೩೬. ನೇತ್ರಬಸ್ತಿವ್ಯಾಪಚ್ಚಿಕಿತ್ಸಿತಮ್

Meaning of the śloka

Now the treatment of complications arising from the basti nozzle and bag will be explained, as taught by the revered Dhanvantari.

Key terms

netra

The nozzle or tube of the historical basti apparatus in this context.

basti

Here, the historical enema apparatus and its administration.

vyāpat

A complication or adverse outcome associated with the procedure.

praṇidhāna

Insertion or positioning of the apparatus.

Dhanvantari

The authoritative teacher to whom the teaching is attributed.

Meaning of the śloka

If the nozzle shifts, turns, is raised too far, or sinks too deeply, it may injure the anal region and cause pain. The text directs care appropriate to a fresh wound and measures described as pacifying pitta, including sprinkling with unctuous substances. If the nozzle is inserted obliquely or pressed against the side, its opening becomes obstructed and the basti material does not pass properly; one who understands the procedure should make the nozzle straight.

Key terms

netra

The nozzle whose displacement or faulty direction is described as causing injury or obstruction.

sadyaḥkṣata

A newly sustained wound or traumatic injury.

pittaghna

Described by the commentary as measures with sweet, cooling, and related qualities that pacify pitta.

sneha

An unctuous substance used in the source's account of sprinkling the injured area.

tiryaṅ-praṇihita

Inserted obliquely, causing the nozzle opening to be blocked against the side.

Meaning of the śloka

A nozzle that is excessively thick, rough, or sharp-edged may cause abrasion, injury, and pain in the anal region; the text refers back to the treatment for a fresh wound. If its collar is too near, or if the nozzle is broken or has an excessively small opening, the basti material leaks or the administration becomes ineffective, so these defects are to be avoided. If the collar is too far away, pressure on the vulnerable anal region may cause bleeding; the text again indicates pitta-pacifying care and a picchila basti. A nozzle that is too short or too narrow causes difficulty and may make the material return, producing disorders attributed to obstructed basti. A nozzle that is too long or too wide is said to produce effects like excessive pressure.

Key terms

karṇikā

The collar or flange on the nozzle, whose position is discussed as a source of procedural complications.

avaseka

Leakage or escape of the administered material.

gudamarma

The vulnerable or vital anal region said to be injured by pressure.

picchila basti

A slimy or mucilaginous basti mentioned as a historical response to bleeding.

mūtrāghāta

Urinary retention or obstruction listed among disorders attributed to impeded basti.

mūtrakṛcchra

Painful or difficult urination listed among the possible resulting disorders.

Jejjaṭa

The authority whose alternative reading identifies ‘basti as before’ with picchā basti.

Meaning of the śloka

If the basti bag is too broad or too thick, the defect is said to resemble one that is poorly tied. If the bag is too small, the quantity of material is correspondingly small and its attributed benefits are considered limited. A poorly tied or minutely torn bag is to be understood like a broken nozzle.

Key terms

basti

In this passage, the bag or reservoir of the historical basti apparatus.

prastīrṇa

Too broad or spread out, described as a defect of the bag.

bahala

Too thick, another stated defect of the bag.

durbaddha

Poorly tied or inadequately secured, allowing leakage.

aṇubhinna

Having a minute tear or puncture through which the material may leak.

Meaning of the śloka

If the basti reservoir is compressed too forcefully, the material is said to pass toward the stomach and, driven by vāyu, emerge through the nose or mouth. The text describes immediate countermeasures. If compression is too weak, the material does not reach its intended location or accomplish its purpose. Repeated compression is said to confine vāyu within the abdomen, producing distension and severe pain; the corresponding basti is prescribed for each condition. Delay beyond the proper time causes distress and aggravates the disorder, for which another basti directed against the strength of that disorder is advised.

Key terms

atiprapīḍita

Compressed with excessive force, the first compression fault described here.

avadhūnana

A shaking action described by the commentary as one of the historical responses.

ādhmāna

Abdominal distension attributed here to vāyu confined within the abdomen.

yathāsvam bastayaḥ

The respective basti considered a countermeasure for each stated complication.

anuloma

Restoration of the proper direction of movement, invoked in the commentary's explanation of the aggravated disorder.

Meaning of the śloka

Unprocessed oil is said to cause coating and swelling of the rectum; the text recommends a cleansing basti and purgation. An insufficient amount of either kind of basti has little effect, whereas an excessive amount is said to cause obstruction, exhaustion, and diarrhea. Excessively hot or sharp preparations are associated with fainting, burning, diarrhea, and an increase of pitta; overly mild or cold preparations are associated with obstruction of vāyu and abdominal distension. The stated general principle is to use an opposing measure for such faults. A thick nirūha is said to coat the rectum and basti region, while one that is too thin and weak may cause pravāhikā. The text accordingly states a thin preparation for excessive thickness and a thick one for excessive thinness. Excessive unctuousness is said to produce marked moistness, while excessive dryness causes stiffness and distension; opposite qualities are then prescribed.

Key terms

apakva sneha

Unprocessed or uncooked oil blamed here for coating and swelling.

upadeha

A coating or smear, as glossed by the commentary.

pratyanīka

A measure with qualities opposite to the identified fault.

nirūha

One of the two basti categories discussed in relation to consistency and amount.

pravāhikā

A disorder named as a possible consequence of a thin, weak preparation; the source does not further define it here.

atijāḍyakṛt

Producing excessive moisture, according to the commentator's gloss.

