Charaka Siddhisthana Chapter 2 - Panchakarmiya Siddhi

This article explains the second chapter of siddhisthana of Charaka samhita called 'Panchakarmiya Siddhi Adhyaya'. In this chapter, indications, contra-indications and adverse effects of Vamana, Virechana, Niruha, Anuvasana and Dhumapana are explained.

Prologue
????? ???????????? ??????? ??????????????||?||
??? ? ????? ????????????||?||
We shall now expound the chapter dealing with the "Indications and contra-Indications for Panchakarma Therapy'. Thus, said Lord Atreya [1-2]

Dialogue
????? ??????? ??????????????????? ? ???????|
????? ? ??????????? ??? ????? ??????????????||?||
yesam yasmat pancakarmanyagnivesa na karayet|
yesam ca karayettani tat sarvam sampravaksyate||3||
O! Agnivesa, we shall now describe all the patients for whom Panchakarma therapies are contra indicated, reasons for which these are contraindicated, and for which type of patients these therapies are indicated. [3]

Table of Contents

Prohibition for Panchakarma

Persons in whom panchakarma is prohibited:

????? ??????? ????? ??????? ?????? ?? ?|
???????????? ???????? ??????????? ?????????||?||
?????????? ??????????? ?????? ??????? ??|
???? ?????????????? ??????????? ?????????||?||
?????????????? ?????????? ?????????|
?????????? ?????? ????? ???????????????||?||
?????????? ??????????? ???? ??????????????|
??????? ????????????? ??????? ?????? ? ????????||?||
candah sahasiko bhiruh krtaghno vyagra eva ca|
sadrajabhisajam dvesta taddvistah sokapiditah||4||
yadrcchiko mumursusca vihinah karanaisca yah|
vairi vaidyavidagdhasca sraddhahinah susankitah||5||
bhisajamavidheyasca nopakramya bhisagvida|
etanupacaran vaidyo bahun dosanavapnuyat||6||
ebhyo'nye samupakramya narah sarvairupakramaih|
avastham pravibhajyaisam varjyam karyam ca vaksyate||7||
The wise physician should not give Panchakarma therapies to the following types of patients -
Those who are forceful, rash, cowardly, ungrateful and fickle minded
Those who hate good persons, kings and physicians, and in turn hated by them
Those who are afflicted by grief
Those who does not believe in God (Yadrcchika = Nastika)
Those who are in the terminal stage of the disease, and are destined to die
Those who are unable to arrange the essential items (Karana) for the treatment
Those who are inimical to the physician
One who is an imposter and considers himself to be a physician
One who is skeptical and
Those not having faith in the physician
Those who do not carry out the instructions given by the physician
The physician who administers Panchakarma therapy to the above-mentioned types of patients invites many difficulties upon himself.
Persons other than those mentioned above should be treated with all the different types of Panchakarma therapies.
Hereafter, we shall explain the indications and contraindications of each of the different types of Panchakarma therapies. [4-7]
Ayurvedic Panchakarma Treatment: Introduction, Benefits, Dosha Relation

Contraindications of Vamana

?????????????- ??????????????????????????????????????????????????? ?????????????????????????????????????????????????- ??????????????????? ????????????????????????????????????????????????????????????????????????????????? ???????????????????????- ???????????????????????????????????????????????????????????||?||
avamyastavat- ksataksinatisthulatikrsabalavrddhadurbalasrantapipasita ksudhitakarmabharadhvahatopavasamaithunadhyayanavyayamacinta- prasaktaksamagarbhini sukumarasamvrtakosthaduschardanordhvaraktapittaprasaktacchardirurdhvavatasthapitanuvasita hrdrogodavartamutraghata- plihagulmodarasthilasvaropaghatatimirasirasankhakarnaksisulartah||8||

Emetic therapy is contra- indicated for the following:
The patient suffering from Ksata (phthisis)
The patient who is Ksina (suffering from consumption),
Ati-sthula (excessively obese), atikrsa (excessively emaciated), Bala (infant), Vriddha (old) and Durbala (weak)
One who is sranta (fatigue), Pipasita (thirsty) and Ksudhita (hungry);
One who is broken down because of hard work, carrying heavy weight and long walks;
Those who have become weak by excessive fasting, sexual indulgence, study, exercise and worry,
Pregnant woman
One having tender health
One whose gastrointestinal tract is occluded by Vayu and
Those who does not respond easily to emetic therapy;
One suffering from aliments characterized by bleeding from upward tract;
One who is suffering from incessant vomiting
Those suffering from upward movement of Vayu or wind;
Those who have taken evacuative type of medicated enema and
Those who have taken unctuous type of medicated enema
One suffering from heart-diseases
One suffering from mis-peristalsis
One suffering from suppression of urination, pleeha, gulma, udara, enlarged prostate, choked voice and cataract; and
One suffering from pain in the head, temporal region, ears and eyes [8]
Read: Vamana Therapy - Right Method, Side Effects, Management

