“ASTUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF ...

“ASTUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF

MADHUTAILIKA BASTI WITH STANDARDIZED ATURA

HASTA PRAMANA IN KATIGRAHA W.S.R. TO LOW BACK

PAIN- AN OPEN CLINICAL TRIAL”

by

Dr. YADAV GAURISHANKAR BAMS

Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bengaluru

In partial fulfillment

of the requirements for the degree of

Post Graduation

in

PANCHAKARMA

Under the guidance of

Dr. SHRIVATSA.M. NAVALUR

(AYU)

Panchakarma

Ayurveda mahavidyalaya

Hubballi

2018

Abbreviations

“A Study To Assess Samyak Nirooha Lakshana of Madhutailika Basti Administered with Standardised Atura Hasta Pramana in Katigraha W.S.R to Low Back Pain – An Open Clinical Trial “

ABBREVIATIONS OF REFERENCES

As. Hr. - Ashtanga Hridaya

As. Sa. - Ashtanga Sangraha

Bh. Pr. - Bhava Prakasha

Bh. Ra. - Bhaishajya Ratnavali

Bh.S. - Bela Samhita

C.D. - Chakra Datta

Ch. Sa. - Charaka Samhita

Chi. - Chikitsasthana

Ind. - Indriya Sthana

K.S. - Kashyapa Samhita

Ka. - Kalpa Sthana

M. Kh. - Madhyama Khanda

Ma. Ni. - Madhava Nidana

Ni. - Nidana Sthana

Pu - Purvardha

Pu.Kh. - Purvakhanda

Sh. S. - Sharngadhara Samhita

Sh. - Shareera Sthana

Si. - Siddhi Sthana

Su. Sa. - Sushruta Samhita

Su. - Sutrasthana

Ut. Kh. - Uttara Khanda

Vi. - Vimana Sthana

Y.R - Yoga Ratnakara

TABLE

NO: Content Page No.

1. Showing Historical review of enema 22

2. Showing word meaning of Bati 24

3. Showing Paryaya of Guda Shareera 26

4. Showing Rachana Shareera and Pramana of Guda Valis 26

5. Showing Guda valis Kriya karma 28

6. Showing Guda valis Sthana and modern terminologies 29

7. Showing sub division of Large intestine 30

8. Showing Different type of basti 33

9. Showing karma bheda of basti 34

10. Showing Madhutailika basti matra according to Charaka Aacharya 36

11. Showing Madhutailika basti matra according to Susruta Aacharya 37

12. Showing Madhutailika basti matra according to Ashtanga Sangraha 38

13. Showing Madhutailika basti matra according to Ashtanga Hridaya 38

14. Showing Madhutailika basti matra according to Sharangadhara 39

15. Showing Madhutailika basti matra according to Kashyapa 39

16. Showing Netra Dosha and its Effects 40

17. Showing Putaka dosha and its Effects 41

18. Showing Ashthapana Basti Ayogya 42

19. Showing Ashthapana Basti Yogya 44

20. Showing Anuvasana Basti Ayogya 46

21. Showing Matra in various Age groups 48

22. Showing Matra of Nirooha Basti according to Age with respect to

Anjali Pramana

49

23. Showing Kashaya Basti matra according to doshic predominance 50

24. Showing Matra of Nirooha Basti based on doshic predominance 53

25. Showing Sneha Basti Vyapat 54

26. Showing Samyak Yoga, Atiyoga,Ayoga lakshanas of Basti 61

27. Showing basti Krita Vyapat 64

28. Showing vaidya Krita dosha Vyapad 65

29. Showing aharaj Nidana of Vata vyadhi 75

30. Showing viharaj Nidana of Vata vyadhi 76

31. Showing miscelleanous Nidana of Vata vyadhi 76

32. Showing drug varieties of Rasa Panchaka Haritakyadi yoga 105

33. Showing drug Review of Haritakyadi yoga 107

34. Showing drug Review of Tila taila 108

35. Showing drug Review of Murchana drugs 108

36. Showing Rasa Panchaka of Murchana drugs 110

37. Showing drug Review of Sahacharadi taila 112

38. Showing Rasa Panchaka of Sahacharadi taila 113

39. Showing drug Review of Eranda Moola 113

40. Showing drug Review of Madhutailika Basti 114

41. Showing Rasa Panchaka of Madhutailika Basti 115

42. Showing ingredients of Haritakyadi Churna 116

43. Showing drug used in Taila Murchana 118

44. Showing Ingredients of Sahacharadi taila 119

45. Showing Ingredients of Madhutailika Basti 120

46. Showing treatment detail subjects 124

47. Showing Visual Analogus scale 131

48. Showing Age wise distribution of 20 patients of Kati graha 136

49. Showing Sex wise distribution of 20 patients of Katigraha 137

50. Showing Religion wise distribution of 20 patients of Kati graha 138

51. Showing Marital status wise distribution of 20 patients of Kati graha 139

52. Showing Educational status wise distribution of 20 patients of Kati graha 139

53. Showing Occupational wise distribution of 20 patients of Kati graha 140

54. Showing Nature of work wise distribution of 20 patients of Kati graha 141

55. Showing Socio-economical status wise distribution of 20 patients of Kati graha

141

56. Showing Habitat wise distribution of 20 patients of Kati graha 142

57. Showing Aahara wise distribution of 20 patients of Kati graha 143

58. Showing Agni wise distribution of 20 patients of Kati graha 143

59. Showing Koshta wise distribution of 20 patients of Kati graha 144

60. Showing Addiction wise distribution of 20 patients of Kati graha 145

61. Showing Nidra wise distribution of 20 patients of Kati graha 145

62. Showing Deha prakruti wise distribution of 20 patients of Kati graha 146

63. Showing Sara wise distribution of 20 patients of Kati graha 146

64. Showing Samhanana wise distribution of 20 patients of Kati graha 147

65. Showing Pramana wise distribution of 20 patients of Kati graha 148

66. Showing Satwa wise distribution of 20 patients of Kati graha 148

67. Showing Satmya wise distribution of 20 patients of Kati graha 149

68. Showing Aahara shakti wise distribution of 20 patients of Kati graha 150

69. Showing Vyayama wise distribution of 20 patients of Kati graha 150

70. Showing Aahara Rasa Predominance wise distribution of 20 patients of Kati graha

151

71. Showing Aahara Guna Predominance wise distribution of 20 patients of Kati graha

152

72. Showing Viharaja Nidana wise distribution of 20 patients of Kati graha 153

73. Showing Nature of Mala pravritti wise distribution of 20 patients of Kati graha

153

74. Showing Manasika Bhava wise distribution of 20 patients of Kati graha 153

75. Showing Chronicity wise distribution of 20 patients of Kati graha 154

76. Showing Symptoms wise distribution of 20 patients of Kati graha 155

77. Showing Samyak Nirooha Lakshana wise distribution of 20 patients of Kati graha

155

78. Showing Treatment history wise distribution of 20 patients of Kati graha 156

79. Showing Matra of Sahancharadi taila Anuvasana Basti wise distribution of 20 patients of Kati graha

157

80. Showing Temperature of Anuvasana Basti wise distribution of 20 patients of Kati graha

158

81. Showing Mean Systolic Blood Pressure wise distribution of 20 patients of Kati graha

159

82. Showing Mean difference of Systolic Blood Pressure wise distribution of 20 patients of Kati graha

160

83. Showing Mean Diastolic Blood Pressure wise distribution of 20 patients of Kati graha

160

84. Showing Vegas after Anuvasana Basti wise distribution of 20 patients of Kati graha

161

85. Showing Samyak Yoga lakshana wise distribution of 20 patients of Kati 162

graha

86. Showing Nirooha basti matra according to Aatura Hasta Pramana wise distribution of 20 patients of Kati graha

163

87. Showing Matra of Eranda Moola Madhutailika Basti wise distribution of 20 patients of Kati graha

164

88. Showing Mean of Matra of Eranda moola Madhutailika Basti wise distribution of 20 patients of Kati graha

164

89. Showing Temperature of Nirooha Basti dravya wise distribution of 20 patients of Kati graha

164

90. Showing Peristalitic movement wise distribution of 20 patients of Kati graha

165

91. Showing duration of administration wise distribution of 20 patients of Kati graha

166

92. Showing No of vegas after Nirooha Basti wise distribution of 20 patients of Kati graha

167

93. Showing Mean systolic Blood Pressure wise distribution of 20 patients of Kati graha

167

94. Showing Diastolic Blood Pressure wise distribution of 20 patients of Kati graha

169

95. Showing Mean difference of Diastolic Blood Pressure wise distribution of 20 patients of Kati graha

170

96. Showing Respiratory Rate wise distribution of 20 patients of Kati graha 170

97. Showing Samyak Nirooha Lakshana wise distribution of 20 patients of Kati graha

171

98. Showing Ashtamahadoshakara Bhavas wise distribution of 20 patients of Kati graha

172

99. Showing Samyak Nirooha Lakshana as a Subjective Parameter wise distribution of 20 patients of Kati graha

173

100. Showing Roga Upashanthi wise distribution of 20 patients of Kati graha 174

101. Showing Oswestry dis-ability score Index wise distribution of 20 patients of Kati graha

175

102. Showing Visual Analogue scale wise distribution of 20 patients of Kati graha

175

103. Distribution 20 subjects according to no. Of putaka in each 177

104. Observation on no. Of putaka in each niruha in kala basti 177

105. Distribution of 20 subject according to number of putaka 178

106. Observation of antiki lakshana in kala basti on 20 subjects. 179

107. Comparition within the groups in 20 subjects 180

108. Multiple comparition in antikiby tukey krammer post hoc test 180

109. Observation P.V.M.S. in katigraha among 20 subjects 182

110. Observation on P.V.M.S. in kala basti 182

111. Multiple comparition of P.V.M.S. in kala basti 183

112. Observation on ashaya laghuta in kala basti among 20 subjects 184

113. Observation in ashaya laghuta within the group kati graha 185

114. Multiple comparision of ashayalaghuta in kala basti 186

115. Observation on laghuta in kala basti among 20 subjects 187

116. Observation on laghuata within the group in katigraha 188

117. Multiple comparition of laghuta in kala basti 188

118. Observation on Gatramardavata in kala basti among 20 subjects 190

119. Observation on Gatramardavata within the group in kala basti 191

120. Multiple comparition of Gatramardavata in 20 subjects 191

121. Observation on indriyaprasannata in kala basti among 20 subjects 192

122. Observation on indriyaprasannata within the group in kala basti 193

123. Multiple comparition of indriyaprassannata in 20 subjects 194

124. Observation on Ruchi and agni vriddhi in katigraha among 20 subjects 195

125. Observation on ruche and agni vriddhi within the group in kala basti 196

126. Multiple comparition on Ruchi and agni vriddhi in 20 subjects 196

127. Basti dravya retention time 197

128. Observation of retention time 199

129. Multiple comparition of retention time 199

130. Showing oswestry disability index 202

131. Roga upashanti 205

132. Visual analog scale 206

LIST OF FIGURES

FIGURE NO:

CONTENT PAGE NUMBER

Figure no. 1

Age wise distribution of 20 subjects of

Katigraha

136

Fig. No.2 Sex-Wise Distribution of 20 Subjects of

katigraha 137

Fig. No.3 Religion-wise Distribution of 20 subjects of

katigraha 138

Fig.no. 4 Marital Status-wise Distribution of 20

Subjects of katigraha:

138

Fig. No. 5 Educational Status-wise Distribution of 20

Subjects of katigraha. 139

Fig.no. 6 Occupation-wise Distribution of 20

Subjects of katigraha 140

Fig.no. 7 Occupation-wise Distribution of 20


Fig. No.8

Socio Economic Status-wise Distribution of

20 Subjects of katigraha.

141

Fig. No. 9 Showing Habitat-wise Distribution of 20


Fig no. 10 Ahara-wise Distribution of 20 Subjects of

katigraha 142

Fig no. 11 Agni wise distribution of 20 subjects of

katigraha 143

Fig. No. 12 Koshta wise distribution of 40 subjects of

katigraha

143

Fig. No.13 Addiction wise distribution of 20 subjects

of katigraha 144

Fig. No. 14 Nidra wise distribution of 20 subjects of

katigraha

145

Fig. No. 15 Deha Prakruti wise distribution of 20

subjects of katigraha 146

Fig. No.16 Sara wise distribution of 20 subjects of

katigraha: 146

Fig. No. 17 Samhanana wise distribution of 20

subjects of katigraha: 147

Fig. No. 18 Showing Pramana wise distribution of 20


Fig. No. 19 Satwa wise distribution of 20 subjects of

katigraha.

148

Fig no. 20 Satmaya wise distribution of 20 subjects

of katigraha.

149

Fig no. 21 Ahara Shakti wise distribution of 20


Fig. No. 22

Vyayama Shakti wise distribution of 20

subjects of katigraha.

150

Fig. No. 23 Predominant Ahara Rasa wise distribution

of 20 subjects katigraha:

151

Fig. 24 Showing Predominant Ahara Guna wise

distribution of 20 subjects’ katigraha

152

Fig. No 25 Viharaja Nidana of 20 subjects of

katigraha 152

Fig. No. 26 Nature of Mala Pravruti wise distribution

of 20 subjects of katigraha. 153

Fig no. 27 Manasika Bhavas wise distributions of 20

subjects of katigraha.

154

Fig no. 28 Showing Chronicity of 20 subjects of

katigraha 154

Fig no. 29 Showing Symptoms of katigraha:

155

Fig no. 30 Showing Samyak nirooha lakshana wise

distribution of 20 subjects of katigraha. 156

Fig .no. 31 Showing Treatment History Wise

Distribution of 20 Subjects of katigraha

156

Fig. No. 32 Showing Temperature of Anuvasana Basti

dravya wise distribution in 20 Subjects of

katigraha.

159

Fig no. 33

Showing Vega (Mala pravrutti) after

Anuvasana Basti, distribution of 20

Subjects of katigraha.

162

Fig. No. 34 Showing Samyak yoga lakshanas observed

in 20 Subjects of katigraha: 162

Fig. No. 35

Showing Temperature of Nirooha Basti

dravya wise distribution

of 20 Subjects

165

Fig no. 36 Showing Peristaltic movements observed

in 20 Subjects of katigraha.

166

Fig no. 37 Showing Time duration for administration

(Pranidhana Kala) of Nirooha basti 166

observed in 20 Subjects of katigraha

Fig. No. 38 Showing No. of Vegas (Mala Pravrutti)

after Nirooha basti,distribution of 20

Subjects of katigraha

167

Fig no. 39

Showing Mean systolic Blood Pressure of

20 subjects of katigraha was recorded

before and after administration of Nirooha

Basti

168

Fig. No. 40

Showing Mean difference of diastolic

Blood Pressure of 20 subjects of katigraha

under

170

Fig. No. 41 Showing Mean Respiratory rate of 20

subjects of kati graha was recorded before

and after administration of Nirooha Basti

171

Fig. No 42 Showing Samyak yoga lakshanas observed

in 20 Subjects of Katigraha after Nirooha

Basti :

172

Fig. No. 43 Showing Ashtamahadoshakara Bhava

observed in 20 Subjects of katigraha

during Parihara Kala

173

Fig. No. 44 Showing Samyak nirooha lakshana as a

Subjective Parameter wise distribution of

20 patients in Katigraha:

173

Figure

no. 45 Roga upashanti. 174

Figure no.

46

Showing Oswestry disability index score

wise distribution of 20 patients of

Katigraha

175

Figure no.

47

Showing Visual Analogue Scale Rating for

pain wise distribution of 20 patients of

Katigraha

176

ABSTRACT

“ASTUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF MADHUTAILIKA

BASTI WITH STANDARDIZED ATURA HASTA PRAMANA IN KATIGRAHA

W.S.R. TO LOW BACK PAIN- AN OPEN CLINICAL TRIAL”

TITLE:

A STUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF

MADHUTAILIKA BASTI ADMINISTERED WITH STANDARDIZED

ATURA HASTA PRAMANA IN KATIGRAHA W.S.R TO LOW BACK

PAIN – AN OPEN CLINICAL TRIAL”

BACK GROUND:

Kati graha is one of the vata vyadhi which affects the normal function of lower

limb hampering the daily activities of the person. Katigraha as a separate disease has

been described in the classical test gada nigraha. It has been correlated in the present

study with low back pain, katigraha is shosha, stambha, shula predominant vyadhi.

Basti is considered as the supreme therapeutic modality among panchakarma

as it radically weeds out the morbid vata that is responsible for pathogenesis of

various disease. Nirooha Basti plays a major role when compared to the Anuwasana

Basti, because of its variety of drug combination and utility in wide range clinical

conditions.

In the panchakarma procedures dose is one of the important factor to attain

optimum effect of the therapy. Acharya Susruta, dose of Nirooha Basti should be

measured with Aatura Hasta and which is equivalent to Prasruta Pramana. Acharya

Gayadas commenting the same clarifies that Prasrusta is not 2 pala but it is Kunchita

Anjali Pani i.e. lesser in quantity compared to routinely practiced dose.

Acharya Charaka opines that any treatment procedure find its maximum

benefits only when Samyak Lakshana is achieved and this is applicable for Nirooha

Basti also. Basti can be administered 2,3,4,5 times or as many as required till the

attainment of Samyak Nirooha lakshnas. Erandamoola Madhutailik Basti which is

ABSTRACT




administered hare is having a wide role in management of Katigraha because of its

maximum therapeutic efficacy and is given in Kala Basti schedule for 16 days with

the Katigraha dose as Aatura Hasta Pramana

Objective:

1) To assess Samyak Nirooha Lakshana of Erandamoola Madhutailika Basti

administered in standard Aatura Hasta Praman in Katigraha.

2) To Standerdize prasruta by atura hasta pramana.

3) To study safety and efficacy of madhutailik basti administration with

standerdized atura hasta pramana in katigraha.

Methodology:

The 20 subjects suffering from Katigraha fulfilling diagnostic and inclusion

criteria belonging to either sex, irrespective of socio-economic status and caste were

selected for the clinical study and test for effect of therapy is calculated by ANOVA

TEST, multiple comparasion by post hoc test or tukey Kramer test.

Result: A single administration of erand moola madhutailik basti by aatura hasta

praman is not suffient to attain SNL hence repeated administration of madhu tailik

basti is helpful i.e. 37 putaka were require to attain SNL in 1st nirooha,in the same

way 35,30.31,34,32 putaka were require to attain SNL in 2nd

,3rd

, 4th

,5th

,6th

niroha

respectively.

Conclusion:

Acccording to Aacharya Susrutha, the dose of Kashaya Basti matra is Aatura

Hasta Pramana which varies individually which is very much effective in

reducing the Symptoms of Katigraha. Here in this study, Eranda Moola

ABSTRACT




Madhutailka Nirooha Basti and Sahacharadi taila Anuvasana Basti has

provided Statistically significant result in all the parameters.

Kroora koshta participants require more number of Putaka for Attainment of

Samyak Nirooha Lakshana.

Madhutailika Basti administered with Standardize Aatura Hasta Pramana is

effective for producing major Samyak Nirooha Lakshana.

Quantity of Prasrita after standardization by Aatura Hasta Pramana is 623.6ml.

Key words:

Katigraha, Low back pain, Erandamoola Madhutailik Basti, Atura Hasta

Pramana, Kunchit Anguli pani, Samyak Nirooha Lakshana Kala Basti.

INTRODUCTION



W.S.R. TO LOW BACK PAIN- AN OPEN CLINICAL TRIAL” Page 1

“A STUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF

MADHUTAILIKA BASTI ADMINISTERED WITH

STANDARDIZED ATURA HASTA PRAMANA IN KATIGRAHA

W.S.R TO LOW BACK PAIN – AN OPEN CLINICAL TRIAL”

INTRODUCTION

AYURVEDA is one of the most ancient medical sciences of the world. It

conceives and describes applied aspects of life process, health, disease and its

management in terms of its own principles and approaches. The signs of wellbeing of

freedom from illness are well depicted in the ancient treatise. The description gains

more weightage even in this present modern era when the concept of health as

describe by WHO includes the state of physical and mental wellbeing, appears to be

influenced by the ancient theories of Ayurveda.

AYURVEDA attributes its prime importance to maintenance of health in

healthy individuals and alleviation of disease in ailing population. It explains human

body as amiable homeostasis of Dosha, dhatu, and mala.The function of dhatu is

dharana of shareera.

Panchakarma is a unique branch of Ayurveda which deals with purification

and detoxification of the body. It is unique in several senses, as this therapy is based

on eradication of the factors causing disease to the body, which no other system in the

world has addressed. This procedure of eliminating the excessively vitiated doshas are

carried out in sequence consists of three phases viz. Purva Karma, Pradhana Karma,

and Paschaat Karma. For the easy, proper, and effective administration of the

Shodhana Karma it is essential to prepare the body by specific therapeutic procedures.

INTRODUCTION




These preliminary procedures include Deepana, Pachana, Snehana and Swedana, and

referred by the name Poorvakarma.

Basti is the choice of treatment for a number of conditions especially in Vata

dominant diseases. Charaka has described Basti in Siddhisthana, shows its importance

as a principal method of treatment.

In this new millennium, highly progressive and fast lifestyle has created many

problems. Low back pain is one of man's perennial problems, a malady as widespread

as the common cold, as painful as piles and at times as crippling as a stroke. Surveys

revealed that four out of every five people around the world will be incapacitated by

severe Low back pain at some time in their lives. It has become the endemic disease

of the age, because we lead uncongenial lives which encourage stiff joints, flabby

muscles, postural strain, tension and obesity.

Katigraha is a Vataja nanatmaja vyadhi described by Sharangadhara1. None of

the Bruhatrayee have explained the Katigraha as a separate disease, but have

considered it as a symptom in various diseases such as Vrikkaja vidradhi, vankshana

vidradhi. We find brief description of Kati Graha as a disease with its etiological

factors, symptoms, and treatment in Gadanigraha Vatavyadhi adhikara2. Here it is

explained as a condition characterized by Shula and restricted movements of Kati

caused by Saama vayu.

Analyzing the samprapti reveals that the clinical manifestation of this disease

occurs due to the morbid Vata Dosha or the combination of Vata and Kapha. As we

considered Katigraha of Vata Kapha origin for the present study, the basti procedure

by virtue of its qualities is likely to correct the imbalance of vatadosha. In the same

way swedana procedure helps in rectification of imbalances of vata and kapha dosha.

INTRODUCTION




Epidemological studies shows that back pain is affecting nearly 60-80% of the

population. Even though it is affecting all age groups, it is the number one cause for

disability in patients younger than forty-five years of age causing more off work

occasion than most of diseases. In Ayurvedic texts, the Katigraha has been mentioned

as a very common problem characterised by pain and restricted movement of Kati. It

is a major symptom provoked by vata, even it can be seen in other disorders like

Gridhrasi. Vatarakta, Ashmari etc.

As vata is the causative agent,mainly Vatahara ahara, oushadha are employed

to achieve relief. Many studies have been conducted on katigraha with established

preparations. Studies are also conducted on the effectiveness of Basti, the chief

treatment aimed in alleviating Vata dosha and thus Katigraha. Mankind has been

dealing with various methods to avert pain which is the main symptom of provoked

Vata ever since its origin. Fomentation is the ancient method towards the pain or at

least lessens the suffering due to them. Along with this basti is also help to reduce kati

graha. Among different types of Nirooha basti madhutailika basti is indicated in

clinical conditions of vitiated Vata associated with Kapha. Madhutailika basti has its

own importance in katigraha.

In the study,the subject were selected according to the inclusion and exclusion

criteria and it is open clinical trial, single case study on 20 subjects. Haritakyadi

churna3 twice a day was given for 3-5 days with the Anupana of ushna jala before

food till the appearance of nirama lakshana of patients. In this group Madhutailika

basti4 with Eranda mula kashaya is used for niruha basti according to patients Aatura

Hasta Pramana5 and Anuvasana basti with Sahachardi taila

6 in kala basti schedule.

Sahacharadi taila is used as sthanika abhyanga followed by Mrudu Bashpa swedana.

Follow up was done after Parihara kala of 32days.

INTRODUCTION




The basti dravya in which Madhu & Taila are taken in equal quantity is called

as Madhutailika Basti. Anjali is defined as a hollow cavity formed by joining both the

palms together by the medial ends. The quantity of jala or any liquid that is held into

one such posture is called as one Anjali7.

प्रकीर्ण: पुष्पार्ा हरिचिर्योिं जलििय ॥8

The quantity of flowers for offering at Gods feet is one Anjali.

The Nirooha basti kwatha matra is selected as “Aatura Hasta Pramana” or

“kunchita anguli paani” 9 which is explained in sushruta samhita.

Nirooha basti kwatha matra differs for different age group and it is constant between

the age of 18yr to 70yr i.e. Dwadasha Prasuta pramana10

.

Aacharya Sharangadhar has explained that 2 Prasuta = 1 Anjali11

so 12 Prasuta = 6

Anjali which is constant for the age of 18 to 70 years.

According to different Acharyas different Nirooha Basti matra is explained

according to different ages. In the sameway Aaturahasta Pramana is also explained.

So an attempt is made in this study to evaluate and standardise Aatura hasta Pramana,

with this maximum retention & result can be obtained without any Upadravas.

With this intention the following study entitled “A STUDY TO ASSESS

SAMYAK NIROOHA LAKSHANA OF MADHUTAILIKA BASTI

ADMINISTERED WITH STANDARDIZED ATURA HASTA

PRAMANA IN KATIGRAHA W.S.R TO LOW BACK PAIN – AN

OPEN CLINICAL TRIAL” is conducted.

OBJECTIVES OF STUDY




OBJECTIVES OF STUDY

In view of this a clinical study to evaluate the therapeutic effect of

Madhutailika basti is used in Katigraha along with Anuvasana basti. In Vataj and

Vataj Kaphaja condition of following objectives

1. To study in detail about katigraha.

2. To study in detail about Low backache according to Modern Medicine.12

3. To study the effect of Madhutailika Basti in Katigraha

4. To study the effect of Sahacharadi taila in Katigraha

5. To study about the Aatur Hasta Pramana and prasuta pramana explained

in classics.

6. To study Samyak Nirooha Lakshana.13

REVIEW OF LITERATURE





PREVIOUS WORK DONE

Dr. Dhongade S; 1994; Katigrahavar Kati Basti chi Upayogita; Govt.

Ayurveda College, Nagpur; Submitted to Nagpur University, Nagpur.

Dr. Bhatt Mrinalini R; 1997; A clinical study on the role of Eranda Moola

Basti in the management of Katigraha; IPGT&R, Jamnagar, Gujarat.

Dr.Vitalakarpranati, 2004, Prishtavanshagata Kati-Kasherukancha

Rachanatmaka Abhyasa va Sandardhita Kati Graha: Ek Vivechanatmaka

Adhyayana, Dept. of KayaChikitsa, Govt. Ayurved college, Nagpur.

Dr.J.Mahalakshami 2009 “ To evaluate the effect of matra basti with narayan

taila and sahacharadi taila in kati graham –A comparative study”

Dr. Shridhara. R.2012“A comparative study of the effect of kati basti and kati

pichu with vishagarbha taila in the management of katigraha w.r.t. low back

pain.” Dept. Of pancakarma, S.J.G.A.M.C, Koppal

Dr. Anjaly. N.v, 2014 A study on the effect of Swedana with Kolakulathadi

Choorna and Valuka sweda in Katigraha, K.V.G. Ayurvedic Medical College

and Hospital, Sullia.





HISTORICAL REVIEW

Ancient Acharya have not described a specific disease as Kati Graha but the

description of symptoms of the disease can be traced in some other conditions like

Kati Shula, Kati Vayu, Trika Shula, Prishta Shula, and Vatika Shula. The disease

invariably comes under the umbrella of Vata Vyadhi. Here an attempt has been made

to trace the disease from Vedic Period till date.

VEDIC PERIOD:

In the Rigveda and Atharvaveda, Anuka and Anukyat words has been used for

the back or spine. In Veda, where the diseases are mentioned by the names of organs

involved, the spinal diseases have been clearly mentioned. The disease Balas is

referred many times in Atharvaveda where it is described as a painful disease of spine

and dislocation of the bone has been mentioned as a symptom. The commentators

Keshva and Mahidhara opinions it as a degenerative condition.

Viskandha which is described as a Maharoga of Vata has 101 varieties

etymologically denotes a disease of trunk which destroys or damages joints and

causes dislocation in them. It restricts the movements and hampers joint

functions.Thus it may be correlated with degenerative disease of joints. In the

treatment of Balas and Viskandha respectively application of paste of Palashasplinter

mixed with water etc and affected joints are to be tied with Jangida(Arjuna) and Aralu

(Kantakari) has been mentioned. Samskandha, Jambha, Visara, Abhilochana are some

other diseases of Vata, described in Atharvaveda in which Samskandha denotes a

condition of body parts.





SAMHITA PERIOD:

Charaka Samhita

Charaka Acharya has given detailed description of the types of Vata,

properties, locations, functions, symptoms of provoked (vitiated) Vata, general and

specific etiological factors, major manifestations and their management etc.Prishta

Graha14

has been mentioned as a Nanatmaja Vyadhi of Vata along with its associated

symptoms like Pada Shula, Pada Suptata, Prishta Shula, Trika Shula, etc.Kati Shula

which is the cardinal symptom of Kati Graha has not been directly mentioned as a

disease. But in the context of:

Trika vedana in Pakvasaya gata vata15

Kati Sangraha in Svedana Yogya.16

Prishta Shula, Kati Graha as a symptom of Vrikka Vidradhi.17

Vata Vikara of Prishta due to excess of Katu Rasa sevana.18

Different types of pain in Kati and Prishta of Vatika Jwara.

Prishtaroga and Trikaroga due to Gudastha vata, trikavedana due to

Pakvashayagata vata. Also Charaka Acharya has given Kati Shula as a

symptom in the description of Gridhrasi (Sciatica) the radiating pain described

in the classics is one of the major symptoms of Lumbar Spondylosis though it

may present in many other diseases.19

Sushruta Samhita (176-340AD)

Being an expert of anatomy Sushruta Acharya has described 30 bones and 24

Pratara type of joints in the spine. Similarly in Nidanasthana 15th Chapter, a detailed

description of various fractures and dislocations are given. In the management of

dislocation of lumbar spine, Apakarshana (traction) followed by Basti has been





mentioned, excessive movements of spine delay the healing of damaged part; hence

Kapaatashayana is advised for these patients.20

The cardinal symptom of Kati Graha, Kati shula has been mentioned as a

symptom of Vatika Arsha, Vankshanottha Vidradhi, Bhagna, 7th stage of Sarpa

Visha, Akshepaka and indirect reference can be drawn from Dalhana commentary

about Pakvashaya Gata Vata that along with Trika Vedana there will be Jangha, Trika

and Pristha vedana.

Astanga Samgraha and Hridaya (600AD)

Both the texts have mentioned Kati Toda, Kati Bheda as Purvarupa of Vata

Rakta, Prishta Ruja and Shroni Ruja in Sarvadhatvaavrita Vata and Kati Shula as a

disease caused by provoked Vata seated in Pakvashaya21

. Sciatica has been mentioned

as Sakti Utkshepa Nigrahnati which is a sign of test (straight leg raising test) as

diagnostic test of gridhasi.

Bhela Samhita (210BC)

A total of 45 bones in the back and 15 in the cervical region have been

mentioned by Bhela Acharya in the section of anatomy. This probably includes the

intervertebral discs. The Vata Vyadhi is classified in two main groups i.e.

SarvangaRoga and Ekanga Roga. The pain predominant diseases and deformities of

Kati and Prishta are listed under Ekanga Roga.(Kati Graha and Kati Shula is observed

as a symptom of various diseases like Vataja Kasa22

etc. and Mandagni and impeded

movement of Vata are the main causes for production of Kati Shula. In the general

management, Brimhana Therapy has been advised for VataVyadhi . For the diseases

of Kati and Prishta Anuvasana Basti is indicated and similar to Charaka Acharya





administration of Basti has been advised along the direction of Spine which shows

detailed knowledge of the spinal anatomy. A special reference has been given in the

context of Yapana Basti i.e. it relieves the pain in Trika, Prishta and other parts of the

body and also relieves Prishta Stambha and pada harsha.

Harita Samhita (210BC)

Acharya Harita has not described Kati Graha but has mentioned Shula and its

ten types giving a separate status to disease. Vata has been said to be an inevitable

factor in production of Shula. Obstruction to the downward motion of Vata and

impaired Agni produces Vatika Shula.

Kashyapa Samhita

Kati Shula has been mentioned as a disease due to mismanagement of labor

(Dushtaprajata). Etiology, pathology etc along with eight types of Shula has been

explained in Khilasthana 18th. Chap. Swedana is advised in Prishta and Kati Graha23

.

Further Anuvasana, Erandamuladi Yapana Basti are said to be effective in Prishta and

kati shoola.

Madhava Nidanam (7th centuary AD)

Trika Graha has been mentioned as a symptom of Ama Vata and Kati

Stambha as a symptom of Aanaha. Though the direct references are rare, sufficient

references can be found on the cardinal symptom of Kati Shula. Vayu is said to be

responsible for all types of pain. Shula has been classified under Eka Dosha,

Samsargaja, Sannipatika and Aamaja varieties. Prishta Shula and Trika Shula have

been mentioned under Vatika Shula. Acharya Madhava has given a detailed





description of Kati Shula in 26th chapter. In the commentary Atanka Darpana, Shri

Vachaspati Vaidya said, Prishta, Trika, Kati, Sphika Sandhi are seats of Vayu. Hence

Vayu first gets lodged in these places, unites with these parts and produce Shula.

Further Shula has been described as a symptom of Purisha Stambha,Vata Stambha,

Sangraha Grahani, Vataja Arsha, Vatanubandhi Raktarsha,Kshatakshina, Vata Rakta

Purva Rupa, Gridhrasi, Vatodara, VankshanotthaVidradhi, Pandu Purva Rupa, Vataja

Pradara, Moodha Garbha, and Kati sandhi mukta.

Vrinda madhava (9th cen.AD)

In this Siddha Yoga text, the principles and drugs have been mentioned

extensively for the treatment of Kati Shula and Kubja. As Acharya Vrinda Madhava

states that back pain is a symptom of Kubjatva. While fracture of Kati has been

mentioned as a cause of Kubjatva chronic disease has been termed incurable thus

treatment should not be attempted. As pain is a symptom of provoked Vata and as it

has Ashukari (quick spreading) nature,Vata should be immediately treated. Only

Brimhana Chikitsa can cure Vata Vyadhi, therefore Agni of patient should be good.

On this principle SvalpaRasona Pinda is advocated in diseases of Kati.Niruha Basti

with Virechana is indicated in Vata Vyadhi. In the management of Kati Shula Svalpa

Rasona Pinda, Eranda Payasa, Aardraka Swarasa with Matulunga Swarasa, Chukra

with Jaggery, oil or Ghee, Shunti Phanta, Trayodashanga Guggulu, Masha, Gokshura

Kvatha, Sunthi-Guduchi with Pippali,Ajamodadi Vataka, Shunti Gritha, Kanjika

Shatpala, Shandaki etc have been mentioned. Rasona with Madya has been advised in

Vata KaphajaShula. Exercise, Sexual intercourse, Liquor, salty spicy diet, suppression

of natural.urges, anger and pulses have been mentioned as Apathya (non- beneficial)

for the patients.





Chakradatta (11th Cen.AD)

Being a therapeutic guide, in Chakradatta, Acharya Chakrapani Datta has

described many formulations for conditions like Kati Graha, Kati Aamaya, Kati

Shula24

,Kati Ruja etc. Many of the formulations are similar to that of Vrinda

Madhava.

Basava Raajiyam (12th Cen AD)

This text has described distinct types of Vata Vikara. Kati Vata has been

mentioned in detail i.e Kati Bhanga, Kati Vikara, Maha Shula and mental irritation

being its symptoms25

. Vatakesari Rasa has been prescribed for above conditions.

Further, the backache along with Prishta Shula has been mentioned under

KaphaVataja Shula and Udaya Bhaskar Rasa has been prescribed.

Gada Nigraha (12th Cen .AD)

Kati Graha26

as a separate disease entity has been mentioned for the first time

in this text. The chief complaint of Kati Graha is Kati Shula (Backache). Vata

(Saamaor Niraama) moves into Kati and residing there produces the pain.

TrayodashangaGuggulu and other preparations described by Acharya Shodala (author

of GadaNigraha) are similar to that of Acharya Vrinda Madhava. Few new

compounds contributed are Avagahana, Abhayadi Churna, Ajamodadi Churna,

Shringa Bhasma etc.

Sharangdhara Samhita (1226AD)

Kati Graha has been enlisted under Vataja Nanatmaja Vyadhi27

. Adhamalla

while commenting on the disease in Dipika Commentary has said that it is a





specifictype of a pain which occurs due to stiffness.No commentary has been given

for the symptoms of Anga Pida and Anga Shula. Most of the compounds used are

repetitionsof Vrinda Madhava, Chakradatta and Gada Nigraha.

Rasaratna Samucchaya (13th Cen. AD)

Rasaratna Samucchaya has mentioned backache as an invariable symptom of

Aama Vata28

. Mritotthapana Rasa and Udayabhaskar Rasa are indicated in this

condition.

Vaidya Manorama

This text has identified Kati Pradeshastha Vata as a separate disease.

ErandaTaila (Castor oil) and Nirgundi Swarasa (juice) has been prescribed orally in

the management of same.

Bhava Prakasha (16th Cen. AD)

Unlike the Gada Nigraha, Bhava Prakasha Samhita has discussed Kati Graha

under the chapter of Amavata29

. The description and management is similar to that of

Vrinda Madhava.Acharya Bhava Mishra has introduced Trika Shula as a separate

disease and defined Trika as the joint of 2 hip bones and spinal column. Valuka

Sweda, Agni Sweda and Trayodasanga Guggulu have been prescribed in the

management of this condition.

Yoga Ratnakara (17t Cen AD)

Various terms like Kati Shula, Kati Vata, Kati Samira, Kati Prishta Amayaand

Kati Peeda etc have been used in the text to indicate backache. Methi Modaka with





Aardrakadi Sneha, Karpasasthyadi Lepa is some of the preparations prescribed in

these conditions.

Anjana Nidanam and Hamsaraja Nidanam

Anjana Nidana has mentioned Kati Shula as a symptom of Vata Prakopa.

Further Kati Vata as a symptom is noted in Gridhrasi.Hamsaraja Nidana has included

Kati Ruja amongst the symptoms of Adhogata Vata.

Modern view:

The Lumbar Spondylosis and the complications arising out of it were

collectively termed as the spinal degenerative disease previously. In earlier periods

when the pathology could not be differentiated it was categorized under the umbrella

of sciatica. People have been crippled by backache for thousands of years.

Hippocrates (490-370BC) has described sciatica and has practiced spinal

manipulation and traction. These same methods were used by Galen (131-202 AD)

and Arabian physicians like Avicenna, Abuquasim. Pore (1510- 90) of France

observed that continuous heavy work with flexed back may bring about severe

backache and has described spinal manipulation for the same with illustrations. The

structure of intervertebral disc was first described by Vesalius in 1543 while the

anatomist and English physician Thomas Willis described spinal nerves in 1684. F.

Fontane of Florence in 1797 detailed that root compression leads to paresis in sciatica.

Beckett W. in 1724 described that as age advances cartilages hardens which lead to

reduction in height by 1.5- 2.4 cm in elderly people.In 1850, the anatomical structure

of the disc and their pathological changes were published by Virchow and Luschka.

E. Harrison in 1821 made certain fundamental observations about anatomy,





physiology and pathology of spinal column. The strenuous position of spine lead to

compression of intervertebral disc and displacement of nucleaus pulposus and

ligament laxity leads to displacement of vertebrae. Harrison30

was of the opinion that

displaced bone should be restored to its natural position; this became the basis of

osteopathy. Lasegue in 1864 described the carriage and posture characteristically

associated with sciatic pain and this showed close relationship between backache and

sciatica. H. C. Raidore described the root pain which occur due to cord compression

at foramen and degeneration of the intervertebral disc. Carl Von Reiktansk y, Austrian

Pathologist was the first to describe spondylolisthesis in 1939. In 1911, for the first

time Middleton and teachers in Glasgow reported a case of rupture of disc caused by

excessive exertion where as in 1922 Adson and Ott reported the first surgical removal

of disc protrusion. In 1927, R. F. Herdon published his analysis of relation between

aging and backaches. Highest incidence of back related conditions were seen in age

groups 38- 39years, 40-49 years and 20-29 years

Devor M. et al (1989) has elaborated the neurophysiologic mechanism of pain

where as Biagos et al (1990) has studied the influence of psychological and

occupational factors on low backache31,32

. Sacro-iliac strain may also occur due to

disc disease (Henry and Raymond, 1994). The search for an absolute pin point cause

for backaches and similar targeted management is an ongoing quest in the medical

world till date.





HISTORICAL REVIEW OF BASTI

Retrospective study provides information about the evolution of science from

the primitive stage to the present stage. Historical glance enables us to understand the

merits and demerits of the science in a particular field based on which present and

future planning can be made for its uplifting. The science of Ayurveda aids to achieve

the long and healthy life essential for attaining the Purushartha Chatushtaya. This is

the ultimate goal of Human Being.

Lord “Brahma” the creator of the Universe narrated the science of life and

welfare of the human being. This divine message was canalized by Maharshi

Bharadwaja from Heaven to Earth. To go ahead without any trouble it is necessary to

get a clear picture about past. Vedas,are considered to be the first available literature

of the World. In Ayurveda, most of the basic thoughts are rooted from the Vedas. It is

explained as under:

VEDA KALA (2500 BC – 1000 BC):

We can find references of Basti in Rigveda and Atharvaveda. Kaushika Sutra

of Atharvaveda lays down use of Enema as substitute for minor operation.

PURANAS (between 3rd and 10th century CE):

Agni Purana has made direct reference to the Basti therapy especially

designed for tired Horses named as “Turanga Basti”. The quotation there in states that

the fatigue of the Horse could be relieved by the use of Taila Basti. In Siddhaushadha

Kathana Adhyaya of Agni Purana, explanations about the Panchakarma are available,

where he says, Basti as best line of management for vata. Different Snehas has been

told to use for Basti according to season.





YOGIC LITERATURE (200 to 500 BCE):

References regarding Basti are found in Gheranda Samhita, basically a text

book of yoga, in two categories namely

1. Jala Basti

2. Shushka Basti

In Jala Basti, Yogic person are used to sit in naval deep water in Utkatasana

and sucking water through Guda to clean the Rectum and lower bowel by contraction

relaxation of their Guda. Jala Basti is indicated in Prameha, Udavarta, and Morbid

Vata etc. and to gain Handsomeness. Shushka basti is mainly a Yogic Kriya the

details are not explained here.

SAMHITA PERIOD

Charaka Samhita (1000 B.C):

It is one of the oldest text books of Ayurveda which is still practiced by the

Physicians since centuries. Charaka has called Basti as Ardha chikitsa33

. Siddhi

Sthana is the particular section of this book which deals with the Panchakarma

procedures and full knowledge of Basti Karma. In the first chapter of Siddhi sthana,

Kalpanasiddhi, references regarding the time, frequency of Anuvasana Basti, effects

of Niruha and Anuvasana Basti, importance of Basti therapy, Samyak, Ayoga,

Atiyoga Lakshanas of Anuvasana and Niruha Basti34

, Karma- Kala- Yoga Basti

Schedule are found35

. In the second chapter Panchakarmeeya Siddhi Adhyaya

references regarding the Indications and Contraindications of Niruha Basti and

Anuvasana Basti and the adverse effects of both, if administered in contraindicated

conditions are explained36

. In Bastisootriyam Siddhi, 3rd Chapter explanations

regarding Basti Netra37

, Basti Putaka38

, Basti Samyojana Vidhi, Method of





administering the Basti, Paschat Karma, dose of Niruha Basti for different age

groups39

, different Niruha formulations etc. are found. In the 4th Chapter Sneha

Vyapad Siddhi Adhyaya different Anuvasana Basti formulations, complications

arising from their wrongful administration and treatment of these complications are

mentioned40

. In Netrabasti Vyapad Siddhi, 5th chapter of Siddhi sthana references

regarding the Basti Netra and Basti Putaka which are Varjya and complications

arising out of their use, Basti Pranetra Dosha and treatment of those complications41

.

In the sixth chapter (Vamana Virechana Vyapad Siddhi) no references regarding Basti

is found.

In the 7th chapter Bastivyapad Siddhi Adhyaya Complications arising out of

the administration of Basti, its number, causes, signs and symptoms and treatment are

mentioned42

. In the 8th

chapter Prasritayogeeya Siddhi different Basti Yogas are

mentioned43

. In the next chapter Trimarmeeya Siddhi Adhyaya Basti marmaghata

chikitsa is mentioned44

. In Basti Siddhi Adhyaya, 10th Chapter of Siddhi Sthana

excellent Basti preparations are mentioned45

.

In 11th Chapter, Phalamatra Siddhi the topics discussed are action of various

types of phala46

, excellence of basti therapy, netra and putaka for giving basti to

animals47

, sadaatura and treatment for them48

. In the last chapter, Uttarabasti Siddhi

different Yapana Bastis are mentioned along with their adverse effects if used

excessively and their management49

.

