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Background: Basti Karma, the administration of medicated decoctions or oils through the rectal route, is regarded in classical texts as the foremost Panchakarma procedure, particularly for Vata disorders. Objective: To review the classical concepts of Basti and to summarise recent clinical and mechanistic studies. Methods: Narrative review based on a PubMed search and classical texts. Findings: Studies of Basti in rheumatoid arthritis (Amavata) report symptomatic and laboratory improvement, including a randomized comparison of 118 patients in which adding Matra Basti to Vatari Guggulu gave better relief than the drug alone. A randomized open-label study of 70 patients with chronic heart failure reported improved functional capacity with a Panchakarma-based add-on programme that included Basti, with seven mild treatment-emergent events. A pilot proteomic study of Lekhana Basti in obesity identified changes in eight hub proteins in urinary exosomes. Protocols for trials in hypothyroidism and knee osteoarthritis are registered. Conclusion: Basti is a versatile procedure with promising preliminary data. Most studies are small, open-label or uncontrolled. Future trials should specify Basti type, dose and duration and should report safety systematically.