INTRODUCTION:

Vasti Chikitsa [medicated enema treatment]; a part of elimination therapy has been given special status in Ayurveda. It is also considered as Ardha Chikitsa [half of the entire treatments] in Ayurveda ^[1]. It is mainly of two kinds i.e. Niruha Vasti and Sneha Vasti ^[2].

There is a description of different variants of Vasti for different ailments in Ayurvedic classics. Vaitarana Vasti is such a kind of Vasti which has a unique formulation and specific indications. Vaitarana or Vaitarani river, as mentioned in the Garuda Purana and various other Hindu religious texts, lies between the earth and the infernal Naraka, the realm of Yama, Hindu God of death and is believed to purify one’s sins ^[3]. Also, Vaitarani River is mentioned in other texts like Harihareshwara Mahatmya, Tirtha Yatra Parva of Mahabharat, Matsya Purana, Vamana Purana and Padma Purana. Lastly, it is the Padma Purana which reveals the etymology of Vaitarani in Vaitarani Mahatmya, where it is defined as Vai (truely) tarini (saving) ^[4]. The term Vaitarana is used as a name associated with Salyatantra Acharya in Sushruta Samhita ^[5]. Here in the context of Vaitarana Vasti, it implies that the timely administration of this Vasti restores the health of the person from the hell of rogas. Vaitarana Vasti is practiced now a day’s extensively with excellent results. The diseases include Amavata, Katisoola, Gridhrasi, Infertility, Vishamajwara etc. The classical references are available in different textbooks like Chakradutta, Vrindhamadhava, Vangasena etc. there is some difference in the formulations laid down by each Acharya. In clinical practice, it is seen that the ingredients are changed according to the disease conditions.

Therapeutic indications:

It is indicated in Soola, Sopha, Anaha Amavatha, Vatha Kaphaja conditions, Gridhrasi and in other conditions where Srotosodhana is needed.

Table: 1

Chakradutta ^[6]

Vrindhamadhava^[7]

Vangasena^[8]

Soola, Anaha, Amavata

Soola, Amavata, Sopha Of Kati,Uru, Prushta,

Urusthambha,Gridhrasi, Janusamkocham, Vishama Jwara, Klaibya

Ingredients:

The ingredients of Vaitarana Vasti are Saindhava Lavana, Guda, Amlika, Gomutra/Godugda and Ishat Taila (little quantity of oil) in prescribed quantity. Ingredients as per different Acharayas are given below.

Table: 2

	Chakradutta^[9]	Vrindha madhava^[10]	Vangasena^[11]
*Saindhava*	1 Karsha	1 Karsha	1 Karsha
*Guda*	1 Sukti	1 Sukti	½ Pala*
*Amlika*	1 Pala	1 Pala	1 Pala
*Taila*	Quantity Not mentioned	Quantity Not mentioned(Ishat taila)	Quantity Not mentioned(Ishat taila)
*Gomutra*	1 Kudava**	1 Kudava**	Not mentioned
*Godugda*	Not mentioned	Not mentioned	1 Kudava

Half Pala*=1 Sukti, 1 Kudava **= 4 Pala

Out of 5 ingredients; 4 i.e. Saindhava, Guda, Taila & Amlika are found common in all the three formulations and there is difference in opinion with Drava Dravya only. In clinical practice different Drava Dravyas are used other than the classically mentioned like Dhanyamla, Kulatha Kwatha etc. So critical analysis is needed while selecting Drava Dravya. Vangasena has mentioned ‘Surabhi Payah’ instead of Gomutra. The concept of the Vasti formulation is confused to some extent when one refers to Lala Saligramavaidya’s Hindi translation of Vangasenasamhita, which includes gomutra instead of milk as a constituent. The reason may be the influence of former treatises like Vrindha Madhava and Chakradutta. The first reference regarding Vaitarana Vasti is probably found in the Sidhayogah or Vrindha Madhava [“Ksharam (Ksiram) Na Cedvaitaranam Pradaya Dvaye Trayahe Va Apy Anuvasaniyah”] and is explained as a separate section after Niruha Adhikara as this formulation does not satisfy the common pattern of the combination as in Niruha. The critical edition of Vrindha Madhava by Dr. Premavati Tiwari and Dr. Ashakumari reports a variant reading where Guda is replaced by Hingu [“Amlika Hingu Sindhujanma Gomutraih”]. Sharngadhara has given certain important rules regarding the quantity of Drava Dravya to be taken for Sneha preparations. Srikantha Dutta and Sivadas Sen opined to apply this rule of Dravya Samyojana in Vasti also. So, double the quantity of Gomutra or Goksheera mentioned can be taken, i.e. 2 Kudava. Nischalakara and Sivadasa Sen stipulate the quantity of Taila as 1 Pala on the basis of existing clinical tradition (“Ishat Tailamiti Palamiti Vyavaharanti Vriddah”). Tatwachandrika tika presents the practice of adding 1 Madanaphala to Vaitaranabasti which is (usually) added to every Niruhabasti ^[12].

