Nirooha Vasthi or Decoction Enema
Nirooha is the procedure where, combinations of medicaments are
administered through rectal route, for local as well as systemic effects.
Depending on the dose and nature of ingredients, Nirooha is of several types
like Ksheeravasthi, Yapana, Vaitharanavasthi etc
Indications of Decoction Enema
Persons suffering from
i)
Vata disorders
(Sarvanga vata/ ekaanga vata)-Rheumatic disorders including Paralysis, hemiplegia,
ii)
Disorders of
abdomen (kukshi roga)
iii)
Difficulty in
passing stool, urine or flatus
iv)
Loss of strength,
Lusture, Semen etc..
v)
Worm infestation
vi)
Diarrhoea
vii)
Pain and
inflammation in joints (Arthritis)
viii)
Splenic Diseases
ix)
Fistula-in-ano
x)
Fissure-in-ano
xi)
Fever
xii)
Head ache
xiii)
Pain in ears
xiv)
Low Back Pain
xv)
Intra abdominal
Swellings (gulma)
xvi)
Convulsions
xvii)
Wasting
(emaciation)
xviii)
Vatic Disorders
(Rheumatic Diseases)
Contra-indications of Decoction Enema
i)
Indigestion
ii)
Athi sneha (who
is very unctuous)
iii)
Immediately after
sneha pana
iv)
Utklesha dosha
condition
v)
Mandaagni
vi)
Exhausted due to
hunger and thirst
vii)
Fatigueness
viii)
Emaciated
conditions
ix)
Immediately after
vamana and virechana
x)
Cough, dyspnoea,
Hiccough (shvasa, kasa, hikka)
xi)
Intestinal
obstruction (Baddha udara)
xii)
Intestinal
perforation (Chidrodara)
xiii)
Disorders due to
ama
xiv)
Diarrhoea etc…
Materials required:-
1. Mortar and pestle
2. Vasthinethra
3. Polythene cover of at least 1&1/2 liter capacity/
Traditional Vasthi putaka
4. Hot water
5. Utensils
6. Good quality fine sieve
7. Cotton towel
8. Measuring apparatus
9. Cotton thread-1/2 meter
10. Cotton
11. Sterile glove.
12. Oil for Abhyanga
13. Medicaments as per prescription in the required quantity
14. Churner
Preparation of
Vasthidravya:
v
Initially Saindhava is put in the Khalwa yantra
and it is powdered well
v
Madhu is added in thin stream triturating
properly to ensure a homogenous mixture.
v
It is followed by the mixing of appropriate tailam
in required quantity mentioned in the yoga slowly by the side of the mortar and
it is continuously stirred until it attains a uniform consistency.
v
The kalka, which is the fine paste of drugs
mentioned in the yoga is added little by little along with proper grinding with
pestle.
v
Then appropriate kwatha in required amount as
per yoga is added slowly and properly mixed.
v
The Avapa, if mentioned in the yoga/if needed,
is added at last followed by proper stirring.
v
The mixture is filtered through a fine sieve and
finally made lukewarm by keeping over a hot water bath.
v
This mixture is churned well with the help of a
churner.
v
When it is lukewarm (Sukhoshna), and comfortable
for the patient, it is transferred to a
plastic cover (vasti putaka)
having sufficient thickness and then vasti netra of bronze or plastic is tied
to it very well with plugging the other tip with a cotton varti.
Time of
administration
v
Madhyahne kinchidavarthe, Nathibubhukshitha
v
This time varies depending on desha and kala and
is generally in between
10
– 11am.
Poorvakarma of
Nirooha
v
The procedure is usually done in empty stomach
v
Those who are Sukumara and Ksheena are asked to
take very light food in early morning.
v
Sarvanga Abhyanga and sveda should be done
before the procedure. .
Pradhanakarma:
v
Position of the patient
1. Patient is
asked to lie on a cot of knee-height, in left lateral position.
2. His left
lower limb extended and right lower limb flexed at knee and hip.
3. His left upper limb is kept folded
under his head.
v
Procedure
§
A small amount of plain ghee/medicated oil is
smeared over the tip of Vastinetra as well as the anus of the patient for
lubrication.
§
Wearing the hand gloves, per rectal examination
is carried out to rule out loaded rectum, or any other obstruction.
§
Hold the vastinetra in the left hand and putaka
in the right hand.
§
Remove the plug from the tip of vastinetra and
evacuate the air and close the tip with left index finger.
§
Vasthi netra is then gently introduced into the
anus and putaka is pressed slowly and steadily to push the vasthidravya into
the patient’s rectum.
§
Patient is asked to count up to 30 and to
breathe deeply through the mouth during introduction.
§
Vastinetra is withdrawn with a little amount of
medicament remained in the putaka to avoid the entry of air.
§
If the patient feels the urge for defecation during
the procedure, he is allowed to pass stools after removing vasthinethra and the
remaining medicine is administered later.
Paschathkarma
v
Patient is asked to lie in supine position till
the urge for defecation occurs.
v
He is asked to clear the bowels as many times he
feels Vega and advised
to take bath in luke warm water.
v
Then diet according to dosha vitiation and satmya
is given (preferably rice
with mudgayoosha or mamsarasa).
v
Blood pressure, pulse rate, time of retention,
number of evacuations and if
discomforts any are observed.
v
He is asked to take rest and light food is given
at night.
Complications
v
Abdominal
discomfort and pain – after careful evaluation about the cause appropriate
management can be adopted. General measures like abyanga, sweda, deepana
anulomana drugs are advised.
v
Immediate
evacuation without retention: - Another vasthi with less lavana, ushna and
quantity should be administered immediately after ruling out sphincteral
incontinence.
v
Giddiness,
Low pulse, Cold extremities, Delirium: - Console the patient, Foot end
elevation, Hot drinks, Warming extremities. Drugs like Sidhamakaradhwaja,
Drakshadi kashaya, Dhanwantharam gulika etc can be given.
v
Vomiting:
- Usually subsides without specific management. Drugs like Chandrakalarasa,
Dhanwantharam gulika, Drakshadi kashaya, Mayoorapichabhasma etc can be given
v
Anaphylactic
reaction: - Skin eruptions, Itching, Urticaria, Dyspnoea etc. Careful
history taking to identify known allergens and avoiding them. Haridrakhanda,
Thrikatu with sitha, Chandanasavam, Draksharishtam etc can be given.
v
Long
retention: - Known causes like obstruction of anal canal by pile mass,
enlarged prostrate, fecal matter etc should be excluded. Rubber tube or
specific gudavarthis can be introduced into anal canal for evacuation.
