Madhumeha prasrutika pk029_gdg


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EFFECT OF PANCHATIKTA PRASRUTIKA BASTI IN MADHUMEHA W.S.R.T. HYPOGLYCEMIC ACTIVITIES By Dr. Biswajit Dash, Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.

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Madhumeha prasrutika pk029_gdg

  1. 1. Ayurveda is simply translated as "Science of Life" and more comprehensively as "the knowledge that teaches us which substances and activities are beneficial or harmful to life".
  2. 2. EFFECT OF PANCHATIKTA PRASRUTIKA BASTI IN MADHUMEHA W.S.R.T. HYPOGLYCEMIC ACTIVITIES By Dr. Biswajit Dash Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfilment of the degree of Ayurveda Vachaspati M.D. in Panchakarma Under the Guidance of Prof. Dr. P. Sivaramudu M.D. (Ayu) M.A. (San) M.A. (Psy) Head of Department, P.G. Dept. of Panchakarma DEPARTMENT OF PANCHAKARMA POST GRADUATE STUDIES & RESEARCH CENTRE D.G.M. AYURVEDIC MEDICAL COLLEGE GADAG - 582103 2008-2011
  3. 3. Rajiv Gandhi University of Health Sciences DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled ‘‘EFFECT OFPANCHATIKTA PRASRUTIKA BASTI IN MADHUMEHA W.S.R.T.HYPOGLYCEMIC ACTIVITIES’’ is a bonafide and genuine research work carried outby me under the guidance of Prof. Dr. P. Sivaramudu, M.D. (Ayu) M.A. (San) M.A.(Psy), H.O.D. in Panchakarma, D.G.M. Ayurvedic Medical College, Gadag. Date : Place : Gadag (Dr. Biswajit Dash)
  4. 4. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “EFFECT OF PANCHATIKTAPRASRUTIKA BASTI IN MADHUMEHA W.S.R.T. HYPOGLYCEMICACTIVITIES" is a bonafide research work done by Dr. Biswajit Dash in partialfulfilment of the requirement for the post graduation degree of “Ayurveda VachaspatiM.D. (Panchakarma)” Under Rajiv Gandhi University of Health Sciences, Bangalore,Karnataka. (Prof. Dr. P. Sivaramudu)Date : H.O.D Dept. of PanchakarmaPlace: Gadag PGS&RC, DGMAMC
  5. 5. J.S.V.V. SAMSTHE’S D.G.M. AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG - 582 103 Endorsement by the H.O.D, Principal/ Head of the Institution This is to certify that the dissertation entitled ‘‘EFFECT OF PANCHATIKTAPRASRUTIKA BASTI IN MADHUMEHA W.S.R.T. HYPOGLYCEMICACTIVITIES’’ is a bonafide research work done by Dr. Biswajit Dash under theguidance of Prof. Dr. P. Sivaramudu, M.D. (Ayu) M.A. (San) M.A. (Psy), H.O.D. inPanchakarma, DGMAMC, PGS & RC, Gadag, in partial fulfilment of the requirement forthe post graduation degree of “Ayurveda Vachaspati M.D. (Panchakarma)” Under RajivGandhi University of Health Sciences, Bangalore, Karnataka.. (Dr. P. Sivaramudu) (Dr. G. B. Patil) Professor & H.O.D, Principal, Dept. of Panchakarma, D.G.M. Ayurvedic Medical College, PGS&RC Gadag Date: Date: Place: Gadag Place: Gadag
  6. 6. Copy right Declaration by the candidate I hereby declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate thisdissertation/ thesis in print or electronic format for the academic / researchpurpose.Date :Place : Gadag (Dr. Biswajit Dash) © Rajiv Gandhi University of Health Sciences, Karnataka
  7. 7. Acknowledgement With the blessings of Lord Dhanwantari, I am thankful to the peoplewho supported me to complete my research as without seeds crops cannot be grown. Itake great pleasure to record my gratitude to all the concerned persons who haveundertaken pains willingly for consummating this work. I express my deep sense of gratitude to his great holiness Shri JagadguruAbhinava Shivananda Mahaswamiji, for his divine blessings. I express my obligation to my honorable guide Prof. Dr. P. SivaramuduM.D. (Ayu) M.A. (San) M.A. (Psy), H.O.D, P.G. Department of Panchakarma, P.G.S &R.C, D.G.M.A.M.C, Gadag for his critical suggestions and expert guidance for thecompletion of this work. I express my deep gratitude to Dr. G. B. Patil, Principal, D.G.M.A.M.C,Gadag, for his encouragement as well as providing all necessary facilities for thisresearch work. I am very much thankful to Dr. U. V. Purad M.D. (Ayu) Asst. Professor,Dr. S. N. Belavadi M.D. (Ayu) Asst. Professor, Dr. J. P. Basarigidad M.D. (Ayu)Lecturer, Dr. S. G. Patil M.D. (Ayu) Lecturer for their sincere advices and assistance. I also express my gratitude to Dr. S. D. Yerigei, R.M.O, D.G.M.Ayurvedic Hospital, Gadag, for his moral support and special care in providing allfacilities for this trial work. I extend my thanks to Dr. Ashok Patil, Lecturer, for his kindco-operation in providing the statistical data systematically and in stipulated time. I take the privilege to thank Prof. Dr. S. Suresh Babu, Prof. Dr. M.C. Patil,Prof. Dr. G.V. Mulagund, Dr. C. S. Hiremath, Dr. R.V. Shetter, Dr. B. M. Mulkipatil, Dr. i
  8. 8. Yasmeen Paniband, Dr. Kuber Sankh, Dr. G. N. Danappagowdar, Dr. J. Mitti, Dr. S. B.Nidagundi and other P.G. staff for their constant encouragement. I also express my sincere gratitude to Dr. G. S. Hiremath, Dr. B. G.Swami, Dr. M. V. Aiholli, Dr. R.R. Joshi, Dr. Shakuntala M. Garwad, Dr. K. S. Paraddi,Dr. S. H. Radder, Dr. M. D. Samudri and other undergraduate teachers for their supportin the clinical work. I thank to Shri. V. M. Mundinamani (Librarian), Shri. B.S.Tippanagoudar (Lab technician), Shri. Dadapeer, Shri. Sheshachal (PanchakarmaAttendant), Smt. Sunanda, Smt. Agasimani and other hospital as well as office staff fortheir kind support in my study. I express my sincere thanks to my colleagues and friends Dr. Aneesh, Dr.Joshi, Dr. Renukraj, Dr. Sangamesh, Dr. Sanjeev, Dr. Jayakar, Dr. Satish, Dr. Raghavrao,Dr. Vijaykumar, Dr. Shrikant Patel, Dr. Praveen, Dr. Triveni, Dr. Pushpa, Dr. Bhagyesh,Dr. Surej, Dr. Babasaheb, Dr. Vijayamahantesh , Dr. Vinod Barwal and other postgraduate scholars for their support. I owe my heartedly thanks to my seniors Dr. Udaya, Dr. Adarsh, Dr.Shailej, Dr. Mukta, Dr. Nataraj, Dr. Sanath, Dr. Sabareesh, Dr. Jayasankar, Dr. Rajesh,Dr. Deepak and my juniors Dr. Manish, Dr. Raghavendrachar, Dr. Paresh, Dr. Jagadeesh,Dr. Shilpa for their constant encouragement and helped lot in the success of myendeavour. I pay homage to my late ancestors whose lives and achievements haveinspired me to take up Ayurveda as my profession. I pay my respect to my grandfatherPandit Pranakrusna Misra who has been a source of inspiration for many. ii
  9. 9. I specially thank to my teachers and friends in UG for their help andsupports (S.S.N. Ayurveda College & Research Institute, Paikmal) and Internees, UG andPG friends in DGMAMC. I also thank Prof. Habib I. Khatib and family and Smt.Neelamma for the support and encouragement provided during my stay at Gadag. I acknowledge my patients for their wholehearted consent to participate inthis clinical trial. I express my thanks to all the persons who have helped me directly andindirectly with apologies for my inability to identify them individually. I am highly thankful to Dr. J. P. Panda, my brother in law Dr. SanjibKumar Kar and my brother Shri. Debasish Dash for their constant help andencouragement throughout the work. I am also thankful to my sister in law Dr. RadhikaPanda and sister Smt. Swati Dash for their constant support and encouragement and mybeloved nephew Rishit and my niece Tanisha whose sweet smile made my work moreeasy. Finally I dedicate this work to my respected parents Shri. NrusinghCharan Dash (Senior Master, RSP, SAIL) and Smt. Jyoshna Moyee Mishra (Asst.Teacher, Govt. of Orissa) who are the prime reasons for all my success.Date : Dr. Biswajit DashPlace : Gadag iii
  10. 10. Abstract Among Indian population approximately 6 Crores of Madhumeha (DM) patientsare detected as so far. The Prameha (Madhumeha) which is prevalent all over the globe ismisunderstood, as a disease dependent upon mere Insulin and pancreas. Finally it isnecessary to conquer “The triumph of sugar over diabetes” as said by George JeanNathan 1882–1958 by the present selected trial “Panchatikta Prasrutika Basti”. To understand the etiology, patho-physiology, complications and managementmethods is necessary to emphasize the disease Madhumeha. The word Madhumehaconsists of two words, “Madhu” and “Meha”. Sayana highlighted the vatic nature of thisailment Madhumeha. In Charaka Samhita, described Nirupasthambha Madhumeha butalso the Avaranjanya Madhumeha which is a unique contribution of this Samhita. Susrutatypically mentioned the decoctions according to each type of Prameha and mentioned thebody constitution and symptoms related to Sahaja and Apathyanimittaja Prameha andused Kshaudrameha synonym to Madhumeha in Nidana 6th chapter. Regarding clinical metabolic Research in Ayurveda, there are considerable researchis needed in Madhumeha regarding remedies and effective treatment in elevating thedoshas and does samprapti vighatana. The main Research focus or point is to evaluate aneffective measure in the treatment of Madhumeha and to evaluate chosen panchatiktaprasrutika basti is having the role in effecting the metatabolic system with reference tohypoglycemic activity.Objectives of the Study: 1. Evaluate the Efficacy of “Panchatikta Prasrutika Basti” in the management of Madhumeha. 2. Evaluate the Hypoglycemic effect of Panchatikta Prasrutika Basti in the management of Madhumeha. iv
