Matrabasti vatastila pk007-gdg

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A COMPARARATIVE EFFECT OF MATRABASTI AND SNEHAPANA (SHAMANA SNEHAPANA) WITH SUKUMARAKUMARAKA GHRITA IN THE MANAGEMENT OF VATASHTILA (BENIGN PROSTATE HYPERPLASIA).” VIJAYAMAHANTESH. M. HUGAR Post graduate department of Panchakarma,Shri D. G. Melmalagi Ayurvedic Medical College,Gadag – 582103.

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Matrabasti vatastila pk007-gdg

  1. 1. “A COMPARARATIVE EFFECT OF MATRABASTI AND SNEHAPANA (SHAMANA SNEHAPANA) WITH SUKUMARAKUMARAKA GHRITA IN THE MANAGEMENTOF VATASHTILA (BENIGN PROSTATE HYPERPLASIA).” By VIJAYAMAHANTESH. M. HUGAR Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M.D. (PANCHAKARMA) In PANCHAKARMA Under the guidance of Dr. P. Shivaramudu, M.D. (Ayu) And co-guidance of Dr. Shashidhar. H. Doddamani, M.D. (Ayu) Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103. 2006.
  2. 2. Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled“A Compararative Effect of Matrabasti And Snehapana (ShamanaSnehapana) with Sukumarakumaraka Ghrita In the Management ofVatashtila (Benign Prostate Hyperplasia).” is a bonafide and genuineresearch work carried out by me under the guidance ofDr.P.Shivaramudu, M.D. (Ayu) , Professor, Post-graduate department ofPanchakarma and co-guidance of Dr. Shashidhar. H. Doddamani, M.D.(Ayu),Assistant Professor, Post graduate department of Panchakarma.Date:Place: VIJAYAMAHANTESH. M. HUGAR
  3. 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled“A Compararative Effect of Matrabasti And Snehapana (ShamanaSnehapana) with Sukumarakumaraka Ghrita In the Managementof Vatashtila (Benign Prostate Hyperplasia).” is a bonafide researchwork done by VIJAYAMAHANTESH. M. HUGAR in partial fulfillmentof the requirement for the degree of Ayurveda Vachaspathi. M.D.(Panchakarma).Date:Place: Dr. P. Shivaramudu, M.D. (Ayu). Professor Post graduate department of Panchakarma.
  4. 4. ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled“A Compararative Effect of Matrabasti And Snehapana (ShamanaSnehapana) with Sukumarakumaraka Ghrita In the Managementof Vatashtila (Benign Prostate Hyperplasia).” is a bonafide re-search work done by VIJAYAMAHANTESH. M. HUGAR under theguidance of Dr.P. Shivaramudu, M.D. (Ayu), Professor, Postgraduate depart-ment of Panchakarma and co-guidance of Dr. Shashidhar.H. Doddamani,M.D. (Ayu), Assistant Professor, Post graduate department of Panchakarma.Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil. Professor & H.O.D, Principal.Post graduate department of Panchakarma.
  5. 5. CERTIFICATE BY THE CO- GUIDE This is to certify that the dissertation entitled“A Compararative Effect of Matrabasti And Snehapana (ShamanaSnehapana) with Sukumarakumaraka Ghrita In the Managementof Vatashtila (Benign Prostate Hyperplasia).” is a bonafide re-search work done by VIJAYAMAHANTESH. M. HUGAR in partialfulfillment of the requirement for the degree of Ayurveda Vachaspathi.M.D. (Panchakarma).Date: Dr. Shashidhar.H. Doddamani, M.D. (Ayu).Place: Assistant Professor, Post graduate Department of Panchakarma.
  6. 6. COPYRIGHT Declaration by the candidate I hereby declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use anddisseminate this dissertation / thesis in print or electronic formatfor academic / research purpose.Date:Place: VIJAYAMAHANTESH. M. HUGAR© Rajiv Gandhi University of Health Sciences, Karnataka.
  7. 7. i ACKNOWLEDGEMENT “Many hands make light work”. I take this opportunity to mention my deepgratitude to several personalities who have helped me in the successful completion of thiswork. I express my obligation to my honorable H.O.D, Dr. G. PurushothamacharyuluM.D. (Ayu), H.O.D., P.G. Department of Panchakarma, P.G.S&R, D.G.M.A.M.C, Gadagfor his critical suggestions and expert guidance for the completion of this work. I express my obligation to my honorable guide Dr. P. Shivaramudu M.D (Ayu),Assistant Professor, for his critical suggestions and expert guidance for the completion ofthis work. I am extremely grateful and obliged to my co-guide Dr. Shashidhar.H.Doddamani, Asst. Professor, P.G.S.&R, D.G.M.A.M.C, Gadag for his guidance andencouragement at every step 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 this research work. I express my sincere gratitude to Lecturer Dr. Santhosh. N. Belavadi MD (Ayu),Lecturer for their sincere advices and assistance. I express my sincere gratitude to Dr. V. Varadacharyulu M.D (Ayu), Dr.M.C.PatilM.D (Ayu), Dr. Dilip Kumar M.D. (Ayu), Dr. Mulgund M.D (Ayu), Dr. K.S.R.PrasadM.D. (Ayu) (Osm), M.A. (Jyotish), Dr. R.Y.Shettar M.D. (Ayu), Dr. Kuner Sankh M.D.(Ayu), Dr. Girish Danappagoudar Dr. Jagadish Mitti M.D. (Ayu), Dr. ShashidharNidagundi M.D. (Ayu) and other PG staff for their constant encouragement. I express my sincere gratitude to Dr. Venkatesh S. Karanth M.D. (Patho) D.N.B.Lecturer Shri. Nandakumar (Statistician), for their sincere advices and assistance. I also express my sincere gratitude to Shri. V.M. Mundinamani (Librarian), Dr. S.D. Yerageri, Dr. D. M. Patil, Dr. S. A. Patil, Dr. P.C. Chappanamath, Dr. M. V. Aiholi,Dr. B. S. Patil, Dr. S. B. Govindappanavar, Dr. B. G. Swamy, Shri. C.S. Bhatt, Dr. U. V.Purad, Dr. Mallagoudar, Dr. R.K. Gachhinmath, Dr. G.S. Hiremath, Dr. Avvani, Dr. S.H. Radder, Dr. C. S. Hiremath, Dr. Juktihiremath, Dr. Kudarikannur, Dr. R.R. Joshi, Dr.K.S. Paraddi, Dr. V. M. Sajjan for their support in the clinical work. i
  8. 8. ii Shri. B.S. Tippanagoudar (lab technician), Shri. Basavaraj (X-ray technician), Mr.Shavi, Mr. Nabhi, Mr. Kulkarni, Mr. Hatti and other hospital and office staff for theirkind support in my study. I express my sincere thanks to my colleagues and friends Dr. Ratna Kumar, Dr.Uday Kumar, Dr. Jayaraj Basarigidad, Dr.P.Chandramouleeswaran, Dr. KendadamathDr. Shaila. B, Dr. Santhosh.L.Y, Dr. Subin Vaidyamadham, Dr. Febin .K. Anto, Dr,Satheesha.R, Dr., Dr. K. Krishnakumar, Dr. Ashwini Dev, Dr. Suresh Hakkandi, Dr.Vijay Hiremath, Dr. Manjunath Akki, Dr. L. R.Biradar, Varsha.S. Kulkarni, Dr.Hadimani, Dr. C. S.Hanumanta Gouda, Dr.Shankargouda, and other post graduatescholars for their support. I also express my obligations to my friends Dr. B.L. Kalamath, Dr. Venkareddy,Dr. Basavaraj Ghanti, Dr. Pradip, Dr. Sajjan, Dr. Ashok Bhingi, Dr. Umesh Kumbar, Dr.Devendrappa Budi, Dr. Shubu Prasad, Dr. Ashok M.G., Dr. Payappagouda, Dr.Madhushri, Praveen. Dr. hemanta. Manju. Kushi. Kittu. etc. I acknowledge my patients for their wholehearted consent to participate in thisclinical 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 my parents Shri. Mahadevappa D. Hugar & Smt.Sarojadevi M. Hugar for her constant help and encouragement throughout the work. I amalso thankful to my beloved brother Mr. Vasanth Mrs. Geetha for their constant supportand encouragement.Date : VIJAYAMAHANTESH. M. HUGAR.Place : Gadag. ii
  9. 9. iiiList of Abbreviations Used ⇒ A. Hr.. – Ashtanga hridaya. ⇒ A. S. – Ashtanga samgraha. ⇒ B. P. – Bhavaprakasha. ⇒ B. R. – Bhaishajya ratnavali. ⇒ Ch. – Charaka. ⇒ C. S. – Charaka samhitha. ⇒ G. N. – Gada nigraha. ⇒ H. S. – Hareetha samhitha. ⇒ M. N. – Madhava nidana. ⇒ No. – Number. ⇒ Pt.’s – Patients. ⇒ Sl. – Serial number. ⇒ S. S. – Sushruta samhitha. ⇒ Su. – Sutrasthana. ⇒ V. S. – Vangasena samhitha. ⇒ Y. R. – Yogaratnakara. ⇒ Sk. D. – Shabdakalpadruma. ⇒ SKKG – Sukumaraka Kumaraka Ghrita.
