Charaka Siddhisthana Chapter 1 - Kalpanasiddhi

Jan 2023

This article explains the first chapter of siddhisthana of Charaka samhita called 'Kalpana siddhi Adhyaya'. In this chapter, basic concepts of Vamana, Virechana, Basti and Nasya treatments are explained.

<strong>Prologue
????? ????????????? ??????????????||?|| ??? ? ????? ????????????||?||
athatah kalpanasiddhim vyakhyasyamah||1|| iti ha smaha bhagavanatreyah||2||
Now we shall expound the chapter dealing with "the Procedure for successful administration of PanchaKarma". Thus, said Lord Atreya. [1-2]

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Table of Contents

Queries of Agnivesha

Agnivesha, the foremost among the disciplines (of Punarvasu Atreya) puts his queries before his preceptor. They are as follows:
What is the prescribed procedure for the administration of Panchakarma (five specialised therapies)? [The answer will be provided in verse nos.6 2/4 - 2/4 10]
In which order these five therapies should be administered? [The answer will be provided in verse nos. 10 2/4- 2/4 15]
What are the signs of proper, improper and excessive administration of these therapies? [The answer will be provided in verse nos. 15 2/4 - 24, 40 2/4 - 2/4 47]
What number of enemas should be given? [The answer will be provided in verse nos. 25-26 and 47 2/4 - 50]
What are the therapeutic effects of medicated enema (Basti)? [The answer will be provided in verse nos. 27- 34, 38- 2/4 40]
What type of Basti (medicated enema) is useful for which type of disease? [The answer will be provided in verse nos. 36-37]
What should be avoided during the course of the treatment? [The answer will be provided in verse nos. 54 2/4- 2/4 55]
What is the interval between the administrations of different therapies? [The answer will be provided in verse no. 2/4 54]
What is the reason for the enema not entering into the rectum after having administered? [The answer will be provided in verse no. 55 2/4- 2/4 56]
What makes the recipe of enema to come out earlier than the scheduled time? [The answer will be provided in verse nos. 56 2/4 - 2/4 57]
What is the cause of delay in the evacuation of the administered recipe of medicated enema? And [the answer will be provided in verse no. 2/4 56]
Why do some diseases though curable do not get cured even when recipes for each are administered? [The answer will be provided in verse nos. 57 2/4- 2/4
59]
In relation to these questions, Punarvasu, who is the foremost among physicians who is well-versed in scriptures, replied as follows with a view of promoting the welfare of human beings. [3-2/4 6]

Duration of Snehana

?????????? ???????? ??? ?? ???????? ??? ??????????? ????? ||?||
???? ??? ??????????????? ????????????? ?????????? ??? ??|?|

tryahavaram saptadinam param tu snigdho narah svedayitavya uktah ||6||
natah param snehanamadisanti satmyibhavet saptadinat param tu|7|

Duration of Oleation therapy
To a person who has undergone snehana therapy, the swedana therapy should be administered. It should be administered continuously for a minimum of three days to a maximum period of seven days. Oleation therapy is not recommended after the seventh day because, by then the person's body gets saturated / accustomed with it. [6 2/4- 2/4 7]

Effects of Snehana, Swedana

Therapeutic Effects of Oleation Therapy:
??????????? ????? ????????? ???? ?????? ????????? ??????||?||
sneho'nilam hanti mrdukaroti deham malanam vinihanti sangam||7||
Oleation therapy -
alleviates aggravated Vata Dosha,
softens the body and
disintegrates the adhered morbid material [in the channels of oleation] [7 2/4]

Therapeutic effects of Fomentation Therapy:
?????????? ???????????????? ???? ????????? ???? ???? ?????????|?|
snigdhasya suksmesvayanesu linam svedastu dosam nayati dravatvam|8|
Fomentation liquefies the morbid material adhered even in the fine channels of the body of a person who has undergone oleation therapy. [2/4 8]

Food to cause Dosha Utklesha

Measures for Exciting Morbid material:
?????????????????? ??????????????????? ???? ? ?????||?||
???????? ????????? ?????? ????????? ??????????????????????|?|
gramyaudakanuparasaih samamsairutklesaniyah payasa ca vamyah||8||
rasaistatha jangalajaih sayusaih snigdhaih kaphavrddhikarairvirecyah|9|
The person who is to be administered emesis is given milk and meat as well as meat-soup of domesticated animals and animals living in aquatic and wetlands in the form of food for causing excitation of kapha.
The person who is to be given purgation therapy is given soup of the meat of animals inhabiting arid zones and vegetable-soup added with fat to bring about the excitation of Pitta, which also do not cause aggravation of Kapha. [8 2/4 - 2/4 9]

Reasons for Vamana, Virechana Working in Opposite Ways

????????????????????? ???????? ????????? ?????????? ??????||?||
??? ???????? ???? ???????????????? ???????? ??????????|??|
slesmottaraschardayati hyaduhkham viricyate mandakaphastu samyak||9||
adhah kaphe'lpe vamanam virecayedvirecanam vrddhakaphe tathordhvam|10|
A person with excessively aggravated kapha vomits without any difficulty, and the person having less aggravated Kapha purges well. However, if there is less of aggravated kapha, the emetic recipe causes purgation through the downward tract. Similarly, if there is aggravated kapha, the purgative recipe causes emesis through the upward tract. [9 2/4- 2/4 10]

