Basti therapy is perhaps the most powerful of the five main procedures of Panchakarma. Charaka, as well as many later Ayurvedic scholars, unanimously praise the value of basti. They say that while vamana, nasya and virechana together contribute fifty-percent of the benefits of Panchakarma, basti by itself, provides the other fifty-percent. The literal meaning of Basti is “bladder,” because centuries ago, bladders made of animal skins or organs were used to administer this procedure. Bas carries the meaning, “to stay in place,” and therefore can be understood as “that which is retained or kept inside.”
Basti is the introduction of medicated liquids into the colon through the rectum. While it directly effects the colon, it is not a localized or symptomatic treatment. The colon is seldom, if ever, addressed for its own sake. Rather, it is utilized because of its vital link with all of the other organs and tissues. Consequently, basti has a wide-ranging influence in the body, effecting all the doshas and dhatus.
Charaka uses the analogy of a large tree with flowers, fruits, leaves, branches, bark and trunk. The whole tree depends for its nourishment on its roots. Through the roots, the tree takes in water and nutrients, which it circulates throughout its structure and transforms into its trunk, branches, leaves, etc. Thus, the root constitutes the primary organ for sustaining the life of the tree. Much like the root, the colon performs the central job of providing the nourishment that sustains all the other organs and tissues of the body.
Three factors explain the colon’s significant role in supporting the body:
(i) It is the main organ for absorption of nutrients from prapaka digestion.
(ii) The colon is the chief seat for vata, the prime mover of the other two doshas, and therefore, all physiological activities.
(iii) It constitutes the primary receptacle for waste elimination.
Basti treatments balance and nurture vata dosha. When vata functions normally, it helps bring toxins and waste matter out of the dhatus and eliminates them. Vata plays a central role in the disease process because it carries ama from the site of origin (in the G-I tract) to the deeper tissues where it generates disease. By managing vata, we gain control of the disease process before it goes into its migratory phase.
The word basti is frequently translated into English as “enema.” However, to associate or confuse basti treatment with enemas misconstrues the true nature of this therapy. Basti differs completely from enemas or colonics in its intent, administration and effect.
Enemas treat localized symptoms of constipation by promoting evacuation. They clear feces that have collected in the rectum and sigmoid colon — the last eight to ten inches of the colon. Colonics clean accumulated fecal matter from the entire colon through repeated flushing with water. In recent years, Western practitioners of colonic therapy have begun to experiment with the addition of other substances to the water.
From the point of view of Ayurveda, emphasis on the colon as a primary eliminative pathway in the body is correct. However, repeated flushing with water, as well as the introduction of oxygen, may weaken the mucous membranes, dry the colon and further disrupt the normal eliminative work of vata dosha. Neither enemas nor colonics address the nutritive capability of the colon.
However, when basti is used in conjunction with Panchakarma’s pre-procedures, it cleans far more than just the colon. It helps purify toxins from all over the body. Healthy colon function is not simply a matter of ridding the body of fecal material. Vata, with its excitable nature and drying tendency, must be nourished and pacified. In fact, the entire body can be nourished through the colon. Basti’s palliative and nutritive qualities address these factors.
Basti introduces medicated, oily substances into the colon to be retained and absorbed by the body. It treats the entire length of the colon, from the ileocecal valve to the anus, and eliminates not only accumulated fecal matter from the colon but also ama and toxins from all the dhatus. In addition to getting rid of toxins, it restores healthy function to the colon, and through the colon nurtures and rebuilds the tissues and organs.
Therapeutic Benefits of Basti Therapy
Basti therapy is the most effective treatment for disorders arising from abnormal vata. This includes chronic constipation, low back pain, sciatica, rheumatism, gout, arthritis; and various neuromuscular disorders, such as paraplegia, hemiplegia, poliomyelitis, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and dystrophy and atrophy of the nerves and muscles. It benefits epilepsy, mental retardation, and sensory dysfunction.
Vata governs and has its secondary seat in the bones. Basti therapy therefore also helps with disorders of asthi dhatu, or bone tissue, such as osteoporosis. When vamana and virechana cannot be used due to emaciation and weakness, patients can receive a combination of nutritive and cleansing bast is. Basti is generally contraindicated for infants, as well as those suffering from diarrhea, rectal bleeding, ulcerative colitis, diverticulitis, colon cancer, polyps, fever and some types of diabetes.
The effectiveness of basti treatment became very clear to me in the first few months of my medical practice. A man came to me with severe hiccups. They continued without stopping. Twenty-four hours a day, whether he was standing, lying down or sitting. He and his family had tried everything they could think of without success. He had become desperate since he could not eat solid food or sleep with this condition. He also reported a history of chronic hyper-acidity and colitis.
He tried homeopathy first, but when the hiccups did not stop, he consulted a number of Western physicians, including a gas-troenterologist. Their examinations turned up only some gastritis and duodenitis; the medications they prescribed for these conditions did not help the hiccups. Finally he resorted to naturapathic treatments, which used medicated poultices, emetics and coffee enemas. After forty-eight hours, he had not improved. In desperation, his family decided to admit him to a Bombay hospital one day’s travel from home, but no rooms were available for three days.