Sushruta Samhita (800 BC to 600 BC):

Acharya Sushruta has devoted 4 chapters completely for the description of

Basti in Chikitsa Sthana.. In the 35th chapter Netrabasti Pramana Pravibhaga

Chikitsitam adhyayam he mentions about the importance of Basti therapy50

,





indications & contraindications51

, Basti netra in relation to age52

, Basti Putaka, Vrana

Basti, Types of Basti and 76 Basti Vyapats. In the 36th chapter Netrabasti Vyapad

Chikitsa, he describes the Chikitsa for the Vyapats53

. In 37th chapter, Anuvasanottara

basti chikitsitam adhyayam, Sushruta explains different kinds of Anuvasana yogya

taila54

, Anuvasana Kala, Vidhi55

, Samyak Lakshanas56

, Snehabasti Vyapad57

, Uttara

basti, Uttarabasti Vidhi58

. He also explains the sites of action of each Anuvasana Basti

administered. He also explains Niruha basti Vidhi, Samyak- Ayoga- Atiyoga

Lakshanas59

, order of mixing of basti dravya60

, and different Basti Yogas61

.

Ashtanga Sangraha (400 AD):

Ashtanga Sangraha, 28th Chapter of Sutrasthana, Basti Vidhi Adhyaya has

been devoted to Basti only. In this Chapter Classification, Indications,

Contraindications62

, Dosage63

, Process of Administration 64

etc. has been described in

detail. Also 4 Chapters of Kalpa Sthana i.e. fifth to eight have been contributed to

Basti. In these Chapters, description regarding importance of Basti, different types of

Basti, and Sneha Basti Vyapad etc. is available.

Harita Samhita (800-700 BC):

In Harita Samhita, 3rd Chapter of Sutra Sthana gives information regarding

Basti Apparatus and Conditions suitable for Basti Karma. Scattered references at

other places are also available.

Bhela Samhita (800-700 BC):

In Bhela Samhita, Basti Matreeya Siddhi, Upakalpana Siddhi, Phalamatra

Siddhi, Dosha Vyapad Siddhi are the Four Chapters which deals with the Description





of Basti. The scattered references about indication of Basti in Particular Diseases are

also available. New Basti formulations like Krida Basti65

, Panasabeejadi basti66

,

Mayooryadya Niruha67

are found here.

Kashyapa Samhita (700 AD):

In Kashyapa Samhita, The Prime Samhita of Kaumarabhritya, Basti has been

explained in Siddhisthana and Khilasthana. “Basti Visheshaniya Adhyaya” in Khila

Sthana contains the secrets of Basti Therapy. In Siddhi Sthana, “Rajaputriya

Siddhi”,“Basti Karmeeya Siddhi” and “Mangala Siddhi” are Chapters that totally deal

with Basti. In Basti Visheshaeeyam Adhyaya in Khila Sthana, details regarding

Karma, Kala, and Yoga Basti are available68

. Here in Karma basti 24 Anuvasana basti

and 6 Niruha basti are mentioned which is different from those mentioned in other

texts69

.

Chaturbadrakalpa basti, Phala Taila, Basti Samyojana Vidhi are also

mentioned in this chapter.In “Rajaputriya Siddhi Adhyaya” of Siddhi Sthana details of

Niruha (Asthapana) Basti have been explained with their Purva Karma, Indications,

Contraindications, Ayoga and Samyak Yoga Lakshanas and about Basti Netra have

been explained. Different formulations of Basti are explained in Mangala siddhi

Adhyaya.

Kalyanakaraka (800 AD):

Detailed description of basti is available in Vatavyadhi Adhyaya, and

Bheshajakarmopadrava chikitsa. Guda taila basti, which is used in Vishama doshata,

has been given importance.





Chakradatta (1200 AD):

Two chapters have been mentioned to describe Anuvasana and Niruha Basti

named as “Anuvasanadhikara” and “Niruhadhikara” respectively. Chakradatta almost

follow Charaka Samhita for the Procedures of Basti administration. In Niruha karma

chikitsitam Adhyayam Suyojitha Niruha Lakshana is mentioned70

.

Gada Nigraha (1200 AD):

Even though he has included Niruha and Anuvasana in Panchakarma,

description about the basti is not available.

Vangasena Samhita (1300 AD):

Vangasena has devoted “Basti Karmadhikara” chapter for description of Basti.

Here Acharya explains importance of Basti, Basti Netra71

and Basti Putaka72

, dose of

basti dravya, Basti Pranidhana73

, Paschat karma, Indications and Contraindications of

Basti74

, Samyak, Ayoga, Atiyoga Lakshanas, Dvadasha prasrita Basti75

etc. He also

explains the sites of action of each Anuvasana Basti administered. Some important

preparations like Guduchi taila76

, Madhutailika Basti77

, Yapana Basti78

, Suddha

Basti79

, Kshara Basti, Mutra Basti80

, and Ardhamatrika Basti81

are also explained.

Detailed explanation regarding Uttarabasti is also available.

Sharangadhara Samhita (1300 AD):

Acharya Sharangadhara devoted 3 Chapters of Uttara Khanda namely “Basti

Kalpana Vidhi”, “Niruha Basti Kalpana Vidhi” and “Uttara Basti Kalpana Vidhi”,

Which describes various aspects of Anuvasana Basti, Niruha Basti (Asthapana) and

Uttara Basti respectively.





Bhavaprakasha (1500 AD):

In this 7th chapter of Purva Khanda has been contributed to the description of

Basti82

.Vrana Basti has been explained in this Grantha also. Bhavamishra has

described both Anuvasana and Niruha Basti (Asthapana) in Paribhasha Prakarana

Bhavaprakasha follows Sharangadhara and Sushruta almost in every aspect.

Todarananda (1600 AD):

In this text, Basti is described in the chapter Basti Vidhi.

HISTORICAL REVIEW OF ENEMA

Nearly every ancient civilization throughout history has employed Enemas to

cleanse their bodies of toxins and waste.

Table No. 01 Showing Historical review of Enema

1500 B.C.

Egyptians were first recorded civilization to use technique of colon

lavage, found in the Ebers Papyrus (Ancient Egyptian medical

document).

600 B.C.

Babylonian and Assyruan tablets include cuneiform inscriptions on the

use of Enemas.

400 B.C. Hippocrates recorded using enemas for fever therapy.

1000 A.D.

The Greek physician Galen one of the most skilled physicians of histime,

was also a proponent of the use of enemas.

500 A.D. Aetius, a Greek physician of the sixth century, who recommended





enemas of pure water.

500+ A.D. It is reported that along the Ivory Coast the inhabitants administer the

enemas by the use of a calabash filled with water. While in certain

African tribes, a hollowed cow horn was utilized for the enema.

1000 A.D. The first recorded apparatus was the enema syringe; however, there is

debate as to who should be credited with first describing the enema

syringe. Lieberman gives credit to Avicenna (980-1036 AD) as the first

to describe the enema syringe, while Friedenwald indicated that honor

should be given to Albucasis of Cordove (1013-1106) who also

developed the ear syringe.

1000+ The preferred and most readily available apparatus remained a tube made

of bone, reed or metal connected to a sleeve or animal bladder called the

“Clyster Purse”. The bag was emptied by squeezing it between the two

hands. Dr. Russell reports that in Spain, the method was called “Playing

the Bagpipes”.

1300 During the middle ages, information on the enema continued to grow and

the use of the enema became the popular vogue of the wealthy and even

reached to the highest levels of the royalty.

2000 During the middle ages, information on the enema continued to grow and

the use of the enema became the popular vogue of the wealthy and even

reached to the highest levels of the royalty.

TODAY There have been many different apparatus types used throughout the

years. Today in the United States there are 8 different types of Colon

Hydrotherapy devices registered with the FDA. Some are open systems





and some are closed systems, terms which describe whether or not the

effluent from the device is piped directly to sanitary waste disposal.

REVIEW OF BASTI

Basti is considered as “Ardha Chikitsa” by Acharya Charaka83

and

Vagabhata84

among all therapeutic measures and even as “Poorna Chikitsa” by some

others because of its multi-dimensional actions. It not only cures Vata rogas but is

also helpful in Kaphaja and Pittaja rogas, Samsargaja and Sannipataja doshas,

Shakhashrita and Kosthashrita rogas also. It does Samshodhana, Samshamana, and

Sangrahana, based on the different kinds of dravya samyoga. Kashyapa in Khila

sthana equated Basti Karma as „Shreshtam‟85

.In brief, basti annihilates the doshas by

eliminating them out of the body, regulates the Vata dosha, cleanses the srotas and

enhances the tissue, in turn prevents the recurrence of the disease, promotes the health

and cures the ailment.

ETYMOLOGY OF BASTI

Etymology reveals the „Origin and Developments‟ in the meaning of a word.

The word „Basti‟ belonging to masculine gender is derived from the root word

“Bas”and “Chit” pratyaya.

Table no – 02 Showing the word meaning of Basti86

:

Vasu Nivase To stay-To reside- To dwell

Vas aacchadane To wrap

Basti vaste aavrunoti mootram Cover the urine

Basti nabhir adho bhaga sthane Reservoir of urine situated in sub

umbilical area.





PARIBHASA OF BASTI

The term Basti in the context of Panchakarma can be used in different sense, it

gives the following meaning.

“Bastinaam deeyate iti Basti ||”87

“Bastirabhideeyate yasmat tasmat Bastiritismrita ||”88

The bag made by animal bladder is termed as “Basti”. The bladder of animals

was used as the device for Basti karma in olden days. It is also said that medicines

like Kashaya, Ksheera, Tail, Ghritha etc administered through Guda marga by a Basti

netra of Basti yantra, first reaches the lower abdominal area of the patient which

contains the organ Basti i.e. urinary bladder. Hence the term Basti is used to designate

the process in Panchakarma.

Acharya Charaka has defined the Bastikarma as the procedure in which the

drug prepared according to classical reference and administered through Guda marga

which reaches Nabhi Pradesha, Kati, Parshva, Kukshi and churns the accumulated

Dosha and Purisha spreading the Veerya of the Oushada dravya to whole Shareera,

extracting the Doshas from whole body with the virtue of Veerya of the Oushada

towards Guda which later is expelled along with the Purisha89

.

GUDA SHAREERA:

Knowledge of Anatomy and physiology of guda and pakwashaya is essential

for the physician, where in the Basti dravya is administered. The word shareera

composes of both structural and functional aspects of the body. As for Bastikarma is





considered it so important to have a view over certain anatomical features of rectum

and large intestine which are relevant are described below.

Guda Shareera / Rectum:

Table No:- 03 Showing No: Paryaya of Gudha shareera:

Sl. No. Author Paryaya

1 Amarakosha Apaanam, Payu

2 Jatadharam Guhyam, Gudavartma

3 Gangadhara Bradhanam

4 Vachaspati Vitmarga

5 Charaka Uttaraguda, Adharaguda, Sthulaguda, Gudamukha

6 Vagbhata Gudamarga

7 Dalhana Gudantram

8 Sushruta Gudamandala,Gudavalaya, Payuvalaya, Gudaustha

Sushruta has explained elaborately on the anatomical structure of guda while

describing Arshoroga. Guda is a part, which is the extension of sthoolantra with four

and half angula in length. It has got 3 valis (parts) named as Gudavalitrayam.

Table No-04 Showing Rachana shareera & Pramana of Gudhavalis90

Sr.no Guda Valis Pramana

1 Pravahini 1½ Angula that which does Pravahana (Contraction of

intestine)

2 Visarjini 1 ½ Angula that which does Visarjana (Evacuation)

3 Samvarani 1 ½ Angula that which does Samvarana (Contraction of





Sphincters)

There is another structure called as Gudostha, which is about a distance of 1½

yavapramana from the end of hairs. The first vali samvarani starts at a distance of 1

angula from gudostha. The width of each vali will be 1 angula and of the colour of

elephant‟s palate.

Charaka while describing about the koshatagni, he had considered uttaraguda

and adharaguda. The modern commentators consider them as rectum and anus

respectively.

Marma:

Anatomical and applied Physiological information about vital parts of the

body called marmas. Which represent the life, is essential for a Panchakarma scholar

so that, he may avoid the possibility of injury or trauma to these vital parts during the

therapy. Sushruta has described the Guda as a Marma, which is one among the

Sadhyo-Pranahara Marma91

, which is attached to Sthulantra and through which Vata

and Purisha is excreted out. Any injury occurring to this part results in immediate

death.

Pranaayathana:

Ayurvedic texts refer to the concept of prana or life force in a unique way

including Dashapranayathana92

(life organs). Among this guda is one important part

of the body where the life phenomenon is most obvious and transparent. Injury to

these organs is considered as fatal.





PHYSIOLOGICAL CONCEPT OF GUDA:

Acharya Sushruta describes Guda as one of the Pancha karmendriyas and its

function is to excrete the mala from the body. He also opines that guda and

Pakwashaya are the seats of Apanavayu which helps in expulsion of vata, mutra,

purisha, shukra, and garbha. In this context after administration of Basti karma,

Apanavata helps in evacuation of Basti dravya along with vitiated vatadosha.

According to Gananath sen Mechanism of defecation through Guda vali and

Apanavata can be understood as below.

Table No-05 Showing Gudha Valis Kriya Karma

Sr.no.

Guda Valis Action

1 Pravahini Helps in compression and pushing the stool downwards

2 Visarjini Relaxes during process and allows stool to pass further

down.

3 Samvarani Expels the stool out and constricts immediately, so that

the continuity of the stool cut out and falls down.

Physiology of Defecation:

Samana Vayu influences digestion of food, separation of nutrients and waste

products, Absorption of nutrients and elimination of waste products. Apana vayu does

the act of defecation. This is significantly seen with a tendency to flow downwards.

Elimination of faeces from the rectum is called defecation. Defecation is a reflex





action aided by Voluntary contractions of the diaphragm and abdominal muscles and

relaxation of the external anal sphincter.

MODERN VIEW:

The rectum forms the last 15cm of digestive tract and is an expandable organ

for the temporary storage of fecal material. Movement of fecal material into the

rectum triggers the urge to defecate. The last portion of the rectum, the Ano-rectal

canal, contains small longitudinal folds, the rectal columns. The distal margins of

rectal columns are joined by transverse folds that mark the boundary between

columnar epithelium of the proximal rectum and a stratified squamous epithelium like

that in the oral cavity.Very close to the anus or anal orifice, the epidermis becomes

keratinized and identical to the surface of the skin. There is a network of veins in the

lamina propria and submucosa of the anorectal canal. The circular muscle layers of

the muscularis externa in the region forms the internal Sphincter and is not under

voluntary control. The external anal sphincter guards the anus and is under voluntary

control. Pudental nerves carry the motor commands.

Table No-06 Showing Gudha Valis Sthana and Modern terminology:

Sr.no. Guda vali Situation Modern terminology

1 Pravahini Proximal Middle houston valve

2 Visarjini Middle Inferior Houston valve

3 Samvarani Distal Dentate line

Pakwashaya / Large intestine:





Pakwashaya is considered as one among the Aashaya‟s by Sushrutha.

Arunadatta comments as pakwashaya is the seat of pakwa anna i.e. that which attains

pureesha ashaya. Charaka and Vagbhata considered this as one among the koshtangas.

Sharangadhara has specified the location of pakwashaya (pavanashaya) as below the

Tilam i.e. the Yakrut and Kloma. The horseshoe shaped large intestine or large bowel

extends from the ileocaecal valve to the anus. Average length is about 1.5 meters and

width of 7.5cms.

Table No-07 Showing Sub divisions of large intestines

1 Caecum T portion

2 Colon Large portion

3 Rectum 5 inches

4 Anal canal 4 cms

Intestinal mucosa contains many Goblet cells, and Muscularis consists of

taenia coli. Mechanical movements of the large intestine include Haustral churning,

Peristalsis and Mass Peristalsis. The last stages of chemical digestion occur in the

large intestine through bacterial action. Substances are further broken down and some

vitamins are synthesized. Large intestine also absorbs water, electrolytes and

vitamins. Faeces consist of water, inorganic Salts, epithelial cells, bacteria and

undigested food.

Absorption in the Large Intestine:

The re-absorption of water is an important function of the large intestine.

Although roughly 1500 ml of material enters your colon each day, only about 200 ml

of faeces is ejected. The remarkable efficiency of digestion can best be appreciated by





considering the average composition of faecal wastes 75% water, 5 % bacteria, and

the rest a mixture of indigestible materials, small quantities of inorganic matter, and

the remains of epithelial cells In addition to reabsorbing water, the large intestine

absorbs a number of other substances that remain in the fecal material or that were

secreted into the digestive tract along its length.

SUPERIORITY AND IMPORTANCE OF BASTI

1. There is none other than Vayu which is the most important causative factor

of diseases in shakha, koshta, marma, urdhwa, sarvavayava and anga.

Vayu is responsible for the vikshepa and sanghata of vit, mutra, pitta and

other accumulated malas. When it is exceedingly aggravated there is no

remedy other than basti for its alleviation. That‟s why basti is considered

to be Ardha Chikitsa by most acharayas and Poorna Chikitsa by some

authors.

2. Basti is invariably useful in diseases of Vataja, Pittaja, Kaphaja and

Raktaja disorders and also in Samsarga and Sannipataja conditions of

doshas.

3. Basti is the major therapy among Panchakarma because by combination of

different dravyas it does Samshodhana, Samshamana, Sangrahana of

Doshas. It increases the Shukra quantitatively and qualitatively, does

brimhana to krisha and vice versa, nourishes the eye, destroys Valipalita

and retards ageing.

4. Basti karma is equivalent to all other karmas and if administered properly

acts like Amrita. Basti is beneficial in children, young, elder, healthy and

patients.

5. Basti nourishes the body upto the tip of hairs and nails.





6. Basti is major among all karma because it destroys the disease by

cleansing the Srotas and by increasing the Oja, Teja, Shukra, Agni and

Medha.

7. As a piece of cloth soaked in the water mixed with powder of Kusumbha

(Carthamus tinctorius) absorbs raga (dye) from it, similarly Nirooha Basti

eliminates the doshas which are liquefied by Snehana and Swedana from

the body.

8. Just like the rays of sun absorb the water from the earth similarly basti

administered into Pakwashaya draws out doshas from Pada to Mashtaka by

its Veerya.

9. Vata has got role in normal functioning of Pitta and Kapha and also the

role of vata in Pitta and Kaphaja Vyadhi can‟t by neglected. So Vata

should be protected first. There is no treatment equivalent to Basti in

protection of Marma and in the management of its affliction, which is

considered as vital parts in the body.

10. There is no other therapy equivalent to Basti as it does Shodhana quickly

and comfortably, does Apatarpana or Santarpana rapidly and is also free

from complications. While administering Virechana dravya which are non-

palatable due to pungent, kshara and ushna properties it may produce

abdominal discomforts, unpleasant belching, nausea etc. Hence some

patients show intolerance and unwillingness to Virechana. For them also

Basti can be administered. Also for Bala who have aprapta dhatu, aprapta

bala and for Vriddha who have heena dhatu and heena bala Virechana

can‟t be administered especially Asthapana Basti.





CLASSIFICATION OF BASTI

One cannot find any uniformity in classification of Basti among the authors of

classical texts. As Basti is an important method of therapy in Ayurveda, it can be

classified in various ways for better understanding. Generally the term Basti has been

used for all types of Bastikarma, which includes Niruha, Anuvasana, Uttara Basti etc.

But Charaka has used this term Basti exclusively for Niruha as per the commentary of

Chakrapani.Similarly the term Basti has also been referred to the method of Shiro

Basti, Uro Basti and Vrana Basti etc. So a rational thinking on various aspects of

Bastikarma has brought about the following classification.

1. Adhishtana bheda:

According to the site of application of Basti it is classified into two types –

a. Internal

b. External

Table No-08 Showing different types of Basti:

Pakwasayagata basti The administration of medicine via Gudamarga to Pakwashaya

Garbhasayagata basti The administration of medicine via Yonimarga to Garbhashaya

Mutrashayagata basti The administration of medicine via Mutramarga to Mutrashaya

Vranagata basti The medicine administered through the Vranamukha by the

process of Bastikarma.

b. External (basti modification)

In certain diseases the medicated oil is kept over the part of the body using a

cap or with flour paste for prescribed period of time and named after the site of

application of oil such as – Shiro Basti, Kati Basti, Uro Basti, etc.





2. Dravya bheda:

It is based on the major ingredients of Bastidravya - kwatha or sneha and so

classified into two types: -

i. Niruha Basti – In Niruha Basti, Kashaya (decoction) is the predominant content

with the Kashaya, Madhu, Saindhava, Sneha and Kalka are the ingredients commonly

used. Its synonyms are Asthapana Basti, Kashaya Basti etc. Its action in the body is

beyond the perception of physician.

ii. Anuvasana Basti – Sneha is the chief ingredient of Anuvasana. The term

Anuvasana is coined due to the unharmful effect of the Bastidravya even if it is

retained inside the koshta. Moreover, this type of Basti can be practice daily without

any serious precautionary measure, as it is less harmful than Niruha.

3. Karma bheda: Sushruta and Vagbhata have made the following classification

according to their actions.

Karma Bheda of Basti:

Table No-09 Showing Karma Bheda Of Basti:

Shodhana basti Contain the shodhana dravyas and remove the vikrita drava and

malas from body.

Lekhana basti Reduced the medo dhatu and does the lekhana of sharera

Sneha basti Contain more of snehana and does the snehana of shareera.

Brimhana basti Increases the Rasadi dhathus and indirectly it helps in the growth

of body.

Utkleshana basti Causes Utklesha of malas and doshas by increasing its Pramana

and causes dravabhootha





Doshahara basti Purificatory or eliminating type.

Shamana basti Causes Shamana of Doshas

4. Sankhya bheda:

It is stated that neither Sneha Basti nor Niruha Basti can be applied alone. So,

Charaka has made this classification based on the number of Sneha Basti and Niruha

Basti in a treatment.

a) Karma Basti – There are 30 numbers of Basti in this group out of which Sneha

Basti and Niruha Basti are 18 and 12 respectively. Prescribed in chronic diseases of

prolonged nature and particularly of vata predominant.First Sneha Basti then alternate

Sneha and Kashaya- each 12 and 5 sneha Basti in the end.

b) Kala Basti – There are 16 numbers of Basti. First Basti is anuvasana, then 6

Niruha and 6 anuvasana must be given alternately and in the end 3

anuvasana.Indicated in patients of madhyama bala and vatapitta predominant

conditions.However, a difference of opinion regarding the number of Niruha is also

prevailing.

c) Yoga Basti – There are 8 numbers of Basti. 5 sneha Basti and 3 Niruha Basti. First

Basti is anuvasana, then 3 Niruha and 3 anuvasana and last 1 sneha Basti. Indicated in

diseases where involvement of vata dosha is found less.

5. Matra bheda:





This classification of Basti is based on the quantity of Basti dravya prescribed. The

quantity may vary according to the age, strength of the patient and severity of the

disease.

Dvadashaprasruta Basti– In Niruha, the maximum dose or quantity of

Bastidravya prescribed is Dvadashaprasruta i.e. 24 palas.

Prasritayogika Basti – Charaka has prescribed various types of Niruha in

different doses like 4, 5, 6, 7, 8, 9 and 10 prasrutas, considering the strength of

the patient and condition of the disease.

Padaheena Basti – In this type of Basti, 3 Prasrutas i.e. ¼ of Dvadashaprasruta

is less form the total quantity of Niruha used i.e. 9 prasruthis.

Anuvasana is also classified into 3 according to the differ quantity of sneha used.

Sneha Basti– 6 palas (¼of total quantity of Niruha)

Anuvasana Basti – ½ of the quantity of SnehaBasti.

Matra Basti– ½ of the quantity of Anuvasana Basti

6. Anushangika bheda (Miscellenious)

a. Yapana Basti

b. Siddha Basti

c. Yuktaratha Basti

d. Vaitharana Basti

e. Ksheera Basti

f. Ardhamatrika Niruha Basti

g. Piccha Basti

h. Mutra Basti

i. Rakta Basti

j. k)Madhutailika basti





In general approximately 216 kinds of Basti are mentioned by Acharya

Charaka in various chapters of Siddhi Sthana.

A REVIEW OF MADHU TAILIKA BASTI

According to Acharya Charaka prayayas of Madhutailika basti are Yapana,

Yuktaratha, Doshahara Basti in Siddhisthana.

Table No-10 Showing Madhutailika Basti Matra According to Charakacharya93

:

Makshika 2 prasruta

Taila 2prasruta

Jala 4 prasruta

Shatapushpa kalka ½ prasruta

Saindhava lavana ½ pala

Which does the deepana, brimhana, balavarna kara, vrushyatama, rasayana,

krimi, kustha, udavarta, gulma, plihamedahara etc.

Table No-11 Showing Madhutailika Basti Matra According to Susrutacharya94

:

Madhu- tailam Equal quantity

ErandamulaKashaya Same as Madhu and Taila





Shatapushpa ½ pala

Saindhava lavana 1 karsha

Madanaphala 1 in no.

Table No-12 Showing Madhutailika Basti Matra According to Ashtanga

Sangraha95

;

Madhu- Tailam Equal quantity


Shatapushpa 2 karsha

Erandamula kashaya Same as Madhu and Taila

It acts as Rasayana, pramehahara, arshahara, krimi, gulma, aantravrudhi hara.

In this if yasthimadhu is added it is acts. Like netra roga, Raktapitta.

Table No-13 Showing Madhutailika Basti Matra According to Ashtanga

Hridaya96

;

Madhu Tailama Equal quantity


Shatapushpa 2 karsha





Erandmula Kashaya Same as Madhu and Taila

Table No-14 Showing Madhutailika Basti Matra According to Sharangadhara97

;

Madhu tailam 8-8 pala

Saindhava ½ pala

Shatapushapa ½ pala

ErandmulaKashaya 8 pala

Table No-15 Showing Madhutailika Basti Matra According to Vangasena

samhita98

;

Madhu- Taila 6-6 Prakunja

Saindhava 1 karsha

Shatapushapa ½ pala

ErandamulaKashaya 6 prakunja

BASTI YANTRA:

It is an apparatus which is used to give Basti. It mainly contains:

a) Basti putaka

b) Basti netra

Enemator- is the term used in the modern science which is an apparatus for

giving enema.

BASTI PUTAKA:





It is a part of Basti yantra where the Basti dravya is filled and then tied to the

required length of the Basti netra. In olden days, they used animal bladder for this

purpose. Bladder of vrudha go, mahisha, haarina, aja, was used. And it should be

made suitable for well fitting with the Basti netra and should not have any bad smell.

All the authors opined that, it should be Drudha, snigdha, mrudu, seasoned with

kashaaya, etc. Authors have explained the qualities of Basti putaka which are to be

avoided.

BASTI NETRA:

It is a tubular structure which is tied to the putaka and introduced into the guda

while administering the Basti.

Authors gave a detailed description of this netra.

According to Kaashyapa, it should be prepared in punya ahani.

It is prepared out of suvarna, rajata, taamra, kaamsya, trapu, ayas,

shrunga,asthi, or any other available materials.

In the absence of these, it should be prepared out of naadi, nala, vamshaasthi.

Generally netra must resemble like tail of cow with a tapering end and a wider

base, or like pyramid shape with round ends and smooth surfaces.

NETRADOSHA AND PUTAKADOSHA99

:

Table No-16 Showing Netra dosha and its effects:

Sl.no. Netra dosha Features Effects

1 Hraswa Too short Not reach upto pakwashaya.

2 Deerghata Too long Dravya go beyond the





pakwashya.

3 Tanuta Too thin Produce kshobha

4 Sthoolata Too big Produce kshanana

5 Jeeranata Old dhatu used Injury to guda

6 Sthithilabandhana Not fixed properly to

the putaka

Dravya comes out

7 Parshwachhidra Hole on side Leakage of dravya happens

8 Vakrata Curved/irregular Dravyagati become irregular

9 Assannakarnika Karnika too near Karma become no use

10 Prakrustakarnika Karnika too far Causess raktasrava by

gudamarma peedana

11 Anusrotata Small hole Cannot perform properly

12 Mahasrotrata Broad hole Cannot perform properly

Table No-17 Showing Putaka dosha and its effects:

Sl.no Putaka dosha Features Effect

1 Vishama Shape not in uniform Gati vishamata

happens during

pressing

2 Mamasala Muscular tissue present Produces offensive

smell

3 China chidra yukta Presence of hole Dravya comes out

4 Sthoola Thick one Does not push

dravya





5 Jalayukta Anastamosis present Produces leakage

6 Vatala Excess air space Frothy type of

draavya

7 Snigdha Unctuous Slip from the hand

8 Klinnata Wet Difficult to pass

through

Asthapana Basti Ayogya / Anasthapya

Table No-18 Showing Basti Ayogyas100

Sl.no. Types of patients. Cha. Su. Vag. Complication.

1 Ajeerna + + - Dooshya udara, moorcha,

shotha.

2 Atisnigdha + - + Same as above

3 Peetasneha + - - Same as above

4 Utklista dosha + - - Teevra aruchi

5 Alpagni + + + Same as above

6 Yanaklanta + - - Shareera shosha, prana

uprodha, kruchra shwasa.

7 Atidurbala + + - Same as above

8 Kshudhaarta + - - Same as above

9 Trishnaarta + + - Same as above





10 Shramaarta + - - Same as above

11 Atikrisha + + + More karshya utklesha of

dosha happens

12 Bhuktabhakta + - + Same as above

13 Pitodaka + - - Same as above

14 Vamita + - + More rookshana happens

15 Virikta + - + Same as above

16 Krita nasyakarma + - - Manovibhrama, srotonirodha

17 Krudha bheeta + - - Basti drava moves up

18 Matha + + - Same as above

19 Murchita + - - Sanghya nasya and hrudaya

20 Moorchita + + - Same as above

21 Prasaktachhardi + + + Basti drava moves up

because of the existing urdha

gati of vata.

22 Prasaktanishteeva + - + Same as above

23 Shwasprasakta + + + Same as above

24 Kasaprasakta + + + Same as above

25 Hikkaprasakta + - + Same as above

26 Baddhagadodara + - + Leads to death by causing

severe distension of abdomen

27 Chhidrodara + - + Same as above

28 Adhmana + - + Same as above

29 Alasaka + - - Causes teevra amavstha of





the body

30 Visuchika + - - Same as above

31 Amatisara + - + Same as above

32 Madhumeha,prameha + + + Vyadhi vardhakam

33 Kushta + + + Same as above

34 Udakodara + - - Leads to death by causing

severe distension of abdomen

35 Amodosha + - - Same as above

Asthapana Basti Yogya:

Table No-19 Showing Asthapana Basti Yogyas:101

Sl. No. Indication Ch. Su. Va. Sl.

No.

Indication Ch. Su. Va.

1. Sarvangaroga + + - 37. Rajalshaya + + +

2. Ekangaroga + + - 38. Vishamagni + - -

3. Kukshiroga + - - 39. Sphikshoola + - -

4. Vatasanga + + + 40. Janushoola + - -

5. Mutrasanga + + + 41. Janghashoola + - -

6. Malasanga + + + 42. Urushoola + - -

7. Shukrasanga + - + 43. Gulphashoola + - -

8. Balakshaya + - - 44. Parshnishoola + - -

9. Mamsakshaya + - - 45. Prapadashoola + - -

10. Doshakshaya + - - 46. Yonishoola + + -

11. Shukrakshaya + + - 47. Bahushoola + - -

12. Aadhmana + + + 48. Angulishoola + - -

13. Angasupti + - - 49. Sthanashoola + - -

14. Krimikoshta + - - 50. Dantashoola + - -





15. Udavarta + + - 51. Nakhashoola + - -

16. Sudhatisara + + + 52. Parvasthishoola + - -

17. Parvabheda + - - 53. Shopha + - -

18. Abhitapa + - - 54. Stambha + - -

19. Pleehadosha + - + 55. Aantrakoojana + - -

20. Gulma + + + 56. Parikartika + - -

21. Shoola + + + 57. Maharogoktavatavyadhi + - +

22. Hridroga + - - 58. Jwara - + +

23. Bhagandara + - - 59. Timira + + -

24. Unmada + - - 60. Pratishaya - + -

25. Jwara + - + 61. Adhimantha - + -

26. Bradhna + + + 62. Ardita + + -

27. Shirashoola + + + 63. Pakshaghat + + -

28. Karnaroga + - - 64. Ashmari - + -

29. Hritshoola + - - 65. Upadamsha - + -

30. Parshwashoola + - - 66. Vatarakta - + -

31. Prushtashoola + - - 67. Arsha - + -

32. Katishoola + - - 68. Stanyakshaya - + -

33. Vepana + - - 69. Manyagraha + + -

34. Aakshepa + + - 70. Hanugraha + + -

35. Angagaurava + - - 71. Ashmari - + +

36. Atilaghava + - - 72. Moodhagarbha - + +

INDICATIONS FOR ANUVASANA BASTI

Anuvasana is indicated in patients who are already indicated for asthapana, but

specialmentionhasbeengiventocertainconditionslike ruksha, kevala vata rogaand

atyagni where anuwasana basti is more beneficial.

Table No-20 Showing Person Ayogya For Anuvasana Basti:102

Sl. No. Contraindications Ch. Su. Vag.

1. Ansthapya + + +

2. Abhuktabhakta + - +





3. Navajwara + - -

4. Kamala + - +

5. Prameha + - +

6. Arshas + - -

7. Pratishyaya + - -

8. Pandu + + +

9. Arochaka + - -

10 Mandagni + - -

11 Durbala + - -

12 Pleehodara + + +

13 Kaphodara + + +

14 Urustambha + - +

15 Garapeeta + - +

16 Kaphabhishyanda + - +

17 Gurukostha + - +

18 Shleepada + - +

19 Galaganda + - +

20 Apachi + - +

21 Krimikoshta + - +

22 Prameha - + +

23 Kushta - + +

24 Sthaulya - + +

25 Peenasa - - +

26 Krushna - - +

27 Varchobheda + - +

28 Vishapeeta + - +

PREPARATION AND PROCEDURES OF BASTIKARMA:

The preparation and procedures made before, during and after administration

of Niruha, Anuvasana, Uttara Basti with little differences. Generally, these procedures

are classified into three parts: -





1. Poorvakarma

2. Pradhanakarma

3. Paschatkarma

In classics many complications are mentined that are produced due to

improper and in efficient administration. Better practical experience is necessary to

prevent the possible complications.

Selected patients for Basti therapy have to undergo through clinical

examinations to ascertain the physical as well as the mental conditions. Usually the

following ten factors are to be considered for clinical examination.

1. Dosha 2. Oushadha 3. Desha 4. Kala 5. Satmya

6. Agni 7.Satwa 8. Vaya 9. Bala 10. Auka Satmya

This will enable the physician to decide, the type of Basti, number of Bastis,

Basti dravya, etc to be administered in the particular patient.

A REVIEW OF MATRA OF NIROOHA BASTI ACCORDING TO

DIFFERENT ACHARYA.

Basti is one among the five shodhana procedure explained in ayurveda. It is a

treatment of choice in vata vikara. The quantity / matra of basti varies according to

age. Different measurement of basti dravya has been explained by acharya charaka,

sushruta, vagbhata etc.

Explanation of basti by different acharyas is given below:-

Charaka samhita- Acharya Charaka has explained the matra of nirooha basti in

prasruta pramana. Matra of basti dravya at the age of 1 year is ½ prasruta,for





the progressive year the matra must be increased by ½ prasruta. At the age of

12 year it becomes 6 prasruta. From 12 year of age to till 18 year it becomes

the matra must be increased by 1 prasruta, then at the age of 18 year it become

12 prasruta,the same matra is maintain upto 70 year of the age. The basti

dravya matra for person > 70 year of the age is same age of a 16yr i.e. 10

prasruta.

Table No-21 Showing Matra in various Age Groups:

Sr.No. Age (yr.) Acc. to Caraka

(Prasruti)

Acc. to Vagbhata

(Prakuncha)

Quantity In Tola

1 1 ½ 1 4

2 2 1 2 8

3 3 1½ 3 12

4 4 2 4 16

5 5 2½ 5 20

6 6 3 6 24

7 7 3½ 7 28

8 8 4 8 32

9 9 4½ 9 36

10 10 5 10 40

11 11 5½ 11 44

12 12 6 12 48





Sushruta samhita:-The basti dravya matra for asthapana basti should be equal

to the quantity that can be held in the once aatura(palm of the hand of patient)

or 2,4,8,12 prasruta respectaly for the age of 1,8,16,25 years of old person.

Table No-22 Showing Matra of Nirooha Basti According to Age with respect to

Anjali Pramana103

:

Ages of the person Quantity of niruha basti

in prasruta

Quantity of niruha basti

In anjali pramana

1 year 2 prasruta 1 anjali




Above 70 years 8 prasruta 4anjali

The quantity of niraha basti matra should in increases according to

age,strength, and physique of the person.

13 13 7 Same as Charaka

in Prasruti 7

56

14 14 8 8 64

15 15 9 9 72

16 16 10 10 80

17 17 11 11 88

18 18 12 12 96

19 19-70 12 12 96

20 Above 70 10 10 80





Ashtanga hridaya:- Acharya Vagbhata has explained basti dravya matra of

nirooha basti be 1 prakuncha( 1 pala= 48gm.) at the 1st year of age. For each

succeeding year it should be increased by 1 prakunja, till it become 6 prasruta(

1 prasruta= 2 pala), i.e. at the age of 12 year of age the matra is 6 prasruta.

Further it should be increased by 1 prasruta till it become 12 prasruta at the

age of 18 years. This matra is fixed upto the 70 years of the age and for the

more than 70 year of age 10 prasruta is advice.

Sharngadhar samhita:- Matra of nirooha basti is divided into 3 parts i.e. uttam,

madhayam and hina.

Table No-23 Showing Kashaya Basti Matra According to Doshik Predominance:

Matra by doshadi

bala,abala

Matra on based of MANAK

mana

In tola.

Uttama Prastha padaottaram(1 ¼ prastha) 80 tola

Madhyama 1 prastha 64 tola

Hina Kudava traya(3 kudava) 48 tola

Chakradatta:- Chakrapani has explain that nirooha basti matra according to

doshika predominance i.e. in

Table No-24 Showing Matra Of Nirooha Basti based on Doshik Predominance:





Dosha makshika Snahana Kalka Kashaya Prashepaka

dravya

VATA 3 pala 6 pala 2 pala 10 pala 3 pala

PITTA 4 pala 4 pala 2 pala 10 pala 4 pala

KAPHA 6 pala 3 pala 2 pala 10 pala 3 pala

Kashyapa samhita:- Acharya kashyapa has explain the basti dravya matra of

nirooha basti in prasruta pramana. According to him the matra can be

increased considering roga avastha and bala. in the same way matra has to be

increased and decreased according to considering the roga,bala and abala as

well.

ANUVASANA BASTI:

Poorva Karma:

The patient should pass his natural urges then body of the patient should be

anointed with suitable sneha dravya and mrudu sweda with hot water should be given.

He is advised to have his prescribed meal which is madyama matra and made to take a

short walk. Patient is asked to lie over Basti droni which is not very high, and the

head must be at lower level. The patient should be on his left side drawing up the right

leg and straightening the left leg.

Reasons for giving Anuvasana Basti after food:





The Gunas of the taila are Vyavayi, Tiskhna, Ushna and Sukshma. These

properties help the Sneha Dravya to move to the upper part of colon and reach the

Agnyashaya and destroy the Agni & digestive power. The foods taken before

Anuvasana Basti prevent such movements and will allow oil to stay and act in the

Pakwashaya. Hence, the Sneha is to be administered after food. If Anuvasana Basti

given before food patient develops complication like Agnimandya, Chardi, Bhrama.

Basti Dravya preparation:

Saindhava Lavana and Sathahva Choorna are added in small quantity with the

Anuvasana Taila. The adding of Saindhava & Kalka of Sathava increases the Vata

Shamana Property. By mixing above two items thoroughly, add the Sneha Dravya

slowly and mix it up.

Pradhana Karma:

The prescribed amount of taila should be taken in the Bastiputaka and tied

well placing the Bastinetra in position. Air is trapped from Bastiyantra by gently

pressing the Bastiputaka. Then the anal region and the netra should be smeared with

oil to minimize the pain and irritation. Gently probe the anal orifice with the index

finger of the left hand and introduce the Bastinetra through it into the rectum upto the

mark of first karnika. Keeping in the same position press the Bastiputaka by putting

the adequate force then withdraw from the sight.

Importance of Left Lateral Position:

Guda and grahani are in same path in the left side of the body so it is easy to

penetrate the Basti dravya into the pakwashaya. Three Rectal Valves- a) Superior b)

Middle c) Inferior. Middle one is important, which is situated in the right side of

rectum. It plays an important role in defecation process. In Left lateral position this

valve is protected, other than this position is adopted then the valve is injured and





produces feacal incontinence. This position helps in the gravity because of

Anatomical slope, it facilitates passing of Basti Dravya across the rectum to other

areas. In right lateral position Basti Dravya has to go against gravity. The duration of

time for squeezing the enema bag shall be 30 matras i.e. ½ to 1 minute for Anuvasana

Basti.

Paschat Karma:

The patient is kept in same position as long as it would take to count up to

hundred.The patient should be gently struck three times on each of the soles and over

the buttocks. The distal part of the cot should be raised thrice. Allow him to lie for

sometime in the same position, if given sneha passed immediately; another anuvasana

Basti should be adopted. After passing the motion with sneha in proper time the

patient is allowed to take light food if he feels hungry.

Retention of Matra Basti:

The normal Pratyagamana Kala of Sneha Basti is 3 Yama i.e. 9 hours. Being a

type of Sneha Basti, the Pratyagamana Kala of Matra Basti is also 3 Yama i.e. 9

hours. There is no harm if Matra Basti retains in the body because, while describing

Anuvasana Basti it has been said that it is not harmful to body even in the event of its

being retained in the body for a whole day. Also the dose of Sneha in Matra Basti is

very small, which can get easily absorbed in the body without coming out. It is

believed that Sneha Basti should be retained in the body. If Basti material returns

much earlier, it cannot produce the desire effect in the body.

Table No-25 Showing Sneha Basti Vyapat:104

Sr.no Sneha vyapata Lakshana Chikitsa

1 Vata avrita Agnimandya, Jwara, Niruha basti prepared by rasna,





sneha Adhmana, Stambha,

Urupida, Parshwashula

pitadaru, sura, sauviraka, kola,

kulattha, yava, gomutra, panchamula.

2 Pitta avrita sneha Daha, raga, trasa, moha,

tamaka and jwara

Basti prepared with madhura amd

tikta dravyas

3 Kaph avrita

sneha

Tandra, sheeta, jwara,

alasya, praseka, aruchi,

gaurav, murccha and

glani.

Basti prepared with kashaya, katu,

tikshaya and ushna dravya and with

sura and gomutra and mixed madana

phala and amla dravas.

4 Anna avrita

sneha

Chhardi, murccha,

aruchi, glani, shula,

nidra, agni mandya and

ama lakshanas with

daha.

Kashaya and choorna of katu and

lavana dravyas, mrudu virechana.

5 Purish avrita

sneha

Purisha sanga, mutra

sanga, vata sanga, shula

gaurava, adhamana and

hridaroga.

Snehana, swedana, along with

phalavarti. the anuwasana basti and

niruha basti prepared with shayama,

bilva etc. Should be used. Also the

treatment indicated in udavarta

should be followed.

6 Avabhukta

pranita basti

It reaches up very high

and from there it may

reach the throat and may

come out from yje upper

orifice of the body.

Niruha basti and anuwasana basti of

sneha prepared with gomutra,

shyama, trivritta, yava, kola, kulattha

should be given and condition where

it is coming out the throat. It should

be treated kashaya dravyas, pressure

on throat by virechana and

chardhighrana is measure.

Pathya – Apathya:

The Matra Basti does not demand any regimen of diet or behaviour. It can be

given at all times and in all seasons without any restriction. However, Ashtanga

Samgrahakara has restricted the day sleep after being treated with Matra Basti.

Samyak Yoga Lakshana of Sneha Basti:

The Lakshana of Samyaka Anuvasana are the return of Sneha with the fecal

matter without being stuck up anywhere, the clarity of Rakta, Mamsa etc. Dhatus and





sense organs, good sleep, lightness of body, increase of strength and regulation of the

excretory urges.

COMPLICATION OF ANUVASANA BASTI

Though it is said that there is no major complication by the use of Matra Basti

but sometimes complication may be produced due to obstruction of Sneha by Vata,

Pitta, Kapha or by excess of Mala or food and when given to a person on empty

stomach. These are six conditions of complications likely to arise during the use of

Sneha Basti.

NIROOHA BASTI:

Poorva Karma:

Basti is to be administered when the patient is having the symptoms of

Jirnahara and doesn‟t have very much hunger. Abhyanga and swedana should be done

prior to the procedure and the patient is advised to lie on the cot as in Anuvasana

Basti( left lateral position).

Reason for giving Nirooha Basti in Empty stomach:

According to some Acharyas, Kashaya Basti has to be administered after

proper digestion of the previous meal which means empty stomach. When there is

empty stomach there is naturally Vata vruddhi. So administering Kashaya Basti in

empty stomach pacifies vruddha Vata.

Procedure for mixing of Nirooha Basti:





In our classics the order of mixing of Kashaya Basti is clearly mentioned. It

includes Madhu, Saindhava, Kalka, Kashaya and Avapa Dravya. First madhu is taken

in the vessel. Acharya kashyapa105

opines, madhu is auspicious hence taken first,

subsequently other contents are added and churned continuously. Then saindhava is

added, it causes disintegration of picchila, bahula and kashayata of madhu by its

teekshna guna. Then sneha is added followed by kalka and kwatha. At last avapa

dravyas like mutra etc are added and churned to obtain a uniform mixture. Addition

should be such that the mixture should be homogenous before adding next ingredient.

