Nirooha
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
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:
Initially Saindhava is put in the Khalwa yantra and it is powdered well
Madhu is added in thin stream triturating properly to ensure a homogenous mixture.
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.
The kalka, which is the fine paste of drugs mentioned in the yoga is added little by little along with proper grinding with pestle.
Then appropriate kwatha in required amount as per yoga is added slowly and properly mixed.
The Avapa, if mentioned in the yoga/if needed, is added at last followed by proper stirring.
The mixture is filtered through a fine sieve and finally made lukewarm by keeping over a hot water bath.
This mixture is churned well with the help of a churner.
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
Madhyahne kinchidavarthe, Nathibubhukshitha
This time varies depending on desha and kala and is generally in between
10 – 11am.
Poorvakarma of Nirooha
The procedure is usually done in empty stomach
Those who are Sukumara and Ksheena are asked to take very light food in early morning.
Sarvanga Abhyanga and sveda should be done before the procedure. .
Pradhanakarma:
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.
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
Patient is asked to lie in supine position till the urge for defecation occurs.
He is asked to clear the bowels as many times he feels Vega and advised
to take bath in luke warm water.
Then diet according to dosha vitiation and satmya is given (preferably rice
with mudgayoosha or mamsarasa).
Blood pressure, pulse rate, time of retention, number of evacuations and if
discomforts any are observed.
He is asked to take rest and light food is given at night.
Complications
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.
Immediate evacuation without retention: - Another vasthi with less lavana, ushna and quantity should be administered immediately after ruling out sphincteral incontinence.
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.
Vomiting: - Usually subsides without specific management. Drugs like Chandrakalarasa, Dhanwantharam gulika, Drakshadi kashaya, Mayoorapichabhasma etc can be given
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.
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.
