Vasti Chikitsardha

Chikitsa in Ayurveda 

         The functional equillibriuam between dosas, dhatus and malas, which is responsible for the health of a person is controlled by the healthy agni. Physiological aspects of a person is represented by dosa, structural integrity and function by dhatus,'Srotas' responsible for the enzymatic, bio-chemical , functional and circulatory activity related to each dhatu.
         'रोगस्तु दोषवैषम्यं दोषसाम्यमरोगता '
and aim of this sastra is achieved through
       तन्त्रस्यास्य प्रयोजनं स्वस्थस्य स्वास्थ्य संरक्षणं आतुरस्य विकारप्रशमनं च I
That means Ayurveda gives equal importance to the maintenance of health by prevention of ailments and curing them.
        The curative treatment is divided in to संतर्पन & अपतर्पन .They are again subdivided in to 6 therapeutic measures given as follows.

        1. Brmhana - naurishing
        2. Langhana - depleting
        3.Stambhan - blocking
        4. Svedana - sudating
        5. Snehana   - oleating
        6. Rukshana - drying

        Brmhana & langhana are the synonyms of santarpana and apatarpana respectively. Langhana is again divided in to शोधन  & शमन .

* Samana
Measures included under शमन therapeutics are palliative in nature. As  samana will only pacify the deranged dosas and will not eliminate the marbid factors from the body, there may be an aggravation in the future.
        न शॊधयति यद्दोषान् समान्नोदीरयत्यपि |
        समीकरोति विषमान् शमनं  ..

* Sodhana
   The word sodhana means cleansing and purifying . The word 'parimarjanam' is a synonym for sodhanam. Cleansing or detoxifying is system is an integral concept of Ayurveda.

Importance of शोधन therapy

      Among these two types of treatment, sodhana cikitsa is considered to be more effective , since the disturbed dosas are eliminated from the body and the disease will not reoccur.
                यतेत च यथाकालं मलानां शोधनं प्रति |
                अत्यर्थसन्जितास्ते हि क्रुद्धा स्युर्जिवितच्छद: |
                दोषा कदाचित् कुप्यन्ति जिता लंघनपाचनै: |
                 ये तु संशोधनैर्शुद्धा न तेषां पुनरुद्भव: : I
                                                               (A.H. Su:4)
This sloga itself explains  the importance of sodhana therapy over samana therapy.
     Vata is amurta in nature, Pittha and Kapha are murta doshas and they have the common quality 'Sneha' that is being targeted for utklesana and for elimination in sodhana therapy. Sneha is also the quality of ama which produces srotorodha. Once the kleda is removed, it automatically brings the normal flow of vayu.
     Before Sodhana, Snehana and Svedana are done as purvakarma which helps in lubricating and dislodging the morbid material to flow and reach the koshta. When we give snehapana, the mala is increased in the sakha and brought to the koshta by svedana and eliminated by sodhana.
              स्नेहक्लिन्ना कोष्ठगा धातुगा वा |
              स्रोतोलीना ये च शाखास्थिसंस्था: |
              दोषा: स्वेदैस्ते द्रवीक्रित्य कोष्ठं |
              नीता सम्यक् शुद्धिभिर्निह्रियन्तेI (A. H. Su: 17)

Sodhana therapy is prescribed after snehana with drugs prepared which are pacana and dipana followed by sveda.Then they are to be expelled out by means of appropriate sodhana therapy through the proximal route in proper time, considering the strength of the patient.

            पाचनैर्दीपनै: स्नेहैस्तान् स्वेदैश्च परिष्क्रितान् |
            शोधयेच्छॊदनै: काले यथासन्नं य़थाबलं |
                                                               ( A.H. Su: 13)
Appropriate drugs used along the oral,nasal and rectal routes(proximal routes) expels malas located in amasaya, urdhva jatru, and pakvasaya respectively.
          हन्त्याशु युक्तं वक्रेण द्रव्यमामाशयान्मलान् |
          घ्राणेन चोर्ध्वजत्रूत्थान् , पक्वाधानात् गुदेन तु |
The dosas from the pakvasaya is expelled out through guda marga

Pancasodhana and Pancakarma

According to Vaghbhata, the following five procedures are considered as Sodhana chikitsa.

            यदीरयेत् बहिर्दोषान् पन्जधा शोधनं च तत् |
            निरूहो वमनं कायशिरोरेको अस्रविस्रुति: |
                                                                       (A.H. Su: 14)
          1. Vamana (therapeutic emesis)
          2. Niruha  (decoction enema)
          3. Kayareka (therapeutic purgation)
          4. Siroreka (nasya)
          5. Asravisruthi (bloodletting)

Caraka has enumerated the following procedures as pancakarma therapy.
           वमनं रेचनं नस्यं निरूहश्च अनुवासनं |
           एतानि पन्चकर्माणि कथितानि मनीषिभि: |
           1). Vamana
           2).Virecana
           3). Asthapana Vasti
           4). Anuvasana Vasti
           5). Nasya
These are the 5 procedures used for दोष नि:सरन apart from panca sodhana where Raktamoksha  included, resulting in धातु नि:सारण (Raktaधातु ).
         Ability to evacuation, superiority of efficacy & enormity of the procedures , target dosa eradication and multitude of action are characteristics of panchakarma.
        The importance of panchakarma in the health care system is a proven fact for the Ayurvedic fraternity of India.The Sanskrit word 'Panchakarma' has reached beyond the oceans nowadays. Most of the people around world use this word as the 'Synonym of Ayurveda' too. Panchakarma has a cardinal role among the Ayurvedic treatment methodologies.
Sarangadhara and Bhava misra also have mentined the above 5 procedures.
Caraka has stated that the elimination therapies are four in the context of langhana(चतुष्प्रकार संशुद्धि ).

1.Vamana 2.Virecana 3. Asthapana 4. Sirovirecana.