Complications of Vamana

???? ??????? ???? ????????????????????????? ??????, ???????????????????????????????????????????????? ???????????, ????????????????????????? ? ??????, ??????????????????????????????????????????????????????????
????????????????????????????? ??????, ????????? ??????????????????????????????? ????????????, ?????????? ?????????????????????? ?? ??????????????????, ????????????????????????????????????????????? ????????????? ??????????? ???????????????????? ??????? ?????? ?????????? ???? ??, ?????????????????? ??????????????? ???????? ?????????? ???????????????, ??????????????????????, ???????????????????????????????????? ????????????????, ????????????????????, ?????????? ????? ???????? ??????????????????, ??????????????????????? ??????????????????????, ????????????? ???????????????, ???????????? ?????????????; ????????? ? ??????|
?????????? ?? ????????? ?????????????????????????????????????????????? ??????????????????????? ||?||
tatra ksatasya bhuyah ksananadraktatipravrttih syat, ksinatisthulakrsabalavrddhadurbalanamausadhabalasahatvat pranoparodhah, srantapipasitaksudhitanam ca tadvat, karmabharadhvahatopavasamaithunadhyayanavyayamacintaprasaktaksamanam
rauksyadvataraktacchedaksatabhayam syat, garbhinya garbhavyapadamagarbhabhramsaccadaruna rogapraptih, sukumarasya hrdayapakarsanadurdhvamadho va rudhiratipravrttih, samvrtakosthaduschachardanayoratimatrapravahanaddosah samutklista antahkosthe janayantyantarvisarpam stambham jadyam vaicittyam maranam va, urdhvagaraktapittina udanamutksipya pranan haredraktam catipravartayet, prasaktacchardestadvat, urdhvavatasthapitanuvasitanamurdhvam vatatipravrttih, hrdroginohrdayoparodhah, udavartino ghoratara udavartah syacchighratarahanta, mutraghatadibhirartanam tivratarasulapradurbhavah, timirartanam timirativrddhih, sirahsuladisu sulativrddhih; tasmadete na vamyah|
sarvesvapi tu khalvetesu visagaraviruddhajirnabhyavaharamakrtesvapratisiddham sighratarakaritvadesamiti ||9||

Complications caused by Vamana administered in contraindicated Conditions:

Effect

it further aggravates the injury [to the lungs], and causes excessively haemoptysis

Ati-Sthula (excessively obese),

Bala (infant),

Durbala (weak),

this endangers their life because such patients are incapable of tolerating the effects of drugs which are used for emesis

to a person who is fatigued, thirsty and hungry

similar effect is produced (as explained above)

to a person who is broken down by doing hard work, carrying excessive weight and long wayfaring, and is weakened by incessant fasting, sexual indulgence, study, exercise and worry

because of excessive dryness caused by these, the vayu in his body gets aggravated, he may get haemorrhage or injury to his lungs

this may give rise to complications of pregnancy and occurrence of serious diseases because of the abortion of immature foetus

person having tender health

because of the strain in his heart, this may give rise to haemorrhage through the upward and downward tracts

excessive bouts of urges for vomiting leading to the excitation of Doshas causing internal erysipelas, stiffness, numbness, mental perversion or death

it provokes Udana-vayu leading to death or excessive bleeding

similar effects (as mentioned above)

this causes upward movement of the wind in excess

it leads to cardiac arrest

this leads to severe mis-peristalsis which is serious nature, and which results in quicker death of the patient

leads to the manifestation of colic pain of more acute nature

leads to excessive increase of this ailment

leads to the excessive aggravation of pain

Therefore, emetic therapy is contraindicated for the above types of patients.
However, administration of emetic therapy is not prohibited even in the above mentioned (contraindicated) ailments if the person is suffering from
Visa (ailments caused by natural poisons),
Gara (ailments caused by artificially prepared poisons),
Viruddhahara (ailments caused by the intake of mutually contradictory ingredients), Ajirna Abhyavahara (intake of foods which cause indigestion) and Ama (ailments caused by the product of improper digestion and metabolism), because these ailments produce their effects instantaneously. [9]
Read: Vamana Virechana - Emesis and Purgation - Ashtanga Hridayam Sutrasthana 18

Indications of Vamana

???????? ??????; ?????????? ??????????????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????? (???????) ?????????????????????????????????????????????????????????????????????????? ?????????????? ??????? ????????????????????; ????? ?? ???? ?????????????????? ????????????? ???????????????????????||??||
sesastu vamyah; visesatastu pinasakusthanavajvararajayaksmakasasvasagalagrahagalagandaslipadamehamandagniviruddhajirnanna visucikalasakavisagarapitadastadigdhaviddhadhahsonitapittapraseka (durnama) hrllasarocakavipakapacyapasmaronmadatisarasophapandurogamukhapakadustastanyadayah slesmavyadhayo visesena maharogadhyayoktasca; etesu hi vamanam pradhanatamamityuktam kedarasetubhede salyadyasosadosavinasavat||10||
Emetic therapy is indicated for the remaining aliments especially for -
Pinasa (Coryza), Kustha (skin diseases),
Nava Jvara (freshly occurring fever), Rajayaksma (tuberculosis),
Kasa (cough), Svasa (Asthma), Galagraha (spasm in the throat),
Galaganda (Enlargement of thyroid gland),
Slipada (elephantiasis), Meha,
Mandagni (suppression of the power of digestion),
Viruddhanna (ailments caused by the intake of mutually contradictory food ingredients), Ajirnaanna (ailments caused by indigestion of food),
Visucika (cholera), Alasaka (flatulence / tympanitis),
Visa-Pita (ailments caused by the intake of artificially prepared poisons), Visa-Dasta (poisonous bites),
Visa-digdha-Vidddha (ailments caused by injury with weapons smeared with poisons material), Adhah-sonitapitta (an ailment characterized by bleeding from downward tracts),
Praseka (Ptyalism), Durnama (piles),
Hrllasa (nausea), Arocaka (anorexia), Avipaka (indigestion),
Apaci (cervical adenitis), Apasmara (epilepsy), Unmada (insanity),
Atisara (diarrhoea), Sopha (Oedema), Pandu-roga (anemia),
Mukha-Paka (stomatitis), Dusta-stanya (polluted breast-milk), etc
The emetic therapy is especially useful for diseases caused by Kapha which are described in Sutra 2): 17.