Order of Administering Vamana, Virechana

????????? ???? ???? ??????? ???????? ????????????????||??|| ?????????? ??????????????????????????? ???????? ?????????? |??|
snigdhaya deyam vamanam yathoktam vantasya peyadiranukramasca||10|| snigdhasya susvinnatanoryathavadvirecanam yogyatamam prayojyam |11|
Emetic therapy is administered to a person according to the appropriate procedure (described in Kalpa 1:14) after his body has been subjected to oleation therapy.
After emesis, he is given systematic dietetic regimen (samsarjana-Krama) with Peya (thin gruel), etc.
Thereafter, the person who has undergone oleation and fomentation therapies, is administered the best suited purgation therapy appropriately (ref. Sutra 15:17) 10 2/4 - 2/4 11)

Post- therapeutic Measures (Samsarjana karma)

????? ??????????? ???? ? ???? ??? ??????????????????||??|| ?????? ????? ??????????? ?????????????????????????|??|
peyam vilepimakrtam krtam ca yusam rasam trirdvirathaikasasca||11|| kramena seveta visuddhakayah pradhanamadhyavarasuddhisuddhah|12|
After the body is cleansed of the morbidities [by emesis and purgation therapies] the patient is given the below mentioned in the form of food -
Peya (thin gruel),
Vilepi (thick gruel),
Akrta as well as Krta yusa (unseasoned and seconded vegetable juice) and
Artaka as well as Krta-Rasa (unseasoned and seasoned meat-soup)
Each of these dietary items is given for three, two or one meal times to the person whose body is cleansed in accordance with either Pradhana Shudhi (maximum cleansing), Madhya Shudhi (moderate cleansing) or Avara Suddhi (minimum cleaning) respectively. [11 2/4 - 2/4 12]

Effects of Samsarjana Krama
?????????????????????????? ?????????????? ???? ??????||??|| ????? ?????? ???????????? ???????? ??????????????????|??|
yatha'nuragnistrnagomayadyaih sandhuksyamano bhavati kramena||12|| mahan sthirah sarvapacastathaiva suddhasya peyadibhirantaragnih|13|
Just like a small spark of fire gets kindled into a big and stable flame when fed gradually with dry grass, cow-dung cake, etc., the internal fire or the enzymes in the body responsible for digestion and metabolism [which was subdued because of purificatory measures] in a purified person grows to become strong and stable, and becomes capable of digesting all types of food by the [gradual] administration of Peya - thin gruel), etc. dietetic regimen. [12 2/4- 2/4 13]

3 levels of Shuddhi of Vamana, Virechana

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???? ?? ???????????? ?????? ??????????? ???????????????????| ??????????????? ???? ??????????? ??????? ? ??????????||??||
?????????? ???????????? ?????????? ?????? ???? ?? ?????|??|
jaghanyamadhyapravare tu vegascatvara ista vamane sadastau||13||
dasaiva te dvitriguna vireke prasthastatha dvitricaturgunasca| pittantamistam vamanam virekadardham kaphantam ca virekamahuh||14||
dvitran savitkanapaniya veganmeyam vireke vamane tu pitam|15|

In Vamana -
in Jaghanya or Avara shudhi (minimum type of cleansing) - 4 Vegas (bouts of vomiting) with quantity of vomitus - 1 Prastha - 768 ml
In Madhya Shudhi (Moderate) - 6 vegas - quantity of vomitus - 1.152 liters
In Pravara Shudhi (maximum cleansing) - 8 bouts of vomiting - quantity of vomitus - 1.536 liters

In Virechana,
in Jaghanya or Avara Suddhi - 10 Vegas, with 2 Prastha mala (1.536 liters of quantity of stool)
Madhyama Shudhi - 20 Vegas with 3 Prastha mala (2.304 l)
Pravara Shudhi - 30 Vegas with 4 Prastha mala (3.072 l)

pittantamistam vamanam - It is desirable that the emetic therapy should end up with the vomiting of Pitta (bile).
And the vomited material is half of what is described for purgative therapy [by implication, in the Jaghnya Shudhi, Madhya Shudhi and Pravara shudhi, the vomited material is one, one and a half, and two Prastha respectively.]

kaphantam ca virekam - The purgation therapy should end up with the voiding of Kapha (phlegm).
In the case of purgation therapy, the first two or three motions containing faeces should not be taken into account while measuring the quantity of voided material. Similarly, in the case of emetic therapy, the quantity of drugs taken for the therapy is excluded while measuring the vomited material. [13 1/2 - 2/4 15]

Vamana Samyak, Mithya Yoga, Ayoga

??????? ??? ?????????????? ??????? ??????????? ? ?????||??||
??????????????????????????????????? ??? ?????????? ? ??????????|??|
kramat kaphah pittamathanilasca yasyaiti samyagvamitah sa istah||15||
hrtparsvamurdhendriyamargasuddhau tatha laghutve'pi ca laksyamane|16|

