Ayurvedic Basti Therapy: Medicated Enema (Vasti)

Basti therapy, also called vasti, is the most important among Ayurveda’s five purification procedures (panchakarma). In western medicine, enema is mainly given to remove fecal matter from the large intestine.

In Ayurveda however, Ayurvedic basti has both preventive and curative perspectives. Let’s take a look.

In this article, we’ll cover Ayurvedic basti (also called vasti) enema therapy, its importance, its classification, indications and contraindications, correct method of administration, along with its mode of action.

Here’s a breakdown by sub-heading.

• What Is Basti (Vasti)?
• The Guda
• Basti Benefits (Vasti Benefits)
• Types Of Basti
• Yapana Vasti: Longevity Enema
• Indications And Contraindications
• How Ayurvedic Basti Is Administered
• Preparatory Steps
• Main Procedure
• After Basti
• Signs Of Perfect Basti Therapy
• When To See The Doctor
• Ayurvedic Basti (Vasti Enema): How It Works
• The Pharmacokinetics Of The Basti Solution
• Basti Research
• Conclusion

What Is Basti (Vasti)?

In ancient times, this therapy was administered using a urinary bladder of an animal, which is called a basti.

The ancient Ayurvedic sage Charaka defined basti (vasti) as the procedure in which an herbal decoction or oil is administered through the anus.

It reaches up to the umbilical region (nabhi pradesha), lumbar region (kati) and sides of the chest and flanks.

It churns the accumulated dosha and stool, spreads unctuousness (potency of the herbal solution) all over the body and easily comes out along with the churned stools and doshas.¹

The Guda

The association of twelve live attributes of fire (agni), water (soma) and air (vayu), the three integral components of the mind, the five sense organs and the soul is Prana.² The place where these reside is called Pranayatana.

The anus or guda is one such Pranayatana. It is also one of the vital points of the body, called marma points. It is made up mainly of muscle and is considered highly sensitive.

Any major injury to this vital point may lead to sudden death.³

Even a mild stimulation to the region, such as with basti, may sensitize the whole body. Basti may instigate vigorous action of vayu (Vata dosha) through the veins present in the body.

Basti Benefits (Vasti Benefits)

Vata is considered the main cause of problems pertaining to any of the body parts. It is especially a cause of problems in the extremities, alimentary tract, organs, and all organs above the shoulder.

Vata is responsible for the transportation and removal of increased feces, Kapha, Pitta, and other metabolic wastes. Ayurvedic basti therapy is considered the best choice for the management of increased Vata dosha and Vata associated with Kapha and Pitta.  

Basti is referred to as ‘half a treatment’ for all health problems. Sometimes it is a complete treatment for all body ailments.⁴

Basti solution is prepared in a variety of ways and has several effective functions. 

It expels the morbid doshas from the body, pacifies aggravated doshas and acts as an aphrodisiac for those suffering from depletion of semen.

It nourishes the body and helps reduce excess fat. It nourishes the eyes and prevents greying of the hair. It is beneficial for premature aging. It enhances color, complexion, strength, immunity, health and longevity.⁵

Types Of Basti

There are four types of basti, according to the route of administration.

• Rectal 
• Urethral
• Uterine
• Wound 

There are two types of liquid used.

• A decoction based basti causes elimination and reduces fat.
• An oil-based basti produces lubrication and increases or nourishing all tissues.⁶

There are three types according to schedule.

• A schedule of 30 bastis (18 oil +12 decoction) is called karma basti.
• A schedule of 15 bastis (10 oil + 5 decoction) is called kala basti.
• A schedule of 8 bastis (5 oil + 3 decoction) is called yoga basti.⁷

There are four types according to the quantity of solution administered.

• 1200 ml
• 1000 ml
• 300-600 ml
• 900 ml⁸

Yapana Vasti: Longevity Enema

The vasti or basti which enhances life span, maintain youthfulness ,and promotes longevity is called yapana vasti.

Yapana vasti includes a decoction along with milk, meat soup, honey, ghee, jaggery or egg yolk of a rooster. This basti is considered suitable for all ages and can be given in all seasons. It is thought to nourish the body, increase strength and semen and may support infertility.⁹

If you’d like to learn more about vasti and other Ayurvedic detox therapies and remedies, check out Dr. Kristine Jerome’s course below.