In all the above-mentioned conditions, emesis is the best therapy. As paddy, etc., in a field full of water are likely to get spoiled, but an outlet made through its wall to take out water saves the crop, similarly, emetic therapy cures diseases caused by aggravated kapha by eliminating these Doshas from the body. [1)]

Contraindications of Virechana

????????????? ?????????????????????????????????????????????????????????????????????????????????????????????????- ????????????????????????????????????????????????????????? ?????????? ?????????????||??||
avirecyastu subhagaksatagudamuktanaladhobhagaraktapittivilanghitadurbalendriyalpagninirudhakamadivyagrajirninavajvari- madatyayitadhmatasalyarditabhihatatisnigdharuksadarunakosthah ksatadayasca garbhinyantah||11||

Purgation therapy is contra-indicated for the following:
Subhaga (persons having tender health / delicate nature),
Ksata-Guda (persons having anal injury),
Mukta-Nala (prolapse rectum),
Adhobhaga rakthapitta (an ailment characterized by bleeding through downward tracts),
Vilanghita (person who is on fasting),
Durbalalendriya (person having weak sensory and motor organs), Alpagni (person having less power of digestion),
Nirudha (person who has undergone evacuative type of enema therapy), Kamadi vyagra manasa (person whose mind is agitated by passion etc),
Ajirni (Person suffering indigestion),
Madatyayita (person suffering from alcoholism),
Adhmata (person suffering from abdominal distension),
Salyardita (person afflicted with foreign bodies),
Abhihata (person with bodily injury),
Ati-snigdha (person who is over-unctuous),
Ati-Ruksa (person is excessively un-unctuous),
Daruna-Kostha (person having hard bowel) and Other persons having ailments beginning from Ksata (phthisis) and ending with Garbhini (pregnancy) as described in Paragraph no. 8[11]
Read: Virechana Therapy - Right Method, Side Effects, Management

Adverse effects of Virechana administered in contraindicated conditions

???? ??????? ???????????? ???? ??????, ?????????? ????? ???? ?????????????? ????? ??????, ?????????????????????? ???????, ?????????????????? ??????, ????????????????????????????????????? ??????? ? ??????, ???????????????? ? ????????? ????????? ?? ???????????????????? ????????, ???????? ?????? ??????, ??????????????????? ?????? ? ????????? ?????? ? ???????, ???????????? ?????????? ???? ????? ??????????? ????????, ?????????????? ?? ??????????? ?????? ?????????????? ?????????? ???????? ???? ?? ??????, ?????????????????? ????? ???????????? ?????? ?????????, ?????????????????????? ?????, ???????? ???????????????? ????????, ????????????? ???????????? ???? ???????????????????????????????????????????????????????? ???????? ??????, ?????????? ??????????????? ?????????? ???? ??????; ????????? ? ?????????||??||
tatra subhagasya sukumarokto dosah syat, ksatagudasya ksate gude pranoparodhakarim rujam janayet, muktanalamatipravrttya hanyat, adhobhagaraktapittinam tadvat, vilanghitadurbalendriyalpagninirudha ausadhavegam na saheran, kamadivyagramanaso na pravartate krcchrena va pravartamanamayogadosan kuryat, ajirnina amadosah syat, navajvarino'vipakvan dosan na nirhared vatameva ca kopayet, madatyayitasya madyaksine dehe vayuh pranoparodham kuryat, adhmatasyadhamato va purisakosthe nicito vayurvisarpan sahasa"naham tivrataram maranam va janayet, salyarditabhihatayoh ksate vayurasrito jivitam himsyat, atisnigdhasyatiyogabhayam bhavet, ruksasya vayurangapragraham kuryat, darunakosthasya virecanoddhata dosa hrcchulaparvabhedanahangamardacchardimurcchaklamanjanayitva pranan hanyuh, ksatadinam garbhinyantanam chardanokto dosah syat; tasmadete na virecyah||12||

If purgation therapy is given to a person in Subhaga (persons having tender health), then he will suffer from the same disorders as described for emetic therapy administered to sukumara (person having tender health) in para no. 9a
When administered to persons having anal injury it causes ulcers in the anal / rectum region which further causes severe and intolerable pain causing threat to life.
If purgation medicine is given to those having prolapse of rectum there will be excessive defecation which leads to death.
When administered to those having bleeding through downward passages, purgative medicine causes excessive bleeding leading to death.
When purgation medicine is administered to people who have fasted, those having weak sense organs, those having less digestion power and those who have undergone evacuative enema, they cannot tolerate the intensity of medicine i.e., they would suffer from severe purgation.
If purgation recipes are administered to those whose mind is agitated with passion etc the medicine would not produce purgation or the purges (motions) happen with difficulty which in turn causes complications which would be caused by deficit administration of purgation medicine.
When purgation is administered to those having indigestion it causes ama dosha.
When purgation medicine is administered to those who are suffering from alcoholism, the vayu gets severely aggravated in the body which has been emaciated and depleted causes threat to life (can cause death)
When purgation is administered to those suffering from abdominal distension, the vayu accumulated in the colon wanders throughout the gut in all directions and causes severe flatulence or death.
When purgation is administered to those who are afflicted by foreign bodies, the vayu accumulated in the site of foreign body will cause death.
When purgation is administered to those who are over unctuous it may cause atiyoga i.e., symptoms of excessive administration of purgation therapy (symptoms of excessive purgation).
When purgation is administered in people who have excessive dryness of the body, the vayu gets aggravated and causes gripping pain in the body parts
When administered to people having hard bowel, purgation medicine causes severe aggravation of doshas which in turn cause pain in heart, pain in the small joints of the fingers, flatulence, pain in body parts, vomiting, fainting (unconsciousness), fatigue etc. which can lead to death.
When purgation medicine is given to a patient who is having ailments beginning from phthisis and ending with pregnancy it will cause the same complications which are mentioned in the context of giving emesis therapy in the same cases.
Therefore, purgation therapy is contra- indicated in the above-mentioned cases. [12]