  10. 10. ivABSTRACT Obstruction at different levels in the urinary tract produces different effects.Ayurveda too deals with the chapter of urinary obstruction under Mutraghata and alsoprinciples of its managements. Here a sincere attempt is made to asses the efficacy ofAyurvedic formulations in the conservative management of Vatashtila (BPH.) Research begins with doubts and ends with facts, that serve as new data to beverified again. Thus the process of research never ends, but at the end of it the researcherwould have become wiser with plans to counter newer challenges. The present study is “A Comparative effect of Matrabasti and as ShamanaSnehapana with Sukumara Kumarak Ghrita in the management of Vatashtila(BPH)” MatraBasti is one the most important among the Panchakarmas. It has alreadybeen proved that the “Basti” is the choice of treatment Vata pradanavyadisas theVatashtila is one of the Vata pradanana vyadi. And Shamana Snehapana is indicated inmutrakrachar, it is having importance to alleviates disease quickly. Sukumara Kumaraka Ghrita is the name itself indicates, it is recommended forSukumaras viz old age persons without any hesitation .The ingredients viz- Dashamula,Laghupanchamoola, Punarnava etc are having properties like Rasayana, Balya,Shoolahara and Vatahara.etc which helps in correcting the pathology of Vatashtila(BPH). Hence this study has under taken. iv
  11. 11. vObjectives Of The Study:- 1) To evaluate the effect of Sukumara kumaraka ghrita Matrabasti in themanagement of Vataashtila (BPH). 2) To evaluate the effect of Sukumara kumaraka ghrita as Shamana snehapana inthe management of Vatashtila (BPH). 3) To compare the effect of Sukumsr kumaraka ghrita Matrabasti and as shamanasnehapana in the management of Vatashtila (BPH). Clinically this study deals with the management of patients of Vatashtila (BenignProstatic Hyperplasia.). It is a common problem in who is men over 50years of age;Approximately one half of 50 years, by the age of 60 years 50 % of men have histologicalevidence of BPH, and an estimated three fourths of all men over the age of 60experiences such symptoms as difficulty in initiating urinations, Nocturia, and frequency.As life expectancy increases, primary care physicians will likely see significantly moremale patients with this disorder. Vatashtila (BPH) is characterized by both Obstructive and Irritative symptoms.The main severity of symptom is not correlated with the size of the prostate. Many menwith enlarged prostate have no symptoms whereas others, some times with lesserenlarged, experience severe symptoms. The management of BPH is divided into Non-operative treatment, Conventional operative treatment and Minimally invasive treatment.All these considerations provided a firm launch pad to make excursion into thetherapeutic alternatives, which could be provided by Ayurveda, the Mantra of“NIRAMAYA” Therefore a set of therapeutic procedures was designed to assess itsefficacy on symptomatology of BPH. v
  12. 12. vi In this present work the schedule of treatment was as follows – 30 patients are selected and are randomly categorized into two groups. Group A – 15 patients with Matrabasti with Sukumara Kumarak Ghrita, 8 daysMatrabasti with 70ml of Ghrita, 16 days for pariharakala total study duration was 24days. Group B – 15 patients with Shaman Snehapana with Sukumara KumarakGhrita, 16 days Shaman Snehapana with 30ml Ghrita, divided dose twice Daly up to 16days and 8 days for pariharakala total study duration was 24 days.Subjective parameters: Cardinal symptoms of Vatashtila (BPH).viz – Ashtila vatha Ghanam Ghranthi,Mala, Mutra, Anila Sanga, Adhmana, Sashula yukta mutratyaga. And AmericanUrological Association Symptoms Index & (I-PSS).Objective parameters: Digital Rectal Examination and Ultrasonography.Response of the treatment:Subjective complaints were relieved significantly in the range of 38.88% patents fromgood respond after the completion of Matrabasti in Group A, and 22.22% of patients arefrom moderate respond, where as 22.22% of patients are from poor respond.In the objective parameter 6.66% good respond, 26.66% poor respond. Comparing thesubjective and objective parameter, subjective parameter is having better effect. In Group B the range of relief was observed from subjective parameter 55.55% ispoor respond, 11.11%is moderate respond. Where as objective parameter among 15patients there is no any respond has seen. Comparing the subjective and objectiveparameter, group-A and group-B, group-A (Matrabasti) is having better effect. vi
  13. 13. viiiTABLE OF CONTENTS Chapters Page No. 1. Introduction 1-4 2. Objectives 5-9 3. Review of literature 10-81 4. Methodology 82-104 5. Results 105-137 6. Discussion 138-168 7. Conclusion 169-171 8. Summary 172-173 9. Bibliography 1-16 10. Annexure 17-31
  14. 14. ix LIST OF TABLESTable Showing the Page No. No. 01. Indications for Bastikarma are as follows – 26 02 Sneha guna, Panchabhoutika sanghatana & Karmukata of Sneha dravyas. 29 03 Source of Sthavara sneha according to Charaka 32 04 Sushruta’s classification of Sthavara sneha. 32 05 Sneha Bhedha based on the Paka. 33 06 Opinion about Sneha Matra 35 07 Sneha Matra according to Sushruta. 35 08 Indications of Sneha Matra. 35 09 Indications of Shamanasneha. 39 10 General Contraindications of Snehana. 40 11 Sneha Jeeryamana and Jeerna Lakshana. 44 12 Nidanas as explained classics. 61 13 Symptomatology Of BPH. 66 14 Pathya-Apathya In Vatashtila (BPH). 79 15 Combination of this ghrita are like as mentioned 83-86 16 Chief Complaints. 92 17 Digital Rectal Examination Chart. 100 18 Grade for U.S.G findings 103 19 Distribution of patients by age groups. 105 20 Distribution of patients by religion. 106 21 Distribution of patients by occupation. 106 22 Distribution of patients by socio-economical status. 107 23 Distribution of patients by dietary habits. 107 24 Distribution of patients by Vyasana. (Addiction). 108 25 Distribution of patients by Viaharaja Nidana. 108 26 Distribution of patients by Nidra. (Sleeping Habits). 109 27 Distribution of patients by Jatharagni. (Status ofJatharagni). 109 28 Distribution of patients by nature of Koshta. 110 29 Distribution of patients by nature of Mala pravritti. 110 30 Distribution of patients by Mutra pareekshya bhavas. 111 31 Distribution of patients by type of Desha. (Nature of Habitat). 111 32 Distribution of patients by dosha pradhanata in Prakriti. 112 33 Distribution of patients by Nidana. 113 34 Distribution of patients by Chief complaints. 115 35 Prostate findings by Digital Rectal Examination. (DRE) 116 36 Residual Urine in cubic centimeter. 118 37 Subjective parameters before and after treatment in Group-A as 119 38 Subjective parameters before and after treatment in Group-A as per AUA 120 (I-PSS) symptom score index. 39 Subjective parameters before and after treatment in Group B. 121 40 Subjective parameters before and after treatment in Group B as per AUA 122
  15. 15. x (I-PSS) symptom score index.41 Changes (DRE) findings in Group A 12342 Changes in Prostate size in Group A. 12343 Changes in weight of the Prostate in Group A. 12444 Residual Urine values in Group A. 12445 Changes (DRE) findings in Group B 12446 Change in Prostate size in Group B. 12547 Change in weight of the Prostate in Group B. 12648 Residual Urine values in Group B. 12649 Over all effect of I-PSS Index of Vatashtila ( BPH ). 12750 Over all effect of Malasanga. 12751 Over all effect of Mutrasanga. 12852 Over all effect of Anilasanga. 12853 Over all effect of Ruja /Sashoolyukta Mutra tyaga. 12954 Over all effect of Ruja /Sashoolyukta mutra tyaga. 12955 Over all effect of size of the prostate. 13056 Over all effect of upper border of the prostate. 13057 Over all effect of mobility, of the prostate. 13158 Over all effect of Residual Urine. 13159 Over all effect of Weight of prostate. 13160 Overall results of Subjective and Objective parameters in Group A. 13261 Over all effect of Subjective and objective parameters in Group B. 13262 Individual study of Group A. 13363 Individual study of Group B. 13364 Inter group comparison. (A.U.A) Symptom score index. Comparative 134 effect of Group A and Group B65 Individual study of (Mala, Mutra, Anilasanga ,Adhmana, Ruja/ Sashool 134 ukta Mutra tyaga.) group-A66 Individual study of (Mala, Mutra, Anilasanga, Adhmana, Ruja/ Sashool 135 ukta Mutra tyaga.) Group B.67 Inter group Comparative effect of (Mala, Mutra, Anilasanga, Adhmana, 135 Ruja/ Sashool ukta Mutra tyaga.)Group A and Group B.68 Individual study of (Weight of Prostate, Residual Urine) Group A. 13669 Individual study of (Weight of Prostate,Residual Urine) group-B 13670 Inter group comparison Weight of Prostate,Residual Urine. Comparative 136 effect of Group A and Group B71 Composition of the Phytotherapy extracts 16072 Components of Plant Extracts: 161