Comparison between Vaitarana Vasti and Niruha Vasti:

The ingredients in classical Niruha Vasti are Makshkika, Lavana, Sneha, Kalka and Kwatha ^[13]. Vaitarana Vasti is considered as a variant of Niruha but does not satisfy the classical combination of ingredients in Niruha Vasti. In Vaitarana Vasti the ingredients are Saindava, Guda, Chincha, Taila, and Drava Dravya. Both the Vastis have Saindhava as the common ingredient. In Vaitarana Vasti, Guda is mentioned instead of Makshika. This may be due to the influence of Jainism as they might have consciously avoided the Jangama Dravya.

Apart from this while describing the Abhava Dravya, in the absence of Makshika, Purana Guda can be substituted ^[14]. In Vaitarana Vasti, Chincha serves the role of Kalka. Since it is a Rooksha Vasti the amount of Sneha should be minimal. That might have been the reason for stating “Eeshat Taila” or “Taila Yutho” without stating the exact quantity of Sneha Dravya by Acharyas. In Niruha Vasti, Madanaphala is also an ingredient ^[15]. Tatwachandrika tika presents the practice of adding 1 Madanaphala to Vaitaranabasti which is (usually) added to every Niruhabasti. This tradition seems to be a conscious effort to grant the status of Niruha [Basti] to Vaitarana [Basti] ^[16].

The action of Vasti is not localized but it has a systemic effect. In Ayurveda, it is said that the Veerya [potency] of Vasti Dravyas administered into Pakwasaya reaches the whole body through Srotas [channels] just like water when poured into the root of the tree reaches the whole plant ^[17]. Vasti administered into Pakwasaya draws out the morbid matters from the body just like a cloth while colouring absorbs only colour not water ^[18].

Properties of the ingredients in Vaitarana Vasti

1. Saindahava Lavana (Rock salt):

Saindhava Lavana is the purest form of rock salt, considered the best among all variety of salt and advisable in Ayurveda for daily consumption. It possesses 85% NaCl and 15% trace materials, whereas another salt contains 97% NaCl. It contains 84 trace elements, out of 92 trace materials of the human body and is a rich source of calcium, iron, zinc, potassium, magnesium, and copper. According to Ayurveda, it is salty and slightly sweet in taste; Madhura Vipaka, Sheeta Veerya, light and unctuous in nature. It is Tridoshahara, Agni Deepaka, Rochaka, Pachaka, Pathya, Vrishya, Chakshusya, Avidahi, and Hikkahara. It has numerous health benefits. It helps in digestion, relieves constipation, flatulence, and maintains body electrolytes. It is good for respiratory disorders, joint disorders and stiffness, skin ailments, gastritis and bloating. In Vasti therapy during Panchakarma, while preparing the Vasti liquid, rock salt is added to prepare an emulsion. It helps to dissolve and expel Doshas from the intestines. It helps in absorption of other nutrients into the body from GI tract. It also eliminates toxins from the body and used during sudation therapy. It strengthens the body, fortifies the bone and connective tissue and relieves muscle cramps, worm infestation, and halitosis ^[19].

2. Chincha / Tamarind (Tamarindus indica L.) Tamarind is found in the name of Chincha or Amlika in Ayurvedic texts. It is a cheaply available plant and has a long history of wide medicinal uses. It is rich in tartaric acid which is a potent antioxidant and is a good source of Iron and Thiamine. The ripe fruit of Tamarind is Madhura-Amla (sweet-sour) in taste. It possesses Guru and Ruksha Guna, Usna Veerya, Amla in Vipaka. The ripe fruit is Vata Pitha Samaka. It has Rochana-Deepana (Appetizing-Digestive), Trisnanigrahana (suppresses thirst), Yakrtituttejaka (liver stimulant), Sothahara (anti-inflammatory), Mutrala (diuretic), Vishaghna (anti dote to certain poisons), Vastisodhaka (urinary antiseptic), Klamahara (anti-fatigue) actions. It is useful for fever, constipation, loss of appetite, wound, sunstroke, rheumatism, inflammation and diabetes. Its fruit is laxative. Leaves are useful to destroy parasitic intestinal worms. It is used as a food and has culinary uses. It is made into a refreshing and cooling beverage particularly used in fever. It possesses anti-oxidant, anti-inflammatory, anti-microbial, anti-fungal, anti-viral, hepato-protective, anti-nematodal, molluscicidal, anti-diabetic, anti-cytotoxic activities ^{[20] [21]}.