Indications of Virechana

???????? ?????????; ?????????? ???????????????????????????????????????????????????????????????????????????????????????????????????????????????- ??????????????????????????????????????????????????????????????????????????????????????????????????- ??????????????????????????????????????????????????????????????????????????????? ???????????? ??????? ????????????????????; ????? ?? ??????? ???????????????????????????????????????||??||
sesastu virecyah; visesatastu kusthajvaramehordhvaraktapittabhagandarodararsobradhaplihagulmarbudagalagandagranthivisucikalasakamutraghatakrimikosthavisarpa- pandurogasirahparsvasulodavartanetrasyadahahrdrogavyanganilikanetranasikasyasravanahalimakasvasakasakamala- pacyapasmaronmadavataraktayoniretodosataimiryarocakavipakacchardisvayathudaravisphotakadayah pittavyadhayo visesena maharogadhyayoktasca; etesu hi virecanam pradhanatamamityuktamagnyupasame'gnigrhavat||13||
In all the other conditions (other than the above), purgation therapy is indicated.
Especially it is indicated for the patients suffering from -
Kustha (skin diseases), Jvara (fever),
Meha,
Urdhvaga- Raktapitta (bleeding from the upward tracts),
Bhagandara (fistula- in-ano), Udara (obstinate abdominal diseases including ascites),
Arsas (piles), Bradhna (inguinal swelling), Pliha (splenic disorders),
Gulma (phantom tumour), Arbuda (tumour),
Gala-Ganda (thyroid enlargement), Granthi (lymphadenitis),
Visucika (choleric diarrhoea), Alasaka (intestinal torpor),
Mutraghata (suppression of urination),
Krimi-Kostha (parasitic infestation of intestines),
Visarpa (erysipelas), Pandu-roga (anaemia),
Sirah-sula (headache), Parsva-Sula (pain in the sides of the chest), Udavarta (upward movement of wind in the abdomen),
Netra-daha (burning sensation in the eyes),
Asya-Daha (burning sensation in mouth / face),
Hrd-roga (heart diseases), Vyanga (freckles),
Nilika (bluish black moles),
Netra -Sravana (excessive discharge from eyes),
Nasika-sravana (excessive discharge from the nose),
Asya-srvana (excessive salivation), Halimaka (a serious type of Jaundice),
Svasa (asthma), Kasa (cough), Kamala (jaundice),
Apaci (cervical adenitis), Apasmaara (epilepsy),
Unmada (insanity), Vata-Rakta (gout),
Yoni-dosa (gynaecological disorders),
Reto-Doshas (seminal morbidities),
Timira (cataract), Arocaka (anorexia),
Udara (obstinate abdominal disorders including ascites; this appears to be a repetition), Visphotajka (pustular eruptions) etc.
Purgation therapy is also especially useful for Paittika type of diseases described in Sutra 2):14.
For the above-mentioned ailments, purgation therapy is the foremost remedy.
As the extinguisher of fire normalizes Agni-Grha (a house on fire), similarly, purgation therapy, by eliminating aggravated Pitta, cures all the above-mentioned diseases. [13]

Prohibitions for Niruha Basti

??????????????? ?????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????? ?????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????- ?????????????????||??||
anasthapyastu ajirnyatisnigdhapitasnehotklistadosalpagniyanaklantatidurbala ksuttrsnasramartatikrsabhuktabhaktapitodakavamitaviriktakrtanastah karmakuddhabhitamattamurcchitaprasaktacchardinisthivikasvasa kasahikkabaddhacchidrodakodaradhmanalasakavisucikamaprajatamatisara- madhumehakusthartah||14||
Administration of asthapana or Niruha (evacuation type of medicated enema) is prohibited for the following:
Person who is suffering from Ajirna (indigestion),
Person who is administered with excessive oleation or the one to whom oleation has just been administered
Persons in whom Doshas are excited (Utklista-Dosa) and those suffering from mandagni (suppression of the power of digestion);
To a person fatigued due to excessive riding of vehicle
Persons who are excessively weak, excessively hungry, excessively thirsty and excessively tired due to indulgence in hard (strenuous) work,
Excessively emaciated persons
Persons who have just taken the meal and has just consumed water
Persons who have just taken emetic therapy and those who have just undergone purgation therapy or those who have just taken inhalation therapy
Persons who are angry and fearful
Persons who are intoxicated and those who have fainted
Those suffering from incessant vomiting, ptyalism, asthma, cough and hiccup;
Those suffering from intestinal obstruction, intestinal perforation, ascites associated with meteorism
Those suffering from intestinal torpor, cholera, miscarriage and first stage of diarrhoea and
Those suffering from diabetes mellitus, all pramehas or skin diseases. [14]
Read: Niruha Basti (Kashaya Basti) Panchakarma Method, Uses, Side Effects

Adverse Effects of Niruha

????????????????????????????????? ????????? ?????????????????? ??????, ?????????????????????????????????????, ????????????? ?????????????? ????????? ???? ???????, ????????????????????????????????? ?????????????? ??????, ????????? ???????? ???????????, ????????????????????????????????????? ???????????????????????? ???????? ?????? ??????????????, ????????????????? ?????? ????? ?????? ????? ????? ?? ?????, ?????????????? ???????? ????????????????? ????????, ????????????????????????????????????, ??????????????? ?????? ?????????? ?????????? ????????????? ??????? ??????, ?????????????????????????????????????????????????????????? ???????????? ?????? ?????, ??????????????????????????????? ?????????????? ?????? ???????? ?????????, ????????????????????????????????????? ???? ??????, ??????????????????????? ????????????; ????????? ???????????||??||
tatrajirnyatisnigdhapitasnehanam dusyodaram murcchasvayathurva syat, utklistadosamandagnyorarocakastivrah, yanaklantasya ksobhavyapanno bastirasu deham sosayet, atidurbalaksuttrsnasramartanam purvoktodosah syat, atikrsasya karsyam punarjanayet, bhuktabhaktapitodakayorutklisyordhvamadho vavayurbastimutksipya ksipram ghoran vikaranjanayet, vamitaviriktayostu ruksam sariram niruhah ksatam ksara iva dahet, krtanastahkarmano vibhramsam bhrsasamruddhasrotasah kuryat, kruddhabhitayorbastirurdhvamupaplavet, mattamurcchitayo rbhrsam vicalitayam sanjnayam cittopaghatad vyapat syat, prasaktacchardirnisthivikasvasakasahikkartanamurdhvibhuto vayururdhvam bastim nayet, baddhacchidrodakodaradhmanartanam bhrsataramadhyapya bastih pranan himsyat, alasakavisucikamaprajatamatisarinamamakrto dosah syat, madhumehakusthinorvyadheh punarvrddhih; tasmadete nasthapyah||15|