  16. 16. xi LIST OF FLOW CHARTChart Showing the PageNo. No.01 Samprapti of Vatashtila. 71-7202 Pathogenesis of Benign Prostate Hyperplesia 7303 Discussion to treat BPH. 81-8204 Probable mode of action for local effect of Matrabasti on Vatashtila 165 (BPH).05 Probable mode of action of Matrabasti therapy. 16506 Showing probable mode of action of Matrabasti therapy on Basti, 165 (urinary bladder). LEAST OF FIGUREFigure Showing the Page No. No. 01 Anatomy of Prostate and Bladder. 56 02 Vertical section of the pelvis showing the prostate in relation with 59 surrounding structures. 03 Ingredients of SKK Ghrita, Procedure and instruments for Matrabasti 86-87 04 Digital Rectal Examination (DRE). 93Least of Graphs.01 Showing distribution of patients by age groups in both groups. 118-11902 Showing distribution of patients by religions in both groups. 118-11903 Showing distribution of patients by occupation in both groups. 118-11904 Showing distribution of patients by socio-economic status in both groups. 118-11905 Showing distribution of patients by food habits in both groups. 118-11906 Showing distribution of patients by vyasana in both groups. 118-11907 Showing distribution of patients by Viharaja nidana in both groups. 118-11908 Showing distributions of patients by sleep habits in both groups. 118-11909 Showing distribution of patients by Jatharagni in both groups. 118-11910 Showing distribution of patients by the nature of koshta in both groups. 118-11911 Showing distribution of patients by nature of bowel habits in both groups. 118-11912 Showing distribution of patients by age groups in both groups. 118-11913 Showing distribution of patients by age groups in both groups. 118-11914 Showing distribution of patients by prakrit in both groups 118-11915 Showing distribution of patients by nidana in both groups. 118-11916 Showing distribution of patients by chief complaints in both groups. 118-11917 Showing distribution of patients by residual urine in both groups. 118-11918 Showing overall response in Group A.. 118-11919 Showing overall response in Group B. 118-119
  17. 17. When the hair becomes gray and scanty when speaks of earthy matter beginto be deposited in the tunica of the artery and when white zone is formed at the marginsof cornea, at this same period the prostrate gland usually. I might perhaps say invariablybecomes increased in size. it is the statement of “SIR BENJAMIN BODIE”. In Ayurveda, there are two main treatment principles explained i.e. (1) Shamana(2) Shodhana. The Panchakarma comes under the Shodhana, because of their nature, i.e.elimination or purification methods. It has been mentioned, the diseases which have beentreated with shodhana therapy, will alleviate the disease from its root cause Na-teshamPunarudbhavaha. The panchakarma techniques have the prime importance in thetreatment, as well as in the two goals of Ayurveda i.e. Swasthasysa Oorjaskara andAturasya Roganut. Ayurveda considered Jara chikitsa i.e. science of geriatrics as one of the eightdivisions of Asthanga Ayurveda. Ayurveda perceives ageing as a special entity and laiddown its own multidimensional treatment approach towards it, which stresses on Vatapacification along with the nourishment of depleted Dhatus, by means of Rasayana andVajikarana. The phenomena of ageing is considered in an entirely new angle, by thiseternal science. Total life span is considered as hundred years by our Aacharys in theirclassics. Different stages of ayu are – Balya avastha (before 16 years) Madhyama avastha (16-60 years) Vridha avastha (after 60 years) 1 Introduction
  18. 18. Last phase of life span is considered as jara, which is natural and inevitableprocess as the age advances and is associated with its own disorders. During this periodnaturally depletion in Dhatu, Indriya, Veerya, Bala And Ojus occurs, gradually. As ageadvances loss of hairs, wrinkling on skin of whole body, senile cough, and short breathappears. As per Ayurveda Jaravastha is associated with vitiation of vatadosha and is moreprone to Vatavyadi’s. Vatashtila is one of the vata predominant disease, which succeedswith old age. Acharyas susrhutha explained Vatashtila under vata vyadi nidana in firstchapter. Ageing is defined as the “Sense of a progressive generalized impairment of functionresulting in a loss of adaptive response to stress and growing risk of age related diseases” isexpected that with the present rate, in early part of next century, we will be having around25% of population in a geriatric group. Among the geriatric problems major systemsinvolved are central nervous system, cardio vascular system and third major is urinarysystem. Common urinary diseases which affects elderly men is Benign ProstaticHyperplasia. (BPH) Vatashtila is one of the Mutraghata which explained by all Brahatries andLaghutries. Acharya Charaka has explained it in Siddhisthana 9th chapter of“Thrimarmeeyasiddhi” and considered as one of the Bastigata vikara, but not as a type ofMutraghata. Acharya Sushruta and others explained regarding Vatashtila, in the context ofMutraghata. The diseases like Vatashtila, and Mutragranthi, which are having similar signsand symptoms to that of BPH. Out of the two, the signs and symptoms of Vatashtila are inresemblance to BPH. Vatashtila manifests mainly due to the derangement of Apanavata,which is responsible for normal voiding of function. There by produces stone like swelling“Ashteelavath Ghanam Granthi” which is firm, Sthira and Unnatha. Manifesting between theGuda and basti pradesha, it leads to bahirmrga avarodini means obstruction of Mutra, Anila,Purisha and Adhmana. 2 Introduction
  19. 19. NEED FOR STUDY The long-term exposure to drug induced adverse events and the prohibitive costs arethe primary limitations of prevention therapy of BPH. In addition, effective medical andsurgical therapy exists when BPH ultimately does becomes clinically evident. Because thereis no clinically evidence, biochemical, or genetic predictors of BPH development orprogression. So every male is at risk. The ability to identify those individuals who arepredisposed to develop clinical BPH refractory to medical therapy would provide a morecompelling rational for prophylaxis. There is evidence that men with very large prostates areat greater risk for developing urinary retention. (Jacobsen et al, 1997) As the high incidence of disease Vatashtila (BPH) in elderly men, at the beginning ofthe 4th decade of life, 8% of men have histopathological Benign Prostatic Hyperplasia. 50%of men aged 51 to 60 yrs, and 90% of the men over the age of 80 yrs. Have histologicalevidence of benign prostatic hyperplasia. Approximately 23 million men world wide sufferfrom moderate to severe BPH. In the management of Vatashtila (BPH), which is the out come of vitiated vata,Acharyas gave importance to the Sneha as the choice of treatment. because Sneha is havingantagonistic properties to that of Vata. The Basti and Sneha are indicated in Mutrakricchraand Mutraghata. In general Matrabasti is the major and effective treatment modality which iseasy to administer and can be given to old age persons without any complications. Shamanasnehapana is having the capacity to do the Shamana of the Vikaras, “Shigram”Doshanukarshani, Sarvamarga i.e. Koshta, Sandi, Marma, Shaka, Sancharini and isBalya, Punarnavikari, Sharira, Indriyachetasam, which is widely indicated in gulma,Mutrakrichra, Gadhavarchas, etc. (Ch. Su. 13., Uttama Matra) (A. Hr. Su. 16/19) Thereby these two remedies i.e. Matrabasti and Shamana snehapana are considered as the besttreatment options to treat Vatashtila (BPH). 3 Introduction
  20. 20. In contemporary system of medicine various surgical approaches have been practicedto relieve this embarrassing disorder of BPH. because medicines are practically of no avail.Even surgery is not supposed to be an ideal treatment owing to various complicationsassociated with operative problems, hemorrhage etc. Incontinence of urine is noted in severalof cases post-operatively, which is more frustrating than the disease itself. The patientdoesn’t want to be treated surgically in the first instance, rather he prefers non-invasivetherapy. Acharyas elaborated the different kinds of treatment modalities regarding thetreatment of various types of Mutravaha Srotovikaras, Mutravikaras. In the managementof Vatashtila Acharya Susrhuta mentioned, Swedana, Abhyanga, Basti Uttara basti, andKashaya, Kalka, and Sarpi. Susrhuta specifies treatment for Vatashtila in 5th chapter ofChikitsa Sthana and he emphasizes to that of Gulma and Abhyantara Vidradivat Chikitsa(5th Cha. Chi.) to be carried out with regards to Vatashtila. Sukumara kumaraka ghrita is indicated in Mutrakricchra Chikitsa in the textbookof Chakradutta and Bhaishajyaratnavali which is best Vatahara, Balya, Rasayana andVedana shyamaka. With regard to this Sukumara Kumaraka ghrita was considered forthis present clinical study as Matrabasthi and shamana Snehapaana in Vatasthila (BPH). 4 Introduction
  21. 21. To evaluate the effect of Sukumarakumaraka ghrita Matrabasti in the management ofVatashtila (BPH).To evaluate the effect of Sukumarakumaraka ghrita as Shamana snehapana in themanagement of Vatashtila (BPH).To compare the effect of Sukumsrkumaraka ghrita Matrabasti and as shamanasnehapana in the management of Vatashtila (BPH). The goals of treatment for Vatashtila (BPH) include relieving – LUTS, Decreasing BOO (Bladder Outflow Obstruction). (Mutra sanga) Improving bladder emptying. (Mutra sanga) Ameliorating destrusor instability.(Mutra sanga) Reversing renal insufficiency. Preventing future episodes of gross hematuria. Urinary tract infection and Urinary retention. (Mutraghata) Preventing future episodes of gross hematuria, (Raktha mutrata) In our classics there is no explanation about anatomical structure of Vatashtila as well as BPH but acharya Sushruta has mentioned the term Pourusha which can be compared with Prostate gland. In Ayurveda Vatashtila is closely resembles to the BPH according to its location and signs and symptoms. Vatashtila is one of the Vata pradhna vyadhi, incidence of both are in old age persons, obstruction induced changes in detrusor muscle function, compounded by age related changes in both bladder and nervous system function, lead to urinary frequency, urgency and nocturia. Old age which is inevitable stage of life also acts as Nidana for Vatashtila which is one among Vatavyadhi. (A. Hr. Su 1/8). 5 Objectives of the Study