Madhu:

It forms the homogenous mixture with the Saindhava and it is best among the

vehicles.

Saindhava:

Due to its Ushna, Tiksha, properties, it is easily mixed with honey and forms

homogenous mixture. It destroys the Picchila, Bahula and Kasaya properties of honey.

Sneha:

The qualities of Sneha like, Snigdha and Guru get mixed with above solution

and form again a uniform mixture. It counteracts some of irritating properties of both

Madhu and Saindhava.

Kalka:





This is one of the ingredients mainly according to the disease. Kalka gives

thickness to the Basti Dravya. We can use the fresh drugs in the form of Kalka, those,

which we cannot use for the decoction. Again the drug containing volatile properties

can be used in the form of dry powder or paste.

Kwatha:

This is the main content of Basti dravya. The drugs used for decoction are

mainly according to the disease and the stage of the disease. The drugs, which are

water soluble we can use by this way. Water base is always essential for the

absorption of the drugs from the intestine. The Kwatha gives essential quantity to the

Basti Dravya for administration during preparation it gets mixed with above mixture.

Avapa:

The fluids which are added at the end are avapa dravyas. These are mootra,

kanji for kapha dosha, ksheera for pitta dosha, mamsa rasa for vata dosha

predominance of the patient.

VARIOUS METHODS ADOPTED FOR BASTI MIXING

Conventional churing method

Mixing with Churner

Characteristics of a well prepared Basti Dravya106

:

A well prepared Basti Dravya should not run quickly out of the hand nor it

should stick/coat or remain steady on the hand. It should be uniform mixture without





separation (Samhata) of its contents. After preparing the Basti Dravya, it is to be filled

in the Basti Putaka which is clean and devoid of Putaka Dosa, than the Bastinetra

which is clean and devoid of Dosha is to be tied with the Basti Putaka in such a way

that air will not be present in the Putaka, than a cotton piece is to be kept in the hole

of the Basti Netra.

Pradhana Karma:

It includes advise to the Patient, Basti Pranidana, Basti Pratyagamana and

observing the Samyaka yoga, Ayoga and Atiyoga Lakshana.

Advise to the patient:

Patient is to be asked to pass his natural urges before Basti Pranidana and not

to laugh, cough, sneeze and take the yawnings while administering Basti.

Basti Pranidana:107


Jirnahara and is not very much hungry. After performing Saravadaihika Abhyanaga

and Sarvadaihika Bashpa Sveda, the patient is asked to lie down in the left lateral

position on the Basti table which should be cleaned and covered with the bedsheet,

then is asked to keep his left hand below the head as a pillow, to extend the left leg

completely and to flex the right leg at the Knee Joint keeping on the left leg by flexing

the hip Joint. Then Sukhosna Sneha is to be applied in the anal region and on the

Bastinetra, remove the cotton piece and the air bubble if any and keep the thumb on

the Netra till introducing it. Then introduce the Bastinetra gradually in the parallel

direction to that of the vertebral column upto 1/4 part of the Netra i.e till the





nearerKarnika fixes over the anus. Then hold the Basti Putaka in the left hand and

keep the right hand on the Putaka and press it gradually with the constant pressure

neither too fast nor to slow without any tremor of the hand. By asking the patient to

breath in push the Bastidravya into the rectum till a little quantity remains in the

Putaka otherwise Vayu enters into the Pakvasaya. And then withdraw the Netra

gradually.

Then the patient is asked to lie down in the supine position gradually and

Sphikatadana is to be done slowly and softly 3-4 times and the foot end of the table or

the legs of the patient are to be lifted three times slowly. The patient is then asked to

lie in a comfortable position with a pillow below the hips till he gets the urge for

defecation and when he/she gets the urge ask him/her to sit in Utkatasana and pass the

urge.

VARIOUS MODIFIED METHODS OF ADMINISTRATION OF BASTI

Conventional enema can method

Matra Basti by Metal Syringe and Catheter

Basti Pratyagamana:

One Muhurta (48 mts) is the maximum period of time with in which the

Pratyagamana of Basti should occur. If it does not occur then it causes untoward

consequences like Vata Pratilomata, Vistabdhata, Sula, Arati, Jvara and even

death.Hence if it doesnot comes out within the stipulated time period certain measures

are to be undertaken for the Basti Pratyagamana like administration of the Tiksna





Basti,Phalavarti, Svedana over the pelvic region, Utrasana (Showing fear) and

administration of Virechana oushadhi. Till the Pratyagamana takes place, the

physician should observe the patient. However Kasyapa opines that Yapana Basti

owing to its Mrdu nature, retains for longer time, and Tiksna Basti comes out in 100

matra period, hence Atitikshna Basti should not be administered.

Table No-26 Showing Samyak Yoga - Ayoga - Atiyoga Lakshana of Basti:108

Sl.no. Lakshana

1 Samyak Prasrsta Vitkata, Prasrsta Mutrata, Prasrsta Vata,

Kramena - mala, Pitta, Kapha & Vayu Visarjana, Laghuta,

Ruci, Agnidipti, Asaya Laghuta, Rogopa Shamana,

Prakrtisthitata, Bala Vrddhi.

2 Ayoga Siro - Hrt - Guda - Basti - Medhra Vedana, Sotha,

Pratisyaya, Parikartika, Hrillasa, Vatasanga, Mutrasanga,

Svasakrcchrata, Alpa Vega, Alpa Basti Pratyagamana, Alpa

Mala- Anil Pratyagamana, Aruci, Gaurava. In Ayoga,

measures for Basti Pratyagamana should be undertaken.

3 Atiyoga These Lakshanas are similar to that of Virecana

Atiyoga. i.e. Angasupti, Angamarda, Klama, Kampa, Nidra,

Daurbalya, Tamapravesa, Unmada, Hikka. In atiyoga, Grahi,

Dipana, Pacana Oushadhi are to be administered andaccording to

symptoms it is to be managed.

Paschat Karma:

After the pradhana karma patient is lie in supine position pillow should be

placed below the Shroni pradesha. The other procedures followed in anuvasana

should not be done in this codition. After passing motion he may be advised to take

bath with hot water and have normal food along with yusha, mamsarasa or milk in

kapha, vata and pitta predominant diseases respectively. The maximum time for basti





pratyagamana is one muhurtha (48 minutes). If it did not pass out, giving Basti, which

consists of sneha, kshara, mutra, amla dravyas and Phalavarti, can bring it out. If the

Niruha is passed out instantly again 2 or 3 Bastis can be given. But if the patient

shows aggravated symptoms of vata, sneha Basti should be given immediately. As

jataragni is not much hampered; so specific regimen is not necessary during the

pariharakala.

Pathya Ahara - Vihara and administration of Anuvasana Basti :-

After observing the Samyaka Nirudhita Lakshana, the patient is advised to

take hot water bath and light diet in accordance with the dominance of Dosa i.e. Yusa,

Ksira & Mamsarasa in Kapha, Pitta and Vata dominant conditions respectively or in

general, Mamsarasa with rice is to be taken. The hot water bath and food taken

prevents the occurance of diseases produced by agitated and moving Mala caused by

Basti. The patient should also be advised for not doing heavy laborious work, day

sleep, sexual intercourse etc. and in the evening Anuvasana Basti is to be

administered.

Ashta Maha Dosha kara Bhavas:109

The patient should avoid all the prohibited activities as said by the physician

but he should avoid the eight factors which are exceedingly harmful.

1. Uchchaih bhasya: speaking loudly for long period of time

2. Ratha Kshobha: traveling in uneven roads.

3. Ati chankramana: excessive walking.





4. Ati asana: improper posture

5. Ajirna: intake of food which cannot be digested.

6. Ahita bhojana: food intake which is non condusive to health.

7. Diwaswapna: sleeping in day time.

8. Maithuna: sexual intercourse.

COMPLICATIONS OF NIRUHA BASTI:

Generally Basti vyapatas are classified under two categories:-

o Basti Kruta

o Vaidya Kruta

Basti vyapats:

Table No-27 Showing Twelve Bastikruta vyapats which are explained in classics

those are as follows:110

Sl.no. Vyapats Lakshana

1 Ayoga If administred less quantity of basti dravya, saidhava add oil leads

to heaviness in abdomen, obstruction of flatus stool and urine, local

burningsensation, inflammation, itaching, anorexia and dyspepsia.

2 Atiyoga Administration of teekshna basti in mridu koshta person leads to

atiyoga and symptoms are similar as in vamana-virechanma

atiyoga.

3 Klama Condution of mridu basti in ama avastha, pitta and kapha gets

vitiated and srotorodha, leads to dyspepsia.There after vata also

become vitiated and couse fatigue, syncope, burning sensation,





colic, chest pain, heaviness.

4 Adhmana Due to administration of alpa veerya to strong person,rookshan

person and costive bowel, the drugs not able to expel vitiated dosha

and vata gets vitiated leads to adhmana cousing pain in basti and

hridaya,severe burning sensation pain in testicles and groin.

5 Hikka Hiccup resulp in administering teekshna basti to weak person and

mrid koshta with excessive expulsion of doshas.

6 Hritprapti Bastidravya reaches the heart by entering into deeper levels due to

complete squeezing or improper handling of bastiputaka and causes

pain in the chest and surroundings.

7 Urdhwaga

mana

Suppression of urges before or after bastikarma and squeezing

bastiputaka with high pressure leads to the upward movement and

may come through mouth.

8 Pravahika Administration of less potent and insufficient quality of bastidravya

to the person suffering from intensive vitiated doshas leads to

pravahika.

9 Shiroarti Includes symptoms of headache, earache, deafness, tinninus and

coryza, eys disorders due to administration of less potent

sheetaveerya dravyas with insuffient quantity toweak persons.

10 Angarti Administration of teekshna basti without conducting preoperative

procedure like abhyanga and sweda leads to angarti with upward

movement of vata and twisting and pricking pain in the body.

11 Prakastika Administration of ruksha and teekshan basti inexcessive quantity to

the person having mridukoshta and in conduction of less vitiated





dosha leads to the excessive expulsion of dosha causing parikartika.

12 Parisrava Administration of teekshana and ushna. Basti to the person

suffering from pitta roga/ raktapitta leads to parisrava and couse

burning sensation,erosion and cutting pain in anal region,severe

bleeding and fainting

Vaidya Kruta Dosha:

Table No-28 Showing Vaidyakruta Dosha Vyapads:

Sl.no. Vyapads Lakshana

1 Sa Vata Bastidana Entry of an air into rectum leads to pain in

abdomen and colic.

2 Druta Praneeta Quick administration Basti dravya leads to pain in

hip, anus, thigh, calves and retention of urine.

3 Tiryak praneeta Horizontal introduction leads to blockage at the

tip of bastinetra. Introduction of Bastidravya

bypressing Basti Putaka more than once leads to

pain, headache and pain in thighs.

4 Ullipta Introduction of Bastidravya by pressing

bastiputaka more than once leads to pain,

headache, pain in thighs.

5 Sakampa

Bastidana

Shivering while administration leads to erosion,

burning and swelling at anal region. Not deeply

introduced leads to burning pain in intestines.

6 Apraneeta Not deeply introduced leads to burning pain in

intestines.

7 Atimanda data If done too slowly, drug does not reach till

intestines.

8 Ativega data Forceful introduction leads to the dravya reaching

upto koshtha and sometimes may come out

through upper orifices.

PHARMCO DYNAMICS OF BASTI

Anuvasana Basti:

Anuvasana Basti is being a small quantity; it retains in rectum and colons,

absorbed into the body and performs its actions as mentioned. Rectum with its





vascularity (Haemorrhidal veins) and venous plexus provides good absorbing surface

and many soluble substances enters into the systemic circulation produces their effect

more quickly without passing the liver where they may be destroyed.

Kashaya Basti:

Shodhana Basti is being a Kwatha predominant Basti which enters into

Pakwashaya and gets absorbed into the body by virtue of vyavahi, vikasi gunas of

Basti dravyas dwell the doshas from tissue level and brings to pakwashaya and throws

out from the body.

In other words it can be hypothetically explained that, being a hypertonic

solution (Nirooha Basti) after entering the large intestines the fluids may transfer

because of osmosis from hypotonic to hypertonic solutions i.e. fluid along with the

toxic material dragged from intracellular and extra cellular level into the large

intestines and throws out from the body.

Basti Karmukata:

Ayurveda is having its unique approach of explaining the complex subjects by

giving the similes which are commonly seen in day to day life to understand the

subject easily. Similes were used, because the objective parameters were not

developed to an extent as they are today. Similes were used to explain complex

mechanisms in the Physiology, Pathology (Symptomatology) and in The Therapeutic

Measures. The same is true in the case of Basti also.

Eliminative or purificative action of the Basti:

Basti administered into the Pakwashaya draws the Dosa/Mala from all over

the body from the foot to the head by virtue of its Virya, just as the sun situated in the

sky draws the moisture from the earth by virtue of its heat.Why only the waste





substance (Mala) is eliminated, this is explained by another simile as follows i.e. as

the cloth sucks up the pigment only from the water dyed with Kusumbha flower;

similarly Basti eliminates only the Mala (waste substances) from the body.

Systemic Action of the Basti:

The Virya of the drugs administered through the Basti into the Pakwashaya

reaches the whole body through the channels (Srotas), as the active principles in the

water when poured at the root of the tree reaches the whole plant.

Nutritive Action of Basti:

Just as a tree fed with water at its roots, puts forth green leaves and delicate

sprouts, and in due time grows into a big tree, full of blossom and fruit, similarly does

a man grow strong by means of Anuvasana Basti.In order to explain the manner in

which it occurs, Chakrapani quotes aquotation from Parashara i.e.

Mulam Gudam Sharirasya Sirastatra Pratishthita,

Sarva Shariram Pushnanti Murdhanam Yavadshrita. (Parashara)

Guda is the Mula of the body and the vessels present in that region provides

nourishment to the whole body with the help of substances poured in it.

Supportive views from the Modern Science:-

Brimhana Basti improves the health of the bacterial flora of the intestine

thereby enhancing the production of Vitamin K and B complex Both the Vitamins are

very much essential particularly B complex plays significant role in preventing

Degenerative Neurological Disorders.

The route of drug administration depends upon the following factors:-

1. Physical and Chemical properties of the drug (Solid, liquid, Gas),

solubility, Stability, PH, Irritability.





2. Site of desired action: Generalized and not approachable or localised and

approachable.

3. Rate and extent of absorption of the drug from different sources.

4. Effect of digestive Juices and first pass metabolism of the drug.

5. Rapidity with which the response is desired.

6. Condition of the patient.

The drug administered through systemic route is intended to be absorbed into

the blood and distributed all over the body including the site of action through

circulation

PROBABLE MODE OF ACTION:

It is practically seen that after appropriate administration of Basti karma the

signs and symptoms of Vatavyadhi will be reduced.

Left lateral position is the best posture for better and effective administration

of basti as anal canal turns to left side to rectum, sigmoid colon and descending colon

where more mala to be dissolved and is present. Moreover, medicines stay at these

surfaces, get absorbed more and show their best effect. The absorptive area of mucosa

is more on this side. On left side colon area is easily approachable through anus rather

than on the right side and this posture relaxes the ileo-ceacal junction and makes the

easy flow into the sigmoid colon. According to modern science, as per Basti/Enema

concerned, in trans-rectal route, the rectum has a rich blood and lymph supply and

drugs can cross the rectal mucosa like other lipid membrane. Thus, unionized and

lipid soluble substances are readily absorbed from the rectum. The portion absorbed

from the upper rectal mucosa is carried by the superior haemorrhoidal vein in to the

portal circulation, whereas that absorbed from the lower rectum enters directly into

the systemic circulation via the middle and inferior haemorrhoidal veins.





The advantage of this route is total gastric irritation is avoided and that by

using a suitable solvent the duration of action can be controlled. Moreover, it is often

more convenient to use drugs rectally in the long time in case of geriatric and

terminally ill patients.

Bastidravya enters into the Pakwashaya. It is the place where the water and

minerals are absorbed in proximal colon. Sodium and potassium which are essential

fundamental factors for nerve impulses and Vit B12 which is essential factor for the

development and proper functioning of the nervous system are also absorbed from the

colon i.e. Pakwashaya. Bastikarma helps to increase the absorbing capacity of the

colon by its actions.

Behind the Pakwashaya, there are large numbers of nervous plexuses

originating from the hypo gastric plexus and lumbo-sacral plexus etc. These plexus

will get nourishment and soothing effect from Bastikarma because Basti mainly acts

on the Pakwashaya, here it nourishes, purifies and expels the unwanted toxins from

the Body. Another probable method is based on Veerya. It is possible that the Veerya

of the Basti dravya pass through the autonomic nervous system and expels out

vitiated\ Dosha from the body. It is described in the modern physiology that the wall

of the rectum has pressure receptors. Whenever the stool enters the rectum, these

receptors are stimulated and the defecation reflex is initiated.

When Bastinetra is introduced in the rectum the same phenomenon may take

place, which results in initiation of defecation reflex due to visceral distension and

pressure response. As regard the absorption of basti dravya, it is reported that the

water is absorbed 60%-80% from the gut and normal saline is absorbed freely. Amino

acids are also reported to be absorbed. Absorption in the proximal colon is better than

the distal part.





Fig No 01- Showing Mode Of Action Of Nirooha Basti:

` Mode of action of nirooha basti

Pakvashaya ashrita basti dravya

Proximal half of the colon has more absorption rate

Gets absorbed into the intestinal walls by osmosis and

diffusion process

Enters into capillaries

Superior mesenteric vein and splenic vein

Enters into portal vein

Inferior venacava

General circulation

KATIGRAHA

INTRODUCTION

The delicate yet magnificent anthropometry of human body had been a

wonder to the master minds of science as well as arts. The specifications are so





minute that one may wonder how human beings survive without disturbing such

specific anthropometry. Vertebral column (Prishtavansha) can be compared to a pillar

which bears the whole weight of body.

The backache or lumbago is one of conditions which results from violation of

bio mechanics of spine as it results when the physical and mental strain and faulty

postures alter anthropometrical precision. The 70-80% of world population suffers

from backache at some point of their life. The present age speed and competition had

increased stresses and strains resulting in to increasing the prevalence of life style

related health problems and at times it becomes difficult to even give a specific name

to a disease condition. Thus Acharyas have correctly advised that,“Any symptom

may manifest as a separate

ज्ञ्यानार्थयाननचोक्ताननव्यानिनिन्गाननसगं्रहे

व्याियस्तेतदात्वेतुनिन्गाननव्यानननामया:

(Ch.Ni.8/40)

In classics Katigraha is presented as both- disease as well symptom. As a

disease it is one among the eighty Nanatmaja Vata Vikara In Ayurveda there are

different diseases in which Graha is given as a symptom, i.e. Manyagraha,

Prishthagraha, Katigraha etc., in same way due to causative factors, when Graha

occurs at Kati region, that condition is called as Katigraha.

“Any symptom may manifest as a separate disease.”Thus each disease can

become a symptom and each symptom may manifest as a disease. Hence a group of

symptoms put together is termed as a disease. Various terminology has been used in

Samhita to label the entity, disease i.e. Vyadhi, Ruja,Papma, Atanka etc and each of

these terms hold a specific scientific meaning where body and mind is subjected to

pain/misery and suffering. Sushruta Acharya declares that which ever traumatizes





body and/or mind should be termed as disease. The definition of health according to

the classics shows the requirement of equilibrium in physical component– Dosha,

Dhatu and Mala as well as psycho spiritual component– Atma, Mana and Indriya.

Agni which keeps a person alive affects the state of both these components therefore

it is said that all diseases occur due to Mandagni.The main causative factors for any

disease production are 3 Dosha (Vata, Pittaand Kapha). When a disease occurs due to

pure vitiation of one Dosha it is termed as Nanatmaja Vyadhi. Though Kati Graha has

not been described as a separate disease entity by any text except Gada NiGraha it has

been categorized under Vatika Nanatmaja Vyadhi in Charaka Samhita. The

Nanatmaja Vikara can be categorized as, Akarmanyata Pradhana (loss of function

predominant), Kampa Pradhana (tremors dominant), Shula Pradhana (pain dominant),

Shosha Pradhana ( wasting/ degeneration predominant) or Stambha Pradhana

(stiffness predominant). Kati Graha is Shosha, Stambha and Shula predominant

Vyadhi. As correctly said by SushrutaAcharya without vitiation of Vata, Shula (pain)

can not be produced.

वाय:ु कक्ष्याश्रित: शधु्द: सामोवाजनयेतरुजम।

कटीग्रह: सश्रवजेय: पन्गुसश्रथिआश्रित: ॥

As Gada Nigraha clearly states pain is produced due to stiffness produced by

Saama or Niraama Vayu movement in to Kati hence this suggests of presence of

Dhatu Kshayatmaka and Marga Avarodhaka type of Samprapti.

In the coming pages an attempt has been made to justify the usage of the word Kati

Graha in the present work to explain the disease Lumbar Spondylosis by stating the

etymology, causes, pathogenesis, clinical picture etc and making scientific

correlation.

NIRUKTI:





The Sanskrit word Kati Graha is made out of 2 words, i.e. Kati and Graha.

Kati:

Acc. to Amarkosha kati means shroni(pelvis) & accoreding to shabadakalpa

druma kati is a body part situated near shroni and has circumference 16 angula.

कट् + इन्शारररअवयवश्रवशेष:

कट्िोश्रिफलक:

कटयतेवस्त्राश्रदनाश्रियतेअसौ

Vachaspatyam: िोश्रिदेशे “Kati Gatyam” Gatyam Dhatu means movement and

when “in” Pratyaya is added the word Kati is derived.Thus Kati is a bony

structure situated near Shroni and is of 16 Anguli.

According to Parishadya Shabdartha Shareeram, the region which is situated

in between Uraha and Nitamba is called as Kati. Thus it can be taken as lumbo-sacral

region (low back); lower part of the back and site in between the ribs and pelvis. The

term Kati is also considered as hip, buttocks and lumbar region.

In classics, Kati is stated as the seat of Vata Dosha. As Shroni is said the synonym of

Kati, it can be consider as the seat of Apanavata.

Graha- The term Graha is formed by the root „Gany‟ meaning Grahana according to

Shabdakalpadruma. Nirukti of Graha is that which has Sanga as a prominent feature.

1. Vachaspatyam गहृिाश्रतगश्रतश्रवषेशाश्रनश्रत – ग्रहयश्रतग्रहश्रतग्रहिे

“Graha ko Grahyati Graahati, Ash aangaadireva Manyate”, Graha of the

different parts of the body is termed Graha.

2. Monnier Williams‟ Sanskrit-English Dictionary: Graha means seizing,

holding, catching or obstruction.





In Ayurvedic clas sics this word has been used in different contexts. It has

been used to denote a branch of Ashtanga Ayurveda (Graha Chikitsa), Bala Graha

(specific group of pediatric diseases), a symptom of a disease, Vedana (pain) etc. But

here the meaning can be derived as the restriction of movements (stiffness/seizing).

Hence in this context Kati Graha denotes a group of symptoms characterized by the

restriction of movements of Kati (lumbar) region in which pain would be a main

feature as Graha alternatively means pain as restriction is said to produce pain in the

particular region. The word “Spondylos” (Greek) means Spine and “Lysis” means to

disintegrate.

Paribhasha:

Katigraha can be defined as a type of seizing or catching pain which is

occurring due to vitiation of Sama or Nirama Vata. Katigraha is a condition which is

characterized by excruciating pain and restriction of movements in lumbar spine.

Katigraha being most common disease in the clinical practice is not explained in any

Brihattrayi, as a disease. It is explained as a Lakshana in various diseases as, vrikka

vidhradhi, vankshana vidradhi. As a separate disease, it is explained in Sharangadhar

Samhita, Gadanigraha and Vrindamadhava.

Katigraha is considered as one among the 80 Vata Nanatmaja Vikara. The

Lakshana of Katigraha are Vedana and Stabdhta in Kati. When Shuddha or Sama

Vata enters into Kati, and produces the symptoms like Shoola and Stabhdata in

Katipradesha, that condition is called as Katigraha. Vrndamadhava and Gadanigraha

have given the same symptoms of Katigraha and describe its treatment in detail.





NIDANA PANCHAKA

The knowledge of Nidana is very essential for understanding of any disease.

Every disease has its own causative factors, knowledge which is essential for

diagnosis, Sadhyasadhyata and treatment. Katigraha is not explained as a separate

disease in Brihatrayis and in other texts it is not described elaborately. But as it is

counted under Vataj Nanatmaja Vikara, so Samanya Vata Vyadhi Nidana Panchaka

are considered here. The Nidana can be classified under;

i. Aaharaja (dietetic factors)

Table No-29 Showing the Aharaja Nidana of Vata Vyadhi

Ahara S.S. C.S. A.H. Y.R. M.N. V.S.

Ruksha ahara + + + + + +

Sheeta ahara + + + + + +

Alpahara + + + + + +

Laghu ahara + + + + + +

Kashayarasapradhana + + + + + +

Katurasa pradhana + + + + + +

Mudga + + + + + +

Masura - + - - - -

Nishpava - + - - - -

Harenu - + - - - -

Kalasa - + - - - -





Table No: 30 Showing the viharaja nidana for vata vyadhi:

Vihara S.S. C.S. A.H. Y.R. M.N. B.P. V.S.

Ativyama + + + + + + +

Ratrijagrana + + + + + + -

Ativyavaya + + + + + + -

Langhana + + + + + + -

Vegadhrana + + - + + + +

Vishama

upachara

+ + - _ - _ -

Shrigrayana + + - - + - -

Purvavata - + - - - - -

Dukshshayya - + - - - - +

Shrama - + - - - - +

Table No: 31 Showing the Manasika nidana of vatavyadhi:

Manasika

nidana

s.s c.s. A.H M.N. B.P. V.S. Y.R.

Chinta - + + + + + +

shoka - + + + + + +

Bhaya - + - - - - -

krodha - + - + + + +





Table No-31 Showing miscellaneous Nidana of Vatavyadhi:

Anya nidana S.S. C.S. A.H. Y.R. M.N. B.P. V.S.

Rogatikarshana + + + + - - -

Dhatukshaya + + - + + + -

Ama + - + + + - +

atiraktasrava + + + + - - -

PURVARUPA

The Purvarupa (prodromal symptoms) of diseases are exhibited during

the stage of Sthana Samshraya of the Dosha. It is important to diagnose and

treat the disease (as early as possible) at this stage, so that patient may be

saved from the functional or organic damage which may be created during

complete manifestation of the disease.

Aacharya Charaka has mentioned that Avyakta Lakshana as the

Purvarupa of the Vatavyadhi. Chakrapanidatta commenting on the word

Avyakta mentions that few mild symptoms appearing before actual

manifestation of the disease may also be taken as the Purvarupa. Gangadhara

has also of the same opinion. But Vijayarakshita, the commentator of Madhava

Nidana has given the clear meaning of the term Avyakta, according to which

symptoms not exhibited clearly, are Purvarupa and they are due to-

Weak causative factors

Very less or mild symptom

Less Avarana of Dosha

It is obvious from the above reference that Avyakta is Alpa Vyakta or less

manifested. So, as Katigraha comes under Vata Vyadhi only, in Katigraha also





Purvarupa can be taken as slender symptoms produced before the actual manifestation

of the disease.

The symptoms like mild back pain causing restrictions in the movements of

the spine, difficulty in walking due to low back pain, heaviness in the low back region

etc. can be conferm as the Purvarupa of Katigraha.

ROOPA

There are two symptoms of Katigraha stated in the classics; Ruja or

Katishoola and Katigraha or Stambha at Katipradesha. Katishoola- Pain located at the

lumbar spine, buttock or radiating to the lower limbs till thighs.

Graha - Difficulty in the movements of spine like flexion, extension, rotation

and bi- lateral movements. So the symptoms of Katigraha can be understood as, pain

and stiffness in low back region (lumbo-sacral region).

SAMPRAPTI

The morbid process taking place in the production of disease is called

Samprapti.The knowledge of Samprapti is very essential for physician. It helps in

understanding the pathogenesis of diseases and its better management. But in classics,

specific Samprapti of Katigraha is not mentioned. So, here Samprapti of Katigraha

can be assumed as, the above listed Nidana, like Abhigata etc., causes the

Khavaigunyata. Thereby leading to Sthanasamshraya of vitiated Dosha; especially

Vata (Sama or Nirama) at Katipradesh, leading to the symptoms like Katishoola and

Katigraha and manifestation of disease Katigraha takes place. In Katigraha, Vyana

Vata is affected which is responsible for the Prasarana, Akunchana of Adhoshakha.

The Sheeta Guna of Vata is increased which leads to Shula and Stambha.





Fig no- Schematic presentation of samprapti of katigraha w.s.r. to

shadkriyakala

Nidana Sevana

Chaya Vata Dosha Chaya Khavaigunya in

Katipradesha Avastha (Due to Vata Prakopaka Nidana)

(Due to specific Nidana like

excessive work, Trauma, exertion etc)

Prakopa Vata Prakopa

Avastha (With its Cala, Ruksa, Khara and

Daruna Guna)

Prasara Propagation of Vata Dosha throughout

Avastha the body

Sthana Localization of

Samsraya Prakupita Vata in

Avastha Katipradesha

.

Ksaya of local Sleshaka Kapha





Rachanatmaka and Kriyatmaka Vikriti in Kati Pradesha

Vyakti &

Bheda

Shoola and Stambha in Katipradesha

Katigraha

Samprapti Ghataka:

Dosha : Vata, Kapha

Dushya :Rasa, Mamsa, Asthi, Kandara, Snayu

Srotas : Rasavaha,Mamsavaha, Asthivaha

Sroto Dusti Prakara : Sanga

Agni : Jatharagni, Dhatvagni

Ama : Jatharagni and Dhatvagnimandya Janya Ama

Udbhavasthana : Pakvashaya

Sancharsthana :Kati Pradesh

Vyaktasthana :Katipradesh

Adhistana : Katipradesha

Rogamarga : Madhyama





Classification of Katigraha

There are different classifications are given in classics for Vyadhi like

according to Doshik involvement, nature of disease, prognosis of disease etc. In

classics, there is no classification is given of Katigraha. Given classification is made

with proper reasoning to understand it more clearly and treat according to underlying

cause.

1. Mrudu and Daruna-

The word mean of Mrudu is mild in nature, so Mrudu Katigraha can be

understand as it caused by Alpa Hetu, Alpa Dosha, Alpa Dooshana of Dhatu, Naveena

Svabhava (acute) and gets cured by simple line of treatment.

Daruna type of Katigraha caused by Balavan Hetu, Balavan Dosha involved

and more involvement of Dhatu, Chirakaleena (chronic), which requires different

types of treatment and takes more time to give relief from symptoms.

2. Svatantra and Paratantra-

Svatantra Katigraha is not caused by any other disease like Ajeerna, Jvara etc.

Having its own Nidana, Samprapti, Pratyatma Lakshana and cured by Vatavyadhi

Chikitsa.

Classification of Katigraha:

There are different classifications are given in classics for Vyadhi like

according to Doshik involvement, nature of disease, prognosis of disease etc. In

classics, there is no classification is given of Katigraha. Given classification is made

with proper reasoning to understand it more clearly and treat according to underlying

cause.





1. Mrudu and Daruna-

The word mean of Mrudu is mild in nature, so Mridu Katigraha can be

understand as it caused by Alpa Hetu, Alpa Dosha, Alpa Dooshana of Dhatu, Naveena

Svabhava (acute) and gets cured by simple line of treatment.

Daruna type of Katigraha caused by Balavan Hetu, Balavan Dosha involved

and more involvement of Dhatu, Chirakaleena (chronic), which requires different

types of treatment and takes more time to give relief from symptoms.

2. Svatantra and Paratantra-

Svatantra Katigraha is not caused by any other disease like Ajeerna, Jvara etc.

Having its own Nidana, Samprapti, Pratyatma Lakshana and cured by Vatavyadhi

Chikitsa.

CHIKITSA

In classics the treatment is divided into,

Nidana Parivarjana

Samshodhana therapy

Shamana therapy

Nidana Parivarjana:

The first line of treatment in all diseases is aversion towards Nidana. The

Nidana of Katigraha, listed above should be avoided.





Samshodhana Chikitsa:

The Samshodhana Chikitsa is applying for removal of morbid Dosha from the

body. In Katigraha, the Samshodhana Chikitsa should be selected as per the vitiation

of Dosha.As Katigraha is considering as the Vata Vyadhi, Mridu Samshodhana is

ideal one as per Vatasyaupakrama. Mridu and Snigdha Virechana will be the choice

of Shodhana in Katigraha. Shodhana Basti can be plan according to the Doshik

involvement.

Virechana:

If Katigraha does not subside by any of Shamana Chikitsa, then along with

Sneha and Mrudu Virechana should be given. Following Virechana Yoga can be

selected as per the condition, Tilvaka Siddha Ghrita, Mishrak Sneha, Saptala Siddha

Ghrita, Eranda Taila with Dugdha, and Eranda Taila with Nirgundi etc.

Shodhana Basti:

Basti is said as the best treatment modality in Vata Vyadhi. As per the

condition, Shodhana and Brumhana type of Basti can be selected for the condition of

Katigraha. The Basti like Erandamula Basti, Dashamula Basti, Vaitarana Basti,

Kshara Basti etc. will be the choice in Katigraha. Anuvasana Basti can be planned

with Vatahara Taila of Ghrita. Basti produces the Shodhana of the vitiated Dosha

mainly cantered at Pakvashaya. It is assumed that the Basti treatment contributes for

reducing the inflammation gives strength to the muscles and nerves of the affected

area, there by gives relief.





Shamana Chikitsa:

Snehana: Snehana Chikitsa is indicated in Vata Vyadhi. It can be given in the

form of Abhyantara Snehapana, Abhyanga, Seka, Pichu etc.

Svedana: Svedana is said as the Shoolahara and Stambhahara Chikitsa, thus

having important role in the management of Katigrha. The choices of Svedana in

Katigraha are, Parisheka Sveda, Avagaha Sveda, Patrapotali Sveda, Jambeerapinda

Sveda, Shashtikashali Pinda Sveda, Choorna Pianda Sveda, Nadisveda, Kati Basti,

Upanaha Sveda etc. Drava Sveda like Avagaha and Parisheka are having the

combined effect of Snehana and Svedana.

The main effects of combined therapy (Snehana and Svedana) are,

Relieves spasm

Reduces inflammation of the disc and associated structures

Relieves inflammation of nerves

Inhibits the transmission of pain impulses

Shamana Aushadhi:

The Vatahara Shaman Aushadhi can be used in the treatment of Katigraha. If

Sama Avastha of Katigraha is present, Deepan Pachan, Rookshana Chikitsa will be

helpful. For better results, Shaman Aushadhi can be used followed by Shodhana

Karma. As per condition, the internal use of Vati (Guggulu), Choorna, Kashaya,

Aasav-Arishta can be used.

Sadhya-Asadhyata:

Katigraha is a Krichha Sadhya Vyadhi because all the Vata Vyadhi are

difficult to cure and they are said as Mahagada. So being a Vata Vyadhi, Katigraha is

Krichha Sadhya. Madhyama Rogamarga, involving Marma Asthi Sandhi, vitiation of





Asthi and Majja, and Dhatukshya and occurs in Vriddhavastha; all these factors also

make it Krichha Sadhya.

ANATOMY & BIOMECHANICS OF LUMBAR SPINE:

Vata is associated with all movements in the body. Asthi and Sandhi are

Lodgingplaces of Vata. In Atharvaveda prayers are addressed to Vata deity not to

leave the body till old age thereby allowing the mobility and at the same time there

are prayers to protect the Uru, Jangha, Prishta etc. from diseases like Viskandha.

Viskandha is a condition where there is crushing pain along with burning

sensation.

Sushruta Acharya a pioneer in anatomy and surgery, in his description about

the Asthi (bones) and Sandhi (joints) mentions that the Sandhi is of 2 varieties: i.e.

Chala (movable) and Achala (immovable). Amongst these also the joints of Shakhas

(limbs) have more range of movements than that of Kati and Hanu (mandible region)

which have limited movement.

Sandhi are further classified in to 8 groups depending on the structure: Kora,

Ulukhala, Samudga, Pratara, Tunnasevani, Vayastunda, Mandala, Sankhavarta;

amongst these Kati Sandhi belongs to the Pratara type of Sandhi which have

limitedrange of movements.

This can be proved through modern anatomy as the spinalsegments have

limited range of movement as compared to the synovial joints.

The Prishtha (spine) is said to have 24 bones. Sandhi is the Upadhatu of Meda

and Sroto Mula (origin of Strotas) of Majja.According to Chakrapani Datta, Bandhana

(binding) quality of Prakrita Kapha (natural Kapha) means Sandhi Bandhana (binding

of different structures found in thejoint). Another commentator Dalhana agrees to this





idea while Sushruta Acharya has mentioned this same concept in term- Sandhi

Sanshleshana among the natural functions of Kapha.

According the modern anatomy the spinal cord which travels through the bony

structure of the spine as well as the innervations of the bony structures indicates the

Sroto Mulatva of Asthi for Majja. Kshaya or the deficiency of Shleshaka Kapha plays

a major role in degeneration, as it can be rightly correlated with the nucleaus pulposus

of the intervertebral disc, which along with its shock absorbing capacity acts as a

source of nourishment.

LOW BACK PAIN:

Low back pain: Pain in the area between the 12th rib and the gluteal folds

with or without radiation to the lower extremities. Among other popular words used

for low back pain are lumbago, dorsalgia and myalgia dorsi.

Acute low back pain: Usually defined as pain which lasts up to three months.

Such a time frame definition is roughly estimated, but is often used. In daily life low

back pain is characterised by the fact that it comes and goes with a varying number of

relapses and pain intensity. Periods of improvement/relapses often slide into each

other, sometimes it associates with episodes of acute aggravation also.

Acute low back pain is commonly condition treated by physicians in general

practice. In most cases, only conservative therapy is needed. However, the history and

physical examination may elicit warning signals that indicate the need for further

work-up and treatment. The treatment of acute low back pain usually consists of non-

steroidal anti-inflammatory agents or acetaminophen and a gradual return to usual

activities. Surgery is reserved for use in patients with severe neurologic deficits and,

possibly, those with severe symptoms that persist despite adequate conservative trea





EPIDEMIOLOGY

Low back pain is one of the top 10 reasons patients seek care from a doctor. In

epidemiologic studies of different populations, the prevalence of low back pain has

varied from 7.6 to 37 per cent. Peak prevalence is in the group between 45 and 60

years of age, although back pain is also reported by adolescents and by adults of all

ages.

National and International Guidelines

The severity of low back pain can be understood easily as there are many

national and international guidelines are made for low back pain.

• Low back pain Evidence Review from Great Britain

These are selected because they are multi professional and have the same

focus as the existing guidelines. They deal for example with the diagnostic triad,

advice in relation to activity and bed rest, manipulation and medicinal treatment, and

are directed especially to actors in the primary health care service. They were revised

in 1998, are regarded as though, build upon systematic reviews based upon searches

in the databases Medline and Embase and were originally based to a considerable

extent upon the American guidelines from 1994 that also are regarded as very

thorough and good. The British guidelines have been used as the basis for the

development of other international guidelines.

• The European Guidelines for the Management of Acute Non-specific Low Back

Pain in Primary Care

The aim of the European guidelines is to give recommendations for the

development of national guidelines, and by this way contribute to improve back care

in the primary health care service in European countries. Elements in this process are

to contribute recommendations about treatment, ensure that an approach on the basis





of evidence- based knowledge is used, provide recommendations that are multi

professionally accepted and encourage multi professional cooperation. The main

focus is aimed towards the primary health care.

The European guidelines were developed by a multi professional work group

with experts from 10 European countries, and were published in a first edition in

January 2002. The European guideline is a result of a systematic evaluation of 15

international guidelines, in addition to the evaluation of 31 systematic reviews. For

every recommendation there has been a thorough study of documentation and

recommendations from other guidelines with regards to consistency.

Occupational Health Guidelines for the Management of Low Back Pain at Work

These have been used for occupational medical interventions, and are regarded

as the most comprehensive, thorough, relevant and updated (March 2000) within this

field, together with the Swedish SBU149.

Duration of Symptoms

Back pain is classified into three categories based on the duration of

symptoms. Acute back pain is defined as pain that has been present for six weeks or

less. Sub-acute back pain has 6 to 12 week duration and chronic back pain lasts longer

than 12 weeks.

Using these three categories, one can make predictions about prognosis. At

least 60 percent of patients with acute low back pain return to work within one month,

and 90 percent return within three months. With minimal intervention, most patients

improve in the first few weeks.





Clinical Categories of Low Back Pain

Low back pain can be caused by many conditions, both serious and benign.

Because of this, the AHCPR has grouped back pain into three categories:

1. Potentially serious spinal conditions

2. Sciatica

3. Nonspecific back symptoms

1. Potentially Serious Spinal Conditions:

Spinal tumor, infection, fracture and the cauda equina syndrome are

potentially serious causes of acute low back pain. These conditions are suggested by

characteristic findings from the history and physical examination. Immediate further

treatments are usually needed.

2. Sciatica:

The word Sciatica is defined in Taber‟s Medical Dictionary as “pain along the

course of the sciatic nerve of different aetiology”. Sciatica is thus a non-specific term

that means radiating pain in the leg and foot. The Back-related lower extremity

symptoms suggest nerve root conciliation. Sciatica is often debilitating but, in most

cases, the pain abates with conservative therapy.

3. Nonspecific Back Symptoms:

Some patients have symptoms primarily in the back that suggest neither nerve

root compromise nor a serious underlying condition. Mechanical low back pain is in

this category. These patients also usually improve with conservative treatment.

With this clinical classification, the examiner can use the history and physical

findings to specify the type of back pain affecting the patient and properly treat

patients who have potentially serious spinal conditions.





HISTORY

The diagnosis of low back pain requires a careful history to determine whether

the causes are mechanical or secondary and more threatening. Mechanical causes of

acute low back pain include dysfunction of the musculoskeletal and ligamentous

structures. Pain can originate from the disc, annulus, facet joints and muscle fibres.

Mechanical low back pain generally has a favourable outcome, but back pain with a

secondary cause requires treatment for the underlying condition.

The secondary causes of low back pain are much less frequent than

mechanical causes. An important consideration in the patient's history is age. Patients,

who are older than 50 and younger than 20, are more likely to have secondary causes.

Less common secondary causes of acute low back pain include metabolic diseases,

inflammatory rheumatologic disorders, and referred pain from other sources, Paget's

disease, fibromyalgia and psychogenic pain.

Red flag: Red flag means warning factors in a patien‟s case history and from

clinical findings relating to possible serious underlying pathology e.g. fracture,

tumour or infection. The symptoms under the category of Red flags in low back pain

are-

Age under 20 or above 55 years

Constant pain, possibly increasing over time; pain whilst at rest

Thoracic pain

General feeling of illness and /or loss of weight

Injury, cancer, use of steroids or immunosuppressant, drug abuse

Widespread neurological signs

Deformity of the spine

High ESR, declared morning stiffness that lasts for more than one hour





PHYSICAL EXAMINATION

The physical examination is not as important as the history in identifying

secondary causes of acute low back pain. certain aspects of the physical examination

are considered important.

Gait and Posture:

Observation of the patient's walk and overall posture is suggested for all

patients with low back pain. Scoliosis may be functional and may indicate underlying

muscle spasm or neurogenic involvement.

Range of Motion:

The examiner should record the patient's forward flexion, extension, lateral

flexion and lateral rotation of the upper torso. Pain with forward flexion is the most

common response and usually reflects mechanical causes. If pain is induced by back

extension, spinal stenosis should be considered. Unfortunately, the evaluation of

spinal range of motion has limited diagnostic use, although it may be helpful in

planning and monitoring treatment.

Straight Leg Raising Test:

With the patient in the supine position, each leg is raised separately until pain

occurs. The angle between the bed and the leg should be recorded. Pain occurring

when the angle is between 30 and 60 degrees is a provocative sign of nerve root

irritation.

Bending the knee while maintaining hip flexion should relieve the pain, and

pressure in the popliteal region should worsen it (popliteal compression test). If

placing the knee back in full extension during straight leg raising and dorsi-flexing the

ankle also increase the pain (Lasègue's sign), nerve root and sciatic nerve irritation is

likely.





The result of straight leg raising is positive in 95 per cent of patients with a

proven herniated disc, but it is also positive in 80 to 90 per cent of patients without

any form of disc protrusion. In contrast, crossed straight leg raising is less sensitive

but much more specific for disc herniation. In the crossed straight leg raising test, the

contralateral, uninvolved leg is raised. The test result is positive when pain is

produced

Palpation or Percussion of the Spine:

Point tenderness over the spine with palpation or percussion may indicate

fracture or an infection involving the spine. Palpating the paraspinous region may

help delineate tender areas or muscle spasm.

Heel-Toe Walk and Squat and Rise:

A patient unable to walk heel to toe, and squat and rise may have severe cauda

equina syndrome or neurologic compromise.

Palpation of the Sciatic Notch:

Tenderness over the sciatic notch with radiation to the leg often indicates

irritation of the sciatic nerve or nerve roots.

EXAMINATION OF SPINE

Lumbo-Sacral Spine Flexion:

The forward bending of lumbo-sacral region is a combination of spinal and hip

flexion. The normal range of movement is 800 angles from the vertebrae prominence

and if patients can bend up to ground, concern as normal. Patients with an acute disc

protrusion may find it difficult to reach even to the knees. It was assessed with the

help of measuring tape.