Administration of Niruha basti in contra-indicated conditions produces adverse effects as follows:

Niruha Basti (decoction enema) therapy given to

Effect

Dusyodara - obstinate abdominal diseases caused by the aggravation of all the three Doshas, fainting or

severe type of anorexia

person fatigued due to excessive riding of vehicles,

causes excessive agitation leading to instantaneous emaciation of the body

person who is excessively weak and who is suffering from hunger and fatigue,

causes the same disorders as described before

person who has just taken his meal or water,

causes excitement of vayu as a result of which the recipe of enema is pushed upwards or downwards leading to the causation of serious ailments instantaneously

person who has taken his meal or water,

causes excitement of vayu as a result of which the recipe of enema is pushed upwards or downwards leading to the causation of serious ailments instantaneously

person who has already taken emetic or purgation therapy,

person who has taken inhalation therapy,

niruha-basti causes impairment of senses, and further obstruction of the channels of circulations

person who is angry or fearful,

intoxicated and fainted persons

causes further agitation in the consciousness leading to the complications because of mental damage

persons suffering from incessant vomiting, ptyalism, asthma, cough or hiccup,

niruha-basti causes the aggravated vayu in the upper part of the body to draw the recipe of enema upwards

person suffering from intestinal obstruction, intestinal perforation or ascites, which are associated with abdominal distension,

Niruha-basti further increases the intestinal distension and may lead to the death of the patient

person suffering from intestinal obstruction, intestinal torpor, cholera, abortion or amatisara (first stage of diarrhoea),

Niruha- Basti causes ailments due to ama (product of improper digestion and metabolism)

person suffering from Madhu-meha (obstinate urinary disorders including diabetes) and Kustha (obstinate skin diseases including leprosy),

administration of Niruha-Bsti further aggravates these ailments

Therefore, Niruha basti is prohibited for the above-mentioned type of patients. [15]

Indications of Niruha Basti

???????????????????; ?????????? ???????????????????????????????????????????????????????????????????????????????????????????????????????????????- ???????????????????????????????????????????????????????????????????????????????????????????????????????????????- ????????????????????????????????????????????????????????????????????????????????????????????????- ?????????????????????????????????????????????????????????? ?????????? ??????? ????????????????????; ?????????????? ?????????????????? ??????????????????||??||
sesastvasthapyah; visesatastu sarvangaikangakuksirogavatavarcomutrasukrasangabalavarnamamsaretahksayadosadhmanangasuptikrimikosthodavartasuddhatisara- parvabhedabhitapaplihagulmasulahrdrogabhagandaronmadajvarabradhnasirahkarnasulahrdayaparsvaprsthakatigrahavepanaksepakagauravatilaghava- rajahksayartavisamagnisphigjanujanghorugulphaparsniprapadayonibahvangulistanantadantanakhaparvasthisula- sosastambhantrakujaparikartikalpalpasasabdogragandhotthanadayo vatavyadhayo visesena maharogadhyayoktasca; etesvasthapanam pradhanatamamityuktam vanaspatimulacchedavat||16||
In all the other conditions Niruha basti (evacuative type of medicated enema) is indicated. It is especially useful in treating the below mentioned conditions -
Sarvanga-Roga (paralysis of the whole body),
Ekanga- Roga (paralysis of one of the limbs), Kuksi-Roga (diseases of pelvic region), Vata-Sanga (retention of flatus),
Varcah-Sanga (retention of stool), Mutra-Sanga (retention of urine),
Sukra-Sanga (retention of semen),
Bala-Ksaya (diminution of strength),
Varna Ksaya (diminution of complexion),
Mamsa-Dosa (morbidity of muscle tissue),
Reto-Dosa (morbidity of semen),
Adhmana - bloating, gaseous distension of abdomen (meteorism), Anga- Supti (numbness of limbs), Krimi Kostha (worm infestation / parasitic infestation of the intestine), Udavarta (upward movement of the wind in the abdomen),
Suddhatisara (diarrhoea without the association of ama - a product of indigestion and altered metabolism), Parva- bheda (joint pain, pain in the interphalangeal joints), Abhitapa (feeling of burning sensation), Pliha (splenic disorder),
Gulma - tumours of the abdomen (phantom tumour),
Sula (colic pain), Hrd-roga (heart diseases),
Bhagandara (anal fistula), Unmada - Schizophrenia (Insanity), Jvara - fever (fever), Bradhna - prolapsed rectum (inguinal swellings),
Sirah- Sula (headache), Karna-Sula (earache),
Hrdaya- Graha (cardiac spasm),
Parsva graha (stiffness in the sides of the chest),
Prstha graha (stiffness of the back), Kati- graham (stiffness of the lumbar region), Vepathu (tremor), Aksepaka- Arti (convulsions),
Gaurava- Arti (excessive heaviness of the body), Atilaghava- arti (excessive lightness of the body), Rajah Ksaya (amenorrhoea),
Visamagni (irregular power of digestion),
Sphik sula sosa stambha - stiffness, pain, atrophy and stiffness of the buttocks,
Janu Sula Sosa Stambha - pain, atrophy and stiffness of knee-joints,
Jangha Sula Sosa Stambha - pain, atrophy and stiffness of the thighs,
Gulpha Sula Sosa Stambha - pain, atrophy and stiffness of ankles,
Parsni Sula Sosa stambha - pain, atrophy and stiffness of heels,
Prapada Sula Sosa stambha - pain, atrophy and stiffness of feet, Yoni sula sosa stambha - pain, atrophy and stiffness of female reproductive organs,
Bahu sula sosa stambha - pain, atrophy and stiffness of arms,
Anguli Sula Sosa Stambha - pain, atrophy and stiffness of fingers,
Stananta Sula sosa stambha - pain, atrophy and stiffness at the end of the breasts or nipples, Danta sula Sosa stambha - pain, atrophy and stiffness of teeth,
Nakha Sula sosa stambha - pain, atrophy and stiffness of nails,
Parva Sula sosa stambha - pain, atrophy and stiffness of bones,
Antra-Kujana (intestinal gurgling),
Parikartika (sawing pain in the abdomen),
Alpalpa-utthana (voiding stools in small quantities, frequently), Sasabdotthana (voiding stools with noise),
Ugra-Gandha-utthana (voiding of foul-smelling stool) and such other ailments Niruha- basti is especially useful in Vatika diseases described in Sutra 2):11
For the above-mentioned ailments, Niruha basti is the foremost medication. As a tree gets destroyed by cutting its roots, similarly the above-mentioned diseases get cured by the administration of Niruha basti. [16]