  22. 22. In the classics there is no explanation about Sadhasadhyata for Vatashtila. But by considering, in general Mutraghata are difficult to cure due to involvement of Basti marma. Where as in contemporary system of medicine, there is no satisfactory treatment modalities in controlling the symptoms and preventing the complications of the BPH. They include α blockers, androgen suppressants, aromatase inhibitors and phytotheraphy, i.e. the plant extracts. However surgical intervention is Prostectomy, even today it is the ultimate choice of treatment, then also not recommendable. Because most of the patients in late sixties and seventies, the risk for cardiovascular diseases, hypertension, diabetes mellitus are high, serious post operative complications like hemorrhage, infective processes such as Cystitis, and also delayed complications like urge or stress urinary incontinence. Therefore by considering the contraindications of surgery, risk of surgery and very less satisfactory results by the hormonal treatment. On the aim of one should get rid of age related disorders like Vatashtila (BPH), here an attempt has made with Panchakarma modalities to find a better solution to maintain the normal life in old age also. 1) “To evaluate the effect of Sukumarakumaraka ghrita Matrabasti in themanagement of Vatashtila (BPH)”. Matrabasti is best treatment for old age persons, because of its less dose and minimum complication. The drug of Matrabasti is sneha, as it is perfectly antagonistic to the Vata and the disease Vatashtila is vatadosha pradhana vyadhi (Apanavata). 6 Objectives of the Study
  23. 23. Matrabasti is selected, as the Apanavata is prime cause for the disease and the seat of Apanavata is “Apano apanaga shroni basti medhrorugocharaha.” The administered Basti dravya stays in Pakvashaya and it will reach to the affected area quickly by the Anupravaranabhava of Sneha and the properties of ingredients like Dashamoola, Laghupanchamoola, Punarnava, Ashwagandha etc, as the affected area is near to the Pakvashaya. Hypothetically the Matrabasti can bring vitiated doshas to balanced state, severity of the signs and symptoms of the Vatashtila (BPH) may reduce. 2) To evaluate the effect of Sukumara kumaraka ghrita as Shamanasnehapana in the Management of Vatashtila (BPH). Shamana snehapana, is having the capacity to (Ch. Su. 13 cha. Uttama Matrasneha ) spared all over the body immediately and it can restore the normal health. Shamana snehapana is indicated in Gulma, Mutrakricchra etc, as the Sneha is the best vatahara, it can be used for the treatment of Vatashtila (BPH). By the virtue of active principles of Sukumara kumaraka ghrita it can spread all over the body and reach the affected area, does the shamana of the disease. 3) To compare the effect of Sukumara kumaraka ghrita Matrabasti and asShamana snehapana in the management of Vatashtila (BPH). Sukumara Kumaraka Ghrita is the name itself indicates, it is recommended for Sukumaras viz old age persons without any hesitation. The ingredients viz.- Dashamooula, Laghupanchamoola, Punarnava etc are having properties like Rasayana, Balya, Shoolahara and Vatahara, etc., which helps in correcting the pathology of Vatashtila. (BPH). 7 Objectives of the Study
  24. 24. As Basti is the prime treatment for the Vatavyadhies and Vatavyadhies are generally correlated with Neurological disorders, by correcting the Apanavata inturn it acts on the nervous system related to the prostate because normal function of the Apanavata is the normal function of voiding. This study has undertaken with the hypothesis that the Matrabasti is having better results than the Shamana snehapana because as already mentioned the affected area is near to the Pakvashaya. This study has under taken to compare the effect of Sukumara kumaraka ghrita Matrabasti and as Shamana Snehapana in the management of Vatashtila (BPH). To evaluate the effect of two groups, among two which is best treatment by assessing the before and after treatment datas of the study. Ayurvedic preparations, which are having minimal side effects and no complications, even in aged persons also can be given. Acharya Susrhuta mentioned, Gulma and Abhyantara Vidradivat Chikitsa for Vatashtila (BPH). The main aim of the present study is not only reveals the symptoms of the Vatashtila (BPH) but also induce reduction in size and weight of the prostate and decreases the residual urine.LIST OF FEW STUDIES CONDUCTED The research papers published by Rashatriya Ayurveda Vidyapeetha in March, 2003. 1) Ashtila Vyadhi ka (Prostate enlargement) ayurvediya upachara. By Dr. Prakashshraj Singh, Dr. Dayanandan Mana and Ach. Jyotirmita, Varanasi 2) Management of Benign Prostatic Hyperplasia (Vatashtila) in Panchakarma theatre with reference to Vasti, By - Dr. Anand, Belgaum. 8 Objectives of the Study
  25. 25. 3) Ayurvedic therapy in the management of Benign Prostatic Hyperplasia By Dr. Shivji Gupta, Dr. Ramesha Bhat, and Dr. M. Sahu, Varanasi.4) Role of Varunadi Kashaya in the management of Benign Prostatic Hyperplasia. By Dr. Praveen Kumar, and Dr. K. K. Sijoria, Delhi.5) Poursh granthi vriddhi ki Ayurvedic chikitsa - Ek aturia adhyayan. By:- Dr. B. P. Gupta, Delhi.6) A clinical study on Yavnalkshaya and Chandraprabhavati in Mutrasanga (Retention of urine w.s.r.t. B.P.H. - Pundir R.K. (1984).7) A clinical study on Mutraghata (Relation of urine w.s.r. to Mutraghata (B.P.H.) - Raut S.Y. (1987)8) Role of Punarnavadi compound in the management of Mutraghata w.s.r. to B.P.H. Jagruti Joshi (1995)9) Clinical evaluation of Kshara and Uttar Basti in the management of Mutraghata - Akasha Kembhavi (1998)10) Role of Mustadi Kalpa in the management of Mutraghata w.s.r. to B.P.H. - Dr. Ashish B. Soni (1999)11) A Clinical study on the role of Devdarayadi Kshaya and Dashmool Siddha Taila Uttar basti in the management of Mutraghata w.s.r. to B.P.H. - Dr. N.H. Kulkarni (2002).12) Some of scholars in Contemporary system of medicine they tried Phytotherapy (plant extracts) in BPH/LUTS. They have gained widespread usage since about 1990 among them (Plosker and Brogden, 1996), (Gormley et al, 1992), (Disilverio et al, 1998), (Lowe and Fagelman1999). 9 Objectives of the Study
  26. 26. HISTORICAL REVIEW Historical view is an essential part of the literature in which review is done aboutthe past events. Ayurveda starts since ancient period, before going to write any treatisesin Ayurveda. It would be a judicious to review the references of Vedas and Samhitas. The Vedas are the first written documents of human civilization. Therefore theavailable information can be formulated as follows – A. Vedic Kala – 2500 B.C. – 1000 B.C. B. Samhita Kala – 1000 B.C. – 100 A.D. C. Sangrahakala – 100 A.D. – 800 A.D. D. Aadhunika Kala – 17 A.D. – onwards.Veda kala There is so many reference we can get in Vedas especially Atharva Vadaexplanation Basti, (1/3/7Ater) “Vishitam te Vastibilam . . . . . . this type of explanationare available but there is no explanation regarding Vasti Karma in Vadas.1Samhitas kala:- All classical treatises of Ayurveda have emphasized the importance of Bastikarmaand Matrabasti as the most effective therapeutic measure than any other such methodsprescribed for various ailments especially in the diseases occurring due to Vatadosha.Acharya Charaka has described the Bastikarma, its usage, dosage, advantages,complications, and indications with different yogas, in Charaka samhitha Siddhisthana(1stchap. 4,5,7,8,10,12.).2 Sushruta has elaborately described the Bastikarma procedures,about Bastiyantra, types of Bastis, complications, management, in different chapters ofkalpasthana3 and Chkistasthana- (35,36,37chapters) Acharya Vagbhata has explained thebastikarma in Ashtangasangraha and Ashtangahridaya like Avastha Anusrutabastis,Prasrutikabastis and Vyapaths.4, 5, 6. 10 Historical Review
  27. 27. Madhyama kala Sarngadharasamhita also has given much importance to Bastikarma with theBrihatriyee’s methods of explanations in Uttarakhanda (5 to 7 chapters) includingUttarabasti. Yogaratnakara, Bhavaparakasha dealt the bastikarma, and added newercombinations to the Ayurvedic world for a better practice.7 Acharya Kashyapa equatedthe Bastikarma as Amrutam in first chapter of Siddhisthana, because of its wideapplications even in both infants and old age.8 Later, modern authors in Ayurveda has also elaborately explained the Bastikarma,modifications of Bastiyantra, converted the older measurements to the present daymeasurements and made the things easier for the practitioners.SNEHAVeda Kala In Rigveda description of many herbal plants and qualities of Tila Pinji Tilataila,Sarshapa, are available. The Atharvana veda, gives plenty of references regarding the useof Sneha therapeutically.9Samhita Kala In Charaka samhita references regarding the therapeutically use of Sneha invarious disorders. The author has devoted an entire chapter in the Sutra Sthana on“Shadvidopakramas.”10 (Ch. Su. 22nd) Snehana as Pradhana karma is the most significanttherapeutic procedure. Among them Charaka has extensively dealt with the subject“Snehana” and its Qualities, doses, time sedulous, advantages, complications, andindications, separately in 13th chapter of Sutrasthana,11 and about Shodhananga snehanain Charaka siddhisthana.12 Here he has described in detail the properties of Snehadravyas, basic sources of Sneha dravya, indication and contraindications of Snehana etc. 11 Historical Review