Lumbo-Sacral Spine Extension:

Ask the patient to bend backwards, supporting the shoulders. An assessment

of extension is highly subjective, but not gets an impression of loss of extension, to

athird or two-thirds of the normal range. The normal range of flexion is 400 angles

with the line between the sacrum and vertebrae prominence.

Lumbo-Sacral Spine Lateral Flexion:

Lateral flexion is usually good in patient with lumbar pain of mechanical

origin. The normal range of which is 400 angle from medial line, on each side. Note

the patient for the pain during movement.

Lumbo-Sacral Spinal Rotation:

The normal range of movement of rotation is 400 angles with the medial line.

Reflexes and Motor and Sensory Testing:

Testing knee and ankle reflexes in patients with radicular symptoms often

helps determine the level of spinal cord compromise. An altered knee or ankle reflex

alone does not suggest the need for invasive management because this finding is

generally transient and fully reversible. Weakness with dorsiflexion of the great toes

and ankle may indicate L5 and some L4 root dysfunction. Sensory testing of the

medial (L4), dorsal (L5) and lateral (S1) aspects of the foot may also detect nerve root

dysfunction.

Limited Neurologic Testing:

In the primary care of patients with low back pain and leg symptoms, the

neurologic examination can be limited to just a few tests. These include the testing of

dorsiflexion strength of the ankle and great toe, ankle reflexes and light touch over

aspects of the foot, as well as the straight leg raising test. This abbreviated neurologic

examination of the lower extremities allows the detection of most clinically important.





Radiculopathy related to lumbar disc herniation. If patients with abnormal findings on

these tests do not show improvement by one month, further diagnostic work-up or

referral to a specialist is necessary. The patients with progressive symptoms should

undergo further evaluation without delay.

GILLET TEST :(sacro iliac dysfunction):

The gillet test is used to assess for abnormal movement of the sacroiliac

joint.It is also known as sacral fixation test.

SCHOBER TEST :( lumber spine flexion):

The purpose of the schober test is to reflect the lumber ROM during flexion.

GAENSLEN TEST:

Pain on hyperextention of the hip with pelvis fixed by flexion of opposite hip,

cause a torsion stress at sacroiliac and lumbosacral joints.

PUMP HANDLE TEST:

Both knee and hip joints are fully flexed, while forcing them towards the chest

and opposide shoulder, pain felt over SI joint means test is positive.

LABORATORY TESTS

Laboratory tests generally are not necessary in the initial evaluation of acute

low back pain. If tumour or infection is suspected, a Complete Blood Cell Count and

Erythrocyte Sedimentation Rate should be obtained. Other blood studies, such as

testing for HLA-B27 antigen (present in ankylosing spondylitis) and serum protein

electrophoresis (results abnormal in multiple myeloma), are not recommended unless

clinically warranted. Additional laboratory tests, such as urine analysis, should be

tailored to the possible diagnoses suggested by the history and physical findings.





RADIOGRAPHIC EVALUATION

Plane x-ray of the spine-

The use of plane x-ray of the spine is a good way of identifying degenerative

reduction in the height of the spinal disc and osteophytes, and also of evaluating the

relation of the axes and bone structure/density. It is however, uncertain

correspondence between x-ray based signs of degeneration and clinical symptoms and

findings.

Plane x-ray of the spine can also reveal fracture, malignancy, infection and

inflammation as causes of back pain, but MRI is more sensitive in these conditions.

Plane x-ray of the spine should be primary examination if spondylolysis,

spondylolisthesis and pathological mobility aresuspected, and may be necessary

preoperatively to avoid surgery at the wrong level (especially relevant if there is an

extra sacro-lumbar vertebra that can be difficult to recognise with CT and MRI).

Computerized Tomography (CT)-

It is based on the photography of sections with the use of x-ray radiation. The

method is relatively cheap and the availability is good. The main advantage of this

method is a very good view of skeletal changes. CT can thus show fractures that

cannot be seen on conventional pictures, and can be used for a more detailed viewing

of known fractures. In the lumbar section the method also gives a good view of

changes in the soft tissue areas in the spinal canal inclusive herniated discs.

Magnetic resonance imaging (MRI)-

The MRI images are made with the help of a magnetic field and radio waves.

MRI is better than CT with regard to changes in soft tissue, and is also more sensitive

to changes in bone marrow, for example in relation to malignity. MRI is especially

sensitive to changes in water content, and shows dark discs in the lower lumbar





section for the majority of adults, as a sign of dehydration at the beginning of

degeneration. There is no certain correlation between this finding and clinical

symptoms.

Since ionising radiation is not being used, the method is without any known

harmful effects unless the patient has any of the following: a pacemaker, vascular

clips, suspected metal object in the eye or cochlea implant.

Myelography-

It is used in most cases replaced by CT or MRI, which are both more sensitive

than myelography to identify herniated discs. Myelograpy is usually only used as a

preoperative examination for spinal stenosis and for herniated disc patients with an

unclear correlation between clinical practice and CT or MRI.

Radiation dosages

Conventional x-rays of the lumbosacral column give a radiation dosage

corresponding to about 15 x-ray examinations of the lungs. This corresponds to the

background radiation in nature (that everyone is exposed to) during 9-10 months

(about 1.7 mSv). With lumbar CT the radiation load is about 2.5 times as large as with

conventional x-rays (4.5mSv), and with lumbar myelography 3-4 times as large (6.3

mSv). Myelography with following CT that is often done preoperatively thus gives

the patient an x-ray dosage of over 10 mSv. With repeated examinations the

totalradiation dosage becomes relatively large. This should be considered, especially

with younger individuals at a fertile age.

Plain radiographs are not recommended for the routine evaluation of acute low

back pain within the first month unless a finding from the history and clinical

examination raises concern. If red flags suggest cauda equina syndrome or

progressive major motor weakness, the prompt use of computed tomography (CT),





magnetic resonance imaging, myelography or combined CT and myelography is

recommended. In the absence of “red flags” after one month of symptoms, it is

reasonable to obtain an imaging study if surgery is being considered.

TREATMENT

Most patients require only symptomatic treatment for acute low back pain. In

fact, about 60 per cent of patients with low back pain report improvement in seven

days with conservative therapy, and most improvement noted within four weeks.

Patients should be instructed to watch for worsening symptoms such as an increasing

loss of motor or sensory functions, increasing pain and the loss of bladder or bowel

function. If any of these occur, the patient should be undergone further evaluation and

treatment immediately, with weekly follow-up.

Medications commonly used for the treatment of acute low back pain include

aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen

and, muscle relaxants. Patients taking opioid analgesic drugs, often used in the first

few days after the development of acute low back pain, do not return to full activity

sooner than patients taking NSAIDs or acetaminophen. Muscle relaxants are more

effective than placebo but no better than NSAIDs in relieving acute low back pain.

Oral corticosteroids and antidepressants do not appear to be effective in patients with

acute low back pain, and their use is not recommended.

Spinal manipulation has been shown in several randomized trials to be

beneficial. Shoe insoles over-the-counter foam or rubber inserts and custom-made

orthotics may also be beneficial in some patients. Spinal traction, transcutaneous

electrical nerve stimulation, biofeedback, trigger-point injections, facet joint

injections and acupuncture are usually not helpful in the management of acute low

back pain. Surgery may be indicated in selected patients who are not helped by





conservative treatment and who have debilitating symptoms after one month of

therapy. Patients with “red flags” noted at the initial evaluation may be applicants for

immediate surgery.

When back pain does not respond to more conventional approaches, patients

may consider the following options:

Acupuncture involves the insertion of needles the width of a human hair

along precise points throughout the body. Practitioners believe this process triggers

the release of naturally occurring painkilling molecules called peptides and keeps the

body‟s normal flow of energy unblocked. Clinical studies are measuring the

effectiveness of acupuncture in comparison to more conventional procedures in the

treatment of acute low back pain.

Release of naturally occurring painkilling molecules called peptides and keeps

the body normal flow of energy unblocked. Clinical studies are measuring the

effectiveness of acupuncture in comparison to more conventional procedures in the

treatment of acute low back pain.

Traction involves the use of weights to apply constant or intermittent force to

gradually “pull” the skeletal structure into better alignment. Traction is not

recommended for treating acute low back symptoms.

Ultrasound is a non-invasive therapy used to warm the body‟s internal

tissues, which causes muscles to relax. Sound waves pass through the skin and into

the injured muscles and other soft tissues.

Minimally invasive outpatient treatments to seal fractures of the vertebrae

caused by osteoporosis include vertebraplasty and kyphoplasty.





Vertebroplasty uses three-dimensional imaging to help a doctor guide a fine

needle into the vertebral body. A glue-like epoxy is injected, which quickly hardens to

stabilize and strengthen the bone and provide immediate pain relief.

Discectomy is one of the more common ways to remove pressure on a nerve

root from a bulging disc or bone spur. During the procedure the surgeon takes out a

small piece of the lamina (the arched bony roof of the spinal canal) to remove the

obstruction below.

Foraminotomy is an operation that “cleans out” or enlarges the bony whole

(foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened

with age can cause narrowing of the space through which the spinal nerve exits and

can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg.

Small pieces of bone over the nerve are removed through a small slit, allowing the

surgeon to cut away the blockage and relieve the pressure on the nerve.

Intra-Discal Electrothermal Therapy (IDET) uses thermal energy to treat

pain resulting from a cracked or bulging spinal disc. A special needle is inserted via a

catheter into the disc and heated to a high temperature for up to 20 minutes. The heat

thickens and seals the disc wall and reduces inner disc bulge and irritation of the

spinal nerve.

Nucleoplasty uses radiofrequency energy to treat patients with low back pain

from contained, or mildly herniated, discs. Guided by x-ray imaging, a wand-like

instrument is inserted through a needle into the disc to create a channel that allows

inner disc material to be removed. The wand then heats and shrinks the tissue, sealing

the disc wall. Several channels are made depending on how much disc material needs

to be removed.





Difficulties in Diagnosing Acute Low Back Pain

Nonorganic factors are sometimes important contributors to the symptoms of

acute low back pain. Psychosocial factors can be economic (e.g., greater financial

compensation when not working) or social (e.g., job dissatisfaction). To determine

whether psychosocial factors are relevant, the examiner can obtain “pain drawings”

by asking the patient to mark the type and distribution of the pain on a figure of the

human body or “visual analogue scale”.

If the distribution is non-anatomic, a psychogenic cause is highly likely. The

Waddell tests, a set of five manoeuvres easily performed during a routine physical

examination, identify patients in whom nonorganic issues play an important role in

the persistence of symptoms. The Roland Morris Low Back Pain and Disability

Questionnaire; consisting about 25 questions, is also one of the diagnostic tools, used

for researches on low back pain.

LOW BACK PAIN EXERCISES

Exercises that stretch and strengthen the muscles of abdomen and spine can

help prevent back problems. If the back and abdominal muscles are strong, it will help

to maintain good posture and keep the spine in its correct position. Some Yogic Asana

which are beneficial in the treatment of backache are Bhujangasana,Halasana,

Uttanpadasana and Shavasana.

The exercises can be start with warm up the muscles with light aerobic activity

like brisk walking before doing any strengthening or stretching. One should wear

loose clothing to make it easier to do the exercises. Few methods of exercises are

given below-





Lying supine hamstring stretch:

Lie on your back with a small rolled towel under your waist (lower back).

Place your left leg down with knee straight. Bend your right hip so your knee is

pointing to the ceiling. Hold your right thigh by interlocking your fingers. Keep your

elbows straight, while holding and straighten your right knee and move, the foot

toward the ceiling. You should feel a stretch on backside of your thigh. Hold for 30

seconds and repeat 2 times. Repeat the same stretch on your other leg.

Cat Stretch:

In a hands and knee position, place your hands under the shoulders and the

knees under your hips. Let your head drop down while at the same time tuck your

hips under and raise the middle of your back as high as you can. You should try to

create a gradual curve of your back towards the ceiling. Hold the position for 5

seconds and repeat 10 times.

Camel Stretch:

In a hands and knee position, place your hands under the shoulders and the

knees under your hips. Raise your head up while at the same time raise your hips up

and allow your stomach to fall to the floor. Hold the position for 5 seconds and repeat

10 times

Pelvic tilt:

Lie on your back with your knees bent and your feet flat on the floor. Tighten

your abdominal muscles and push your lower back into the floor. Hold this position

for 5 seconds, and then relax.

Partial curl:

Lie on your back with your knees bent and your feet flat on the floor. Tighten

your stomach muscles and flatten your back against the floor. Tuck your chin to your





chest. With your hands stretched out in front of you, curl your upper body forward

until your shoulders clear the floor. Breathe out as you come up. Hold this position for

3 seconds. Relax. Repeat 10 times. Build to 3 sets of 10. To challenge yourself, clasp

your hands behind your head and keep your elbows out to the side.

Prone hip extension:

Lie on your stomach with your legs straight out behind you. Tighten up your

buttocks muscles first and then lift one leg off the floor about 4-8 inches. Keep your

knee straight. Hold for 5 seconds. Then lower your leg and relax. Repeat the same

with the opposite leg.

Exercises to Be Avoided

It is best to avoid the following exercises because they strain the lower back.

• Lying on your stomach with legs extended and lifting together

• Sit-ups with legs straight

• Hip twists

• Any stretching that requires quick and bouncy movements.

Sports and other activities:

Physical activities such as walking or swimming can help strengthen the back.

Some good activities for people with back problems includes the, walking, bicycling,

swimming, strength training on machines, aerobic etc.

• Sit-ups with legs straight

• Hip twists

• Any stretching that requires quick and bouncy movements.





Sports and other activities:

Physical activities such as walking or swimming can help strengthen the back.

Some good activities for people with back problems includes the, walking, bicycling,

swimming, strength training on machines, aerobic exercise on machines etc.

GUIDELINES FOR MAINTAINING OF POSTURE

The patients of low back pain can be educated for maintain the correct

postures during routine activities such as sitting, driving and computer working etc.

Sitting: One should sit as little as possible and only for short periods of time.

Always sit with a back support (such as a rolled-up towel) placed at the hollow of

back.

Keep the hips and knees at a right angle (use a foot rest or stool if necessary).

The legs should not be crossed and feet should be flat on the floor. Try to sit in a high-

back chair with arm rests. Sitting in a soft couch or chair will tend to make round the

back and won't support the hollow of back. Give rest to elbows and arms on the chair

or desk and keeping the shoulders relaxed. When standing up from the sitting

position, move to the front of the seat of chair. Stand up by straightening the legs.

Avoid bending forward at waist region. Immediately stretch the back by doing 10

standing backbends.

Driving: Use a back support (lumbar roll) while sitting or driving in the car.

Move the seat close to the steering wheel to support the hollow of the back.

Standing: Stand with head up, shoulders straight, chest forward, weight

balanced evenly on both feet and hips tucked in. Try to avoid standing in the same

position for a long time. If possible, adjust the height of the work table to a





comfortable level. When standing, try to elevate one foot by resting it on a stool or

box. After several minutes, keep switching the foot position.

Guidelines for Computer Workstations:

In modern era working on computer is the need in everywhere. For sustained

use of laptops, one should consider purchasing either, external keyboard, and docking

station.

Desk Height: Middle row of the keyboard should be level with the elbow,

(forearms parallel to the floor). If the desk is too low raise with desk feet, if too high

use a foot stand and raise seat height. Place mouse in easy reach zone by keyboard.

The computer monitor should be placed centrally and directly in front of person. Put

the monitor at a comfortable height. User's eyes should be in line with a point on the

screen about 2-3" below the top of the monitor casing. The best position for a

computer monitor is for the centre of the screen to be at around 17.5 degrees below

eye level. Viewing distance should be around an arms length.

Rest breaks: after every 30 to 60 minutes one can stand up, move around and

do something else. This allows the rest and exercise different muscles and person will

feel less tired.Hand outs regarding wrong posture and correct posture, can be

distribute to the patients as the part of patient education.

DIETARIES FOR BACK PAIN:

The diet of those suffering from backache should consist of a salad of raw

vegetables such as tomato, carrot, cabbage, cucumber and at least two steamed or

lightly cooked vegetables such as cauliflower, cabbage, carrot, spinach, and plenty of

fruits, except bananas. The patient should have four meals daily. Fruit and milk are

advised for breakfast, steamed vegetables and whole wheat Chapati for lunch; fresh

fruit or fruit juice in the evening; and a bowl of raw salad and sprouts during dinner.





The patient should avoid fatty, spicy, and fried foods, curd, excess sugar, tea and

coffee. Foods that have been processed for preservation should also be eliminated

from the diet. Smoking or taking tobacco in any form should be given up completely.

DRUG REVIEW

The four aspects of therapeutics are the Bhishak, Dravya, Upastha and Rogi.

They are responsible for the cure of diseases.Though the physician occupies the





most important position in these four, he becomes lame without drug. Hence, the

drug is a second important factor for the cure of diseases. The world "Drug" is

derived from the greek word "Drouge". Drouge means "Drug herb." Any Chemical

Substance that is synthetic or of plant origin or of animal origin and of known or

unknown composition which is used as a medicament for prevention or cure is

called as a drug. Ayurveda believes in maintaing the balance of Tridosha in the

body to keep person healthy. The effect of certain Ayurvedic preparations with the

concerned Vyadhihara Dravyas has been explained with their threrapeutic action in

the ancient Ayurvedic literature. The pharmacodynamics of these drugs and their

compound preparation have been explained on the basis of Rasa, Guna, Virya,

Vipaka and Prabhava .

The study entitled “A STUDY TO ASSESS SAMYAK NIROOHA

LAKSHANA OF MADHUTAILIKA BASTI ADMINISTERED WITH

STANDARDISED ATURA HASTA PRAMANA IN KATIGRAHA W.S.R TO

LOW BACK PAIN – AN OPEN CLINICAL TRIAL” was carried out with the

following drugs.

DRUGS UNDER TRIAL

1. HARITAKYADI CHURNA:

Haritakyadi Yoga:Acharya Charak has stated to consume Hritakyadi

yoga prior to Rasayana therapy .

Table no-32 showing Rasapanchaka of Haritakyadi Yoga

Name

/Com

mon

Name

Botanical

Name

Rasa Guna Virya Vipa

k

Doshaghnta Karma





Harita

ki

Terminalia

Chebula

Kashaya

Pradhan

Lavan

Varjit

Panchar

asa

Laghu,Ruk

sha

Ushn

a

Mad

hura

Tridoshhara Anuloman

a,Rasayan

a,Hridya,

Lekhan

Amalk

i

Emblica

Officinalis

Amla

Pradhan

Lavan

Varjit

Panchar

asa

Laghu,Ruk

sha

Shita Mad

hura

Tridoshhara Vayahstha

pan,Rasay

an,

Vacha Acorus

Calamus

Katu,Tik

ta

Laghu,Tiks

hna

Ushn

a

Katu Vata-

Kaphahara

Lekhaniya

,Medhya

Vidan

ga

Embelia ribes Katu,Ka

shaya

Laghu,Ruk

sha,Tikshn

a

Ushn

a

Katu Vata-Kapha

Shamaka

Dipana,Kr

imighna,V

ishaghna

Haridr

a

Cucuma

Longum

Tikta,Ka

tu

Laghu,Ruk

sha

Ushn

a

Katu Kapha-Vata

Hara

Lekhan,V

arnya,Vis

haghna

Shunt

hi

Zingiber

officinale

Katu Laghu,

Snighdha

Ushn

a

Mad

hura

Kaphavata

Shamaka

Deepan,P

achana,Ro

chana,

Vedanasth

apana,Sw

asahara,K

aphaghna.

Pippal

i

Piper nigrum Katu Laghu,

Tikshna

Ushn

a

Katu Vata-

Kapha

Shamaka

Deepan,

Paachana,

Vatanulo

man

Guda

-

Madhu Snigdha,La

ghu

Ushn

a

Mad

hura

Tridoshaghn

a

Mutrasho

dhaka,Ag





nideepana

Lavan

a

Sodii

Chloridum

Lavana,

Madhur

a

Snigdha,

Tikshna,

Sukshma &

Laghu

Anus

hna

Sheet

a &

Sheet

a

Mad

hura

Tridoshahara Agni

Deepaka,

Pachaka,

Ruchikara

ka, Kapha

Vilayana

&

Chedana,

Vrisya,

Chakshus

ya

Table no-33 showing Drug Review of Haritkyadi Yoga

Sanskrit Name Botanical Name Family Name Part Used

Haritaki Terminalia Chebula Combretaceae Fruit

Amalaki Emblica Officinalis Euphorbiaceae Fruit

Vacha Acorus Calamus Araceae Root

Vidanga Embelia Ribes

Burum

Myrsinaceae Fruit

Rajani Curcurma Longa Scitaminae Rhizome

Pippali Pipper Longum Pipperaceae Fruit , Root

Shunti Zingiber Officinale Scitaminae Rhizome

Samanya Karma:Deepana, Ama Pachana, Rochana, Vatanulomana, Lekhaniya,

Bhedana, Varnya, Rasayana, Vrushya, Chakshushya, Hrudhya, Kapha Vata hara.

Chemical constituents:

Few important Chemical constituents of each drug has been elaborated below as, in

Hritaki: Chebulin, Chebulinic Acid;

Amalki: Phyllemblin, Ellagic Acid, Linolic Acid;





Vacha: Acolamone, Acorenone, Calaone;

Rajani: Curcurmene, Curcurmenon, Camphor;

Pippali: Pipperin, Piplartine, Piperlongumine;

Shunthi: Α- Curcumene, Gingerone B & C.

Doshagnata: Mainly KAPHA VATA hara, tridosha hara.

2. TILA TAILA:

Table no-34 showing drug review of tila taila:

Table no : 35 drug review of Murchana drugs

DRAVY

A

LATIN

NAME

FAMILY GANA SYNONYMS CHEMICAL

COMPOSITI

ON

ROGAPRABHAV

A

Manjisth

a

Rubia

Cordifol

ia

Rubiaceae Jwaraghna,

Varna

Visha

ghna

Samanga,

Vastrabhus

hana,

Vastraranji

ni

Rubimallin,

Rubifolic

acid,

Ruberythri

c acid.

Kushtha, Pramha,

Vatarakta, Jwara,

Mutrakrichra,

Visarpa

Haritaki Termina

lia

chebula

Combretac

eae

Jwarahara,

Kasag

hna,

Arsho

ghna

Abhaya,

Pathya,

Kayastha, Jaya

Anthraquinone

glycoside,

Chebulic

acid,

Tannicacid

Shotha, Prameha,

Krimi,

Kushtha,

Chhardi,

Vatarakta

DRAVY

A

LATIN

NAME

FAMILY GANA SYNONYM

S

CHEMIC

AL

COMPOS

ITION

PART

USED

Tila taila Sesamumin

dicum

Pedaliacea

e

Svedopaga,

Purishaviraji

niya

Til,

Sesamum,

Nuvulu, Ellu

Sesamolinol,

Sesaminol

Seeds





Vibhitaki Termina

lia

bellirica

Combretac

eae

Jwarahara,

Kasaghna,

Virecheno

paga

Akshaphala,

Kalidruma,

Karshaphala

Fructose,

Galactose,

Glucose,

Mannitol

Jwara, Kasa,

Shwasa,

Atisara, Ashmari,

Chardi, Trishna,

Shvitra

Amalaki Embilic

a

Officina

lis

Euphorbia

ceae

Jwarahara,

Kasaghna,

Virechano

paga

Abhaya,

Dhatri,

Vayastha

Ellagic acid,

Tannin,

Vitamin C,

Linolic

Acid

Prameha,

Raktapitta,

Netraroga,

Kushtha, Arshas,

Somaroga, Pradara,

Mutrakrichra Usheera Vetiver

a

Zizinoi

dis

Graminae Angamard

a

prashaman

a, Chardi

Nigrahana

Nalada,

Samagandhaka

,

Sugandhamala

Benzoic acid,

Eudesmol,

Eugenol

Jwara, Daha,

Trishna,

Raktapitta, Chardi,

Mutrakrichra,

Visarpa

Musta Cyperus

Rotund

us

Cyperacea

e

Lekhaniya

,

Trishna

nigraha,

Kandughn

a

Hima,

sugandhi,

Gundra,

Ghana,

Megha,

Abadha

Copadiene,

Cyperol,

Cyperolone,

Copaene

Jwara, Trishna,

Grahani, Kasa,

Visarpa, Apasmara,

Kushtha

Haridra Curcum

a longa

Zingiberac

ae

Lekhaniya

,

Kandugha

na

Nisha, Gouri,

Yohittapriya

Curcumene,

Curcumenone

Prameha, Kushtha,

Krimi, Kandu,

Vrana

Lodhra Symplo

cus

Racemo

sa

Symploca

ceae

Kashaya

Skaanda,

Shonita

sthapana

Tilvaka,

Rodhra,

Nayanoushadh

i,

Akshibhaishaj

ya

Symposide,

Loturine,

Loturidine

Pradara, Raktapitta,

Pravahika, Atisara,

Jwara, Shotha

Ketaki

pushpa

Pandam

usodoro

tissimus

Pandanace

ae

- Suchipushpa,

Krakachada

Physcion,

Cirsilineol,

Pandamarine

Prameha, Kushtha,

Masurika, Jwara





Vatankur

a

Ficus

bengale

nsis

Moraceae Mutra

sangrahani

ya,

nyagrodad

hi

Nyagrodha,

Raktaphala,

Ksheeri

Leuccoanthocya

nin,

Tiglic acid

Vandhyatava,

Vyanga,

Raktapitta,

Yoniroga

Table no : 36 showing Rasa panchaka ofmurchana drugs

DRAVYA

RASA GUNA VIRYA

VIPAKA

DOSHAGHNATA

KARMA PART

USED





Manjistha Madhura, Tikta,

Kashaya

Guru,

Ruksha

Ushna Katu Pitta Kaphaghna

Varnya,Vishaghna

Moola

Haritaki Pancharasa except

lavana

kashay

a

pradha

na

Laghu,

Ruksha

Ushna Madhura

Tridoshahara

Jwaraghana,

Kasagh

na,

Arshog

hna

Phala

Vibhitaki Kashaya Laghu,

Ruksha

Ushna Madhura

Kaphapittaghna

Keshya

Chakshushya,

Bhedana,

Madakari

(PhalaMajja)

Phala

Amalaki Pancha rasa except

lavana,

Amala rasa

Pradhana

Ruksha Sheeta Madhura

Tridoshahara

Vayahsthapana,

Rasayana,

Chakshus

hya,

Vrishya

Phala

Usheera Tikta, Madhura

Laghu,

Ruksha

Sheeta Katu Kaphapittaghna

Pachana,

Sthambhana

Moola

Musta Tikta, Katu, Kashaya

Laghu,

Ruksha


Deepana, Pachana,

Grahi,Lekhana

Kanda

Haridra Tikta, Katu Laghu,

Ruksha

Ushna Katu KaphaVataghna

Lekhana,

Vishaghna

Kanda

Lodhra Tikta, Kashaya

Laghu,

Ruksha


Grahi,

Chakshushya

Twak

Ketaki

pushpa

Tikta, Madhura, Katu

Laghu,

Snigdh

a

Ushna Katu Pitta Kaphaghna

Chakshushya Pushpa





Table no : 37 showing drug review of Sahacharadi taila :

Table no: 38 showing Rasa panchaka ofsahacharadi taila

Vatankura

Kashaya Guru,

Ruksha


Mutrasangrahaniya,Varnya, Sthambhana

Ankura

DRAVYA

LATIN

NAME


COMPOSITI

ON

PART

USED Sahachara

Barleria

prionitis

Acanthaceae

Kantakapanchamoola

Sahachara, Jhinti,

Kuranta, Artagala

Barlacristone,

Barleri

B-

sistoste

rol.

Moola

Devadaru

Cedrus deodara

Pinaceae Stanya, Shodhana,

Vatasashama

na

Indradaru, Bhadradaru,

Drukilinam,

Amaradaru

Essential oil,

Atlantone,

Deodarin,

Toxifolin

Bark,

Leaves

Shunthi Zingiber

officinale

Zingiberaceae

Trikatu, Pipplayadi

Nagara,

Srangavera,

Vishvabh

eshaja,

Mahoush

adh

Curcumene, D-

Curcume

ne, D-

borneal

Kanda

Tila taila Sesamum

indicum

Pedaliaceae

Svedopaga,

Purishaviraji

niya

Til, Sesamum, Nuvulu,Ellu

Sesamolinol,

Sesaminol

Seeds





DRAVYA RASA GUNA VIRYA

VIPAKA

DOSHAGHNATA

KARMA UPAYOGA

Sahachara Tikta, Madhura

Laghu Ushna Katu KaphaVataghna

Kesharanjaka

Vatarakta,Kandu,Visha.

Kushtha,

Khalitya,

Palitya,

Vatavyadhi

Devadaru Tikta, Katu,

Kashay

a

Ruksha,

Laghu

Ushna Katu Kaphavataghna

Deepana,

Kasahara

Kasa-Shwasa, Hikka,

Prameha,

Adhmana,

Jwara, Krimi,

Kandu, Kushtha

Shunthi Katu Guru,

Ruksh

aTiksh

na

Ushna Madhura Vatakaphaghna

Deepana,

Bhedana

Shoola, Amavata, Atisara,Kasa, Shwasa, Shopha

Tila taila Madhura, Tikta

Guru,

Snigdh

a,

Tikshn

a,

Suksh

ma

Ushna Madhura Vataghna Vatahara,

Twach

ya,

Balya,

Keshya

,

Shukra

la

Vataroga,Grahani,

Dourbalya,

Agnimandya,

Yoniroga

Table no : 39 Showing drug review of Eranda moola

DRAV

YA

LATINE

NAME

FAMI

LY

GA

NA

SYNONYMS CHEMICA

L

COMPOSI

TION

ROGA

PRABHAVA

Eranda

mula

Madhura

Anurasak

atu,

Kashaya

Snigd

ha,

Tiksh

na,

Suksh

ma

Ush

na

Panchanga,gan

dharva hasta.

Ricin,ricinine. Katishoola,

Gridhrasi

Vatavikara,Ang

amarda

Vibandha,Amav

ata,

Vatarakta





Table no – 40 Showing Drug Review of Madhutailika Basti:

Table no-41 Showing Rasa Panchaka of Madhutailika Basti :

DRAVYA

LATIN

NAME


COMPOSITIO

N

PART

USED

Madhu Honey - Madhu varga,Ikshukadi varga,Oshadi varga

Makshika,

Kshaudra

Fructose

Sucrose,

Maltose

-

Erandamoola

Ricinus commnisu

Euphorbiaceae

Bhedaniya,

Angamarda

prashamana

Panchangula,

Gandharvahasta,

Rubuka,Urubuka

Recin,

Ricinine,

Gliseroids

Root,

leaves,

fruits,seeds

Shatapushpa

Anethum

graveole

ns

Apiaceae Asthapanopaga, Anuvasanopaga

Shatahv

a,

Chatra

Carvone,

Limonen

e

Fruits

Saindhava

Rock Salt - - Sheetashiva, Sindhuja

Sodium

chloride, Iodine,

Magnesium

-

Madanphala

Randia

dumetoru

m

Rubiaceae Asthapanopa

ga,

Anuvasanopa

ga

Madana, Chardana, Shalyaka

Citric ,Tartaric

acid, Randianin

Root, Fruit





DRAVYA RASA GUNA VIRYA

VIPAKA

DOSHAGHNATA

KARMA UPAYOGA

Madhu Madhura,Kashaya

Ruksha,Laghu

Sheeta Madhura Deepana

Erandamoola

Madhur

a,katu,

Kashay

a

Snighda

,Sukhm

a

Ushna Madhura Vatakaphahara

Krimighna

m,Vatasha

manam,dee

panam

Gulma,Krimi,S

wasa,Kasa

Shatapushpa Katu,Tikta

Laghu

,Tiksh

na

Ushna Katu Vatapittahara

Deepana,B

hedana

Jwara,Vrana,Shula

Saindhava Lavana Laghu Sheeta - Tridoshahara

Rechan

a,vrish

ya,dee

pana

Hikka,Viband

ham,Vrana

Madanaphala

Tikta,Madhura

Laghu,Ruksha

Ushna Katu Vatakaphahara

Lekhana Kushta,Pratishyaya,Vrana,Shotha

METHODOLOGY




METHODOLOGY

The present clinical study entitled “A STUDY TO ASSESS SAMYAK

NIROOHA LAKSHANA OF MADHUTAILIKA BASTI ADMINISTERED

WITH STANDARDIZED ATURA HASTA PRAMANA IN KATIGRAHA

W.S.R TO LOW BACK PAIN – AN OPEN CLINICAL TRIAL” which will be

carried out with the following materials-

1. Amapachana with Haritakyadi choorna.

2. Sahacharadi tailam for Sthanik Abhayanga and for Anuvasana basti

3. Madhu tailika with Eranda moola for Niroohabasti

1-HARITAKYADI CHOORNA-

Table no: 42 showing ingredients for Haritakyadi choorna:

Ingredients Quantity

Haritaki 1 part

Saindhava lavana 1 part

Amalaki 1 part

Guda 1 part

Vacha 1 part

Vidanga 1 part

Rajani 1 part

Pippali 1 part

Shunthi 1 part

METHODOLOGY




Methods of preparation:

All the drugs were taken in completely dry form. Each drug was separately

pounded and sieved, later the choornas were mixed thoroughly in equal quantity and

stored in air tight containers.

Dose: 5gm thrice day

Anupana: ushna jala

Time of administration: before food.

Duration: 5 days and till nirama lakshana attained

Preparation on SAHACHARADI TAILA:

The total quantity of Sahacharadi taila required to carry out the clinical study

was about 25 liters. Initially, tila taila was subjected to Moorchana samskara to

remove bad odour and impurities.

Method of Murchana:

The Samskara was do not remove the Gandha, Dosha and Ama Dosha. The

various drugs used for murchana are:

METHODOLOGY




Table no : 43 Showing the drugs used for Taila Murchana

Sanskrit

Name

Latin Name Quantity taken for preparing 33 Litre

Of Oil

Manjistha Rubia cordifolia 1.5 kg

Hareetaki Terminalia chebula 390gm

Vibheetaki Terminalia bellarica 390gm

Amalaki Embilica officinalis 390gm

Musta Cyperus rotundus 390gm

Haridra Curcuma longa 390 gm

Ketaki Pandanus Odaratissimus 390gm.

Nyagrodha Ficus bengalensis 390gm

Lodhra Symplocos racemose 390gm

TilaTaila Sesamum indicum oil 25Litres

All the drugs were made in course powder form and were boiled in 400 Litre

of water. When it got reduced to 100 liters, kashaya was filtered and kept.

Then the Tila taila was taken in a vessel and heated mildly. Then the prepared

kashaya was added to it and allowed to boil. It was continued till the phenodgama

was seen.The obtained oil is allowed to get cooled and filtered and kept in clean dry

containers.

METHODOLOGY




Table no: 44 showing the Ingredients of Sahacharadi taila-

Sl. No. Sanskrit

Name

LatinName Quantity

1. Sahachara Barleria prionitis 1.5kg

2. Suradaru Cedrus deodara 1.5kg

3. Shunthi Zingiber officinale 1.5kg

4. TilaTaila Sesamum indicum oil 25 Ltrs

5. Jala Water 100Ltrs

Method of Preparation of Sahacharadi taila:-

Coarse powder of above 3 drugs were boiled in 150 Litres of water and were

allowed to reduce to 1/4th

after the preparation of kashaya, 25 litres Moorchita Tila

taila was added.Then kalka dravyas were taken in a vessel and mixed with sukhoshna

Jala to make paste and added to it and mixed well and boiled. The whole content was

allowed to boil in medium flame till the madhyama sneha paka lakshanas are seen i.e.

when the kalka gets separated from taila.

During the preparation, the mixture was continuously stirred with stainless

steels spatula.

When taila paka lakshanas are seen, then the fire is put off and the taila is kept

aside for cooling.Whole procedure was completed in 4 days.Every day evening the

fire is put off and the mixture is kept undisturbed.

Usage:

Used as Sneha dravya in madhu tailika Nirooha Basti.

Used for Anuvasana Basti

Used for Sthanika Abhyanga

METHODOLOGY




MADHU TAILIKA BASTI -

PREPARATION OF BASTI DRAVYA:

Madhu tailika basti with eranda moola kashaya

Table no- 45 showing Ingredients of Madhutailika Basti:

Sl. No. Dravya Matra taken in present study

1. Madhu 120 – 140 ml

2. Saindhava Lavana 5 – 10 gm

3. Sahacharadi Taila 120 – 140 ml

4. Shatahva Kalka 10 gm

5. Erandamoola Kashaya 300 – 350 ml

Preparation of Kashaya:

Coarse Powder of Eranda moola was taken in a vessel and 2 liters of water

was added and boiled to make Kashaya.It was reduced to 400ml.It was then filtered

and kept aside. This Kashaya was used as Madhutailika for Basti.

Preparation of Kalka dravya:

Kalka is the main drug which gives potency to whole combination of Basti

dravya. Kalka helps to disintegrate the Mala by increasing the osmotic permeability of

solution.20 to 40grams of Kalka dravya of Madhutailika Nirooha Basti Yoga

(Shatahva) were taken and mixed with little bit of warm water and made into Kalka.

METHODOLOGY




Mixing of Basti dravya:

Initially 80-150ml of Makshika is taken and added with 10-15 grams of

Saindhava

Lavana in powder form and mixed slowly and properly.

Later 80-150 ml of Sahacharadi Taila should be added and stirred well.

The Shatahva kalka 20–40gms is added and mixed well,followed by Kashaya

400– 600 ml.This was mixed well with the help of stirrer.Mixing is continued

to have uniform Basti dravya (homogenous mixture), and then made

lukewarm during administration of basti.

Methodology:

Source of Data:

In the present study a minimum of 20 subjects diagnosed as Kati graha were

selected for the study.Research scholar proposes to take the subjects attending the

O.P.D of Department of Post-Graduate studies in Panchakarma, Ayurveda

Mahavidyalaya Hospital, Hubballi.

Methods of collection of Data

i. A clinical survey of the patients attending the O.P.D and I.P.D of

Department of Post-Graduate studies in Panchakarma Ayurveda

Mahavidyalaya Hospital, Hubballi will be made and patients fulfilling the

criteria of diagnosis as per the Proforma will be selected for the study.

METHODOLOGY




ii. A clinical evaluation of the patients will be done by collection of data

through information obtained by History, Physical examination and

Laboratory Tests.

iii. For collecting the data of the participants a case record form will be

prepared to record all the possible demographic data along with relevant

clinical findings, all the clinical feature of Katigraha, Samyak Lakshana of

Nirooha, Ayoga and Atiyoga lakshanas are necessary for assessment will

also be incorporated.

iv. Review of Literature will be collected from the Post Graduate library,

Department of Panchakarma Ayurveda Mahavidyalaya Hospital, Hubballi

and from Authentic Research Journals, Websites, and Digital Publications

etc.

v. The drug required for the clinical study will be procured and prepared in

the Department of Rasashastra and Bhaishajya Kalpana ,Ayurveda

Mahavidyalaya and Hospital, Hubballi.

Study design:

An open clinical Study

Sample size:

20 patients (suffering from Kati Graha) fulfilling the diagnostic and

inclusion criteria belonging to either sex irrespective of socio-economical status and

caste will be randomly selected for clinical study , excluding drop outs.

METHODOLOGY




Inclusion criteria:

Aasthapana arha patients.

Subjects of either sex between age group of 20-60 yrs.

Patient belonging to any type of Koshta.

Patient with Nirama vyadhi avastha

Exclusion criteria:

1. Patients who are having Lumbar Spondylolisthesis

2. Patient with fracture of Lumbo-Sacral Spine.

3. Patients with Tuberculosis of Spine and spinal malignancies.

4. Patients with Cauda Equina Syndrome

5. Patients with any associated systemic disorders.

6. Post-surgical backache.

7. Anarha patients for Basti karma.

Investigations:

X ray for L.S spine, AP and LATERAL VIEW.

Blood for

Fasting blood sugar(FBS)

Post prandial blood sugar(PPBS)

C reactive protein(CRP)

HB% ,TC,DC,ESR.

LFT

Serum creatinine

Blood urea

METHODOLOGY




PATIENTS EXAMINATION AND DIAGNOSIS:

This study is exclusively based on clinical trial. The following clinical features

were considered as diagnostic features for kati graha i.e. low back pain.

1. Patient should be Nirama lakshana.

2. Pain over the kati Pradesha should be present.

3. Any two of the following test should be positive:

GAENSLEN SIGN

GILLET TEST

PUMP HANDLE TEST

SCHOBER TEST.

Table no-46 showing Treatment details of 20 Subjects:

Sample size 20 patients

Drug detail Amapachana- haritakyadi yoga

Anuvasana basti – sahachardi taila

Nirooha basti- Madhu tailika basti with erandmoola kashaya

Route Pakwasayagata basti

Dosage Depending upon the roga and rogi bala

Duration 16 days

Pariharakala 32 days.

METHODOLOGY




Intervention:

Madhutailika Basti in Kala Basti Schedule

Administration of Anuvasana Basti:

SthanikaAbhyanga with Sahacharadi Taila.

Sthanika Swedana.

Laghu Ahara Sevana.

Administration of Anuvasana Basti with Sahacharadi Taila.

Administration of Madhutailika Basti:

Sthanika Abhyanga with Sahacharadi Taila.

Sthanika Swedana.

Administration of Madhutailika Basti

Dosage: Depend upon the Roga and Rogi Bala

Duration: 16 Days

Pariharakala: 32 Days

Parameters of study:

1. Prasrustavinmutrasamiranatvam: (especially for bowel habit)

Well satisfactory,without any strain – 3

Satisfactory to some extent but with strain – 2

Returns of only basti dravya without mala,mutra-1

No returns of Basti dravya-0

METHODOLOGY




2. RUCHI VRIDHI:

Total unwilling for meal - 3

Unwilling towards food but could take the meal- 2

Willing towards one among Ahara/Rasavishesha-1

Equally willing towards all the bhojya padartha and Rasavishesha-0

3. AGNI VRIDHI:

JARANA SHAKTI-

Scoring according to jeerna ahara lakshana present after 6-8 hours after taking

food.

They are Utsaha, laghuta, udgara shuddhi, kshut, trishna pravritti, yathochita

malotsarga.

Absence of all 5 symptoms - 3

Presence of 1-2 symptoms - 2

Presence of 3-4 symptoms - 1

Presence of 5 symptoms - 0

ABHYAVARANA SHAKTI-

Person not at all taking food - 3

Taking food in less quantity once in day - 2

Taking food in modern twice a day - 1

Taking food in normal quantity 2-3 time a day – 0

METHODOLOGY




4. Ashaya laghavani:

Feeling of complete lightness all over the body after satisfactory evacuation of

basti dravyas - 3

Feeling of lightness only in abdomen but slight heaviness all over the body - 2

Feeling of heaviness in abdomen, after evacuation of basti dravya - 1

Feeling of generalised heaviness - 0

OBJECTIVE PARAMETERS:

1. Rogaupashanti:

Feeling of well being at physical and mental level after awakening -0

Feeling of well being after ½-1 hr after awakening -1

Not feeling well and not interest in any work after awakening -2

2. OSWESTRY DISABILITY INDEX SCORE:

1. Pain intensity:

I have no pain at the movement-0

The pain is very mild at the movement -1

The pain is moderate at the movement -2

The pain is fairly severe at the movement -3

The pain is severe at the movement -4

The pain is worst imaginable at the movement -5

METHODOLOGY




2. LIFTING OF WEIGHT:

I can lift heavy weight without extra pain -0

I can lift heavy weight but it gives extra pain -1

Pain prevent me from lifting heavy weight off the floor but I can manage if

they are conveniently positioned -2

Pain prevent me from lifting heavy weights but I can manage light to manage

light to medium weight if they are conveniently positioned -3

I can lift only very light weights - 4

I cannot lift or carry anything at all - 5

3. ABILITY TO WALK:

I can run or walk without pain - 0

I can walk comfortably, but running is painful -1

Pain prevent me from walking more than 1 hour - 2

Pain prevent me from walking more than 30 minutes -3

Pain prevent me from walking more than 10 minutes - 4

I am unable to walk or can walk only a few steps at a time - 5

4. PAIN WHILE SITTING:

I can sit in any chair as long as I like - 0

I can sit in my favorite as long as I like -1

Pain prevent me from sitting for more than 1 hour -2

Pain prevent me from sitting for more than ½ hour -3

Pain prevent me from sitting for more than 10 min -4

Pain prevent me from sitting at all -5

METHODOLOGY




5. SEXUAL FUNCTION:

My sex life is normal causes no extra pain -0

My sex life is normal but causes some extra pain -1

My sexual life is nearly normal but is very painful -2

My sex life is severely restricted by pain -3

My sex life is nearly absent because of pain -4

Pain prevents any any sex life at all -5

6. SLEEP QUALITY:

My sleep is never disturbed by pain -0

My sleep is occasionally disturb by pain -1

Because of pain I have less than 6 hours sleep -2

Because of pain I have less than 4 hour sleep -3

Because of pain I have less than 2 hour sleep -4

Pain prevent me from sleeping at all -5

7. ABILITY TO TRAVEL:

I can travel anywhere -0

I can travel anywhere but it gives me pain -1

Pain in bed but I can manage to travel over two hour -2

Pain restricts me to journeys of less than one hour -3

Pain restricts me to trips less than 30 minutes -4

Pain prevents me from travelling -5

METHODOLOGY




8. ABILITY TO STAND

I can stand as long as I want without extra pain -0

I can stand as long as I want but it gives me extra pain -1

Pain prevent me from standing for more than 1 hour -2

Pain prevent me from standing for more than 30 min -3

Pain prevent me from standing for more than 10 min -4

Pain prevent me from standing at all -5

9. SOCIAL LIFE

My social life is normal and causes me no extra pain-0

My social life is normal but increases the degree of pain-1

Pain has no significant effect on my social life apart from limiting my more

energy interests’ e.g dancing etc.-2

Pain has restricted my social life and i do not go out as aften-3

Pain has restricted my social life to my home-4

I have no social life because of pain-5

10. Personal care (washing,dressing etc.)

I can look after normally without causing extra pain-0

I can look after myself normally but it is very painful-1

It is painful to look after myself and i am slow and careful-2

I need some help but manage most of my personal care-3

I need help every day in most aspect of self care-4

I do not get dressed, wash with difficulty and stay in bed-5

METHODOLOGY




3. VISUAL ANALOG SCALE RATING FOR PAIN:

Table no-47 showing Visual Analog scale rating for Pain:

SCALE RATING

1.no pain 0

2.mild pain 2

3.moderate pain 4

4.severe pain 6

5.very severe pain 8

6.worst possible pain 10

Observational Parameters of Basti:

Anuvasana Basti

1. Assessment of Koshta of Athura

2. Matra Nirnaya of Anuvasana Basti Dravya

4. Basti Samyojana.

5. Temperature of Anuvasana Basti Dravya

6. Physicochemical analysis of Basti dravya

7. B.P, Pulse, Heart rate and Respiratory rate before and after administration of

Basti.

