Basti: The Primary Treatment for Vata

As nature transitions seasons and exhibits change, Ayurveda recommends cleansing and rejuvenation to help the body adapt. Of particular focus at this time of the year is balancing vata. As discussed in the last newsletter, there is no system in the body that is not touched by vata, and according to Ayurvedic tradition, vata alone is responsible for more that 55% of the diseases encountered by humans.

Panchakarma is recommended at the change of seasons to help balance the shifts in doshas that can accumulate with the change in environment. The primary treatment in panchakarma that is geared towards vata is basti (Ayurvedic enema). Basti is so highly revered in the panchakarma process that it is said that the benefit received from basti is equal to the cumulative benefit of the other four processes in panchakarma.  And that only makes sense, given the prevalence that vitiated vata plays in the disease process. 

Basti works in the region of the colon, but its impact is so far reaching and deep that simply calling this process an enema does not do it justice. Recall that as the major seat of vata in the GI tract, the colon is critical in keeping vata balanced in the entire body. In the stages of samprapti (Ayurvedic pathogenesis), vata first accumulates in the colon, and then as it begins to “overflow”, it will spread and create imbalanced vata in other susceptible parts of the body. This systemic imbalanced vata can affect almost any system in the body, as vata is a necessary presence throughout the body; it is likely to affect the systems which have some weakness (a khavaigunya). Basti provides herbal cleansing and nourishment directly into the intestines and colon, without having to be digested by the stomach and upper GI tract, as would be the case with anything taken by mouth.

Traditional Ayurvedic teaching reminds us that basti can be used for a variety of reasons, including bowel regularity, joint support, excess vata in digestion causing occasional gas, nervous system support, and healthy sleep patterns.1 Clearing vata from the system also helps create energy and vitality as well as clarity in the mind.6 Basti promotes overall well-being, a graceful aging process, luster and a healthy glow. Multiple international studies have been done regarding the benefits of basti, and they also show benefits to joint, back, and bone health.2,3,4,5

Basti does have some general situations in which it is contraindicated, including pregnancy, menstruation, diarrhea, inflammation of the anal region or rectal bleeding, and extreme weakness or debility.1 Generally, basti is well tolerated in appropriate candidates, and a proper basti should result in 1-2 bowel movements with cleansing of the fecal matter as well as a feeling of lightness and a promotion of appetite and agni.1,6 If the basti was insufficient, one may be left with pain, incomplete fecal clearing, and/or swelling.6 

Prior to doing basti, one can prepare by applying warm oil (such as sesame) to the abdomen and lower back in a clockwise direction following the flow of the intestines. If one is so inclined, one can even do a full body massage with warm oil to help with oleation and loosening of toxins. After massage with warm oil, one can place a warm pack, such as a hot water bottle) to the abdomen for a few minutes, allowing the intestines to be primed for the application of basti. 

Basti can be classified in a variety of ways. While there are a number of treatments that can be referred to with the term basti, here we are speaking only of rectal basti, as this is the primary treatment for our dosha of choice, vata. Rectal basti is usually one of two major types: niruha basti, which is done with herbal decoctions and is purifying and cleansing in nature; and anuvasana basti, usually done with oil, which is nourishing, strengthening, and oleating in nature. 

Niruha basti, which is best done in the morning on an empty stomach, can use an endless variety of hebal decoctions. Often dashamula is used as one of the ingredients, as it is a primary herbal remedy to dispel excess vata. Classical formulas add triphala, rock salt and honey to the dashamula.6 Modern variations will choose any number of cleansing or rasayana herbs depending on the desired outcome. Guduchi has a cooling, calming effect and can help balance pitta. Punarnava helps balance excess water in the system and can also balance kapha. Other nourishing rejuvenatives can include ashwagandha or shatavari. To help irritation in the system, licorice can provide a soothing nature. And for a cleansing effect, triphala is a solid choice. Niruha basti can be held for 15-20 minutes, or longer if comfortable, up to 48 minutes.6 Following the administration of niruha basti, one can have a light meal of easily digestible food. 

Anuvasana basti is primarily oil based and is meant to be building and nourishing. Locally, providing oleation for any dryness caused by vata can support a healthy, supple colon. More broadly, the oil helps to ground vata and promotes energy and vitality. Anuvasana basti is usually based in sesame oil, which may be plain or herbalized with supportive Ayurvedic herbs. Anuvasana basti can be held for longer periods of time, even up to a full day, as long as it is comfortable for the client, as it continues to provide a supportive effect. 

There are a variety of traditional schedules which can use a combination of alternating niruha and anuvasana basti in order to achieve optimal effect. The usual protocol starts with an anuvasana basti to prime the colon, then alternates niruha and anuvasana basti to cleanse and nourish (so the colon does not become overly depleted), and ends with a number of anuvasana bastis in order to replenish and rejuvenate the colon and balance, ground, and nourish vata after the cleansing process. Caraka recommends schedules of yoga basti (8 bastis), kala basti (16 bastis), and karma basti (30 bastis), used based on the degree of vata vitiation.6 Another alternative can also be to mix the herbal decoction and oil together, blend to make a solution, and administer the basti. 

After doing basti, one should take care to follow vata balancing recommendations. Eat light, grounding, warm, oleative food. Rest and avoid vata provoking activity, including excessive talking, extremely windy or cold weather, travel, and busy activity. In this way, basti can be used to keep vata balanced on a routine basis, cleanse vata during seasonal transitions, and manage more extreme vata imbalances that are causing issues in the deeper tissues.

References

1 Dr. Vasant Lad.  http://www.ayurveda.com/pdf/basti_colon_cleansing.pdf

2 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456864/

3 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215425/

4 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456847/

5 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764877/

6 http://www.atreya.com/assets/files/ebook/EBook_CoursePK_EN.pdf