Caraka has not considered raktamoshana as one of the pancakarmas . Anuvasana vasti does not eliminate the dosas considerably, but still it eliminate faeces and flatus for which it is included under the five elimination therapies by other authors.Anuvasanam in a broad sense, is a brmhana sodhana.

       For elimination of disturbed dosas from the body, the following pradhana karmas- vasti, virecana and vamana are indicated as the best for vata,pitta and kapharespectively.In this context,Kasyapa says vasti denotes anuvasana.

Significance of वात 
      Due to its peculiar property 'चलत्व' ability to move & yogavahitva (act as a catalyst), vata controls dormant pitta & kapha  and makes them active. पक्वाशय is the main seat of वात , and vata itself and in combination with other dosas also results in multiple diseases , vata has to be protected, and the normal function is maintained,
      दोशवैषमय is the root cause of disease and vatadosa is significant among dosas.
  पित्तम् पन्गु कफं पन्गु पन्गवो मलधातवा |
  वायुना यत्र नीयन्ते तत्र गच्छन्ति मेघवत् |
     Anabolism and catabolism depends upon the normal physiological activities of vata.The functions of agni is also controlled by वात.
Five types of vayu, prana-udana-samana- apana-and vyana have different systemic effects in the body.So, controlling the functions of vata, by considering the fact
    'नेतुभन्गेन द्रिष्टो हि समं सैन्य पराजय:'
by winning over the leader, can defeat the companions, that means by controlling vata, we can control other dosas and the diseases arise from it.Vasti can be considered as the ultimate therapy for diseases caused by the vitiation of वात.
      शरीरजानां दोषाणां क्रमेण परमौषधं |
      वस्तिर्विरेको वमनं तथा तैलम् घ्रूतं मधु: |
                                                     (A.H. Su: 1)
So vasti is importan as परमोपध for शोधन चिकित्सा of वातिक संसर्गाज  diseases.The two reasons of वातकोप is indluging in धातुक्षयकर nidanas and due to avarana of vata.

Vasti Karma
     Vasti karma is regarded as the prime treatment modality among the panchakarma. It is having curative,preventive, promotive and rejuvenative actions. Vasti therapy is considered as ardha cikitsa among all therapy,some physicians recognize it as absolute therapy because vasti has a vast  field of therapeutic actions.Vasti is said to have an edge over any other Sodhana Procedure as it is rightly told as pradhanatana karma among all therapeutic measures.
    Vasti is always useful in diseases caused by vata,pitta, kapha and rakta and in samsarga, sannipataja dosic conditions also.
      वस्तिर्वाते च पित्ते च कफे रक्ते च शस्यते |
      संसर्गे सन्निपाते च वस्तिरेव हिता सदा |
                                                 (सु . सं .चि : 35/6)
So vasti is the most beneficial karma with a wide range of therapeutic applications in almost all diseases of the body.Vasti can be administered ti persons of all age groups from bala to vrdha where all other sodhana procedures are restricted or contra indicated.
       'आजन्ममरणम् शस्तं प्रतिमर्षस्तु वस्तिवत् '

Nirukti of Vasti:-

• Vas nivase - means to reside or to stay

                             Eg: शिरोवस्ति , कटिवस्ति  etc .

• वस्तिना दीयते वस्तिं वा पूर्वमन्येतीत्यतो वस्ति: |

Definition

नाभिप्रदेशं कटिपाश्वकुक्षिं गत्वा शक्रूद्दोषचयं विलोड्य |
संस्नेह्य काय़ं सपुरीषदोष: सम्यक् सुखेनेति चय स वस्ति |

                                                   (Ca. Sa. Si.-I)

The therapy which while moving in the umbilical region , lumbar region, sides of the chest and pelvic region chums up the stool including all other morbid matter located there, and appropriately eliminates them with ease after nourishing the body is called vasti.

CLASSIFICATION OF VASTI

 Different authors classify the vastikarma considering the various aspects of procedure. Generally vastikarma is classified in to Nirooha, Anuvasana and Uttara vasti

              उपक्रमाणां सर्वेषां सोअग्रणीस्त्रिविधश्च स: |

              निरूहो अनुवासनं वस्तिरुत्तर:      (A. H.Su: 19)

स तु वस्ति: त्रिविध: आस्थापनमनुवासन उत्तरवस्तिश्च |
तत्रास्थापनं दोषदूष्यानुसारेण नानाद्रव्यसंय़ॊगादि निर्व्रुत्तं |
तस्य भेदा उत्क्लेशनं शोधनम् शमनं लेखनं ब्रिंहणं वाजीकरणं
पिच्छावस्तिर्माधुतैलिकमित्यादय: माधुतैलिक्स्य पर्याया यापनो युक्तरथो
दोषहर: सिद्धवस्तिरिति |

                                                               (A. S. Su: 28)

But Caraka has used the term vasti exclusively for Nirooha

   अत्र वस्तिश्ब्दो निरूहो एव वर्तते  I

                                                          (चक्रपाणि )

Niruha Vasti

• तत् वयस्थापनात् दोषस्थापनाद्वा आस्थापनमित्युच्यते  I

                                                                 (A.S. Su: 28)

It sustains youth & dosa in its own site

• शरीररोहणात् दोषनिर्हरणात् अचिन्त्यवीर्यप्रभावतया चास्मिन्नूहासम्भवान्निरूह इति I (A.S. Su:28)

It's action is through out the body by expelling dosa, and its virya and prabhava is unimaginable so also results in immaginable effect.