  11. 11. It was a Simple randomized Pre-post test single blind clinical study. The results arenot much variant as the time schedule for the research is quite minimal and sample size isalso marginal. There is a response to the given prasrutika yoga basti is found and thepurpose of understanding glucose metabolism in this protocol is successful. In thisclinical trial, the Overall assessment shows that 59.94% were not responded, 26.64%were responded, and 9.99% shows Palliative and rest of 3.33% showed Regulated to thegiven treatment. Statistically the study is significant.Key words: Madhumeha; Avarana; GIT glucose absorption inhibition; Panchatikta;Prasrutika Basti v
  12. 12. List of Abbreviations Used AH. – Ashtanga hridaya. AS. – Ashtanga samgraha. BP. – Bhavaprakasha. BR. – Bhaishajya ratnavali. BS. – Bhela samhita. Ch. – Charaka. CS. – Charaka samhita. GN. – Gada nigraha. HS. – Harita samhita. KS. – Kashyapa samhita. MiR – Mild response. MN. – Madhava nidana. MoR – Moderate response. No. – Number. Pt.’s – Patients. Sl. – Serial number. SS. – Sushruta samhita. Su. – Sushruta. Vag. – Vagbhata. VS. – Vangasena samhita. YR. – Yogaratnakara. vi
  13. 13. TABLE OF CONTENTSSl. no. Chapters Page No. 1 Introduction 1-7 2 Objectives 8-14 3 Review of Literature 15-112 4 Methodology 113-126 5 Results 127-162 6 Discussion 163-184 7 Conclusion 185-186 8 Summary 187-188 9 Bibliography 189-202 10 Annexure 203-214 vii
  14. 14. LIST OF TABLESSl. no. Title Page No. 1 Showing sankhya bheda of basti 28 2 Showing bheda of basti according to Kashyapa 28 3 Showing classification of Basti karma based on 30 site of administration 4 Showing Measurements of Bastiyantra 32 5 Showing netradosha of Basti netra 33 6 Showing putakadosha of Basti Putaka 34 7 Showing contra indicated for Niruha 34 8 Showing indicated for Niruha 36 9 Showing Contraindications for Anuvasana 38 10 Showing symptomatic evaluation of differential 90 diagnosis in madhumeha 11 Showing differentiation of anilatmaka & kapha 91 sambhava madhumeha 12 Showing master chart no. 1 127 13 Showing master chart no. 2 128 14 Showing the grades of Subjective parameters 129 15 Showing the Objective values 130 16 Showing the grades of objective parameters 131 17 Showing the incidence of ahara nidana 132 18 Showing the incidence of vihara nidana 133 19 Showing the Chief and associated complaints 134 20 Showing the glucose activity during the basti 135 21 Showing the distribution of sex 136 22 Showing the incidence of religion 136 23 Showing the incidence of occupation 137 24 Showing the distribution of age 138 25 Showing the marital status of patients 139 26 Showing the socioeconomic conditions 139 27 Showing the distribution by sleep 140 28 Showing the habits of the patient 141 29 Showing the Nature of kostha 142 30 Showing the Status of agni 143 31 Showing the chronicity of disease and response 143 32 Showing the distribution of diet 144 33 Showing distribution of Chief complaints 145 34 Showing associated complaints 146 35 Showing aharaja nidana 147 36 Showing viharaja nidana 148 37 Showing anya nidana 149 viii
  15. 15. 38 Showing retention of niruha basti 150 39 Showing retention of anuvasana basti 150 40 Showing overall response to treatment 151 41 Showing analysis of improvement in subjective 153 parameters 42 Showing overall improvement in subjective 154 parameters 43 Showing improvement in subjective parameters 155 after follow up 44 Showing overall improvement in subjective 156 parameter after follow up 45 Showing improvement in objective parameters 157 46 Showing overall Improvement in objective 158 parameters 47 Showing overall improvement in subjective and 159 objective parameters 48 Showing overall assessment of treatment 160 49 Showing a comparative statement of Madhumeha 176 and DM LIST OF FIGURES, PHOTOGRAPHSSl. no. Title Page No. 1 Figure gross anatomy of Pancreas 66 2 Photo of drugs used in Panchatikta Bastikarma 104 LIST OF GRAPHSSl. no. Title Page No. 1 Showing the distribution of sex 136 2 Showing the incidence of religion 137 3 Showing the incidence of occupation 137 4 Showing the distribution of age 138 5 Showing the marital status of patients 139 6 Showing the socioeconomic conditions 140 7 Showing the distribution by sleep 141 8 Showing the habits of the patient 142 9 Showing the Nature of kostha 142 10 Showing the Status of agni 143 ix
  16. 16. 11 Showing the chronicity of disease and response 14412 Showing the distribution of diet 14513 Showing distribution of Chief complaints 14614 Showing associated complaints 14715 Showing aharaja nidana 14816 Showing viharaja nidana 14917 Showing anya nidana 14918 Showing retention of niruha basti 15019 Showing retention of anuvasana basti 15120 Showing overall response to treatment 15221 Showing analysis of improvement in subjective 154 parameters22 Showing overall improvement in subjective 155 parameters23 Showing improvement in subjective parameters 156 after follow up24 Showing overall improvement in subjective 157 parameter after follow up25 Showing improvement in objective parameters 15826 Showing overall Improvement in objective 159 parameters27 Showing overall improvement in subjective and 160 objective parameters28 Showing overall assessment of treatment 161 x
  17. 17. Introduction INTRODUCTION UDHYAMENA HI SIDHYANTI KARYANI NA MANORATHAIH Our problems are man-made; therefore they may be solved byman. And man can be as big as he wants. No problem of human destiny isbeyond human beings. — J. F. Kennedy. In today’s convulsively changing world, scientific advances, politicalmutations, profit maximizations, social interventions, and human interpretations areproducing new and often confusing, perceptions of health and disease, to the extentthat one wonders if such primary human aspirations as equity, well-being, andfreedom from suffering are being forgotten. The galloping spread of globalization, the increasing realization that nonation is isolated from another and that health is essential to progress, have led toattempts to engage those factors that influence national and international health.1 Metabolism is the set of chemical reactions that happen in living tomaintain life. These processes allow organisms to grow and reproduce, maintain theirstructures, and respond to their environments. The chemical reactions of metabolism 1 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  18. 18. Introductionare organized into pathway. Metabolic pathways, in which one chemical istransformed through a series of steps into another chemical, by a sequence ofenzymes. Enzymes are crucial to metabolism because they allow organisms to drivedesirable reactions that require energy and will not occur by themselves, by coupling(physics) coupling them to “Spontaneous process”. Spontaneous reactions that releaseenergy. Basal metabolic rate (BMR), and the closely related resting metabolic rate(RMR), is the amount of energy expended while at rest in a neutrally temperateenvironment, in the post-absorptive state (meaning that the digestive system isinactive, which requires about twelve hours of fasting in humans). The release ofenergy in this state is sufficient only for the functioning of the vital organs, theKidneys and the rest of the nervous system, intestine.2 According to Ayurveda, Dhatu metabolism, the transformation of the food-essence has four results: • The unstable portion becomes stable in the form of another dhatu. This is the beneficial portion (prasadapaka). • A secondary tissue called an upadhatu is created. • A waste portion known as a kittapaka is produced. • The formative layer or asthayi portion of the next tissue is formed. The strength of the digestive fire (dhatu-agni) is vital to the quality andquantity of tissue produced. An agni that is too high will result in deficient tissues dueto hyper metabolism and an agni that is too low will result in an excess of low qualitytissue due to lack of use. Agni is the determinant of tissue quality as it has the abilityto transform ahara rasa into the assimilable form for each dhatu to develop from. The 2 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  19. 