The application of an Anuvásana-vasti (enema) should be followed by that of one of the Ásthápana class. The body of the patient should be first anointed (with a Sneha) and fomented. Previous to the application of a vasti, the bowels and bladder should be relieved of all (fœcal) accumulations (flatus and urine). The clyster (Vasti) should be applied at noon in a well-cleansed chamber, devoid of any gust of wind, and the patient should be laid on his left side on a spacious bed not furnished with any pillows, but a little raised up there where his buttocks would rest, and there should be attendants at his feet. The patient should continue in a. cheerful mood with his left thigh held in an outstretched posture and the right one flexed, and should refrain from speaking to any body. The digestion of the ingested food taken by the patient is necessary (before the application of the Vasti). The physician having placed the pipe of the enema (Vasti) upon his left foot should firmly press its Karniká with the first and the second toes of his right foot. One half of the mouth of the Vasti should be kept contracted by pressing it with the small and ring finger of his left hand and the (other) half should be stretched with the aid of his thumb, index and middle fingers, and thus the medicinal solution should be poured into the bladder (Vasti). The pipe should be held with the middle and the index finger of the right hand. Care should be taken not to let the medicinal solution overflow from the surface of the pipe, nor to admit of even a bubble of air into the bladder (of the enema), nor to produce its over-contraction nor dilatation during the process (of pouring the medicine). The bladder filled with the proper quantity of medicinal solution should then be held in the left hand, and washed with the right hand. It should then be firmly tied (at the neck) just over the (surface of the) medicinal solution with ligatures of two or three rounds of thread. 2-A.
The Vasti should then be held up on the palm of the right hand, its pipe gripped with the middle and index fingers of the left hand, and the orifice closed with the thumb of the same hand. The neck of the pipe should be previously lubricated with clarified butter, and gently introduced into the rectum of the patient up to its Karnika (protuberance) along the line of spinal column and with its mouth upturned. The patient should be asked to take the same with care. 2.
The physician should then hold the enema (Vasti) with his left hand and press its bladder with his right. The injection (of the medicinal solution contained in the enema) should be made at once, neither too slowly nor too hurriedly. 3.
The pipe should then be withdrawn and removed, and the patient should be asked to remain in the same position for a period sufficient to utter thirty Matras *
* According to Agnives'a the time necessary for the tips of the fingers to fall down upon the right thighs, i.e., the time required for a twinkling of the eye (Nimesha) is called a Mátrá. Paras'ara says that the time necessary to close and open the eye-lids (Nimesha and Unmesha) once, while throwing the arm around the right thigh is called a Mátrá. He has prescribed one hundred such Mátrás in respect of a patient of constipated bowels, and thirty-seven in respect of a patient of lax from the time of injection. The patient should then be asked to get up and sit on his legs for the full outflow of the injected solution. The period of a Muhurta (about forty-eight minutes) is usually required for a complete outflow of the Niruha-vasti (from the bowels). 4.
This method of applying the Vasti should be continued three or four times as required in each case by the physician, experienced in the application of the same. It should be discontinued after certain characteristic symptoms had been fully developed and manifested (in the system of the patient). Less is better than excess (in respect of Vasti-applications and more so particularly in the case of a patient of a delicate constitution. 5.