Vamana Samyak Yoga:
Signs of appropriately Administered Emetic Therapy -
Below mentioned are the signs of properly administered emetic therapy -
- Expulsion of Kapha (Phlegm), pitta (bile) and Vayu (flatus and wind) in succession,
- Feeling of clarity in heart, sides of the chest, head and channels of circulation,
- Feeling of clarity of the sense organs,
- Feeling of lightness of the body,
- Feeling energetic,
- Promotion of Agni (power of digestion and metabolism),
- Freedom from diseases (caused by Doshas for which the purgation therapy was administered) and
- Expulsion of faeces, Pitta (bile), kapha (phlegm) and Vayu (flatus) in succession (that order)

Mithya Yoga of Vamana
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Signs of Improperly Administered Emetic Therapy -
Improperly administered emetic therapy (i.e., with the recipe of small quantity), gives rise to
sphotaka (postural eruptions),
kotha (urticaria),
kandu (itching),
lack of clarity in the heart as well as
sense organs and heaviness of the body [16 2/4]

Ati Yoga of Vamana

????????????????????????????????????????????? ? ??????|??|
trnmohamurcchanilakopanidrabaladihanirvamane'ti ca syat|17|

Signs of Emetic Therapy Administered in Excess:
If there is excessive administration of emetic therapy, then the person suffers from -
thirst,
moha (unconsciousness),
murccha (fainting),
aggravation of Vayu,
insomnia,
debility, etc.

Virechana Samyak, Mithya Yoga and Ati Yoga

Signs of Appropriately Administered Purgation Therapy
??????????????????????????????? ???????????????????????????||??|| ??????????? ??????????????????? ???????????????? ????? ??????|??|
srotovisuddhindriyasamprasadau laghutvamurjo'gniranamayatvam||17|| praptisca vitpittakaphanilanam samyagviriktasya bhavet kramena|18|
If the purgation therapy is appropriately administered, the following signs are observed -
purity of the channels of circulation,
clarity of the sense organs,
lightness of the body,
feeling energetic,
promotion of Agni (power of digestion and metabolism),
freedom from diseases (caused by Doshas for which the purgation therapy was administered) and expulsion of feces, pitta (bile), kapha (phlegm) and Vayu (flatus) in succession

Virechana Mithya Yoga
Signs of Improperly administered Purgation Therapy:
???????????????????????????????? ????????????????????? ?????????||??||
??????? ??? ??????????????? ???????????? ? ? ????????????|??|
syacchlesmapittanilasamprakopah sadastatha'gnerguruta pratisya||18||
tandra tatha cchardirarocakasca vatanulomyam na ca durvirikte|19|

Below mentioned are the signs of improperly administered purgation therapy (i.e., with the recipe of small quantity),
excessive aggravation of kapha, Pitta and Vata,
suppression of Agni (power of digestion and metabolism),
heaviness of the body,
coryza,
drowsiness,
vomiting,
anorexia and
absence of downward movement of the flatus [18 2/4- 2/4 19]

Virechana Atiyoga
Signs of Purgation Therapy Administered in Excess:
?????????????????????????? ????????????????????????????||??||
??????????????????????? ???????????????? ???????????|??|
kaphasrapittaksayajanilotthah suptyangamardaklamavepanadyah||19||
nidrabalabhavatamahpravesah sonmadahikkasca virecite'ti|20|

Below mentioned are the signs of excessive administration of purgation therapy -
ailments caused by the aggravation of vayu as a result of the diminution of kapha, blood as well as Pitta,
numbness,
malaise,
mental fatigue,
tremor, etc.,
insomnia,
debility,
fainting,
insanity and
hiccup [19 2/4- 2/4 20]

Spacing of Vamana, Virechana, Basti

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?????????????? ??? ?????? ?????????????????????????????| ?????????? ???????? ?????? ???????? ?? ?????? ????????||??||
??????? ???????????????? ?????????? ?????????????? |??|
samsrstabhaktam navame'hni sarpistam payayetapyanuvasayedva||20||
tailaktagatraya tato niruham dadyatryahannatibubhuksitaya| prasyagate dhanvarasena bhojyah samiksya va dosabalam yatharham||21||
narastato nisyanuvasanarho natyasitah syadanuvasaniyah |22|

After Samsarjana-Krama, on the 9th day after Vamana, the patient is given a portion of ghee [if purgation therapy is intended to be given subsequently]. [Similarly, on the ninth day of purgation therapy, after Samsajana-Krama, anuvasana, i.e., unctuous enema is given subsequently].

