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Introduction: Panchakarma, the cornerstone of Ayurvedic therapeutics, emphasizes systemic detoxification and restoration of doshic equilibrium. Among its five principal modalities, Basti Karma (therapeutic enema) is revered as “Ardha Chikitsa” (half of all therapies) due to its profound impact on Vata dosha, the primary regulator of body functions. Methods: A narrative review was conducted using Ayurvedic classical texts, commentaries, and contemporary research published from 2000–2024. Databases searched included PubMed, Scopus, Web of Science, AYUSH Research Portal, and Google Scholar. Keywords such as “Basti Karma,” “Ayurveda enema,” “Panchakarma,” and “Vata disorders” were used. Both clinical trials and experimental studies were included. Articles unrelated to Basti or not in English were excluded. Results: Classical texts classify Basti into Niruha/Asthapana Basti (decoction-based), Anuvasana Basti (oil-based), and Uttara Basti (urogenital administration). The therapy follows a structured regimen of Purva Karma (preparatory measures), Pradhana Karma (administration), and Paschat Karma (post-procedures). Modern evidence indicates multiple pharmacological effects—anti-inflammatory, immunomodulatory, neuroprotective, gut microbiota modulation, and systemic rejuvenation. Clinical research supports Basti’s efficacy in arthritis, neurological conditions, irritable bowel syndrome, metabolic syndrome, and infertility. Mechanistic insights point toward rectal drug absorption, gut-brain axis modulation, and systemic dosha correction. Discussion: While Ayurveda emphasizes Basti’s role in correcting Vata, modern studies highlight its systemic detoxification, immunological balance, and microbiome regulation. Gaps include lack of standardization, small sample sizes, and inadequate biomarker validation. Conclusion: Basti Karma stands as a unique integrative therapy with preventive, curative, and promotive roles. Bridging Ayurvedic concepts with modern biomedical frameworks is essential for its global acceptance and clinical integration.

Keywords: Ayurveda, Basti Karma, Panchakarma, Therapeutic enema, Vata