8. Peristaltic movement

9. Time of administration ofAnuvasana Basti

10. Basti Pratyagamana Kala

11. Samyak Yoga lakshana of Basti

12. Observation duringParihara Kala.

METHODOLOGY




Nirooha Basti (madhutailika Basti)

1. Assessment of Koshta of Athura

2. Matra Nirnaya of Nirooha Basti dravya

3. Basti Samyojanam

4. Temperature of NavakarshikaNirooha Basti Dravya

5. Physicochemical Analysis of Basti dravya

6. B.P, Pulse, Heart rate and Respiratory rate before and after

administration of Basti

7. Peristaltic movements

8. Time of administration of navakarshika nirooha basti.

9. Basti Prathyagamana Kala

10. Ayoga and Atiyoga Lakshanas of Nirooha Basti (if any)

11. Observations during Parihara Kala and its Assessment

Assessment Criteria:

Subjective and objective parameters before and after treatment will be

analysed and a final conclusion will be drawn using appropriate statistical methods.

Oswestry disability index score in 1980. Event evaluation scale will be assessed by:

Samayak evaluation lakshana on 2,4,6,8,10,12th

day.

Visual analogue scale will be assessed from 0 to 17th

day.

Basti evaluation scale

Oswestry disability index for back pain.

METHODOLOGY




Oswestry disability index score( ODI) includes

0% to 20%: minimal disability

21% to 40% moderate disability

41% to 60% severe disability

61% to 80% crippling back pain

81% to 100%: these patients are either bed- bound or have an exaggeration of

their symptoms.

STATISTICAL TESTS:

Test for effect of therapy by: t – test, Paired test, Sample for Mean Attainment

of Samyak Nirooha Lakshana by:

One way ANOVA Test to compare between four different putaka in each

NiroohaBasti

Multiple comparisons by Post HOC Test or Tukey Kramer Test.

The significance was discussed on the basis of mean, scores, percentage, SD,

SE, t and p values.

Level of significance:

p > 0.05 is statistically Insignificant

p = < 0.05 and p = < 0.01 is statistically Significant

p = < 0.001 is statistically highly Significant.

METHODOLOGY




Overall relief of clinical features of Kati graha Before and after treatment,

were statistically analyzed and the Result will be categorized as-

Marked Improvement – Above75% Improvement

Moderate Improvement – 51%-75% Improvement

Mild Improvement – 25%-50% Improvement

Unchanged – Below 25% Improvement

Sample size Estimation

“A STUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF MADHUTAILIKA BASTI

WITH STANDARDIZED ATURA HASTA PRAMANA IN KATIGRAHA W.S.R. TO LOW

BACK PAIN- AN OPEN CLINICAL TRIAL” Page 135

SAMPLE SIZE ESTIMATION

SAMPLING FRAME: 20 SUBJECTS WERE SELECTED FROM OPD AND IPD OF

AYURVEDA MAHAVIDYALAYA HOSPITAL, HUBBALLI WITH PRIOR CONSENT

SAMPLING TECHNIQUE: CONVENIENT SAMPLING METHOD

SAMPLE SIZE: A STUDY IN INDIA REPORTED THAT THE PREVALENCE RATE OF LOW

BACK PAIN IS 6 CASES PER 1000 POPULATION

i.e. (6/1000*100)

Sample size is calculated by the formula Z2P (1-P)/C

2

Z = CONFIDENCE LEVEL OF 95 % (1.96)

P= PREVALENCE INTERVAL 0.6

C= CONFIDENCE INTERVAL 0.05

SAMPLE SIZE OBTAINED IS 369

SINCE THE STUDY WAS FOR A SHORT DURATION OF 3 AND THE WHOLE STUDY WAS RESTRICTED TO

HUBBALLI (NEAR BY AREAS OF AYURVEDA MAHAVIDYALAYA HOSPITAL, HUBBALLI) A MINIMUM

SAMPLE SIZE OF 20 WAS SELECTED RANDOMLY IN SINGLE GROUP.

OBSERVATIONS




OBSERVATIONS

In the present study on katigraha (low back pain), 20 subjects

fulfilling the inclusion and exclusion criteria were selected and the

subjects were treated. The General Observations like Age, Sex, Religion,

Occupation etc. as well as Observations related to the disease and

Observations related to Basti were recorded and are given hence forth.

OBSERVATION ON DEMOGRAPHIC DATA

Table no- 48 Showing Age-Wise Distribution of 20 patients of katigraha.

Age in year No. of subjects Percentage (%)

20-30 6 30%

30-40 7 35%

40-50 7 35%

50-60 0 0

Fig No. 1 Age wise distribution of 20 subjects of Katigraha

0

1

2

3

4

5

6

7

8

20-30 31-40 41-50 51-60

Percentage (%)

No.of subjects

OBSERVATIONS




Out of 20 subjects studied in this series, maximum number of subjects i.e. 7(35%)

were in the Age group of 31-40 and 41 to 50 years each. 6 subjects (30%) were in the

Age group 20 to 30 years.

Table no-49 Showing Sex-Wise Distribution of 20 Subjects of katigraha:

Sex No. Of subjects Percentage (%)

Male 14 70%

Female 06 30%

Figure no. 2 Sex-Wise Distribution of 20 Subjects of katigraha:

Out of 20 subjects studied in this series maximum number of subjects i.e. 14

(70%) were male, 06 subjects (30%) were female.

Table no-50 Showing Religion-wise Distribution of 20 subjects of katigraha:

Religion No. Of subjects Percentage (%)

Hindu 15 75%

Muslim 05 25%

Christian 00 00

Others 00 00

0

5

10

15

20

(%)

No. Of subjects Percentage

Female

Male

OBSERVATIONS




Grapha no. 3

Fig. No. 3 Religion-wise Distribution of 20 subjects of katigraha

Out of 20 subjects studied in this series maximum number of subjects i.e.

15(75%) were Hindus, 05 subjects (25%) were Muslims.

Table no-51 Showing Marital Status-wise Distribution of 20 Subjects of

katigraha:

Marital status No. of subjects Percentage.

Married 17 85%

Unmarried 03 15%

Fif. No.4 Marital Status-wise Distribution of 20 Subjects of katigraha:


(85%) were married , while 05 subjects (15%) were unmarried.

Table no-52 Showing Educational Status-wise Distribution of 20 Subjects of

katigraha.

0

5

10

15

20

Hindu Muslim Christian Others

Percentage(%)

No. Of subjects

0

5

10

15

20

Unmarried

Married

OBSERVATIONS




Educational status No. Of subjects Percentage.

Primary 2 10%

Higher secondary 2 10%

P.U.C. 5 25%

Graduate 6 30%

Post graduate 2 10%

Un educated 3 15%

Fig.no.5 Educational Status-wise Distribution of 20 Subjects of katigraha.


(30%) were graduate, 05 subjects (25%) were from puc, 03 subjects (15%) were un-

educated,02 subjects (10%) were primary,higher secondary and post-graduates.

Table no-53 Showing Occupation-wise Distribution of 20 Subjects of katigraha

Occupational status No. Of status Percentage.

Farmer 02 10%

Business 01 05%

Govt. Service 04 20%

Labour 01 05%

Housewife 06 30%

Student 02 10%

Unemployed 00 00%

01234567

Percentage.

No. Of subjects

OBSERVATIONS




Pvt.job 04 20%

Fig. No.6 Occupation-wise Distribution of 20 Subjects of katigraha

Out of 20 subjects studied in this series, maximum number of 6 subjects (30%)

were housewives, 4 subjects (20%) were govt. Job. and pvt. Job each. 2subjects

(10%) were farmer and student each, 1 subject (05%) is businessman and labour each.

Table no-54 Nature of work wise distribution of 20 patients of katigraha

Nature of work No. Of subjects Percentage

Sedentary 6 30%

Mild 4 20%

Moderate 4 20%

Laborious 2 10%

Standing 2 10%

Travelling 2 10%

Fig.no.7 Occupation-wise Distribution of 20 Subjects of katigraha

01234567

Percentage.

No. Of status

0

1

2

3

4

5

6

7

Percentage

No. Of subjects

OBSERVATIONS





did sedentary work, 4 subjects (20%) did mild and moderate work each. 2 subjects

(10%) did laborious, standing and travelling work each.

Table no-55 Showing Socio Economic Status-wise Distribution of 20 Subjects of

katigraha.

Socio Economic No. Of subjects Percentage (%)

Poor 02 10%

Middle 18 90%

Rich 00 00

Figure no.8 Socio Economic Status-wise Distribution of 20 Subjects of katigraha.

Out of 20 subjects studied in this series, 18 subjects (90%) belonged to middle

class, 02 subjects (10%) belonged to poor class and no subjects belonged to Rich

class.

Table no-56 Showing Habitat-wise Distribution of 20 Subjects of katigraha:

Habitat No. Of subjects Percentage

Rural 04 20%

Urban 16 80%

0

5

10

15

20

Poor Middle Rich

Percentage(%)

No. Of subjects

OBSERVATIONS




Figure no.9 Showing Habitat-wise Distribution of 20 Subjects of katigraha

Out of 20 subjects studied in this series, 16subjects (80%) were from Urban

area while remaining 04subjects (20%) were from Rural area.

OBSERVATIONS ON PERSONAL HISTORY

Table no-57 Showing Ahara-wise Distribution of 20 Subjects of katigraha:

Ahara No. Of subjects Percentage

Niramisha 13 65%

Samisha 07 35%

Figure no.10 Ahara-wise Distribution of 20 Subjects of katigraha

Out of 20 subjects studied in this series, 13 subjects (65%) were consuming

niramisha aahara and 07 subjects (35%) were consuming samisha aahara.

0

5

10

15

20

Urban

Rural

0

5

10

15

20

Samisha

Niramisha

OBSERVATIONS




Table no-58 Showing Status of Agni wise distribution of 20 subjects of katigraha

Agni status No. Of subjects Percentage

Manda 10 50%

Teekshana 05 25%

Vishama 05 25%

Sama 00 00%

Fig no. 11 Agni wise distribution of 20 subjects of katigraha

Out of 20 subjects studied in this series, maximum number i.e. 10 subjects

(50%) had Mandagni, while 05 subjects (25%) had Teekshnagni and 05 subjects

(25%) had Vishamagni.

Table no-59 Showing Koshta wise distribution of 40 subjects of katigraha

Koshtha No. Of subjects Percentage

Mrudu 05 25%

Madhyama 05 25%

Kroora 10 50%

Fig. No. 12 Koshta wise distribution of 40 subjects of katigraha

02468

1012

Percentage

No. Of subjects

05

1015

Percentage

No. Of subjects

OBSERVATIONS




Out of 20 subjects most of the subjects i.e. 10 subjects (50%) had mrudu

Koshta,while 05 subjects (25%) had Madhyama Koshta and 05 subjects (25%) had

kroora Koshta.

Table no-60 Showing Addiction wise distribution of 20 subjects of katigraha

Addiction No. Of subjects Percentage (%)

Excessive Tea 14 70%

Alcohol 04 20%

Smoking 03 15%

Tobacco chewing 04 20%

None 02 10%

Fig. no. 13 Addiction wise distribution of 20 subjects of katigraha

Out of 20 subjects studied in this series, 14 subjects (70%) had the habit of

excessive intake of tea, 4 subjects (20%) each had the habit of excessive intake of

alcohol and tobacco chewing,03 subjects(15%) had the habit of smoking, 02

subjects(10%) had no habits.

02468

10121416

Percentage(%)

No. Of subjects

OBSERVATIONS




Table no-61 Showing Nidra wise distribution of 20 subjects of katigraha

Nidra No. Of subjects Percentage

Sukha 02 10%

Vishama 08 40%

Alpa 07 35%

Ati 03 15%

Fig. No.14 Nidra wise distribution of 20 subjects of katigraha

Out of 20 subjects studied in this series, maximum number of subjects i.e. 8

(40%) were recorded with Vishama Nidra ; 07 subjects (35%) with Alpa Nidra ; 03

subjects (15%) with Ati Nidra,2 subjects (10%) with Sukha Nidra.

Table no-62 Showing Deha Prakruti wise distribution of 20 subjects of katigraha

Deha prakruti No. Of subjects Percentage

Vata pitta 07 35%

Pitta kapha 03 15%

Kapha vata 10 50%

02468

10

Percentage

No. Of subjects

OBSERVATIONS




Figure no. 15 Deha Prakruti wise distribution of 20 subjects of katigraha

All the subjects were of Dwandwaja Deha Prakruti. Out of 20 subjects studied

in this series, 10 subjects (50%) were of Vata Pittaja Prakruti; 07 subjects (35%) were

of Vata Kaphaja Prakruti, and 03 subjects (15%) were of Pitta Kaphaja Prakruti.

Table no-63 Showing Sara wise distribution of 20 subjects of katigraha :

Sara No. Subjects Percentage(%)

Pravara 00 00%

Madhayama 19 95%

Avara 01 5%

Fig. No. 16 Showing Sara wise distribution of 20 subjects of katigraha

Out of the 20 subjects studied in this series, 19 subjects (95%) had Madhyama

Sara; 01 subject (5%) had Avara sara.

Table no-64 Showing Samhanana wise distribution of 20 subjects of katigraha:

Samhanana No. Of subjects Percentage (%)

Pravara 00 00%

Madhayama 17 85%

Avara 03 15%

0

5

10

15

Vata pitta Pitta kapha Kapha vata

Percentage

No. Of subjects

05

101520

Percentage(%)

No. Subjects

OBSERVATIONS




Fig. No. 17 Samhanana wise distribution of 20 subjects of katigraha:

Out of the 20 subjects studied in this series,17 subjects (85%) had Madhyama

Samhanana ; 03 subjects(15%) had Avara samhanana.

Table no-65 Showing Pramana wise distribution of 20 subjects of katigraha:

Pramana No. Of subjects Percentage(%)

Pravara 02 10%

Madhyama 18 90%

Avara 00 00%

Fig. No. 18 Showing Pramana wise distribution of 20 subjects of katigraha

Out of the 20 subjects studied in this series,18 subjects ( 90%) had Madhyama

Pramana while 02 subjects (10%) had Pravara Pramana and no subjects had Avara

Pramana.

Table no-66 Showing Satwa wise distribution of 20 subjects of katigraha.

05

101520

Percentage(%)

No. Of subjects

0

5

10

15

20

Pravara Madhyama Avara

Percentage(%)

No. Of subjects

OBSERVATIONS




Satwa No. Of subjects Percentage(%)

Pravara 02 10%

Madhyama 16 80%

Avara 02 10%

Fig no. 19 Satwa wise distribution of 20 subjects of katigraha.

Out of 20 subjects studied in this series,16 subjects (80%) were of Madhyama

Satwa; 02 subjects (10%) were of Pravara Satwa ; and 02 subjects (10%) had Avara

Satwa.

Table no-67 Showing Satmya wise distribution of 20 subjects of katigraha :

Satmya No. Of subjects Percentage (%)

Pravara 01 5%

Madhyama 15 75%

Avara 04 20%

0

2

4

6

8

10

12

14

16

18


Percentage(%)

No. Of subjects

OBSERVATIONS




Fig. No. 20 Satamya wise distribution of 20 subjects of katigraha.

Out of 20 Subjects studied in this series,15 subjects (75 %) had Madhyama

satmya, 04 subjects (20%) had Avara satmya and 01 subject (5%) had Pravara satmya

Shakti.

Table no-68 Showing Ahara Shakti wise distribution of 20 subjects of katigraha.

Ahara Shakti No. Of subjects Percentage(%)

Pravara 00 00%

Madhyama 16 80%

Avara 04 20%

Fig. No. 21 Ahara Shakti wise distribution of 20 subjects of katigraha

Out of 20 subjects studied in this series,16 subjects (80%) had madhyama

ahara sakti, 4 subjects (20%) had avara ahara shakti.

0

5

10

15

20


Percentage(%)

No. Of subjects

0

5

10

15

20


Percentage(%)

No. Of subjects

OBSERVATIONS




Table no-69 Showing Vyayama Shakti wise distribution of 20 subjects of

katigraha.

Vyayama shakti No. Of subjects Percentage

Pravara 01 5%

Madhyama 09 45%

Avara 10 50%

Fig. No. 22 Vyayama Shakti wise distribution of 20 subjects of katigraha.

Out of 20 subjects studied in this series, 10 subjects (50%) had avara vyayama

shakti, 9 subjects (45%) had madhyama vyayama shakti, 1 subject (5%) had pravara

vyayama shakti.

Table no-70 Showing Predominant Ahara Rasa wise distribution of 20 subjects

katigraha:

Predominance of ahara rasa. No. Of subjects Percentage (%)

Madhura 6 30%

Amla 4 25%

Lavana 7 35%

Katu 6 30%

Tikta 8 40%

Kashaya 8 40%

0

5

10

15


Percentage

No. Of subjects

OBSERVATIONS




Fig. No. 23 Predominant Ahara Rasa wise distribution of 20 subjects katigraha:

Out of 20 subjects studied in this series, maximum number of 8 subjects i.e

(40%) consumes tikta and kashaya pradhana rasa,were as 7 subjects (35%)consumes

lavana rasa. 06 subjects i.e. (30%) consumes madhura and katu pradhana rasa each,4

subjects (25%) consumes amla rasa.

Table no-71 Showing Predominant Ahara Guna wise distribution of 20 subjects’

katigraha

Predominance of Ahara guna No. Of subjects Percentage (%)

Guru 12 60%

Laghu 07 35%

Sheeta 16 80%

Ushna 03 15%

Snigdha 07 35%

Ruksha 10 50%

0123456789

Percentage(%)

No. Of subjects

OBSERVATIONS




Fig. No. 24 Showing Predominant Ahara Guna wise distribution of 20 subjects’

katigraha

Out of 20 subjects,16 subjects (80%) were consuming sheeta guna pradhana

ahara.12 subjects (60%) were consuming guru guna pradhana ahara,10 subjects (50%)

were consuming Ruksha guna pradhana ahara,7 subjects each (35%) were consuming

laghu guna and snigdha guna pradhana ahara,3 subjects (15%) were consuming ushna

guna pradhana ahara.

Table no-72 Showing Viharaja Nidana of 20 subjects of katigraha :

Viharaja Nidana No. Of subjects Percentage (%)

Ati Chankramana 06 30%

Diwaswapna 04 20%

Ratri Jagarana 02 10%

Yana 08 40%

Fig no. 25 Viharaja Nidana of 20 subjects of katigraha

0

5

10

15

20

Percentage(%)

No. Of subjects

0

2

4

6

8

10

Percentage(%)

No. Of subjects

OBSERVATIONS




Out of 20 Subjects studied in this series,8 Subjects (40%) had history of Yana,

6 Subjects (30%) had history of Ati Chankramana , 4 Subjects (65%)had history of

Diwaswapna and 2 Subjects (10%) had history of Ratri Jagarana.

Table no-73 Showing Nature of Mala Pravruti wise distribution of 20 subjects of

katigraha.

Mala Pravruti No. Of subjects Percentage (%)

Prakruta 4 20%

Baddha Mala 16 80%

Fig. No. 26 Nature of Mala Pravruti wise distribution of 20 subjects of katigraha.

Out of 20 Subjects studied in this series ,16 subjects (80%) were having

Baddha Mala Pravrutti and 4 subjects (20%) were having Prakruta Mala Pravruti.

Table no-74 Showing Manasika Bhavas wise distributions of 20 subjects of

katigraha.

Manasika Bhavas No. of subjects Percentage (%)

Chinta 8 40%

Shoka 7 35%

Bhaya 5 25%

0

10

20

Baddha Mala

Prakruta

OBSERVATIONS




Fig no. 27 Manasika Bhavas wise distributions of 20 subjects of katigraha.

Out of 20 Subjects studied in this series,8 subjects (40%) were having Chinta,

7 subjects (35%) were having Krodha, and 5 subjects (25%) were having bhaya.

Table no-75 Showing Chronicity of 20 subjects of katigraha.

Duration No. Of subjects Percentage (%)

6months - 1 year 13 65%

1-2 year 5 15%

2-3 year 2 10%

3-4 year 0 0%

4-5 year 0 0%

Fig no. 28 Showing Chronicity of 20 subjects of katigraha

Out of 20 Subjects studied in this series ,Maximum number of subjects i.e. 13

subjects (65%) were having chronicity of 6 month to 1 yr, 5 subjects (15%) were

having chronicity of 1yr to 2yr, 2 subjects (10.00%) were having chronicity of 2yr to

3 yr.

Table no-76 Showing Symptoms of katigraha:

0

5

10

Chinta Shoka Bhaya

Percentage(%)

No. of subjects

0

5

10

15

Percentage(%)

No. Of subjects

OBSERVATIONS




Sl. No. Symtoms No. Of subjects Percentage (%)

1 Kati graham 12 60%

2 Kati shoola 08 40%

Fig. 29 Showing Symptoms of katigraha:

Table no-77 Showing Samyak nirooha lakshana wise distribution of 20 subjects

of katigraha.

Samyak nirooha lakshan No. Of subjects Percentage (%)

Prasrushta vit 20 100%

Prasrushta mutra 20 100%

Prasrushta vaayu 20 100%

Ruchi vruddhi 18 90%

Agni vruddhi 16 80%

Aashaya laghavani 15 75%

0

5

10

15

20

2 Kati shoola

1 Kati graham

OBSERVATIONS




Fig no. 30 Showing Samyak nirooha lakshana wise distribution of 20 subjects of

katigraha. Out of 20 subjects studied in this series, all the subjects i.e. 20 subjects (100%)

were recorded with prasrushta vit,prasrushta mutra,prasrushta vaayu, 18 Subjects

(90%) were recorded with Ruchi vruddhi,16 subjects(80%) were recorded with

agnivrudhi and 15 subjects (75%) were recorded with aashaya laghavani.

Table no-78 Showing Treatment History Wise Distribution of 20 Subjects of

katigraha

Drugs No. Of subjects Percentage (%)

NSAIDS 04 20%

Steroids 00 00

Surgical Procedure 00 00

Ayurvedic 03 15%

Fig. No. 31 Showing Treatment History Wise Distribution of 20 Subjects of

katigraha

0

5

10

15

20

25

Percentage(%)

No. Of subjects

012345

Percentage(%)

No. Of subjects

OBSERVATIONS




Out of 20 Subjects studied in this series, 4 subjects (20%) were having

treatment history of NSAIDS, 3 subjects (15%) were having treatment history of

Ayurvedic medicines.

OBSERVATION ON KARMA:

Observations On Sahacharadi Taila Anuvasana Basti

Table no-79 Showing Matra of Sahacharadi Taila Anuvasana Basti Dravya

observed in 20 subjects of katigraha.

All the 20 Subjects selected for the study were between the age of 20 yrs – 60

Yrs and the dose is decided according to the matra of niruha basti.

Sl.no. Matra of anuvasana basti

1 83ml.

2 75.35 ml.

3 66.5ml

4 72.25 ml.

5 79.25ml.

OBSERVATIONS




6 83.5 ml

7 66.5 ml.

8 81.5ml.

9 100.5ml.

10 67 ml.

11 82.5 ml.

12 67.5 ml.

13 87.5 ml.

14 85 ml.

15 70 ml.

16 81.25 ml.

17 67.5 ml.

18 92.5 ml.

19 86.5 ml.

20 90 ml.

Mean anuvasana basti matra 79.257ml.

Time of administration of Sahacharadi Taila Anuvasana Basti observed in 20

subjects of Katigraha.

In all the 20 subjects selected for the study, Anuvasana basti was administered

between 8:00 am – 10:00am after intake of lite food.

Table No-80 Showing Temperature of Anuvasana Basti dravya wise distribution

in 20 Subjects of katigraha.

Temperature of Anuwasana Basti

dravya (oF)

No. Of subjects Percentage (%)

98.6 – 99 16 80.00%

99.1 – 100 04 20.00%

OBSERVATIONS




Fig no. 32 Showing Temperature of Anuvasana Basti dravya wise

distribution in 20 Subjects of katigraha.

Out of 20 Subjects studied in this series, for 4 subjects (20%) the temperature

of anuvasana basti dravya administered was between 99.1oF -100

oF and for 16

subjects (80%) the temperature of anuvasana basti dravya administered was between

98.6oF -99

oF.

Table no-81 Showing Mean systolic Blood Pressure of 20 subjects of katigraha

was recorded before and after administration of Anuvasana Basti.

Sl. No. of the patient B.A.B A.P.B.

01. 120 122

02. 118 124

03. 128 126

04. 126 130

05. 126 128

06. 116 120

07. 124 128

0

5

10

15

20

99.1 – 100

98.6 – 99

OBSERVATIONS




08. 126 128

09. 128 120

10. 120 126

11. 124 120

12. 114 120

13. 126 136

14. 124 130

15. 122 136

16. 120 126

17. 120 126

18. 120 120

19. 122 128

20. 126 126

B.A.B- Before administration of Anuvasana Basti

A.P.B-After Pratyagamana of Basti

Table no-82 Showing Mean difference of systolic Blood Pressure of 20 subjects of

katigraha under

Mean systolic blood pressure Mean Systolic blood pressure Mean Difference

B.A.B. A.P.B.

122.5 126 3.5

Out of 20 Subjects studied in this series, mean difference of systolic blood

pressure of anuvasana basti in kati graha is 3.5

Table no-83 Showing Mean diastolic Blood Pressure of 20 subjects of katigraha

was recorded before and after administration of Anuvasana Basti.

Sl. No. of the patient B.A.B A.P.B.

01. 76 80

02. 74 78

03. 78 82

04. 74 80

05. 78 80

06. 76 80

OBSERVATIONS




07. 78 82

08. 80 84

09. 76 80

10. 74 76

11. 78 80

12. 80 82

13. 78 80

14. 82 86

15. 74 78

16. 78 80

17. 72 76

18. 70 76

19. 76 78

20. 74 82

Mean diastolic blood pressure Mean diastolic blood pressure Mean

B.A.B. A.P.B.

76.3 80 3.7

Out of 20 Subjects studied in this series, mean difference of diastolic blood

pressure of anuvasana basti in kati graha is 3.7

Table no-84 Showing Vega (Mala pravrutti) after Anuvasana Basti, distribution

of 20 Subjects of katigraha.

Mala pravrutti No. Of subject Percentage(%)

1-2 16 80%

3-4 04 20%

OBSERVATIONS




Fig. No. 33 Showing Vega (Mala pravrutti) after Anuvasana Basti, distribution

of 20 Subjects of katigraha.

Out of 20 Subjects studied in this series, 16 subjects (80%) had 1-2 mala

pravrutti vegas and 4 subjects (20%) had 3-4 mala pravrutti vegas.

Table no-85 Showing Samyak yoga lakshanas observed in 20 Subjects of

katigraha:

Samyaka Yoga Laxanas No. Of subjects Percentage (%)

Sa anila sa purisha sneha

Pratyagamana

20 100.00

Swapnanuvrutti 18 90.00

Laghavata 17 85.00

Bala vruddhi 19 95.00

Fig. No. 34 Showing Samyak yoga lakshanas observed in 20 Subjects of

katigraha: Out of 20 Subjects studied in this series, sa anila sa pureesha sneha

pratyagamana seen in 20 subjects (100%),bala vruddhi seen in 19 subjects (95%),

0

10

203-4 time

1-2 time

020406080

100120

Percentage(%)

No. Of subject

OBSERVATIONS




swapnanuvrutti seen in 18 subjects (90%),laghuta of the shareera seen in 17 subjects

(85%).

Observations during Nirooha Basti Samyojana:

Lakshanas like Na dhavati oushadham panim, Na tishtathi oushadham panim

and a homogenous mixture formation were found in all Nirooha Basti dravya

prepared. Those Basti dravya without these lakshanas were discarded and new one

was prepared again.

Table no-86 Showing Nirooha Basti matra according to Aatura Hasta Pramana:

S.N. 1st 2nd

3rd

4th

5th

6th

7th

8th

9th

10th

Mean

1 660ml 650ml. 670ml. 660ml. 680 ml 660ml. 670ml 660ml. 660ml 670ml. 664 ml

2 590ml. 600ml. 610ml 600ml 620ml 620ml. 610ml 600ml 590ml 590ml 603ml

3 540ml. 530ml. 520ml. 530ml. 530ml. 520ml. 530ml. 520ml. 530ml. 540ml. 529ml.

4 580ml. 580ml. 560ml. 570ml. 580ml. 570ml. 580ml. 570ml. 590ml. 600ml 578ml


6 670ml 660ml 660ml 670ml 670ml 670ml. 660ml. 670ml. 670ml. 670ml. 667ml.

7 540ml. 530ml. 540ml. 520ml. 520ml. 540ml. 540ml. 530ml. 520ml. 540ml 532 ml.


9 800ml. 780ml. 810ml 800ml. 800ml. 800ml. 820ml. 800ml. 800ml. 800ml. 801ml.


11 660ml 650ml. 650ml. 660ml. 660ml. 660ml. 650ml 660ml. 660ml. 660ml. 657ml.


13 700ml. 720ml. 720ml. 700ml. 710ml. 700ml. 710ml. 700ml. 700ml. 700ml 706ml.


15 560ml. 580ml. 580ml. 560ml. 570ml. 580ml. 560ml. 560ml. 570ml. 570ml 569ml.


17 540ml. 530ml. 540ml. 540ml. 530ml. 530ml. 530ml. 550ml. 560ml. 550m0 540ml.




Table no-87 Showing Matra of Erandamoola madhutailik Basti Dravya

observed in 20 subjects of katigraha

Sr. No. Matra of madhu tailik basti

OBSERVATIONS




01 664 ml.

02 603 ml.

03 529 ml.

04 578 ml.

05 634 ml.

06 667 ml.

07 532 ml.

08 651 ml.

09 801 ml.

10 536 ml.

11 657 ml.

12 538 ml.

13 706 ml.

14 675 ml.

15 569 ml.

16 657 ml.

17 540 ml.

18 732 ml.

19 679 ml.

20 724ml.

Table no-88 Showing mean of Erandamoola madhutailik Basti Dravya

observed in 20 subjects of katigraha

Mean of erandamoola madhu tailik

basti matra

623.6 ml.

Table no-89 Showing Temperature of Nirooha Basti dravya wise distribution

of 20 Subjects

Temp. Of nirooha basti no. Of subjects Percentage(%)

98.6 – 99 17 85%

99.1 – 100 02 10%

100.1 – 101 01 05%

OBSERVATIONS




Fig. No. 35 Showing Temperature of Nirooha Basti dravya wise distribution

of 20 Subjects

Out of 20 Subjects studied in this series, for 17 Subjects (85%) the

temperature of niruha basti dravya administered was between 98.1oF-99.00

oF, for 01

Subject (05%) the temperature of niruha basti dravya administered was between

100.1oF-101

oF, for 02 Subjects (10%) temperature of niruha basti dravya

administered was between 99.1oF-100

oF

Table no-90 Showing Peristaltic movements observed in 20 Subjects of

katigraha.

Peristaltic movement. No. Of subjects Percentage.

3-4/min 03 15.00

4-5/min 12 60.00

5-6/min 05 25.00

0

5

10

15

20

98.6 – 99 99.1 – 100 100.1 – 101

Percentage(%)

no. Of subject

OBSERVATIONS




Fig. No. 36 Showing Peristaltic movements observed in 20 Subjects of katigraha.

Out of 20 Subjects studied in this series, 12 Subjects (60%) had 4-5peristaltic

movements while 05 Subjects (25%) had 5-6 peristaltic movementsand 03 subjects

(15%) had 3-4 peristaltic movements

Table no-91 Showing Time duration for administration (Pranidhana Kala) of

Nirooha basti observed in 20 Subjects of katigraha:

Time duration for Administration No. Of subjects Percentage (%)

1-2 min. 18 90%

2-3 min. 02 10%

Fig. No. 37 Showing Time duration for administration (Pranidhana Kala) of

Nirooha basti observed in 20 Subjects of katigraha Out of 20 Subjects studied in this series, 6 nirooha basti’s were administered.

In which 18 subjects (90%) time taken for administration was about 1 to 2 minutes. In

2 subjects subjects (10%) time taken for administration was about 2 to 3 minutes.

0

20

40

60

80

3-4/min 4-5/min 5-6/min

Percentage.

No. Of subject

0

5

10

15

20

No. Of subject Percentage(%)

2-3 min.

1-2 min.

OBSERVATIONS




Table no-92 Showing No. of Vegas (Mala Pravrutti) after Nirooha

basti,distribution of 20 Subjects of katigraha.

No. of Vegas (Mala Pravrutti) No. of subjects Percentage (%)

1-2 15 75%

3-4 03 15%

5-6 02 10%

Fig. No. 38

Out of 20 subjects studied in this series, the maximum number of 15 subjects

(75%) had pratyagamana in 1 to 2 minutes, 3 subjects (15%) had pratyagamana in 3 to

4 minutes,2 subjects (10%) had pratyagamana in 5-6 minutes.

Table no-93 Showing Mean systolic Blood Pressure of 20 subjects of katigraha

was recorded before and after administration of Nirooha Basti:

Sl. No. Of the patient

systolic Blood Pressure

B.T. A.T.

1 126 128

2 124 128

3 132 136

4 130 132

5 134 136

6 126 128

7 128 128

8 128 128

9 128 132

10 120 124

11 124 126

0

5

10

15

20

1-2 time 3-4 time 5-6time

Percentage(%)

No. of subject

OBSERVATIONS




12 122 126

13 126 126

14 128 128

15 126 122

16 122 124

17 126 132

18 134 134

19 134 136

20 126 132

B.N.B-Before Administration of Nirooha Basti

*A.P.B-After Pratyagamana of Basti

Mean systolic Blood Pressure Mean systolic Blood Pressure Mean Difference

B.N.B. A.P.B

126.9 129.4 2.5

Fig no. 39 Showing Mean systolic Blood Pressure of 20 subjects of katigraha was

recorded before and after administration of Nirooha Basti:


pressure of Niruha basti in kati graha is 2.5.

0

20

40

60

80

100

120

140

Mean systolic Blood Pressure

Mean systolic Blood

Mean Difference

Ряд3

Ряд2

Ряд1

OBSERVATIONS




Table no-94 Showing Mean diastolic Blood Pressure of 20 subjects of katigraha

was recorded before and after administration of anuvasana basti.

Under:

Sl. No. of the patients

Mean diastolic blood pressure

B.N.B A.P.B.

1 78 80

2 70 72

3 74 76

4 78 80

5 80 82

6 78 80

7 78 80

8 84 86

9 80 82

10 82 84

11 86 88

12 80 82

13 82 86

14 82 84

15 88 90

16 84 86

17 76 78

18 78 80

19 76 78

20 72 74

B.N.B-Before Administration of Nirooha Basti

A.P.B-After Pratyagamana of Basti

Table no-95 Showing Mean difference of diastolic Blood Pressure of 20 subjects

of katigraha under

OBSERVATIONS




Mean diastolic Blood Pressure Mean diastolic Blood Pressure Mean Difference

B.N.B A.P.B

79.3 85.7 6.4

Fig no. 40 Showing Mean difference of diastolic Blood Pressure of 20 subjects of

katigraha under

Out of 20 Subjects studied in this series, mean difference of diastolic blood

pressure of Niruha basti in kati graha is 6.4.

Table no-96 Showing Mean Respiratory rate of 20 subjects of kati graha was

recorded before and after administration of Nirooha Basti under

Sl. No. of the patients Mean respiratory rate

B.T. A.T.

1 18 20

2 20 22

3 18 22

4 18 20

5 20 20

6 18 22

7 20 22

8 22 20

9 22 22

10 18 20

11 20 22

12 18 20

13 18 20

14 16 20

0102030405060708090

Mean diastolic Blood Pressure

Mean diastolic Blood

Mean Difference

Ряд3

Ряд2

Ряд1

OBSERVATIONS




15 18 22

16 20 22

17 20 22

18 22 20

19 20 22

20 18 22

Mean respiratory rate B.T Mean respiratory rate A.T. Mean

19.2 21.1 1.9

fig. No. 41 Showing Mean Respiratory rate of 20 subjects of kati graha was

recorded before and after administration of Nirooha Basti

Out of 20 Subjects studied in this series, mean difference in respiratory rate of

Nirooha basti in kati graha is 1.9.

Table no-97 Showing Samyak yoga lakshanas observed in 20 Subjects of

Katigraha after Nirooha Basti :

Samyak Nirooda Lakshanas No. of Subjects Percentage (%)

Prasrushta Vit 20 100%

Prasrushta Mutra 20 100%

Prasrushta Vayu 20 100%

Ruchi Vardhnam 16 80%

Agni Vardhanam 14 70%

Bala Vardhnam 12 60%

Ashaya Laghuta 10 50%

0

10

20

30

Mean respiratory rate

B.T

Mean respiratory rate

A.T.

Mean

Ряд1

OBSERVATIONS




Fig. No. 42

Out of 20 Subjects studied in this series, Samyak Nirooha Lakshanas like

Prasrushta Vit, Mootra and Vayu, were seen in all the 20 Subjects (100%), 16 subjects

each (80.00 %) had Ruchi Vardhanam ,14 subjects (70%) had Agni Vardhanam , 12

subjects each(60%) had Bala Vardhanam,. and 10 subjects (50%) had Aashaya

Laghuta.

Ayoga and Atiyoga lakshanas observed in 20 Subjects of katigraha after

Nirooha Basti:

No Ayoga and Atiyoga Lakshanas were observed in any of the 20 Subjects

ofKatigraha after Nirooha Basti.

Table no-98 Showing Ashtamahadoshakara Bhava observed in 20 Subjects of

katigraha during Parihara Kala:

Ashtamahadoshakara Bhava No. Of subjects Percentage

Uchaih Bhashya 0 00

Ratha Kshobha 0 00

Ati Chankramana 0 00

Ati Asana 1 05

Ajirna 0 00

Ahita Bhojana 0 00

Diwaswapna 2 10

0

5

10

15

20

25

Percentage (%)

No. of Subjects

OBSERVATIONS




Maithuna 0 00

Fig. No. 43 Showing Ashtamahadoshakara Bhava observed in 20 Subjects of

katigraha during Parihara Kala All the 20 Subjects who had completed the katigraha schedule were advised

with Parihara Kala of 32 days. 1 subject did ati asana and 2 subjects did diwaswapna.

Subjective parameters:

Table no-99 Showing Samyak nirooha lakshana as a Subjective Parameter wise

distribution of 20 patients in Katigraha:

Lakshana 2nd

N.B 4th

N.B. 6th

N.B. 8th

N.B. 10th

N.B. 12th

N.B.

Prasrusta vina

mutra

samirantavam

20 20 20 20 20 20

Ruchivriddhi 1 1 2 2 4 6

Agni vruddhi 0 1 2 4 3 4

Ashaya

laghavani 0 0 2 2 2 4

Fig. No. 44

Out of 20 subjects, prasrusta vin mutra samirantavam was observed in all the

02468

1012

Percentage

No. Of subject

0

5

10

15

20

25

30

35

2nd N.B

4th N.B.

6th N.B.

8th N.B.

10th N.B.

12th N.B.

Ashaya laghavan

Agni vruddhi

Ruchivriddhi

Prasrusta vina mutra samirantavam

OBSERVATIONS




20 patients on all the days of nirooha basti. Ruchi vruddhi was observed in 1

subjects on the 2nd

and 4th

day of nirooha basti, In 2 subjects each on 6th

and 8th

day of

nirooha basti, in 4 subjects on 10th

day of nirooha basti and 6th

subjects on 12th

day of

nirooha basti. Agni vruddhi was observed in 1 subject on 4th

day of nirooha basti, in 2

subjects on 6th

day of nirooha basti, in 4 subjects on 8th

and 12th

day of nirooha basti

each, and in 3 subjects on 10th

day of nirooha basti. Ashaya laghavani was seen in 2

subjects each 6th

, 8th

and 10th

days of nirooha basti, 4 subjects on 12th

day of nirooha

basti.

A) Roga upashanti.

Rogaupashanti No. Of subjects Percentage (%)

Feeling of well being at physical and

mental level

18 90%

Feeling of well being after ½ -1 hours

after walking.

02 10%

Not feeling well and not interested in

any work after aweking

00 00

Figure no. 45: Roga upashanti.

Out of 20 Subjects studied in this series, Roga upashanti Lakshanas like

Feeling of well being at physical and mental level were seen in 18 subjects (90%),

Feeling of well being after ½ -1 hours after walking were seen in 2 subjects (10%).

02468

101214161820

Feeling of well being at

physical and mental level

Feeling of well being after ½ -1 hours after

walking.

Not feeling well and not interested in

any work after aweking

Percentage(%)

No. Of subjects

OBSERVATIONS




B) Table no-101 Showing Oswestry disability index score wise distribution of 20

patients of Katigraha :

Characteristics No. Of subjects Percentage

Pain intensity 16 80%

Lifting of weight 13 65%

Ability to walk 17 85%

Pain while sitting 18 90%

Sexual function 17 85%

Sleep ability 18 90%

Ability to travel 17 85%

Ability to stand 19 95%

Social life 18 90%

Personal care 16 80%

Figure no. 46 Showing Oswestry disability index score wise distribution of 20

patients of Katigraha

Out of 20 Subjects studied in this series, Oswestry disability index score like

ability to stand is recorded in 19 subjects (95%), pain while sitting,sleep ability,social

life is recorded in 18 subjects (90%) each, ability to walk,sexual function,ability to

travel is recorded in 17 subjects (85%),Pain intensity,personal care is recorded in 16

subjects (80%) each, lifting of weight is recorded in 13 subjects (65%).

c) Table no-102 Showing Visual Analogue Scale Rating for pain wise

distribution of 20 patients of Katigraha :

Scale Rating No. Of subjects Percentage

02468

101214161820

Percentage

No. Of subjects

OBSERVATIONS




1 No. Pain 0 0 00%

2 mild pain 2 2 10%

3 moderate pain 4 2 10%

4 severe pain 6 4 20%

5 very severe pain 8 8 40%

6 worst possible pain 10 4 20%

Figure no. 47 Showing Visual Analogue Scale Rating for pain wise distribution of

20 patients of Katigraha

Out of 20 Subjects studied in this series, Visual analog scale rating for pain like very

severe pain is recorded in 8 subjects (40%) , severe pain and worst possible pain is

recorded in 4 subjects (20%) each , mild pain and moderate pain is recorded in 2

subjects (10%) each.

05

101520

Percentage

No. Of subjects

Rating

OBSERVATIONS




RESULT

Tab. No. 103 Distribution of 20 subjects according to no. Of putaka in each

niruha

Kala basti Putaka No. Of

subjects

% Total

putak

Grand total

1 Niruha 1st 20 54.05

37

199

2nd

10 27.027

3rd

5 13.51

4th

2 5.405

2 Niruha 1st 20 57.14

35 2

nd 9 25.71

3rd

4 11.428

4th

2 5.714

3 Niruha 1st 20 66.666

30 2

nd 6 20

3rd

3 10

4th

1 3.333

4 Niruha 1st 20 64.516

31 2

nd 7 22.58

3rd

3 9.677

4th

1 2.702

5 Niruha 1st 20 58.823

34 2

nd 8 23.529

3rd

4 11.764

4th

2 5.8823

6 Niruha 1st 20 62.5

32 2

nd 7 21.875

3rd

4 12.5

4th

1 3.125

Tab. No. 104 Observation on no. of putaka in each niruha in katigraha:

Niruha basti No of Patients Putaka Mean %

OBSERVATIONS




1st 20 37 1.85 54.05

2nd

20 35 1.75 57.14

3rd

20 30 1.5 66.666

4th

20 31 1.55 64.516

5th

20 34 1.7 58.823

6th

20 32 1.65 62.5

Out of 20 subjects in the 1st Niruha Basti total no of 37 Putaka were used with

mean 1.85 and 54.05%, 2nd

Niruha Basti total no of 35 Putaka were used with mean

1.75 and 57.14%, 3rd

Niruha Basti total no of 30 Putaka were used with mean 1.5 and

66.66%, 4th

Niruha Basti total no of 31 Putaka were used with mean 1.55 and 64.51%,

5th

Niruha Basti total no of 34 Putaka were used with mean 1.7 and 58.82% and in 6th

Niruha Basti total no of 32 Putaka were used with mean 1.65 and 62.05%,

Tab no. 105 Distribution of 20 subjects according to number of putaka.