19. Introductiontissues have many vital functions, qualities, secondary tissues, wastes and diseasetendencies.3 “Metabolic syndrome” refers to the phenomenon of risk factor clustering—anaggregation of metabolic traits occurring in the same individual with Frequenciesgreater than expected by chance, and presumably reflecting a unifying underlyingpathophysiology. It has long been recognized that type 2 diabetes and cardiovasculardisease (CVD) share many risk factors in common and that their co-occurrence isprobably linked to insulin resistance and obesity 4. Broadly speaking, the term ‘Prameha’ means passing of fairly large amounts ofunclear urine. It covers a large aspect of symptoms as well as local diseases involvingGenito-urinary system. However, the definition of “Madhumeha” – to pass “Madhusamam” Urine i.e. Sweet like honey, makes it much closes to glycosuria. Vagbhatahas also quoted that in Madhumeha, another essential feature i.e.; “Madhuryacchatanorathah’ probably hyperglycemia condition along with “Madhviva mehati”glycosuria for a disease to be labeled as “Madhumeha”.5 The Classical term in Indian Medicine, Madhumeha is synonymous with DiabetesMellitus with Modern Medical Science. It has taken the place of World’s 3rd largestkiller next to Cardiac Ailments. About 25% of the Senior Citizens have become thevictim and this percentage may grow more very soon in future, as modern sedentarylifestyle, food habits of the peoples open the door for this disease to Pervade.LACUNAS IN CURRENT KNOWLEDGE: Diabetes mellitus is the third largest killer in the world behind the cardiacailments and cancer. The World Health Organization estimates that more than 180 3 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  20. 20. Introductionmillion people worldwide have diabetes. This number is likely to more than double by2030. In 2005, an estimated 1.1 million people died from diabetes. Almost 80% ofdiabetes deaths occur in low and middle-income countries. Almost half of diabetesdeaths occur in people under the age of 70 years; 55% of diabetes deaths are inwomen. Most notably, diabetes deaths are projected to increase by over 80% in upper-middle income countries between 2006 and 2015.6 Although many advances in modern science, the management of diabetesis still unsatisfactory. Consequent to such projections alarm bell are already ringing inthe circle of health care institutions. Inspite of more and more chemical moleculesflooding the market with claims of better efficiency in the management of diabetesmellitus, but the over all treatment scenarios is not of confident, drug relatedresistance and toxicity etc are creating an opinion for provision of safe anti-diabetics. There is no doubt that attention is coming back to our ancient Indianheritage of Ayurveda to explore its rich literature and come out with some efficaciousremedies, to co-fight the challenge of diabetes.NEED FOR STUDY Diabetes mellitus is the third largest killer in the world behind the cardiacailments and cancer. It is becoming a great national catastrophe with a currentprevalence rate of 2.4% to 11.6% in urban dwellers. The danger of this epidemicdisease is not only confined to individual’s mortality and morbidity but also extendsto affect the national health care system and economy. Starting from simple endocrine and metabolic stimulation or suppression testssuch as the insulin and glucagon administration or glucose tolerance tests, a series ofmore sophisticated tests has been developed over the last three decades. 4 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  21. 21. Introduction The major part of glucose production occurs in the liver, although the kidney(Gersosimo et al. 1994; Stumvoll et al. 1995) and the intestinal bed (Croset et al.2001) the circulating concentration of glucose is both representative of and central tothese homeostatic processes. Under normal, basal conditions, it is maintained within aremarkably tight range by an exquisite balance of the rate at which it is produced(primarily by the liver) and the rate at which it is utilised. Perturbations such as meals,stress or exercise result in altered glucose fluxes, such as the entry of additionalglucose from intestinal absorption. Negative feedback effects rapidly restore anyaltered glucose concentrations to their steady state concentration. The underlyingfluxes are generally reinstated more slowly. Type 2 diabetes is characterized bychronic alterations in glucose levels. Probing of the normal homeostatic responses,and of the deregulation that occurs in diabetes, clearly needs to take place at the levelof the fluxes.7 By using the oral diabetes medications now available, many people withtype 2 diabetes can control blood glucose levels without insulin injections. Studies areunderway to determine how best to use these drugs to manage type 2 diabetes. Madhumeha is one of the mahagadas explained as it is a type of Pramehaand is one among the disorders where in maximum number of srotases get vitiatedwith the vitiation of almost all the dhatus and ojas due to which the condition ofpatient afflicted with Madhumeha goes on deteriorating. In Ayurveda classics, mentioning of diet and its importance and Dinacharya andRitu charya has been dealt to assist good digestion and metabolism in detail to livehappily without misery. In this way, Shodhana chikitsa ‘Panchatikta Prasrutika Basti’explained in classic is selected. The present study is an attempt to evaluate the 5 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  22. 22. Introductionbeneficial effect of ‘Panchatikta Prasrutika Basti’ and popularize it among thePractitioners and therapists of Ayurveda and also to know the procedural effect. RESEARCH POINT: Regarding clinical metabolic Research in Ayurveda, there are considerableresearch is needed in madhumeha regarding remedies and effective treatment inelevating the doshas and does samprapti vighatana. More than 200 Ayurvedic thesis/works were conducted all over India on Madhumeha in the form of shodhana andshamana line of treatment. In many P.G & Research centers across India and alsoresearch in abroad are doing many research projects on Madhumeha (Diabetes) andclaiming the results at various level. Still research in this aspect is necessary and herethe main research focus or point is to evaluate an effective measure in the treatment ofMadhumeha and to evaluate chosen panchatikta prasrutika basti is having the role ineffecting the metabolic system with reference to hypoglycemic activity or not?HYPOTHESIS: Madhumeha / Ojomeha - represent the degenerative state of the body with increased susceptibility to various infections & associated dhatu kshaya. Basti is a process by which doshas are eliminated through the Adhomarga. Acharyas also given a prime importance to it. Even it termed as Ardhachikitsa and it removes the vitiated doshas from all systems of the body. As the vata dosha is one of the main contributing factors, some specific types of Basti have been explained in the management of Madhumeha. The best way to analyze Bastikarma is by checking its effect over multisystemic disordes like Madhumeha. 6 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  23. 23. Introduction In the present study Panchatikta Prasrutika Basti is taken with an intension that, Basti is shrestha vatasamaka along with Panchatiktas. Panchatiktas are having the properties like Laghu and ruksha majorly will help in counter-acting the 10 drava and snigdha pradhana dushyas involved in the pathogenesis of Madhumeha. MAIN HYPOTHETICAL POINT: All the five dravyas used in panchatikta prasrutika basti are patola, nimba, bhunimba, saptacchada and Rasna having tikta and katu rasa pradhana is having a role in effecting the metabolic system with reference to hypoglycemic activity. An another hypothetical point of choosing this treatment is the medicine or drugs used in the panchatikta prasrutika basti will act faster than the drugs given through oral root in stabilizing glucose levels in Madhumeha. Hence, the present work titled as the “EFFECT OF PANCHATIKTAPRASRUTIKA BASTI IN MADHUMEHA W.S.R.T. HYPOGLYCEMICACTIVITIES” is selected for clinical trial. 7 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  24. 24. Objectives OBJECTIVES SIDDHASYARDHASYA SAMPRAPTE KO VIDWAN YATNAMACHARET? An idea is not worth much until a man is found who has the energy and theability to make it work. —Anonymous Physicians are faced daily with disease, illness, suffering and death. The medicalProfession aims to help cure, treat, comfort, and save the lives of those who seek help. In1996, an international group of health scholars and practitioners reclarified the traditionalgoals of all medicine. These goals are: The prevention of disease and injury and promotion and maintenance of health. The relief of pain and suffering caused by maladies. The care and cure of those with a malady, and the care of those who cannot be cured. The avoidance of premature death and the pursuit of a peaceful death.8 Madhumeha/DM is the present burning issue alarming the world. Madhumeha is adisease known to the mankind since Vedic period and it is mentioned as one of the 20obstinate urinary disorders, where “Prabhuta Mutrata” i.e. polyuria is as the cardinalsymptom.9 8 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  25. 