Indications + Contraindications

Oil Enema

It is indicated for the clients who are eligible for decoction enema (niruha vasti), in certain conditions like dryness (Rooksha), diseases due to Vata (Vata Roga) and in case of increased digestive power.¹⁰

Clients who are contraindicated for decoction enema, empty stomach, in acute fever, jaundice, diabetes, piles, rhinitis, anorexia, low digestive fire, weak, thigh fatigue, allergic conjunctivitis (kaphabhishyanda), heaviness in the stomach, Filariasis, thyroid, worm infestation, skin problems, obesity, diarrhoea , anaemia.¹¹

Decoction Enema

A decoction enema is used in cases of tumors of the abdomen, bloating, fullness, gout, splenomegaly, diarrhea, chronic fever, rhinitis, obstruction of semen, flatus.

Decoction enemas are beneficial for those who have done excess oleation therapy, have chest injury, are highly emaciated, or who have diarrhea or vomiting. It is used in those who have gone through purification therapy, who have asthma, a cold cough or excessive salivation.

It is also beneficial for hemorrhoids, hiccups, constipation, urinary calculi, amenorrhoea and other diseases due to Vata dosha.¹²

This type of basti is also beneficial for abdominal bloating, low digestive power, swelling in the rectum, intestinal obstruction, intestinal rupture, ascitic, skin disease, one who have just taken food.¹³

How Ayurvedic Basti Is Administered ¹⁴

Please remember, basti therapy should be done under the supervision or guidance of a qualified Ayurvedic practitioner only. 

Basti can be administered as an independent therapy, outside of Ayurvedic panchakarma cleansing treatments, after doing oil massage and sudation. For an oil basti, no particular preparation is required.

Basti is administered by a therapist under the supervision of a qualified practitioner. Generally, a regimen that involves both oil and decoction bastis is planned for Vata disorders. Oil basti is safe but decoction basti may cause some adverse effects, though this is rare.

So experience is required on the part of the practitioner to manage these complications.

Careful selection of the patient as per textual instructions rules out complications to a great extent. Self-administration of a decoction basti is not advised.

Listed now are the tools needed for basti therapy and the steps involved in the process.

1. Basti Instruments

A basti yantra (the instruments for giving basti) is composed of two parts, an enema bag, and enema nozzle. The enema bag is a plastic bag of 50 microns thickness. It has a 1.5-liter capacity and is disposed of after single use.

The enema nozzle is a tubular structure usually made of brass. It has a tapered end and a wider base. It has three rings on its external surface and these are called ridges. The last two at the bottom are used to tie the enema bag to the enema nozzle.

2. Basti Solution 

For oil enema, boiled and lukewarm oil is used. The maximum quantity of oil enema is approximately 280 ml.

For decoction enema, a lukewarm homogeneous solution close to body temperature is prepared. One by one, honey, rock salt, fats, herbal pastes, and herbal decoctions are added. The vasti is made to be either intense (bitter) or soft, and this will affect the particular dosha.¹⁵

For oil enema, the quantity of unctuous is approximately ¼ of the quantity of the decoction enema.

The proportion of ingredients for preparing the vasti solution for a decoction enema is as follows.

Fat or oil should be one-fourth of the herbal decoction. The herbal paste should be one-eighth of the herbal decoction. Honey is added as required and rock salt too as required.¹⁷

Preparatory Steps

Please remember, basti therapy should be done under the supervision or guidance of a qualified Ayurvedic practitioner only. 

The body of the client should be prepared by massaging with a suitable oil (Abhyanga) and sudation (swedana).

An oil enema is administered after waste (urine, feces) has been eliminated. The client is advised to have a light meal and take a short walk, and then the process begins.

A decoction enema is administered when previous food is digested. That means it’s done on an empty stomach condition.

Next, the client lays down on their left side, on a comfortable table which is not very high.

Their head must be at a lower level. Keep the left hand below the head and extend the left leg completely. Flex the right leg at the knee joint. 

