VASTHI -MEDICATED ENEMAS

MEDICATED ENEMAS – VASTI

In this procedure medicated oils and decoctions are introduced into the large intestine through rectum with the help of an enema pot or special bag made for this purpose. The word “Vasti” means the urinary bladder. In the ancient days for introduction of liquid substances into the rectum the urinary bladders of cow, buffalo, sheep were used. A metal or wooden nozzle would be attached to it for smooth function.

Today, the best instrument for this purpose is the adult size enema pot, which holds approximately 450 ml. of liquid.

Medicated enema is universally regarded as the most important Panchakarma procedure. Because it removes the excess Vata dosha from the entire body. In modern terms for enema, the world colon therapy is used. But these modern procedures are nothing more than bowel cleansing or nutritive therapies. The scope of Ayurvedic Vasti treatment is far more significant and hence cannot be compared with contemporary enema.

Types of medicated enema
It is mainly of two types.

• Niruha or Asthapan Vasti:- this is also called as decoction or cleansing enema. The word ‘Niruha’ means “that whose benefit is great.
  

• Anuvasana or Sneha Vasti:- This contains only oil. The word ‘Anuvasana’ means “ that which remains inside (vas) the body for a long time (anu) without causing harm.” This can also be given daily (anudina) without any side effects hence it is called as – anuvasana.
  

The niruha is given usually for purification and the anuvasana is used for nourishing and for reducing Vata.

In decoction enema, salt, honey, oils, pastes, and decoctions of herbs are used. According to the variation of substances used, this Vasti is further classified into yapana, brimhana, etc.,

In Anuvasana Vasti only sesame oil or medicated sesame oil is used.
Depending on the properties of the herbal medicine which is used, Vasti has a number of different functions.

1. It can be used for radical purification or for gentle alleviation therapy.
2. It can be used for increasing semen or for nourishing weak individuals – with anabolic herbs – brimhana

3. It can have a reducing effect (langhana) or scrapping effect (lekhana) for obese patients;

4. Or can also be used for protecting the vision (chakshushya).
5. It can prevent age related diseases (jarahara) and to promote strength and longevity.

Classification of medicated enemas.
1. According to the site

• Rectum
  
• Vagina
  
• Urethra
  
• A wound cavity
  

2. According to the substance used

• Cleansing or decoction (Niruha)
  
• Oleating (Anuvasana)
  

3. According to therapeutic action
· Shodhana – for purification
· Lekhana – for reducing excess tissue
· Snehana – for oleation
· Brimhana – for increasing deficient tissues in the body
· Shamana – for palliation
· Doshahara – to remove particular doshas

4. According to the course of treatment

• Karma – Total course of thirty enemas are given. In this course first one Anuvasana Vasti is given, then alternately twelve Niruha and twelve Anuvasana are given, and finally five Anuvasana are given.
  

• Kala – Total course of sixteen enemas. First one is Anuvasana then alternately six Nuruha and six Anuvasana are given, and finally three Anuvasana.
  

• Yoga – Total course of eight enemas. First one Anuvasana, then alternately three Anuvasana and three Niruha, and finally one Anuvasana is given.
  

Herbs used for decoction or cleansing enema
Charaka has explained 6 groups of these herbs according to the predominant taste.

• Those having predominant sweet taste – There are 86 herbs in this group including Shatavari, Yashtimadhu, draksha etc.
  
• Those having predominat sour taste – These include different forms of wines and yogurt etc., prepared from herbs like amalaki etc.,
  

• Different types of salts – herbs do not contain salts but in this group there are varieties of salts.
  

• Those having predominant pungent taste – This group includes 35 herbs like garlic, trikatu etc.,
  

• Those having predominant bitter taste – This group includes 45 herbs like guduchi, katuka etc.,
  

• Those having predominantly astringent taste – This group includes 63 herbs like ashoka, triphala etc.
  

However the commonest herbs are – ten roots, sida cordifolia, tinospora cordifoiia, tribulus terrestris, terminalia chebula; withania somnifera, aegle marmelos, gmelina arborea, emblica officinalis, mucuna prureins and bacopa monniera.




Contra-indications of Cleansing medicated enema
It is contra-indicated in conditions of indigestion, obstruction or perforation in the intestines, for very old or debilitated patients, for toxins (Ama) in the gastro-intestinal tract, diarrhoea and vomiting. It is also contra-indicated in patients who have received too much oleation, have severe loss of appetite (Agnimandya), and are tired due to long travel, hunger and thirst, immediate after meals or purgation, in status asthamaticus, ascitis and piles.