Tamarind fruit has anti spasmolytic activity by blocking calcium channel, has a laxative effect due to the presence of malic acid, tartaric acid and potassium and it prevents cardiovascular diseases and obesity due to the content of polyphenol and flavanoids in it^[22].

3. Guda (Jaggery):

Jaggery (Gur/Guda) is a sugarcane product (Ikshuvikara) used extensively in Ayurvedic medicines for therapeutic uses, dietary sources and pharmaceutical process of Ayurvedic medicines. It is not completely refined like sugar. It doesn’t increase Kapha Dosha. It is a rich source of minerals like potassium, iron, magnesium, zinc, selenium, calcium, vitamins and antioxidants. It also contains polyphenols, a phenolic compound which is responsible for anti-oxidant and cytoprotective activities. Jaggery is a very useful substance for oedema patient when it is consumed along with ardraka, abhaya, sunthi, or pippali. It is also good for the patients with dysuria, constipation, cardiac problems, asthma, allergies, chronic fever, piles, throat and lung infections, malabsorption syndrome (Grahani) and Kapha Vataja Rogas ^[23][24].

4. Gomutra (Cow urine):

Gomutra (Cow urine) described in Ayurveda as an effective medicinal substance of animal origin with numerous therapeutic uses. It is considered as the best and useful among all mutra ^[25]. It is told as ‘Sanjivani’ and ‘Amrita’ in Ayurveda. It is a non-toxic waste material consists of water, urea, and a mixture of salts, hormones and enzymes. According to Ayurveda, it is good for worm infestation, skin disorders, and pruritus ^[26]. It is pungent (Katu) in taste, Tiksna, Usna, alkaline (Kshara), Agnideepaka, Medhya, Kaphavatahara, Pithavardhaka and beneficial in Sula, Gulma, Udara, Anaha. It is useful for Virechana and Asthapana Karma. It is useful in obesity, certain cardiac and renal diseases, indigestion, stomach ache, diarrhoea, oedema, jaundice, anaemia, haemorrhoids and skin diseases including vitiligo. Gomutra is capable of removing all the imbalances in the body, thus maintaining the general health. It acts as bio-enhancer and has antifungal, antimicrobial, germicidal, bactericidal, anthelmintic, antioxidant and antineoplastic action. It is useful in hypersensitivity reactions and in numerous other diseases including increasing the life span of a person. It has immune enhancer properties. It augments B and T blastogenesis and IgA, IgG and IgM titer in experimental animals. It exhibits antimicrobial and germicidal activity due to the presence of urea, creatinine and Arum hydroxide (Swarna Kshar) in it.

Its anti-cancerous activity is due to the presence of uric acid and Allantoin in it. It shows wound healing activity due to the presence of allantoin, immunomodulation due to presence of Arum hydroxide. It prevents cardiovascular diseases due to the presence of kallikrein, urokinase, hippuric acid and ammonia in it. It attributes anti-obesity properties due to the content of copper. It exhibits anti-toxic activity by virtue of Arum hydroxide present in it ^[27]

5. Gudugdha (Cow milk):

Cow milk has been described as nutritive (Jeevaniya) and good for vital organs such as eyes, brain and heart. It possesses sweet taste (Madhura Rasa), Sheeta Veerya (Cooling). It acts as Rasayana (immunomodulator) and Oja Vardhaka (increases vitality) ^[28]. It is an emulsion or colloid of butterfat globules within a water-based fluid that contains dissolved carbohydrates and protein aggregates with minerals. The calcium in milk ensures high absorption under unfavourable physical condition due to the presence of lactose; even in the absence of vitamin D. it is good balances of all fat soluble vitamins and vitamin B12. It is easy to digest and can be consumed by all age group of people due to its homologous nature. Cow’s milk is a good source of protein, fat and minerals such as calcium. It improves immunity due to the presence of globulin, and boosts intelligence and promotes bone strength ^[29].

