types of infertility; it is usually performed along with other
treatments such as भवरे चन, योग बभस्ि & नस्य.
CHAPTER VIi: nasya
 Introduction
 Paribhāṣā:
According to Sushruta Saṁhitā
औषधर्ौषधभसद्धो वा स्नेिो नाभसकाभ्यां दीयि इभि नस्यर्् ॥ (सु - भच - ४०)
Nasya is the instillation of medicine along with Sneha through both nostrils.
-> Modes of formulation which are used for Nasya include:

Taila, Ghṛta, Svarasa, Kvātha, Kshīra, Jala, Chūrṇa, Madhu, Māṁsarasa
Taila is considered as best Nasya Dravya. It is generally considered superior to
Ghṛta because Taila does not disturb the pH of nasal mucosa, whereas Ghṛta is
alkaline and causes changes in the pH.
According to Aṣṭāṅga Saṅgraha

नासायां प्रभर्यर्ानर्ौषधं नस्यर्् । (अ.स.ं - सू - २९)
Instillation of medicine through nostrils is known as Nasya.
According to Bhāvaprakāsha Nighantu

नासां ग्रह्यं यदौषधं िद् नस्यर्् । (िा - प्र - पू - ५)
Receiving medicine through the nose is considered as Nasya.
 Importance of Nasya:
ऊ्वमजत्रभु वकारेषु भवशेषान्नस्यभर्ष्यिे ।
नासा भि भशरसो द्वारं िेन िदव्् याप्य िभन्ि िान् ॥ १ ॥ (अ.हृ. - सू - २०)
नस्िःकर्म च कुवीि भशरोरोगेषु शास्त्रभवद ।

द्वारं भि भशरसो नासा िेन िदव्् यप्य िभन्ि िान् ॥ ८८ ॥ (च - भस - ९)
 Age limit for Nasya:
According to Ācharya Vāgbhaṭa, Nasya can be done from 7 years of age onwards.
Dhūmapāna should not be performed in persons below the age of 18.
According to Ācharya Sharṇgadhara, Nasya can be done from 8 years of age
onwards.
Generally, after the age of 80, Nasya should not be done.
Pratimarsha Nasya is the exception; it may be done from birth till death, same as
Mātrābasti.
आजन्र्र्रर्ं शस्िं प्रभिर्शमस्िु बभस्िवि् । (अ.स.ं - सू - २९ / अ.हृ. - सू - २०)
 Karmukta / Mode of Action:
In Aṣṭāṅga Saṅgraha it is explained that Nāsa is the entry to Shira. The drug
administered through the nostrils reaches the Shṛṅgāṭaka Marma, which is a Sirā
Marma, by Nāsa Srotas and further spreads in the Mūrdha (brain), reaches the
junctional place of Netra (eyes), Srotra (ears), Kaṇṭha (throat), Sirāmukha (opening
of the vessels) etc. and removes or detatches the morbid Doṣa present in the
supraclavicular region.
According to Āchārya Charaka, Nāsa is the gateway of Shira. The drug

administered through the nose reaches the brain and eliminates the morbid Doṣa
responsible for producing disease. The Dravya administered by Nasya Karma enters
in to Shira and draws out exclusively the morbid matter.
Āchārya Sushruta has explained Shṛṅgāṭaka Marma as a Sirā marma, present

in the middle of the confluence of Sirā supplying nourishment to the Nāsa, Karṇa,
Chakṣu and Jihvā. Under the complication of Nasya Karma, Ā. Sushruta noted that
the excessive Shodhan Nasya may cause Mastuluṅga (CSF) to flow out; this further
shows the relation between Nāsa and Shira.
Keeping the head in a lowered position and retention of medicine in the naso-
pharynx helps in providing enough time for local drug absorption.
Any liquid soluble substance has greater possibility for passive absorption directly
through the cells of the membrane.
Massage and local fomentation enhance the drug absorption.
The nose is connected to the brain through a vascular system, lymphatic path,
nerve plexus of olfactory nerve and ophthalmic and maxillary branches of
trigeminal nerves.
Diffusion of Medicine
Lipid soluble substances have grater affinity for passive absorption through the cell
walls of nasal mucosa. The cilia of the olfactory cells and perhaps the portions of
the body of the olfactory cells contain relatively large quantities of lipid materials.
Non-polar hydrophobic molecules diffuse through the lipid bilayer of the plasma
membrane, into and out of cells. Such molecules include oxygen, carbondioxide
and nitrogen gases; fatty acids, steroids, and fat soluble vitamins.
It is a route of absorption of some nutrients and excretion of waste by body cells
which are lipid soluble. Further drug absorption can also be enhanced by local
massage and fomentation.
Vascular Path
Vascular path transportation is possible through the pooling of nasal venous blood
into the facial vein, which naturally occurs. At the opposite entrance, the inferior
ophthalmic vein also pool into the facial vein.
The facial vein has no valves. It communicates freely with the intracranial
circulation, not only at its commencement but also by the supra orbital veins which
are connected with the ophthalmic vein, a tributary of the deep facial vein, which
communicates through the pterygoid plexus with the cavernous venous sinus.
Such a pooling of blood from nasal veins to venous sinuses of the brain is more
likely to occur in head lowering position due to gravity.
Lymphatic Path
Drug transportation by lymphatic path can reach direct into the CSF. It is known
that arachnoid matter sleeve is extended to the submucosal area of the nose along
with the olfactory nerve.
Neurological Path
It is concerned with the olfactory stimuli. The olfactory nerve differs from other
cranial nerves in its close relation with the brain.
The peripheral olfactory nerves are chemo-receptor in nature. The olfactory nerves
are connected with the higher centers of brain i.e. limbic system, consisting mainly
of amygdaloidal complex, hypothalamus, epitheliums, anterior thalamic nuclei
parts of basal ganglia etc.
So the drugs administered through the nose stimulate the higher centers of brain
which shows action on regulation of endocrine and nervous system functions.
They stimulate the hypothalamus which in turn regulates the contraction of
smooth and cardiac muscles, and secretions of many glands. It is a major regulator
of visceral activities, including heart rate, peristalsis and contraction of bladder.
It is responsible for integrating the functions of the endocrine system and the
nervous system.
It is known to have direct nerve connection with the posterior pituitary lobe.
Additionally, the hypothalamus is connected with the anterior pituitary lobe
through portal vessels which supply blood to the gland conveying chemical
messages through inhibitory and releasing hormone.
Further, the hypothalamus regulates emotional and behavioral patterns, body
temperature, cardiac rhythm, etc.
 Nasya Bheda
 According to Sushruta Saṁhitā: सम - धि - ४०

A) धिधवि
1) स्नेिन
2) भशरोभवरेचन
B) पञ्िधवि
1) र्शम -> Vāta-Pitta shamana, Sneha Dravya is used
2) भशरोभवरेचन -> Kapha shodhana, Sneha Dravya is used

a) र्ृद ु Sub-classification is according to Aṣṭāṅga Hṛdaya.
b) िीक्ष्र्
c) िीक्ष्र्िर्
3) अवपीडन -> Kvātha, Svarasa, Kshīra is used

a) स्िम्िन Sub-classification is according to Sharṇgadhara Saṁhitā.
b) शोधन
4) प्रधर्न -> Sūkṣma Chūrṇa is used; it is also known as ्र्ापन
5) प्रभिर्शम Sneha Dravya is used as Snehana & Shamana for Vāta-Pitta

 According to Charaka Samhita:
A) पञ्िधवि (ि - सू - ५)
1) नावन
a) स्नेिन
b) शोधन
2) अवपीड
a) स्िम्िन
b) शोधन
3) धर्ू पान
a) प्रायोभगक -> Mild Kapha shodhana; used for Dinacharya
b) वैरेचभनक -> Strong Kapha shodhana
c) स्नैभिक -> Vāta shamana / Snehana
4) ्र्ापन -> भशरोभवरे चन
5) प्रभिर्शम -> स्नेिन
B) धत्रधवि (ि - धस - ९)
1) िपमर् -> Vātaja Roga
2) रेचन -> Kaphaja Roga
3) शर्न -> Pittaja & Raktaja Roga
 According to Aṣṭāṅga Hṛdaya: अ.हृ - सू - २०

A) पञ्िधवि - Same as per Sushruta Saṁhitā.
B) धत्रधवि - Same as per Charaka Saṁhitā, only the names are slightly different.
1) बृिं र्
2) भवरेचन
3) शर्न
C) धिधवि
1) र्शम
2) प्रभिर्शम
 Nasya Vidhi
Nasya Vidhi is the procedure of performing Nasya Karma. The following basic procedure
should be followed; except in case of Pratimarsha Nasya which is used for Dinacharya,
Pūrvakarma and Pashchātkarma are not required.
1) पव
ू क
म र्म
2) प्रधानकर्म
3) पश्चात्कर्म
1) पूवुकमु
i) र्लप्रवृभत्त (Purīṣa & Mūtra; if there is constipation, Mṛdu Virechana Dravya may
be given so that the patient has Vit pravṛtti on the day of procedure)
ii) दन्िधावन (It is done for Kapha vishodhana.)
iii) अल्पिोजन (Patient should have eaten small quantity of food; Nasya is performed
around 30 minutes after intake of food.)
iv) धर्
ू पान (Prāyogika; Mukha-Sroto Shuddhi; it may not be indicated in patients
with severely aggravated Vāta, Pitta or in case of severe dryness.)
v) पाभर्िापस्वेद & र्दमन (Warming the hands by rubbing and performing mild massage
on Gala-Kapola-Lalāṭādi / Urdhvajatru pradesha -> सु - भच - ४०)
OR
भस्नग्धभस्वन्नोत्तर्ाङ्गस्य (Abhyaṅga & Svedana of Uttamāṅga -> अ.हृ - सू - २०