25. Objectives There is no doubt that attention is coming back to our ancient Indian heritage ofAyurveda to explore its rich literature and come out with some efficacious remedies, toco-fight the challenge of diabetes. The accurate and effective proposed ShodhanaTherapy ‘Panchatikta Prasrutika Basti’ explained in Shastras if the same could bescientifically skillfully administered on the patient would herald confidence in both thedoctors and patients and usher a ‘NEW AGE’ in Ayurveda System of Medicines. As, per the Statistics of W.H.O the increasing incidence of Madhumeha in Indiais galloping and between 1995-2025 would increase by 195%. The world healthorganization (WHO) has projected that the global prevalence of type 2 DM will morethan double - from 135 millions in 1995 to 300 millions by 2025. Type 2 diabetesmellitus epidemic in India is a result of societal influences and changing lifestyles. It isreported that at the end of 2025, the incidence of diabetes in Indian continent is risingvery fast at a rate of >3 times the entire world. After observing the above discussed points, Panchatikta prasrutika basti is chosenfor clinical trial and the present study “EFFECT OF PANCHA TIKTA PRASRUTIKABASTI IN MADHUMEHA W.S.R.T. HYPOGLYCEMIC ACTIVITIES” is undertaken. Objectives of the study - 1. To evaluate the efficacy of Panchatikta Prasrutika Basti in the management of Madhumeha. 2. To evaluate the hypoglycemic effect of Panchatikta Prasrutika Basti. 9 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  26. 26. Objectives Evaluate the Efficacy of Panchatikta Prasrutika Basti in the management of Madhumeha: One of the most important features of Modern Medicine differentiating it fromAyurveda is the method of breaking complex phenomena into their component parts anddealing with each in isolation. In Diagnosis, it looks for a single cause; in Therapy, ItSearches for the Active Principle. Modern Medicine thus developed a reductionistapproach, forgetting to treat the patient as a whole. Ayurveda lays more emphasis on thepromotion of positive health and prevention of diseases. The Ayurvedic management of Madhumeha aims not only to achieve a strictglycemic control but also to treat the root cause of the disease. Since the disease is notcurable, effective control is the need of the hour. For the prevention and control of thediabetes, at various levels prevention is to be implemented. One of the main procedures of Panchakarma Chikitsa, Basti karmaconcentrates on the elimination of the loosened vata dosha out through the rectum. Thetreatment involves the introduction of medicinal substances such as herbal oils anddecoctions in a liquid medium, into the rectum of the person. This is because vata ispredominantly located in the colon and bones. Depend upon utility of the basti, Prasrutika yogika basti is explained by theachayas like charaka (, Vagbhata (Ah. kal 4/23, As. Kal 4/43) and Vangasena(Vs.bastikarmadhikara83/162) have respectively pointed out that the pancha tiktaprasrutika basti could be the panacea for kushta, prameha, abhishyanda and krimi rogas. 10 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  27. 27. Objectives Basti has significant multiple effects and hence cannot be compared withcontemporary enema, which is used for bowel cleansing or nutritive therapies. Thereasons behind the choosing the selected prasrutika Basti treatment in Madhumeha isover loading oral drug administrations making tender stomach to get gastritis & othercomplications. The alternative Controlled - Release Preparations, Sublingual, Transdermal,Subcutaneous, Parenteral, Intravenous, Intramuscular, Intra arterial, Pulmonary, Topical,etc are not equals Ayurveda Panchakarma – Basti as it is - The rectal route often is useful when oral ingestion is precluded because the patient is unconscious or when vomiting is present - a situation particularly relevant to young children. Approximately 50% of the drug that is absorbed from the rectum will bypass the liver; the potential for hepatic first-pass metabolism thus is less than that for an oral dose. However, rectal absorption often is irregular and incomplete, and many drugs can cause irritation of the rectal mucosa. Evaluate the Hypoglycemic effect of Panchatikta Prasrutika Basti The maintenance of the plasma glucose concentration is a critical bodily function.Hyperglycemia is associated with long-term micro and macro vascular complications,while hypoglycemia can lead to serious injury to the brain, which is dependent on plasmaglucose as a fuel source. At any given time the body’s plasma glucose concentration is abalance between the relative rates of glucose appearance and disappearance. These ratesare regulated by several key organs through the actions of multiple hormonal signals. 11 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  28. 28. Objectives The mechanisms underlying glucose-stimulated insulin secretion from β-cells arecomplex and involve the integration of signals from multiple internal and externalstimuli. Under normal circumstances, glucose elevation induces a biphasic pattern ofinsulin release. The discovery of the incretin effect led to a search for mechanisms triggered by oralglucose administration which might play a role in mediating insulin secretion. While anumber of factors were initially proposed, currently the incretin effect is attributedlargely to two hormones secreted by specialized endocrine cells in the gut: glucose-dependent insulinotropic peptide (GIP, also termed gastric inhibitory polypeptide) andglucagon-like peptide-1 (GLP-1).10 In this study, Saindhavadi taila is selected for anuvasana basti purpose and Panchatikta dravyas like patola, nimba, bhunimba, saptacchada and rasna. Goghrita is used forsneha in classical preparation of niruha Basti. The plan of treatment of giving panchatikta prasrutika basti is in yoga Basti Pattern. As the samprapti, lakshanas explained in context of Madhumeha is need to studyclinically as these play important role in explaining the mode of action of given or chosentreatment. Hypothetically it is already mention that Anal route of administration of drugsthrough Prasrutika Basti will act faster than oral route. However, the action or mode of action of given treatment basically depend on Rasa,guna, virya, vipaka and prabhava of the drugs in composition of yoga. 12 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  29. 29. ObjectivesSome research points regarding Madhumeha (DM) from Modern Diabetes: Latest Research Source: National Institute of Diabetes and Digestive and Kidney Diseases Researchers continue to search for the cause or causes of diabetes and for ways toprevent and cure the disorder. For example, scientists are looking for genes that may beinvolved in type 1 or type 2 diabetes. Some genetic markers and other indicators for type1 diabetes have been identified, so it is now possible to check relatives of people withtype 1 diabetes to see if they are at risk. Scientists are also researching ways to prevent ordelay many of the complications associated with diabetes. Many drugs are now available to treat type 2 diabetes. These include, for example,drugs that help the pancreas produce more insulin, make tissues more sensitive to insulin,or improve the livers response to insulin. By using the oral diabetes medications nowavailable, many people with type 2 diabetes can control blood glucose levels withoutinsulin injections. Studies are underway to determine how best to use these drugs tomanage type 2 diabetes. The findings of the Diabetes Control and Complications Trial, sponsored by theNational Institute of Diabetes and Digestive and Kidney Disease or NIDDK, showed theimportance of tight control of blood glucose in slowing or preventing complications ofdiabetes such as eye, kidney, and nerve damage.11 DANCE THERAPY: Dr. A.V Satyanarayana, is a Bharatanatyam, Kathak exponent, teaches dance as atherapy. He combines the movements and gestures of Bharatanatyam and Kathak intophysical and psychological therapy. Inspired by the therapeutic value of Bharatanatyam, 13 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  30. 30. ObjectivesSatyanarayana started his dance therapy workshop. He has devised a way to transform theart form into a something which is of tangible and practical value to people. Bycombining various "Mudras" of both Bharatanatyam and Kathak with a smattering of theChau dance, he has evolved a dance therapy that could be of immense use to thosesuffering from diabetes, hypertension and migraines. He has taken diabetes awareness classes at Mallya Hospital in Bangalore. Inconsultation with physiotherapists (to confirm the safety of a range of dance movementsfor patients), Dr. Satyanarayana devised a 17 minute routine that also uses elements fromChau, a martial art cum folk dance form of the eastern state of Orissa.12 Dr. S. V. Chowtiof Mallya Hospital, Bangalore confirms. Dr. Satyanarayana has been conferred theAthmaseva National Award at All India Conference at Vijayawada 2003 for hiscontribution in dance therapy in the field of alternative medicine. 14 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic Activities