6. Dhanyamla:

Since Gomutra is very much Ruksha and Goksheera is Mridu, in spite of these Drava Dravyas in clinical practice Dhanyamla is seemed to be used as Drava Dravya which is neither too Teekshna nor too Mridhu and is indicated for Asthapana. It can be used in Vata and Vata Kaphaja conditions ^[30].

7. Kulatha (Macrotyloma uniflorumL):

Kulatha Macrotyloma uniflorum L) is a legume mentioned in the context of diet as well as medicine in Ayurveda. It is specifically esteemed for its use in urinary disorders. It is endowed with astringent (Kashaya) and Amla (sour) taste and hot in nature (Usna Veerya). It is Kapha Vatahara (reduces aggrevated Kapha and Vata Dosha). It is useful in Rukshana Karma (emaciating Body). It has carminative, diuretic, antipyretic and anthelmintic properties. It is useful for fever, cough, asthma, urinary calculus, rheumatism, colic, goitre, obesity, worms, hiccup, amenorrhea, urticaria and abdominal tumours. It contains high source of iron, molybdenum, calcium, polyphenols, flavanoids and in the unprocessed form, it is hypoglycaemic and reduces insulin resistance ^[31].

8. Tila Taila (Sesame oil):

Tila Taila or gingelly oil is a vegetable oil obtained from sesame seeds. Sesame is Katu-Tikta-Madhura in taste, Guru, Snigdha in nature, Vatahara, Kaphapittakara, anodyne, tonic (Balya), Keshya (hair vitlizer) and Garbhasaya Sodhakam. The health benefits of sesame oil include its ability to improve hair and skin health, help in bone growth, reduce blood pressure, maintain good heart health, manage anxiety and depression, protect infant health, cure dental problems, prevent cancer, improve digestive process and lowers inflammation ^[32]. Sesame oil is very nutritious and provides an excellent source of protein, calcium, omega-6 fatty acids, magnesium, iron, zinc and vitamin A & E. Sesame oil soothes skin, lubricates intestines, relieves constipation and is recommended for stiff joints, weak knees and nervous spasms ^[33].

Method of preparation of Vasti Dravya:

In Nirooha at first Saindhava is ground well, then Makshika (honey) is added to Saindhava followed by adding Sneha Dravya, Kalka Dravya, and Kwatha Dravya in successive order ^[34]. In Vaitarana Vasti there is no description of the method of mixing up of ingredients, so usual method of mixing for Niruha Vasti is followed. In Vaitarana Vasti first Saindhava is ground well and then syrup of Purana Guda is added to Saindhava. Then Talia is added to a thin stream and mixed well. The Chincha devoid of seeds ground well and made into a paste is added to the above mixture. To this mixture, Drava Dravya is added slowly and mixed thoroughly. This solution is filtered and made lukewarm by keeping over a water bath.

Time of administration:

Since it comes under the category of Niruha Vasthi the general time for administering Niruha Vasti i.e. “Madhyahne Kinchidavarthe” ^[35] can be adopted here also. A day can be divided into 3 Ahnas ie. Purvahna, Madhyahna and Aparahna. Madhyahna falls in the time period between 10 am to 2 pm. Hence Niruha Vasti is given in this time when the patient feels not so much hunger. Vrindha Madhava and Vangasena explain that Vaitarana Vasti can be administered to all types of patients; it can be given even after consumption of food ^[36], which deviates from the general norm of administering Niruha Vasti. According to Vrindhamadhava, it can be administered during evening time also. The administration of Vaitarana Vasti immediately after food intake should be considered as an exceptional rule and should be administered in special cases like Amavatha where the patient is too weak to withstand the strength of the Vasti.

Recent researches done on Vaitarana Vasti:

Vaitaranbasti became popular after the research work by P. Sankarankutty, M.R. Vasudeva Namoodiri and V.K. Sasikumar at Govt. Ayurveda College, in 1991, which was inspired by the compilation work on bastiyoga-s by Dr.K.Rajagopalan. The practice of this basti vary considerably from one institution to another and from individual to individual ^[37].