Main Procedure

The vasti solution is placed in the enema bag and tied well, with the nozzle placed in position. 

Trapped air in the enema nozzle is expelled by gently pressing the enema bag.

Lukewarm oil is applied to the anal region and the nozzle of the vasti instrument.

The enema nozzle is then gradually introduced in a parallel direction to that of the vertebral column.

During this procedure, the client is asked to breathe in. The enema nozzle is carefully removed when a little quantity of basti solution remains inside the enema bag. Otherwise, vata can enter into the intestine.

After Basti

After basti, the client is kept lying on his back in a supine position for a count of one hundred.

Next, the buttocks of the client are patted with the palms and the same digit of both feet is pulled slightly. The lower limbs are raised three times.

If the client gets the urge for defecation then he or she can attend to the matter.

After passing the motion with oil at the proper time, the client is allowed to have light food if he or she feels hungry.

The ideal time for the oil enema solution to release is 9 hours¹⁸, but it may be retained for 24 if it is not disturbing the client.¹⁹

For decoction enemas, 48 minutes is the maximum period of time in which the vasti should release.²⁰

Please note.

1. Oil enema is administered first and decoction enema is administered on the third or fifth day after oil enema.
2. Oil enema is given during the day time in cold seasons whereas in other seasons it is given during the night. Decoction enema is given after midday.
3. In conditions in which oil or unctuous liquid passes immediately, another oil enema can be given.

Please remember, basti therapy should be done under the supervision or guidance of a qualified Ayurvedic practitioner only. 

Signs Of Perfect Basti Therapy

For oil enema, a release of unctuous fat along with fecal matter is a sign of the basti therapy has gone as it should.

Following basti, all the body tissues become clear and there is a feeling of good sleep, lightness in the body and an increase in strength.

There is also the proper evacuation of feces without any obstruction.

For decoction enema, signs of effective basti therapy include the proper evacuation of the feces, urine, and flatus.

One should also notice an increase in appetite, lightness in body parts, pacification of health problems and an increase in strength and vigor of the body

When To See The Doctor

Ayurvedic basti is similar to other purification techniques like panchakarma because it gives desired results when performed in a systematic way.

It is advised to be performed under proper guidance from a highly trained and skillful Ayurvedic practitioner.

It is best to consult your health care practitioner about your present condition before practicing this therapy.

While performing decoction enema, if the solution doesn’t come out within the prescribed time period or signs of a perfect basti therapy are not attained, then the condition should be attended to by an expert Ayurvedic practitioner.

Ayurvedic Basti (Vasti Enema): How It Works

Basti treatment has multidimensional action. Its mode of action is complex, which makes it a unique therapy.

According to the ancient Ayurvedic sage Charaka, basti is like a tree irrigated in its roots, attaining nourishment for the whole tree.

In the same way, vasti solution is given through the anus which is rich in blood vessels, lymph, and nerves, nourishing all the limbs and organs of the body.²¹

Although basti acts mainly on the structures related to the anus or guda, it influences the whole body. The anus is the main site of apana Vata, one of the five types of Vata which are responsible for controlling evacuation of stool and urine.

According to the ancient Ayurvedic sage Vagbhatta, the potency of the collective basti solution is first taken up by apana Vata and then it is transferred to Samana vata, Vyana vata, Udana vata and Prana vata simultaneously. Then it reaches the sites of Pitta and Kapha.

This potency of the basti solution is propagated by the Apana in a downward direction, by the vyana Vata in a lateral direction, and by prana vayu in an upward direction. 22

Thus the potency of the basti solution is capable of bringing the vitiated Vata along with vitiated Pitta and Kapha to their normal state. 23

The Pharmacokinetics Of The Basti Solution

The action of the decoction enema depends on the ingredients used in the basti solution.

Rock salt, in general, has the properties which facilitate the action of the vasti components. It promotes the evacuation of the bladder and rectum.

It has a minuscule property called sukshma guna. Due to this property, the potency of the ingredients present in the vasti solution reaches the microchannels.

The hotness, sharpness and liquefaction properties of rock salt assist in breaking the compactness of the doshas into smaller particles and liquefying the morbid dosha, assisting in their elimination.