Contraindications of Anuvasana

? ???????????????? ????????????? ?????; ??????????????????????????????????????????????????? ????????????????????????????????????????????????????????? ???????????????????????????? ??????????????????????????????????? ||??||
ya evanasthapyasta evananuvasyah syuh; visesatastvabhuktabhaktanavajvarapandurogakamalaprameharsah pratisyayarocakamandagnidurbalaplihakaphodarorustambhavarcobheda visagarapitapittakaphabhisyandaguru kosthaslipadagalagandapacikrimikosthinah ||17||

Anuvasana Basti is prohibited in all the conditions for which Niruha basti is contra- indicated. It is especially contraindicated in the following conditions:
Abhukta- Bhakta (a person who has not taken food) and
The persons suffering from -
Nava-Jvara - fever (freshly occurring fever / acute fever),
Pandu Roga (anaemia),
Kamala - Jaundice, Liver diseases, Prameha - Urinary tract disorders, diabetes and
Arsas (piles),
Pratisyaya (coryza)
Arocaka (anorexia),
Mandagni - low digestion strength (suppression of the power of digestion), Daurbalya (weakness),
Plihodara (splenic disorders),
Kaphodara - Kapha type of Ascites (obstinate abdominal ailments caused by aggravated Kapha),
Uru-Stambha - stiffness / spasticity of thighs,
Varco-Bheda (ingestion of natural poison),
Pittabhisyanda (conjunctivitis caused by aggravated pitta),
Kaphabhisyanda (conjunctivitis caused by aggravated Kapha),
Guru Kostha (hard bowel),
Slipada (elephantiasis),
Galaganda (enlargement of thyroid gland),
Apaci (cervical adenitis) and
Krimi Kostha (intestinal parasites) [17]
Read: Anuvasana Basti: Method, Benefits, Mode Of Action, Contra Indications

Adverse Effects of Anuvasana basti in contraindicated conditions

???????????????????????????????????????????????? ??????, ?????????????????????????????? ??????????????????????????, ?????????????????????????????????? ????????, ??????????????????????? ????????????, ??????????????????????????????? ????????, ?????????????????????? ????????????????????? ??? ?? ???? ????????; ????????? ???????????||??||
tatrabhuktabhaktasyanavrtamargatvadurdhvamativartate snehah, navajvarapandurogakamalapramehinam dosanutklisyodaranjanayet, arsasasyarsamsyabhisyandyadhmanam kuryat, arocakartasyannagrddhim punarhanyat, mandagnidurbalayormandataramagnim kuryat, pratisyayaplihadimatam bhrsamutklistadosanam bhuya eva dosam vardhayet; tasmadete nanuvasyah||18||
Administration of Anuvasana Basti in contraindicated conditions produces adverse effects as follows:
Sl No Anuvasana Basti (unctuous enema) therapy given to Effect
1 person who has not taken any food, Anuvasana Basti spreads upwards due to the absence of any obstruction in the alimentary tract
2 person suffering from
Nava-Jvara (fever of recent origin), anaemia,
Jaundice, and
Prameha - Urinary tract disorders, diabetes, causes excitation of Doshas leading to the manifestation of Udara - ascites, enlargement of the abdomen (obstinate abdominal diseases including ascites)
3 person suffering from piles, administration of Anuvasana Basti produces stickiness in the piles leading to Adhmana - bloating, gaseous distension of abdomen (abdominal distension)
4 person suffering from anorexia,
administration of Anuvasana Basti further impairs the desire for food
5 person suffering from
mandagni - low digestion strength (suppression of the power of digestion) and debility, administration of Anuvasana- basti further reduces the power of digestion
6 person suffering from coryza, splenic disorder (and such other ailments described in the no. 7 of the para-17 above), then the administration of Anuvasana Basti causes excessive aggravation of the already aggravated Doshas
So Anuvasana Basti must not be administered to the above category of patients.

Indications of Anuvasana Basti

? ?????????????? ????????????; ?????????? ?????????????????? ??????????????????; ????? ?????????? ?????????????????? ???? ??????????????||??||
ya evasthapyasta evanuvasyah; visesatastu ruksatiksnagnayah kevalavatarogartasca; etesu hyanuvasanam pradhanatamamityuktam mule drumaprasekavat||19||
Anuvasana -Basti is indicated in the very conditions for which Niruha- Basti is indicated (vide para no. 16). It is especially indicated for -
the person having un-unctuousness (dryness),
Tiksnagni (sharp power of digestion) and
Kevala- Vata-Roga (diseases caused by Vayu alone, i.e., not associated with Ama - A product of indigestion and altered metabolism),
In these conditions, Anuvasana Basti is the foremost therapy.
As sprinkling of water at the root prevents withering out of the tree. Similarly, administration of Anuvasana - basti cures diseases in the body of the person. [19]