• आस्थापनं , निरूह इत्यनर्थान्तरं तस्य विकल्पो माधुतैलिक:

           तस्य पर्यायश्ब्दो यापनो युक्तरथ सिद्धवस्तिरिति |

• माधुतैलिकं - यस्मान्मधु च तैलं च प्राधान्येन प्रदीयते |

           माधुतैलिक इत्येवं भिषक्भिर्वस्तिरुच्यते |

                           - मधुतैलेसमे कर्ष:सैन्धवाद् द्विपिचुमिसि  I

                               एरण्डमूलक्वाथेन निरूहों माधुतैलिक: I

• युक्तरथवस्ति- रथेष्वपि च युक्तेषु हस्त्यश्वे चापि कल्पिते  |

          यस्मान्न प्रतिषिद्धोअयमतो युक्तरथ: स्म्रित:|

• सिद्धवस्ति - बलोपचयवर्णानां यस्मात् व्याधिशतस्य च |

          भवन्त्येतेन सिद्धिस्तु सिद्धवस्तिरतो मत: |

                                                                    (Su. Sam. Ci: XXXV)

Indication

      Niruha vasti indicated in many disease conditions by acaryas, mainly in vatavrdhi due to srotorodha or avarna janya. Here the action of ingradients of vasti dravya make an important role.

Niruha Samyojana

माक्षिकं लवणं स्नेहं कल्कं क्वाथमिति क्रमात् |
आवपेत निरूहाणामेष संयोजने विधि: |

                                                          (A. H. Su: 19)

Makshika itself acts as yogavahi and in combination with saindhava acts on kapha results in vilayana & chedana. Honey & salt represent glucose and electrolytes and they prevent dehydration. Salt has the property of stimulating ion action potential which may be one of the causative factor for made of action of vasti.

          Snehadravyas taila and ghrta are widely used for vastikarma. Taila can be used in vata kapahaja diseases and ghrta in vata paittika condition.'Yogavahitwam of taila and 'Samsakarasya anurthanam of ghrha'can be brought to the action of vasti.

           Dhanwantaram mezhukupakam, Sahacaradi tailam Mezhukupakam etc. are widely used in the management of vata vyadhis. Ghrtas like Sukumara ghrtam (gyneacological purpose mainly) & guggules tiktaka ghrtam etc. also used.

           Kalka gives potency to the whole combination because it helps to disintegrate the malas by increasing the osmotic permeability of the Solution.Commonly used kalka dravya is Shatahva. Wherever kalka dravya is not mentioned , kalka dravya of bala gulucyadi  vasti in A.H. kalpam can be used as common kalka dravya. according to clinical needs , choornas like shuddharanam, vaiswanaram, hinguvacadi can also be used. Kasaya also selected  according to the dosa, doosya of the disease.

            Time of administration of niruha vasti - मध्याह्ने किच्चिदावर्ते also imports effect on sodhana of dosa.That means in empty stomach, vata is more prodiminently, it can tackle vata very well, eliminate malas properly.

           Action of nirooha over other sodhanas in eliminating pakvasaya gata vata is well explained in the context of jvara cikitsa, that is Sramsana results in elimination of pitta or kapha pitta from pakvasaya where as vasti eliminates all the tridoshas.

Effects of Niruha

वस्तिर्वयस्थापयिता सुखायुर्बलाग्निमेधा स्वरवर्णक्रिच्चा |
स्वार्थकारी शिशुव्रुद्ध्यूनां निरत्यया सर्वगदापहश्च |
विश्वक्स्थितं दोषचयं निरस्य सर्वान् विकारान् शमयेन्निरूहा |
                                                        (Cha. Sam. Si: I)

It can be used in neurological defects,arthropathies,low back ache,peripheral vascular disorders, headache,infertility etc.

Anuvasana Vasti

• अनुवासरं वा दीयत इति अनुवासनं |(Hrdhayabodhika commentary of A.H. Su:19)
• अनुवसन्नपि न दूष्यत्यनुदिवसं वा दीयत इत्यनुवासनं | (A.S. Su: 28)   

Anuvasana is mainly indicated in vatika conditions or after niruha to exclude the chances of aggravation of vata sodhana'.

Effectcs of anuvasana
 देहे निरूहेण विशुद्धमार्गे संस्नेहनं वर्णबलप्रदं च |
न तैलदानात् परमस्ति किन्जित् द्रव्यं विशेषेण समीरणार्ते |
स्नेहेन रौक्ष्यं लघुत्तां गुरुत्वात् औष्ण्य़ाच्च तैलं पवनस्य हत्वा |
तैलं ददात्याशु मनप्रसादं वीर्यं बलं वर्णमथाग्निपुष्टिं |
मूले निषिक्तो हि यथा द्रुम: स्यान्नीलच्छ्द कोमल पल्लवाग्रा |
काले महान् पुष्पफलप्रदश्च तथा नर: स्यादनुवासनेन |
                                                             (Cha. Sam. Si : I)
The channels of the body get cleansed by niruha. There is no therapy better than the administration of taila which is specifically useful for the patient affected by the diseases of vata.
  Taila acts by its properties of unctousness, heavness and heating property counterates the rakshata,laghutva and gunas of vata respectively and it instantaneously produces calrity of mind and promotes energy, strength, complexion & agni. Just as a tree integrated 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 by the administration of anuvasana.

दत्तस्तु प्रथमो वस्ति : स्नेहयेत् वस्तिवम्क्षणौ |

सम्यदत्ते द्वितीयस्तु मूर्धस्यमनिलं जयेत् |
जनयन् बलवर्णौ च त्रूतीयस्तु प्रयोजित |

रसं चतुर्थो रक्तस्तु पन्चम स्नेहयेत्तथा |

षष्ठस्तु स्नेहयेन्मांसं मेदस्सप्तम एव च |

अष्ठमो नवमश्चास्थिमज्जानां च यथाक्रमं |

ऎवं शुक्लगतान् दोषान् द्विगुणात्साधु साधयेत् |

                                   ( Su. Sam. Chi:37)
The first anuvasana administered properly lubricates the urinary bladder and groins the second enema mitigates vata localised in the head, the third enema bestows strength and colour, the fourth lubricates rasa dhatu, the fifth lubricates rakta, the sixth lubricates mamsa, the seventh medas, the eighth and ninth asthi and majja respectively and double of nine (18) enema properly given cures all disorders of sukra.
      General indication of anuvasana is well explained in the context of jvara cikitsa.
           प्रक्षीणकफपित्तस्य त्रिकप्रुष्ठकटीग्रहे |
           दीप्ताग्नेर्बद्धशक्रुत: प्रयुन्जीतानुवासनं |

Anuvasana should be given only after taking food. Because taila has got vyavayi,tiksna, usna and sukshma gunas.By these properties, Sneha will move to the upper part of the coln and reach the amasaya results in mandagni.So,food taken before anuvasana prevent such chances.