  28. 28. Acharya Sushruta has contributed separate chapter on “Sneha” in 31st chapter ofChikitsasthana. Here he has classified Snehana on the basis of its Karmukata asShodhana, Shamana and Brumhana and explained the preparation of “Sneha” i.e. Ghritaand Taila.13 Also we found that number of references regarding the uses of sneha in theShodhana and Shamana or alleviation of different diseases. Types and qualities of Ghritaand Tailas, method of preparations of Aushadhisiddha ghritas and method ofadministration have been mentioned in Sutrasthana and Chikitsasthana of AstangaHridaya.14 Kasyapa an eminent personality in Koumarabhritya has dealt in detail regardingSnehana in 22nd chapter of his Sutrasthana and added use of different ghrita and taila inmanaging various Balarogas.15 Bhela one of the six celebrated disciples of Atreya hasmentioned the use of different Sneha in treating different disorders.16 Qualities of eachtaila their specific indications have been mentioned in 14th chapter in Harita samhita.17 Later others like Yogaratnakara18, Bhavamishraa19, Sharangadhara20, Vangasenaand Chakrapani they explained Paryayas, Swaroopa, Utpattisthana, Gunas of Ghrita andTaila and their indications.Adhunika Kala Detailed explanation about uses of both animal product ghee and plant productsoils, in materia medica and added classification of fats, oils, properties and sources of oilexpression of oils, have been mentioned. Textbook of pharmacognocy, Teiz’s text bookof clinical Biochemistry, etc are the textbooks where literary review regarding the use ofsneha can be obtained clinically.21 12 Historical Review
  29. 29. VATASHTILAVedic period In vedic period there is no explanation about Vatashtila, but we can get referencesof Mutraghata. A comprehensive description regarding Mutraghata, and its treatmentwith the use of “Loha Shalaka” this kind of references give as account of the knowledgethat our ancestors had with regards to the anatomical, physiological, pathological andtherapeutic aspects of the human body. (A.V.1-3-1 to 4 & 6 to 9). Another one important references in treating the Mutraghata in Atharvaveda isexplained as “Mutramoochana.” Atharvana veda22 is treasure house of mantras and theycan be linked to nuclear energy, among the innumerable mantras. This type ofexplanation we can get in Ayurveda also. i.e. Acharya Sushruta declares that studentdesires of studying Ayurveda should be initiated into the regular practice of “GayatriMantra” and Acharya Charaka also mentioned chanting of “Vishnusahasranama” inSannipataja jwara.Samhita kala This was the golden period of ayurveda and the two great works viz. Charakasamhita and Sushruta samhita were written in this period. Acharya Charaka in 9th chapterof Siddhisthana in the name of Trimarmeeyasiddhi adhyaya explained 13 types of Bastisambhandi vyadhis among those Vatashtila is one of the mutravarodha janya vyadhi.23Where as Sushrut explained 12 types of Mutraghata, Nidanapanchaka laxanas andChikitsa eloberately,24 particularly for Vatashtila in the 1st chapter of VatavyadhiNidadana25 and also 5th chapter of Chikitsasthana.26 Ashtanga sangrahakara, Ashtangahridayakara including Kashyapa fallowed the same view of Charaka and Sushruta.27 13 Historical Review
  30. 30. Madhyama kala The important work has been done in the text book of Chakradutta28 andBhishajyaratnavali29 have given more concentration over Chikitsa with different Yogas inthe context of Mutrakricchra and Mutraghata chikitsa. Other Acharyas Vangasena,Yogaratnakara contributed over Mutraghata. The commentators of Chakrapani,Gangadhara and Dalhana have fulfilled their commentary for the better understanding ofthe Samhitas. 14 Historical Review
  31. 31. Yutpatti and Nirukti of Basti The word Basti is derived form ‘vas + tich’ and is masculine gender. “Vasu nivase”30 - Means residence. “Vas-aachadane” - That which gives covering. “Vas vasane surabhikarane” - That which gives fragrance. “Vasti vaste aavrunothi muthram” - That which covers the urine. “Nabheradhobhage mutradhare” - The position of Basti is just below nabhi (umbilicus) and is the collecting organ of urine in the body i.e. urinary bladder.Paribhasha In the context of Panchakarma the term Basti is used in different sense. “Vastina deeyate iti vasti”31 “Vastibhir deeyate yasmat tasmat vastiriti smritha”32 “Vastina deeyate vastini va Purvamanyattavasto vasti” 33 The term Basti means bladder. It is used as a device for Bastikarma. Hence, theterm Basti is used as a name in Panchakarma therapy to designate the process. Themedicated decoctions, milk, oil, ghee, mamsarasa of prescribed quantities are taken inBasti and introduced into Gudamarga by means of a device Bastinetra after properpretreatment procedures.SNEHA NIRUKTI The word ‘sneha’ is derived from the root “sniha” with “Lute” pratyayaVachaspathyam.34 In general speaking the process in which “Snigdhata” of the body isbrought about is called as Snehana. 15 Vyutpatti & Paribhasha
  32. 32. . The word Sneha is masculine gender and is derived from “Snih” Dhatu by suffix“Lyut” Pratyaya The verb root “Snih” has two implications – • Snih – Preetau. to render affection. • Snih – Snehane. to render lubrication. The term Sneha implies that a substance that brings oiliness or unctuousness.Sneha literally means oiliness, unctuousness, fattiness, greasiness, lubricity, viscidity,affection, love, kindness and tenderness.35PARIBHASHA “Snehanam - sneha vishyandha mardhava kledakarakam”.36 Achrya Charaka defines, the Sneha indicates Snighata, Vishadana reffers tovilayana, or fluidit. Vishyando Vilayana Chakrapani. Mardavata indicates softness, andKleda is moistness, which signifies the increase in apya guna of body. It means theSnehana is the process by which Snigdhata, Vishyandana, Mardavata and Kledana areproduced in the body. These measures are adopted to bring about snigdhata in the body isknown as snehana. The word Sneha is used to describe application of Sneha dravyas in Ayurvedictext. It is refers to internal administration as well as external use of Sneha. There are suchspecific nomenclature used for external application of sneha i.e. Abhyanga, Lepa, etc forinternal administration Shodhana poorva snehapana, Shamansneha and Brimhana snehasuch are used. Hence which does the Shaman or normalizes the aggravated doshas all over thebody is Shamanasneha.37 16 Vyutpatti & Paribhasha
  33. 33. NIRUKTI OF VATASHTILA ASHTILA :- Ashtila Uttarapathe Deergha Vartula Pashana Vishesha.38 Ashtila means it is situated in just above the Guda pradesha and below the Basti. It is elongated, round, apple and stony like structure. It is a feminine gender.Meaning of Ashtila It is a round bulk, stone, ball or globe like structure. It is a globular swelling. 39 Ashtila is a type of Mutraghata vyadhi. Mutra + Aghata = Mutraghata 40 Enn + Dhanya + Add = AghataPARIBHASHA Astilavat Ghanam Granti Urdhwa Ayata Unnatam 41- means Ashtila is the hard,round, stone like structure which is situated in between Vasti and Guda and its structureresemblance to Urdhwa, Ayata,Unnata. 01. Yen mootra kricchre mootram kricchrena vahit | Mootraghate mootram shoshyate partihanyate va || (Cha. Chi. 2643-44 Chakrapani) Means which is cause for the difficulty in micturation, which will dries up themutra and leads to its obstruction is known a Mutraghata.42 2) Mutraghate Tu Vibhandho Balavan Kricchratva | (Vijayrakshita) The one which causes the obstruction of mutra and leads to difficult inmicturation. 17 Vyutpatti & Paribhasha
  34. 34. Paryaya and Bheda of Basti • On the basis of Adhisthana - Pakwashayagata, Grabhashayagata, Vranagata, Mutrashayagata. • On the basis of Dravya - Nirooha, Anuvasana, Sneha, Matra. • On the basis of Karmukata - Shodhana, Lekhana, Snehana, etc. • On the basis of Samkhya - Kala, Karma, Yoga. • On the basis of Anushangi - Yapanabasti, Sidhabasti etc. But Charaka has used the term Basti exclusively for Nirooha as per thecommentary of Chakrapani.43 Similarly the term Basti has also been referred to themethod of Shirobasti, Urobasti, Janubasti, etc.Synonyms of Sneha The synonyms mentioned for Snehana are Sneha, Snigdhata, Mritkshana,Abhyanga and Abhyanjana.44Bheda of Vatashtila “Ashtila and prathya ashtila”45 18 Vyutpatti & Paribhasha