Honey forms a homogeneous mixture with rock salt and is capable of breaking and liquefying sticky Kapha for easy elimination. It is easy to digest and is readily absorbed by the body.

Oil produces unctuousness in the body which in turn helps in easy eliminations of dosha and mala or waste. It also protects the intestinal mucosa from the untoward action of irritating ingredients.

An herbal decoction promotes secretions, excitation and pacification of doshas and are selected on the basis of dosha, dushya and channels involved in causing the health problem. Their main action is breaking the pathogenesis of the disease.

Basti Research

In a research study it was observed that in intrarectal route administration supplied as enema solutions, foams and suppositories, foam and anal suppositories are retained mainly in the rectum and sigmoid colon. Enema solutions, on the other hand, have a great spreading capacity.²⁴

The intestine is covered by four layers namely muscular, submucosal, serosal and mucosal layer.

The mucosal layer is superficial and comes in contact with the basti solution when it is administered. During one research study, x-ray revealed that basti can reach a up to the ileocecal junction. It can travel throughout the large intestine.²⁵

When the intestine gets purified daily, the layers of intestine and villi receive nutrition and further absorption of micronutrients may be enhanced. These micronutrients may enter circulation and finally reach the target organ.

According to evidence obtained from a study conducted on colon drug delivery, it can be said that the active constituents of the basti formulation may be absorbed in systemic circulation and their concentration and rate of absorption depends upon properties of its constituents.²⁶

Highly lipid-soluble constituents are in general rapidly absorbed through the intestinal mucosa and finally reach into circulation.  

The rectum contains minute veins. Basti solution may be absorbed through the veins of the rectum which can bypass the second part of metabolism and the active constituents of the basti solution may be delivered to the target tissues.

Thus, basti is potent in curing many health problems.²⁷

In addition, the human colon has over 400 distinct species of bacteria as residents or gut flora.

Many reactions carried out by these gut microflora may also be responsible for the metabolism of ingredients in the basti solution and may also be responsible for colon-targeted delivery of peptide-based macromolecules.

According to recent advancements in gut-brain theory, the gastrointestinal system has a network of nerve fibers, which are known as the enteric nervous system (ENS). Similar to the brain, the ENS sends and receives impulses, records experiences and responds to various stimuli.

The gut-brain possesses a number of neurotransmitters.

ENS is loosely connected with the central nervous system (CNS) through the vagus nerve and can mostly function alone, without instruction from the top. Thus, the ENS works in synergism with the CNS.

Stimulation by basti either by chemo or mechanoreceptors may produce neuromuscular remodeling or pain modulation by influencing the ENS (Enteric Nervous System).

This leads to activation of the concerned part of the CNS (Central Nervous System) which may precipitates results accordingly.²⁸

Conclusion

The functioning of Vata dosha can be correlated to that of the nervous system. Basti is prescribed as the best remedy for Vata.

This fact also validates the efficacy of basti therapy on the nervous system.

Purification is the first line of management mentioned in the classic Ayurvedic texts for various chronic and lifestyle disorders.

In a healthy person, periodic purification by Ayurvedic basti is indicated to be performed in early rain, to prevent the accumulation of morbid doshas especially Vata dosha.

Vata dosha may progress to a pathological state if unattended to.

Purification with basti provides three benefits, disease prevention, curative effects, and health promotion. Ayurvedic basti is relevant for a healthy individual and it’s the best Ayurvedic management for detoxification.

Please consult a qualified Ayurvedic practitioner before undergoing basti/vasti therapy. 