  31. 31. Literary Review REVIEW OF LITERATURE SARVASSARVAM NA JANATI SARVAJNO NAASTI KACHANA! As to diseases make a habit of two things—to help, or at least, to do no harm. —Hippocrates, Epidemics, Book 1, Section XI (400 b.c.) Diabetes can affect almost every system in the body. In routine clinical practice,examination of the patient with diabetes (Madhumeha) is focused on examination of thehands, blood pressure, eyes and feet. General aetiology and pathology of CharakaPrameha13 and also to Vagbhata14 who are at the common opinion of that all Prameha leftuntreated or not properly treated leads to Madhumeha. Two types of Prameha namelySahaja and Apathyanimittaja can be compared to insulin dependent and non-insulindependent diabetes respectively. Whatever be the type of Madhumeha, as it is MadhyamaRogamarga (Basti – Marma) associated becomes incurable and needs very long activemanagement strategy. Susruta has used the word Kshaudrameha. ‘Madhu’ and kshaudra are literallysynonyms of each other, which mean honey.15 But he placed a different chapter formanagement of the ‘Madhumeha’ in his Chikitsa. He has legitimated Madhumeha to be astage of complications of appearing in Prameha16. When literal meaning of the word‘Madhumeha’ is compared to the contemporary Diabetes Mellitus fits exactly in theframe work. Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 15 Activities
  32. 32. Literary ReviewREVIEW OF BASTI KARMA: The eminent ancient physicians, Charaka, Susruta and Vagbhata are consideringthe body constitution and strength of the body of the patient when dealing with themanagement aspect. Charaka considers two types of patients; one is that with stout body structure andwith strength and the other is thin and impaired strength. Susruta said that the sahajameha (born diabetic) rogi will be krusha (thin) and apathyanimittaja rogi will be sthula(stout). Chikitsa (Management Proper) and Chikitsa sutra (principles of treatments) arethe two divisions of disease management. Both are illustrated very well in Ayurveda. Butthe concepts of methods are different in considering the disease. Basti karma posesses both Samshodhana and Samshamana effects along withthis it does the functions of shukradharana, brimhana in emaciated person; Karshana inobese person, Chakshushya, prevents the aging, improves the luster, strength and helpslongevity by acting locally as well as systematically at cellular level. Thus, it has a wideapplication in treatment aspect.HISTORICAL BACKGROUND: Veda Kala - In Kaushika Sutra of Atharvaveda, Bastikarma is indicated as a substitute for minor operation.17 Purana Kala – Agnipurana - bastikarma is indicated as a principle treatment in complaints marked by predominance of vata.18 Samhita Kala – Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 16 Activities
  33. 33. Literary Review Charaka Samhita- in Siddhisthana out of 12 chapters, 8 chapters are on the bastichikitsa. First two chapters of Siddhisthana deals with properties of basti samyakayoga,ayogalakshanas, indications and contraindications.19 Susruta Samhita - Chikitsasthana four chapters have been devoted completely for thedescription of the bastikarma. In these chapters, detailed information regarding bastinetra,indication, contra-indications, complications, classification of basti are available.20Astanga Samgraha - Full length explanation of basti is found in Bastividhi adhyaya. Inthis chapter, classification, indication, contra-indication, dosage, process ofadministration etc. have been described in detail.21 Kalpasthana four chapters are devotedto bastikarma. In these chapters, description regarding importance of bastikarma,different types of basti, snehabasti vyapat etc. are given.Astanga Hridaya - Vagbhata has explained the bastikarma in Astanga samgraha andAshtanga hridaya like avastanusrutabastis, prasrutikabastis, vyapat etc.22 Sutrasthana ofAstanga hridaya Basti Vidhi and Kalpasiddhi chapters named as Bastikalpa andBastivyapad siddhi explain the every aspect of bastikarma. Later samhitas like Kashyapa samhita, Sharangadhara samhita and Madhavachikitsa described about basti kalpana vidhi and particularly Madhava chikitsakaraexplained about basti kalpas like Deepana basti and Ardhamatrika Basti (MadhavaChikitsa 70-75).Bhela samhita - description of Basti is available in four chapters of Siddhisthana-Bastimatriya Siddhi, Upakalpa Siddhi, Phalamatra Siddhi and Dosha Vyapadika BastiSiddhi.23 Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 17 Activities
  34. 34. Literary Review Later other samhitas like Chakradatta explained the two chapters namedAnuvasanadhikara and Niruhadhikara are dealt with Anuvasana and Niruha bastirespectively.24Vangasena samhita has devoted “Basti Karmadhikara” for description of bastikarma.25Bhavaprakasha Purvakhanda has been contributed to describe basti and also vrana bastihas been explained26BASTI THERAPY (ENEMA) IN MODERN ERA- Basti karma, a shodhana procedure explained in ayurveda by the achayas has so much difference in administration and combination of drugs used in modern science as enemas. The procedure “Colonics” which is used by the modern physicians has some resemblance to the principles and application of Basti karma. The terms “colonic irrigation,” “colonic,” and “colon hydrotherapy” are interchangeably. The term “colonic irrigation” has never referred to a single procedure, but there are some common elements. Colonics are distinguished from enemas in that (1) they are not self-administered, but instead are administered by a person with some professional training, and (2) they are administered using some type of device to control the water flow. Their purpose is to infuse the entire colon with water, in contrast to the more limited infusion of water in an enema27 The rationale for colonic irrigation was originally based on the concept of “autointoxication.” Autointoxication is an ancient theory based on the belief that toxins originating in the intestine can enter the circulation and poison the body. Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 18 Activities
  35. 35. Literary Review Colonic irrigations as a treatment for autointoxication became popular in the late 1800s and early 1900s. Kelvinson (1995) cites a variety of respected physicians of the time who advocated colonic irrigations, noting that even the Royal Society of Medicine in 1913 cited the colon as a major factor in health. The book, Nostrums and Quackery, which he edited for the AMA Press (Cramp, 1911, 1921), particularly takes issue with Charles Tyrrell’s “J.B.L. Cascade,” a home enema device that consisted of a water-filled cushion with a nozzle. The criticism comes in a chapter on “Mechanical Fakes.” The issue is not that the device does not clean the colon, but that Tyrrell makes excessive claims in his advertising, such as “there is only one disease,” and “there is only one cause for disease and that is autointoxication” (Cramp, 1911, p. 312, italics in original).28NIRUKTI (ETYMOLOGY) : The word Basti is derived from the root vas by adding Tich Pratyaya and itbelongs to masculine gender- According to Vachaspatyam. Meanings of the root vas • “Vasu Nivase” Means to reside, to stay, to dwell. • “Bas-aachadane” means to cover / to coat • “Vas snehaachadana Praharaneshu” coating of sneha for the elimination Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 19 Activities
  36. 36. Literary Review • “ Basta gandha ardhane” Gandha denotes bad smell hence it refers to mala, and the verb Ardhane isderived from “Ardha gatou Yachane cha” - denotes the movement (in the colon) and tobeg (drawing of waste material in the colon from all over the body.) • “Vas vasane surabhikarane” To produce the effect of pleasant smell. • “Baste aavrunoti mutram” It denotes an organ, which covers the urine • “Nabhisthodhobhage Mutradhare sthane” It denotes an organ situated below the umbilicus, which holds the urine. • “Oushadha danarthe dravyabhede” It denotes an instrument used for the administration of the medicine. From the above foregoing descriptions, the following two conclusions can be drawn: Basti denotes Karma wherein the drugs administered through the rectal canal stay for certain period in the body then produces the coating of the Sneha in the body and draws out the waste substances from all over the body into the colon and eliminates them out of the body by producing movements in the colon resulting into pleasant (beneficial) effect. Basti denotes an organ, which is receipted or reservoir of urine i.e. ‘urinary bladder’ as it is basically a receipted having soft and elastic nature. It was used as an instrument for the administration of the drugs with a constant pressure.DEFINITION: It is defined in two ways: Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 20 Activities