Effect of Niruha and Anuvasana
Vasti is specially useful for both शाखागत & कोषठगत  diseases, also have good effect in infertility .
स्तब्धाश्च ये संकुचिताश्च येअपि ये पंगवो येअपि च भग्नरुग्णा |
येषां च शाखासु चरन्ति वाता श्स्ते विशेषेण हि तेषु वस्ति: |

It is effective in diseases affecting bahya roga marga like whose limbs have become stiff and contracted who suffer from lameness,who are afflicted with fractures and dislocations.
आध्मापने विमथिते पुरीषे शूले च भक्तानभिनन्दने च |
एवं प्रकाशश्च भवन्ति कुक्षौ ये चामयास्तेषु च वस्तिरिष्ट: |

The disease affecting abhyantara roga marga like distension of the abdomen, gradhita purisa,colic pain, disliking for food etc. also can be controlled by vasti.
      It also have good effect in both male & female infertility.Where it is caused by the aggrevation of vata.

Number of vasti according to dosa:-

एकं त्रीन् वा वलासे तु स्नेहवस्तीन् प्रयोजयेत् |
पन्च वा सप्त पित्त्तेन् नवैकादश वाअनिले  |
पुनस्ततो अप्ययुग्मास्तु पुनरास्थापनं तत: |
                                          (A. H. Su:19)
One or three Snehavasti should be done in case of kapha predominance . 5 or 7 in pitta and 9 or 11 in vata. Justification for the odd numbers prescribed for snehavasti is said to be auspiciousness. Caraka is also has the same opinion.
     But, according to Kasyapa, this uneven number of vasti for the cure of the irregular disease, that the diseases caused by irregularity in doshas.
         अयुग्मा वस्तयो देया न तु युग्मा: कथान्जन |
          विषमा विषमैरेव हन्त्यन्ते वस्तिभिर्गदा |
                                          (K.S. Khila :8)
    The scheduled enemata like karma vasti (combination of 30 vastis), kala vasti(15 vastis) and yoga vasti(8 vastis) are not only just routes of drug administration. These are procedures as such, meant for specific action in specified condition in specific term formats.The drugs used need not vary in each of these enemata, but importance given to time frame. Because, the opinions of acaryas substantinating the need of only 3 vastis for the pacification of three doshas is applicable only in the case of patients of good strength and the patient get samyag laksana in each days. So, these are applicable practically.


-Vatahara Vasti:

• Use of an unctous, warm vasti having sweet and sour tast, consisting of decoction of drugs of vatahara property,along with trvrt , saindhava & mixed with rasa is good.

-Pittahara Vasti:

• In case of pitta, two vastis which are sweet and cold potency , consisting of nyagrodhadi guna & padmakadi guna with sita,ajya,ksira, makshika should be given.

-Kapahara Vasti:

• In kapha, 3 ruksha, tiksna, usna & katu vastis consisting of decoction of aragvadadi gana & vatsakadi gana along with ksoudra & gomutra is beneficial.

-Tridoshahara Vasti

• In case of  Sannipata, also 3 vastis are enough , as these will mitigate the tridoshas. There is no disease which is not caused by the vitiation of dosa. Sa vasti is enough to control all the diseases.

    एको अपकर्षयत्यनिलं स्वमार्गात् पित्तं द्वितीयस्तु कफं त्रितीय: I

                                    (Hrdaya bodhika commentary of A. H: Su: 19)

Some other physicians do not desire vasti more than these 3, as there is no 4th dosa, for which another enema need to be given.

                      त्रिभ्य: परं वस्तिमतो चिकित्सका        I

                      न हि दोषश्चतुर्थो अस्ति पुनर्दीयते यं प्रति I

               (A. H: Su: 19)

It is substantiated through the application of 3 vastis of which first one should be citklesana, second effect will be Sudhi and the third will cause Samana of doshas.

                      उत्क्लेशनं शुद्धिकरं दोषाणां शमनं क्रमात्    I

                      त्रिधैवं कल्पयेत् वस्तिमित्यन्ये अपि प्रचक्षते I

                                        (A. H: Su: 19)

In Saranagadhara samhita, examples for each of these  purpose are mentioned.

      In another context,Susruta describes that who takes 18 enemas, 18 times (324 in total) alternately with niruha, anuvasana will attain following effects.

                                            अष्टादशाष्टादशकान् वस्तीनां य़ॊ निषेवते   I

                      यधोक्तेन विधानेन परिहारक्रमेण च       I

                      स कुन्जरबलोअथस्य जवैस्तुल्यो अमरप्रभ:  I

                      वीतपाप्मा श्रुतधरा सहस्रायुर्नरो भवेत्      I

                                                                               (Su. Sa. Sam.Ci: 35)

Uttara Vasti:
                                उत्तरमार्गदीयमानतया किंवा श्रेष्ठगुणतया उत्तरवस्ति |

                                                       
                                                                              (Ca.Pa.On Ca Sam.Ci:9)

Method to introduce medicine into genito-urinary tract, As per Vaghbhata, it is useful in diseases of vasti,yoni and garbhasaya in female. Vaghbata advises uttaravasti to be preformed after Sneha,Sveda and Niruha vasti.