References
1. Charak samhita, by kaviraj Ambika Dutta Shastri Chaukhamba Sanskrit, sansthan, Varanasi 2009,  Kalpa siddhi Sthana Chapter Chapter 1 verse 40
2. Sushruta, Illustrated Sushruta Samhita translated by Prof. K.R.Srikantha Murthy Volume-1, Shaarir Sthana, Garbha Vyakarana Shaarir, 4/3, Third Edition, Chaukhambha Orientalia, Varanasi, 2007;50
3. Sushruta, Illustrated Sushruta Samhita translated by Prof. K.R.Srikantha Murthy Volume-1 Shaarir Sthana, Garbha Vyakarana Shaarir, 6, Third Edition, Chaukhambha Orientalia, Varanasi, 2007;50
4. Charak samhita, by kaviraj Ambika Dutta Shastri Chaukhamba Sanskrit, sansthan, Varanasi 2009, KalpaSiddhiSthan Chapter 1 verse 38-39
5. Sushruta,Sushruta Samhita , Edited by Vidhya Yadavji Trikamji  and NarayanRam Acharya 9 th edition 2007, published by Chaukhambha Prakashan, varanasi  chikitsa sthan chapter 35 verse 1)
6. Sushruta,Sushruta Samhita , Edited by Vidhya Yadavji Trikamji  and NarayanRam Acharya 9 th edition 2007, published by Chaukhambha Prakashan, varanasi Chikitsa sthana Chapter 35 verse 18-19)
7. Charak samhita, by kaviraj Ambika Dutta Shastri Chaukhamba Sanskrit, sansthan, Varanasi 2009,  Kalpasiddhi Chapter 1 verse 47,48
8. Panchakarma – applied aspects, kerala, vaidhyaratnam ayurveda foundation., 2010; 56. 9
9. Charak samhita, by kaviraj Ambika Dutta Shastri Chaukhamba Sanskrit, sansthan, Varanasi 2009,   Siddhi Sthana, chapter 12/22
10. Charak samhita, by kaviraj Ambika Dutta Shastri Chaukhamba Sanskrit, sansthan, Varanasi 2009, KalpaSiddhi sthan chapter 2 verse 19
11. Charak samhita, by kaviraj Ambika Dutta Shastri Chaukhamba Sanskrit, sansthan, Varanasi 2009, KalpaSiddhi sthan  chapter 2 verse 17
12. Ashtang Hridaya, by Kaviraj Atri Dev Gupta, Chaukhambha Prakashan, varanasi, 2007, Sutrasthan chapter 19 verse 2)
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15. Ashtang Hridaya, by Kaviraj Atri Dev Gupta, Chaukhambha Prakashan, varanasi, 2007, Sutrasthan .19/45)
16. Sushruta,Sushruta Samhita , Edited by Vidhya Yadavji Trikamji  and NarayanRam Acharya 9 th edition 2007, published by Chaukhambha Prakashan, varanasi Chikitsa sthana Chapter 35 verse 18
17. Vagbhata, Ashtangasamgraha with Hindi commentary by Kaviraj Atridev Gupta, Chaukhambha Prakashan, varanasi, 2007, Sutrasthan 28/36)
18. Charak samhita, by kaviraj Ambika Dutta Shastri Chaukhamba Sanskrit, sansthan, Varanasi 2009, Kalpasiddhi Sthan Chapter1 verse 46)
19. Sushruta,Sushruta Samhita , Edited by Vidhya Yadavji Trikamji  and NarayanRam Acharya 9 th edition 2007, published by Chaukhambha Prakashan, varanasi  Chikitsa sthan .35/18)
20. Ashtang Hridaya, by Kaviraj Atri Dev Gupta, Chaukhambha Prakashan, varanasi, 2007, Sutra sthana 19 verse 47-48)
21. Charak samhita, by kaviraj Ambika Dutta Shastri Chaukhamba Sanskrit, sansthan, Varanasi 2009,  Kalpnasiddhi sthan Chapter 1 verse 30)
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24. Anil  K, Betty Philip,  Philip AK,-Colon Targeted Drug Delivery Systems: A Review on Primary and Novel Approaches OMJ. 25, 70-78 (2010); doi:10.5001/omj.2010.24 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215502/
25. Yashwant M.Juneja, clinical evaluation of Basti  administered through Basti pu-tak (pressure method),  Enema pot meth-od (gravity fed method and syringe method in ksheena sukra(oligospermia)
26. Peters  R, Kinget R. Film-forming  poly-mers for colonic drug deliver: Synthesis and physical  and chemical properties of methyl derivatives of Eudragit  S. Int J Pharm 1993;94:125-134 ).
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