Indications for Cleansing medicated enema
Excluding all above diseases, decoction or cleansing enema can be given for any disorder. This is indicated in diseases of Vata especially when it is vitiated due to the obstruction in the channels. e.g. conditions like pain in the abdomen, chest, pelvic region, eyes, ears or legs, headache, cardiac pain, hemiplegia, facial paralysis, constipation, obstruction in urination, worms, stiffness in the body, fistula, joint diseases, stiffness in back and hip, problems of lactation, tremors, loss of strength in the body and gout.

Indications for Anuvasana medicated enema
A person, who is suitable for Niruha Vasti is usually suitable for Anuvasana Vasti. It is also indicated in patients having dryness of the body. Very strong gastric fire, all diseases of Vata, due to tissue loss (wasting and debilitating diseases). It is given for the purpose of oleation and nutrition also.


Contra-indications of Anuvasana medicated enema
It is contra-indicated in acute fever, Anemia, jaundice, diabetes, ascitis and Kapha in gastro-intestinal tract.

Preparation of Decoction medicated enema
To prepare the mixture for decoction enema, one must follow a sequence of mixing various ingredients. First add honey and rock salt and mix properly. Then add sesame oil or ghee, again mixing properly. Then add to it a fine paste (kalka) of herbs, and finally add to it the medicated decoction. The whole mixture, when thoroughly mixed, should be heated to body temperature over water vapour. Then pour these contents into an enema bag.

The exact amount of the ingredients is as follows—

• Select all herbs useful for cleansing enema total 1200 gm. Mix powder of 8 fruits of randia dumetorum (madana phala), add 16 times water and prepare decoction of 1 litre.
  

• Add oil or ghee according to the purpose of alleviation of particular dosha, for the enema used for Vata – ¼ ^th amount of decoction or 30 gm. For Pitta - 1/6^th or 20 gm. For Kapha – 1/8^th or 15 gm.
  

• Then add 1/8^th or 15 gm. of fine paste of herbs or kalka.
  
• Then add 5 gm. each of jaggery and saindhava and 20 gm of honey.
  

Then mix the contents in particular sequence described above. Usually Decoction enema contains 400 ml of decoction, 50 to 60 ml of oil, ghee, honey and 3 g. rock salt and 3 to 6 g. of herbal paste (kalka). Dose can be increased if necessary. The standard volume of this enema is 450 ml.

Method of administration

• Preliminary procedure
  

Physician must carry out proper examination of the patient to know what is the state of aggravated dosha, agni, satmya, age, strength, season and then decide what herbs one must select for the procedure.

If doshas are aggravated one should use decoction enema, if doshas are in the state of very low and the body strength is reduced one should use nourishing or brimhana type, if they are amalgamated in blood use varnya type of enema to purify the blood, if doshas are in muscle, use scrapping or lekhana enema, if they are lodged in bones use enema containing meat soup, milk and herbs having bitter taste.

• Main procedure
  

This procedure should be carried out four to six hours after food has been taken and preferably early in the morning or in the evening. Before introducing Vasti, there is no necessity to give internal oleation. Only oil should be applied to the region of abdomen and back and then fomentation should be done.

The patient should then lie on a bed with the head low and in the left lateral position. He should be asked to extend his left leg, with the right leg taken near the abdomen by folding it.

He should keep his left hand below the head. Then a small amount of oil should be applied to the rectum as well as to the nozzle of the Vasti instrument. After this, the nozzle should be inserted slowly into the rectum and the balloon should be squeezed. It is very important not to introduce any air into the rectum with the Vasti. When all the contents of the Vasti have entered into the large intestine, the nozzle should be slowly withdrawn. The medicated contents should be retained in the intestine for maximum 48 to 50 minutes and then allowed to come out again along with the faecal matter and excess pitta and Kapha. The patient should be asked to use the bed pan.

· Instruct the patient to evacuate when there is urge of passing out the stools. He should not strain or pass motion forcibly or retain forcibly.

· Every Niruha Vasti is followed by Anuvasana Vasti on alternate day.
· In chronic cases, Vasti can be given for 8 days, 16 days, or even for 30 days.
After administering all the contents of Niruha Vasti, the patient feels the urge to pass out the contents within 48 to 50 minutes. Sometimes the patient will need to eliminate immediately after the Vasti is given. In this case the Vasti must be re-administered. If the patient has retained the Vasti for 15 minutes, there is no need to re-administer the same.