Contraindications of Dhoomapana

???????????????????? ???????????????????????????????????????? ?????????? ?????????? ????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????, ????? ???????? ????||??|
asirovirecanarhastu ajirnibhuktabhaktapitasnehamadyatoyapatukamah snatasirah snatukamah ksuttrsnasramartamattamurcchitasastradandahatavyavayavyayamapanaklantanavajvarasokabhitaptaviriktanuvasitagarbhininavapratisyayartah, anrtau durdine ceti||20|
Shiro- virecana (inhalation therapy) is prohibited for the following:
The person who has indigestion or to a person who has already taken food
The person who has already taken oleation therapy
The person who has taken alcohol or water
The person who has taken head-bath or who desires to take bath
The person who is hungry and thirty
The person who is suffering from fatigue, intoxication or fainting;
The person afflicted by injury with a weapon or a stick;
The person who is fatigued because of sexual intercourse, physical exercise or intake of alcohol:
The person afflicted with freshly occurring fever and grief;
The person who has taken purgation therapy or Anuvasana -Basti;
A pregnant woman;
The person who is suffering from freshly occurring coryza; and
In inappropriate season or on a cloudy day

Adverse effects of Dhoomapana in Prohibited Conditions

??????????????????????????? ??????????? ???????????????? ??????????????????????????????????, ?????????????????????????? ???? ? ?????? ????????????????????????????????????????????, ?????????? ???? ? ????????????? ???????????, ???????????? ??????????, ???????????? ???????????????????? ??????? ?, ????????????????????????????????????? ???? ??????, ????????????????????????? ???? ??????, ??????????????????????????? ???????????????????????, ???????????????????????? ????????????????? ?????? ??????????? ? ????????, ?????????? ??????????????????? ????????, ??????????? ??? ??????????????????????????????????, ????????? ????? ?????????? ? ???? ????? ??????? ???????? ?? ?????, ??????????????????? ????????? ???????????, ????? ???????? ? ????????? ????????? ???????? ? ??????; ????????? ? ????????????????||??||
tatrajirnibhuktabhaktayordosa urdhvavahani srotamsyavrtya kasasvasacchardipratisyayanjanayet, pitasnehamadyatoyapatukamanam krte ca pibatam mukhanasasravaksyupadehatimirasiroroganjanayet, snatasirasah krte ca snanacchirasah pratisyayam, ksudhartasya vataprakopam, trsnartasya punastrsnabhivrddhim mukhasosam ca, sramartamattamurcchitanamasthapanoktam dosam janayet, sastradandahatayostivrataram rujam janayet, vyavayavyayamapanaklantanam sirahskandhanetrorahpidanam, navajvarasokabhitaptayorusma netranadiranusrtya timiram jvaravrddhim ca kuryat, viriktasya vayurindriyopaghatam kuryat, anuvasitasya kaphah sirogurutvakandukrimidosanjanayet, garbhinya garbham stambhayet sa kanah kunih paksahatah pithasarpi va jayate, navapratisyayartasya srotamsi vyapadayet, anrtau durdine ca sitadosan putinasyam sirorogam ca janayet; tasmadete na sirovirecanarhah||21||
Administration of inhalation therapy in contra-indicated conditions gives rise to adverse effects as follows:
Sl No Shiro Virechana - nasal medication therapy given to Effect
1 person suffering from indigestion or he who has already taken food, causes occlusion of the channels of circulation moving upwards causing therapy cough, asthma, vomiting and coryza
2 person who has already taken oleation therapy or he who desires to take oleation therapy, alcohol or water or if he takes water after the therapy, gives rise to ptyalism, discharge from the nose, stickiness of eyes, cataract and head diseases
3 person who has taken head-bath or takes head-bath after the therapy, gives rise to coryza
4 a hungry person aggravates vayu
5 a thirsty person intensifies thirst, and causes dryness of the mouth
6 a person afflicted with fatigue, intoxication or fainting
produces the same adverse effects as mentioned in respect of Niruha- Basti
7 a person injured by weapon or beaten by a stick produces excruciating pain
8 a person fatigued because of sexual indulgence, physical work or taking alcohol (even after a day) causes pain in the head, shoulders, eyes and chest
9 a person suffering from Nava-Jvara (fever of recent origin) and grief, causes the heat to spread into the channels of the eyes resulting in Timira (cataract) and further aggravation of the fever
10 a person who has already taken the purgation therapy
the Vayu in his body gets aggravated leading to the injury to his sense organs
11 a person who has already taken Anuvasana Basti
kapha in his body gets aggravated leading to heaviness of head, itching and parasitic infestation
12 a pregnant woman,
the growth of the foetus gets arrested, and she gives birth to and offspring who may be Kana (blind by one eye), Kuni (with deformity of upper limbs), Paksahata (hemiplegic) or Pitha-Sarpi (with deformity of the lower limbs)
13 a person who is suffering from nava pratisyaya (freshly occurring coryza), may cause morbidity of the channels of circulation
14 on a cloudy day or during inappropriate seasons may cause ailments due to cold, Puti- nasya (putrefied rhinitis) and Shiro-Roga (head -diseases)
Therefore, in the above-mentioned conditions inhalation therapy is prohibited. [21]
Read: Dhumapana Vidhi Adhyaya Ashtanga Hridaya Sutrasthana 21

