Basti Procedure Note (Anuvasana/Niruha)

(Use past tense throughout. Keep factual and concise. Omit sections that do not apply to the encounter; do not leave empty headings. Always include the Complications section—write "None" if no complications occurred.)

Date: [Date] Time: [Start time – End time] Patient Name: [Patient full name] DOB: [DOB] MRN: [MRN] Procedure: [Anuvasana Basti / Niruha Basti] Session: [Session number, e.g., #3 of 8, or "single session"] (If part of a series, include course type such as Kaala Basti or Yoga Basti.) Location: [Clinic/facility/room]

Indication

[Brief statement linking the patient's condition/symptoms to rationale for basti selection]

Pre-Procedure Assessment

Baseline vitals: BP [BP]; HR [HR]; Temp [Temp] (Add RR, SpO2, weight if obtained.)

Contraindication screen:

• Acute fever: [yes / no]
• Active diarrhea: [yes / no]
• Rectal bleeding: [yes / no]
• Hemorrhoids/fissures: [yes / no]
• Recent rectal surgery: [yes / no]
• Pregnancy status: [pregnant / not pregnant / not applicable]
• Severe weakness/dehydration: [yes / no]
• Indigestion (ajirna): [yes / no]

Allergies reviewed: [Medication, herbal, latex, and food-related allergies (e.g., milk, ghee, honey) or "No known allergies"]

Readiness: Vegotsarga (voided): [yes / no]; Digestion status: [description]; Timing relative to food: [For Anuvasana: time since last meal and meal size / For Niruha: empty stomach or post-digestion confirmed]

Consent

[Written / Verbal] consent was obtained. The procedure, benefits, material risks (abdominal cramping, nausea, rectal irritation, rare bowel injury, infection), and alternatives (oral therapy, external therapies, no procedure) were explained. The patient had the opportunity to ask questions, demonstrated understanding, and agreed to proceed. (If consent was not obtained, document why and the resulting plan.)

Preparation (Poorva Karma)

(Only include this section if pre-procedure therapies were performed; otherwise omit entirely.)

• Abhyanga: [Areas treated], [oil used], [approximate duration]
• Swedana: [Type], [duration]

Materials and Formulation

Delivery apparatus: [Basti putaka with netra / enema syringe / catheter / other]

Medicament(s): (List components used; include name, quantity, and source/lot/expiry if available.)

• Taila (oil): [Name], [volume], [source/lot/expiry if available]
• Kashaya (decoction): [Name], [volume], [source/lot/expiry if available]
• Kalka (paste): [Name], [quantity], [source/lot/expiry if available]
• Additives: [Name], [quantity], [source/lot/expiry if available]

Final prepared volume: [Volume] mL, warmed to appropriate temperature. (For standard pre-mixed products, record product name and volume. Detail mixing steps only if custom on-site compounding was performed.)

Procedure (Pradhana Karma)

The patient was positioned in left lateral position with appropriate draping. Lubrication was applied to the anal area and device tip. The device was inserted to [depth in cm]. The medicament was administered steadily while the patient was coached on breathing. [Small residual volume was left to avoid air introduction, if applicable.] The device was removed without difficulty. Total volume delivered: [volume] mL. (Document any deviations: immediate expulsion, pauses, repositioning, repeat administration, or other events with reasons.)

Response and Tolerance

Tolerance: [Well / Fair / Poor]. Cramping: [present with severity 0–10 / absent]. Pain: [present with severity 0–10 and location / absent]. Nausea: [present / absent]. Dizziness or anxiety: [present / absent].

(For Niruha) Time to urge: [minutes]; Evacuation characteristics: [amount, consistency, notable features].

(For Anuvasana) Retention guidance: [planned retention time]; Outcome: [actual retention time or immediate expulsion].

Post-procedure vitals: [Vitals if obtained, or omit line if not obtained]

Complications

[None / Description of complication] (If occurred, document severity, interventions taken with medication name/dose/route if applicable, and outcome.)

Post-Procedure Care (Paschat Karma)

[Immediate post-procedure steps performed, e.g., positioning, assistance to toilet, hygiene]. Dietary instructions: [e.g., light warm liquids, peya]. Activity restrictions: [restrictions or "none"]. Medications: [oral medications prescribed or continued, or "none"].

Disposition and Follow-up

Disposition: [Home / Continued observation / Other]. Next session: [Date/time if part of series, or "N/A"]. Return precautions provided: seek care for persistent severe abdominal pain, fever, significant rectal bleeding, inability to pass stool or gas, or syncope.

Clinician Signature: [Signature]
Name/Credentials: [Printed name and credentials]
Date/Time Signed: [Date and time]