It may be contraindicated in Pittaja Prakṛti/Vikṛti to avoid Atisvedana.
Mṛdu Svedana only should be performed on Netra.
Abhyaṅga is done until circulation is stimulated; warmth is felt.
Svedana is done until perspiration is starting.
Duration of Abhyaṅga & Svedana depend on Prakṛti or Vikṛti of the
patient. Hīnayoga or Atiyoga must be avoided.)
vi) भनवामि-भनरािप-रजिीनगृि (Sthāna for performing Nasya should be devoid of

exposure to wind & direct sunlight and dust exposure should be
minimal; the atmosphere should not be too cold, too hot or cloudy.)
vii) द्रव्यसङ्ग्रिर् & औषध भसद्ध (Collection of medicinal drugs and preparation of
medicine used for Nasya Karma.)
2) प्रिानकमु
i) उत्तानशायन & प्रसररि करपादचरर् (Supine position of the patient with extended
arms & legs to be comfortable and relaxed.)
भकभञ्चि् प्रलभम्बि भशरः (Slightly head-low position.)
ii) वार्िस्ि प्रदेभशभन नासाग्र उन्नयेि् (With the forefinger of the left hand, the tip of the
patient’s nose is lifted / pushed up.)
दभषर्िस्ि शुभक्त भपचु भवधरयेि् (With the right hand, Shukti or Pichu is held with
Koṣṇa Sneha for instillation.)
iii) अल्पिोजन (Patient should have eaten small quantity of food; Nasya is performed
around 30 minutes after intake of food.)
iv) अनवभछिन्न धारा (Instillation of Nasya Dravya should be uninterrupted.)
v) र्ात्रा -> According to Ācharya Sushruta:

i) अष्टभबन्द ु / प्रर्ार्ाष्टौ भबन्दवः (8 Bindu) -> अवर
ii) शुभक्तप्रर्ार् (32 Bindu) -> र््यर्
iii) पाभर्शुभक्तप्रर्ार् (64 Bindu) -> उत्तर्
-> According to Ācharya Sharṇgadhara:

i) शार् (8 Bindu) -> अवर
ii) चिुशामर् (32 Bindu) -> र््यर्
iii) अष्टशार् (64 Bindu) -> उत्तर्
-> According to Ācharya Vāgbhaṭa:

i) अवर (6 Bindu)
ii) र््यर् (8 Bindu)
iii) उत्तर् (10 Bindu)
धिन्दम प्रमाण
One Bindu is considered as the quantity which drops from the finger of
the patient after it is dipped into Sneha Dravya for 2 Aṅgula.
vi) Instructions for the patient during instillation of Nasya Dravya:
-> न कम्पयेि् भशरः (Do not move the head)
-> न िाषयेि् (Do not talk)
-> न िस्येि् (Do not laugh, be angry or sneeze)
-> न कुप्येि (Do not be angry)
-> न षवथु (Do not sneeze)
-> भकभञ्चि् उभछिंििे् (Slightly forceful inhalation)
-> न उपभगलेि स्नेि (Do not swallow the Sneha Dravya which reaches
the throat; Sneha which reaches the Gala
contains Dosha from Shṛṅgāṭaka Marma, so it
should be spit out.)
3) पश्चात्कमु
i) १०० र्ात्रा (Patient should remain in the same position for 100 Mātrā; it should be
counted by the patient as it varies depending on the Prakṛti. During
this period, Sneha should be spit out laterally into a vessel without
moving the head excessively. After 100 Mātrā, the patient is allowed to
stand up.)
ii) र्दमन & स्वेदन (Mardana and Svedana is done on Pādatāla, Hasta, Skanda, Grīva,
Gala, Kapolādi.)
iii) धर्
ू पान (Prāyogika; Kapha vishodhana)
iv) कवल (सुखोष्र्ाम्बु -> Kavala is done with lukewarm water)
v) िोजयेछचौनर्भिष्यभन्द (Food is taken which does not create moisture.)
vi) अपथ्य -> रजोधर्

ू स्नेिािपर्द्द्रवपानभशरःस्नानाभियानक्रोधादीभन च पररिरेि् ॥
(सु - भच - ४०/३१)
Parihāra Vishaya: Patient is advised to stay in Nivāta Sthāna, consume only Laghu
Āhāra, and drink Koṣṇodaka.
Apathya (see above)
The whole course of Nasya Karma may be done for 1 / 2 / 7 / 21 days.

The duration of Nasya Karma depends on the disease and is done until
Samyak Lakṣaṇa are obtained.
 Nasya Kāla
 According to Sushruta Saṁhitā; on the basis of Doṣa:
1) पूवामिन -> Kapha (morning)
2) र््यािन -> Pitta (noon)
3) अपरािन -> Vāta (evening)
 According to Charaka Saṁhitā & Aṣṭāṅga Hṛdaya; on the basis of Ṛtu:

1) पवू ामिन -> Vāsanta, Sharada
2) र््यािन -> Shishira, Hemanta
3) अपरािन -> Grīṣma
In Varṣa Ṛtu, Nasya should only be done if the sky is clear. Mostly, there are
excessive clouds & rain in Varṣa Ṛtu, so Nasya is generally contraindicated.
 Sneha Nasya
िस्य योगाभियोगायोगानाभर्दं भवज्ञानं िवभि ॥ ३२ ॥
लार्वं भशरसो योगे सुखस्वप्नप्रबोधनर्् ॥
भवकारोपशर्ः शुभद्धररभन्द्रयार्ां र्नःसुखर्् ॥ ३३ ॥
कपप्रसेकः भशरसो गरुु िेभन्द्रयभवभ्रर्ः ॥
लषर्ं र्ू्न्यमभिभस्नग्धे रूषं ित्रावचारयेि् ॥ ३४ ॥
अयोगे वािवैगण्ु यभर्भन्द्रयार्ां च रूषिा ॥
रोगाशाभन्िश्च ित्रेष्टं ियू ो नस्यं प्रयोजयेि् ॥ ३५ ॥ (सु - भच - ४० ३२-३५)
 Samyoga / Samyak Lakṣaṇa
- Lāghavam Shiraso (Lightness of head)
- Sukha Svapna-Prabodhanam (Pleasant sleeping and awakening)
- Vikāra prashama (Pacification of disease)
- Shuddhi-indriyānām (Purification of sense organs)
- Manaḥ sukham (Pleasant state of mind)
 Atiyoga Lakṣaṇa
- Kaphapraseka (Excessive salivation)
- Shiraso gurutā (Heaviness of head)
- Indriya vibhrama (Disturbance of sense organs)
- Mūrdhni-Atisnigdha (Excessive unctuousness of head)
 Ayoga / Hīnayoga Lakṣaṇa

- Rūkṣa (Dryness)
- Vātavaigunya (Improper function of Vata)
- Indriyānām rūkshatā (Dryness of sense organs)
- Roga-ashantaḥ (Disease does not get pacified)
 Sneha Nasya Lābha:
- स्नेिनाथम (भशरः ग्रीव स्कन्ध उर)
- बल जननाथम
- दृभष्ट प्रसादनाथम
 Yogya: वाि-भपत्तज ऊ्वमजत्रर्

ु ि रोग
- भशरोरोग, भशरोशूल
- नासरोग
- कर्मरोग, दारुर् कर्मशल ू , कर्मक्ष्वडे
- नेत्ररोग, भिभर्र
- र्ुखशोष, स्वरोपर्ाि, अवबािुक
- दन्ि-के श-श्र्श्रु पाि
- कपाल वभलि पभलि
 Dravya used for Sneha Nasya: वाि-भपत्त शर्न गर् द्रव्य

1) Vāta Shamana -> Kuṣṭha, Haridrā, Varūṇa, Balā, Atibalā, Sahachara, Eraṇḍa,
Arka, Shatāvarī, Punarnavā, Vāsukā, Bharṅgī, Vṛshchikāli, Yava, Kola, Kulattha,
Vidāri, Ashvagandhā, Dashamūla (Shyonaka, Patāla, Gambhārī, Bilva,
Agnimantha, Shālaparṇī, Pṛshniparṇī, Gokṣura, Bṛhatī, Kaṇṭakārī)
2) Pitta Shamana -> Chandana, Hribera, Ushīra, Mañjiṣṭha, Payasya, Vidāri,

Shatāvarī, Utpala, Dūrva, Mūrva, Kakola, Sāriva, Añjana, Nyagrodha, Tṛṇa
Pañchamūla (Kusha, Kāsha, Nāla, Darbha, Kaṇḍekṣu)
 Shirovirechana Nasya
1) र्ृदु
2) िीक्ष्र्
3) िीक्ष्र्िर्
1) मृदम धििोधविेिन
It is Marsha Nasya with Shirovirechana Gaṇa Dravya.
 Vidhi: The procedure is generally performed same as for Sneha Nasya, but
Dhūmapāna is not indicated as Pūrva- or Pashchātkarma. Also Nasya Kāla
is different -> िुक्तकाले अिुक्तवि् (At the time of lunch, but without having
eaten. Food is given after the procedure.)
Siddha Sneha Auṣadha is processed with Shirovirechana Dravya.
 Shirovirechana Dravya: (च - सू - २ / च - सू - ४ / सु - सू - ३९)

Apāmarga, Shuṇṭhī, Pippalī, Maricha, Viḍaṅga, Shigru, Sarṣapa, Elā,
Harenuka, Surasa, Shveta Aparajita, Shirisha bīja, Lashuna, Haridrā,
Dāruharidrā, Saindhava lavaṇa, Sauvarchala lavaṇa, Jyotishmatī, Karavīra,
Bimbī, Vachā, Karañja, Arka, Ativishā, Shṛṅgavera, Talīsā, Iṅgudī,
Mātuluṅgī, Jātī, Hiṅgu, Madya, Goshakṛt svarasa, Mūtra, Manaḥshila,
Haritāla
 Matra: i) अवर (4 Bindu)

ii) र््यर् (6 Bindu)
iii) उत्तर् (8 Bindu)
 Yogya:
- दबु मल, िीरु, स्त्री, सुकुर्ार, ऊ्वमजत्रर्ु ि कफज रोग
- िालु-कण्ठ-भशरः कफभस्थि
- भशरोगौरव, भशरोशल ू , अधामविेदक, अभिष्यन्द, अभधर्न्थ, अरुभच, जाड्मय,
कृ भर्, अपस्र्ार, प्रभिश्याय
 Samyagādi Lakṣaṇa: Same as for Sneha Nasya
In case of Shirovirechana Atyoga, additionally there may be
र्स्िल
ु ङु ् ग आगर् -> secretion of cerebrospinal fluid from nose known as
CSF rhinorrhea which is an emergency condition.
2) तीक्ष्ण धििोधविेिन
It is Shodhana type of Avapīḍa Nasya.
Avapīḍa Nasya is classified into:
a) स्िम्िन
b) शोधन
a) स्तम्भन अवपीड नस्य