  Caraka indicates uttaravasti in the diseases in which doshas may invade the vasti. (C. S. Si. 9/49)

  Susruta states , uttaravasti has to be done in Sukradosa after adequate preparatory procedures. (S. S.Sa. 2/10). Susruta points out that uttaravasti can be administered in severe conditions affecting vasti. It is also useful in Sukra dosa,artava dosa,mutraghata,asmari and pain in the regions of bladder, groin and penis . (S.S.Ci.37/125).

Yapana Vasti

                       निरूहादुत्तरमुत्तरेण वा मार्गेण दीयते इत्युत्तरवस्ति |

- means prolonging or supporting life

      General characteristics:

       "It has properties of both Sneha vasti and niruha vasti(Snigdha ruksho napumsaka vasti)"

• It can be utilized for healthy persons,sick people, young and old.
• It does not require purvakarma.
• It will not create problems like atiyoga or ayoga.
• It has got Rasayana and Caksusya.
• Suitable for administration in all seasons and diseases
• It is useful in infertility, cosmetic skin problems and in uterine disorders.
• Most of them are vata raktahara and vrsya.

Relevance of yapana vasti nowdays:-

• The importan factor is that yapana vasti do not need any purvakarma, no need of other Sodhana procedures and there is no much restrictions in the daily activities and food habits. So, it is easy to administer and there is no issue regarding time consuming procedures.That means it can be administered as an O.P.D. procedure.
• With the changes in the life style and food habits, people with infertility cases increased terribly.In this situation effects of the type of vasti (vrsya, sukrakara both in quality and quantity) can be applied infertile couples.
• Susruta and others explain the "Mustadi yapana vasti" as the king of all yapana vastis (Raja yapanam), which has the specific effect like vrsya & vataraktahara.

Mode of action of vasti

      Acharya Caraka has stated in agrya sangraha that vasti is the main treatment of vata dosha. The mode of action of vasti is explained by different acharyas Susrtuta and Vaghbata have defined niruha as the one whose action is unimaginable.

       Through vasti is Sodhana in general, they may act as samana, brmhana, stambhana etc.
                                     पक्वाशये तथा श्रोण्यां नाभ्यधस्ताश्च सर्वत:    I
                                     सम्यक् प्रणिहितो वस्ति: स्थान्वेष्वेतेषु तिष्टति  I
                                     पक्वाशयात् वस्तिं वीर्यं स्वैर्देहमनुसर्पति        I
                                     व्रृक्षमूले  निषिक्तानामपां वीर्यमिव द्रुवं        I
                                                                                (Su. Sam. Ci. 35)

Vasti when properly administered remains in the pakvasaya, pelvis and below the umbilicus, the virga of vasti dravya spreads to the whole body through the srotas just like water poured at the roots spread to the whole tree by its power.

                                    यश्च पक्वाशयस्थेअपि दोषानापादमस्तकं    I
                                    वीर्येण वस्तिरादत्ते स्वस्थो अर्को भूरसानिव  I
                                                                                  (Su. Sam. Ci. 35) 

 Remaining in the pakvasaya it draws the doshas present  from head to foot, just as the sun remaining in the sky draws the moisture from the earth.

 The ousadha virya from pakvasaya transfers directly to apana, apana to samana vayu,saman gives it to vyana and prana.The virya helps to aquire prakrtavastha or equillibrium of panca vayus.Then it controls the other dosas and diffuse throughout the body. It results in the proper function of body constituents and there by the health of the body.
                                 स चापि सहसा वस्ति: केवल: समलोअपि वा  I
                                  प्रत्येति वीर्यं त्वनिलैरपानाघैर्विनीयते           I
                                  स कटी पॄष्ठस्थान् वीर्येणालोड्य़ सेचयान्      I
                                  उत्खातमूलान् हरति दोषाणां साधुयोजित:      I
                                                                                      (Su. Sam. Ci. 35)

 Dalhana clarifies that ' veerya' refers to snehadi gunas,which are carried to the adhakaya by apana vayu,to the urdhvakaya by udara vayu and in all directions by vyana vayu. Chakrapani comments that veerya is the inherent power of the vasti, by when it is capable of overcoming doshas all over the body within a day,distinguishing it from pachanadi karmas.

How does Niruha & Anuvasana works?

     The two factors resulting in vata vrdhi- one is dhatu ksaya and the other,marga avarana- Srotorodha. Niruha vasti is the only one made which removes kapha pitta from the site of vata.The ingredients of nirooha vasti like saindhava,madhu etc. are vata vardhana but Sukshma, Sroto Sudhikara, yagavahi,anuloma and kaphahara. Further lavana has the unique property of annihilating stambha- bandha- sanghata. Mainly any decoction is kapha pittahara than vatahara because of its rasa. These , no doubt helps in removal of kapha and pitta.By removing these, vata will be pacified.If samana of the vata is only the need,anuvasana alone would be sufficient.

     So, for removal of srotorodha -niruha, for vataharatva in sroto sodhita environment and for counteracting the rukshata after niruha- sneha vasti.That is for वातोल्बणेषु  दोषेषु -niruha , for वात - anuvasana. Vasti also serves the dual purpose of elimination of wastes on one hand and medicinal action of the ingredients on the other.

    Action of Nirooha is compared to serving of the roots of a tree by Charaka and Vaghbhata. Vasti enters pakvasaya removing the prakupita vata from the root,which cures vata vikaras in other parts of the shareera similar to cutting the root of a tree destroys the branches,flowers, fruits and leaves of the tree.
                                 एतेष्वास्थापनं प्रधानतममित्युक्तं वनस्पतिमूलछॆद्वत् I
                                                                            (Cha. Sam. Ci.: II)

Vayahastapakatva and prajabala are due to srotoshodhakatva of nirooha as well as dhatuposhakatva of anuvasana. All the rogas in different conditions,as well as requiring different upakarmas also can be managed by altering the combinations of dravyas in vasti.