  35. 35. IMPORTANCE OF BASTIKARMA Different Acharyas appreciated this form of treatment considering the efficacy itgenerates. No other elimination therapy is equal to Basti because it expels the vitiateddoshas rapidly and easily from the body and also reducing as well as nourishing the bodyvery fastly. Though emesis and purgation eliminate the vitiated doshas form the body,the drugs used in these therapies contain Katurasa, Ushnaguna and Teekhsna gunas,which cannot be taken easily by children or older people. But Basti can be given in allage groups without any hesitation.46 Bastikarma is the best method of treatment in dealing with Vatavikaras and Vatadominating other Vikaras as Vata being the chief controller among the causative forces ofdisease.47 As per the fundamental principles of Ayurveda; vata is responsible for everymovements and activities in the body whether it is of constructive or of destructivenature. On the other hand Vata is functionally required to co-ordinate with Pitta andKapha in order to accomplish various duties assigned to them in the organization of life.48 Pakwasaya is considered to the seat of Vata. Direct application of this kind oftreatment to Pakwasaya helps for the proper regulation and co-ordination of the functionsof Vatadosha not only in its own site but also control the related doshas which areinvolved in the pathogenesis of disease.49 Hence, it is considered as one of the appropriatetreatment for Vata predominant disease and also called it as Ardhachikitsa by Vagbhata.50Apart form this, Basti is considered as superior to the other therapeutic measures onaccount of its varied actions like Samshodhana, Samshamana and Samgrahana of doshason this basis of drugs used in it.51 19 Review of Bastikarma
  36. 36. Basti is indicated for providing rejuvenation, happiness, longitivity, strength,improving memory, voice, digestive power and complexion. It removes noxious mattersform the tissues, pacifies the doshas and rectifies the process of excretion. Consequently,it affords stability and thus indirectly strengthens the reproductive capacity in man.52Kashyapa equated the bastikarma as ‘Amrutam’, because of its wide application even inboth infants and in old age.53Classification of Basti Basti is an important method of therapy in Ayurveda. For better understanding itcan be classified in various ways. We cannot find uniformity in classification of bastiamong the authors of classical texts. Generally, the term Basti has been used for all typesof Bastikarma, which includes Nirooha, Anuvasana, Uttarabasti etc. But Charaka hasused this term Basti exclusively for Nirooha as per the commentary of Chakrapani.54Similarly the term Basti has also been referred to the method of Shirobasti, Urobasti,Vrina basti etc. So a rational thinking on various aspects of Bastikarma has brought aboutthe following classification.55 Adhishtana bheda – The site of application. Dravya bheda – The medicinal preparations used. Karma bheda – The action it does. Sankhya bheda – The number of bastis given. Anushangika bheda – Always associated Matra bheda – Based on amount used. 1. Adhishtana bheda According to the site of application of basti it is classified into two types – a. Internal b. External 20 Review of Bastikarma
  37. 37. a. Internali) Pakwasayagata basti – The administration of medicine via ano-rectal route to Pakwasaya.ii) Garbhasayagata basti – The administration of medicine via vaginal route to Garbhasaya.iii) Mutrasayagata basti – The administration of medicine via urethral route to Mutrasaya.iv) Vrinagata basti – The medicine administered through the Vrinamukha by the process of Bastikarma. b. External In certain diseases the medicated oil is kept over the part of the body using a capor with flour paste for prescribed period of time and named after the site of application ofoil such as – Shirobasti, Katibasti, Urobasti, etc. 2. Dravya bheda It is based on the major ingredients of Bastidravya - kwatha or sneha andso classified into two types: - i) Nirooha basti – The main ingredient is Kwatha and it is the important type ofBastikarma having varied therapeutic effects. The Basti is able to eliminate doshas formthe body and so called Nirooha. Also called Asthapana, as it is Vaya and Aayusthapakathe Vikalpa of Nirooha basti are synonyms.56 The effect of Nirooha will spread all overthe body even in the cellular level and helps to eliminate the vitiated doshas adhered inSrotases and its action in the body is beyond the perception of physician.57 21 Review of Bastikarma
  38. 38. ii) Anuvasana basti – Sneha is the chief ingredient of Anuvasana. The termAnuvasana is coined due to the unharmful effect of the Bastidravya even if it is retainedinside the Koshta. More over this type of Basti can be practiced daily without any seriousprecautionary measure, as it is less complications than nirooha.583. Karma bheda Sushruta and Vagbhata have made the following classification according to theiractions.59,60 Shodhana basti – Contains shodhana dravyas and removes doshas and malas from the body. malas from the body. Lekhana basti – Reduces medodhatu and produces lekhana in the body. Sneha basti – Contains more of sneha and produces snehana in the body. body. body. body. Brumhana basti – Increases the rasadi dhathus and indirectly it helps in the growth of the body. growth of the body. Utkleshana basti – Causes utklesha of malas and doshas by increasing its Pramana and causes dra Pramana and causes dravabhootha. Doshahara basti – Purificatory or eliminating type. Shamana basti – Produces shamana of doshas. Sharangadhara added, shodhana basti to it also he has added lekhana, brimhana,deepana and pachana types of bastis.61 Vataghna basti, Balavarnakrita basti, Snehaneeyabasti, Sukrakrit basti, Krimighna basti, Vrushatvakrit basti has been explained in variouscontexts by Charaka.62 22 Review of Bastikarma
  39. 39. 4. Sankhya bheda It is stated that neither snehabasti nor niroohabasti can be applied alone63 So,Charaka has made this classification based on the number of snehabastis andniroohabastis in a treatment.64 a) Karma basti – There are 30 numbers of bastis in this group out of whichsnehabastis and niroohabastis are 18 and 12 respectively. Prescribed in chronic diseasesof prolonged nature and particularly of vata predominant.65 First 1 snehabasti thenalternate sneha and kashaya- each 12 and 5 snehabastis in the end. b) Kala basti – There are 16 numbers of bastis. First basti is anuvasana,then 6 nirooha and 6 anuvasana must be given alternately and in the end 3 anuvasana.Indicated in patients of madhyamabala and vatapitta predominant conditions.66 However,a difference of opinion regarding the number of nirooha is also prevailing. c) Yoga basti – There are 8 numbers of bastis. 5 snehabastis and 3niroohabastis. First basti is anuvasana, then 3 nirooha and 3 anuvasana and last 1snehabasti. Indicated in diseases where involvement of vata dosha is found less.675. Matra bheda This classification of basti is based on the quantity of bastidravya prescribed. Thequantity may vary according to the age, strength of the patient and severity of thedisease.68 a) Dvadashaprasruta basti – In nirooha, the maximum dose or quantity ofbastidravya prescribed is dvadashaprasruta i.e. 24 palas. b) Prasritayogika basti – Charaka has prescribed various types of niroohain different doses like 4,5,6,7,8,9, and 10 prasrutas, considering the strength of the patientand condition of the disease.69 23 Review of Bastikarma
  40. 40. c) Padaheena basti – In this type of basti, 3 prasrutas i.e. ¼ ofdvadashaprasruta is less form from the total quantity of nirooha used i.e. 9 prasruthis.Anuvasana is also classified into 3 according to the difference in the quantity ofsneha70used. Sneha basti – 6 palas (¼of total quantity of nirooha)71 Matra basti – The sneha that will be digested in 6 hrs if taken orally.72 Anuvasana basti – ½ of the quantity of sneha basti.736. Anushangika bheda01. Yapana basti – Enhances bala, shukra and mamsa. Mostly employed in treatingthe vyapats produced by excessive coitus. It can be given during all the seasons of theyears. It increases life span. Charaka has explained 26 bastis of this type. Kukkutamamsa,ksheera, eggs, kwatha, madhu, ghrita, mamsarasa are should be added to prepare this.7402. Siddha basti – The basti creates bala, varna, prasanata and it purifies more than100 diseases.7503. Yuktaratha basti – Mainly indicated for travelers on horse, different types ofvehicles etc.7604. Vaitarana basti – It is explained by both Vangasena and Chakradutta. It is mainlyconcentrating on the elimination of doshas. It has got wide applications.7705. Ksheera basti – Explained for shoolam, vitsangam, anaha, murakrirchha.7806. Ardhamatrika nirooha basti – No need for sneha sweda pratikriya. Sarvaroganivarana in nature, mainly rajayakhsma, shoola krimi, vatarakta. It improves sukha andojus and has the nature of pumsavana.79 24 Review of Bastikarma