 Vidhi: Similar as for Sneha Nasya; Dhūmapāna is not done.
 Stambhana Dravya: Vāsā svarasa, Shatāvarī svarasa, Dāḍimapuṣpa
svarasa, Sharkarodaka, Ikṣu svarasa, Nārī kṣīra, Gokṣīra
If Svarasa is obtained from Kalka of a specific Dravya (e.g. Vāsā patra), it is
also known as Kalka Nasya.
 Mātrā: Same as for Mṛdu Shirovirechana.
 Yogya: ऊ्वमगरक्तभपत्त, राजयक्ष्र्, षिषीर्
 Samyagādi Lakṣaṇa: Same as for Mṛdu Shirovirechana.
b) िोिन अवपीड नस्य

 Vidhi: Similar as for Sneha Nasya; Dhūmapāna is not done.
 Shirovirechana Dravya: Same as for Mṛdu Shirovirechana.
 Mātrā: Same as for Mṛdu Shirovirechana.
 Yogya: Same as for Mṛdu Shirovirechana. र्ेदो-कफ दभु ष्ट, सपमदशं भवसंज्ञा
3) तीक्ष्णतम धििोधविेिन
It is Pradhamana / Dhmāpana Nasya.
 Vidhi: Similar as for Sneha Nasya; Dhūmapāna is not done. Nāḍī Yantra is
used; it has a length of 6 Aṅgula (of patient) to forcefully blow Sūkṣma
Chūrṇa into the nostrils.
 Shirovirechana Dravya: Same as for Mṛdu Shirovirechana.
 Mātrā: 3 Mucchuti (3 pinches of patient = 1 Kola = 6 gm)
 Yogya: Same as for Mṛdu Shirovirechana.
भशरोभस्थि कफ, गलगण्ड, र्नोभवकार, उन्र्ाद, अपस्र्ार, कृ भर्, भवष
-> Nastaḥ Pracchardana is a term to denote the meaning of Shirovirechana. Its literal
translation means nasal emission. It was used by Āchārya Charaka (Ch. Sū. 1/85).
 Pratimarsha Nasya
Pratimarsha Nasya is the administration of Sneha Dravya into both nostrils in a small
dosage. It should be performed as part of Dinacharya to maintain the health.
Pratimarsha Nasya provides mild Shodhana and Snehana Karma. It can be administered
irrespective to seasonal or day time. It does not cause complications and its
administration procedure is simple. It is useful for preserving and promoting health, as
well as curing some diseases. It provides nourishment to Ūrdhvajatru Pradesha and
promotes normal functioning of the sense organs.
 Mātrā: 2 Bindu (each nostril)
 Dravya: Tila taila should be used for regular/daily application of Pratimarsha Nasya.
Shira is Kaphasthāna, hence other Sneha Dravya are not suitable for regular use.
Aṇu taila can be used as well; especially if Pratimarsha Nasya is used for treatment
of diseases.
 Pratimarsha Nasya Kāla: (According to Aṣṭāṅga Hṛdaya)

Partimarsha Nasya provides Sroto Shuddhi if administered after:
1) Nisha (the night; in the morning)
2) Aha (the day; in the evening)
3) Bhukta (eating)
4) Vānta (vomiting)
5) Svapna (sleep)
Partimarsha Nasya relieves Klama if administered after:

6) Adhva (long walk / travelling)
7) Shrama (exercise)
8) Retasa (ejaculation)
Partimarsha Nasya promotes Dṛgbala (eyesight) if administered after:

9) Shirobhyaṅga (oil massage on head)
10) Gaṇḍūṣa (withholding fluid in oral cavity)
11) Prasrāva (micturition)
12) Añjana (collyrium)
13) Varcha (defecation)
Partimarsha Nasya bestows Danta Dārḍhya (stability/strength of teeth) if

administered after:
14) Dantakāṣṭha / Dantadhāvana (cleaning of teeth)
Partimarsha Nasya pacifies Vāta Doṣa if administered after:

15) Hāsa (laughing)
 Yogya:
- Kṣatakṣīṇa, Bāla, Vṛddha, Sukhātma, Durbala
- Varṣa Ṛtu, Dinacharya
- Valita, Palita, Khālitya
- Manyāstambha, Shiroshūla, Ardita, Hanustambha, Ardhāvabhedaka, Shirokampa,
Tṛṣṇa, Mukhashoṣa
- Āshu Urdhvajatru Roga
 Ayogya:
- Duṣṭa Pīnasa - Pratimarsha Nasya is contraindicated due to excessive presence of
Doṣa. Doṣa are filled everywhere around the nose. Pratimarsha Nasya does
Bṛmhana Karma, so Doṣa will get further aggravated and Duṣṭa Pīnasa is not
relieved.
- Utkliṣṭa Doṣa, Bahu Doṣa
- After intake of Madya
- Abala Shrotra, Bādhirya (Sneha Nasya is indicated)
- Kṛmi (Shirovirechana Nasya is indicated)
 Differences between Marsha & Pratimarsha Nasya:
Marsha Nasya Pratimarsha Nasya

Uttama Mātrā = 10 Bindu Mātrā = 2 Bindu
Madhyama Mātrā = 8 Bindu
Hīna Mātrā = 6 Bindu
Shodhana, Shamana, Bṛmhaṇa Mṛdu Shodhana, Shamana, Bṛmhaṇa

depending on Dravya
Indicated in Chirakāri Roga Indicated in Āshukāri Roga
Indicated in Madhyama Avashta Indicated in Bāla, Madhyama & Vriddha Avastha

(age 7-80) in case of Bahu Doṣa Roga (all age groups), Alpa Doṣa, Durbala, Kṣatakṣīṇa,
Garbhinī, Sukhātma, Varṣa Ṛtu, Dinacharya
May cause complications Does not cause complications
Strong & quick acting Mild & slow acting
Curative Preventive & Curative
Pūrvakarma, Pashchātkarma, Parihāra Not specifically required

are essential
 Dhūmapāna
Dhūmapāna is the therapeutic procedure of inhaling medicated fumes produced by
medicinal drugs while subjecting them to heat.
It helps in prevention and elimination of diseases of Ūrdhvajatru Pradesha which are due
to Kapha and Vāta Doṣa.
Dhūmapāna through the nasal route is called Dhūma Nasya.
 Bheda:
A) According to Ā. Charaka: - 3
1) Prāyogika (Vāta-Kapha shamana)
2) Vairechanika (Kapha haraṇa)
3) Snaihika (Vāta shamana)
B) According to Ā. Sushruta: - 5
1) Prāyogika (Vāta-Kapha shamana)
2) Vairechanika (Kapha haraṇa)
3) Snaihika (Vāta shamana)
4) Kāsaghna (Kāsa shamana)
5) Vāmanīya (Vamana karma)
C) According to Ā. Vāgbhaṭa: - 3
1) Snigdha / Mṛdu (Vāta shamana)
2) Madhya (Vāta-Kapha shamana)
3) Tīkṣṇa (Kapha haraṇa)
D) According to Ā. Shārṅgadhara: - 5
1) Shamana (Vāta-Kapha shamana)
2) Bṛmhaṇa (Vāta shamana)
3) Rechana (Kapha haraṇa)
4) Kāsahara (Kāsa shamana)
5) Vāmana (Vamana karma)
 Dhūmapāna Dravya:
1) Prāyogika: Elā, Māṁsī, Tvak, Patra, Nāgapuṣpa, Priyaṅgu, Hareṇuka, Madhuka,
Guggulu, Sarjarasa, Guggulu, Shilājatu, Ushīra, Devadāru, Keshara, Lodhra,
Nyagrodha, Utpala, Plakṣa, Udumbara, Ashvattha, Tagara, Kuṣṭha, etc.
2) Vairechanika: Tīkṣṇa Dravya; Shuṇṭhī, Maricha, Pippalī, Viḍaṅga, etc.
3) Snaihika: Tila, Shigru, Bibhītakī, Madhucchiṣṭa, Sarjarasa, Guggulu, Madhuka,
Musta, Elavāluka, Madana, Ushīra, etc.
4) Kāsaghna: Bṛhatī, Kaṇṭakārī, Shuṇṭhī, Maricha, Pippalī, Hiṅgu, Guḍūchī, etc.
5) Vāmanīya: Madanaphala, Jīmūtaka, Ikṣvāku, Vatsaka, Dhāmārgava, etc.
 Dhūmapāna Kāla:
A) According to Charaka Saṁhitā:
1) Snātvā (after bathing)
2) Bhuktvā (after eating)
3) Samullikhya (after tongue scrapping)
4) Kṣutvā (after sneezing)
5) Dantānnighṛṣya (after cleaning the teeth)
6) Nāvanānte (after Nasya karma)
7) Añjanānte (after collyrium)
8) Nidrānte (after sleeping)
B) According to Aṣṭāṅga Hṛdaya:

1) Mṛdu Dhūmapāna is administered after Kṣavathu, Jṛmbha, Viṭ-Mūtra pravṛtti,
Strī sevā, Shastra (surgery), Hāsa, Dantadhāvana.
2) Madhyama Dhūmapāna is administered after dinner, Nāvana and same

conditions as mentioned under Mṛdu Dhūmapāna.
3) Tīkṣṇa Dhūmapāna is administered after Nidrā, Nasya, Añjana, Snāna and

Vamana karma.
 Dhūmanetra:
Dhūmanetra is the Nāḍī Yantra which is used for Dhūmapāna Vidhi. It is a straight,
tubular instrument.
The proximal end should have the width of a little finger with an opening of the size
of a green pea (Kalāya).
The distal end should have the width of a thumb with an opening of the size of a
horse gram (Kulattha).
Length: A) According to Charaka Saṁhitā:

i) Prāyogika = 36 aṅgula
ii) Vairechanika = 24 aṅgula
iii) Snaihika = 32 aṅgula
B) According to Sushruta Saṁhitā:

i) Prāyogika = 48 aṅgula
ii) Vairechanika = 24 aṅgula
iii) Snaihika = 32 aṅgula
iv) Kāsaghna = 16 aṅgula
v) Vāmanīya = 16 aṅgula
 Yogya:
Kāsa, Shvāsa, Pīnasa, Visvaratva (hoarsness of voice), Pūtigandha (halitosis),
Keshadoṣa, Kehsapātana, Karṇa-Āsya-Akṣi Srāva, Kaṇḍū, Arti, Jāḍya, Tandrā,
Hidhmā/Hikkā, Shirogaurava, Shiroshūla, Ardhāvabhedaka, Karṇashoola,
Netrashūla, Galagraha, Putīnasya, Manyāgraha, Kṛmi, Atinidrā, Danta Daurbalya,
Khālitya, Palita, Kṣavathu
 Ayogya:
- Pitta duṣṭi, Rakta duṣṭi
- Udara, Meha, Timira, Ūrdhvānila, Ādhmāna, Rohiṇī, Pāṇḍuroga
- Shirasya abhihate (head injury)
- Virikta (those who have undergone purgation)
- Datta-Bastiṣu (those who were given Basti)
- Jāgarite Nishi (those who kept awake at night)
- After consuming Matsya, Madya, Dadhi, Kṣīra, Kṣaudra, Sneha, Viṣa
 Dhūmapāna Vidhi:
The patient should be seated comfortably and sit upright while focusing on the
procedure only.
According to Ā. Vāgbhaṭa, medicated fumes should be inhaled through both

nostrils alternately, while keeping the other one closed and the mouth open.
However, if the Doṣa located in the nose and head are not in Utklesha Avastha, for
Utkleshanārtha, fumes are first inhaled through the mouth. Then they are inhaled
through the nose.
If Doṣas are residing in the throat, for Utkleshanārtha, fumes are first inhaled
through the nose, then through the mouth.
According to Ā. Charaka, medicated fumes should be inhaled through the nose if