Symptoms of optimum purification
Evacuation of stools, urine and flatus, increase in the digestive fire and then patient feels hungry and he also relishes the food he consumes. Symptoms of the disease for which the enema is given are alleviated.

Symptoms of inadequate purification
The contents which have been introduced do not come out and hence there is distension of abdomen and pain not only in abdomen but in head, in the region of heart also and patient may develop dyspnoea or difficulty in breathing.

Treatment
If the patient has not eliminated the material introduced and has developed certain symptoms like distension of abdomen or pain in the abdomen, within 48 to 50 minutes, the following steps should be taken.

1. Administer another 450 ml. of fluid consisting of a hot herbal decoction.
2. Give slight fomentation to the lower abdominal region (with the help of fomentation through tube or with hot water bottle)

3. Ask the patient to drink plenty of hot water.
4. Administer purgative herbs if the above three measures are not effective within 50 minutes.

Yoga Posture
Paschimottanasana (Seated forward bend) is useful in this state.
Introduce suppository (phalavarti) in the rectum and give warm water to drink with tab. shankha vati 250 mg. 2 to 4 times a day.


Symptoms of excessive purification
Same as that of excessive purgation e.g. repeated loose stools leading to dehydration, severe weakness, fainting, hiccough, Treatment should be the same like the one given for excessive purgation.

After treatment the patient should be given rest. Then he is given warm water and when hungry, should be given a diet consisting of grains, milk and other nourishing substances.

Post decoction enema procedure
Once the symptoms of optimum purification are observed, ask the patient to take a warm bath and followed by bed rest. Then he should take light diet of moong kichari. He should then follow certain rules of do’s for certain period which is known as ‘Parihara kala’. During this period he should not travel, make loud speech or wander in hot sun.

Method of administration of Anuvasana vasti
1. Preliminary procedure
Physician should carry out proper examination of the patient and then decide whether he needs only oil enema or medicated oil enema. Charaka has advised different types of medicated oil enema in different diseases.

2. Main Procedure
The main procedure and post Vasti treatment is the same as that of decoction or cleansing enema. The only difference is that, here the quantity being small, from 60 to 100 c.c. a rubber catheter and a plastic syringe can be used. Now ready-made oil Vasti are also available which are disposable and easy to use.

The contents of the Vasti, being small in quantity, do not cause any harm to the patient even when retained in the intestine for more than 24 hours. While giving oil enema to adult patient, medicated or plain sesame oil is mixed with fine powder of anise and rock salt before it is administered.

Now ready made oil enemas are also available. They can also be used.
Some useful medicated enemas

• Eranda taila and Lavana jala Vasti:- Rock salt 3 to 4 g. in + 50 to 60 ml. of castor oil mixed with one pint of warm water to relieve constipation.
  

• Madhu tailika Vasti:- Eranda moola kwatha (Ricinus Communis) 300 to 400 ml, Honey - 50 ml, Rock salt - 3 g, Anise powder 6 g. for pain due to Vata and constipation.
  

• Ksheera Vasti:- 200 ml. of Milk, 50 ml of honey, 50 ml. of Ghee and 50 ml. of Oil thoroughly mixed and given by drip method, is useful in abdominal pain, ulcers and pitta diseases.
  

• Tikta Vasti:- It is a combination of medicated ghee with bitter herbs + ksheera Vasti (50 ml), which is very useful in osteo arthiritis, lumbar, sacral pain, back pain, sciatica and other pain.
  

• Rajyapan Vasti:- Mustadi decoction (Cyperus rotundus), meat soup, milk, ghee and honey are used in this Vasti, which is useful for myopathic problems, weakness, epilepsy, tuberculosis, anaemia etc.
  

• Piccha Vasti:- Decoction of bark of Udumbara or decoction of mocharasa Kwatha, oil and ghee used in diarrhoea, dysentery, rectal bleeding, colitis and ulcerative colitis.
  

• Matra Vasti:- Most commonly used in which, 25 to 40 ml. of Sesame oil is given.
  

Post anuvasana procedure
Once the optimum symptoms are developed e.g. the contents return back within 12 hours and do not cause any untoward effects, the patient should be asked to take rest and he can be given light meals.

Benefits of Vasti:
1. Vata dosha is brought under proper control, all other aggravated doshas and waste products are removed and hence all the tissues are properly developed.

2. Person remains healthy and does not fall prey to any diseases.
3. Strength, agni and intelligence are increased
4. The complexion of the skin and voice becomes good.