  41. 41. 07. Pichha basti – It is given with a drug called as Shalmaliniryasa. It producessthamba (stoppage) of pichasrava and jeevashonita. It is also called as Sangrahibasti.8008. Mutra basti – Gomutra is the main ingredient and it has the qualities of mriduin nature, pacifies all doshas and it is harmless.8109. Rakta basti – When there is severe blood loss from the body, acharya hasadvised to perform raktabasti that which stops the further blood loss and initiates theproduction.82Importance of Matrabasti Matra + Basti = Matrabasti. The word meaning of matra. Arunadutta, states for the word meaning of matra, “Matra ShabdastharaPramanarthaha”. (A. Hr. Su 16/25).83 The term Matra conveys many meanings such as measurement, quantity, size,duration, number, degree, unit of time and moment, but here in this context Matra refersto measure i.e. quantity of Basti dravya as Ashtanga Hridaya states that Hhrusva matra itmeans Alpamatra of sneha, which is given in the name of Matra basti.84 Sushruta states that Matrabasti is Vikalpa of Anuvasana basti it means it is thetype of Anuvasana vasti.85 As per Ashtanga hrudaya “Hrusvaya Sneha Panasya Matrayam” from the abovestatement it is clearly understand that it can be given at any age viz. Bala, Vridha, etceven for Alpagni person also. It is not having any complications due to its less quantityof Sneha. Hemadri used the term Sukha which gives meaning of easy to handle.86 According to Charaka “Yethashta Ahara Chestashya Sarva Kalam Nirathaiyah”this quotation gives more importance to Matrabasti. Because during the administration ofMatrabasti it does not require any regimen like ahara chesta.. There is no any particulartime schedule for it.87 25 Review of Bastikarma
  42. 42. Ashtanga Hridaya gives the terms like Nishparihara. Arunadutta added the wordAniyantrana means, there is no any restriction for the day today activities and no Pariharakala also as explained for other Bastis. No restrictions of time to follow other proceduresafter the administration of Matrabasti.88 Ashtanga sangrahakar states that “Sevyaha Sada Cha Madutailikavat”, it can berestored to always just as Madhutailika basti.89Properties of Matrabasti Acharya Charaka explained benefits of Matrabasti as, it increases strength of thebody (Balya), easily administrable (Sukhopacharya) and no much restrictions afteradministration, makes easy evacuation of bowel (Shrishta purishakrita), best forVatavyadhies.90 Vagbhata opines the same as Charaka and added it can be given regularly, whichis indicated for Bala, Vriddha, and Alpagni person also it as Varnya, Doshaghna etc.91 Hemadri commenting on the term “Sukho-Vyapad Rahitha”, it is devoid ofcomplications.92Indications And Contraindications Of Matrabasti As Matrabasti is variety of Anuvasan basti so the persons who are fit forAnuvasan they are also fit for Matrabasti.93,94,95.Table No. 01. Showing the indications for Bastikarma are as follows –Sl. Indications C.A A.S H.S Sl. Indications C.A A.S H.S 1 Karma karsita + _ _ 8 Vriddha _ + + 2 Vyayam karsita + + + 9 Bala + + + 3 Bhara karsita + _ + 10 Chinta _ + + 4 Yana karsita + + _ 11 Stree _ + + 5 Durbala + + + 12 Sukumar _ + + 6 Vataroga + + _ 13 Alpagni _ + + 7 Bhagna + + + 26 Review of Bastikarma
  43. 43. Contraindications for Matrabasti No such particular contraindications for Matrabasti but Ashtanga sangrahakarstated it should not be administered in case of Ajeerna and Diwaswapna.96Matrabasti sevana kala and sevana vidhi Acharya Charaka stated that it can be given regularly at any time and in allseasons.97Dosage of Matrabasti Matrabasti, the term is popular because of its dose. Because Sneha isadministered in the Hriswa matra. “Hraswaya snehapanasya matrayaha yojita samaha |” 98 So the dose of Matrabasti is equal to the quantity of Sneha which can digestwithin 6 hours when taken orally. Acharya Dalhana mentioned the quantity of this as 11/2phala i.e. 6 tola.99 Where as Kashyapa prescribed the quantity of Matrabasti as 2 palas asUttamamatra, 112 pala as Madhyama matra and 1 Prakuncha as Hriswa matra. He statedthat even half pala of Sneha can be given in Kaumara. (K. Khi. 8104-105).100 Chakrapani stated pramana of Matrabasti as 112 pala. But whereasSharangandhara101 mentioned matra of Matrbasti as 2 palas. (i.e.8 tolas) (Su. U.55)102Matrabasti Procedures Poorvakarma (Pre-treatment procedure) The mridu abyangha and swedana administered prior the pradhana karma. Thenadvised to have alpha ahara a short walk. Patient must have passed natural urges. Thenmade the patient laid on a cot comfortably, which is not very high and the head must beat little lower level. Pillows should not be used. The patient should be in left lateral sidedrawing up the right leg and straightening the left leg.103,104,105. 27 Review of Bastikarma
  44. 44. Pradhana karma (Treatment procedure) The sneha prescribed for Matrabasti taken in the Bastiputaka and tied well placingthe Bastinetra in position. The entrapped air in Bastiyantra is expelled by gently pressingthe Bastiputaka. Then the anal region and the Netra should be smeared with oil. Gentlyprobe the anal orifice with the index finger of the left hand and introduce the Bastinetrathrough it into the rectum up to first Karnika. Keeping in the same position press theBastiputaka with right hand with adequate and uniform force. Bastinetra should bereleased carefully when a little quantity of sneha remained inside the Bastiputaka.106 Paschyata karma (Post-treatment procedures) The patient is kept lying on his back as long as it would take to count up tohundred. The patient should be gently struck three times on each of the soles and over thebuttocks by Vaidhya’s own hand. The distal part of the cot should be lifted thrice. Allowhim to lie for sometime in the same position. If he gets the urge for defecation he may doit. But in the event of sneha passed immediately another Anuvasana basti should beadministered. After passing the motion with sneha in proper time the patient is allowed totake light food if he feels hungry.107,108 There is no specific duration of retention of matrabasti so we can consider duration of sneha basti. i.e. 3 yamas it means 9 hours. 28 Review of Bastikarma
  45. 45. SNEHASNEHA GUNAS 109,110,111. Gunas in the drugs are responsible for the different functions of drug. Theproperties of Sneha dravya’s are Snigdha, Sara, Drava, Picchila, Guru, Sheeta, Mandaand Mrdu, which are having opposite properties to Rukshana dravyas. Though drughaving these qualities but always it may not produce Snigdhata in the body. There arefew exceptions to this general rules like Yava, possesses Guru, Sheeta, Sara gunasproduces Rukshata. Rajamasha in spite of having Guru guna produces rukshata. Tila tailais having Tikshna and Ushna it acts like Snehana. That may be the reason why Acharyashave used the term Prayo, while explaining Sneha dravya.Table No.02 : Showing the Sneha guna, Panchabhoutika sanghatana & Karmukataof Sneha dravyas.112Guna Dominant Mahabhoota Karmukata Prathvi Ap Teja Vayu AkashaPicchila - ++++ - - - Lepana, Jivana, Samghata, Sandhana, Balya, GouravataSukshma - - ++ ++ +++ Sroto Vishodhana, Vivarana, SoushiryakaraSara - ++ - + - Anulomana, Vyaptisheela, PreranasheelaSnigdha + ++++ - - Snehana, Mardavata, Kledana Bandhana, Vishyandana,Drava - ++++ - - - Prakledana, Vilodhana, Prasari.Guru ++++ ++ - - - Brumhana, Malavriddhikara, Tarpana, Angaglani, Balakara,Sheeta - +++ - ++ - Sthambhaka, HladanaManda ++ + - - - ShamanaMrudu - ++ - - +++ Shaithilya of Avayava, Mardavata. By seeing above table it can be justified that Sneha Dravyas are ofapyamahabhuta predominant. 29 Review of Sneha
  46. 46. PROPERTIES OF CHATURVIDHA SNEHAS 1. Ghrita Rasa – Madhura. Guna – Snigdha, Mrdu, Guru, Manda. Veerya – Sheeta. Vipaka – Madhura. Prabhava – Agnideepaka. Karma – Pitta-vatahara, Svara Lavanyab and Tejobalakara, Chakshushya, Medhya, Increases Rasa, Shukra and Ojas, Vayasthapaka, Dahashamaka, Alpaabhishyandi, Vrishya, Rasayana, and best agnideepaka. Seasonal indication – Sharad Ritu.Suitable condition for Ghrita application Following are the conditions in whcih the ghrit can be used efficiently –Vata-pitta Prakrti persons, Vata-pitta pradhana Vikratis, those desirer of longevity, Bala,Varna, Swara, Pushti, Smriti, Medha, Dhee, and the some oft the conditions likeDahapeedita, Shastra peedita,Visha Pidita.etc 113,114,115,1162: Properties of Taila Rasa – Madhura. Anu rasa – Tikta, Kashaya. Guna – Snigdha, Guru, Teekshna, Vikasi, Sara gunas. Veerya – Sheeta Vipaka – Madhura. 30 Review of Sneha
  47. 47. Karma – Vata-kaphahara, Pittakara, Balakara, Varnya, Twacha mardavakara, Krimighna, Garbhashaya Shodhaka, Bhagna Sandhanakara , Subsides Yoni shoola and Yoni vyapats. Seasonal indication – Pravrita (Sheeta Kala)Suitable condition for Tilataila Snehana Vata Prakriti, Shleshma pradhana vyadhis, Taila Satmya, Vatavyadhi, Nadivrina,Bhagandara, Krura Koshta, and along with those desires of Bala, Tanutva, Laghuta,Drdhata and Sthiragatrata. 113,114,115,1163. VasaProperties – These are similar with the Mamsa of animals from which they are obtained.Seasonal indication – Madhava Kala. 113,114,115,116Suitable Condition for Vasa Prayoga Due to vast origin and qualities of Vasa, it is indicated for the Mahat agnibalapersons along with those who are capable of bearing klantata of ruksha Vayu and Atapa,karshatwa due to carrying of excess weights and it is found much beneficial in the vikritisfound in Asthi-Sandhi-Marma-Koshta ruja and Avarana like conditions.4. MajjaProperties – Properties should be understood based on its source.Seasonal Indication – Madhava Ritu.Suitable condition for Majja Prayoga This is the most heaviest sneha dravya. Hence, indicated in persons havingDiptagni, able to bear Klesha, having Krura Koshta and habituated to Sneha. 113,114,115,116So Majja prayoga is indicated in those who desire of Bala-Shukra-Majja-Asthi Vardhanaand Snehana quickly. 31 Review of Sneha