Doṣas are located in Shiraḥ, Ghrāna or Akṣi; and through the mouth if Doṣas are
located in Kaṇtha or Mukha.
According to Ā. Sushruta:
i) Prāyogika Dhūmapāna - through the nose
ii) Vairechanika Dhūmapāna - through the nose
iii) Snaihika Dhūmapāna - through the mouth & nose
v) Kāsaghna Dhūmapāna - through the mouth
vi) Vāmanīya Dhūmapāna - through the mouth
The fumes should always be exhaled through the mouth. Exhalation through the
nose (Pratiloma Gati) will lead to Netraroga / Dṛk-vighāta.
(Conclusive, Dhūma Nasya is only of 3 types: Prāyogika, Vairechanika, Snaihika)

 Dhūmapāna Mātrā:
1 time = 3 inhalations & exhalations
1) Prāyogika = 2 times
2) Vairechanika = 3-4 times in Kapha vṛddhi / Until Kapha Nirharaṇa
3) Snaihika = 1 time in Vāta vṛddhi
 Samyak Dhūmapāna Lakṣaṇa:

- Hṛt-Kanṭha-Indriya Saṁshuddhi
- Shirasaḥ-Ura-Kaṇṭha Laghutva
- Doṣa shamana, Kapha Tanuta (liquification of Kapha)
 Ayoga Dhūmapāna Lakṣaṇa:

- Avishuddha Svara
- Sa Kapha Kaṇṭha
- Stimita Mastaka (rigidity of head)
 Atiyoga Dhūmapāna Lakṣaṇa:

- Tālu-Mūrdha-Kaṇṭha Shuṣkatā
- Tṛṣṇā
- Muhyate (being perplexed, confused)
- Raktasrāva
- Adhika Srāva (excessive lacrimation)
- Shirobhrama
- Mūrcchā
- Indriya Upatapyante (disturbance of sense organs)
 Upadrava:
Raktapitta, Āndhya, Bādhirya, Tṛṣṇā, Mūrcchā, Mada, Moha, Shirobhrama
Chikitsā = Shītopchāra, Sarpi pāna, Snaihika Nāvana, Añjana, Tarpaṇa
CHAPTER VIii: raktamokshana
 Introduction
Raktamokṣaṇa is a type of Shodhanakarma. It is a blood cleansing procedure which is
mentioned as one of the Pañchakarma according to Ā. Sushruta and Ā. Vāgbhaṭa.
Ā. Charaka has mentioned the procedure, but did not include it under Pañchakarma.
Same as the other Shodhanakarma, Raktamokṣaṇa may be done for preventive or
curative purpose.
 Nirukti & Paribhāṣā:

Rakta = Blood
Mokṣaṇa = Releasing
Raktamokṣaṇa is the therapeutic procedure of releasing blood from the body.
रक्तस्य र्ोषर्ं रक्तस्रावः ।
 Paryāya: Shoṅitamokṣaṇa, Raktanirharaṇa, Raktaharaṇa, Raktasravaṇa, Raktasrāva,

Asravisṛti, Avasechana
 Mahatva:
- Raktamokṣaṇa is the best method to purify vitiated Rakta Dhātu.
- Those who undergo Raktamoḳsaṇa regularly at proper time will not be afflicted
with Tvakroga, Granthi, Shopha and other Raktaja Vikāra.
- In Shalya Tantra, Raktamokṣaṇa by Sirāvyadha is considered as half the treatment
or even complete treatment for diseases, same as Basti Karma is in Kāyachikitsā.
- Among all Shodhana Karma, Raktamokṣaṇa is the best for treating skin diseases.
- In Visarpa, Raktamokṣaṇa is the best treatment. It alone produces the same effect
as all other therapies combined.
 General Principles & Rules:

1) Raktamokṣaṇa should be done according to the strength of Rogi, Roga and
Āshaya (site of structure from where blood is released). The blood flows easily
and properly out from vessels of located in the limbs; less so from the head.
2) If Raktasrāva does not occur properly, vitiated blood should be removed again
either on the same day in the evening or on the next day. If the blood is
excessively vitiated, Raktamokṣaṇa should be done again after a fortnight.
3) Raktamokṣaṇa Kāla:
- Raktamokṣaṇa should be performed in moderate climatic conditions; neither
too hot nor too cold.
- It should be done during the day when the sun is visible.
- During Sharada Ṛtu, Rakta tends to get vitiated so Raktamokṣaṇa is indicated.
- During Varṣa Ṛtu, it should be done when the sky is clear.
- During Grīṣma Ṛtu, it should be done when the atmospheric temperature is
comparatively low (morning or evening).
- During Shīta Kāla (Hemanta & Shishira Ṛtu), it should be done during mid-day.
4) Raktamokṣaṇa should not be done on persons who are below the age of 16 or
above the age of 70 years.
5) Rakta is Jīvasthāna. So one should always take care not to cause Atiyoga of
Raktamokṣaṇa. Additionally, due to excessive Raktamokṣaṇa, Vāta gets
aggravated. Therefore, extra special care should be given if the patient is
afflicted with Vātavyādhi.
 General Indications:
Kuṣṭha, visarpa, Piḍaka, Raktapitta, Asṛgdara, Guḍapāka, Meḍhrapāka, Mukhapāka,
Plīhā, Gulma, Vidradhi, Nīlikā, Vyaṅga, Piplu, Tilakālaka, Dadru, Charmadala,
Shvitra, Pāma, Asramaṇḍala, Akṣirāga, Puṣṭyasyagandhatā, Upakusha, Raktameha,
Vātarakta, Vaivarṅya, Agnimāndya, Gurugatratā, Santāpa, Aruchi, Shiroruja,
Annapāna vidāha, Tiktodgāra, Amlodgāra, Kaṭūdgāra, Klama, Krodhādhikyatā,
Buddhisammoha, Lavaṇāsyatā, Sveda, Sharīra daurgandhya, Mada, Kampa,
Svarakṣaya, Atinidra, Ati-tamodarshana, Kaṅḍū, Kotha, Mashaka, Nyaccha,
Indralupta, Arbuda, Aṅgamarda, Upajihvikā, Raktatvak, Raktanetratā,
Raktamūtratā, Bhrama, Arsha, Apachī, Dantapuppuṭa, Dantaveṣṭa, Granthi,
Galashūla, Shlīpada, Ūrustambha
 General Contraindications:
Bāla, Vṛddha, Garbhinī, Sūtikā, Abhukta, Daurbalya, Asvinna, Atisvinna, Sarvāṅga
Shopha, Kṣīṇa, Pāṅḍuroga, Udara, Mūrcchā, Chardi, Shoṣa, Shvāsa
 Vargīkaraṇa / Prakāra:
1) Shastra kṛta visravaṇa
a) Sirāvyadha
b) Pracchāna
2) Anushastra kṛta visravaṇa

a) Jalaukāvacharaṇa
b) Shṛṅgāvacharaṇa
c) Alābū-avacharaṇa
d) Ghaṭīyantrāvacharaṇa
 Sirā
Sirā is the Upadhātu of Rakta Dhātu. It is one of Pitṛja Bhāva.
It is the vessel which carries Ashuddha Rakta and where continuous motion is present.
Sirā origin from Nābhī and spread all over the body.
 Bheda & Saṅkhyā:
Bheda Mūla Sirā Saṅkhyā

Vātaja 10 175
Pittaja 10 175
Kaphaja 10 175
Raktaja 10 175
 Aṅga & Saṅkhyā: - 700
Aṅga Bheda Saṅkhyā

Shākhā 4 x 25 = 100 4 x 100 = 400
Madhyasharīra 4 x 34 = 136 136
Shira 4 x 41 = 164 164
- - 700
 Avedhya Sira: - 98
Avedhya Sirā are the vessels which should not be punctured.
Aṅga Saṅkhyā
Shākhā 16 / 400
Madhyasharīra 32 / 136
Shira 50 / 164
- 98 / 700
 Sirāvyadha
The surgical procedure of puncturing or sectioning a vein for therapeutic purpose and
thereby accomplishing Raktamokṣaṇa is called Sirāvyadha.
It should be done in people who are physically strong and not afraid of the procedure.
The vein which is near the site of the lesion or disease is most ideal for Sirāvyadha.
It is preferred to perform this procedure in the morning after taking light and liquid diet.
 Yogya: Visarpa, Vidradhi, Plīhā, Gulma, Agnimāndya, Jvara, Mukharoga, Netraroga,