  37. 37. Literary Review • One indicates the whole of the Karma / therapy mainly for Vata disorders and for purification. Other definition indicates that, just the material / apparatus / instrument used for the Karma. • All the drugs or medicaments, which are introduced though the rectum with the help of basti (made up of Animal urinary bladder) is designated as Basti. • Charaka defined the Basti on the basis of Action / Karma similar to that of Vamana and Virechana. Basti is the Karma in which, the medicine prepared according to classicalreferences is administered through rectal canal reaches upto the Nabhi Pradesha, Kati,Parshwa, Kukshi (i.e. upto small intestine, anatomical land marks on the abdomen)churns the accumulated Dosha and Purisha (morbid humors and fecal matter) spreads theunctuousness (potency of the drugs) all over the body and easily comes out along withthe churned Purisha and dosha (impurity) is called Basti.29 This definition denotes the Niruha and Anuvasana basti as they eliminate theaccumulated Purisha and Dosha (Impurity). • Another definition mainly explains the apparatus used for Basti. The procedure in which either basti is used for the administration of the drugsor the drugs administered first reaches to the Basti.30 CLASSIFICATION OF BASTI: Basti is the procedure and method of drug administration. So it can beadministered through various routes with the use of different drugs, for different periodand for various purposes. Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 21 Activities
  38. 38. Literary Review Classification is the thing, which can helpful to understand any subject in awell explorative manner. It helps to highlight each and every aspect of the subject withvarious angles. Basti can be classified as follows:On the Basis of Adhisthana: According to the site of application of basti it is of two types – a) Internal b) ExternalInternal Route Administration of Basti: Classification of Basti karma based on Route of administration - (A) Pakwashayagata Basti : The drugs are administered through Rectal canalinto the colon (Pakvashaya). So called Pakvashayagata, It includes both Niruha andAnuvasana Basti. (B) Garbhashayagata Basti : The drugs are administered through the vaginainto the uterine cavity (Garbhashaya), so called Garbhashayagata Basti. (C) Mutrashayagata Basti : The drugs are administered through the urethrainto the urinary bladder (Mutrashaya) so called mutrashayagata Basti. Garbhashayagataand Mutrashayagata Basti both are called as Uttara Basti. (D) Vrana Basti : The drugs are introduced into the Vranadi for its shodhanaand ropana purpose. It is mentioned by Susruta. Pakwashayagata Basti : Classified on the Basis of main ingredient i.e. dominance of Sneha or Kashayaas follows: Snehaika Basti : Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 22 Activities
  39. 39. Literary Review Mainly the Sneha in the form medicated Taila, Ghruta, Vasa and Majja isadministered through the rectal canal into the colon. This Snehaika Basti is classified into three types according to the dose. (i) Sneha Basti : The quantity of Sneha Basti is decided ¼th to the quantity of theNiruha. So, 6 pala (298 ml ) Sneha is administered. (ii) Anuvasana Basti : Anuvasana term can be used for the Snehika Basti too.Definition: The Sneha Basti which will not cause any harm even if it is retained for oneday and can be administered every day after taking food.31,32 “Yatta cha sonnamanuvasannapi…… deeyate etyanuvasanam”33 “Anuvasannapi na………..deeyata ityanuvasanah” 34 The quantity of this basti is half to the Sneha Basti i.e. 3 pala (144 ml) (iii) Matra Basti : This is the minimum quantity of Sneha Basti i.e. ½ Pala (72ml)can be given without complication.Niruha Basti : Niruha Basti is also called as Asthapana Basti. Kashaya is the predominant contentin this Basti. • “Sa doshanirharana……. Niruha:”35 • “Sarirarohanaaddosha….niruha iti”36 • “Niruho doshaharana….. tano” (Vangasena) • “Kashayaksheerito…… nigadhyate” (Vangasena) • “……niruho dosha vahanat” (Ka.sam) The Basti which eliminate the vitiated dosha from the body. This increase thestrength of the body because of its potency is called Niruha Basti. Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 23 Activities
  40. 40. Literary Review Asthapana Basti : Name itself shows the purpose. • “Vayah sthapanaad………….asthapanam”37 • “Tadvayaha………………….asthapanamitchuchyate”38 • “Aasthapye…………………smrutah:”(Vanagasena) • “Swasthana…………………sthapanam matam”(Sharangadhara) Stabilizes the Age (Vaya) or Ayu, Stabilizes the normal functions of Dosha andDhatu and stabilizes Deha i.e strength of the body so called Asthapana Basti. In NiruhaBasti along with the Kasaya, Madhu, Saindhava, Sneha and Kalka are the ingredientscommonly used. If Kashaya is not used then Mamsa Rasa, Kshira, Mutra, Amlakanji,Dadhimastu, Rakta etc are also can be used. Niruha type of Basti is mainly used in various disorders and described elaboratelyin the classics. To understand its practical utility, can be classified according to differentviews as follows. According to various authors the synonyms of Niruha Basti are Madhutailika,Yapana, Yuktaratha, Siddha basti etc. On the Basis of special purpose with special indications: (1) Madhutailika Basti (2) Siddha Basti (3) Yuktaratha Basti (4) Yapana Basti (5) Piccha Basti (6) Picchila Basti Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 24 Activities
  41. 41. Literary Review (7) Vaitrana Basti (8) Krida BastiOn the Basis of chief action: (1) Snehana Basti. (2) Brumhana Basti. (3) Shamana Basti. (4) Lekhana Basti. (5) Shodhana Basti. (6) Sangrahika Basti. (7) Rasayana Basti. (8) Vajikarana Basti. (9) Balavarnakruta Basti. (10) Chakshusya Basti. (11) Dipana Basti.On the basis of Action on the Dosha and Dushya: (1) Vatahara Basti. (2) Pittahara Basti. (3) Kaphahara Basti. (4) Sonita Dosahara Basti. (5) Dosa Sansargahara Basti. (6) Utklesana Basti. (7) Sodhana Basti. Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 25 Activities
  42. 42. Literary Review (8) Samana Basti. (9) Dosahara Basti.On the Basis of Specific indications: (1) Pramehahara Basti. (2) Visarpahahara Basti. (3) Raktapittahara Basti. (4) Kusthahara Basti. (5) Vataraktahara Basti. (6) Gulmahara Basti. (7) Abhishyandahara Basti. (8) Krimihara Basti. (9) Dahaghna Basti. (10) Mutrakricchrahara Basti. (11) Parikartikahara Basti.On the basis of Nature of the Basti Dravya: (1) Mrudu Basti (2) Madhyama Basti (3) Tiksna BastiOn the Basis of Rasa predominance in the Basti Dravya: (1) Madhura Rasa Skandha Dravya Basti. (2) Amla Rasa Skandha Dravya Basti. (3) Lavana Rasa Skandha Dravya Basti. Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 26 Activities
  43. 43. Literary Review (4) Katu Rasa Skandha Dravya Basti (5) Tikta Rasa Skandha Dravya Basti. (6) Kasaya Rasa Skandha Dravya BastiOn the Basis of chief drug: (1) Ksira Basti. (2) Mamsa Rasa Basti. (3) Gomutra Basti. (4) Rakta Basti. (5) Ksara Basti. (6) Dadhimastu Basti. (7) Amlakanji Basti. (8) Prasannakruta Basti. (9) Surakruta Basti. (10) Asavakruta Basti.According to the dose of the Basti: (1) Dvadasa Prasruta Basti. (2) Ekadasa Prasruta Basti (3) Nava Prasruta Basti. (4) Asta Prasruta Basti (5) Sapta Prasruta Basti (6) Shada Prasruta Basti. (7) Pancha Prasruta Basti. (8) Catuh Prasruta Basti. Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 27 Activities
  44. 44. Literary ReviewClassification According to the fixed schedule: According to the disease and condition of the patient we can use one of thefollowing schedule. Here, we can administer Snehaika and Niruha Basti, single Basticannot be given by this schedule as follows:39Table No.1 : Showing Sankhya Bheda of Basti PrakaraBASTI SANKHYA ANUVASANA NIRUHAPRAKARA SANKHYA SANKHYAYoga Basti 8 5 3Kala Basti 16 10 6Karma Basti 30 18 12Table No.2: Showing According to Kashyapa:Basti Prakara Sankhya Anuvasana Niruha sankhya sankhya Yoga Basti 8 5 3 Kala Basti 15 12 3 Karma Basti 30 24 6 Karma Basti : In this schedule we can administer 30 Basti, out of which 18 Anuvasana and 12Niruha. First day one Anuvasana is administered then 12 Niruha and12 Anuvasana can begiven alternately and at last 5 Anuvasana can be given. Every day one Basti can be given.Kasypa having different opinion he scheduled 30 Basti like 24 Anuvasana and 6 Niruha. Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 28 Activities