    Astanga sangraha clarifies the elimination of morbid dosa from pakvasaya through an example.

                                 यथा कुसुम्भादियुतात्तोयाद् रागं हरेत् पट: |
                                तथा द्रवीकॄ्ताद् देहात् वस्ति निर्ह्ररेत् मलान् |
                                                                           (A.H. Su: 19)

  A cloth being squeezed after dipping in water containing kusumbha, grasps the colour only, leaving water behind. Similarly vasti removes only malamsha from the sweda draveekritha shareera without harming its prasada bhava.

      Anuvasana vasti causing sodhana of pakvasayagata vata in person having prabala agni is compared to purification of air by water in Kashyapa's view. Being included under pancakarmas anuvasana though mild, is also a sodhana. Chakrapani substantiates that bahudosha nirharana does not occurs in anuvasana as in vamanadi,but it does sodhanaof pakvasaya gata vata and pureesha to be called as panchakarma. Though all the Samhitas highlight  the brmhana karma of it, Arunadatta  clarifies that even brmhana dravyas may also cause sodhana as the case of ksheera.

      Either nirooha or anuvasana should not be taken in excess Execessive administration of anuvasana gives  rise to citklesha of kapha and pitta and suppression of the power of digestion. Excessive administration of niruha leads to the risk of vata getting aggravated.

                                      स्नेहवस्तिं निरूहं वा नैकमेवातिशीलयेत्      I
                                      उत्क्लेशाग्निवधौ स्नेहान्निरूहान् पवनात् भयम् I
                                       तस्मान्निरूह: संस्नेह्यो निरूहश्चानुवासित:    I
                                       स्नेहशोधनयुक्त्यैवं वस्तिकर्म त्रिदोषनुत्      I
                                                                         (Cha. Sam. Ci.: II)

 Therefore, after niruha vasti, the patient should be given anuvasana vasti, and after anuvasana vasti niruha vasti should be given. Thus, by giving anuvasana vasti niruha vasti appropriately , this vasti therapy cures the diseases caused by all the three doshas.

Importance of left lateral position:-

    The entry of vasti dravyas in to the grahani is well explained by charakacharya while describing the reason of lying in left lateral position for the administration of vasti.

                                     वामाश्रये हि ग्रहणी गुदे च तत् पार्श्वसंस्थस्य सुखोपलब्धि: I
                                     लीयन्त एवं वलयश्च तस्मात् सव्यं शयानोअर्हति वस्तिदानं I
                                                                                               ( Cha. Sam. Ci.: III)

   Chakrapani has clearly mentioned that in this position vastidravyas reach the grahani. The promotion of jataragni present in the grahani by the vasti can be explained by this phenomenon. Snehadravya by its sookshma guna enters the sookshma srotas to reach the grahani. here it acts on samana vayu, which is the promoter of jataragni there by helping it in achieving its normal function(jataragni deepti). Also vasti performs the function of apananulomata,thus increases  the jataragni and enhances the function of pureesha. ie vayu- agni dharana.  Thus vasti has its effect on agni, which is said to be the main cause of disease. 

   Vasti has its effects on two important factors , ie vata and agni, both are responsible for chetananuvrthi, proper formation of dhatu.

   Importance of vata among the doshas and the role of vasti in controlling the vataja vikaras are explained by Susruta as follows. It is capable of pacifying all doshas.

                                     दोषत्रयस्य यस्माच्च प्रकोपे वायुरीश्वर: |
                                     तस्मात्तस्यातिवॄद्धस्य शरीरमभिनिघ्नत: |
                                     वायोर्विषहते वेगम् नान्या वस्तेध्रूते क्रिया |
                                    पवनाविद्ध्तोयस्य वेला वेगमिवोदधे:    |
                                                                         (Su. Sam. Ci: 35)

  Vata is the lord; the chief cause for aggravation of the diseases, when aggravated it destroys the body, there is no other treatment except vasti to control it, just like the borders of the ocean of controlling the waves produced by the wind.

Explanation for mechanism of action:-

    There are different modes through which an enema can act.Vasti acts by its virya throughout the body.not by 'prabhava' as that of vamana, virecana

   I). Cleaning the colon:-

          Enema cleanses the lowergut, removing the harmful bacteria, worms etc, along with the faeces, thus relieving the disease. Thus action can be applied in the treatment of gulma, vibhandha etc.

II) Nourishment:- Enemas which retain for longer durations get absorbed & nourishing the body as that of anuvasana.

III) Medication:- Transrectal route is one of the major routes of administration of drugs. Rectum has got rich blood and lymph supply and the drugs can cross the rectal mucosa like other lipid membranes.

       It may be considered that nirooha vasti is hyper osmotic, which facilitates absorption of morbid factors into the solution, where as the sneha vasti and other nourishing vastis containing hypo osmotic solution facilitates absorption into blood.

IV)Increasing Vitamins:-Pyruvic acid is reduced in the blood following vasti and its level is inversely proportional to that of Vit. B1in the blood. This vitamin plays a vital role in maintaining the normalcy of the nervous functions, cardio vascular diseases etc.

    Changing the environment of GIT suitable for bacteria,soothing effect, stimulation of gut brain etc. are also takes part in the action of vasti.