In the mean time, his brother-in-law heard of me and decided to give me a call. I visited the patient and gave him a thorough examination. Frankly, I felt a bit intimidated by the situation. So many doctors had tried and failed to help this man, and I was just beginning my practice and had little experience. However, I appreciated the challenge and thought to myself, “Well, let us see what this ancient knowledge can do.” When I examined him, I discovered that he had not had a bowel movement in six days. His mother and wife said this was because he could not eat solid food and was taking only liquids. Though my examination confirmed the metabolic dysfunction noted by the other doctors, I felt that some key factor was being overlooked.
I deeply considered the problem, and my intuition told me to look for the answer in the Charaka Samhita’s description of vata and it’s sub-functions. There it states that vata dosha is divided into five sub-doshas, (called vayus), each of which governs a specific type or direction of movement in the body. Apana vayu has a downward movement and is responsible for eliminating urine and feces. I reasoned that apana was not working properly because elimination was not taking place. I felt that instead of moving downward, it was, in fact, moving upward. This upward distortion of its natural movement interfered with the normal function of udana vayu, another sub-dosha, and precipitated a crisis between them. This conflict, I thought, could be the cause of the hiccups.
I remembered from the texts that basti treatment is always prescribed for any acute vata imbalance. I explained to the man and his family what I thought should be done, but they could not understand how an “enema” would help. Luckily, the mother-in-law was somewhat familiar with Ayurvedic treatment and said, “OK, let’s try it. If it works we will not have to travel 600 miles to Bombay.”
First I administered a water-based, cleansing nirooha basti. After three hours, I administered an oil-based, nourishing anuwasan basti. Three hours later, I administered another nirooha basti. I went to see him the next morning and found that there was no change in his condition. His family was disappointed that nothing had yet happened. However, I was confident that the theory was sound, so they allowed me to continue treatment.
I administered an anuwasan basti, and after three hours, another nirooha basti. Then I went home. When I came back in the evening to administer one more anuwasan basti, the patient greeted me at the door. He said, “You are a great doctor! After you left I had a bowel movement. Stone-like fecal matter came out, and then suddenly, after that evacuation, my hiccups stopped. Thank you!” Needless to say, I was happy and even a little surprised at the success of this uncomplicated treatment.
When I went home, I pondered the fact that this man had experienced such wonderful results in such a short period of time. The treatment was so simple. The previous treatments had concentrated on the inflammation of the upper G-I tract. They did not consider the possibility that wastes and toxins remained in the patient’s body and impaired the normal functions of vata.
I did not specifically treat the gastritis or the hiccups. I treated apana vayu, restoring its natural downward direction and thus the normal peristalsis of the colon. This reduced the bloating and gas and eliminated the malas that had accumulated in his colon. With apana vayu flowing in its proper direction and some of the toxins removed from the colon, the other sub-functions of vata regained their correct functioning. As soon as the hyperactivity of udana vayu sell led clown, the hiccups ceased.
Another example of the effectiveness of basti therapy came from treating a man who had suffered a stroke six months before coming to sec me. I lis left side was completely paralyzed. He had been diagnosed with a type of flaccid paralysis hemiplegia and his family had been told that nothing could be done except maintain his vital functions. The doctors suggested physiotherapy, but doubted whether it would have much effect. The bedridden patient received six months of physiotherapy, but his condition showed no improvement.
He came to my clinic in a wheelchair and could not even lift his hand. The Ayurvedic texts generally attribute such conditions to a block in vata’s movement. Accordingly, I put him on a special regimen, including snehana, pinda swedana, nasya and a type of basti therapy designed to strengthen mamsa dhatu and restore neuromuscular function. In the two years that he has been under treatment, he has recovered almost total mobility and coordination. Today he walks well on his own, although he occasionally needs to pay attention when walking fast or lifting. He returned to work and now leads a normal life.
Because of poor nutrition and physical stress, many patients in India suffer from spondylosis, an inflammation of the cervical or lumbar vertebrae and a herniation of the discs. Even with surgery, many people become physically incapacitated or experience chronic pain. I have repeatedly found that Panchakarma with an emphasis on basti quickly reduces or eliminates the pain and muscle spasms, and in most cases, restores spinal mobility. However, I have not yet determined to what extent degenerated discs can be restored, and it will take years of research to do so.
I have also had great success treating sciatica-types of disorders with basti therapy. Not only do these patients return to work free from pain, but, in many cases, no longer require surgery. Such spinal diseases usually result from debilitated asthi and majja dhatus. The spinal inflammation common to these bone and marrow disorders is due to an ama accumulation that severely blocks vata’s work in that area.
Since vata governs bone and bone marrow, bastis — particularly oil-predominant bastis — are an essential part of the treatment program. Oil’s slow, heavy qualities directly counteract the dry, rapid and mobile qualities of deranged vata. These patients need thorough internal and external oleation. This removes ama from the spine, corrects vata dysfunction and reestablishes pain-free mobility. I have also used this therapy with extremely good results in cases of poliomyelitis and muscular dystrophy.