  45. 45. Literary ReviewAt first 5 Anuvasana can be given then 1 Niruha and 3 Anuvasana alternately given andat last 4 Anuvasana can be given40. He also mentioned that this Karma Basti could begiven in the patient having good strength and Vata predominance.According to Bhela, Karma Basti includes 24 Basti41 .Kala Basti: According to Charaka it includes half number of Basti to that of Karma Basti.But Chakrapani opined that it includes 16 Basti. According to Vagbhata it includes 15 Basti. He missed out one Anuvasana inthis Schedule. Day first 1 Anuvasana can be given then Afterwards 6 Anuvasana and 6Niruha given alternatively and at last 3 Anuvasana are administered. Kashyapa mentioned, 12 Anuvasana and 3 Niruha, 3 Anuvasana in thebeginning then 1 Niruha and 3 Anuvasana alternately and at last 3 Anuvasana are given.He also mentioned that this schedule can be used in the patients having moderate strengthand in the disease where along with Vata, Pitta also a vitiated dosha.42Yoga Basti : According to Charaka it includes 8 Basti out of which 5 Anuvasana and 3Niruha. First day 1 Anuvasana then 3 Niruha and 3 Anuvasana alternatively and at last 1Anuvasana is given. Kasyapa mentioned same number of Basti with same Niruha and Anuvasanaschedule. According to Kashyapa due to less use of Sneha it is mild in Action. This Bastischedule called yogabasti. It is used in the patients having Kapha Sansarga along withVata vitiation. Kasyapa mentioned the Basti courses according to their use in paediatric patients. Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 29 Activities
  46. 46. Literary Review Though in classics there are few numbers of Basti schedules according to Dosha,like 9, 7, 4, 5 respectively for Vata, Pitta, Kapha and in Swastha. Schedule is to be mentioned in such way that not a Single Basti i.e. Niruha /Anuvasana cannot extent beyond the seventh day. According to Dalhana this Basti schedule i.e. Karma, Kala and Yoga for Vata, Pittaand Kapha predominance respectively. Gayadasa also explained the schedule according to the indication like -(1) Karma Basti : Can be used in the patient where marked vitiation of Dosha due to thecause Balavadvigraha.(2) Kala Basti : It is to be given in the patients where moderate vitiation of Doshas dueto seasonal changes occurs.(3) Yoga Basti : It is to be given in the patients where. Mild vitiation of Dosa, It can begiven in swastha for attainment of Vrushyatva.External Route of administration of Basti: In certain Vyadhis the Ausadha siddha taila is kept over the part of the body using aMasha Pishta or with cap for prescribed period of time and named after the site ofapplication of oil such as – Shirobasti, Katibasti, Janubasti, Greevabasti, Urobasti, etc.Table no. 3: Showing Classification of Basti karma based on site of administration 1 Shiro basti Aushada siddha taila placed over shirapradesha(scalp) 2 Kati basti Aushada siddha taila placed over katipradesha(Lumbo- sacral region) Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 30 Activities
  47. 47. Literary Review 3 Janu basti Aushadha siddha taila placed over janu sandhi 4 Greeva basti Aushadha siddha taila placed over greeva pradesha (cervical/intra-scapular below neck) 5 Uro basti Aushadha siddha taila placed over uro pradeshaDrugs used in Basti Karma: Number of drugs belonging to animal and plant origin has been described in theclassics, which are used in bastikarma. For example, sasya, Ksheera, Mamsarasa,Swarasa, Mutra, Kshara, Lavanam etc. The above lists suggest that almost all availabledrugs can be used for bastikarma.1. Phalini drugs:- Drugs useful for emesis can be used in Asthapanabasti. e.g: -phala,jeemutaka, ikshwaku, dhamargava, kutaja & kritavedhana.2. Sneha dravyas: Ghrita, taila, vasa, majja.3. Mutravarga dravyas: Aja, avi, go, mahisha, hasti, ushtra, haya, etc.4. Asthapana & Anuvasanagana: Dashamoola, bala, punarnava, eranda, yava, kola,kulatha, guduchi, madanaphala, palasa etc5. Kalka dravya for asthapanabasti: Trivrit, bilwa, pippali, kushta, sarshapa, vacha,kutaja, satahwa, yashtimadhu, madanaphala.6. Kalka dravya for anuvasanabasti: Rasna, devadaru, bilwa, madanaphala, satahwa,swetapunarnava, raktapunarnava, gokshura,etc Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 31 Activities
  48. 48. Literary ReviewBasti Yantra : The device used for basti karma is called as bastiyantra. • Basti Netra The netra should be made of gold, silver, and copper or with other highermetals, alloys, long bones, bamboo, wood etc. Generally netra must resemble like tail ofcow with a tapering end and a wider base, or like pyramid shape with round ends andsmooth surfaces.43The dimensions are different for different age groupTable 4 Showing Measurements of Bastiyantra:44No. Age in Length in Lumen of netra Years Angula Diameter of narrow end Diameter of broad end1. <1 5 1 angula2. 1–6 6 Size of green gram 1 angula3. 7- 11 7 Size of black gram 1½ angula4. 12-15 8 Size of kalayam 2 angula5. 16- 20 9 Size of wet kalaya 2½ angula6. > 20 12 Karkandhu 3 angulaUttarabastiyantra7. - 12 – 14 Sarshapa size -Susruta’s opinion8. 1 6 Green gram Feather of kanku bird must pass through.9. 8 8 Black gram Feather of eagle must pass through.10. 16 10 Kalayam Feather of peacock must through.11 >25 21 Kolasthi Feather of vulture must pass through.Pramana of vranabasti netra:The hole should be of a mudga pramana, with 8 angulas of length45Karnika: Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 32 Activities
  49. 49. Literary Review Two karnikas are provided on the netra at distance of 2 angulas between one,another at proximal end to tie the bastiputaka properly. In order to prevent unduepenetration of the bastinetra deep in to the rectum, a karnika or rim has to be made. It isto be placed at a required point above the distal end.Table 5 - Showing netradosha of Basti netra46No. Netradosha Features Effect1. Hraswata Too short Dravya will not reach pakwasaya2. Deerghata Too long Dravya go beyond the pakwasaya3. Tanuta Too thin Produces kshobha4. Sthoolata Too big Produces lakshana5. Jeernata Old dhatu used Injury to guda6 Shithilabandhana Not fixed properly to the Dravya comes out putaka7. Parshwachhidra Hole on side Leakage of dravya happens8. Vakrata Curved / irregular Dravyagati becomes irregular9. Asannakarnika Karnika too near Karma becomes of no use10. Prakrustakarnika Karnika too far Causes raktasrava by gudamarma peedana11. Anusrotata Small hole Cannot perform properly12. Mahasrotrata Broad hole Cannot perform properlyBastiputaka:The container of the bastidravya is known as bastiputaka. And it should be made frombladder of animals to fit the bastinetra and should not have any bad smell. If good bladderis not available other materials like skin of lower limb or neck of monkeys or otheranimals; thick cloth with sufficient strength and size are recommended for thepurpose.47As the technology advances the development various types of materials areavailable to make bastiputaka and even disposable bastinetra are available. The rubber Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 33 Activities
  50. 50. Literary Reviewbladder and polythene bags, plastic can are best choice as these materials are disposable,safe and easy to perform.Table no. 6 Showing putakadosha of Basti Putaka48No. Putakadosha Features Effect1. Vishama Shape not in uniform Gati vishamata happens during pressing 2. Mamsala Muscular tissue Produces offensive small present 3. Chinnachiddrayukta 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 dravya 7. Snigdha Unctuous Slip form the hand 8. Klinnata Wet Difficult to pass throughIndications and Contra-indications of Bastikarma. As basti is one of the prime treatment modality of Ayurveda, the knowledge of theindication and contraindication will make the success in the treatment. A brief descriptionhas been made here.Niruha ayogya/ Anasthpya49Table No 7 Showing the Contraindications of Niruhabasti7.No. Atidurbala Type of patient Cha. + + Su. - Vag. Complication8. Kshudhaarta + - -1.9. Ajeerna Trishnaarta + + -2.10. Atisnigdha Sharmaarta + - + - Dooshyodara, Murccha, Shotha.3.11. Peetasneha Atikrisha + - + - +4.12. Utklishtadosha Bhuktabhakta + - - + More karshya, utklesha of dosha5.13. Alpagni Pitodaka + + - + - happens Teevra aruchi6.14. Yanaklanta Vamita + - - + Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 34 Activities
  51. 51. Literary Review43.15. Kandhasosha Virikta + - - + + - More rukshata happens44.16. Kshataksheena Krita nasyakarma + - - + + Manovibhrama, Srotonirodha45.17. Krudha garbini Saptamasa + - - + - +46.18. Bala,Vruddha Bheeta + - - + - Bastidravya moves up47.19. Alpavarcha Matha + - + - + -48.20. Gudashosha Moorchita + - + - + - Samnjanasha and Hrudayopaghata49.21. Amaprajata Prasaktachhardi + + - + -50.22. Shopha Prasaktanishteeva - + - - +23. Swasaprasakta + + + Bastidravya moves up because of the24. Kasaprasakta + + + existing urdhwagati of vata25. Hikkaprasakta + - +26. Baddhagudodara + - +27. Chhidrodara + - + Leads to death by causing severe28. Dakodara + - + distension of abdomen29. Adhmana + - +30. Alasaka + - -31. Visuchika + - -32. Asmadosha + - - Causes teevra amavastha of the body33. Amatisara + - +34. Madhumeha, + + + Vyadhi vardhakam Prameha35. Kushta + + +36. Arsha - + +37. Pandu - + -38. Bhrama - + -39. Arochaka - + -40. Unmada - + -41. Shokagrasta - + -42. Sthoulya - + - Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 35 Activities