Indications of Dhoomapana

??????????????, ?????????? ?????????????????????????????????????????????????????????????????????????
???????????????????????????????????????????????????????????????????????????????????????????????- ????????????????????????????????????????????????????????? ?????????????????????????????? ???????????; ????? ??????????? ??????????????????, ?????????????????????????? ?????????????????????? ????? ???????? ???????????||??||
sesastvarhah, visesatastu sirodantamanyastambhagalahanugrahapinasagalasundikasalukasukratimiravartmarogavyango
pajihvikardhavabhedakagrivaskandhamsasyanasikakarnaksimurdhakapalasirorogarditapatantrakapatanakagalaganda- dantasulaharsacalaksirajyarbudasvarabhedavaggrahagadgadakrathanadaya urdhvajatrugatascavatadivikarah paripakvasca; etesu sirovirecanam pradhanatamamityuktam, taddhyuttamangamanupravisya munjadisikamivasaktam kevalam vikarakaram dosamapakarsati||22||
Inhalation therapy is indicated for the remaining ailments. It is especially useful in the below mentioned conditions -
Shiro-stambha (stiffness of the head),
Danta-Stambha (Stiffness of teeth),
Manya-stambha (torticollis),
Gala-Graha (spasm of the teeth),
Hanu-Graha (lock-jaw),
Pinasa (chronic coryza),
Gala-Sundika (tonsillitis),
Gala-Saluka (tumour in the throat),
Sukra (corneal ulcer),
Timira (cataract),
Vartma-Roga (diseases of eye-lids),
Vyanga (freckles),
Upa-Jihvika (Uvulitis),
Ardhavabhedaka (hemicrania),
Griva-roga (diseases of the neck),
Skandha-roga (diseases of the shoulders),
Amsa-roga (diseases of the scapula),
Asya-roga (diseases of the mouth),
Nasika-roga (diseases of the nose),
Karna-Roga (diseases of the ears),
Aksi roga (diseases of the eyes),
Murdha-Roga (diseases of the head),
Kapala-roga (diseases of the cranium),
Shiro-roga (diseases of the head),
Ardita (facial paralysis),
Apatantraka (convulsions with unconsciousness),
Apatanaka (convulsions with consciousness),
Galaganda (goitre),
Danta-Sula (toothache),
Danta-harsa (tingling of teeth),
Danta-cala (looseness of teeth)
Aksi-Raji (conjunctivitis),
Arbuda (tumour),
Svarabheda (hoarseness of the voice),
Vag-graham (loss of speech),
Gad-Gada (spasmodic speech),
Krathana (stammering) etc
and diseases of the head and neck which are caused by aggravated Vayu and which are fully matured (free from Ama-Dosa).
For the treatment of the above-mentioned maladies inhalation therapy is the foremost remedy. The recipe administered through inhalation therapy enters into the head (cerebrum), and draws out exclusively the morbid matter as the pith (Isika) is taken out after removing the fibrous coating of Munja (a type of Grass) adhered to it. [22]
Read: Herbal Smoking - Benefits, Rules, Side Effects, Blends To Try

Seasonal Propriety of Dhoomapana

?????????????????????????????????? ?????? ????? ???????? ??????????????????; ???????? ??????????, ???? ?????????, ???????????????? ????||??||
pravrtsaradvasantetaresvatyayikesu rogesu navanam kuryat krtrimagunopadhanat; grisme purvahne, site madhyahne, varsasvadurdine ceti||23||
In the case of an emergency, inhalation therapy can be given even in the seasons other than Pravrt (first part of the rainy season), sarat (autumn) and Vasanta (spring) by artificially creating the congenial environment. In the summer, inhalation therapy should be given in the morning. In the winter, it should be given during the mid-day. In the rainy season it should be given when the sky is free from clouds. [23]

Contents of chapter and Epilogue

???? ???????-
??? ???????? ???? ???????? ??????????|?????? ???? ???? ??????? ???? ???????? ????????||??||
? ????????? ?????????????????????????????????| ??????????? ??????? ??????? ????????? ?????||??||
????????? ?? ???????? ????????? ?????| ?????? ???????????? ?????? ???? ?????? ? ????????||??||
??????????????????????? ???? ???? ??????????| ??????? ??????? ?????????? ????????? ????????? ?||??||
??????? ?????? ???????? ??????????? ????? ????| ???? ?????? ?? ???????????????????????? ??||??||
tatra slokah-
iti pancavidham karma vistarena nidarsitam|yebhyo yanna hitam yasmat karma yebhyasca yaddhitam||24||
na caikantena nirdiste'pyarthe'bhinivisedbudhah| svayamapyatra vaidyena tarkyam buddhimata bhavet||25||
utpadyeta hi sa'vastha desakalabalam prati| yasyam karyamakaryam syat karma karyam ca varjitam||26||
chardirhrdrogagulmanam vamanam sve cikitsite| avastham prapya nirdistam kusthinam bastikarma ca||27||
tasmat satyapi nirdese kuryaduhya svayam dhiya| vina tarkena ya siddhiryadrcchasiddhireva sa||28||
To sum up: -
Thus, five elimination therapies taken together called Pancha-karma is explained above in detail with reference to their following aspects;
Contra-indications of these therapies for different categories of diseases.
The reasons for which these therapies are contraindicated and
the ailments for which these therapies are indicted.
A wise physician should not make a judgement exclusively on the suggestions made above in this chapter. He should use his own discretions and reasoning in arriving at the correct judgement.
Due to the nature of the habitat, time and strength of the patient, situations may arise because of which the therapy indicated for an ailment becomes ineffective, and a prohibited therapy may become useful.
In the chapters dealing with the treatment of Chardi (vomiting), Hrd-Roga (heart -diseases) and Gulma (phantom tumour), emetic therapy [though normally prohibited] is prescribed in certain stages of these diseases. Similarly, Basti or enema therapy is prescribed in the chapter dealing with the treatment of Kusthaa (thought is generally prohibited] depending upon the stage of this disease.
Therefore, despite the directions laid down in this chapter, the physician should determine the correct therapy for an ailment by the use of his own discretion. The success achieved without the exercise of the power of reasoning (tarka) is nothing but only the success per chance. [24-28]

??????????????? ??????? ????????????????????????? ?????????????? ???????????? ????????????????????? ???????????????||?||
ityagnivesakrte tantre carakapratisamskrte'prapte drdhabalasampurite siddhisthane pancakarmiyasiddhirnama dvitiyo'dhyayah||2||
Thus, ends the second chapter of siddhi- section dealing with "the Perfect administration of Pancha- karma" in Agnivesha's work as redacted by Charaka, and because of its non-availability, supplemented by Drdhabala.

Share this:

Related