Meaning of the śloka

The text next describes complications attributed to unsuitable patient positioning. With the head too low, effects like those of excessive compression are said to occur; with the head raised, basti is said to produce distension and trouble involving the urinary or genital region. It then names a historical remedy. In a face-down position, the material is said to take a wrong path and fail to reach the pakvāśaya, while vāyu troubles the heart region, rectum, and abdomen. Lying face-up is said to obstruct the route so that basti does not enter, and movement of the nozzle is said to disturb vāyu internally. When the body or both thighs are contracted, the basti is said not to return properly. Given while standing, it returns quickly downward and fails to nourish its intended site. In a right-side position, it is said not to reach the whole pakvāśaya because that structure is described as following the left side. The text therefore disapproves administration in these positions and says that subsequent aggravation of vāyu should be addressed according to the affected condition.

Key terms

avaśīrṣaka

A position with the head lowered, linked here with excessive-compression-like complications.

ucchīrṣaka

A position with the head raised, for which the source preserves differing readings and interpretations.

uttara-basti

A historical basti category proposed in one interpretation and explicitly rejected as the intended sense in another.

netrasaṃvejana

Movement or shaking of the nozzle, according to the commentary.

vimārgaga

Going by an improper route.

pakvāśaya

The internal site the basti is said to fail to reach under unsuitable positioning.

Meaning of the śloka

The complications of sneha-basti will be described in the section devoted to its treatment.

Key terms

vyāpadaḥ

Complications or adverse outcomes.

sneha-basti

The unctuous basti category whose complications are announced for later discussion.

praṇidhāna

Placement or introduction, one category of practitioner-related fault summarized by the commentary.

vaidyanimitta

Arising from the practitioner, as the commentary classifies the forty-four preceding complications.

vaidyāturanimitta

Attributed to both practitioner and patient in the announced discussion.

Meaning of the śloka

The text describes complications beginning with inadequate action (ayoga) and their remedies. A basti that is insufficiently warm, contains too little medicine, or is too small may fail to return as expected; obstruction, abdominal distension, and pain are called ayoga. It then attributes marked distension and severe pain in the cardiac region, waist, flanks, and back to factors such as residual or recently eaten food, abundant doṣa, excessive quantity, insufficient warmth, or unsuitable unctuousness and salt. An excessively sharp, salty, or dry basti is said to aggravate vāyu together with pitta and cause cutting pain around the navel, bladder region, and anus. Excessive sourness, salt, or sharpness is linked with discharge, weakness, exhaustion, burning, and difficult evacuation of mucus and blood. Other described complications include distress affecting the heart, bodily pain, intoxication-like disturbance, fainting, heaviness, stiffness, lassitude, yawning, twisting, tremor, and joint pain. Excessive heat, sharpness, quantity, or use after excessive sweating or when little doṣa is present is said to produce atiyoga, whose signs resemble excessive purgation; a still more severe state includes loss of blood. The nine complications stated for nirūha are also to be recognized in sneha-basti. The physician is enjoined to act so that these complications do not arise.

Key terms

ayoga

Inadequate action of basti, identified here by failure to return together with obstruction, distension, and pain.

parikartikA (parikartikā)

Severe cutting or tearing pain attributed here to an excessively sharp, salty, or dry basti.

parisrAva (parisrāva)

A pathological discharge which the commentary distinguishes from the discharge associated with excessive emesis or purgation.

pravAhikA (pravāhikā)

Painful straining with difficult passage of mucus and blood in this context.

atiyoga

Excessive action, whose signs are compared here with those of excessive purgation.

jIvAdAna (jīvādāna)

A severe complication interpreted by the commentary as loss of blood after excessive treatment.

picchAbasti (picchā-basti)

A mucilaginous basti named by the source among historical responses to several complications.

Meaning of the śloka

The verse states a sequence of intervals among the pañcakarma procedures: after properly performed vamana, virecana is placed after a fortnight, followed subsequently by nirūha. A person who has received nirūha is said to receive anuvāsana on the same day, whereas one who has undergone virecana is said to receive it only after seven nights.

Key terms

vamana

The emetic procedure placed first in the historical sequence discussed here.

virecana

The purgative procedure said in the verse to follow vamana after a specified interval.

nirUha (nirūha)

A non-unctuous basti procedure placed later in the sequence.

anuvAsana (anuvāsana)

An unctuous basti whose timing is distinguished after nirūha and after virecana.

annasaMsarga (annasaṃsarga)

The staged restoration of food intake discussed by the commentary between procedures.

AsthApana (āsthāpana)

A basti procedure for which the commentary preserves differing preparatory circumstances.

Meaning of the śloka

Thus ends the thirty-sixth chapter of the Cikitsāsthāna in the Suśruta Saṃhitā, entitled Netrabastivyāpaccikitsita, concerning the treatment of complications associated with the basti nozzle and basti therapy.

Key terms

cikitsAsthAna (cikitsāsthāna)

The section of the Suśruta Saṃhitā concerned with treatment.

netrabastivyApaccikitsita (netrabastivyāpaccikitsita)

The chapter title concerning treatment of complications related to the basti nozzle and basti therapy.

Nibandhasa~ggraha (Nibandhasaṅgraha)

The title of Dalhaṇa's commentary.

DalhaNa (Dalhaṇa)

The commentator named in the closing statement.