For 3 days, thereafter, the body of the person is massaged with medicated oil, and then Niruha Basti is given when the person is not very hungry.
After the recipe of Niruha (evacuative enema) has come out, the patient is given meat-soup of Jangala type of animals (those inhabiting arid forest zone) or any other appropriate diet depending upon the nature of Doshas and the power of agni (enzymes responsible for digestion and metabolism).
Thereafter, when the patient has not taken a heavy meal in the night, Anuvasana Basti (fat enema) is given to him if the patient is fit for such Anuvasana therapy. [20 2/4- 2/4 22]

Time of Anuvasana Basti

???? ?????? ? ????????????? ?????? ???????????????????||??|| ????? ?????? ????????? ?? ???????? ???? ???????????? ??????|??|
site vasante ca diva'nuvasyo ratrau saradgrismaghanagamesu||22|| taneva dosan pariraksata ye snehasya pane parikirtitah prak|23|
In Shishira and Vasanta Rutu - winter and spring seasons, Anuvasana basti is given during the day;
In Sharath and Greeshma and Varsha Rutus (autumn, summer, raining) it is administered during the night time.
Care is taken to avoid mistakes as described earlier (vide Sutra 13: 19-21) in respect of the administration of oleation therapy. [22 2/4 - 2/4 23]

Frequency of Anuvasana Basti
?????????? ?????????????? ???? ??????? ????????? ???????||??|| ???? ? ?????? ???? ??????? ?? ???????????????????? ?????? ? |
pratyagate capyanuvasaniye diva pradeyam vyusitaya bhojyam||23|| sayam ca bhojyam parato dvyahe va tryahe'nuvasyo'hani pancame va |

??????? ??????? ??????? ?????? ?? ????????????????????? ?||??||
tryahe tryahe va'pyatha pancame va dadyanniruhadanuvasanam ca||24||
After the administered Anuvasana medicine comes out of the anal tract, the patient should not take any food at night.
During the next day, breakfast and dinner is given.
Thereafter, on the 2nd, 3rd and 5th days, Anuvasana is given. After that, every third- or fifth-days Niruha type of medicated enema is given followed by Anuvasana. [23 2/4- 24]

Number of Anuvasana Basti based on Dosha
??? ??? ?????? ???? ?????? ??????????? ???? ?? ???? ?????| ???? ??????? ?? ??????? ?????????????? ????? ?????????||??||
ekam tatha trin kaphaje vikare pittatmake panca tu sapta va'pi| vate navaikadasa va punarva bastinayugman kusalo vidadhyat||25||
In Kaphaja diseases - 1-3 Bastis (medicated enema).
In Paittika diseases - 5-7 Bastis, and in
Vatika diseases -9-11 Bastis are administered.
In this way an expert physician should give Bastis in odd numbers. [25]

Niruha Anuvasana Time gap

Time Gap for Niruha After Virechana and for Virechana After Niruha:
??? ??????????? ????????? ?????????? ?????????????????| ?????? ??????? ??????? ? ????????? ?????? ?????????????||??||
naro viriktastu niruhadanam vivarjayet saptadinanyavasyam| suddho niruhena virecanam ca taddhyasya sunyam vikasecchariram||26||

After purgation, a person should avoid Niruha Basti, and after niruha basti one should avoid purgation therapy for seven days because it will have injurious effects on the body which is already empty [of nourishing material] by the earlier therapy. [26]

Effects of Niruha Basti

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?????????????????????????????? ??????????? ??????????????| ????????????? ?????? ?????? ??????? ???????? ????????????||??||
bastirvayahsthapayita sukhayurbalagnimedhasvaravarnakrcca| sarvarthakari sisuvrddhayunam niratyayah sarvagadapahasca||27||
vitslesmapittanilamutrakarsi dardhyavahah sukrabalapradasca| visvaksthitam dosacayam nirasya sarvan vikaran samayenniruhah||28||

Effect of Niruha Basti
Niruha Basti has the following effects:
It prevents aging process of the body;
It promotes happiness, longevity, strength, power of digestion and metabolism, intellect), voice and complexion
It accomplishes all the objects (including mutually contradictory ones like stability or plumpness and emaciation);
It is harmless for infants, old persons and youth;
It helps in curing all diseases
It helps in drawing out faeces, Kapha, Pitta, Vayu and urine;
It promotes sturdiness of the body
It enriches semen and promotes strength and
While eliminating accumulated Doshas (morbid matter) from the entire body, it (Niruha type of enema) alleviates all the diseases. [27-28]

Effects of Anuvasana Basti

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??????? ???????? ?????? ??????????????????? ?????? ?????? ?????| ???? ????????? ?????????? ?????? ??? ??????????????????? ||??||
???? ???????? ?? ??? ?????? ?????????????? ????????????????| ???? ????? ?????????????? ??? ??? ?????????????||??||
dehe niruhena visuddhamarge samsnehanam varnabalapradam ca| na tailadanat paramasti kinciddravyam visesena samiranarte ||29||
snehena rauksyam laghutam gurutvadausnyacca saityam pavanasya hatva| tailam dadatyasu manahprasadam viryam balam varnamathagnipustim ||30||
mule nisikto hi yatha drumah syannilacchadah komalapallavagryah| kale mahan puspaphalapradasca tatha narah syadanuvasanena||31|

Effects of Anuvasana Basti:
The channels of the body get cleansed by Niruha. Administration of \Snehana or Anuvasana basti to such a person promotes his complexion and strength.
There is no therapy better than the administration of oil (anuvasana basti) which is especially useful for the patient afflicted with diseases caused by Vata.