Importance of Vasti

     There is none other than vata which is the most important causative factor of disease in sakha, koshta, marma, urdhva(upper part of the body), sarva avayava and anga.
                                      शाखागता कोष्ठगताश्च रोगा मर्मोर्ध्वसर्वावयवान्गजाश्च  I
                                     ये सन्ति तेषां न हि कश्चिदन्ये वयो: परं जन्मनि हेतुरस्ति I
                                                                                       (Cha. Sam. Ci.: I)

 Vata is responsible for the separation(viksepa) and combination (sanghata) of stool, urine,pitta including other malas and other asayas. When it gets exceedingly aggravated there is no remedy other than vasti for its alleviation.
                                     विण्मूत्रपित्तादि मलाशयानां विक्षेपसंहारकर स यस्मात् I
                                     तस्यातिव्रुद्धिश्च शमाय नान्यत् वस्तेर्विना भेषजमस्ति किन्जित् I
                                     त्स्मात् चिकित्सार्थमिति भ्रुवन्ति सर्वां चिकित्स्सामपि वस्तिमेके: I
                                                                                            (Cha. Sam. Ci.: I)

 Therefore, vasti is considered by physicians to be half of the entire therapeutic measures by both vaghbhata and caraka. Some physicians even go to the extent of suggesting that vasti represents the whole of therapeutic measures.

   Among all therpeutic procedures, vasti is superio because vamana and virecana can produce only vomiting and purgation respectively. But vasti has got multidimensional therapeutic effect. It can achieve any therapeutic goal brmhana, sodhana, samana, rasayana, vajikarana and any desired therapeutic effect.

   Apart from this, vasti is considered as superior to all other therapeutic measures on account of its various actions like samsodhana(cleansing), samsamana or samgrahana (retaining & absorbing) of dosas based on the properties of the drugs used for it.

                                       तत्र स्नेहादीनां कर्मणां वस्तिकर्म प्रधानतममाहुराचार्य: I
                                       कस्मात्? अनेककर्मकरत्वात् वस्ते: , इह खलु वस्तिर्नानाविध
                                       द्रव्यसंय़ॊगाद्दोषाणाम् संशोधन संशमन संग्रहणानि करोति
                                       क्षीणशुक्रं वाजीकरोति क्रूशं ब्रुंहयति स्थूलम् कर्शयति
                                       चक्षु: प्रीणयति वलीपलितमपहन्ति वय: स्थापयन्ति I
                                                                                               (Su. Sam. Ci. 35) 

  Susruta substantiates the 'aneka karma karatva of vasti' through these verses.

 Acharya Susruta also adds that property administered vasti promotes growth and colour of the body, augments strength, health and lifespan.
                                     शरीरोपचयं वर्णं बलमारोग्यमायुष: I
                                    कुरुते परिव्रुद्धिं च वस्ति: सम्यगुपासित: I

No therapeutic mesure other than vasti, cleanses the body quickly and easily, causes apatarpana and tarpana instantaneously, and is free from any adverse effects.
                                     कर्मान्यत् वस्तिसमं न विद्ध्य्ते शीघ्रमुखविशोधित्वात् I
                                    आश्वपतर्पण तर्पणयोगाच्च निरत्यत्वाच्च           I
                                                                                            (Cha. Sam. Si.:X)

 Vamana and virecana takes few hours to produce sodhana whereas niruhavasti takes only few minutes which substantiate its superiority over other sodhanas.

   The mode of administration of drug and its pallatability is also determines the effectiveness of the procedure, oral administration of medicines for virecana therapy may produce the symptoms like abdominal distress, nausea and anorexia due to kata, tiksna, usna gunas of drugs commonly used for this purpose.
                                   सत्यापि दोषहरत्वे कटुतीक्ष्णॊष्णादि भेषजदानात् I
                                   दुखोद्गारोत्क्लेशाह्रुद्ध्यत्व कोष्ठरुजा वि्रेके स्यु: I
                                                                                         (Cha. Sam. Si.:X)

  Moreover, vivecana cannot be used as a method of sodhana in children and very elederly persons, Because infants have immaturity of tissues and less of strength. There is diminution of dhatus and reduction in strength in old people.
                                  अविरेच्यौ शिशुव्रुद्धौ तावप्राप्तप्रहीनधातुबलौ I
                                  आस्थापनमेव तयो: सर्वार्थक्रूदुत्तमं कर्म   I
                                   बलवर्णहर्षमार्दवगात्रस्नेहान्न्रूणाम् ददात्याशु  I
                                                                                        (Cha. Sam. Si.:X)

  Asthapana vasthi, however be given to both these types of patients which is excellent both for the elimination of dosas and nourishment of the body. It instantaneously promotes strength, complexion, sense of exhileration, softness as well as unctousness of the body.

Shadupakramas through Vasti

           The curative treatment can be brought under the six therapeutic measures. brmhana-langhana, stambhana-svedana & snehana- rukshana. In these btmhana, stambhana and snehana are santarpana (nourishing) in nature and the other three are apatarpana(depleting) in nature.

• Brmhana and Langhana

            Brmhana and langhana are of opposite quality. Guru guna is the guna of kapha, so brmhana increases kapha, and pacify vata and pittanubandha vata.

            Brmhana is achieved through use of brmhana vastis or application of vatahara vastis like dvipancha mooladi vasti, bala guluchyadi vasti,etc.

eg: Brmhana vasti
                                         ब्रुंहणद्रव्य निष्क्वाथा कल्कैर्मधुरकैर्युता: I
                                         सर्पिमांसरसोपेता वस्तयो ब्रूंहणा स्म्रॄता  I
                                                                                (Sha. Sam.)

           Laghu guna increases vata pitta because vata and pitta are laghu. So, langhana reduces kapha and kaphanubandha pitta.

            Langhana is achieved through many types of vastis like vaitarana vasti, kshara vasti etc. Nowadays, it can be widely applicable in controlling life style disorders like obesity, hyper lipidaemia etc.which are the great threat to the developing world.

eg:वैतरण वस्ति :-  
                                  पलशुक्तिकर्षकुदवै: अम्ली गुड सिन्धुजन्म गोमूत्रम् I
                                  ईषत् तैलयुतो वस्ति: शूलानाहामवातहर: I
                                 वैतरण क्षारवस्तिश्च भुक्ते चापि प्रदीयते I
                                                                        (Chakradattha)

lekhana vasti also does the function of langhana.