Putaka 199

Subjects 20

% 10.05%

1) On the first day of niruha total putaka were needed, 35 putaka needed on

second day and 30 putaka on 3rd

day and on 4th

,5th

,6th

day 31,34, 32 putaka

were required for the achievement of samayak niruha lakshan.

From the table no..... it is chart that for the achievement of samayak

niruha lakshan the total number of putaka required by 20 subjects was 199.

This shows that single administration with atura hasta praman dose is not

suffient for producing samayak niruha lakshan.

OBSERVATIONS




2) From the table no...... it is apparent that total 37 patient were required on the

first day of niruha basti. Which was reduced to 35 on second day of niruha, on

the third day of niruha requirement of putaka further reduced to 30, on 4th

, 5th

,

6th

day the required of putaka was 31,34,32 respectively.

An enema of less than half litre is considered to be in small enema and

more than half litre as a large enema, small quantity may sudden reach the

proximal part of colon, it may Act from the mucosa of rectum and sigmoid

colon only. If the basti dravya is little in quantity. It will yield inadequate

bouts of evaculation. From the above data it is evident that single

administration with the atur hasta praman dose is not sufficient for the

producing complete dose nirharana., so multiple administration needed. More

pakwasaya gata dosha nirharana with more number of putaka on initial days of

niruha results in reduction in number of putaka or subjects getting for samayak

niruha lakshan on the later days of niruha.

MAJOR symptoms of Samayak Niruha Lakshana:

Antiki:

Tab.no.106 Observation on Antaki Lakshana in Kalabasti on 20 subjects (1).

Niruha

Basti

Putaka

No. Of

subjects

Mean %

1st nirooha 1

st putaka 20 1 31.74

2nd

putaka 10 1 31.74

3rd

putaka 5 0.75 23.80

4th

putaka 2 0.4 12.69

2nd

nirooha 1st putaka 20 1 34.48

2nd

putaka 9 0.9 31.03

3rd

putaka 4 0.6 20.68

4th

putaka 2 0.4 13.79

3rd


2nd

putaka 6 0.6 26.66

3rd

putaka 3 0.45 20.00

4th

putaka 1 0.2 8.88

OBSERVATIONS




4th


2nd

putaka 7 0.7 29.78723404

3rd

putaka 3 0.45 19.14893617

4th

putaka 1 0.2 8.510638298

5th


2nd

putaka 8 0.8 28.57142857

3rd

putaka 4 0.6 21.42857143

4th

putaka 2 0.4 14.28571429

6th

nirooha 1st putaka 20 1 40

2nd

putaka 7 0.7 28

3rd

putaka 4 0.6 24

4th

putaka 1 0.2 8

Tab.no.107 Observation on antaki (2):

Anova: Single Factor

Groups Count Sum Average Variance

Total no. of grade 0 20 9 0.45 1.944737

Total no. Of grade 1 20 24 1.2 4.273684

Total no. Of grade 2 20 46 2.3 5.8

Total no. Of grade 3 20 120 6 0

ANOVA

Source of Variation SS df MS F P-value F crit

Between Groups 363.6375 3 121.2125 40.34224 1.05E-15 2.724944

Within Groups 228.35 76 3.004605

Total 591.9875 79

Tab.no.108 Multiple comparison on Antaki by Tukey Krammer Post Hoc test(3)

OBSERVATIONS




Number

of

putkas

I (niruha) J

(niruha)

MD(I-J) SE q P

values

Remarks

Total no.

of grade

0

grade1 -0.75 0.387595 -1.93501 3.4 Insignificant

Total no.

Of grade

1

grade 2 -1.1 0.387595 -2.83801 3.4 Insignificant

Total no.

Of grade

2

grade 3 -3.7 0.387595 -9.54603 3.4 Insignificant

Total no.

Of grade

3

grade 4 5.55 0.387595 14.31905 3.4 Highly

Significant

31.74% obtained antiki with 1st putaka, 31.74 % with 2

nd putaka, 23.80 % with

3rd

putaka and 12.69% with 4th

putaka on the first day of niruha basti.

34.48 % obtain Antiki with 1st niruha and 31.03% with the 2

nd putak, 20.68%

with 3rd

putaka and 13.79 with the 4th

putaka on the second day of niruha basti.

44.44% obtained antiki with 1st putaka, 26.66% with the second putaka, 20%

with the 3rd

putaka and 8.88% with the 4th

putaka on the 4th

day of niruha basti.

35.71% obtain Antiki with the 1st putaka, 28.57% with the second

putak,21.42% with the 3rd


putaka on the 5th

niruha

basti.

40% obtain with the 1st putaka,28% with the second putaka,24% with 3

rd

putaka,and 8% obtain with the putaka on the 6th

day of niruha.

For comparision between from different putaka in each niruha in achievement

of antiki one way anova was used which showed signifient change in between four

putaka administered in the last of niruha. But on multiple comparision there was

insignificant effect of four different putaka on all niruha day except on last day.

OBSERVATIONS




3) P.V.M.S. :

Observation on P.V.M.S. in kalabasti, among 20 subjects

Kala basti

niruha

putaka

No. Of

subjects

Mean %

1st nirooha 1

st putaka 20 1 31.7460317

2nd

putaka 10 1 31.7460317

3rd

putaka 5 0.75 23.8095238

4th

putaka 2 0.4 12.6984127

2nd


2nd

putaka 9 0.9 31.0344828

3rd

putaka 4 0.6 20.6896552

4th

putaka 2 0.4 13.7931034

3rd


2nd

putaka 6 0.6 26.6666667

3rd

putaka 3 0.45 20

4th

putaka 1 0.2 8.88888889

4th


2nd

putaka 7 0.7 29.787234

3rd

putaka 3 0.45 19.1489362

4th

putaka 1 0.2 8.5106383

5th


2nd

putaka 8 0.8 28.5714286

3rd

putaka 4 0.6 21.4285714

4th

putaka 2 0.4 14.2857143

6th


2nd

putaka 7 0.7 28

3rd

putaka 4 0.6 24

4th

putaka 1 0.2 8

Tab.no. 110 Observation on P.V.M.S. in kala basti (2)


SUMMARY

Groups Count Sum Average Variance

Total no. of grade 0 20 7 0.35 1.186842

OBSERVATIONS




Total no. Of grade 1 20 17 0.85 2.344737

Total no. Of grade 2 20 34 1.7 3.168421

ANOVA

Source of Variation Sum of

Squares df

Mean

Squares F P-value F crit

Between Groups 18.63333 2 9.316667 4.171642 0.02038 3.158843

Within Groups 127.3 57 2.233333

Total 145.9333 59

Tab. No. 111 Multiple comparison of P.V.M.S. in kala basti (3):

I(niruha) J (niruha) MD(I-J) SE q P values Remarks

grade 0 grade1 -0.5 0.289396 -1.72774 3.4 Insignificant

Total no. Of

grade 1 grade 2 -0.85 0.289396 -2.93715 3.4 Insignificant

Total no. Of


Total no. Of

grade 3 grade 4 5.65 0.289396 19.52343 3.4

Highly

Significant

P.V.M.S. with 1st and 2

nd putaka is 31.74 each. 23.80 % with 3

rd putaka and

12.69% with 4th


34.48% obtained P.V.M.S. with the 1st putaka, 31.03% with 2

nd putaka,

20.68% with 3rd

and 13.79% With 4th

putaka on the 2nd


44.44% obtain P.V.M.S. with the 1st putaka, 26.66% with the 2

nd putaka, 20%

with the 3rd


putaka on the 3rd


In the 1st putaka of P.V.M.S. obtain 42.55%, 29.78% is obtain in 2

nd putaka,

19.14% is obtain in 3rd

putaka and 8.51% obtain on 4th

putaka on the 4th

day of niruha

basti.

OBSERVATIONS




35.71% obtain P.V.M.S. with the 1st niruha basti,28.57% obtain in 2

nd niruha

basti,21.42% obtain in 3rd

niruha basti, In 4th

niruha basti 14.28% obtain on the 5th

niruha basti.

In the 40% obtain P.V.M.S. with the 1st niruha basti,28% obtain in 2

nd niruha

basti, 24% obtain in the 3rd

niruha basti, in the 4th

niruha basti 8% obtain. On the 6th

niruha basti.

For comparision between four difference putaka in each niruha in achievement

of P.V.M.S. one way anova was used which showed signifient changes in between the

niruha putaka in 1st and last niruha putakas for the achievent of P.V.M.S.

On the multiple comparision there was insignifient value between 1st ,2

nd,3

rd

grade of niruha,3rd

and 4th

grade of niruha.

Ashaya laghuta(A.L.):

Tab. No. 112 Observation on ashaya laghuta in kala basti, among 20 subjects

Kala basti niruha Putaka

No. Of subjects Mean %

1st nirooha 1

st putaka 20 1 31.7460317

2nd

putaka 10 1 31.7460317

3rd

putaka 5 0.75 23.8095238

4th

putaka 2 0.4 12.6984127

2nd


2nd

putaka 9 0.9 31.0344828

3rd

putaka 4 0.6 20.6896552

4th

putaka 2 0.4 13.7931034

3rd


2nd

putaka 6 0.6 26.6666667

OBSERVATIONS




3rd

putaka 3 0.45 20

4th

putaka 1 0.2 8.88888889

4th


2nd

putaka 7 0.7 29.787234

3rd

putaka 3 0.45 19.1489362

4th

putaka 1 0.2 8.5106383

5th


2nd

putaka 8 0.8 28.5714286

3rd

putaka 4 0.6 21.4285714

4th

putaka 2 0.4 14.2857143

6th


2nd

putaka 7 0.7 28

3rd

putaka 4 0.6 24

4th

putaka 1 8

Tab. No. 113 Observation on ashaylaghvata in katibasti (2):


SUMMARY

Groups Count Sum Mean SD

Total no. of grade 0 20 8 0.4 1.515789

Total no. Of grade 1 20 18 0.9 2.621053

Total no. Of grade 2 20 39 1.95 4.155263

ANOVA


Squares df

Mean

Square F P-value F crit

Between Groups 25.03333 2 12.51667 4.528404 0.014955 3.158843

OBSERVATIONS




Within Groups 157.55 57 2.764035

Total 182.5833 59

Tab. No. 114 Multiple comparision on ashya laghvata in kala basti (3):

I (niruha) J (niruha) MD(I-J) SE q P values Remarks


Total no. Of


Total no. Of


Total no. Of

grade 3 grade 4 5.6 0.321949 17.39405 3.4

Highly

Significant

31.74% had experienced ashaya laghuta with1st and 2nd

putaka, 23.80 % with

3rd



34.48% subject obtain ashaya laghuta with,2nd

putaka 31.03%, 20.68% with 3rd

and 13.79%With 4th

putaka on the 2nd


44.44% obtained with the 1st putaka, 26.66% with the 2

nd putaka, 20% with

the 3rd


putaka on the 3rd


In the 1st putaka of ashaya laghuta obtain 42.55%, 29.78% is obtain in 2

nd

putaka, 19.14% is obtain in 3rd


putaka on the 4th

day

of niruha basti.

35.71% obtain ashaya laghuta with the 1st niruha basti,28.57% obtain in 2

nd

niruha basti,21.42% obtain in 3rd


niruha basti 14.28% obtain on the

5th

niruha basti.

OBSERVATIONS




In the 40% obtained ashaya laghuta with the 1st niruha basti,28% obtain in 2

nd

niruha basti, 24% obtain in the 3rd


niruha basti 8% obtain. On

the 6th

niruha basti.

For comparition between four difference putaka in each niruha in achievement

of ashaya laghuta one way ANOVA was used which showed significant value in

between the putaka on 1st and last day of nirooha in achieving ashaya laghuta.

On multiple comparision there was insignificant value between 1st & 2

nd, 2

nd

& 3rd

grade of Nirooha and highly significant on the 3rd

& 4th

grade Nirooha.

Laghuta:

Tab. No. 115 Observation on laghuta in kalabasti among 20 subjects:

Kala basti niruha Putaka

No. Of subjects Mean %

1st niruha 1

st putaka 20 1 31.7460317

2nd

putaka 10 1 31.7460317

3rd

putaka 5 0.75 23.8095238

4th

putaka 2 0.4 12.6984127

2nd

niruha 1st putaka 20 1 34.4827586

2nd

putaka 9 0.9 31.0344828

3rd

putaka 4 0.6 20.6896552

4th

putaka 2 0.4 13.7931034

3rd


2nd

putaka 6 0.6 26.6666667

3rd

putaka 3 0.45 20

4th

putaka 1 0.2 8.88888889

4th


2nd

putaka 7 0.7 29.787234

3rd

putaka 3 0.45 19.1489362

4th

putaka 1 0.2 8.5106383

OBSERVATIONS




5th


2nd

putaka 8 0.8 28.5714286

3rd

putaka 4 0.6 21.4285714

4th

putaka 2 0.4 14.2857143

6th

niruha 1st putaka 20 1 40

2nd

putaka 7 0.7 28

3rd

putaka 4 0.6 24

4th

putaka 1 0.2 8

Tab. No.m 116 Observation on Laghuta in katigraha (2):


SUMMARY

Groups Count Sum Mean S.D

Total no. of grade 0 20 7 0.35 1.186842

Total no. Of grade 1 20 21 1.05 3.734211

Total no. Of grade 2 20 44 2.2 5.536842


ANOVA


squares df

Mean

squares F P-value F crit

Between Groups 380.5 3 126.8333 48.51199 1.27E-17 2.724944

Within Groups 198.7 76 2.614474

Total 579.2 79

Tab. No. 117 Multiple Comparision on Laghuta in kala basti (3):

I (niruha) J (niruha) MD (I-J) SE q P values Remarks


Total no.

Of grade 1 grade 2 -1.15 0.361557 -3.18069 3.4 Insignificant

Total no.

Of grade 2 grade 3 -3.8 0.361557 -10.5101 3.4 Insignificant

Total no.

Of grade 3 grade 4 5.65 0.361557 15.62685 3.4

Highly

Significant

OBSERVATIONS




31.74% subjects each obtained Gatra laghuta on 1st and 2

nd putaka,23.80%

with 3rd


putaka on 1st nirooha day.

34.48% obtained Gatra laghuta with 1st putaka,31.03% with 2

nd,20.68% with

3rd

and 13.79% with 4th

putaka on 2nd

Nirooha day.

44.44% subjects obtained Gatra laghuta with 1st putaka,26.66% with 2

nd

putaka,20% with 3rd

putaka and 8.8% subjects got Gatra laghuta with 4th

putaka on 3rd

Nirooha day.

42.55% obtained gatra laghuta with 1st putaka, 29.78% with 2

nd putaka,

19.14% with 3rd


putaka on on 4th

nirooha basti.

35.71% subjects obtained gatra laghuta 1st putaka, 28.57% with 2

nd, 21.42%

with 3rd

and 14.28% subjects with 4th

putaka on the 5th

day of nirooha.

40% subjects obtained with gatra laghuta 1st putaka,28% subjects with 2

nd

putaka, 24% with 3rd

and 8% with the 4th

putaka on the last day of nirooha .

For the comparision between 4 different putaka in each niruha in achievement

of gatra laghuta ONE WAY ANOVA was used which showed significant value for

all nirooha drugs.

On multiple comparition there was significant value on 3rd

and 4th

niruha

grade and was insignificant on 2nd

and 3rd

grade nirooha.

Minor symptoms of Samyak Norooha Lakshana:

Gatra mardavata,Indriya Prasannata and Ruchi and agni were grouped as the

minor symptoms of Samyak Nirooha Lakshana.These symptoms cannot be assessed

OBSERVATIONS




after each putaka rather these symptom cannot be guiding factor in deciding whether

the next administration of vasti is needed in the same sitting.These symptoms unlike

major symptoms of samyak lakshana become evident only after completeness of the

procedure i.e it can be assessed only after each nirooha basti not after each putaka.

Table no. 118 Observation on Gatra Mardavata in katigraha in 20 subjects (1)

Kala basti niruha Putaka No. Of subjects Mean %

1st niruha

1st putaka 20 1 31.7460317

2nd

putaka 10 1 31.7460317

3rd

putaka 5 0.75 23.8095238

4th

putaka 2 0.4 12.6984127

2nd

niruha

1st putaka 20 1 34.4827586

2nd

putaka 9 0.9 31.0344828

3rd

putaka 4 0.6 20.6896552

4th

putaka 2 0.4 13.7931034

3rd

niruha

1st putaka 20 1 44.4444444

2nd

putaka 6 0.6 26.6666667

3rd

putaka 3 0.45 20

4th

putaka 1 0.2 8.88888889

4th

niruha

1st putaka 20 1 42.5531915

2nd

putaka 7 0.7 29.787234

3rd

putaka 3 0.45 19.1489362

4th

putaka 1 0.2 8.5106383

5th

niruha

1st putaka 20 1 35.7142857

2nd

putaka 8 0.8 28.5714286

3rd

putaka 4 0.6 21.4285714

4th

putaka 2 0.4 14.2857143

6th

niruha

1st putaka 20 1 40

2nd

putaka 7 0.7 28

3rd

putaka 4 0.6 24

4th

putaka 1 0.2 8

OBSERVATIONS




Tab. No. 119 Observation on Gatra Mardavata in katigraha (2):


SUMMARY

Groups Count Sum Mean S.D

Total no. of grade 0 20 7 0.35 1.186842

Total no. Of grade 1 20 21 1.05 3.734211

Total no. Of grade 2 20 44 2.2 5.536842


ANOVA


squares df

Mean

squares F

P-

value F crit

Between Groups 380.5 3 126.8333 48.51199 1.27E-

17 2.724944

Within Groups 198.7 76 2.614474

Total 579.2 79

Tab. No. 120 Multiple Comparision on Gatra Mardavata in kala basti (3) :



Total no. Of

grade 1 grade 2 -1.15 0.361557 -3.18069

3.4 Insignificant

Total no. Of

grade 2 grade 3 -3.8 0.361557 -10.5101

3.4 Insignificant

Total no. Of

grade 3 grade 4 5.65 0.361557 15.62685

3.4 Highly Significant

31.74% subjects each obtained Gatra mardhavata on 1st and 2

nd putaka,23.80%

with 3rd



34.48% obtained Gatra mardavata with 1st putaka,31.03% with 2

nd,20.68%

with 3rd

and 13.79% with 4th

putaka on 2nd

Nirooha day.

OBSERVATIONS




44.44% subjects obtained Gatra mardavata with 1st putaka,26.66% with 2

nd

putaka,20% with 3rd

putaka and 8.8% subjects got Gatra mardavata with 4th

putaka on

3rd

Nirooha day.

42.55% obtained gatra mardavata with 1st putaka, 29.78% with 2

nd putaka,

19.14% with 3rd


putaka on on 4th

nirooha basti.

35.71% subjects obtained gatra mardavata 1st putaka, 28.57% with 2

nd,

21.42% with 3rd


putaka on the 5th

day of nirooha.

40% subjects obtained with gatra mardavata 1st putaka,28% subjects with 2

nd


and 8% with the 4th



of gatra mardavata ONE WAY ANOVA was used which showed significant value for

all nirooha drugs.


and 4th

niruha


and 3rd

grade nirooha.

Table 121 Observation on indriyaprasannta in katigraha in 20 subjects (1)

Kala basti niruha Putaka No. Of subjects Mean %

1st niruha 1

st putaka 20 1 31.7460317

2nd

putaka 10 1 31.7460317

3rd

putaka 5 0.75 23.8095238

4th

putaka 2 0.4 12.6984127

OBSERVATIONS




2nd


2nd

putaka 9 0.9 31.0344828

3rd

putaka 4 0.6 20.6896552

4th

putaka 2 0.4 13.7931034

3rd


2nd

putaka 6 0.6 26.6666667

3rd

putaka 3 0.45 20

4th

putaka 1 0.2 8.88888889

4th


2nd

putaka 7 0.7 29.787234

3rd

putaka 3 0.45 19.1489362

4th

putaka 1 0.2 8.5106383

5th


2nd

putaka 8 0.8 28.5714286

3rd

putaka 4 0.6 21.4285714

4th

putaka 2 0.4 14.2857143

6th

niruha 1st putaka 20 1 40

2nd

putaka 7 0.7 28

3rd

putaka 4 0.6 24

4th

putaka 1 0.2 8

Tab. No.122 Observation on Indriyaprasannata in Kala basti (2):


SUMMARY


Total no. of grade 0 20 8 0.4 1.515789

OBSERVATIONS




Total no. Of grade 1 20 19 0.95 2.892105

Total no. Of grade 2 20 41 2.05 4.997368


ANOVA

Source of Variation

Sum of

squares Df

Mean

squares F P-value F crit

Between Groups 383.5 3 127.8333 54.36672 7.1E-19 2.724944

Within Groups 178.7 76 2.351316

Total 562.2 79

Tab.no. 123 Multiple Comparision on Indriyaprasannata among 20 subjects(3) :



Total no.

Of grade 1 grade 2 -1.1 0.342879 -3.20813

3.4 Insignificant

Total no.

Of grade 2 grade 3 -3.95 0.342879 -11.5201

3.4 Insignificant

Total no.

Of grade 3 grade 4 5.6 0.342879 16.33231

3.4 Highly

Significant

31.74% subjects each obtained indriyaprasannata on 1st and 2

nd putaka,23.80%

with 3rd



34.48% obtained indriyaprasannata with 1st putaka,31.03% with 2

nd,20.68%

with 3rd

and 13.79% with 4th

putaka on 2nd

Nirooha day.

44.44% subjects obtained indriyaprasannata with 1st putaka,26.66% with 2

nd

putaka,20% with 3rd


putaka on

3rd

Nirooha day.

42.55% obtained indriyaprasannata with 1st putaka, 29.78% with 2

nd putaka,

19.14% with 3rd


putaka on on 4th

nirooha basti.

OBSERVATIONS




35.71% subjects obtained indriyaprasannata 1st putaka, 28.57% with 2

nd,

21.42% with 3rd


putaka on the 5th

day of nirooha.

40% subjects obtained with indriyaprasannata 1st putaka,28% subjects with 2

nd


and 8% with the 4th



of indriyaprasannata ONE WAY ANOVA was used which showed significant value

for all nirooha drugs.


and 4th

niruha


and 3rd

grade nirooha.

Ruchi and agni vruddhi:

Tab. No. 124 Observation on Ruchi and agni vriddhi in katigraha in 20 subjects

(1)

Kala basti niruha putaka No. Of subjects Mean %

1st niruha 1

st putaka 20 1 31.746

2nd

putaka 10 1 31.746

3rd

putaka 5 0.75 23.810

4th

putaka 2 0.4 12.698

2nd


2nd

putaka 9 0.9 31.034

3rd

putaka 4 0.6 20.690

4th

putaka 2 0.4 13.793

3rd


2nd

putaka 6 0.6 26.667

3rd

putaka 3 0.45 20.000

4th

putaka 1 0.2 8.889

4th


2nd

putaka 7 0.7 29.787

3rd

putaka 3 0.45 19.149

4th

putaka 1 0.2 8.511

OBSERVATIONS




5th


2nd

putaka 8 0.8 28.571

3rd

putaka 4 0.6 21.429

4th

putaka 2 0.4 14.286

6th

niruha

1st putaka 20 1 40.000

2nd

putaka 7 0.7 28.000

3rd

putaka 4 0.6 24.000

4th

putaka 1 0.2 8.000

Tab. No. 125 Observation on Ruchi and agni vriddhi in kala basti (2):


SUMMARY


Total no. of grade 0 20 10 0.5 2.473684

Total no. Of grade 1 20 24 1.2 4.484211

Total no. Of grade 2 20 44 2.2 5.642105


ANOVA

Source of Variation

Sum of

squares df

Mean

squares F

P-

value F crit

Between Groups 360.55 3 120.1833 38.15344

3.78E-

15 2.724944

Within Groups 239.4 76 3.15

Total 599.95 79

Tab. No. 126 Multiple comparision on Ruchi and agni vriddhi(3):

I (niruha) J (niruha) MD (I-J) SE Q P values Remarks


Total no.

Of grade 1 grade 2 -0.95 0.349341 -2.7194 3.4

Insignificant

OBSERVATIONS




Total no.

Of grade 2 grade 3 -4 0.349341 -11.4501 3.4

Insignificant

Total no.

Of grade 3 grade 4 5.65 0.349341 16.17329 3.4

Highly

Significant

31.74% subjects each obtained Ruchi and agni vriddhi on 1st and 2

nd

putaka,23.80% with 3rd



34.48% obtained Ruchi and agni vriddhi on with 1st putaka,31.03% with

2nd

,20.68% with 3rd

and 13.79% with 4th

putaka on 2nd

Nirooha day.

44.44% subjects obtained Ruchi and agni vriddhi on with 1st putaka,26.66%

with 2nd

putaka,20% with 3rd


putaka on 3rd

Nirooha day.

42.55% obtained Ruchi and agni vriddhi on with 1st putaka, 29.78% with 2

nd

putaka, 19.14% with 3rd


putaka on on 4th

nirooha basti.

35.71% subjects obtained Ruchi and agni vriddhi on 1st putaka, 28.57% with

2nd

, 21.42% with 3rd


putaka on the 5th

day of nirooha.

40% subjects obtained with Ruchi and agni vriddhi on 1st putaka,28%

subjects with 2nd


and 8% with the 4th

putaka on the last day of

nirooha.


of Ruchi and agni vriddhi on ONE WAY ANOVA was used which showed

significant value for all nirooha drugs.

On multiple comparision there was significant value on 3rd

and 4th

Nirooha


and 3rd

Grade Nirooha.

OBSERVATIONS




Tab. No. 127 Basti dravya Retention time (1)

Kala basti niruha Putaka N Mean percentage

1st Niruha1st 1st 20

1 28.98551

2nd 10

1 28.98551

3rd 7

1.05 30.43478

4th 2

0.4 11.5942

2nd Niruha 1st 20

1 35.08772

2nd 9

0.9 31.57895

3rd 5

0.75 26.31579

4th 1

0.2 7.017544

3rd Niruha1st 1st 20

1 26.66667

2nd 12

1.2 32

3rd 9

1.35 36

4th 1

0.2 5.333333

4th Niruha1st 1st 20

1 46.51163

2nd 7

0.7 32.55814

3rd 3

0.45 20.93023

4th 0

0 0


1 41.66667

2nd 6

0.6 25

3rd 4

0.6 25

4th 1

0.2 8.333333


1 52.63158

2nd 4

0.4 21.05263

3rd 2

0.3 15.78947

OBSERVATIONS




4th 1

0.2 10.52632

Tab. No.128 observation of Retention time (2)


SUMMARY


Total no. of grade 0 20 6 0.3 0.957895

Total no. Of grade 1 20 21 1.05 3.839474

Total no. Of grade 2 20 40 2 4.736842


ANOVA

Source of Variation

Sum of

squares df

Mean

square F

P-

value F crit

Between Groups 386.7375 3 128.9125 54.08418

8.11E-

19 2.724944

Within Groups 181.15 76 2.383553

Total 567.8875 79

Tab. No. 129 Multiple comparison of Retention time 3

I (niruha) J (niruha) MD (I-J) SE q P

values

Remarks


Total no. Of


Total no. Of

grade 2 grade 3 -4 0.345221 -11.5868 3.4 Insignificant

Total no. Of

grade 3 grade 4 5.7 0.345221 16.51116 3.4

Highly

Significant

28.98% subjects each obtained in retention on 1st and 2

nd putaka,23.80% with

3rd



35.08% obtained in retention on with 1st putaka,31.05% with 2

nd,26.31% with

3rd

and 7.01% with 4th

putaka on 2nd

Nirooha day.

OBSERVATIONS




26.66% subjects obtained retention on with 1st putaka,32% with 2

nd

putaka,36% with 3rd

putaka and 5.3% subjects got agni vriddhi with 4th

putaka on 3rd

Nirooha day.

46.51% obtained retention on with 1st putaka, 32.55% with 2

nd putaka, 20.93%

with 3rd

putaka and 0% with 4th

putaka on on 4th

nirooha basti.

41.66% subjects obtained retention on 1st putaka, 25% with 2

nd, 25% with 3

rd


putaka on the 5th

day of nirooha.

52.63% subjects obtained with retention on 1st putaka,21.05% subjects with

2nd


and 10.52% with the 4th

putaka on the last day of nirooha.





and 4th

niruha


and 3rd

grade nirooha.

Number of Vegas v/s Putaka:

Number of vegas showed in gradual decrease from first nirooha to last nirooha

drug. Vata is Amurtha,Anavastita in nature,Pitta and Kapha are Murta dosha.Nirooha

OBSERVATIONS




basti is the only mode which removes excess pitta and kapha dosha which have

moved from their own abode to Pakvashaya,By removing this vata will be purified.By

removing this vata will be purified .The ultimate purpose of Nirooha basti is to

eliminate dosha.As the number of putaka is increased the quantity of dosha to be

eliminated becomes less.So on the subsequent days of nirooha in order to expel dosha

less number of putaka was required.

Vata being an Amurtha dosha the dosha nirharana can never be related

according to number of vega used to eliminate it and the increase in number of vegas

can never judge the completeness of a procedure which is inteded to eliminate the

dosha which is Amurtha and Anavastitha.

Number of Putakas v/s Koshta:

Influence of koshta on number of putakas on the first day of nirooha basti.

For achievement of samyak nirroha lakshana 25%(5 Patients) of mrudu koshta

participants needed 10 putakas, (mean 2). In madhyama koshta i.e in 25%(5 patients)

for achievement of Samyak Nirooha lakshana 15 putakas were needed and lastly 50%

(10 patients) who belonged to krura koshta needed 66 putaka (mean 6.6) to the

achievement of samyak nirroha lakshana, it is evident by the table that total 10

putaka,15 putaka were needed by Mrudu,madhyama koshta participants and the mean

was calculated 2 and 3 respectively.In the krura koshta participants , the requirement

of putaka was high than the madhyama koshta which was 66%(mean 6.6).In krura

koshta,there is vata dominance. The guna of the dosha is Ruksha and sheeta, this will

result in hard stool, which inturn cause obstruction to normal gati of vata.As per

Aacharya Krura koshta may be strong purgatives simultaneously may also need

multiple administration of basti which is evident for present study to make vata in

OBSERVATIONS




normal direction. Single administration of Aatura hasta pramana is Krura koshta, So

multiple administration of basti was needed.

Table No 130 Showing Oswestri Scale Index in 20 subjects of Katigraha

Parameter Mean MD(

𝑑 )) % of

relief

SD SE Variance ‘t’

value

P* Remar

k BT AT

Pain while

sitting

1.65 0.4 1.25 75.75% 0.433 0.096 0.1874 12.58 <0.001 HS

Pain

Intensity

1.7 0.3 1.4 82.35% 0.489 0.109 0.2399 12.46 <0.001 HS

Lifting

Weight

1.75 0.5 1.25 71.42% 0.433 0.096 0.1874 12.58 <0.001 HS

Ability to

Walk

1.8 0.45 1.35 75 % 0.476 0.106 0.226 12.34 <0.001 HS

Sexual

Functions

1.1 0.25 0.85 77.27% 0.357 0.079 0.127 10.38 <0.001 HS

Sleep

Quality

1.7 0.6 1.1 64.71% 0.3 0.067 0.09 15.98 <0.001 HS

Ability to

travel

1.55 0.45 1.1 70.97% 0.3 0.067 0.09 15.98 <0.001 HS

Ability to

stand

1.4 0.25 1.15 82.14% 0.357 0.079 0.127 14.04 <0.001 HS

Social life 1.25 0.2 1.05 84% 0.217 0.048 0.047 21 <0.001 HS

Personal

Care

1.15 0.05 1.1 95.65% 0.3 0.067 0.09 15.98 <0.001 HS

*Table value of ‘t’ at Level of Confidence 99.99% and Degree of Freedom 19 is

3.883

1) Effect of therapies on Pain while Sitting: The mean score of Pain while Sitting

before treatment was 1.65 and got reduced to 0.4 with mean difference of 1.25 after

treatment. The therapy under this group provided 75.75% relief in Pain while Sitting.

As the calculated‘t’ value 12.58 is greater than table‘t’ value. So our hypothesis gets

OBSERVATIONS




rejected and thus the total effect of therapy provided statistically highly significant

result.

2) Effect of therapies on Pain Intensity: The mean score of Pain Intensity before

treatment was 1.7 and got reduced to 0.3 with mean difference of 1.4 after treatment.

The therapy under this group provided 12.54 % relief in Pain Intensity. As the

calculated‘t’ value 12.58 is greater than the table ‘t’ value so our hypothesis gets


result.

3) Effect of therapies on Lifting of Weight: The mean score of lifting weight before


The therapy under this group provided 71.42% relief in lifting weight . As the



result.

4) Effect of therapies on Ability to Walk: The mean score of ability to walk before


The therapy under this group provided 75.00% relief in ability to walk. As the



result.

.

5) Effect of therapies on Sexual Functions: The mean score of muhurmuhur mutra

OBSERVATIONS




pravritti before treatment was 1.1 and got reduced to 0.25 with mean difference of

0.85 after treatment. The therapy under this group provided 77.27% reliefin

muhurmuhur mutra pravratti. As the calculated‘t’ value i.e. 10.38 is greater than the

table ‘t’ value so our hypothesis gets rejected and thus the total effect of therapy

provided statistically highly significant result.

6) Effect of therapies Sleep Quantity : The mean score of sleep quentity before


The therapy under this group provided 64.71% relief in Alasya. As the calculated‘t’

value i.e. 15.98 is greater than the table ‘t’ value so our hypothesis gets rejected and

thus the total effect of therapy provided statistically highly significant result.

7) Effect of therapies on Ability to Travel: The mean score of ability to travel

before treatment was 1.55 and got reduced to 0.45 with mean difference of 1.1 after

treatment. The therapy under this group provided 70.97% relief in ability to travel. As

the calculated‘t’ value i.e. 15.98 is greater than the table ‘t’ value so our hypothesis

gets rejected and thus the total effect of therapy provided statistically highly

significant result.

8) Effect of therapies on Ability to Stand: The mean score of ability to travel before

treatment was 1.4 and got reduced to 0.25 with mean difference of 1.15 after


the calculated ‘t’ value i.e. 14.04 is greater than the table ‘t’ value so our hypothesis

OBSERVATIONS





significant result.

9) Effects of therapies on Social Life: The mean score of ability to stand before


treatment. The therapy under this group provided 84% relief in ability to travel. As

the calculated ‘t’ value i.e. 21 is greater than the table ‘t’ value so our hypothesis gets


result.

10) Effects of therapies on Personal Care : mean score of ability to travel before



the calculated ‘t’ value i.e. 15.98 is greater than the table ‘t’ value so our hypothesis


significant result.

Tab no. 131 Roga upashanti:

Rogaupashanti in Katigraha is calculated with the help of Mean, variance,

observations, pearson correlation, Hypothesized mean difference by using Paired t

Test-

t-Test: Paired Two Sample for Means

BT AT

Mean 1.35 0.15

Variance 0.239474 0.134211

Observations 20 20

Pearson Correlation 0.572478

OBSERVATIONS




Hypothesized Mean Difference 0

Df 19

t Stat 13.0767

P(T<=t) one-tail 3E-11

t Critical one-tail 1.729133

P(T<=t) two-tail 5.99E-11

t Critical two-tail 2.093024

Parameter Mean MD

(𝒅 ))

% of

relief

SD SE ‘t’ P Remark

BT AT

Pain 1.35 0.15 1.2 88% 0.4 0.09 13.07 <0.001 HS

Effects of therapies on Pain : mean score of ability to travel before treatment

was 1.35 and got reduced to 0.15 with mean difference of 1.2 after treatment. The

therapy under this group provided 88 % relief in ability to travel. As the calculated‘t’

value i.e. 13.07 is greater than the table ‘t’ value so our hypothesis gets rejected and

thus the total effect of therapy provided statistically highly significant result.

Tab. No. 132 Visual analog scale:

Visual analog scale in Katigraha is calculated with the help of Mean, variance,

observations, pearson correlation, Hypothesized mean difference by using Paired t

Test-

t-Test: Paired Two Sample for Means

BT AT

Mean 3.1 0.3

Variance 1.884211 0.536842

Observations 20 20

Pearson Correlation 0.701234

Hypothesized Mean Difference 0

OBSERVATIONS




Df 19

t Stat 12.45659

P(T<=t) one-tail 6.88E-11

t Critical one-tail 1.729133

P(T<=t) two-tail 1.38E-10

t Critical two-tail 2.093024

Parameter Mean MD

(𝒅 ))

% of

relief

SD SE ‘t’ P Remark

BT AT

Pain 3.1 0.3 2.8 90% 0.97 0.21 13.55 <0.001 HS

Effects of therapies on visual analog scale : mean score of ability to travel before


The therapy under this group provided 90 % relief in ability to travel. As the

calculated‘t’ value i.e. 13.58 is greater than the table ‘t’ value so our hypothesis gets


result.

DISCUSSION




DISCUSSION

Discussions are competent deliberations,which are embedded within

knowledge. A productive and a tactful discussion must consider bothopposing view

points, thus resulting in a balanced view in the whole presentation. Discussions

present issues that surround a particular topic mostly found being open and debatable

to the argument.As such, a discussion needs to include a thorough discussion on the

different sides of a given topic. Discussion offer a well rounded understanding of all

issues before the writer shows his conclusion.A fact that is not passed through a

proper channel of Tarka is quoted as„Yadrachcha Siddhi‟ by Acharya Charaka. This

exercise of reasons is necessary inorder to open the truth. It is the duty of research

scholar to bring out the truth, whichis collected in the ancient treaties. In this aspect,

the discussion becomes a necessary part of any research work. It is the process of

churning milk in order to draw the butter of conclusion.

This section titled “Discussion” analyses and contemplates the observations

madeduring the research and results obtained on the selected parameters in kati graha.

This section includes the following:

1. Discussion on Literary review

2. Discussion on Materials and Methods

3. Discussion on Demographic Data

4. Discussion on Results

HISTORICAL REVIEW

In Vedic scriptures,0 neither Kati nor Graha had been mentioned, but other

words like Anuka, Viskhanda, Balasa have been mentioned depicting spine and low

back. Plenty of Mantra has been given for the protection of Anuka and maintaining

mobility of Anuka. Descriptions of treatment for low back pain (LBP) date to

DISCUSSION




Hippocrates (460-370 BC), where joint manipulation and use of traction has been

mentioned. Gada Nigraha has mentioned Kati Graha as a separate disease whereas

texts like Madhava Nidana, Bhava Prakasha, etc has mentioned Kati Graha as a

symptom of Amavata at its later stage. Gada Nigraha had mentioned that when Saama

or Niraama Vata gets lodged in Kati Pradesha it leads to Kati Graha. Keeping these

classical references as base these twotreatments were chosen for present study for

assessing their clinical efficacy.

DISEASE REVIEW

The life-time prevalence of low back pain, which has discdegeneration as its

cause, is present in about 80% in the general population. It is aprimary cause of

disability and estimated costs related to low back disorders exceed$100 billion per

year in the U.S alone. Even today, in modern medicine there is notherapy to arrest or

rejuvenate spine and the ultimate option of lumbar surgery comeswith high risk and

higher cost.In the present study an attempt has been made to understand the

detaileddegenerative process described in contemporary modern texts with Ayurvedic

vision.

Thus in body, in low back, bony architecture and associated specialized soft

tissuestructures, especially the intervertebral disc, provide static stability.

Dynamicstability, however, is accomplished through a system of muscular and

ligamentoussupports acting in concert during various functional, occupational, and

vocationalactivities. The disc and two zygapophyseal joints at the same level function

as a trijointcomplex similar to Tridanda described in Ayurvedic classics. The

overallmechanical effect of these structures maintains the histological integrity of the

trijoint complex. Net load of compressive forces must be maintained below

DISCUSSION




respectivecritical minima to maintain tri-joint articulation integrity.Degenerative

cascade, described by Kirkaldy-Willis, which was used in thepresent study to describe

the pathogenesis, is still the widely accepted pathophysiologicmodel describing the

degenerative process as it affects the lumbar spineand individual motion segments.

Phase I

Due to precipitating factors ( i.e. Vata Aggravating or Kapha vitiating Nidana-

due to Pratiloma Gati of Vayu or Avaranajanya Vata Prakopa) in an individualhaving

Khavaigunya (genetic or acquired weakness) at Kati Pradesha these changesoccur in

three phases that comprise a continuum with gradual transition, rather thanthree

clearly definable stages.

The dysfunctional phase, or phase I, is characterized histologically by

circumferential tears or fissures in the outer annulus. (Sphutana has been mentioned

as Nanatmaja Lakshana of Vata, these tears can be attributed to the pathological

increase of Vata.) Tears can be accompanied by endplate separation or

failure,interrupting blood supply (reduction of Dravamsha of Rasa, Rakta due to

increase of Vayu at Kati region) to the disc and impairing nutritional supply and waste

removal. Such changes may be the result of repetitive micro trauma. Since the outer

one third of the annular wall is innervated, tears or fissures in this area may be painful

(Ruja is inherent property of vitiated Vayu). Circumferential tears may coalesce to

form radialtears. Then nucleus pulposus may lose its normal water-imbibing abilities

as a resultof biochemical changes in aggregating proteoglycans (this can be correlated

withdecrease of Shleshaka Kapha between the Sandhi due to increase in Ruksha

propertyof Vayu).

DISCUSSION




Hence Vata gets vitiated and aggravated at its main lodging place

(Pakvashaya) due to Apana Vaigunya which is created by relative vitiation of Samana

and Prana Vayu due to Nidana Sevana. This vitiated Vayu spreads to its other lodging

places like Kati, Sakti etc. But in those, who already have Khavaigunya (trauma) at

Kati Pradesha this Prakupita Vayu gets settled and starts affecting the Shleshaka

Kapha, Snayu, Mamsa Peshi, Sira etc Kapha relatedstructures in an adverse way due

to its Ruksha, Khara properties. Keeping these factors in mind therapies which have

predominantly Snehana and Brimhana properties (Yapana Basti, Kshira Paka) were

chosen for the present study.

DISCUSSION ON CLINICAL STUDY:

Total 20 patients of Kati Graha were registered for the present study. Patients

were grouped in the following pattern:

DIAGNOSTIC CRITERIA:

Diagnosis of Kati Graha w.s.r. to Low back pain was done with the helpof

multi factors i.e. kati shoola, Gaeslen sign, Gillets test, Schober test and Pump hand

test on radiograph. Thus patients having non-specific backache (without

radiographicchanges indicating spondylosis) were excluded.

ASSESSMENT CRITERIA

In assessing the effect of the therapy special scoring pattern as per

Ayurvedicparameters has been used after certain modifications. As this is a clinical

efficacy, quality of life trial improvement in the symptoms as well as improvement in

quality of life parameters was kept in mind. The Oswestry disability index (7) was used

DISCUSSION




to assess the same. Thus by adopting these criteria, level of functioning, level of

disability and its effect on social, personal life of a person, effect on psychology has

been assessed along with effect on state of body tissues and Dosha etc.

For the assessment of the results, guidelines laid down by classical text of

Ayurveda along with modern assessment scales have been adopted. The results

obtained were statistically analyzed and percentage of relief was obtained. Students

paired t test was applied for objective parameters and„t‟ value and „p‟ values were

calculated by using the significance table.

OBJECTIVE PARAMETERS

One of the many hurdles in assessing the effectivity of the therapies was

lackof exact objective parameter. In the present study Visual analogue scale, Oswestri

disability index score was adoptedto assess the pain though it has its own set of bias

and short comings. Scale was usedto assess the degenerative changes visible on

digital X-ray. Many have prompted the question of whatwould be an effective bio

marker for assessing early degenerative changes on lumbarspine.

DISCUSSION ON SELECTION OF THERAPIES

In this study drug used were:

ERANDMOOLA MADHUTAILIK BASTI:

Harityadi Choorna for Amapachana.

Madhu was used for the preparation of Erand Moola Madhu Tailik Basti.

Saindhava Lavana was used for preparation of Erand Moola Madhu Tailik

Basti. .

DISCUSSION




Sahacharadi Taila was used as Snehadravya for Erand Moola Madhu Tailik

Basti and for Sthanika Abhyanga.

Shatahva was used as Kalka in Erand Moola Madhu Tailik Basti..

Erandmoola kashaya was used in Erand Moola Madhu Tailik Basti.

Amapachana with Harityadi chooran:

In this study Haritakyadi choorna was used for Amapachana which is the first

andforemost treatment before conducting any Shodhana Karma because under

thepresence of Ama, Shodhana will not be proper. The ingredients of this yoga i.e.

Amalaki, Pippali, Vidanga, Guda, Haritaki, Shunthi,Vaca, Haridra, Saidhava Lavana

which are anti-oxidant, digestive, antiseptic, diuretic,carminative and mild laxative in

nature.

Among so many Amapachana formulations this was chosen as, some of

thedrugs in it act as Kapha -Vata shamaka while others have Vata Pitta Shamaka

whichplay a major role in the Shamana of Katigraha. Due to its Katurasa, Tikshna,

laghu rooksha guna, Ushna veerya and Katu-Madhura Vipaka, Haritakyadi choorna

mainly act by its Deepana, Pachana and Saraka guna normalizes the vitiated pitta and

eliminates the excess pitta from the body by its laxative action. Amapachana was

given till body and mala attained Nirama avastha because our Acharyas have thus

opined in Yog Shatak “Nirama Dehasya Hi Bheshajanee Bhawantyuktani

Amrutopamani” With Amapachana it was observed that the subjects attained Deha

Laghuta, Agni Deepti, and Samyak Mala Pravruttti. After attaining Niramavastha,

Basti was administered.