The oil by its unctuousness, heaviness and heating property counteracts the non-unctuousness (dryness), lightness and cooling attributes of Vata respectively. Because of this, administration of oil (Anuvasana-Basti) instantaneously produces clarity of mind, and promotes energy, strength complexion and Agni (power of digestion and metabolism). Just as a tree irrigated with water at the root produces blue leaves, becomes beautiful with tender leaves, and during the course of time grows to produce flowers and fruits, similarly, a person becomes [young and beautiful with procreative power]by the administration of Anuvasana or unctuous type of medicated enema. [29-31]

Effects of Niruha and Anuvasana in General:
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???????? ????????? ?????? ???? ? ?????????????? ?| ?????????????? ?????? ?????? ?? ??????????? ? ???????????||??||
????? ???????? ????????????? ????? ? ????????? ????? ??????| ?????????????? ?? ? ???? ??????? ?????? ???????? ???? ? ????||??||
stabdhasca ye sankucitasca ye'pi ye pangavo ye'pi ca bhagnarugnah| yesam ca sakhasu caranti vatah sasto visesena hi tesu bastih||32||
adhmapane vigrathite purise sule ca bhaktanabhinandane ca| evamprakarasca bhavanti kuksau ye camayastesu ca bastiristah||33||
yasca striyo vatakrtopasarga garbham na grhnanti nrbhih sametah| ksinendriya ye ca narah krsasca bastih prasastah paramam ca tesu||34||

Basti or medicated enema is especially useful for the following types of persons:
whose limbs have become stiff and contracted;
who are lame
who are afflicted with fractures and dislocations and
whose whole limbs are afflicted by the movement of different types of aggravated Vata
Basti is also useful for the treatment of the following ailments:
Distension of the abdomen by air
Scybalous stool
Colic pain
Disliking for food; and
Such other ailments affecting the pelvic region
Basti is an excellent therapy for women who are afflicted with the complications of Vata, and who are unable to conceive in spite of mating with their male partners. It is also extremely useful for men having seminal debility and emaciation of the body. [32- 34]

Selection of Basti for Different Type of Patients:
????????????? ?????? ?????????????????? ??? ??????????| ????????????????????????????? ??????? ??????? ????????? ??????????||??||
usnabhibhutesu vadanti sitanchitabhibhutesu tatha sukhosnan| tatpratyanikausadhasamprayuktan sarvatra bastin pravibhajya yunjyat||35||
According to experts, [in the administration of Pancha-Karma therapy) cooling basti (medicated enema) is given to the patients suffering from diseases caused by hot ingredients. And lukewarm Basti is given to the patients suffering from diseases caused by cooling ingredients.
In all cases, different types of Basti containing ingredients having attributes opposite to the attributes of the etiological factors of diseases are administered. [35]

Contra indications for Anuvasana, Niruha

Contra indications for Anuvasana
? ?????????? ?????? ??????? ??????????? ????? ??????| ???????????????? ???????? ????? ?? ???? ??????????||??||
na brmhaniyan vidadhita bastin visodhaniyesu gadesu vaidyah| kusthapramehadisu meduresu naresu ye capi visodhaniyah||36||
To the patients needing cleansing and detoxification should not be given Brumhaniya or Anuvasana) Basti. For example, people with Kushta, Prameha and obesity need Shodhana Basti, there we need to avoid Anuvasana. [36]

Contra indication for Niruha Basti
????????????? ? ???????????? ??????? ?? ??????????????| ? ????????????? ? ??????????? ????? ? ?????? ???????????||??||
ksinaksatanam na visodhaniyanna sosinam no bhrsadurbalanam| na murcchitanam na visodhitanam yesam ca dosesu nibaddhamayuh||37||

Niruha or evacuative type of Basti should not be given to patients suffering from Kshataksheena, (phthisis), Shosha (consumption), extreme debility and Murccha (fainting), and to those who have already undergone the process of purification, and to those life is dependent upon the holding up of Doshas (morbid matter). [37]

Importance of Basti Chikitsa

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?????????????????????????? ???????????????? ? ???????| ??????????????? ???? ????????????? ???? ????????? ????????||??||
?????????????????????? ????????? ?????? ??????????? ?????????|??|
sakhagatah kosthagatasca roga marmordhvasarvavayavangajasca|ye santi tesam na hi kascidanyo vayoh param janmani heturasti||38||
vinmutrapittadimalasayanam viksepasanghatakarah sa yasmat| tasyativrddhasya samaya nanyadbastim vina bhesajamasti kincit||39||
tasmaccikitsardhamiti bruvanti sarvam cikitsamapi bastimeke|40|

There is none other than Vayu which is the most important causative factor of diseases in
Shakha (peripheral tissue elements),
Kostha (Visceras of the Thorax and Abdomen) (the body), Sarvavayava (covering the entire body) and
Anga (individual parts of the body).
Vayu is responsible for the separation (Viksepa=Vibhaga) and combination (sanghata=Samyoga) of stool, urine, Pitta, (Kapha), including other excreta and tissue elements (Asaya: normally meaning receptacle, which has been interpreted by Chakrapani as tissue elements]. When vata gets exceedingly aggravated there is no remedy other than Basti for its alleviation.
Therefore, Basti is considered by physicians to be half of the entire therapeutic measures. Some physicians even go to the extent of suggesting that Basti represents (not half but) the whole of therapeutic measures. [38 - 2/4 40]