Mada, Lavaṇāsyatā, Kuṣṭha, Vātarakta, Raktapitta, Kaṭūdgāra, Amlodgāra, Bhrama
 Ayogya:
Bāla, Vṛddha, Bhīru, Garbhinī, Rūkṣa, Kṣatakṣīṇa, Shrama, Madyāpa, Klība,
Adhva-karshita, Strī-karshita, Vāmita, Virikta, Asthāpita, Anuvāsita, Jāgarita,
Karshya, Kāsa, Shvāsa, Shoṣa, Pravṛddha Jvara, Ākṣepaka, Pakṣāghāta, Upavāsa,
Pipāsā, Mūrcchā
 Vidhi:
1) Pūrvakarma
- Preparation of equipments: Intravenous cannula, 20 cc syringe, tourniquete,
Kidney tray, Disinfectants, Cotton swab, Bandage material, Madhuka chūrṇa
- Snehapāna (to be done 2-3 days before the procedure)
- Abhyaṅga & Bāṣpa Svedana (to be done on the day of the procedure)
- Laghu & Drava Āhāra (E.g.: Yavāgū)
2) Pradhānakarma
- The patient should be placed in a comfortable position so that the vein which
is to be punctured can be approached easily. Supine position is in most
occasions the best choice.
- The circulation in the selected vein is blocked by applying a tourniquet just
proximal to the site which will be punctured.
- The site is painted with aseptic solution.
- The vein is slightly stroked by releasing the index finger from the thumb to
make it more distended.
- The engorged vein is punctured with the IV cannula. It is inserted into the
vein to its fullest length. The needle within the cannula is removed. This will
lead to release of blood from the vein. Blood flow is allowed until it stops by
itself; or until a maximum amount of 540 ml (1 prāṣṭha) of blood is drained.
- The cannula is removed and the punctured site is bandaged after applying
the powder of Madhuka (Glycyrrhiza glabra).
3) Pashchātkarma
- Pathya: Laghu Āhāra, Dīpana, Vishrāma
- Apathya: Atishīta & Atyuṣṇa Āhāra, Guru Āhāra, Adhyashana, Māruta, Agni,
Ātapa sevana, Krodha, Shokādi, Vyāyāma, Divāsvapna, Travelling, Continuous
studying, Continuous sitting in the same position
 Samyak Vidda Lakṣaṇa:
- Svayameva avatiṣthate (bleeding from the punctured site stops by itself)
- Lāghava (feeling of lightness)
- Vedanā shānti (remission of the pain)
- Vyādhirvega parikṣaya (remission of the disease)
- Manoprasāda (feeling of serenity)
 Upadrava & Chikitsā:

1) Ayoga / Hīnayoga Vidda
a) Nidāna:
- If Sirāvyadha is done on a cloudy day or if it is done in a windy place.
- If Pūrvakarma is not done properly (Snehana, Svedana).
- If puncturing is done improperly.
- If Sirāvyadha is performed after intake of Guru Āhāra.
b) Lakṣaṇa: Shopha, Dāha, Rāga, Pāka
c) Chikitsā: Elā, Kuṣṭha, tagara, Pāṭhā, Bhadradāru, Viḍaṅga, Chitraka,

Trikaṭu, Āgāradhūma, Haridrā, Arkāṅkura, Naktamāla phala; either 3 or 4
or as many as available of these Dravya should be powered, mixed with
plenty of Lavaṇa and Taila, and rubbed on the punctured site. This will
cause proper flowing of Rakta.
2) Atiyoga Vidda
a) Nidāna:
- If Sirāvyadha is done when there is excessive heat.
- If there was Atiyoga of Svedana.
- If the vein is punctured excessively.
- If blood is allowed to flow out excessively by an unskilled, inexperienced
or ignorant physician.
b) Lakṣaṇa: Shiro-abhitāpa, Āndhya, Adhimantha, Timira, Dhātukṣaya,

Ākṣepaka, Pakṣāghāta, Ekāṅgaroga, Tṛṣṇa, Dāha, Hikkā, Shvāsa,
Pāṇḍuroga, Maraṇa
c) Chikitsā: Lodhra, Madhuka, Priyaṅgu, Gairika, Sarjarasa, Shālmalī puṣpa,

Shaṅkha, Shukti, Māṣa, Yava and Godhūma should be powdered above
the the punctured site and pressed with the tip of the finger. The patient
should be covered with a moist cloth, kept in a cold room, treated with
Shīta Upanāha and Pariṣeka; or the are may be burnt (cauterized) either
by Kṣāra or Agnikarma.
Modern Management: Ligation of the punctured vein, hemostatic drugs,

blood transfusion if needed.
 Sirāvyadha Sthāna:
Roga Sirāvyadha Sthāna

Vātarakta, Pādadārī, Pādadāha, Avabāhuka, 2 aṅgula above Kṣipra Marma
Chippa, Visarpa, Vātakantakā, Vicharchikā
Kroṣṭukashirṣa, Khañja, Paṅgu, Vātavedanā 4 aṅgula above Gulpha Sandhi
Gṛdhrasī 4 aṅgula either above or below Jānu Sandhi
Vishvachi 4 aṅgula either above or below Kūrpara Sandhi
Apachī 2 aṅgula below Basti Marma
Galagaṇḍa Urumūla Sirā
Plīhāroga Sirā near Vāma Kūrpara Sandhi (left elbow joint),
between Anāmikā (ring finger) and Kaniṣṭhā (little finger)
Yakṛtodara, Kaphodara, Shvāsa Sirā near Dakṣiṇa Kūrpara Sandhi (right elbow joint),
between Anāmikā and Kaniṣṭhā
Pravāhikā, Shūla Sirā present 2 aṅgula around Shroṇi
Parivartikā, Upadaṁsha, Shukra roga, Meḍhramadhya Sirā
Shukra Doṣa
Mūtravṛddhi Sirā behind Meḍhra
Jalodara 4 aṅgula below and to the left of Nābhī
Antarvidradhi, Pārshvashūla Sirā between Kakṣa (armpit) and Stana (breast)
Jihvā and Danta roga Jihvā Adhobhāga Sirā
Tālu roga Tāulgata Sirā
Karṇa roga Karṇa Ūrdhvagata Sirā
Mukha roga Sirā near Tālu, Oṣṭha, Hanu, Jihvā
Nāsā roga Nāsāgra Sirā
Pīnasa Sirā between Nāsā and Lalāṭa
Vātaja Shlīpada 4 aṅgula above Gulpha Sandhi
Pittaja Shlīpada 4 aṅgula below Gulpha Sandhi
Kaphaja Shlīpada 4 aṅgula above Kṣipra Marma
 Pracchāna
The therapeutic procedue of incising the skin superficially and thereby accomplishing
Raktamokṣaṇa is called Pracchāna.
 Yogya:
- Piṇḍita Rakta (congestion of blood), Indralupta, Kṣudrakuṣṭha, Tvakroga,
Utsedhyukta Vraṇa
- As Pūrvakarma for Shṛṅga, Alābū or Ghaṭīyantra Avacharaṇa
 Ayogya:
- Before or after Sirāvyadha / Jalaukāvacharaṇa
- Marmasthāna
 Vidhi:
1) Pūrvakarma
- Preparation of equipments: Scalpel blade, cotton swab, Gauze piece,
Disinfectants, Madhuka chūrṇa
- No specific preparation of the patient is necessarily needed. However,
Snehana and Svedana can be done to improve the effect of Pracchāna.
Snehapāna (Hīna Mātrā; for 2-3 days before the procedure)
Abhyaṅga & Bāṣpa Svedana (on the day of the procedure)
2) Pradhānakarma
- The site of the lesion where incision will be made is painted with disinfectant.
- With a scalpel, a straight (Ṛju) incision is made which should neither be too
deep (̣Nāti gambhira) nor too shallow (Nāti uttāna). The depth is
approximately 2 mm. The incision is always made from the distal part to the
proximal part of the body. Similar incisions are made parallel to the earlier one
involving the complete area of the lesion; the incesions should not be done
obliquely (Na tiryak).
- While incising, Sirā, Snāyu and Sandhi should be avoided.
- When the bleeding stops, the incised site is bandaged after applying the
powder of Madhuka (Glycyrrhiza glabra).
3) Pashchātkarma
Same as for Sirāvyadha
 Upadrava & Chikitsā:

Excessive bleeding: Dravya should be applied which are Kaṣāya, Shīta and
Stambhaka. If bleeding does not stop, Pāchana should be done with Shaṅkha
Bhasma.
 Jalaukāvacharaṇa
Jalauka refers to the leech. Jalaukāvacharaṇa is a method of accomplishing
Raktamokṣaṇa by applying the leech to a specific site and allow it to suck vitiated blood.
For this purpose, only the non-poisonous (Nirviṣa) leeches are used.
 Jalauka Vargīkaraṇa:
A) Based on Poison
1) Saviṣa Jalauka
i) Kṛṣṇā
ii) Karburā
iii) Algardā
iv) Indrāyudhā
v) Sāmudrikā
vi) Gochandanā
Originate from decomposed urine and feacel matter of toads and poisonous
fish, in ponds of stagnant and turbid water.
General characters: Thick and elongated middle portion, Both ends are thin,
Slow moving, Fatigues quickly, Sucks slowly and little quantity of blood.
2) Nirviṣa Jalauka
i) Kapilā
ii) Piṅgalā
iii) Shaṅkhmukhī
iv) Mūṣikā
v) Puṇḍarīkamukhī
vi) Sāvarikā
Originate from decomposed vegetable matter, decayed stems of several

aquatic plants such as Padma, Utpala, Nalina, Kumuda, Pundarika, etc. found in
clear water.
General characters: Strong and large bodied, “Greedy” (start sucking readily
and a lot of blood), Round, Blue colored lining on the dorsal side of the body.
B) Based on Gender
1) Puruṣa Jalauka
Hard skin, big head along with semi-lunar look with a large front portion.
Indicated in highly vitiated Doṣa and Jīrṇa Roga.
2) Strī Jalauka
Delicate, thin skin, small sized head, the lower body is large.
Indicated in Alpa Doṣa and Āshu Roga.
 Yogya:
- Sāmānya Raktamokṣaṇa Yogya
- Rakta vitiated by Pitta Doṣa
- Bāla, Vṛddha, Sukūmāra, Garbhinī, Bhīru
- Gulma, Arsha, Vidradhi, Vātarakta, Galāmaya, Netraruk, Viṣa-daṁṣṭa,
Visarpa, Kuṣṭha, Shiroshūla
 Vidhi:
1) Pūrvakarma
i) Preparation of equipments: Nirviṣa Jalauka (3-4), Cotton swab, Gauze piece,
Kidney tray, Needle, Saindhava Lavaṇa, Haridrā chūrṇa, Madhuka chūrṇa
ii) Preparation of the leeches: Water is kept in a kidney tray and mixed with
about two spoons of Haridrā chūrṇa. The leeches are placed in the tray.
The leeches become very active. They are kept in the turmeric water for about
48 mintues and are then shifted to another kidney tray containing clear water.
iii) Preparation of the patient: No specific preparation of the patient is