DISCUSSION




PROBABLE MODE OF ACTION OF BASTI THERAPY DRUGS:

MADHU:

It is considered as the best among the vehicles, as it contains various

substancesin it, which denote its Drug (potency of Drug) Carrying Capacity. It has

propertieslike „Yogavaahitwa‟ by which it enhances the properties of substances with

which itis processed. Madhu is a natural product with very complex chemical

composition. Itis composed primarily of fructose and glucose but also contains 4 to

5% fructo-oligosaccharides which serve as prebiotic agents. It contains more than 180

substances, including amino acids, vitamins, minerals and enzymes. Madhu has

simulative effect on colonic probiotic bacteria. It is involved in formation as well as

inactivation of carcinogens in the gut lumen and may be altered in a positive way by

the presence of colonic probiotic bacteria.

Madhu, a natural emulsifying agent which may also be used to help stabilize

the colloid, binding the liquids together. In cases where the emulsion is not

successfullystabilized, components may separate again later on. Antitoxic effect of

madhu neutralizes hydrogen peroxide which is found extensively in mammalian

tissues iscontinuously produced by numerous metabolic reactions in the organism,

bacterialand viral infections.

In case of Katigraha, Graha( stiffness) of katipradesh is due to presence of

sheeta guna of kapha and vata in them.

Madhu by its basic properties of lekhana through basti reduced the graham.

DISCUSSION




SAINDHAVA:

Salt in general has the properties like Vishyandi, Sukshma, Tikshna and

Vataghna, itpromotes the evacuation of bladder and rectum. Owing to the Sukshma

(micro or extremely small) property it helps the drug (potency of the drug) to reach

the micro channels. Saindhava mixed with honey is capable of liquefying the viscid

Kapha andbreaking it into minute particles for their easy elimination. Similarly it may

liquify the morbid Dosha-sanghata and breaks it into smaller particles by virtue of its

Ushna and Tikshna property respectively and thus helps their elimination. Apart from

this,Saindhava destroys the Picchila, Bahula and Kashaya properties of Madhu, and

makes close union with it to form a homogeneous mixture. It also has Chedana,

Vilayana, Avidahi and Tridoshaghna properties. It dissolves and expels Doshas from

colon. Thus it helps in absorption and bio purification process of Basti. Continuous

churning of honey and saindhava increases the homogeneity of the emulsion of Basti

material thus reducing the size of particles with the duration of Basti Bhavana.

SNEHA (Sahacharadi Taila):

Sahacharadi Taila contains Sahachara, Devadaru, Shunthi. Their effects are

discussed.Sahachara is Madhura-Tikta Rasa which gives Bala to the effected Siras,

Mamsa,Rakta and also helps to remove the Avarana of Rakta whereas by its Ushna

Virya itpacifies the Vyana Vayu which controls the movement of the Rakta and

valvesresponsible for pumping By its Roga prabhava it helps to control Vaivarnyata

andKandu.

Devadaru is Tikta-Katu-Kashaya Rasa which does the Bhinnata of Graathita

Rakta inSiras, does Srotoshodhana, Shothaprashamana and Vedanashamana. Due to

its UshnaVirya it pacifies Vata which reduces Shoola in Siragranthi.

DISCUSSION




Shunthi is Katu Rasa removes the Sanga present in Raktavaha and

MamsavahaSrotas by doing Amapachana, alleviates Kandu and reduces the chances

of developing Sirajavrana from Siragranthi.

Tila Taila is Madhura Rasa and Kashaya Anurasa. Being Sukshma it

penetrates through the subtle channels of the body, Vyavayi guna helps it to pervade

all over the body without undergoing paka. In ancient times, the warriors and kings

made use of Tila Taila regularly to get rid of their fatigue in the same way as

katigraha being mainly an occupational disorder, Tila Taila serves best when it comes

to nourishing the ksheena dhatus and Siras. When given in the form of Basti, it does

the preenana of the Sira moola present at Nabhi and Guda Pradesh.

To infer, Sahacharadi taila has Ushna virya and Pitta Vatahara properties and

itsPrabhava is Adhobhaga Vatahara. Due to this it is Srotoshodhana, and due to

removal of Avarana it leads to Vata anulomana. Being a sneha it can penetrate into

micro channels. Thus, Sahacharadi Taila acts at the level of Rasa, Raktha, Mamsa,

Meda, and Majja dhatu.

KALKA (Shatahva):

Shatapushpa is a common kalka dravya in Asthapana basti drugs. Kalka

givesthickness and potency to the Basti dravya. Kalka helps to disintegrate the malas

byincreasing the osmotic permeability of the solution. Fresh drugs are used in the

formof Kalka, those which cannot be used for decoction. In this study Shatahava was

used as Kalka dravya because of its Katu rasa, UshnaVeerya, Vatakaphahara and

Deepana properties.

DISCUSSION




KASHAYA(Erandmoola kashaya):

Acc. To Acharya Charaka it has explain that Vrushya Vata Harnanama

Shrestama.

Due to Ushna virya it does the vata kapha hara properties and it has Rechana

and Vrushya properties.The action of Erandmoola is Vayu Shamana,which helps to

remove the Stabdhadata in shareera and it help in doing Gatisheelana.

Sthanika Abhyanga with Sahacharadi Taila before katigraha

Mrudu Sthanika Abhyanga and Bashpa Swedana was done on abdomen,back,

legs of patient with Sahacharadi Taila before administration of Basti. In Sahacharadi

Taila, Sahachara is Shoolahara,Shothohara, Ushana Veerya and Kaphavata hara in

nature. It contain Barlerine which is anti-inflammatory, analgesic, diuretic and anti-

spasmodic, Sahadaru contain Atlantone and Deodarin antifungal and Aromatic.

Shunthi contain Gingerols and Curcumine which have anti-inflammatory property.

Abhyanga over Kati Pradesh with the help of Sahacharadi Taila, does the

Dosha Viliyan on Kati Pradesha and reduce the Shoola.Thus Abhyanga helps to

stimulate intestinal peristalsis, which helps in proper Basti Dravya absorption also in

conditions like constipation or intestinal spasms.

On the other hand Bashpa Swedana improves peripheral Hemodynamics and

Autonomic regulation and softens the superficial and deep structures of abdomen

providing a beneficial environment for the gastrointestinal movements.

Nadi Swedana in katigraha:

Nadi Swedan enhances local microcirculation, by increasing the diameter and

blood flow velocity of peripheral arterioles, delivering higher level of oxygen and

nutrients to the cells. Ushana of vaspa swedana it help to reduced to vata kapha hara.

DISCUSSION




Discussion on Methods:

Charaka has defined Basti as the procedure in which the drug prepared

according to the classical reference and administered through Guda reaches up to

Nabhi Pradesha, Kati, Parshwa, Kukshi; liquifies the accumulated Dosha and Purisha,

spreads the potency of drugs and unctuosness all over the body and easily comes out

along with the Purisha and Dosha. There is none other than Vayu which is the most

important causative factor of diseases in Shakha, Koshta, Marma, Urdhwa,

Sarvavayava and Anga. Vayu is responsible for the Vikshepa and Sanghata of Vit,

Mutra, Pitta and other Malas. When it is exceedingly aggravated there is no remedy

other than Basti for its alleviation. Thats why Basti is considered to be Ardha chikitsa

by most Acharyas.

Discussion on Basti Yantra:

The instrument or device used for Basti karma is called as Basti Yantra. It

comprisesof two parts – a) Basti Netra b) Basti Putaka.

Suvarna, Roupya, Trapu, Tamra, Reeti, Kamsya, Asthi, Drumavenu, Danta,

Nala,Mani etc. were used to make Basti Netra in ancient days. Now a days plastic

enema nozzles and rubber catheters are available which makes it easy to administer.

In ancient days the urinary bladder of matured animals like Cow, Buffalo, Deer,

Pig,Goat etc. without Chidra, Granthi, Gandha and Sira were used for making Basti

Putaka. It was then processed to make soft and colourful by removing the blood

vessels and other impurities.

Now a days, due to modern technological developments various types of

materials are available to make Basti putaka and even disposable Basti netra are

available. The rubber bladder and polythene bags are the best choice. Presently in

DISCUSSION




most Panchakarma theaters the disposable Basti yantras with polythene bags are in

use.

Discussion on Basti Ingredients:

Madhu is Madhura and Kashaya in rasa, Rooksha and Chedana in Guna and

Ushna in Veerya. Madhu is having Sukshma Marga Anusari guna, by which it can

reach up to the minute Srotas and as it is Yogavahi, it can transport the potency of

drugs into the cells.The Guna of the Lavana are Vishyandi, Sukshma, Teekshna,

Ushna and Vatahara and promotes the evacuation of Bladder and Rectum. Saindhava

destroys the Picchila, Bahula and Kashaya properties of Madhu and makes close

union with it to form a homogeneous mixture. The presence of Na+ (Saindhava) in

Basti Dravya may play an important role for the absorption of the drug as the Na+

channels are the most commonly used channels for the absorption of the substances. If

a membrane is interposed between the two solutions (i.e. Salt + Sugar) of such

character it is freely and equally permeable to water, salts and sugar. The cells of the

Intestinal Mucous Membrane are so easily permeable by Sodium Chloride that

Hypotonic / Isotonic solution are absorbed almost as rapid as pure water. The

concentrated dose of salt causes irritant action on the bowel producing Peristalsis.

Honey along with Rock Salt makes a homogenous mixture to form a solution

havingproperties to permeate the water easily. The retention of irritative substances

may be favoured by making its solution as nearly isotonic as possible by using

Colloidal Fluid such as Starch Water as Diluents.

Owing to the Snigdha Guna, Sneha dravya produces unctuousness in the body

in turn helps for easy elimination and by Sukshma Guna it helps the drug (potency of

the drug) to reach into the micro channels. Apart from these functions, it protects

DISCUSSION




theMucous Membrane from the untoward effect of irritating drugs in the Basti

Dravya. Volatile substances are rapidly absorbed from aqueous or oil solutions. Oil

enema or oil present in enema preparations helps to absorb the toxic substances in it.

Kalka dravya serves the function of Utkleshana or Doshaharana or

Samshamana depending upon its contents and is selected accordingly. It gives

required thickness to the Basti material.

Kwatha helps in maintaining the volume of the Basti dravya, helps in

spreading and cleaning. Besides that, the herbs added are Vatahara in nature which

provide Anulomana and Nirharana of doshas. Some other ingredients like

Goksheera,Gomutra, Amlakanji, Prasanna, Mamsarasa etc are also used in place of

Kashaya in certain Basti Yogas or for the preparation of Kwatha itself. The drugs

used for the preparation of Kalka and Kwatha are selected on the basis of Dosha,

Dushya and Srotas involved in the pathogenesis of the disease hence they are the

mainconstituents of the Basti Dravya. The action of Kalka and Kwatha components

mainly depends upon the drugs used in it, most of them having medicinal value.

Avapa dravyas are used in order to make the Basti either Tikshna or Mrudu and for

effect on the particular Dosha.

Discussion on Basti Pranidhana:


Jirnahara and doesn‟t have very much hunger. After performing Abhyanga and Nadi

Sweda, the patient is asked to lie down in the left lateral position on the droni. As

grahani and guda are located in the left side of the body, administration of Basti while

DISCUSSION




the patient is lying in his left lateral side endows pleasant benefits.Lying on the left

lateral side keeps the sphincters (Valayas) submerged into the surrounding

musculature. Then patient is asked to keep his left hand below the head as a pillow, to

extend the left leg completely and to flex the right leg at the knee joint, keeping on the

left leg by flexing the hip joint so that it makes easy way for inserting the Basti Netra.

It should be inserted up to ¼ part of the Netra until the Agrabhaga Karnika fixes to the

guda. Even though 1 Muhurta is the maximum time told for Pratyagamana of Basti

dravya usually this comes within 10-20 minutes.

Discussion on Mode of action of Basti as mentioned in Ayurvedic Classics:

Mode of action of basti can be attributes to many factors i.e. dose,drug and

procedure etc.

Dose: The adult dose of niruha basti is fixed at 12 prasuta. A palam is 50ml.

According to Govt. Pharmacoepia Committee. Dalhana commenting on Susruta

Samhita clarifies that Madhutailik is Padaheena i.e. devoid of 1/4th

of full ( Dwadasha

Prasuta Basti) is total Basti will be 9 Prasruta( approximately 900 ml.) in classics here

number of Basti Yogas in which the amount of Kashaya mentioned is more than the

amount needed for the single administration. This was not a miscalculation but this

was the amount needed for single administration of Kashaya, which was to be utilized

more than once in a single sitting for administration Basti till attainment of Samyak

Niruha Lakshana. Acharya Charak suggests that any treatment procedure finds its

maximum benefits only when Samyak Lakshana is achieved and this is applicable for

Niruha Basti also. Vagbhata furtherS states that if the Basti dravya is evaculated by its

own i.e. if evaculated without urge/before the defecation reflex is manifested, a 2nd

,

3rd

or 4th

Basti can be given. It attainment of Samyak Lakshana one Niruha is not

DISCUSSION




always equivalent to one Putaka (960ml.) multiple administration may be needed even

though the study has been proved that more than one administration has more input on

attainment of Samyak Niruha Lakshana, still it did not come to practice. Probable

reasons are multiple administration with routine(960mI) is difficult to practise

because some time even after single administration patient get tired without getting

Samyak Niruha Lakshana due to more number of Vega, increased appetite, more time

lag etc. This large dose may harbour the complication of over dose too.

According to Susruta dose of Niruha should be measured with Atura hasta and

which is equal to Prasruta, while Gayadas commenting on the same reference clarified

that Prasruta is not 2 Pala but it is “Kuncitaanguli Paani”. The measurement of

prasruta by atura hasta pramana is kunchita anguli paani is lesser in quantity

compared to routinely practised dose. In this study total quantity of madhutailika basti

calculated by atura basti praman was only 240ml.which is approximately one fourth

of routinely practiced dose(960ml.) but with single administration of this dose its

difficult to achieved samyak niruha lakshan. Hence multiple number of administration

were needed. The effect of basti dravya(medicine) may be pronounced, as there is

more contact tissue for the medicine with colonic mucosa. Even after repeated

administration with dose klama and atibhubhukshan lakshan observed in few patients.

By repeated administrations this dose is able to relieve major symptopms of samyak

lakshanas viz..antaki prasruta vin mutra sameeranatwam, ashaya laghuta,gatra

laghuta.

There was no significant difference noted in attainment of minor lakshanas

between all niruha.

But the increase in percentage of attainment of minor lakshanas from 1st to last

niruha drug can be considered as a measure of effectiveness of basti.

DISCUSSION




DRUG: Madhu has Kapha Chedana and Balya property. Fatty acids present in

honey stimulates peristaltic digestion. The most important properties of Madhu are the

Yogavahitvam and Sooksham Marganusaritvum. Yoga Vahi means Catelist in action,

Suksham Marga Anusaritvama is the potency to penetrate into minute capillaries of

the body. By increasing osmotic permeability.

Saindhava is having an important Guna of being Suksham this may be

important Guna of being Sookshma this may be important for the absorption of Basti

Dravya. It also has the property of the stimulating ionic action potential which may be

one of the causative factors for the mode of action of Basti. Tila taila is the best drug

for alleviating morbid Vata by virtue of its properties like Tikshan, Sukshma and

Vyavavi. It pervades the micro channels. As Sneha in base lubricates Colon, soften

Mala and help to eliminates it without strain. Kalka added for was Shatapushpa,

which is Katu Rasa, Ushan Virya and Vatakapha hara and Deepana in nature. Kalka

help to disintegrate Malas by increasing the Osmotic Permeability of solution,

Erandmoola has got specific action on Trik and Kati Pradesh. Kashaya bring

homogeneously to the mixture. Thus all drugs have mainly Kapha hara and

Vatakapha hara action thus makes, it very suitable for clinical condition Katigraha as

well as for the procedure of Niruha.

PROCEDURE: Katigraha being Vatavyadhi, the vitiation of Vata is mainly

due to Dhatukshata or Margavarodha. This condition is also associated with

Pakvashayagata Vata Kopa. In the present study Apana Dusti was present in almost

all patient. Niruha is the only mode which remove Kapha Pitta from the site of unite

i.e. Pakvashaya then inturn pacifying Vata. Niruha Basti like Madhutailika Basti is

ideal which provides a broad spectrum action over the Doshas. It is Niruha as well as

Anuvasana, because of this it take care of the all the 3 doshas. By expelling the

DISCUSSION




minute Dosha and pacifing Amoorta Dosha. In the Katigraha, there is Kapha,

associated Vata condition is present which is indivated for the Yoga Basti in general

and when condition is chronic and association of Dosha is more than Kala Basti also

may be thought ofthe drugs from intestine.It gives essential quantity (thus maintaining

volume) to Bastidravya thus helping in spreading and cleaning.

Once the properly mixed basti is administered then action of bastidravya starts

in Pakvashaya.Inbasti, it is the Veerya of the drug which brings about an action,

Adhogamidhamani that is present in the Pakvashaya absorbs the veerya and carries it

to urdhwagamani and tiryakgamanidhamani. If the Samyak Lakshana is not achieved

the basti was repeated again upto maximum of four administrations.The first

administration with Aatura Hastapramana dose is not having adequate effect on the

Dosha Shodhana. If the vitiation of dosha is more, it is limited to only

Pureeshashodhana from the Pakvashaya with a repeated administration of Basti Srotas

become clearer the procedure proceeds to Dhatugata Dosha Shodhana.

Basti makes the vitiated Apanavata to move in a downward direction that

results in Apanaanulomata. The potency of Bastidravya present in the colon is

transported quickly by Apana to the region of Samana Vata thus normalising it. From

Samana it moves to Vyana Vata, thereafter it acts on Udanavayu and Pranavayu and

nourishes them. So basti which is introduced in the colon acts upon every system of

the body from head to toe draws out the impurities by its potency like the sun

evaporating water from the earth by its heat. Hence it can be concluded that this

outstanding relation between Apanavata and Pakvashaya is the main reason for

getting relief from Katigraha by multiple administration of Madhutailika Basti with

Atura hasta pramana.

DISCUSSION




Eliminative or purificative action of Basti:

“Aapadatalamoorda Sthana Doshan Pakwashaye Sthitha

Veeryena Bastiradatte Swastho Arko Bhoorasaniva ||” (Ch. Si- 7/64)

Just like the rays of sun absorb the water from the earth similarly Basti

administered into Pakwashaya draws out doshas from Pada to Masthaka by its

Veerya.

“Yadvat Kusumbhasamsritathoyat Ragam Haret Patah

Tadvat Draveekritat Dehan Nirooho Nirharen Malan ||” (Ch. Si 7/65)

As a piece of cloth soaked in the water mixed with powder of Kusumbha

absorbs theRaga (dye) from it, similarly Nirooha Basti eliminates the doshas which

are liquefied by Snehana and Swedana from the body.

Systemic Action of the Basti:

The Virya of the drugs administered through the Basti into the Pakwashaya

reachesthe whole body through the channels (Srotas), as the active principles in the

waterwhen poured at the root of the tree reaches the whole plant.

Nutritive Action of Basti:

Just as a tree fed with water at its roots, puts forth green leaves and delicate

sprouts, and in due time grows into a big tree, full of blossom and fruit, similarly

doesa man grow strong by means of Anuvasana Basti. In order to explain the manner

in which it occurs, Chakrapani quotes a quotation by Parashara i.e.

“Moolam Gudam Sharirasya Sirastatra Pratishthita

Sarvashariram Pushnanti Moordhanam Yavadshrita ||” (Parashara)

DISCUSSION




Guda is the moola of the body and the vessels present in that region provides

nourishment to the whole body with the help of substances poured in it.

Discussion on Mode of action of Basti according to modern science:

The Gastro Intestinal Tract has a nervous system known as “Enteric Nervous

System” lie entirely in the wall of the Gut, Beginning in the Oesophagus and

extending all the way to Anus.The number of Neurons in this Enteric System is about

10 crores almost equal to the number in the Spinal Cord. It especially controls Gastro

Intestinal Movements and Secretion. The Two Plexuses in Enteric System are

Mesenteric Plexus and Sub Mucosal Plexus. The Sigmoidal, Rectal and Anal Regions

of the Large Intestine are considerably better supplied with Parasympathetic Fibers

than other portions. They are mainly stimulatory in action especially in the Defecation

Reflexes. (Dr. M.R Vasudevan Namboodiri, Dr. L. Mahadevan. Principles and

Practices of Basti. 2nd Ed. Kanyakumari: Dr. Y Mahadeva Iyer‟s Sri Sharada

Ayurvedic Hospital; 2006.

The Basti may act in the body indirectly by stimulating these nerves. The

secretory action of colon is increased by stimulating these nerve fibers thereby paving

way for Mala Shodhanam.

Role of Regulatory Peptides:

Recent studies show that some Active Principles - Regulatory Peptides –

Produced and Released by Endocrine and Neural Tissues are present in the Gut and

the Brain. This complex system is known as Peptidenergic Nervous System composed

different types of Peptidenergic Neurons. These Neurons can cause gut movements

independently and belong to Non- Cholinergic Autonomic Nervous System.

DISCUSSION




These Regulatory Peptides can be stimulated by Basti Prabhava and this effect

can be conveyed to the entire body through this peptide chain and to the brain, since

the same regulatory peptides are present in the Gut, Brain and in the Tissues.

Blood Circulation in the Colon:

The blood vessels of the Gastrointestinal System are part of a more extensive

system called the “Splanchnic Circulation”. The design of this system is that all of the

blood that courses through the Gut, Spleen and Pancreas, then flow immediately into

the Liver by way of Portal Vein. In the Liver the blood passes through millions of

fineLiver Sinusoids and finally leaves the Liver by the way of the Hepatic Veins

thatempty into the Venacava of the general circulation. This blood circulation may be

improved by the Basti. Moreover there are chances that the increased secretory effect

caused by Basti may purify the blood, circulating in the reach of colon, by extracting

and eliminating the impurities in it.

Absorption of Basti Dravya in The Colon:

The human small intestine and colon perform important functions including

the Secretion and Absorption of Water and Electrolytes, the storage and subsequent

transport of Intraluminal contents Amorally and the salvage of some Nutrients after

Bacterial Metabolism of Carbohydrate that are not absorbed in the Small Intestine.

Most of the Absorption in the Large Intestine occurs in the proximal half of

the colon, giving this portion the name absorbing colon. Absorption through the

Gastrointestinal Mucosa occurs by active transport and by diffusion.

Water is transported through the Intestinal Membrane entirely by the process

of diffusion. Furthermore this diffusion obeys the usual law of Osmosis.

DISCUSSION




Thereforewhen Chyme is diluted, water is absorbed through the intestinal mucosa into

the blood of the Villi by Osmosis. On the other hand, water can also be transported in

the opposite direction from the plasma into the Chyme. This occurs especially when

hyper osmotic solutions are discharged from the stomach.

Similarly the active principles of Basti Dravya may also be absorbed because

they are mainly water soluble. It may be considered that Nirooha Basti is Hyper-

Osmotic which facilitates absorption of morbid factors into the solution whereas

Sneha Basti contains Hypo-Osmotic solution facilitating absorption into the blood.

The Rectum has rich Blood and Lymph supply and the drugs can cross the Rectal

Mucosa like other Lipid Membranes. Thus unionized and lipid soluble substances are

readily absorbed from the Rectal Mucosa. Small quantities of short chain Fatty Acids

such as those from the Butterfat are absorbed directly into Portal Circulation rather

than being converted into Triglycerides. This is because short chain Fatty Acids are

more Water Soluble and allows direct diffusion from the Epithelial Cells into the

Capillary Blood of the Villi. More over a Volume of about 1000cc of gas is estimated

to be present in Gastro Intestinal Tract which can be readily expelled by Basti Karma.

In regard of the the absorption of Basti Dravya, it is reported that water is

absorbed 60%-80% from the gut and normal saline is absorbed freely. Amino Acids

are also reported to be absorbed. Absorption in the proximal colon is better than the

distal part.

ROLE OF ANJALI PRAMANA IN NIROOHA BASTI:

• Using “निरुहबस्तिमात्रा” by आिुरहतिप्रमाणis more helpful in deciding

theexact matra, which may vary accordingly in different patients.

DISCUSSION




• With this matra,the basti dravya retention time is more and bioavailabilty of

the dravya will increase.

• Thereby we can assess the maximum Samyak Shuddhi Lakshanas ,

without any Upadrava.

ROLE OF DIFFERENT PUTAKAS IN NIROOHA BASTI:

For getting samayak nirooha lakshan different putaka are used, as per classics

niruha basti matra for adult is 12 prasruta but the in this study atura hasta praman is

used for the niruha matra as it is lesser compared 12 prasruta,one putaka is not

sufficient to obtain the samayak nirooha lakshana then next putaka is used till samyak

nirooha lakshana are seen, along with that vaidya should be take care of any patient

that any upadrava should not occurs while giving basti with different putakas.

Discussion on Demographic Data:

AGE:

Out of 20 subjects studied in this series, maximum number of subjects i.e.

7(35%) were in the Age group of 30-40 and 40 to 50 years each. 6 subjects (30%)

were in the Age group 20 to 30 years.

Low back pain is affects 60% to 85% of people at same point of their lives.

Many people have a mild to moderate low back pain. Low back pain is an important

clinical, social, economic, and public health problem affecting the population

indiscriminately. It is a disorder with many possible aetiologies,occurring in many

groups of the population, and with many definitions.The prevalence of Low back pain

in Indian population has been found to vary between 6.2%(in general population) to

92%( in construction workers).

DISCUSSION




Low back pain can be medically and economically devastating as it is the

number one cause for disability in patients younger than forty five year of the age.

According to Ayurveda, Katigraha is having Vataja and Kaphaja Ahara-Vihara, our

study also support fact and hence 35% of subjects were in between 31 to 40 years and

41 to 50 years of age, and 6 subjects were in 20 to 30 years of age.

Sex:


(70%) were male, 06 subjects (30%) were female. From above data it is clear that

Katigraha affect both Men and Women, but ratio of male is more than female due to

continues sitting and work on computers and other IT department.There for in our

study,because of the above stated reason it can be assumed that male were more

affected than female.

Religion wise:


15(75%) were Hindus, 05 subjects (25%) were Muslims.As per the observations the

maximum patients were from Hindu community. From this we cannot conclude that

Katigraha is higher in the Hindu community.Religion does not play any role in the

incidence of Katigraha. The presence of larger number of Hindu patients may be due

to the geographical predominance of Hindu community in and around Hubli.

Marital Status-


(85%) were married, while 03 subjects (15%) were unmarried.

DISCUSSION




There is no role as such in marital status in men and women.

Educational Status-wise:


6(30%) were graduate, 05 subjects (25%) were from PUC, 03 subjects (15%) were

uneducated,02 subjects (10%) were Primary,Higher Secondary and Post Graduates.

Education helps an individual to stay informed about the health camps and

other related information and lack of education will make the individual to stay

unaware of the impending complication of the disease. Therefore education has a role

in the reporting of the cases.

Occupation-wise:


had Govt. Job and Pvt Job each, 2subjects(10%) were farmers Student each, 6

subjects(30%) were House wives and, 1 subject (05%) each werebusinessman and

labour.Significant associations were found with a sitting posture at work in both the

sexes as in our study maximum number were into Govt as well as Private Jobs as the

work was concerned with sedentary type like Computer Job, Bank Job etc.

Housewives, Farmer and Student for who work more in sitting as well as forward

bending posture work.

Work wise distribution:


did sedentary work, 4 subjects(20%) did mild and moderate work each. 2

subjects(10%) did laborious, standing and travelling work each.

DISCUSSION




Socio Economic Status-wise Distribution:

Out of 20 subjects studied in this series, 18 subjects (90%) belonged to middle

class, 02 subjects (10%) belonged to poor class and no subjects belonged to Rich

class.This indicates that this disease is common in all classes and more in middle and

poor class people because of direct link with occupation. Middle class people work

continuously which are the Nidana of Katigraha.

Habitat-wise Distribution:

Out of 20 subjects studied in this series, 16subjects (80%) were from Urban

area while remaining 04subjects (20%) were from Rural area.

Through this statement one can understand clearly that Katigraha is not only

caused by laborious work but also due to sedentary life in the urban population

nowadays.

DISCUSSION ON PERSONAL HISTORY

Ahara-wise Distribution:

Out of 20 subjects studied in this series, 13 subjects (65%) were consuming

Niramisha Ahara and 07 subjects (35%) were consuming Samisha Ahara.

Niramisha Ahara is Sheeta and Guru Guna which is the main cause of the

Graha or Stabdhata in Kati Pradesha. It aggravates the Sheeta Guna of Vata and

Kapha. In our study Niramisha Ahara caused Katigraha in them.

DISCUSSION




Agni wise distribution:

Out of 20 subjects studied in this series, maximum number i.e. 10 subjects

(50%) had Mandagni, while 05 subjects (25%) had Teekshnagni and 05 subjects

(25%) had Vishamagni.

Agni plays a very important role in the manifestation of various Vyadhi,

Katigraha is also one of them. Further due to Mandaagni, Dhatu gets poorly

nourished. In our study majority of the subjects were affected by Mandagni which

leads to Katigraha.

Koshta wise distribution:

Out of 20 subjects most of the subjects i.e. 10 subjects (50%) had Mrudu

Koshta,while 05 subjects (25%) had Madhyama Koshta and 05 subjects (25%) had

Kroora Koshta.

Due to excessive intake of Guru, Sheeta Ahara mainly junk food and improper

sleeping habits does the Vata Kapha Prakopa leading to Agni Dusti and further

causing the Krura Koshtha.

Addiction wise distribution:

Out of 20 subjects studied in this series, 14 subjects (70%) had the habit of

excessive intake of tea, 4 subjects (20%) each had the habit of excessive intake of

alcohol and tobacco chewing,03 subjects(15%) had the habit of smoking, 02

subjects(10%) had no habits.

DISCUSSION




Nidra wise distribution:

Out of 20 subjects studied in this series, maximum number of subjects i.e. 8

(40%) were recorded with Vishama Nidra; 07 subjects (35%) with Alpa Nidra; 03

subjects (15%) with Ati Nidra,2 subjects (10%) with Sukha Nidra.In the present study

40% of subjects had Vishama Nidra as Katigraha is Vata Kaphaja Vyadhi and its

symptoms aggravate in night due to pain over Kati Pradesh, which result in Vishama

Agni or Alpa Agni.

Deha Prakruti wise distribution:

All the subjects were of Dwandwaja Deha Prakruti. Out of 20 subjects studied

in this series, 10 subjects (50%) were of Kapha Vata Prakruti; 07 subjects (35%) were

of Vata Pitta Prakruti, and 03 subjects (15%) were of Pitta Kaphaja Prakruti.

As the katigraha involve mainly in Vatakapha dosha, there is possibility that in

our study 50% of the subject were of Vata Kapha Prakriti.

Sara wise distribution:


Sara 01 subject (5%) had Avara Sara.

Samhanana wise distribution:

Out of the 20 subjects studied in this series,17 subjects (85%) had Madhyama

Samhanana and 03 subjects(15%) had Avara Samhanana.

DISCUSSION




Pramana wise distribution:


Pramana while 02 subjects (10%) had Pravara Pramana and no subjects had Avara

Pramana.

Pramana helps in amount of Basti Dravya; accounting to different Shareera

Pramana there is variation in the Matra of Basti Dravya.

Satwa wise distribution:

Out of 20 subjects studied in this series,16 subjects (80%) were of Madhyama

Satwa; 02 subjects (10%) were of Pravara Satwa, and 02 subjects (10%) had Avara

Satwa. Satwa help in deciding the dose of Basti Dravya, how much it could be

tolerated.

Satmya wise distribution:

Out of 20 Subjects studied in this series,15 subjects (75 %) had Madhyama

Satmya, 04 subjects (20%) had Avara Satmya and 01 subject (5%) had Pravara

Satmya Shakti.Maximum subjects could follow the adviced Pathya-Vihara as they

were of Madhyama Satmya.

Ahara Shakti wise distribution:

Out of 20 subjects studied in this series,16 subjects (80%) had Madhyama

Ahara Shakti, 4 subjects (20%) had Avara Aahara Shakti. Avara Ahara Shakti is

linked to improper and reduced formation of Ahara Rasa thereby leading to the

formation of Ama which is the cause of Katigraha.

DISCUSSION




Vyayama Shakti wise distribution:

Out of 20 subjects studied in this series, 10 subjects (50%) had Avara

Vyayama Shakti, 09 subjects (45%) had Madhyama Vyayama Shakti, 01 subject (5%)

had Pravara Vyayama Shakti.In this study out of 20 subjects, 10(50%) had Avara

Deha Bala, 09 subjects (45%) had Madhyama Deha Bala, 01 subject (5%) had

Pravara Deha Bala.

Ahara Rasa wise distribution:

Out of 20 subjects studied in this series, maximum number of 08 subjectsi.e

(40%) consumed Tikta and Kashaya Pradhana Rasa, 07 subjects (35%)

consumedLavana Rasa, 06 subjects i.e. (30%) consumed Madhura and Katu Rasa

Pradhana Ahara each, 04 subjects (25%) consumed Amla Rasa Pradhaana Ahara.

Symptoms of katigraha:

Out of 20 subjects studied in this series, 12 subjects (60%) complained of

Katigraha whereas 08 Subjects (40%) complained of Katishoola.

Samyak nirooha lakshana wise distribution:

Out of 20 subjects studied in this series, all the subjects i.e. 20 subjects (100%)

were recorded with Prasrushta vit, Prasrushta mutra, Prasrushta vaayu, 18 Subjects

(90%) were recorded with Ruchi vruddhi,16 subjects (80%) were recorded with

Agnivrudhi and 15 subjects (75%) were recorded with Aashaya Laghavani.

In samyak nirooha lakshana all the symptoms at once will not occure thats

why it has divide into major as well as minor symptoms, major symptoms we can see

at once but minor symtoms occurs after completion of nirooha basti procedure.

DISCUSSION




History Wise Distribution:

Out of 20 Subjects studied in this series, 4 subjects (20%) were having

treatment history of NSAIDS, 3 subjects (15%) were having treatment history of

Ayurvedic Medicines.

OBSERVATION ON KARMA:

Matra of Sahacharadi Taila Anuvasana Basti:

Matra of sahachardi taila is divide on the based on nirooha basti kashaya

dravya which is varies person to person. So by seeing kashaya basti dravya

matra of sahachardi taila is also varies person to person.

Temperature of Anuvasana Basti dravya:

Out of 20 Subjects studied in this series, for 4 subjects (20%) the temperature

of Anuvasana Basti Dravya administered was between 99.1oF -100

oF and for 16

subjects (80%) the temperature of Anuvasana Basti Dravya administered was

between 98.6oF -99

oF. This is the temperature any patient can tolerate as it is easily

bearable and causes no complications.

Temperature of basti dravya is slightly higher than body temperature, because

anal temperature is greater than whole body temperature which help in absorb easily.

Mean systolic Blood Pressure of Anuvasana Basti:


pressure of Anuvasana Basti in Katigraha is 3.5

DISCUSSION




Mean diastolic Blood Pressure of Anuvasana Basti:

Out of 20 Subjects studied in this series, mean difference of Diastolic Blood

Pressure of Anuvasana Basti in Katigraha is 3.7

Vega (Mala pravrutti) after Anuvasana Basti:

Out of 20 Subjects studied in this series, 16 subjects (80%) had 1-2 Mala

Pravrutti Vegas and 4 subjects (20%) had 3-4 Mala Pravrutti Vegas.

Vega is depend upon the koshtha of person which is varies person to person

some having 1-2 vega and some may having 3-4 vegas.

Samyak Yoga Lakshana of Nirooha Basti:

Out of 20 Subjects studied in this series, sa anila sa pureesha sneha

pratyagamana seen in 20 subjects (100%), Balavruddhi seen in 19 subjects (95%),

Swapnanuvrutti seen in 18 subjects (90%), Laghuta of the Shareera seen in 17

subjects (85%).

Observations during Nirooha Basti Samyojana:

Lakshanas like Na dhavati oushadham panim, Na tishtathi oushadham

panim and a homogenous mixture formation were found in all Nirooha Basti Dravya

that were prepared. Those Basti dravya without these lakshanas were discarded and

new one was prepared again.

DISCUSSION




Nirooha Basti Matra according to Aatura Hasta Pramana:

In this study it has explain that all the person is having different measures

of matra of kashaya dravya, which is varies person to person due to Aatura

hasta praman.

Temperature of Nirooha Basti dravya:

Out of 20 Subjects studied in this series, for 17 Subjects (85%) the

temperature of Nirooha Basti Dravya administered was between 98.1oF-99

oF, for 01

Subject (05%) the temperature of Nirooha Basti Dravya administered was between

100.1oF-101

oF, for 02 Subjects (10%) temperature of Nirooha Basti Dravya

administered was between 99.1oF-100

oF.

Peristaltic Movements Observed:

Out of 20 Subjects studied in this series, 12 Subjects (60%) had 4-5Peristaltic

Movements while 05 Subjects (25%) had 5-6 Peristaltic Movementsand 03 subjects

(15%) had 3-4 Peristaltic Movements.

Duration for administration (Pranidhana Kala) of Nirooha basti:

Out of 20 Subjects studied in this series, 6 Nirooha Basti‟s were administered

in which for 18 subjects (90%) time taken for administration was about 1 to 2

minutes. In 2 subjects subjects (10%) time taken for administration was about 2 to 3

minutes.

No. of Vegas (Mala Pravrutti) after Nirooha basti:

DISCUSSION




Out of 20 subjects studied in this series, the maximum number of 15 subjects

(75%) had Pratyagamana in 1 to 2 minutes, 3subjects (15%) had Pratyagamana in 3 to

4 minutes and 02 subjects (10%) had Pratyagamana in 5-6 minutes.

Mean Systolic Blood Pressure of Nirooha basti:

Out of 20 Subjects studied in this series, Mean Difference of Systolic Blood

Pressure of Nirooha Basti in Katigraha is 2.5.

Mean Diastolic Blood Pressure of Nirooha Basti:

Out of 20 Subjects studied in this series, Mean Difference of Diastolic Blood

Pressure of Nirooha Basti in Katigraha is 6.4.

Mean Respiratory Rate of Nirooha Basti:

Out of 20 Subjects studied in this series, Mean Difference in Respiratory Rate

of Nirooha Basti in Katigraha is 1.9.

Samyak Nirooha Lakshanas of Nirooha Basti:

Out of 20 Subjects studied in this series, Samyak Nirooha Lakshanas like

Prasrushta Vit, Mootra and Vayu, were seen in all the 20 Subjects (100%), 16 subjects

each (80.00 %) had Ruchi Vardhanam ,14 subjects (70%) had Agni Vardhanam , 12

subjects each(60%) had Bala Vardhanam,. and 10 subjects (50%) had Aashaya

Laghuta.

Ayoga and Atiyoga Lakshanas observed in Katigraha of Nirooha Basti:

DISCUSSION




No Ayoga and Atiyoga Lakshanas were observed in any of the 20 Subjects of

Katigraha after administration of Nirooha Basti.

Ashtamahadoshakara Bhava observed of Katigraha during Parihara Kala:

All the 20 Subjects who had completed the Katigraha schedule were advised

with Parihara Kala of 32 days. 01 subject did Atyasana and 02 subjects did

Diwaswapna.

Subjective parameters:

Samyak Nirooha Lakshana:

Out of 20 subjects, Prasrusta vin mutra samirantavam was observed in all the

20 patients on all the days of Nirooha Basti. Ruchi Vruddhi was observed in 01

subject, on the 2nd

and 4th

day of Nirooha Basti, In 02 subjects each on 6th

and 8th

day

of Nirooha Basti, in 04 subjects on 10th

day of Nirooha Basti and 06 subjects on 12th

day of Nirooha Basti. Agni Vruddhi was observed in 1 subject on 4th

day of Nirooha

Basti, in 2 subjects on 6th

day of Nirooha Basti, in 04 subjects on 8th

and 12th

day of

Nirooha Basti each, and in 03 subjects on 10th

day of Nirooha Basti. Ashaya

laghavani was seen in 02 subjects each 6th

, 8th

and 10th

days of Nirooha Basti, 04

subjects on 12th

day of Nirooha Basti.

Discussion on Result

Major symptoms of Samyak Nirooha Lakshana

DISCUSSION




Aantiki, Prasrushta Vit, Mutra, Sameerana, Aashaya Laghuta and Laghuta are

considered as major symptoms of Samyak Nirooha Lakshana and were assessed

immediately after each Putaka. These Lakshana are the guiding features for

determining the requirement of further administration on each day of Nirooha Basti.

1) On the first day of niruha total putaka were needed, 35 putaka needed on

second day and 30 putaka on 3rd

day and on 4th

,5th

,6th

day 31,34, 32 putaka

were required for the achievement of samayak niruha lakshan.

From the table no..... it is chart that for the achievement of samayak

niruha lakshan the total number of putaka required by 20 subjects was 199.

This shows that single administration with atura hasta praman dose is not

suffient for producing samayak niruha lakshan.

2) From the table no...... it is apparent that total 37 patient were required on the

first day of niruha basti. Which was reduced to 35 on second day of niruha, on

the third day of niruha requirement of putaka further reduced to 30, on 4th

,5th

,6th

day the required of putaka was 31,34,32 respectively.

An enema of less than half litre is cousireded to be in small enema and more

than half litre as a large enema, small quantity may sudden reach the proximal part of

colon, it may Act from the mucosa of rectum and sigmoid colon only. If the basti

dravya is little in quantity. It will yield inadequate bouts of evaculation. From the

above data it is evident that single administration with the atur hasta praman dose is

not sufficient for the producing complete dose nirharana., so multiple administration

needed. More pakwasaya gata dosha nirharana with more number of putaka on initial

days of niruha results in reduction in number of putaka or subjects getting for

samayak niruha lakshan on the later days of niruha.

DISCUSSION




DISCUSSION ON AANTIKI

31.74% obtained antiki with 1st putaka, 31.74 % with 2

ndputaka , 23.80 % with

3rd



34.48 % obtain Antiki with 1st niruha and 31.03% with the 2

nd putak, 20.68%

with 3rd

putaka and 13.79 with the 4th

putaka on the second day of niruha basti.

44.44% obtained antiki with 1st putaka, 26.66% with the second putaka, 20%

with the 3rd


putaka on the 4th


35.71% obtain Antiki with the 1st putaka, 28.57% with the second

putak,21.42% with the 3rd


putaka on the 5th

niruha

basti.

40% obtain with the 1st putaka,28% with the second putaka,24% with 3

rd

putaka,and 8% obtain with the putaka on the 6th

day of niruha.

For comparision between from different putaka in each niruha in achievement

of antiki one way anova was used which showed signifient change in between four

putaka administered in the last of niruha. But on multiple comparision there was

insignifient effect of four different putaka on all niruha day except on last day.

Antiki describes the details of the last vega kapha which is shankha sphatic

sannibha without on association of the mala or mutra indicates the completeness of

the procedure. One the small quantity by Atura hasta pramana pramana the first

putaka in the first day of niruha, capable to charna only faeces mutra present in the

pakwasaya and mutra present in the pakvasaya and by 3rd

And 4th

administration it

can reach deeper dhatu level and couse dhatugata dosha nirharana.

This is evident from the statistical data. The multiple administrations will lead

to more contact of basti dravya with colonic mucosa which can produce maximum

DISCUSSION




stimulation, increased absorption of the active principles and evaculation thus help in

attenning kaphant shuddhi.

DISCUSSION ON P.V.M.S.:

P.V.M.S. with 1st and 2

nd putaka is 31.74 each. 23.80 % with 3

rd putaka and

12.69% with 4th


34.48% obtained P.V.M.S. with the 1st putaka,31.03% with 2

nd putaka,

20.68% with 3rd

and 13.79%With 4th

putaka on the 2nd


44.44% obtain P.V.M.S. with the 1st putaka,26.66% with the 2

nd putaka,20%

with the 3rd


putaka on the 3rd


In the 1st putaka of P.V.M.S. obtain 42.55%, 29.78% is obtain in 2

nd putaka,

19.14% is obtain in 3rd


putaka on the 4th

day of niruha

basti.

35.71% obtain P.V.M.S. with the 1st niruha basti,28.57% obtain in 2

nd niruha

basti,21.42% obtain in 3rd


niruha basti 14.28% obtain on the 5th

niruha basti.

In the 40% obtain P.V.M.S. with the 1st niruha basti,28% obtain in 2

nd niruha

basti, 24% obtain in the 3rd


niruha basti 8% obtain. On the 6th

niruha basti.

For comparision between four difference putaka in each niruha in achievement

of P.V.M.S. one way anova was used which showed signifient changes in between the

niruha putaka in 1st and last niruha putakas for the achievent of P.V.M.S.

On the multiple comparision there was insignifient value between 1st ,2

nd,3

rd

grade of niruha,3rd

and 4th

grade of niruha.

DISCUSSION




P.V.M.S. describes easy evaculatation of the faeces, urine and flatus. For the

achievement of P.V.M.S. there was significant effect between four different putaka on

1st to last day of niruha.