Definition of Basti, Samyak Basti Lakshana

??????????? ????????????????? ????? ??????????? ??????? ||??||????????? ???? ?????????? ?????? ???????? ? ?? ? ?????? |??|
The therapy which while moving in the umbilical region, lumbar region, sides of the chest and pelvic region churns up the stool including all the other morbid matter located there, and appropriately, eliminates them (stool and other morbid material) with ease after nourishing (lit. oleating) the body is called Basti. [40 1/2 - 2/4 41]

Signs of Appropriately Administered Niruha Basti:

?????????????????????????? ??????????????????????????||??|| ???????????? ???????????? ? ??? ? ??? ?????? ??????????????|??|
prasrstavinmutrasamiranatvam rucyagnivrddhyasayalaghavani||41|| rogopasantih prakrtisthata ca balam ca tat syat sunirudhalingam|42|
The following signs are manifested if niruha basti is appropriately administered:
Appropriate elimination of stool, urine and flatus
Promotion of appetite and agni (power of digestion and metabolism)
Lightness of the Asaya (lit. Receptacle: tissue elements according to the earlier commentary of Cakrapani)
Alleviation of diseases and
Restoration of natural health and strength. [41 2/4- 2/4 42]

Signs of improperly Administered Niruha Basti:
???????????????????????????????? ???? ??????????????????? ?||??||
?????????? ??????????????? ?????? ? ?????? ? ???????? ?????|??|
syadrukchirohrdgudabastilinge sophah pratisyayavikartike ca||42||
hrllasika marutamutrasangah svaso na samyak ca niruhite syuh|43|

If the niruha or evacuative type of medicated enema is inappropriately administered (i.e., administered in a smaller dose), then this gives rise to the following signs and symptoms:
Pain in the head, cardiac region, anal region, urinary bladder and oedema of penis, coryza, gripping pain and nausea,
Retention of flatus and urine and
Dyspnoea [42 2/4- 2/4 43]

Signs and symptoms of Niruha Basti excessively administered
?????? ????????????????? ??????????????????????||??||
lingam yadevativirecitasya bhavettadevatiniruhitasya||43||
The signs and symptoms of Niruha Basti or evacuative type of medicated enema when used in excess quantity are the same as those caused by the excessive administration of purgation therapy (vide verse no 19 2/4- 2/4 20.

Signs and symptoms of properly administered Anuvasana Basti:
??????????????? ??????? ???? ?????????????????????????????? |?????????????????????? ??? ? ????????? ????? ??????????? ?????||??||
pratyetyasaktam sasakrcca tailam raktadibuddhindriyasamprasadah |svapnanuvrttirlaghuta balam ca srstasca vegah svanuvasite syuh||44||
Proper administration of Anuvasana Basti or unctuous type of medicated enema gives rise to the signs and symptoms as follows:
Return of the recipe containing oil, etc., with faecal matter without any obstruction;
Purity of the tissues, viz, blood, etc.
Clarity of intellect and senses
Good and continuous sleep;
Lightness and strength in the body; and
Proper manifestation of natural urges without any obstruction [44]

Signs and symptoms of improperly administered anuvasana basti
????????????????????????????? ???????????? ? ??????? |
??????? ??????????????????????????????????????? ||??||
adhahsarirodarabahuprsthaparsvesu rugruksakharam ca gatram |
grahasca vinmutrasamirananamasamyagetanyanuvasitasya ||45||

Improper administration of Anuvasana Basti or unctuous type of medicated enema gives rise to signs and symptoms as follows:
Pain in the lower part of the body, abdomen, arms, back and sides of the chest;
Non-unctuousness (dryness) and roughness of the body; and
Obstruction in the passage of stool, urine and flatus [45]

Signs and Symptoms of excessively administered anuvasana basti:
?????????????????????????????????? ???????????????|??|
hrllasamohaklamasadamurcchavikartika catyanuvasitasya|46|
Excessive administration of Anuvasana - Basti or unctuous type of medicated enema gives rise to nausea, unconsciousness, mental fatigue, exhaustion, fainting and gripping pain . [2/4 46]

Duration of retaining anuvasana basti

?????? ????????????? ?????? ?????? ??? ?????? ? ???????????||??||
???????????????? ??????????? ?????? ? ?????????? ??????????|??|
yasyeha yamananuvartate trin sneho narah syat sa visuddhadehah||46||
asvagate'nyastu punarvidheyah sneho na samsnehayati hyatisthan|47|

If the unctuous material administered for Anuvasana Basti is retained for three Yamas then the body of the person gets cleansed of morbid material. If it comes out quickly (before nine hours) then another Anuvasana Basti or unctuous type of medicated enema is administered. If the unctuous material is not appropriately retained (in the rectum) then an appropriate unctuous effect is not produced in the body of the person. [46 2/4 - 2/4 47]