necessarily needed. However, Snehana and Svedana can be done to improve
the effect of Jalaukāvacharaṇa.
2) Pradhānakarma
Jalaukāvacharaṇa should be done during the morning time.
i) Virukṣaṇa Chikitsā is done on the expected site of leech application. This is
done by rubbing dry powder of properly cleaned soil or cow dung. It is
essential to remove the oiliness because the leeches may not attach if the site
is greasy.
ii) Application of Jalauka: Jalauka is picked up between the thumb and index
finger, and its mouth is held close to the application site. The leech may be
grasped between the fingers with a cotton or gauze piece. If the leech fails to
attach itself, then a drop of milk or blood may be placed on the site. If even
this fails, a small puncture is made with a needle to cause bleeding, and the
leech is applied.
iii) Observation & Care: When the leech starts sucking the blood, rhythmic
wavy movements of its body are seen. It should then be covered by a wet
gauze piece. While draping the leech, the mouth portion is kept free. At
frequent intervals, small amount of water is poured on the leech to keep it
moist and cool. As the leech continues sucking, one can observe the wavy
movements in its body as well as increase in its dimension.
Jalauka only sucks vitiated blood, just like a swan drinks only the milk from a
mixture of milk and water. When it completes sucking, it falls off by itself.
When itching and pain occur at the site of leech application, it indicates that
Jalauka started sucking pure blood. If it does not detach independently,
Jalauka should be removed by sprinkling Saindhava Lavaṇa or Haridrā chūrṇa
over its mouth.
3) Pashchātkarma
i) Care of Vraṇa: As the saliva of the leech contains hirudin and anticoagulant,
even after the leech separated, bleeding continues. Therefore, as soon as the
leech detaches, bleeding should be arrested. After cleaning the site and
dusting with Madhuka chūrṇa, the wound is bandaged tightly.
ii) Care of Jalauka: In a kidney tray, about one spoon of Haridrā chūrṇa or
Saindhava Lavaṇa is kept. The leech is grasped between the thum and index
finger, and its mouth is made to touch the Haridrā chūrṇa or Saindhava
Lavaṇa. Sooner or later, the leech starts vomiting the blood. Leech is allowed
to expel as much as possible. When it stops vomiting, the remaining portion of
the blood is squeezed out. This is done by grasping the tail end between
thumb and index finger, and the body of the leech is squeezed from the tail
towards the mouth. The leech is then placed in clean water, and becomes
more active again.
If the leech is not made to vomit the vitiated blood, it is likely to die.
If it is made to vomit properly, the leech may be reused for Raktamokṣaṇa
after about one week. Jalauka should always be handled gently.
 Upadrava:
Complications mainly occur if Saviṣa Jalauka is mistakenly used for Raktamokṣaṇa.
Lakṣaṇa: Atimātra Shvayathu, Kaṇḍū, Mūrcchā, Jvara, Dāha, Chardi, Mada, Sadana
Chikitsā: Viṣa Nāshaka Chikitsā, Raktapitta prashamana
Indrāyudhā = Asādhya; it leads to Mahāgada

 Shṛṅgāvacharaṇa
Shṛṅga refers to the horn of a cow which is hollow and can be used for Raktamokṣaṇa.
The broad end applied to the skin during the procedure. At the narrow tip, a hole is
made which is then coered with a cloth. The mouth is applied and air from the horn is
sucked to create a vacuum and promote bleeding.
Alternatively, the hole in the tip of the horn is fitted with a rubber tube, which again is
fitted with a 50 ml syringe; a vacuum is created by withdrawing the piston of the syringe.
 Yogya:
- Rakta afflicted with Vāta Doṣa or Vāta-Pitta
- Raktaduṣti is restricted to Tvak
 Ayogya: Rakta afflicted with Kapha Doṣa
 Vidhi:
1) Pūrvakarma
- Preparation of equipments: Shṛṅga fitted with tube and syringe, Scalpel
blade, Cotton swab, Gauze piece, Madhuka chūrṇa
- Snehana and Svedana can be done to improve the effect.
- Pracchāna
2) Pradhānakarma
- When bleeding occurs, the broad end of Shṛṅga is applied on the incised site.
- It is firmly pressed against the skin, and the piston of the syringe is withdrawn
to create a vacuum and promote the flow of blood. After several minutes, the
piston is released and Shṛṅga is removed.
- The wound is cleaned and bandaged after applying Madhuka chūrṇa.
3) Pashchātkarma
 Alābū-avacharaṇa
Alābū refers to the bitter bottle gourd (Lagnaria vulgaris).
The ideal Alābū should be 12 aṅgula in length, 18 aṅgula in circumference, with and
opening of 3-4 aṅgula wide.
It is made hollow by removing its soft core after making a hole at its tip, dried in the sun,
and painted with varnish internally. It can then be used for Raktamokṣaṇa.
 Yogya:
- Rakta afflicted with Kapha Doṣa
- Piṇḍita Rakta
- Lesions involving deeper structures
 Vidhi:
1) Pūrvakarma
- Preparation of equipments: Alābū, Scalpel blade, Cotton swab, Gauze piece,
Taila, Jātyādi taila, Madhuka chūrṇa
- Snehana and Svedana can be done to improve the effect.
- Pracchāna
2) Pradhānakarma
- When bleeding occurs, the cotton swab is soaked in oil, ignited and placed
inside the Alābū. Now the mouth of the Alābū is applied by holding it
horizontally so that the flame of the burning cotton does not come in contact
with the body. The cotton burns as long as oxygen is available. As it removes
the oxygen, a vacuum is generated in the Alābū which draws blood from the
incised wounds. After some time, Alābū is removed.
- The site is cleaned with Jātyādi taila and bandaged after applying Madhuka
chūrṇa.
3) Pashchātkarma
 Ghaṭīyantrāvacharaṇa
Ghaṭīyantra is described as a Nāḍīyantra by Ā. Vāgbhaṭa. It is an earthen instrument with
a larger rounded base and a tubular upper portion used for Raktamokṣaṇa in the same
way as Alābū-avacharaṇa.
 Yogya: Rakta afflicted with Pitta Doṣa, Piṇḍita Rakta

CHAPTER IX: Emergency management of
Complications
 Water & Electrolyte Imbalance

 Clinical Manifsestation:
Weight loss, Thirst, Orthostatic changes in pulse rate and BP, Weak and rapid pulse,
Decreased urine output, Dry mucous membranes, Poor skin tugor
 Prevention of loss & Restoration of Electrolytes:

Coconut water, Celery, Watermelon, Cucumber, Kiwi, Bell peppers, Citrus fruit,
Carrots, Cultured dairy, Pineapple, etc.
 Management:
1) Diet therapy
2) Oral rehydration therapy (ORT): Solutions containing glucose and electrolytes.
E.g.: Pedialyte, Rehydralyte
3) IV therapy: IV therapy is the fastest way to replenish fluids and electrolytes in,
especially if he or she has a serious underlying medical condition and is too ill
to tolerate oral rehydration.
 Shock
A shock is a condition of acute circulatory failure.
It is characterized by prolonges hypotension leading to inadequate tissue perfusion.
All forms of shock result in reduction of effective blood flow (hypoperfusion). It leads to
reduced delivery of oxygen and nutrients, and further, dysfunction of cells.
 General Features:
- Pale, cold and moist skin
- Fast, thready pulse
- Shallow respiration
- Decreased BP
- Oliguria
 Types:
1) Hypovolemic shock
Hypovolemia is total decease in blood or fluid volume.
It may be caused due to severe haemorrhage, fluid loss due to vomiting and
diarrhoea, burns, dehydration.
Management:
Arrest bleeding, IV fluids, Oral rehydration, Treat underlying causes
2) Obstructive shock
It may be caused due to obstruction within veins, compression of heart or
pressure on vessels.
Management:
Heparin, Thrombolysis, Pericardiocentesis, Chest decompression, Chest
drainage
3) Cardiogenic shock
It is caused due to decreased cardiac output due to myocardial infarction,
valve dysfunction, dysrhythmias, cardiomyopathy, cardiac failure.
Management:
Early thrombolysis, Valve replacement surgery, Correction of dysrhytmias
4) Neurogenic shock
It is the result of autonomic dysregulation following spinal cord injury, usually
secondary to trauma. This dysregulation is due to a loss of sympathetic tone
and an unopposed parasympathetic response.
Management:
IV fluids, Vasopressors (norepinephrine, epinephrine, dopamine, vasopressin),
Atropine
5) Allergic shock
It is caused due to hypersensitivity manifesting as a shock; Anaphylaxis.
Management:
Epinephrine, Adrenaline, Chlorphenamine, Hydrocortisone, Bronchodilators,
Oxygen, Fluids, Prevention
6) Septic shock
It is caused due to sepsis in the body at any site. It leads to organ
hypoperfusion, further to multi-organ failure, resulting in acute respiratory
distress syndrome.
Management:
Initial resuscitation, Antibiotics, Identification of exact cause, Vasopressors,
Inotropic therapy
 General Management:
- Establish and maintain clear airways
- Ensure adequate ventilation
- Adequate intravenous access
- Continuous cardiac monitoring
- Urinary catheter
- Recording of fluid balance
- Centra venous monitoring
- Maintain optimum temperature
- Acid-base balance assessment
- Treatment of underlying disorder
 Hematochezia
Hematochezia or Rectal bleeding is the passage of fresh blood per rectum. It is generally
caused by bleeding from the lower gastrointestinal tract, but may occur in patients with
large upper GI bleeds or from small bowel lesions.
The causes of rectal bleeding range from benign to life-threatening disease and can
result in significant haemodynamic instability if not managed appropriately.
 Differential Diagnosis:
Fresh rectal bleeding most commonly results from a source in the rectum or colon,
however large upper GI bleeds can also present with haematochezia.
Common causes of acute lower GI bleeding include diverticular disease, ischaemic
or infective colitis, haemorrhoids, malignancy, angiodysplasia, Crohn’s disease or
Ulcerative colitis, or radiation proctitis.
Diverticulosis
Diverticulosis is the most common cause of lower gastrointestinal bleeding.
Diverticula are outpouchings of the bowel wall that are composed only of mucosa,
most commonly in the descending and sigmoid colon. The incidence of
diverticulosis increases with age. Diverticular disease bleeds are classically painless,
whilst diverticulitis associated bleeds are often painful, secondary to the localised
inflammation.
Haemorrhoids
Haemorrhoids are pathologically engorged vascular cushions in the anal canal that
can present as a mass, with pruritus, or fresh red rectal bleeding.
The blood is classically on the surface of the stool or toilet pan, rather than mixed
in with it. Large haemorrhoids can also thrombose, which can be extremely painful.
Malignancy
With any case of PR bleeding, especially in the elderly population, malignancy
should be suspected, as this may be a colorectal cancer.
In the assessment of any patient with haematochezia, it is important to enquire
about other lower GI symptoms, weight loss, or relevant family history, potentially
suggestive a diagnosis of malignancy.
 Diagnosis:
Patients with PR bleeding should initially be stratified as either stable or unstable.
Key aspects to ascertain from clinical assessment include:
- Nature of bleeding, including duration, frequency, colour of the bleeding, relation
to stool and defecation
- Associated symptoms, including pain (especially associated with defecation),
haematemesis, PR mucus, or previous episodes
- Family history of bowel cancer or inflammatory bowel disease
- Examine the abdomen for any localised tenderness or masses palpable. A PR
examination is essential for every patient presenting with haemotochezia, allowing
assessment for any rectal masses and ongoing presence of blood.
 Management:
95% of cases will settle spontaneously. Often young haemodynamically stable
patients, in who the bleeding has stopped and have a low risk score, can be
discharged and investigated as an outpatient.
Any unstable rectal bleed warrants urgent resuscitation, use of IV fluid and blood
products as required until stabilized.
Potential management options include:

- Endoscopic haemostasis methods include injection (typically diluted adrenaline),
contact and non-contact thermal devices (such as bipolar electrocoagulation or
argon plasma coagulation), and mechanical therapies (endoscopic clips and band
ligation).
- Arterial embolisation is possible in those with an identified bleeding point (termed
a “blush”) of sufficient size on angiogram.
Surgical Intervention: Surgical intervention is rarely required, however may be

considered in patients with ongoing lower GI bleeding with instability (or requiring
continued transfusion), where endoscopic and radiographic treatment has failed.
 Hematemesis
Hematemesis or vomiting blood is the regurgitation of stomach contents mixed with
blood or the regurgitation of blood only.
Vomiting blood can be caused for concern, but sometimes minor causes can trigger
it. This includes ingestion of blood following an injury to the mouth or a nosebleed.
These minor situations are unlikely to cause any damage in the long term.
Vomiting blood can also be caused by more serious conditions such as internal injury,
organ bleeding, or organ rupture.
Regurgitated blood may appear brown, dark red, or bright red in color. Brown blood
often looks like coffee grounds when vomited.
Darker blood shows that the bleeding is from an upper gastrointestinal source, such as
the stomach. Darker blood is a less intense and regular source of bleeding.
Bright red blood often shows an acute bleeding episode originating from the esophagus
or stomach. This can be a source of rapid bleeding.
 Management:
Patients with haematemesis can be extremely unstable. The first step in their
management is a rapid ABCDE assessment, to insert two large bore IV cannulas,
start fluid resuscitation if needed, and crossmatch blood.
Most cases will warrant an upper GI endoscopy (OGD), from which a range of
therapeutic options are available depending on the underlying causes suspected or
confirmed:
- Peptic ulcer disease requires injections of adrenaline and cauterisation of the

bleeding. High dose intravenous PPI therapy should be administered (e.g. IV 40mg
omeprazole) to reduce acid secretion +/- H. Pylori eradication therapy if necessary.
- Oesophageal varices management should be swift and performed at the same

time as active resuscitation, including the use of blood products and propylactic
antibiotics.
Endoscopic banding is the most definitive method of management.
Somatostatin analogues (e.g. octreotide) or vasopressors (e.g. terlipressin) should
also be started, acting to reduce splanchnic blood flow and hence reduce bleeding.
Long term management warrants repeated banding of the varices and long-term
beta-blocker therapy.
- An actively bleeding patient can also be treated with angio-embolisation, in which

the bleeding vessel is embolised. This is most commonly the gastro-duodenal artery
which is eroded into by an ulcer at the back of the first part of the duodenum.
 Epistaxis
Epistaxis refers to bleeding from the nose. In the vast majority, cases will terminate with
simple manoeuvres and minimal intervention. However, in a small proportion of
patients, epistaxis can lead to significant haemorrhage warranting urgent intervention.
Epistaxis can be caused from:

- Anterior bleeds originate from ruptured blood vessels in Little’s area, a highly-
vascularised region formed by the anastomosis of 5 arteries, and cause around 90% of
cases.
- Posterior bleeds originate from the posterior nasal cavity, typically from branches of
the sphenopalatine arteries of the nose, and cause around 10% of cases (more common
in older patients).
Every case of epistaxis should be initially approached as if severe, until deemed

otherwise. Indeed, a patient having a large bleed may be bleeding posteriorly and
swallowing a large volume of blood, therefore showing seemingly little external bleeding.
In cases of life-threatening epistaxis (large volume bleeds, haemodynamic

compromise, failure to stop post-intervention), an A to E approach to the patient is
essential; ensure appropriate airway-trained personnel are present, adequate IV access
obtained, and resuscitation with blood products if required.
 Management
Initial Management:
- The definitive management of ongoing epistaxis occurs in a stepwise manner.
All patients (even severe cases) should be kept sat up and sat forward, attempting
to ensure blood passes anteriorly and out through the nares (and not posteriorly
into the pharynx). Encourage the patient to spit out any blood in their mouth if
present.
- Compression should be applied to the anterior nose (the nares) for 20 minutes
without releasing pressure. Ice can be applied to the bridge of the nose to
stimulate further vasoconstriction.
- If unsuccessful, a thudichum can be used to inspect the septum. If an anterior
bleed point is identified, the vessel can be cauterised using silver nitrate.
The oropharynx should also be examined in all patients, to check for features of a
posterior bleed.
- If there is too much blood present to visualise the septum, adrenaline-soaked
gauze can be inserted into the nasal cavity to cause localised vasoconstriction and
soak-up any excess blood.
Further Management:
- If the epistaxis persists but no bleeding point is visualised, anterior packing should
be trialled, whereby a nasal pack is inserted into the nasal cavity. If this still fails to
control the bleeding, then a contralateral nasal pack can also be inserted.
- Ensure routine bloods (including FBC, clotting, and Group & Save) have been sent
and any reversible underlying causes (e.g. malignant hypertension, coagulopathies)
managed as require.
- If the epistaxis persists and bleeding is entering the oropharynx, posterior packing
with a Foley catheter is warranted. As before, if this fails to control the bleeding,
then a contralateral pack should be inserted.
Surgical Intervention:
If nasal packing fails to stop the bleeding, then contributing blood vessels can either
be ligated surgically or embolised radiologically.
The vessels that are targeted are usually the sphenopalatine artery, anterior
ethmoidal artery (never embolised due to its origin from the ICA), or the external
carotid artery (as a last resort).
CHAPTER X: physiotherapy
 Introduction to Physiotherapy
 Definition:
Physiotherapy is the science of treatment by exercise, massage, heat, light,
electricity or other physical agencies; use of drugs is avoided.
Physiotherapy, also referred to as physical therapy, involves evaluating, diagnosing

and treating a range of diseases, disorders and disabilities by using physical means.
 Utility of Physiotherapy:
Physiotherapy can be used in the diagnosis and management of a wide range of
injuries, disease processes, and other conditions, including:
Back and neck pain, Occupational injuriesm Amputee rehabilitation, Stroke
rehabilitation, Chronic airway disease, Postural problems, Arthritis, Spinal cord
injuries, Sciatica, Asthma management, Neurological conditions, Developmental
and pediatric problems, Impaired mobility, Incontinence, Sport injuries, etc.
 Importance of Physiotherapy:
- Physiotherapy is the most commonly prescribed treatment to assist in the
recovery of many injuries and conditions. Chronic pain, car and sports injuries and
challenges with mobility can all be greatly improved with the use of physiotherapy.
- Physiotherapy is a drug-free health care practice which can be helpful for

individuals of all ages to break down the barriers to physical function. It is used in
patients pre or post surgery, to help people to recover from a chronic illness, injury,
industrial or motor vehicle accidents, and in age related conditions.
- Physiotherapy relieves pain, improves joint mobility, increases strength and

coordination, and improves cardio-respiratory function.
- Physiotherapy also plays an important role in health promotion, disability and

disease prevention.
 Static / Isometric Exercise
Static exercises place tension on particular muscles without moving the surrounding
joints. By applying constant tension to the muscles. isometric exercises can be useful for
improving physical endurance and posture by strengthening and stabilizing the muscles.
Most muscle strengthening exercises involve moving the joints, using the muscles to
push or pull against resistance. However, isometric exercises involve holding static
positions for long periods of time.
There are two types of muscle contraction: isotonic and isometric.

Isotonic contractions occur when muscles become shorter or longer against resistance,
and tension remains the same. Isometric contractions occur when tension increases but
the muscle remains at a constant length.
Many strength building exercises involve concentric or eccentric movements, which

are both isotonic contractions. Concentric movements cause the muscle to shorten, and
eccentric movements lengthen the muscle.
Isometric exercises do not involve the muscles shortening or lengthening. During
isometric exercises, the joints are still, and the muscles do not change shape or size.
Some isometric exercises develop tension by holding the body in a certain position, while
others may involve holding weights. Holding the muscle contraction allows the muscle
tissue to fill with blood and create metabolic stress on the muscle. This can help improve
strength and endurance.
Advantages of isometric exercises is that they are fairly easy to perform, usually do not
require any equipment, and are easily incorporable into many weight lifting exercises.
 Benefits of Isometric Exercises:

- They are useful exercises for activating many muscle fibers at once.
- They require less practice to perform exercises with good form compared with
some dynamic movements.
- They are suitable for people with an injury or medical condition that restricts
movement.
- Some research suggests that isometric exercise training may be an effective way
to lower blood pressure.
- These exercises can improve muscle stability and the ability to hold weight over
longer periods.
- Some research suggests that isometric exercises may help with pain relief for
lower back pain, knee osteoarthritis, and neck pain.
 Examples: Plank, Wall sit, Glute bridge, Dead hang, Isometric squat
 Infrared Therapy
Infrared light is the heat people feel when exposed to the sun. The skin naturally radiates
infrared heat every day.
Low levels of visible or near infrared light is used for reducing pain, inflammation and
oedema, promoting healing of wounds, deeper tissues and nerves, and preventing tissue
damage.
One of the characteristics of infrared light is its ability to penetrate below the skin
layers, providing a much greater depth which is able to effectively provide pain relief. In
fact, this invasive, natural, and painless method can provide a vast range of health
benefits, without damaging the skin through UV radiation.
Infrared light penetrates to the inner layers of the skin at about 2 to 7 centimeters deep.
Hence, it reaches the muscles, nerves and even the bones. Many studies have shown
that a frequency of infrared light, with wavelengths from 700 to 1,000 nanometers, is
best used for healing inflammatory conditions.
Infrared therapy technology allows people to harness the benefits of the sun, without
being exposed to harmful ultraviolet rays. Also, infrared therapy is safe and effective,
without adverse side effects. As a matter of fact, infrared light is safe and is used even
for infants in the neonatal intensive care.
Infrared light is absorbed by the photoreceptors in cells. Once absorbed, the light energy
kickstarts a series of metabolic events, triggering several natural processes of the body
on a cellular level.
The key to the efficacy of infrared light therapy may be nitric oxide, a gas that is vital to
the health of the body’s arteries. Nitric oxide is a potent cell signaling molecule that
helps relax the arteries, battles free radicals to reduce oxidative stress, prevents platelet
clumping in the vessels, and regulates the blood pressure. Hence, this molecule
enhances blood circulation to deliver vital nutrients and oxygen to damaged and injured
tissues in the body. The increase in the blood flow to the different parts of the body
makes it possible for oxygen and nutrients to reach the cells, enabling them to function
properly and effectively. Hence, this therapy stimulates the regeneration and repair of
injured tissues, reducing pain and inflammation.
 Indications:
Arthritis, Rheumatoid arthritis, Back pain, Neck pain, Blunt trauma, Bursitis, Carpal
tunnel syndrome, Diabetic neuropathy, Fibromyalgia, Muscle sprains and strains,
Sciatica, Neuropathy, Temporomandibular joint pain (TMJ), Tendonitis
 Contraindications:
Areas having loss of sensation, Peripheral vascular disease, Eczema, Peptic ulcer,
Patient having hemorrhagic disease
 Diathermy
Diathermy is a therapeutic treatment that uses a high-frequency electric current to
stimulate heat generation within body tissues.
 Types:
1) Shortwave Diathermy (SWD)
Shortwave diathermy uses high-frequency electromagnetic energy to generate
heat. It may be applied in pulsed or continuous energy waves.
It promotes relaxation of muscles, relieves pain and is effective in bacterial
infections.
Indications:
Inflammation of shoulder joint or elbow join (Tennis Elbow), Cervical
spondylosis, Osteoarthritis, Lower back ache, Plantar fascitis, Sinusitis, Kidney
stones, pelvic inflammatory disease, sprains, strains, bursitis, tenosynovitis
Contraindications:
High fever, Fluctuating blood pressure, Sensitive skin, Cardiac pace maker,
Severe kidney and heart problems, Pregnancy, TB of bones, Malignant tumor
2) Microwave Diathermy
Microwave diathermy uses microwaves to generate heat in the body. It can be
used to evenly warm deep tissues without heating the skin. Since it cannot
penetrate deep muscles, it is best suited for areas that are closer to the skin,
such as the shoulders.
3) Ultrasound Diathermy / Ultrasonic Therapy

Ultrasound diathermy uses sound waves to treat deep tissues. Heat is
generated by the vibration of the tissue. This promotes blood flow into the
area. Ultrasound diathermy is used for:
Musculoskeletal sprains, strains, muscle spasms, joint contractures or
adhesions, neuromas
 Risks of Diathermy:
The electromagnetic energy used in shortwave and microwave diathermy can
cause extreme heat in metal devices such as bone pins, dental fillings, metal
sutures. This could cause burns in the tissue near the implant. The procedure
should not be used over these areas to avoid the risk of burning.
During diathermy treatment, the person becomes a part of the electrical field.
Touching a bare metal object, including a metal part of the diathermy cabinet, can
cause a shock or burn.
Diathermy is not considered safe for certain areas of the body. These include:
Eyes, ears, brain, spinal cord, heart, reproductive organs, genitalia
 Electromagnetic Therapy
Electromagnetic therapy or Magnetic field therapy uses different kinds of magnets on
the body to help boost the overall health or help treat certain conditions.
The human body and the earth naturally produce electric and magnetic fields.
Electromagnetic fields also can be technologically produced, such as radio and television
waves. Practitioners of magnetic field therapy believe that interactions between the
body, the earth, and other electromagnetic fields cause physical and emotional changes
in humans. They also believe that the body's electromagnetic field must be in balance to
maintain good health.
Practitioners apply magnetic field therapy to the outside of the body.

The magnets may be:
- Electrically charged, to deliver an electrical pulse to the treated area.
- Used with acupuncture needles, to treat energy pathways in the body.
- Static (not electrically charged) and stationary on the treated area for periods of time,
to deliver continuous treatment.
 Indications: Wound healing, Insomnia, Headaches, Fibromyalgia pain,

Back pain, Joint pain
 Contraindications: Cardiac pacemaker, Insulin pump, Pregnancy

 Wax Bath Therapy
Wax therapy, which uses a bath of molten paraffin wax, is one of the most effective ways
of applying heat to improve mobility by warming the connective tissues.
It is intended to moisturise, soften the skin, improve blood circulation, reduce pain of
joints, relax muscles and relieve stiffness.
 Procedure:
1) Melt the wax in the paraffin wax bath and allow the wax to cool a little.
2) Wash the hands, feet or other application are thoroughly before application.
3) Test on a small area to make sure the temperature is suitable.
4) Dip the hands or feet into the wax and then completely remove them. Allow
the wax to begin solidifying. Rapidly re-dip for another few seconds and
remove again. Separate the fingers or toes before dipping to allow the wax to
coat all around them.
Repeat the process until four or five layers are formed. Then rapidly wrap the
hand with one of the following:
Plastic liner, Foil, Greaseproof paper, Roasting bag
When they are in place, put hand or foot inside a mitten or use an old towel
and wrap it around.
5) Leave the mitten or the towel for approximately 20-30 minutes.

6) Peel off the wax and make it into a ball, exercising the fingers by gripping and
un-gripping the wax before returning it to the pan for future use.
7) Moisturise the hands/feet using emollients or moisturisers.
8) Continue to exercise the joints for at least ten minutes after the procedure.
It is suggested to use the wax 3 times a week.

The wax should not come in direct contact with an open wound or ulcer.

पञ्चकर्म​ Part B

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पञ्चकर्म​ Part B

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पञ्चकर्म

Basti karma is the therapeutic procedure in which Auṣadha Dravya is administered

Age Length (aṅgula)

If Basti of animals is not available, leather or a thick cloth may be used

The enema can/pot with capacity of 1200 ml is commonly used for

Enema syringe is commonly used for administering Sneha Basti.

Praṇetṛta Doṣa Administration Defect Upadrava Chikitsā

B) On the basis of administration site:

C) On the basis of administration schedule:

1) Madhura Rasa Skandha Dravya Basti

- Apathya Vihāra during the course of Pañchakarma:

The Basti Dravya is a combination of various medicinal drugs including Sneha,

Madhu & Lavaṇa:

Kalka: It also helps to disintegrate waste material. It increases osmotic permeability

 Paryāya: Nirūha Basti, Nairūhika Basti, Āsthāpana Basti, Kaṣāya Basti

- Depending upon the therapeutic effect of Nirūha Basti, it is named differently:

- Depending upon specific indication of Nirūha Basti, it is named differently:

- Depending upon the dose of Nirūha Basti, it is named differently:

 Contents and Method of preparation of Nirūha Basti Dravya:

General quantity of Nirūha Basti ingredients:

Parihāra Viṣaya & Kāla:

 Samyak Yoga Lakṣaṇa:

Basti Vyāpat Nidāna Lakṣaṇa Chikitsā

5) Hikkā Atitīkṣṇa Basti Hikkā Hikkānigrahaṇa Dravya, Bṛmhaṇa,

It is called Sneha Basti because Sneha Dravya is the main ingredient.

 Paryāya: Anuvāsana Basti, Sneha Basti

 Yogya: Same as for Nirūha Basti

 Ayogya: Same as for Nirūha Basti

Age Nirūha Basti Mātrā Sneha Basti Mātrā

 Contents of Sneha Basti Dravya:

 Anuvāsana Basti Kāla:

Pathya: Drava, Uṣṇa, Laghu, Pathya, Mātravat Āhāra

Parihāra Vishaya & Kāla:

 Samyak Yoga Lakṣaṇa:

Sneha Vyāpat Nidāna Lakṣaṇa Chikitsā

यस्र्ान्र्धु च िैलं च प्राधान्येन प्रदीयिे ॥

It is also known as Yuktaratha Basti because it can ne administered without any

 Karma: Doṣa nirharaṇa, Balya, Varṇya

5) Mustādi Yāpana Basti / Rājayāpana Basti

Boiled until reduced to one fourth, and filtered.

 Karma: Balya, Jīvana, Vṛṣya, Chakṣuṣya, Shūlanāshana

 Kṛmighna Basti / Kṛmināshaka Basti

 Karma: Shukrajanana, Balya, Varṇya, Vṛṣya, Puṁsavana

 Karma: Dīpanīya, Lekhanīya

 Indications: Shūla, Purīṣa saṅga, Ānāha, Mūtrakṛcchra, Kṛmi, Udāvarta, Gulma

 Dashamūla Kṣāra Basti

 Indications: Āmavāta, Ankylosing spondylitis, Fibromyalgia

 Picchā / Picchila Basti

In Sushruta Saṁhitā, Picchila Basti described as:

Yaṣṭīmadhu Kṣīra Basti

 Indications: Disc prolabpse, Lumbar spondylosis, Disc desiccation

Ashvagandhādi Kṣīra Basti

 Indications: Kārshya, Vātavyādhi, Māṁsa kṣaya

Tiktaka Kṣīra Basti / Pañchatikta Kṣīra Basti

 Ingredients: Pañchatikta Kṣīrapāka 500 ml

 Indications: Vātavyādhi, Vātarakta, Asthisauṣirya

Pañcha Prasṛtika Basti

 Karma: Vātaghna, Balakara, Varṇakara

Aṣṭa Prasṛtika Basti

Nava Prasṛtika Basti

 Karma: Snehana, Anilāpaha

 Indications: Shūla, Ānāha, Āmavāta

 Uttara Basti Yantra:

b) Bastipuṭaka = Urinary bladder of goat, camel or boar.

पञ्चकर्म Part B

पञ्चकर्म Part B