Sukrita mutra nishkramana is the function pf apanvayu. Multiple

administration of Atur hasta praman on the 1st and 2

nd of niruha bring apan vata to its

normle movement which manifest as P.V.M.S. This is the reason for highly signifient

between grade 2nd

and 3rd

of niruha. It was observed that the 1st putaka of 1

st, 2

nd,3

rd

day of niruha P.V.M.S. was attained.

Discussion on ahsaya laghuta:

31.74% had experienced ashaya laghuta with1st and 2nd

putaka, 23.80 % with

3rd



34.48% subject obtain ashaya laghuta with,2nd

putaka 31.03%, 20.68% with 3rd

and 13.79%With 4th

putaka on the 2nd


44.44% obtained with the 1st putaka, 26.66% with the 2

nd putaka, 20% with

the 3rd


putaka on the 3rd


In the 1st putaka of ashaya laghuta obtain 42.55%, 29.78% is obtain in 2

nd

putaka, 19.14% is obtain in 3rd


putaka on the 4th

day

of niruha basti.

35.71% obtain ashaya laghuta with the 1st niruha basti,28.57% obtain in 2

nd

niruha basti,21.42% obtain in 3rd


niruha basti 14.28% obtain on the

5th

niruha basti.

In the 40% obtained ashaya laghuta with the 1st niruha basti,28% obtain in 2

nd

niruha basti, 24% obtain in the 3rd


niruha basti 8% obtain. On

the 6th

niruha basti.

DISCUSSION




For comparition between four difference putaka in each niruha in achievement

of ashaya laghuta one way ANOVA was used which showed significant value in

between the putaka on 1st and last day of nirooha in achieving ashaya laghuta.

On multiple comparision there was insignificant value between 1st& 2

nd, 2

nd& 3

rd

grade of Nirooha and highly significant on the 3rd

& 4th

grade Nirooha.

Ashaya laghuta denotes the meaning of complete elimination of mala,mutra

and vata there by emptiness of pakvashaya, mutra ashaya and amashaya. Mala, pitta,

kapha vata are eliminates in sequence of its nirooha basti,kaphaanta avastha expected

to get ashaya laghuta.

In our study it was observed that 4 putaka were needed to get ashaya laghuta

among all 20 subjects.

Nirooha basti dravya enters pakvashaya, kati, prusta region, liquefy sanchita

dosha in respected region and expells out all the dosha including vata from there

ashaya.

Hence ashaya laghuta was observedin all subjects under study after 4th

putaka

in all nirooha basti.

Laghuta(gatra laghuta):

31.74% subjects each obtained Gatra laghuta on 1st and 2

nd putaka,23.80%

with 3rd



34.48% obtained Gatra laghuta with 1st putaka,31.03% with 2

nd,20.68% with

3rd

and 13.79% with 4th

putaka on 2nd

Nirooha day.

44.44% subjects obtained Gatra laghuta with 1st putaka,26.66% with 2

nd

putaka,20% with 3rd

putaka and 8.8% subjects got Gatra laghuta with 4th

putaka on 3rd

Nirooha day.

DISCUSSION




42.55% obtained gatra laghuta with 1st putaka, 29.78% with 2

nd putaka,

19.14% with 3rd


putaka on on 4th

nirooha basti.

35.71% subjects obtained gatra laghuta 1st putaka, 28.57% with 2

nd, 21.42%

with 3rd


putaka on the 5th

day of nirooha.

40% subjects obtained with gatra laghuta 1st putaka,28% subjects with 2

nd


and 8% with the 4th



of gatra laghuta ONE WAY ANOVA was used which showed significant value for all

nirooha drugs.


and 4th

niruha


and 3rd

grade nirooha.

Laghuta describe feelingof complete lightness all over the body after

satisfactory evacuation of basti. For the achievement of laghuta there was

31.74%,34.74%,44.44%,42.55%,35.71%,40% with 1st putaka on first to last day of

nirooha respectively.

Nirooha basti removes kapha and pitta from the sites of vata i.e. pakwasaya

and couse the purification of vata, but their action of basti is not comited only to

pakwasaya it acts upon whole body i.e. from head to toe and draws out impurity and

by its potency and purify visiated vata from the body.which is reflected as lakshana

gatra laghuta. Single administration is not completely suffiecient for producing this

effects. Only with multiple administration the lakshana laghuta can be achieved. The

stastistical value also showed there was highly significant between grade 3rd

and 4th

.

Discussion on Gatra mardavata:

DISCUSSION




31.74% subjects each obtained Gatra mardhavata on 1st and 2

nd putaka,23.80%

with 3rd



34.48% obtained Gatra mardavata with 1st putaka,31.03% with 2

nd,20.68%

with 3rd

and 13.79% with 4th

putaka on 2nd

Nirooha day.

44.44% subjects obtained Gatra mardavata with 1st putaka,26.66% with 2

nd

putaka,20% with 3rd


putaka on

3rd

Nirooha day.

42.55% obtained gatra mardavata with 1st putaka, 29.78% with 2

nd putaka,

19.14% with 3rd


putaka on on 4th

nirooha basti.

35.71% subjects obtained gatra mardavata 1st putaka, 28.57% with 2

nd,

21.42% with 3rd


putaka on the 5th

day of nirooha.

40% subjects obtained with gatra mardavata 1st putaka,28% subjects with 2

nd


and 8% with the 4th



of gatra mardavata ONE WAY ANOVA was used which showed significant value for

all nirooha drugs.


and 4th

niruha


and 3rd

grade nirooha.

Basti contains five major ingredients viz.. Makshika,lavana,sneha,kalka and

kwatha,each ingredients has its own role in the action of basti.Gatra mardavata or

reduction of stiffness / spasm is produced by sneha and the proportion of sneha should

be changed according to dosha.Even it is advised that 1st kashaya basti should be

snehana if prior Anuvasana is found inadequate.Thus the quantity contained in the

basti is crucial to its action.As here in basti with Aatura hasta pramana the amount of

sneha is less so it may not be effective to reduce the stiffness of the body.

DISCUSSION




Indriyaprasannata:

31.74% subjects each obtained indriyaprasannata on 1st and 2

nd putaka,23.80%

with 3rd




nd, 20.68%

with 3rd

and 13.79% with 4th

putaka on 2nd

Nirooha day.

44.44% subjects obtained indriyaprasannata with 1st putaka,26.66% with 2

nd

putaka,20% with 3rd


putaka on

3rd

Nirooha day.


nd putaka,

19.14% with 3rd


putaka on on 4th

nirooha basti.

35.71% subjects obtained indriyaprasannata 1st putaka, 28.57% with 2

nd,

21.42% with 3rd


putaka on the 5th

day of nirooha.

40% subjects obtained with indriyaprasannata 1st putaka,28% subjects with 2

nd


and 8% with the 4th



of indriyaprasannata ONE WAY ANOVA was used which showed significant value

for all nirooha drugs.


and 4th

niruha


and 3rd

grade nirooha.

The proper functioning of sense organs or sensorial clarity is related to sneha

as it is a sign of various sneha procedures.Hence if the quantity of sneha is less in the

basti,it may not be able to produce Indriya Prasannata.In our study even though the

change is insignificant the repetitive administration of basti gives more and more

unctuousness to the body and show moderate increase in the objective.

DISCUSSION




Ruchi and agni vriddhi:

31.74% subjects each obtained Ruchi and agni vriddhi on 1st and 2

nd

putaka,23.80% with 3rd



34.48% obtained Ruchi and agni vriddhi on with 1st putaka,31.03% with

2nd

,20.68% with 3rd

and 13.79% with 4th

putaka on 2nd

Nirooha day.

44.44% subjects obtained Ruchi and agni vriddhi on with 1st putaka,26.66%

with 2nd

putaka,20% with 3rd


putaka on 3rd

Nirooha day.

42.55% obtained Ruchi and agni vriddhi on with 1st putaka, 29.78% with 2

nd



putaka on on 4th

nirooha basti.

35.71% subjects obtained Ruchi and agni vriddhi on 1st putaka, 28.57% with

2nd

, 21.42% with 3rd


putaka on the 5th

day of nirooha.

40% subjects obtained with Ruchi and agni vriddhi on 1st putaka,28% subjects

with 2nd


and 8% with the 4th






and 4th

niruha


and 3rd

grade nirooha.

Ruchi and agni describe improment in appetite and hunger just after niruha as

this the karma of pitta dosha. Madhutailik basti in atura hasta praman dose is capable

of producing vata anuloman and dosha shodhan with the multiple administration but it

is not able to improve function of pitta. Still the tendency of increase the percentage

DISCUSSION




of attachment of Ruchi and agni from 1st to last day of niruha should be considered as

a measure of its effectiveness.

Retention time:

28.98% subjects each obtained in retention on 1st and 2

nd putaka,23.80% with

3rd



35.08% obtained in retention on with 1st putaka,31.05% with 2

nd,26.31% with

3rd

and 7.01% with 4th

putaka on 2nd

Nirooha day.

26.66% subjects obtained retention on with 1st putaka,32% with 2

nd

putaka,36% with 3rd

putaka and 5.3% subjects got agni vriddhi with 4th

putaka on 3rd

Nirooha day.

46.51% obtained retention on with 1st putaka, 32.55% with 2

nd putaka, 20.93%

with 3rd

putaka and 0% with 4th

putaka on on 4th

nirooha basti.

41.66% subjects obtained retention on 1st putaka, 25% with 2

nd, 25% with 3

rd


putaka on the 5th

day of nirooha.

52.63% subjects obtained with retention on 1st putaka,21.05% subjects with

2nd


and 10.52% with the 4th






and 4th

niruha


and 3rd

grade nirooha.

Retention time showed gradual increase after each administration on all days

of nirooha. But on comparision, This change was statistically insignificant.

DISCUSSION




Retention time increases gradually in following days of basti karma which

shows bio acceptance of basti material in the body. It also depend upon age,amount

and content of the basti. Initially very less quantity of liquid was retained where as in

further days also accepts almost full quantity of basti material.

The prior sensitization of site of reach of basti dravya may be one of the

reasons for the increase seen in the retention time.

As per the classics prolonged retention of nirooha basti is not important

because even if not retained for longer time it will produce shodhana effect. No

measures are mentioned to prolonged retention timeof nirooha basti as told in

anuvasana. There is no relation between prolonged retention time and efficacy of the

basti.

Discussion on Effect of Therapy

Visual Analogous Scale:

Ruk or the Pain is the main symptom present in Katigraha. 10% subjects had

either mild or moderate pain, 20% had severe pain, 40% had very severe pain and the

remaining 20% subjects had worst possible pain. Visual Analogue Scale in Katigraha

was calculated with the help of Mean, Variance, Observations, Karl Pearson‟s

Correlation, Hypothesized Mean Difference by using Paired „t‟ test. PCT <„t‟ one tail

value was 6.88E – 11, „t‟ critical one tail was 1729, P (t < = 1) two tail was 1.38E –

10 and „t‟ critical two tail was 2.093. This shows significance on relief of VAS. So,

Madhutailika Basti in Aaturahasta Pramana dose is effective in reducing VAS.

Katigraha is mentioned as a symptom of Pakvashayagata Vata. There is no

remedyother than Basti for pacification of disease assessed by aggravated vata. The

ingredients of Madhutailika Basti like Lavana, Madhu has Sukshma,

DISCUSSION




Srotoshuddhikara, Yogavahi, Anulomana and Kaphahara property. Further Lavana

has the unique property like annihilating Stambha bandha Sanghaata. Also there is no

other medicine better than this to cure Vatakopa. Erandamoola has specific action in

Trika and Kati region. The kalka which is prepared with Shatapushpa, itself has

Vedanasthapana action.Basti effects of medicine may be more pronoused on theresis

more contact, time, for its medicine with colonic mucosa. In the nut shell niruha bring

vatanuloma in kostha and help in reducing pain and shifting in lower lumber spine.

Treekaruja or tenderness is another symptom, which according to ayurveda

perceptive denotes the associated of other dosha with vata,explain design of ruja is

exphelain in amavata,shoola, V.R. etc. Where vata is associating by kapha or pitta and

pecifies vata, so by this it can reduce tenderness also.

Madhutailik basti contain erand which is having anti inflammatory, analgesic

properties and help to reduce tenderness.

A)Roga upashanti.

Out of 20 Subjects studied in this series, Roga upashanti Lakshanas like

Feeling of wellbeing at physical and mental level were seen in 18 subjects (90%),

Feeling of wellbeing after ½ -1 hour after walking were seen in 2 subjects (10%).

Out of 20 Subjects studied in this series, Oswestry Disability Index Score like

Ability to Stand is recorded in 19 subjects (95%), Pain while Sitting, Ability to Sleep,

Social Life is recorded in 18 subjects (90%) each, Ability to Walk, Sexual Function,

Ability to Travel is recorded in 17 subjects (85%), Pain Intensity, Personal Care is

recorded in 16 subjects (80%) each, Lifting of Weight is recorded in 13 subjects

(65%).

DISCUSSION




c) Visual Analog Scale Rating for Pain:

Out of 20 Subjects studied in this series, Visual Analog scale rating for Pain

like Very severe pain wasrecorded in 08 subjects (40%) , Severe Pain and Worst

possible Pain is recorded in 04 subjects (20%) each , Mild pain and Moderate pain

was recorded in 02 subjects (10%) each.

Discussion on oswestry scale:

Effect of basti on ODI:

This quenrimare is designed to enable us to understand how much low back

pain has affected the ability to manage every days activity.

Basti has affected in both promotive and curative aspect, it stabilised the age,

brings quenlity in life, in improve strength etc. In curative aspects relieves

stiffness,coutvetious, aggravated vata etc.in kostha, distended abdomen, hard stoola

and improve appetive. It also provides clarity of mind, indules some sleep etc.basti

also provide strength to intestine and exhibete daily activity. This may be reason of

reduces in ODI for low back pain.

CONCLUSION




CONCLUSION

Conclusion is the essence of any study. A study from which no conclusion can

be drawn turns out to be fulfilled. A discussion, based on shastra, over any conceptual

and practical oriented study definitely gives one or other fruitful conclusion. From the

particular study also, some consideration are being drawn on the drawn on the basis of

conceptual references, critical review, observations made, result achieved and by

through discussion they are

Based on Nidana Panchaka Katigraham can be correlated to Low back Pain of

the modern science.

All the 20 subjects of Katigraha studied in this were between 20 to 60 year and

most of them were male (70%), belonging to Hindu religion (75%) middle

class (90%) and were married (85%). The patient were of dwandwaja prakruta

with dominance of vata kaphaja prakruti (50%) and most of them having

manda agni (50%), krura kostha (50%), madhyama satwa (90%) and

madhaym satmya (85%) and most of them had habits of consuming tea (70%)

Under the healing of nidana sevana, it was observed that majority of the

subjects were found of madhura rasa ahara followed by katu,tikta rasa.

Viharaja karanas like ativyayama, divaswapna, vegadharana it can be

concluded from the observations that above are predisposing factor for

katigraha formation.

Maximum number of Patients having chronicity of 2-3years which indicates

the development of disease in episodic manner relieved by medication.

Katigraha along with Katishoola was found in maximum number of patients.

CONCLUSION




Here in this study,Eranda Moola Madhutailka Nirooha Basti and Sahacharadi

taila Anuvasana Basti has provide Statistically significance in all the

parameters.

Acccording to Aacharya Susrutha,the dose of Kashaya Basti matra is Aatura

Hasta Pramana which varies individually which is very much effective in

reducing the Symptoms of Katigraha.

Quantity of Prasrita after standardization by Aatura Hasta Pramana is 623.6ml.

Kroora koshta participants require more number of Putaka for Attainment of

Samyak Nirooha Lakshana.


effective for producing major Samyak Nirooha Lakshana.


effective for producing minor Samyak Nirooha Lakshana.

Madhutailika Basti administered with Standardize Aatura Hasta Pramana

doesnot alter the normal blood level of Hb%,TC,DC,FBS,PPPBS,Lipid

profile,C-reactive protein.

Madhutailika Basti administered with Standardize Aatura Hasta Pramana

reduces ESR level.

Madhutailika Basti administered with Standardize Aatura Hasta Pramana in

Kala Basti Schedule is effective in reducing Pain by Visual Anologe

scale,reducing Tenderness and Oswestry Disability Index.


effective for producing Samyak Nirooha Lakshanas is safer and effective in

Katigraha.

CONCLUSION




Limitation:

Sample size was too small to generalize the Conclusions.

No follow up was done to evaluate the consistency of the outcome.

Majority of the parameters were Subjective.

The study design was Open clinical trial,hence comparision was not possible.

Recommendation:

Sample size can be increased.

Comparision with routinely practiced dose of Basti can be done.

Follow up period can be included to prove the consistency of the result.

Prasrita Pramana can be used for other Basti Yoga eg-Ksheerabasti,Yoga

Basti,Karma Basti etc, further affecting retention tissue can be studied.

SUMMARY

“ASTUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF MADHUTAILIKA BASTI



SUMMARY

The present study Entitled “A STUDY TO ASSESS SAMYAK NIROOHA

LAKSHANA OF MADHUTAILIKA BASTI ADMINISTERED WITH

STANDARDIZED ATURA HASTA PRAMANA IN KATIGRAHA W.S.R TO LOW

BACK PAIN – AN OPEN CLINICAL TRIAL” was designed to assess Samyak Nirooha

Lakshana given in Aatura Hasta Pramana dose. The first part includes Objectives of study,

Previous work done and Review of Literature. The Second part deals with Clinical study

including Material and Methods, Observations, Result. The Third part contains Discussion,

Conclusion and Summary.

The present clinical study begins with introductory part about Katigraha in general. In

ayurveda Katigraha is one of the vata vyadhi which affects the normal function of lower limb

hampering the daily activities of the person. Katigraha as a separate disease has been

described in the classical test gada nigraha. It has been correlated in the present study with

low back pain, katigraha is shosha, stambha, shula predominant vyadhi.

The clinical study has 3 Objectives:

1) To assess Samyak Nirooha Lakshana of Erandamoola Madhutailika Basti

administered in standard Aatura Hasta Praman in Katigraha.

2) To Standerdize prasruta by atura hasta pramana.

3) To study safety and efficacy of madhutailik basti administration with standerdized

atura hasta pramana in katigraha.

In Literary review the disease is reviewed in Ayurveda and Modern in detail including

Historical review of both. Madhu tailik basti were reviewed in detail.

SUMMARY




The methodology consists of two parts, materials and methods. Drug review was done

separately. Haritakyadi Choorna, Sahacharadi taila, Eranda Moola Madhutailika Basti

preparations were described in detail.In methods source and methods of collection of data,

sample size, groups, study designs, diagnostic criteria, inclusion criteria, exclusion criteria,

investigations, parameters of study both Disease and Karma, criteria for assessment,

interventions, statistical tests, level of signicance and categorization of overall relief of

clinical features were explained.

The observations made were tabulated and results obtained were statistically analysed

and were presented with details.They were then discussed to draw reasonable conclusions.

Amapachana with Haritakyadi choorna is used prior to Eranda Moola Madhutailika

Basti in Kala Basti schedule. This procedure showed highly significant results in the

Subjective Parameters like Prasrushta Vin Mutra Sameeranatvam, Ruchi Vriddhi, Agni

Vriddhi, Aashaya Laghavani and Objective Parameters like Roga Upashanti, Oswestry

Disability Index score, Visual Analogues Scale.

The major symptoms were assessed immediately after every Putaka and Minor after

each Madhutailika Basti .

Assessment of Samyak Nirooha Lakshanas were analysed by ONE WAY ANOVA,

multiple comparision was done by using Tukey Kramer multiple comparision test or Post

Hoc test.

All Ayoga, Atiyoga, Vyapat symptoms of Basti were compiled to form an Event

Evaluation scale. This scale was used to assess the safety of the Basti on the day of Nirooha.

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edition;Suta sthana;28/10-11;page no-207;pp-408



edition;Suta sthana;28/22;page no-209;pp-408



edition;Suta sthana 28/29;page no-210;pp-408

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Visvabharathi;1st edition-2000;Siddhi sthana 79-63;page no-574-575;pp-660


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70. Chakrapanidatta;Chakradatta;edited by Indradeva Tripathi;Chaukhambha Sanskrit

sansthan,Varanasi;2010 edition;Vatavyadhi chikitsa prakaram;shloka no-12;page no-

861;pp-704.

71. Vangasena;Vangasena Samhita; edited by Dr.Nirmal Saxena;Chowkhambha Sanskrit

series office,Varanasi;2nd

Ed. 2014;Vol 2;Bastikarma adhikara shloka no-13;page no-

1146;pp-1327



Ed. 2014;Vol 2;Bastikarma adhikara shloka no- 12;page no-

1146;pp-1327



Ed. 2014;Vol 2;Bastikarma adhikara shloka no-28 ;page no-

1147;pp-1327



Ed. 2014;Vol 2;Bastikarma adhikara shloka no-53-54 ;page

no-1150;pp-1327

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page no-1160;pp-1327



Ed. 2014;Vol 2;Bastikarma adhikara shloka no-93-95 ;page

no-1154;pp-1327



Ed. 2014;Vol 2;Bastikarma adhikara shloka no-164-165

;page no-1162;pp-1327



Ed. 2014;Vol 2;Bastikarma adhikara shloka no-176 ;page

no-1163;pp-1327



Ed. 2014;Vol 2;Bastikarma adhikara shloka no- 177-

178;page no-1164;pp-1327



Ed. 2014;Vol 2;Bastikarma adhikara shloka no-179-185

;page no-1164;pp-1327




196;page no-1165;pp-1327

82. Bhavamisra;Bhavaprakasha;edited by Prof.K.R.Srikantha Murthy;Chowkhamba

Krishnadas Academy;third,2005 edition;Vol 1-Purva

khanda;Panchakarmavidhiprakarana,82-177 shloka;page no-572-586;pp-738.




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Chowkhambha Prakashan,Varanasi;2008 edition;Sutra sthana;19/785-86;page no-

171;pp-839


Sanskrit sansthan,Varanasi;2000 edition;Khila sthana 8/72;page no-283;pp-364.

86. Vaidya Haridas Shridhar Kasture;Ayurveda Panchakarma Vignyana;Shri Vaidyanatha

Ayurveda Bhavana Pvt Limited;2013 13th

Edition;6th

Chap;page no-343.


Chowkhambha Prakashan,Varanasi;2008 edition;Sutra sthana;19/1-86;page no-

162;pp-839


Dr.Brahmanand Tripathi,Chaukhamba Surbharathi Prakashan;2001 edition; Uttara


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Chandra singh Kushwaha;Chaukhambha Orientalia;Ed-2016; Sutra Sthana;29/3-

4;page no-482;pp-964


Chandra singh Kushwaha;Chaukhambha Orientalia;Ed-2016; Siddhi sthana ;12/3-

4;page no-482;pp-964



edition;Shareera sthana 38/100;page no-175;pp-869


Chowkhambha Prakashan,Varanasi;2008 edition;kalpa sthana ;4/27;page no-600;pp-

839

96.


Dr.Brahmanand Tripathi,Chaukhamba Surbharathi Prakashan;2001 edition; Uttara

khanda 6/29,30,31;page no-365;pp-488.




165;page no-1162;pp-1327


Chandra singh Kushwaha;Chaukhambha Orientalia;Ed-2016; Siddhi sthana 5/4-

7;page no-1013-1014;pp-1172

100. .Agnivesha;Charaka Samhita;Deepika Hindi commentary;edited by Vd.Harish

Chandra singh Kushwaha;Chaukhambha Orientalia;Ed-2016;Siddhi sthana 2/15;page

no-968-969; pp-1172


Chandra singh Kushwaha;Chaukhambha Orientalia;Ed-2016; Siddhi sthana 2/16;page

no-980; pp-1172



18;page no-981; pp.-1172

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commentary;edited by Kaviraja Ambikadutta Shastry; Chaukhambha Sanskrit

Sansthan Varanasi;2001 edition;Chikitsa sthana 35/7;page no-153;pp-869



18;page no-981; pp-1172

105. Vriddha jivaka;Kashyapa Samhita;edited by Pandit Hemaraja

Sharma;Choukhambha Sanskrit sansthan,Varanasi;2000 edition;Khila sthana 8/40-

45;page no-280;pp-364.

106. Chakrapanidatta;Chakradatta;edited by Indradeva Tripathi;Chaukhambha

Sanskrit sansthan,Varanasi;2010 edition;Niruha Adhikara Prakarana;shloka no-8;page

no-680;pp-704.


Chandra singh Kushwaha;Chaukhambha Orientalia;Ed-2016; Siddhi sthana

;3/24;page no-985; pp-1172



43;page no-954-955; pp. 1172


Chandra singh Kushwaha;Chaukhambha Orientalia;Ed-2016; Siddhi sthana

;12/15;page no-1119; pp-1172



6;page no-1040; pp-1172

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA AYURVEDA MAHAVIDYALYA , HUBLI


ADMINISTERED WITH STANDARDISED ATURA HASTA PRAMANA IN KATIGRAHA


Guide: Dr. Shrivatsa M. Navalur Co - Guide: Dr. A.I.Sanakal

MD (Ayu) MD (Ayu)

Researcher: Dr. YadavGaurishankar

PG Scholar

PATIENT CONSENT FORM

I Shri/Miss/Mrs ……………………………………………………………………………………………………… is willing to take

part in the treatment course and give my complete consent to be included as a subject in the clinical

trial on “A STUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF MADHUTAILIKA BASTI

ADMINISTERED WITH STANDARDISED ATURA HASTA PRAMANA IN KATIGRAHA W.S.R TO LOW

BACK PAIN – AN OPEN CLINICAL TRIAL”.

The details has been clearly explained to me in the language which I can understand and I am willing

to abide by the instructions given to me with regards to periodic examination and other treatment

procedures and investigations and I will be responsible for any of the consequences that may arise

from not obeying the instruction from the concerned physician.

I have been informed to my satisfaction by the attending doctor, the purpose of the clinical trial and

the nature of drug treatment, therapeutic procedures, follow – up and probable complications. I am

also ready to undergo necessary laboratory investigations to monitor and safeguard my functions.

I am also aware of my right to opt out of the trial at any time during the course of the trial without

having to give the reasons for doing so.

Signature of Guide:

Dr. Shrivatsa M. Navalur ,MD (AYU)

Signature of the Doctor Signature of the Patient/Guardian

Dr. YadavGaurishankar

Scanned by CamScanner

CASE PROFORMA

1

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA AYURVEDA MAHAVIDYALYA , HUBLI


ADMINISTERED WITH STANDARDISED ATURA HASTA PRAMANA IN KATIGRAHA


Guide: Dr. Shrivatsa M. Navalur Co - Guide: Dr. A.I.Sanakal

MD (Ayu) MD (Ayu)

Researcher: Dr. YadavGaurishankar

PG Scholar

PATIENT CONSENT FORM

I Shri/Miss/Mrs ……………………………………………………………………………………………………… is willing

to take part in the treatment course and give my complete consent to be included as a

subject in the clinical trial on “A STUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF

MADHUTAILIKA BASTI ADMINISTERED WITH STANDARDISED ATURA HASTA PRAMANA IN

KATIGRAHA W.S.R TO LOW BACK PAIN – AN OPEN CLINICAL TRIAL”.

The details has been clearly explained to me in the language which I can understand and I

am willing to abide by the instructions given to me with regards to periodic examination and

other treatment procedures and investigations and I will be responsible for any of the

consequences that may arise from not obeying the instruction from the concerned

physician.

I have been informed to my satisfaction by the attending doctor, the purpose of the clinical

trial and the nature of drug treatment, therapeutic procedures, follow – up and probable

complications. I am also ready to undergo necessary laboratory investigations to monitor

and safeguard my functions.

I am also aware of my right to opt out of the trial at any time during the course of the trial

without having to give the reasons for doing so.

Signature of Guide: signature of co-guide

Dr. Shrivatsa M. Navalur ,MD (AYU) Dr. A.I.Sanakal ,MD (Ayu)

Signature of the Doctor Signature of the Patient/Guardian

Dr. YadavGaurishankar

CASE PROFORMA

2

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA

AYURVEDA MAHAVIDYALYA, HUBLI

TITLE OF DISSERTATION:

“A STUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF

MADHUTAILIKA BASTI ADMINISTERED WITH

STANDARDISED ATURA HASTA PRAMANA IN KATIGRAHA


Guide: Dr. Shrivatsa M. Navalur Candidate: Dr. YadavGaurishankar

M.D.(Ayu) M.D. Scholar

1. Name of the Patient: ………………………………………………. Sl. No.

2. Age : ....... years

3. Sex: Male/Female

4. Address:

……………………………………..

……………………………………..

…………………………………….

5. IPD No. :

6. OPD No. :

7. Phone No. :

8. Bed No. :

9. Group :

10. Religion : Hindu ( ) Muslim ( ) Christian ( ) Others ( )

11. Marital Status : Married ( ) Unmarried ( )

12. Father’s/ Husband’s Name:

13. Educational status : Uneducated ( ) Educated ( )

14. Occupation :

15. Economic Status : Poor ( ) Middle ( ) Rich ( )

16. Desha : Rural ( ) Urban ( )

17. Date of Registration :

18. Date of Schedule Completion :

19. Diagnosis :

20. VyadhiAvastha :

Chief Complaints Duration

CASE PROFORMA

3

Associated Complaints Duration

21. Result :

History of Present Illness :

Mode of Onset

Chirakari(Chronic) Ashukari(Acute) Abhighataja(Traumatic)

Pain (Shoola)

Type Agonizing Tendered Generalized Localized

Time of Onset Day Night

Aggravating

factors

On working On rest

History of Past Illness:

Treatment History

Modern

YES Surgical Non Surgical

NSAID:

Steroids :

Local Injection:

NO

Ayurveda YES Shodhana Shamana

NO

Others

CASE PROFORMA

4

Relief from previous treatment :

Family History:

Personal History

Ahara :

Samisha Niramisha

Type Veg Non Veg

Rasa Madhura Amla Lavana

Katu Tikta Kashaya

Guna Ushna Sheeta Laghu

Guru Snigdha Ruksha

Agni :

Samagni Manda Teekshana Vishama

Kostha :

Madhya Mrudu Kroora

Nidra :

Sukha Alpa Ati Vishama

Vyasana :

Smoking Tobacco Alcohol Others None

CASE PROFORMA

5

Gynaecological/Obstretic History :

Occupational History :

Nature of Work Exposure To

Sedentary Hot

Mild Cold

Moderate Dust

Laborious

Standing

Travelling

Time of Work …………Hours/day.

General Examination:

1. Ashta sthana Pariksha:

a. Nadi:

i. Rate

b. Mutra:

i. Frequency:

Day

Night

ii. Complaints

c. Mala

i. Frequency

Day

Night

ii. Evacuation

Free

Constipated

iii. Consistency

iv. Color

v. Complaints

d. Jihwa: Prakruta/Vaikruta/Cracks/lipta/alipta

e. Shabda: Crepitus/Heard/Felt/None

f. Sparsha:

g. Druk:

h. Akruti:

CASE PROFORMA

6

2. DashavidhaPariksha :

a. Prakruti

i. Sharira : V/P/K/VP/PK/KV/S

ii. Manasa : SR/RT/ST

b. Sara: Pravara/Madhyama/Avara

c. Samhana : Pravara/Madhyama/Avara

d. Pramana : Pravara/Madhyama/Avara

e. Satmya : Pravara/Madhyama/Avara

f. Satva : Pravara/Madhyama/Avara

g. Ahara Shakti :

i. Abhyavaharana Shakti : Pravara/Madhyama/Avara

ii. Jarana Shakti : Pravara/Madhyama/Avara

h. Vyayama Shakti : Pravara/Madhyama/Avara

i. Vaya : Madhyama(20-40)/Vriddha(40-60)

3. Vital Examination :

a. BP: ……………………….mm of Hg

b. Respiratory Rate : ……………./min

c. Temperature: …………………………

4. SamanyaPareeksha :Dosha

Vata :

Kshayalakshana

BT AT Vruddhilakshana BT AT

Angasada Karshya

AlpaBhashana Karshnya

Moha Ushnakamitva

Praseka Kampa

Aalasya Aanaha

Gaurava SakritGraha

Shaitya BalaBhramsa

Shithilangata NidraBhramsa

Shwasa Pralapa

Bhrama

Deenata

Pitta :

Kshayalakshana


Agnimandya VitPeetata

Sheetata MutraPeetata

Prabhahani NetraPeetata

TwakaPeetata

Kshut

CASE PROFORMA

7

Trashna

AlpaNidrata

Daha

Kapha :

Kshayalakshana


Bhrama Agnisadana

Shleshmashaya Praseka

Shoonayata Alasaya

Hradrava Gaurava

Sandhishithilta Shwetata

Sheetata

SamanyaPareeksha :Srotas

Rasa

BT AT Rakta BT AT

Ashradha Kushtha

Jwara Gulma

Asyavairasya Raktapitta

Gaurava Kamala

Hrullasa Charmadala

Palita Pama

Agni Nasa Aasayapaka

Klaibya Asramandala

ArasaJnana Pidaka

Srotorodha Neelika

Angamarda Tilakalaka

Tandra Shwitra

Aruchi Medrapaka

Tama Pradara

Pandu Vidhradhi

Karshya Visarpa

Sada Vyanga

Vali Dadhru

Angasada Gudapaka

Pleeha

Kota

Asrgdhara

CASE PROFORMA

8

MAMSA:

Mamsa

BT AT

Adhimamsa

Gandamala

Gala shaluka

Alaji

Charmakeela

Shundika

Arbuda

Upakihwika

Pootimamsa

MEDA:

Meda

BT AT

Shitalangata

Swapeneshuka

Hrutupralepa

Ratiyekshukha

Sravanopralepa

TaluShosha

Madhurasya

Mutrastanepiplika

Aasaneshukha

JihwaUpalepa

NakhaAtivruddhi

SheetaPreeti

Gala Shosha

ShayyeShukha

AngaGandha

NetraUpalepa

Ghanagatha

Keshativridhi

Karadaha

Padadaha

ASTHI:

Asthi

BT AT

Adhyasthi

Dantashoola

Smasruvivarna

Adhidanta

Nakhavivarna

CASE PROFORMA

9

Medrashoola

Keshavivarna

AsthiShoola

Asthibheda

MAJJA:

Majja

BT AT

Parwashoola

Parvaruk

Bhrama

Murcha

Tamodarshana

Arumshika

SHUKRA:

Shukra

BT AT

Klaibya

Virupiprajautpanna

Gharbhapata

Alpaayu

Klaibyaprajautpanna

Gharbhasrava

Aharsha

Alpayuprajautpanna

PRANA:

Prana

BT AT

Atisrstaswasa

Sasulaswasa

Alpaswasa

Sasabdaswasa

Kupitaswasa

Atibadhaswasa

Abhikshnaswasa

UDAKA:

Udaka

BT AT

Jihwasuska

Klomashuska

CASE PROFORMA

10

Kantashuskata

Osthashushkata

Talushuskata

Atipipasa

ANNA:

Anna

BT AT

Ananabilasha

Chardi

Avipaka

Aruchi

PUREESHA:

Pureesha BT

AT

Malabheda

Malashosha

Malapradushana

Malasanga

Malautsanga

MUTRA:

Mutra BT AT Sweda

BT AT

BahuMutra Swedaadhikyata

AlpaMutra Aswedata

Sandra Mutra Parushyatwacha

Teevra Vega Snigdhatwacha

Alpa Vega AngaDaha

VedanaYukta Lomharsha

SamanyaPareeksha :Doshya

Rasa:

KshayaLakshana BT AT VruddhiLakshana BT AT

Shrama Agni sadana

Roukshya Praseka

Shosha Aalasya

Glani Gaurava

Shabda asahishnuta Shwetata

Sheetata

Shithilangata

CASE PROFORMA

11

Shwasa

Kasa

Atinidrata

Rakta:


Amlapreeti Visarpa

Sisirapreeti Pleehavidhradhi

Sirasaithilya Kustha

Rookshata Vatarakta

Raktapitta

Gulma

Upakusha

Kamala

Vyanga

Agninasa

Sammoha

Raktatwaka

Raktanetra

Raktamootra

Mamsa :


Angagalani Gandaarbuda

Gandasushkata Gandagranthi

Sphiksushkata Udaravrudhi

Sandhivedana Kantavrudhi

Taluvrudhi

Jihwavrudhi

Meda :


Kati swapa Swasa

Pleehavruddhi Sphikvrudhi

Krushangatha Sthanavrudhi

Udaravrudhi

Asthi :


Asthnya Adhyasthi

Asthitodanta Adhidanta

Dantapatana

Keshpatana

Nakhapatana

CASE PROFORMA

12

Majja :


Asthisoushriya Netragaurava

Bhrama Angagaurava

Timira Aroomshika

Shukra :


Sukraparisichyana Asthisthreekamatha

Raktasukrata Sukrasmari

Vrusnatoda

Medratoda

5. Systemic Examination :

a. GIT :

b. CVS :

c. CNS :

d. Respiratory System

6. Other Examination :

Test Before treatment After treatment

Gaenslen sign

Gillet test

Pump hand test

Schober’s test:

Pain in kati pradesha

Total :

NIdanaPariksha :

1. Nidana :

AHARAJA VIHARAJA MANASA

AtiTikta Rasa Vega Dharana Chinta

AtiKashaya Rasa Vegoodeerana Shoka

AtiKatu Rasa AtiVyavaya Bhaya

AlpaBhojana NishaJagrana

PramitaBhojana AtyuchchaBhashana

CASE PROFORMA

13

RookshaBhojana AtiVyayama

SheetaBhojana AtiPrajagrana

LaghuBhojana Langhana

Abhojana Plavana

Abhighata:

Chikitsaapradhanaja :

Vishama Upachar DoshaSravana Ati-asruksravana

2. Poorvaroopa :

3. Roopa :

4. Upashaya/Anupashaya : Ushna/Sheeta/Rooksha/Snigdha

5. Samprapti :

SadhyaAsadhyta :

Investigations :

o Hb %

o TC,DC,ESR

o LFT

o Post prandial blood sugar :

o Fasting blood sugar

o Serum creatinine

o Blood urea

SI.No Anjali Pramana In ml

Mean Anjali Pramana :

CASE PROFORMA

14

Chikitsa Krama :

Group : Eranda moola Madhutailika Basti in Kala Basti Schedule

Amapachana : Ama pachana with HARITAKYADI YOGA ………. Days Dose : 5gms Bd Anupana : Ushnodaka

Nirama Lakshana obtained :

Basti :AnuvasanaBasti : SahacharadiTaila ……………………ml

NiroohaBasti : Eranda moola Madhutailik basti

Date of schedule Initiation:

Date of schedule Completion:

Vital

Examination

BP Pulse Respiratory

Rate

Heart Rate

BT AT BT AT BT AT BT AT

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

CASE PROFORMA

15

Day 13

Day 14

Day 15

Day 16

Observations :

Kal

a

Bas

ti

BastiDravyaPraman

a(ml)

Temp. of

BastiDravya

(oF)

Time of

Administrat

ion

Time of

Retenti

on

BastiPratyagaman

akala

Mal

a

veg

a

Day

1

Day

2

Day

3

Day

4

Day

5

Day

6

Day

7

Day

8

Day

9

Day

10

Day

11

CASE PROFORMA

16

Day

12

Day

13

Day

14

Day

15

Day

16

Samyak – Ayoga – Atiyogalakshanas :

Nir oohaBasti – MADHUTAILIK Basti

Samyak-Nirooha-Lakshana

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6

Prasrushtavit

Prasrushtamootra

Prasrushtavayu

Ruchevardhanam

Agni vardhanam

Pakwashayalaghuta

Bala

Nirooha-ayoga-lakshana Day 1 Day 2 Day 3 Day 4 Day 5 Day 6

Shiroruk

Hrudayaruk

Gudaruk

Vastiruk

Vikartika

Hrillasa

Marutasanga

Mutrasanga

Swasa

CASE PROFORMA

17

Nirooha-atiyoga-Lakshana

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6

Supti

Angamarda

Klama

Vepana

Nidranasa

Balakshaya

Tamapravesha

Unmada

Hikka

AnuvasanaBasti :SahacharadiTaila

Samyak-Anuvasita-Lakshana

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Sa sakruttaila

Indriyaprasada

Sukhaswapna

Laghuta

Bala

Vega pravruti

Anuvasana-ayoga-Lakshana

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Adhosareeraruk

Udarruk

Bahuruk

Prushtharuk

Parshwaruk

Rookshakharagatra

Vitmootrasamiranagraha

Anuvasana-Atiyoga-Lakshana

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Hrillasa

Moha

Klama

Saada

Moorcha

Vikartika

CASE PROFORMA

18

Subjective Parameters:

Samyak Yoga

Lakshana 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Prasruta vinmutrasamirantavam

RuchiVriddhi

Agni Vruddhi

AshayaLaghavani

Ayoga

Lakshana 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Shiro vedana

Hrudaya shoola

Guda shoola

Linga vedana

Shooph

Pratishyaya

Vikartika

Hrulasa

Vatra and mutra avarodh.

Shwas kruchata.

CASE PROFORMA

19

Atiyoga

Lakshana 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Vata vrudhi

Supta angata

Anga marda

Klama

Anidra

Tama pravesha

Unmada

Hikka

Treatment

OBJECTIVE PARAMETERS:

1.Roga upashanti:

Lakshana Rating BT AT

Feeling of well being at physical and mental level after

awakening

0

Feeling of well being after ½-1 hr after awakening 1

Not feeling well and not interest in any work after

awakening

2

CASE PROFORMA

20

2. OSWESTRY DISABILITY INDEX SCORE:

1. Pain intensity:


I have no pain at the movement

0

The pain is very mild at the movement

1

The pain is moderate at the movement

2

The pain is fairly severe at the movement

3

The pain is severe at the movement

4

The pain is worst imaginable at the movement

5

2. LIFTING OF WEIGHT:


I can lift heavy weight without extra pain

0

I can lift heavy weight but it gives extra pain

1

pain prevent me from lifting heavy weight off the floor but

I can manage if they are conveniently positioned

2

Pain prevent me from lifting heavy weights but I can

manage light to manage light to medium weight if they are

conveniently positioned

3

I can lift only very light weights

4

I cannot lift or carry anything at all

5

CASE PROFORMA

21

3. ABILITY TO WALK:


I can run or walk without pain

0

I can walk comfortably, but running is painful

1

Pain prevent me from walking more than 1 hour 2

Pain prevent me from walking more than 30 minutes

3

pain prevent me from walking more than 10 minutes

4

I am unable to walk or can walk only a few steps at a time

5

4. PAIN WHILE SITTING:


I can sit in any chair as long as I like

0

I can sit in my favorite as long as I like

1

pain prevent me from sitting for more than 1 hour

2

Pain prevent me from sitting for more than ½ hour

3

Pain prevent me from sitting for more than 10 min

4

Pain prevent me from sitting at all

5

5. SEXUAL FUNCTION:


My sex life is normal cause no extra pain

0

My sex life is normal but causes some extra pain

1

My sexual life is nearly normal but is very painful

2

My sex life is severely restricted by pain

3

My sex life is nearly absent because of pain

4

Pain prevents any sex life at all

5

CASE PROFORMA

22

6. SLEEP QUALITY:


My sleep is never disturb my pain

0

My sleep is occasionly disturb by pain 1

Because of pain I have less than 6 hours sleep

2

Because of pain I have less than 4 hour sleep

3

Because of pain I have less than 2 hour sleep

4

Pain prevent me from sleeping at all

5

7. ABILITY TO TRAVEL:


I can travel anywhere

0

I can travel anywhere but it gives me pain

1

Pain in bed but I can manage to travel over two hour

2

Pain restricts me to journeys of less than one hour

3

Pain restricts me to trips less than 30 minutes

4

Pain prevents me from travelling 5

8.ABILITY TO STAND:


I can stand as long as I want without extra pain

0

I can stand as long as I want but it gives me extra pain

1

Pain prevent me from standing for more than 1 hour

2

Pain prevent me from standing for more than 30 min

3

Pain prevent me from standing for more than 10 min

4

Pain prevent me from standing at all

5

CASE PROFORMA

23

9.SOCIAL LIFE:


My social life is normal and causes me no extra pain

0

My social life is normal but increases the degree of pain

1

Pain has no significant effect on my social life apart from

limiting my more energy interests e.g dancing etc.

2

Pain has restricted my social life and i do not go out as often

3

Pain has restricted my social life to my home 4

I have no social life because of pain-

5

10. PERSONAL CARE( WASHING,DRESSING ETC.):


I can look after normally without causing extra pain.

0

I can look after myself normally but it is very painful

1

It is painful to look after myself and I can slow and careful

2

I need some help but manage most of my personal care. 3

I need help every day in most aspect of self care.

4

I do not get dressed, wash with difficulty and stay in bed. 5

3. VISUAL ANALOG SCALE RATING FOR PAIN:

SCALE RATING

1.no pain 0

2.mild pain 2

3.moderate pain 4

4.severe pain 6

5.very severe pain 8

6.worst possible pain 10

CASE PROFORMA

24

Follow up :

1st Month :

Reoccurrence (if any) :

PATHYA:

APATHYA:

Signature of Guide: Signature of Scholar:

Dr. Shrivatsa M. Navalur Dr. YadavGaurishankar

M.D.(Ayu.) MD Scholar

PIPPALI VACA GUDA

SAINDHAVA AMALAKI RAJANI

SHUNTHI HARITAKI VIDANGA

HARITAKYADI YOGA

Haritakyadi churna

MURCHIT TILA TAILA SAHACHARADI TAILA

“ASTUDY TO ASSESS SAMYAK NIROOHA LAKSHANA OF ...

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