Different Types of Basti Therapy

???????????? ???? ?? ?????? ?? ?????????????? ????? ????||??||
????????? ?????? ?? ??????? ?????? ????? ??? ?????? ????| ???? ?????????? ??????????? ?????? ???????????????? ??? ?????||??||
???? ???????????? ?? ????? ????????? ?????? ???????????|??|
trimsanmatah karma nu bastayo hi kalastato'rdhena tatasca yogah||47||
sanvasana dvadasa vai niruhah prak sneha ekah paratasca panca| kale trayo'nte puratastathaikah sneha niruhantaritasca sat syuh||48||
yoge niruhastraya eva deyah snehasca pancaiva paradimadhyah|49|

In Karma(n) type, thirty Bastis or enema are administered. In the Kala type of Basti therapy, the number of enemas is half of the former [as explained in the commentary is sixteen in number, and not fifteen]. In the yoga type of Basti therapy, the number of enemas to be given is half of the former [eight according to Chakrapani].

In Karma-Basti, 12 Anuvasanas (unctuous type of enema) and 12 Niruhas are administered, one alternating with the other.
Before this, 1 Anuvasana Basti in the beginning, and 5 at the end are administered for the purpose of oleation. [Thus, in total, thirty Bastis are to be given for Karma Basti.

In Kala basti, 6 Anuvasanas and 6 Niruhas are given, one alternating with the other. Before this, in the beginning, one anuvasana is given for the purpose of oleation. [Thus, in total, sixteen bastis are to be given in Kala Type].

In Yoga basti, three Niruhas are to be given in the beginning, in the middle and at the end, five anuvasana bastis are to be given. [Thus, in this type, eight bastis in total are to be given]. [47 2/ 4- 2/4 49]

Number of anuvasana basti for Snehana
?????? ???? ??????????????? ????? ?????????????????????? [?] ||??||
???????? ????????? ?????????????? ??????????????????? ????????|??|
trin panca va"huscaturo'tha sadva vatadikanamanuvasaniyan [1] ||49||
snehan pradayasu bhisagvidadhyat srotovisudyarthamato niruhan|50|

Some hold the view that after giving three, five, four or six Anuvasana bastis for the purpose of oleation, to patients suffering from diseases caused by Vata (Pitta and Kapha) the physician should thereafter, administer Niruha Basti for the cleansing of the [obstructed] Srotas or channels of circulation. [49 2/4- 2/4 50]

Shiro virechana

????????????? ??? ?????? ???????? ?????????????????????||??||
????????????????????????? ?? ??? ???????? ???????? ???????|
visuddhadehasya tatah kramena snigdham talasveditamuttamangam||50||
virecayettrirdvirathaikaso va balam samiksya trividham malanam|

Errhine Therapy -
When the body of the patient is cleansed, his head is consecutively anointed and fomented with the help of the palm. After ascertaining the strength of the three types of Doshas, he is given errhine therapy, once, twice or thrice. [50 2/4 - 2/4 51]

Nasya Samyak, Mithya yoga and Ati yoga

Samyak Yoga
??????????????????????????? ????????????????? ?????????????||??||
urahsirolaghavamindriyacchyam srotovisuddhisca bhavedvisuddhe||51||

Signs and Symptoms of appropriately administered therapy -
Appropriately administered siro-virecana therapy gives rise to feeling of lightness of the chest and head, clarity of the senses and cleansing of the srotas (channels of circulation). [51 2/4]

Mithya Yoga
???????? ????? ???????? ????????? ?????? ????????????|
galopalepah siraso gurutvam nisthivanam capyatha durvirikte|

Signs and symptoms of inappropriately administered errhine therapy -
Inappropriate administration of Nasya therapy gives rise to
Gala Upalepa - adhesion of sticky material in the throat,
Gurutva Shiraso - heaviness of the head and ptyalism. [2/4 52]

Ati Yoga
??????????????????????????????????????? ?????? ? ???????||??||
siroksisankhasravanartitodavatyarthasuddhe timiram ca pasyet||52||

Signs and symptoms of excessively administered Errhine therapy -
Excessive administration of errhine therapy gives rise to cutting and aching pain in head, eyes temples and ears, and fainting. [52 2/4]

Management of Atiyoga of Nasya

???????????? ???? ???? ????? ? ?????????? ???????? ?? ?????? ????|??|
syattarpanam tatra mrdu dravam ca snigdhasya tiksnam tu punarna yoge|53|
For the management of conditions arising out of excessive Nasya therapy, the patient is given Tarpana drinks which are soft and Snigdha (containing fat)
For the management of conditions arising out of inappropriate administration of errhine therapy, the patient is given Sneha Karma and thereafter, Teekshna Nasya is given to the patient. [2/4 53]

Utility of PanchaKarma Therapy:
?????????????????? ??????? ?????????????????????????||??||
ityaturasvasthasukhah prayogo balayusorvrddhikrdamayaghnah||53||
PanchaKarma (five purificatory therapies) described above bestow happiness to both the patients and healthy persons by promoting their strength and longevity, and also by curing their diseases. [53 2/4]

Interval period between two courses of therapy
??????? ??????????? ???? ????????????? ?????????? ??????????|??|
kalastu bastyadisu yati yavamstavan bhaveddvih pariharakalah|54|
The interval between two courses of Basti (including emesis, purgation and errhine therapies) is double the period for which these therapies were originally administered. [2/4 54]