• Stambhana and Svedana

    Stambhana atands for blocking or withholding which is done by sita guna. Among tridoshas, vata & kapha are of sita guna, where as pitta is of usna guna. So stambhana is done in paittika conditions like bleeding diseases, burns, diarrhoea, syncope etc.

     Sangrahana vastis like picha vasti using salmali, simshipa, kovidara etc, can be used for stambhana purpose in case of excessivee elimination of dosa as in rakatisara, ardrarshas etc.

     Svedana is brought about in the body with the help of usna guna, which is the quality of pitta, Though there is no specific action of svedana in diseas conditions, it generally does the role of svedana by its usna virya clearing the srotas etc.

• Snehana and Rukshana

      Snehana is the quality of kapha and pitta; that is used fir the pacification of vata. Anuvasana vasti, kshira vasti etc. have this effect. In anuvasana, rukshata of vata is counter acted by the use of sneha(taila,ghrta according to condition).
     Eg:                                क्षीरात् द्वौ प्रस्रुतौ मधुतैलघ्रुतात्रय  I
                                          खजेन मधितो वस्तिर्वातघ्नो बलवर्णक्रूत् I
                                                                        (Cha. Sam. Si.)

     Ruksha is the guna of vata. So, it is done in kapha pitta diseases. Lekhana vastis containing gomutra, kshoudra,kshara, ushakadi guna etc. also does the function of langhana along with rukshana. Niruha vastis aslo acts by this principle.

     So, shadupakramas which are confined to "dvi vidhopakramas"-the ultimate treatment principle- brmhana and langhana can be achieved through vasti itself.

Dhatu Poshana effect of Vasti

       Apart from the above described karmas, it also does the functions like rasayana(nourishing rasadi sapta dhatus), lekhana, jeevana(rakta dhatu), brmhana(mamsa, medo, asthi dhatus), sukrakara or vrsya, vajikarana effect

• Bala patoladi vasti etc.have action on the promotion of function of the avayava also - ie caksusya.

      Bala guluchyadi vasti is both brmhana & jeevana- that is action on mamsa, medas, asthi and rakta dhatus. Dvi pancamuladi vasti is vatahara results in brmhana.

Actions like vajikarana (pancha muladi), rasayana, mamsa bala prada, cosmetic effects like varnya also can be achieved. Madhu tailika vasti gives rasayan effect.

                                   मधुतैलो समे कर्षा सैन्धवात् द्विपिचुर्मिसि  I
                                   एरण्डमूलक्वाथेन निरूहो माधुतैलिक:    I
                                   रसायनं प्रमेहार्श क्रिमिगुल्मान्त्रव्रूद्धिनुत्   I
                                                                         (A. H. Kalpa: 4)

Yapana vasti has vrsya as general effect.

• Appropriate use of sodhana and samana and 'samana gana in vast dravya after considering dosa, doosya, rogavastha,rogibala is also beneficial.

      Use of 50 types of kasaya having specific effect described by acharya charaka also give a wide opportunity before us. Combination can be selected according to the condition.

Application of Vasti in chronic diseases

    Use of anuvasana vasti in Bheshajakshapitha (who are debilitated by treatment) is well explained by acarya Vagbhata in the chapter Roganutpadaneeya. In chronically illed patients, subjected to treatment procedures, there is chance for dhatukshaya resulting in ojokshaya. So, it can be given as brmhana. Yapana vastis - which are promoting life- also have applicability in this area.

      Nowaday, modern treatment methodologies and also the management of severe diseases like carcinoma,TB, AIDS etc. have prolonged therapy.Chemotherapic & radio therapic management of carcinoma or malignant conditions are the similar case.So, application of this type of vastis opening the vast area before us.

Vasti in Swasthya Samrakshana & Pregnant Woman

      While considering the main aim of sastra- that is to promote the health of healthy and cure the disease of the diseased, promotion of health is also achieved through vasti.

       In rtu carya prakarana (seasonal regimen), asthapana indicated in varsa rtu for the control of vata, which is aggrarated naturally according to the season.Bala guluchyadi vasti is specifically mentioned for swastha.

       In the context of garbhini paricharya(A. H. Sha:1), anuvasana is described in the 8th & 9th month regimen, using milk, ghrta etc. That is to avoid the complications during delivery and to pacify the aggravated vata resulting in vatanulomana.As the parturation is a complicated procedure results in vatakopa, application of anuvasana in the later month of pregnancy reduces the chance of aggravation of vata, there by preventing complications both in mother and child.

      That is vasti can be used in both diseased & healthy. Vasti has the unimaginable effects in the body and mind of a person has got the prime importance among panca karmas.

                                                          

                                           
                                                             CONCLUSION

1. Vasti is always useful in diseases caused by vata, pitta, kapha and rakta and in samsarga , sannipataja dosic conditions also. So, tridosharatva of vasti is well established.

2. Highly beneficial for saptadhatus from rasa sukra.

3. Effects in the management of diseases affecting bahya, abhyanthara, madhyama rogamargas.

4.As a dravya, it does the karmas like utkleshana, brmhana, langhana, vajeekarana, rasayana etc.,specific action on avayava - cakshushya.

5.The basic 6 therapeutic measures - shadupakramas can be achieved through vasti.

6.Effective in chronic diseases, patients who are debilitated by the treatment- ie in ojokshaya.

7.Specific vastis can be used to promote health, also meant for prevention of diseases as in seasonal regimen.

8. Easy administration, large quantity of medicine (high dose) can be administered and quick action compared to other sodhana procedures.

9. It can be applied from the time of birth of a person upto his death, where other sodhana therapies are contra indicated in bala, vrdha.

10.Curative - preventive- promotive aspects of basic treatment principles of Ayurveda can be depicted through Vasti. So, it is stated as 'Chikitsardha'.