Table-No.3:- A glance on Research done on Vaitarana Vasti

Reserach Title	Ingredients	Conclusion
1. A Clinical Study Of Vaitarana Vasti and Vatari Guggulu In Aamvata (Rheumatoid Arthritis) Dr Manoj Virmani et al, PARIPEX Indian journal of Research; Volume 6/Issue-11/November-2017	Saindhav Lavana 12 g Guda 24 g Chincha 48 g Gomutra 200 ml Tila taila q.s	It is noticed that relief in sign and symptoms was found in patients when treated with Vaitarana Vasti and Vatari Guggulu. Thus it can be said that Vaitarana Vasti works as a curative as well as purifying measure. Proper diet restriction as per Prakruti of patient must be followed. This will provide a better and healthy life to Amavata patients.
2. Efficacy of Vaitarana Vasti and Simhanad Guggulu in Amavata; Wadhava Ritu S, Ghore Jaya K; International journal of applied Ayurveda research ISSN: 2347-6362; Vol II Issue II Jul-Aug 2015.	Saindhav Lavana 10 g Guda 20 g Chincha 40 g Gomutra 200 ml Tila taila 50 ml	The study reveals that a patient has got significant result in functional score and swelling. Patients had got very significant result in morning stiffness, pain, tenderness & grip. Since Amavata is an autoimmune disease patients may require second course of the same pattern.
3. Role of Valuka Sweda and Vaitarana Basti in the management of Amavata (Rheumatoid Arthritis); Pooja B.A et al; Int. J. Res. Ayurveda Pharm. 4/(5), Sep-Oct 2013.	Saindhav Lavana 12 g Guda 24 g Chincha 50 g Gomutra 200 ml Tila taila 50 ml	It is noticed that relief in signs and symptoms of Amavata was found in both group. Comparatively Valukasweda with Vaitarana Basti group showed better result.
4. A piloting study on Godugdha yukta Vaitarana Basti in Vataj Gridhrasi (Sciatica); Shriram Chandra Mishra; Int J Ayu Pharm Chem Vol. I, Issue 1, 2014.	Saindhav Lavana 12 g Guda 24 g Amleeka 48 g Godugdha 192 ml Tila taila 96 ml	The clinical assessment of results proves the efficacy of Vaitarana Basti with moderate improvement in symptoms.
5. Evaluation of the effect of Vaitarana Basti in Sandhigata Vata (Upastambhit) w.s.r to inflammatory arthritis; Chaudhari Tejasini et al; Ayushdhara/ Sep-Oct 2016/Vol 3/Issue 5.	Chincha 20 g Guda 10 g Saindhav Lavana 5 g Tila taila 40 ml Gomutra 160 ml	Vaitarana Basti can be used in the disease in which Niruha Basti is indicated and which are caused due to Ama; Vaitarana Basti have significant result in Sandhigata Vata( Upastambhita)
6. Vaitarana Basti in – Amavata A pilot study; Dr Rahul M. Wanole, Dr. D.S Chothe; ejpmr, 2016, 3(11), 379-382	Saindhav Lavana 12 g Chincha 50 g Guda 25 g Murchita Tila taila 50 ml Godugdha 200 ml	Vaitarana Basti is an effective treatment in the management of Amavata & it shows long lasting result. Vaitarana Basti can be administered without prior Snehapana, Swedana or Virechana.
7. Efficacy of Vaitaran Basti and Virechana Karma along with Shaman Chikitsa in the management of Amavata (Rheumatoid Arthritis) –Case Study; Dr Sangita Medi & Dr. Dilip Wange; World journal of Pharmaceutical Research; 2017, Vol 6, Issue 14, 478-487.	Saindhav Lavana 12 g Guda 25 g Chincha 48 g Tila taila 50 ml Godugdha 192 ml	Vaitarana Basti and Virechana Karma is an effective treatment in the management of Amavata. Proper line of treatment gives better result in Ayurveda.

CONCLUSION:

· Vaitarana Vasti is one of the most effective and economical Vasti which can be administered in a wide range of diseases.

· In Brihat Trayee there is no description of Vaitarana Vasti. We get the references of Vaitarana Vasti from text books like Chakradutta, Vrindhamadhava, Vangasenasamhita etc.

· In clinical practice there is variation in determining the quantity of ingredients, determining the Drava Dravya etc.

· Most of the studies related Vaitarana Vasti focus on Amavata. More studies are to be done on rest of the indications like Klaibya.

· More researches and studies are needed to standardise the quantity of ingredients, selection of ingredients in different diseases conditions and to establish the mode of action of Vaitarana Vasti in different diseases.

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Received on 07.12.2017 Modified on 19.01.2018

Res. J. Pharmacology and Pharmacodynamics.2018; 10(1): 45-50.

DOI: 10.5958/2321-5836.2018.00008.3