Prohibitions during Panchakarma Therapies

?????????????????? ???? ??????? ???? ??????????????||??|| ??????????????????????????????????????? ?|??|
atyasanasthanavacamsi yanam svapnam diva maithunavegarodhan||54|| sitopacaratapasokarosamstyajedakalahitabhojanam ca|55|
While undergoing panchakarma therapies, the patient should avoid the following:
Excessive sitting, standing, speaking and riding (over vehicles and horses)
Sleep during day time
Sexual intercourse
Suppression of the manifested natural urges
Cooling regimens
Exposure to hot Sun
Grief and anger and
Intake of urinary and unwholesome food

Factors inhibiting recipes of basti to enter and come out smoothly:
????? ??????? ????? ? ?????? ?????? ????????????????????? ||??||
? ???? ???????? ???? ?????? ????????????? ??? ????????????|??|
baddhe pranite visamam ca netre marge tatha'rsahkaphavidvibaddhe ||55||
na yati bastirna sukham nireti dosavrto'lpo yadi va'lpaviryah|56|

The recipe of Basti does not reach its destination because of the following:
If the nozzle is clogged or inserted obliquely; and
If the rectal passage is blocked by piles, mucus or hard stool
The recipe after enema does not come out with ease because of the following:
if the path in the enema is obstructed by Doshas
If the recipe of enema is less in quantity and
If the recipe is of low potency [55 2/4- 2/4 56]

Factors Responsible for Quicker Elimination of enema

???????? ?? ????????????????? ???????????????????? ???? ??||??||
?????????????????? ???? ? ?????? ???????????? ??????? ??????|??|
prapte tu varconilamutravege vate'tivrddhe'lpabale gude va||56||
atyusnatiksnasca mrdau ca kosthe pranitamatrah punareti bastih|57|
The recipes of enema come out though the anus immediately after it is administered because of the following:
If there is sudden urge for voiding faeces, flatus or urine;
If there is excessive aggravation of vayu,
If there is lack of strength in the anal muscles to retain the recipe
If the recipe contains ingredients which are excessively hot and sharp and
If the person has lax bowel (mrdu kostha) [56 2/4- 2/4 57]

Incapability of Basti to Cure of curable Disease

???????????????? ???????? ????????????????????? ?????||??||
?????? ?? ??????????????? ????? ???????????? ?? ???? ????????|
??????????????????????????????? ??????????????????????||??||
????????? ????????? ??????? ??????????????????? ????????|??|
medahkaphabhyamanilo niruddhah sulangasuptisvayathun karoti||57||
sneham tu yunjannabudhastu tasmai samvardhayatyeva hi tan vikaran|
rogastatha'nye'pyavitarkyamanah parasparenavagrhitamargah||58||
sandusita dhatubhireva canyaih svairbhesajairnopasamam vrajanti|59|

If the Vayu gets occluded by Medas (fat) and Kapha), then it gives rise to colic pain, numbness of the body and oedema. When an ignorant physician administers Sneha (unctuous recipe in order to alleviate these ailments) then they actually get aggravated. Similarly, they produce other diseases which cannot even be imagined and which probably are difficult to cure. Apart from this, they vitiate blood and other tissues and cause many diseases which are incurable in spite of being administered with good and logical treatments. [57 2/4- 2/4 59]

Reasons for Failure of Chikitsa

????? ? ?????????? ???? ???????????? ???????????||??||
?????????????? ? ?? ?????? ??????? ????? ??????? ??????????|??|
sarvam ca rogaprasamaya karma hinatimatram viparitakalam||59||
mithyopacaracca na tam vikaram santim nayet pathyamapi prayuktam|60|
All therapeutic measures administered to alleviate a disease even though wholesome and skilfully given fail to cure it, if they are used in lesser or excessive doses or at the wrong time or in the wrong manner. Therefore, the diseases get cured only when medicines are administered in the proper dose and proper time by wise and experienced physicians. [59 2/4 - 2/4 60]

???? ??????- ????????????? ?????? ???????????????????? ????????? ??????????||??||
????????????? ?????? ????????? ????????????????????????????||??||
tatra slokah- prasnaniman dvadasa pancakarmanyuddisya siddhaviha kalpanayam||60||
prajahitartham bhagavan maharthan samyagjagadarsivaro'triputrah||61||

To sum up: - Lord Atreya, the foremost among the sages described the successful administration of Panchakarma (five purificatory therapies) for the wellbeing of the people in the form of answer to the twelve queries (described in verse nos. 3-5) [60 2/4- 61]

??????????????? ??????? ????????????????????????? ?????????????? ???????????? ????????????????? ?????????????||?||
ityagnivesakrte tantre carakapratisamskrte'prapte drdhabalasampurite siddhisthane kalpanasiddhirnama prathamo'dhyayah||1||
Thus, ends the first chapter of the siddhi section called "Kalpana- Sidhhi successful administration of therapeutic measures)" in the text of Agnivesha which was redacted by Charaka, and because of its non-availability, supplemented by Drdhabala.

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