  52. 52. Literary Review 50Niruha Yogya/Asthapya.Table No 8 Showing the Indication of Niruhabasti.No. Indication Ch. Su. Vag. No. Indication Ch. Su. Vag.1. Sarvangaroga + + - 37. Rajakshaya + + +2. Ekangaroga + + - 38. Vishamagni + - -3. Kukshiroga + - - 39. Spikshoola + - -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. Antrakujana + - -20. Gulma + + + 56. Parikartika + - -21. Shoola + + + 57. Maharogoktavatavyadhi + - +22. Hridroga + - - 58. Jwara - + +23. Bhagandara + - - 59. Timira + + -24. Unmada + - - 60. Pratishaya - + - Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 36 Activities
  53. 53. Literary Review25. Jwara + - + 61. Adhimantha - + -26. Bradhna + + + 62. Ardita + + -27. Shirashoola + + + 63. Pakshaghata + + -28. Karnaroga + - - 64. Ashmari - + -29. Hritshoola + - - 65. Upadamsha - + -30. Parshwashoola + - - 66. Vatarakta - + -31. Prushtashoola + - - 67. Arshas - + -32. Katishoola + - - 68. Stanyakshaya - + -33. Vepana + - - 69. Manyagraha + + -34. Aakshepa + + - 70. Hanugraha + + -35. Angagaurava + - - 71. Ashmari - + +36. Atilaghava + - - 72. Mudhagarbha - + +Anuvasana yogya.51Anuvasana is indicated in patients who are already indicated for asthapana, but specialmention has been given to certain conditions like rooksha, kevala vataroga and atyagniwhere anuvasana is more beneficial.Anuvasana ayogya.52Table No 9: Showing the Contraindications of Anuvasana basti.No. Contraindications Ch. Su. Vag. Complications1. Anasthapya + + +2. Abhuktabhakta + - + Sneha moves upwards3. Navajwara + - -4. Kamala + - + Leads to udara5. Prameha + - +6. Arshas + - - Leads to aadhmana Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 37 Activities
  54. 54. Literary Review7. Pratishyaya + - -8. Pandu + + +9. Arochaka + - - Leads to more annabhilasha10. Mandagni + - -11. Durbala + - - Increases the condition12. Pleehodara + + +13. Kaphodara + + + Leads to more dosha vardhana14. Urustambha + - +15. Garapeeta + - +16. Kaphabhishyanda + - +17. Gurukoshta + - +18. Shleepada + - +19. Galaganda + - +20. Apachi + - +21. Krimikoshta + - +22. Prameha - + +23. Kushta - + +24. Sthoulya - + +25. Peenasa - - +26. Krushna - - +27. Varchobheda + - +28. Vishapeeta + - +Preparation and Procedures of Bastikarma: The preparation and procedures made before, during and after administration ofNiruha, Anuvasana, Matra, and Uttarabasti with little differences. Generally, theseprocedures are classified into three parts: - • Poorva karma Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 38 Activities
  55. 55. Literary Review • Pradhana Karma • Paschat Karma Selected patients for basti therapy have to undergo thoroughly clinical examinations to ascertain the physical as well as the mental conditions. Following ten factors are to be considered for clinical examination.53 1.Dosha 2.Oushada 3.Desa 4.Kala 5.Satmya 6.Agni 7.Satwa 8.Vaya 9.Bala This will enable the physician to. decide, the type of basti, number of bastis, basti dravya, etc to be administered in the particular patient. PROCEDURE OF BASTI KARMA: Anuvasanabasti. Poorvakarma- The patient should pass his/her natural urges then body of the patient should beanointed with suitable sneha and mrudu sweda. He should not have excessive appetite,then is advised to have his prescribed meal in madyamamatra and made to take a shortwalk. Patient is asked to lie over basti droni which is not very high, and the head must beat lower level. The patient should be lie on the droni on his left lateral position withstraight left leg and semi flexed right knee.54Pradhanakarma- The prescribed amount of sneha should be taken in the bastiputaka and tied wellplacing the bastinetra in position. Air is trapped from bastiyantra by gently pressing thebastiputaka. Then the anal region and the netra should be smeared with oil to minimizethe pain and irritation.55 Gently probe the anal orifice with the index finger of the lefthand and introduce the bastinetra through it into the rectum up to the mark of first Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 39 Activities
  56. 56. Literary Reviewkarnika. Keeping in the same position press the bastiputaka by putting the adequate forcethen withdraw from the site.Paschatkarma. The patient is asked to sleep in same position as long as it would take to count upto hundred. The patient should be gently struck three times on each of the soles and overthe buttocks and where ever pain is there. The distal part of the cot should be raisedthrice. Allow patient to lie for sometime in the same position, if given sneha passedimmediately; another anuvasanabasti should be adopted.56 After passing the motion withsneha in proper time the patient is allowed to take light food in the evening if he feelshungry. Three yama is the maximum time for basti pratyagamana. Niruhabasti: Poorvakarma - Abhyanga and swedana should be done over waist region and over abdomenprior to the procedure. Suitable time to administer niruha basti is Madhyahnekinchidavrute. In empty stomach57 patient should lie comfortably on left lateral position,he should keep his body straight and, and use his folded left hand as pillow. He shouldthen flex his right leg, keeping left leg straight.Pradhanakarma-After the the anal examination the anus should be lubricated and then lubricated basti thnetra should be inserted into it up to the first ring (1/4 part from the top) slowly andstraightly parallel to the vertebral column once we have to wait for a few seconds for thebody to accommodate the nozzle before squeeze the nirooha dravya. Vagbhata in Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 40 Activities
  57. 57. Literary ReviewAstanga Samgraha says that (pidana kala) time taken for squeezing is 30 matras.Practically it takes half to one minute.58Paschatkarma- After the pradhana karma patient is advised lie in supine position, pillowshould be placed below the vankshana pradesha. According to Chakradatta the patienthas to lie in supine position for about 100 matras.59 The other procedures followed in anuvasana should not be done in thiscondition. After passing motion he may be advised to take bath with hot water and havenormal food along with yusha, mamsarasa or ksheera in kapha, vata and pittapredominant diseases respectively.60 The maximum time for basti pratyagamana is onemuhurtha(48 minutes).61 If it did not pass out, giving basti, which consists of sneha,kshara, mutra, amla dravyas and phalavarti, can bring it out. It should have the propertieslike snigdha, ushna, and teekshna if the niruha is passed out instantly again two or three 62bastis can be given.Parihara kala- As jatharagni is not much hampered; so specific regimen is not necessary duringthe pariharakala. During the period patient should avoid vata vardhaka nidanas.Observation of signs and symptoms of proper administration of Basti The following Lakshana should be observed to evaluate the proper function of bastiaccordingly.Samyak yoga lakshnas631. Prasrshta Vitkata (Mala moves at its own accord).2. Prasrshta mootra (Urine moves at its own accord). Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 41 Activities
  58. 58. Literary Review3. Mala, Pitta, Kapha and Vayu all these move gradually.4. Patient feels lightness in the body.5. Prasrshta Vata (flatus will move normally)6. Ruchi (taste) in Bhojana (food) will be produced.7. Laghutva (lightness) of the Pakwasaya (largegut)8. Teekshnagni (increase digestive power)9. Shamana (palliative) roga lakshanas (Disease symptoms)10. Patient will be healthy.11. Rogi bala (strength of patient) increases.Ayoga Lakshnas64 :(Signs and symptoms of improper administration of Basti) If the Niruha basti is not given properly or does not function the following Lakshnasare seen: pain in the head, heart, umbalicus, rectum, penis, Ruja in Siras, Hridaya, nabhi,guda and medra or yoni will occur. Oedema (Shotha), coryza (pratishyaya) cutting pain,hrilasa, Vitsangha mootrasangha, Swasakrchrata, vegalapata and the dravya and malawill come out in small quantity, Aruchi, gurutwa in sarira are also found.Atiyoga LakshanasThe Lakshnas of the Atiyoga (excessive administration) of Basti are found asfollows :1. Angasupti (loss of sensation in the organs),2. Angamadra (Myalgia),3.Klama (Exhaustion),4. Kampa (Tremore or paralysis Agitans),5. Nidra (sleep), Effect of Panchatikta Prasrutika Basti in Madhumeha w.s.r.t.Hypoglycemic 42 Activities