  48. 48. CLASSIFICATION OF SNEHAI Based on Yoni (Source)117,118 There are two sources of Dravys viz., Sthavara and Jangama Based On Yoni (Source) Sthavara JangamaA) Sthavara sneha (Vegetable Origin) Sthavara sneha is extracted from plant source. Phala, Sara, Mula, Tvak, Patra &Pushpa are the main sources of Sthavara sneha. Charaka has told eighteen Ashayas ofSthavara sneha.Table No.03 Source of Sthavara sneha according to Charaka 119Tila Sarshapa Eranda Bibhitaki Priyala AbhishukaBilva Moolaka Chitra Atasi Madhuka KusumbhaAkshodha Abhaya Karanja Shigru Nikothaka HaritakiClassification of Sthavara sneha according Sushruta by their action.Table No. 04. Showing Sushruta’s classification of Sthavara sneha.120 Action Virechanopayogi Pittasamsrusta Vayu Upayogi Vamanopayogi Krshnikarana Upayogi Shiro Virechanopayogi Pandukarana Upayogi Dushta Vranopayogi Dadru, Kushta, Kitibha Upayogi Maha Vyadhi Upayogi Ashmari Upayogi Mutra Sangopayogi Prameha Upayogi 32 Review of Sneha
  49. 49. B) Jangama Sneha (Animal Origin) Jangama Sneha is derived from animal sources. eg. Ksheera, Dadhi, Ghrita,Mamsa, Vasa, Majja, etc.II. PAKA BHEDA Opinion of different authors regarding varieties of Sneha paka and its indicationsare as summarized in following table –Table No. 05. Showing Sneha Bhedha based on the Paka. 121,122,123. Snehana Caraka Sushruta Sharangdhara Abhyanga Khara Madhyama Madhyama Pana Madhyama Mrdu Madhyama Nasya Mrdu Madhyama Mrdu Basti Madhyama Khara Madhyama Karnapurana - Khara MadhyamaIII. SAMYOGA BHEDA:124 Samyoga Bheda Yamaka Sneha Trivrit Sneha Maha Sneha (Taila + vasa) (Taila+ Vasa + Majja) (Sarpi +Taila +Vasa+ Majja) 125,126,127.IV. UPAYOGA BHEDA: Based on the route of administration, Snehana is classified as – Upayoga Bheda Abhyantara Snehana Bahya Snehana (Pana, Basti, Nasya, Bhojana) (Abhyanga, Lepa, Udvartana, etc.,) 33 Review of Sneha
  50. 50. V. PRAYOGA BHEDA 128,129 Based on the method of administration Snehana is of 2 types viz, Prayoga Bheda Accha Peya Vicharana Snehana. (Sneha without mixing with (Sneha with various preparations any other Dravya) like Vilepi and Yavagu etc.)VI. ACCORDING TO VISHISTHA SAGNA 130,131,132. Vishistha sagna Sadyo Snehana Pancha Prasrta Peya AcchapeyaVII. MATRA BHEDA133,134. The following dosage schedule is advocated in the classics based on the timerequired for digestion of sneha taken. Hrasva Matra – The dose of Sneha that is digested within 6 hours. Madhyama Matra – The dose of Sneha that is digested within 12 hours. Uttama Matra – The dose of Sneha that is digested within 24 hours Vagbhata has mentioned about Hrasiyasi Matra the quantity of Sneha, whichdigests within three hours, is known as Hrasiyasi Matra. This is used when the Koshta ofthe person has not been properly diagnosed.135 Fixing the Dosage of Sneha in numerical value is not possible with the reasonthat, dose will vary from person to person based on Dosha, Kostha and Agni level. Hencedosage of the Sneha is explained based on the time required for the digestion of Snehaviz, 01. Hrasiyasi Matra. 02. Hrasva Matra. 03. Madhyama Matra. 04. Uttama Matra. 34 Review of Sneha
  51. 51. Table No. 06. Showing Opinion about Sneha Matra 135,136,137. Author Hrisiyasi M. Hraswa Matra Madhyama M. Uttama matraHemadri 1 Pala, 2 Pala, 4 - - - Pala, 6 PalaSharangadhara - 2 Tola 3 Tola 4 TolaTable No. 07. Shows Sneha Matra according to Sushruta.138Dose Time Action Indication required for digestionSadharana Matra (1/4th day) 3 Hrs. Agnideepti Alpa Dosha AturBruhmana Matra (1/2 day) 6 Hrs. Brimhana, Madya Dosha Atur VrishyaPrabhala Dosha Matra (3/4th 9 Hrs. - Bahu Dosha Aturday)Shrestha Matra (Full day) 12 Hrs. - Glani, Moorcha, MadaUttama Matra (Day & Night) 24 Hrs. - Kushta, Visha, Unmada, Graha, ApasmaraTable No. 08 Showing Indications of Sneha Matra.139,140.Dose Criteria for selection of Action Person DiseaseUttama Prabhuta sneha, Nitya Gulma Shighravikara Shamana,Matra kshut–pipasasaha Sarpa- Doshanukarshini, uttama Agnibala, Damshtra Pervades through all marga Sharira bala, Manasa Visarpa Balya, Rejuvenates body, Bala, etc Unmatta sense organs and mind Mutrakricchra GadhavarchasaMadhyama Madhyama Sharira bala, Arushka No much complications.Matra Manasa bala, Agnibala, Sphota Does not effect strength Mridu koshta, etc Pidaka much. Kandu Brings Snehana Pama comfortably. Kushta Used as Shodhanartha Vatarakta snehanapanaHrisva Vriddha, Bala, Sukumara Chronic Brimhaneeya, SnehaneeyaMatra / Sukhocita, Mandagni disease like Vrishya, Balya and giving Durbala/Avara bala Jvara, Atisara, long lasting benefits. Person not able to Kasa, etc. Doesnot cause any withstand hunger. Complication. 35 Review of Sneha
  52. 52. Hrasiyasi Matra is a trail dose, which is administered on the first day ofSnehapana. Shamana sneha in Hrisva matra acts as Brimhana. Chakrapani mentions that,Uttama matra should be used for Shamana and not for Shodhana poorva snehana. Sodoubt may arise regarding usage of Uttama and Hrisva matra as Shodhana poorvasnehapana.VIII. Karmukata Bheda Based on the Karmukata of Sneha it has been divided into 3 types viz. (i) Shamana Snehana (ii) Brumhana Snehana (iii) Shodhana Snehana(i) Shamana sneha Shamana sneha is a procedure of administration of Madhyama matra of Acchasneha during Annakala when one feels hungry without taking the meal.141,142. Hemadridefines Shamana snehana is one which normalizes the aggravated doshas withoutexpelling them and disturbing the normal doshas 143.(ii) Brimhana sneha The sneha used for Brimhana is called as ‘Bhrimhana sneha’. The administrationof Sneha along with Mamsa rasa, Madya, Ksheera etc., are known as Brimhanasnehana.144 If, Brimhana sneha is given before food, it will cures Adhobhaga rogas, ifgiven in the middle of food cures Madhyamabhaga rogas and if given after food curesUrdhwabhaga rogas and strengthens the body.145 But, here the dose of Sneha should beAlpa or even less than quantity of Hrisiyasi Matra.146 36 Review of Sneha
  53. 53. (iii) Shodhana sneha The Uttama matra of Accha Sneha is administered in morning hours whenpreceding evening food has been digested but individual have shown less hunger is calledas Shodhana sneha.147,148,149. Shodhana snehana is carried out through Matranusara or Arohana orPravicharana. Matranusara and Pravicharana snehapana were already explained.IMPORTANCE OF SHAMANA SNEHA PANA Though the Acharyas explained about Shamana sneha but they did not defined itclearly. But Arunadutta, the commentator of Ashtanga Hridaya stated that “RogaschaShamana Yopa Yuchyate Sneha” which normalizes the aggravated doshas all over thebody is called Shamana sneha.150 Charaka has explained Uttama matra of sneha for the person who is havingUttama koshtaagni and bala, who can withstand thirst, hunger and fatigue (kshut,pipasa). If we administered properly, it can does the shamana of the sarva shareeravyapidoshas immediately, “Vikaran Shamayati Tesham, Shigram, Dhoshanukarshani,Sarvamarga-Koshta, Sandi, Marma, ShakaSancharini. Balya, Punarnavikari, Shareera,Indriyachetasam. (Ch. Su. 13 Uttama Matrasneha) and (A. Hr. Su. 16/19) and it has thecapacity to spread in to sarva shareera like entering into Marma, Asthi and Sandhi. Itcures the vyadhis like Gulma, Sarpadamshtra, Visrpa, Mutrakricchra, and it evacuates thebowel easily. It enhances the Bala, Indriya and Manaprasannata. Arunadatta states that itshould administered when doshas are in relay to kupitavastha.151 Brihatrayee’s explained after Shamasneha, Peyadi krama should be followed“Sneha Viriktavat” after the digestion of sneha. (Ah. S. 16/19, Ch. Su. 13/81) BecauseChkrapani said that after Dhoomapana is cotra-indication.152,153,154. 37 Review of Sneha
  54. 54. MATRA OF SHAMANA SNEHA Regarding the posology of Shamana snehapana there is quite controversy betweenAcharya Charaka and Vagbata. Charaka while describing the dose schedule for sneha,says that Uttamamatra or optimum dose of sneha which gets digested with in 24 hours isthe more suitable dose for Shamana sneha.155 Vagbhat opines that the Madhyama matrasneha which gets digest within 12 hours is the more suitable dose for Shamana sneha.Where as Ashtanga Hridya added that for Shodana purpose Matra should Bahu, but forShamana purpose Madhyama matra should be used,156 It seems to be the time which istaken for the digestion of Sneha dravya is one and same, but there is no contradictoryexplanation by Charaka. Because Uttamamathra sneha will digest within 24 hoursMadyama matra will digest within 12 hours and Hrisvamatra will digest within 6hours.157 , 157 (a) Shrangadhara relatively more recent author has determined the dose dependingupon the digestive capacity of a person. Sneha for person of good digestive capacity isone phala, for the person of medium digestive capacity is 3 karsha, and person of poorcapacity will be 2 karsha, which are considered as pradhana, madhyama, and hrisva matrarespectively.158 A close and critical analysis of the edition of the samhitas would appearthat, there is a gradual decreases in the dose of shamana sneha with the evidence of age.This may be due to the decrease in the strength and power of digestion of the people withadvancement of age.159,160 The validity and applicability of Uttama and Madyama matra are Shamanasnehamatra according to Charaka and Vagbhat respectively. In the present day the person cannot withstand such a high dose of sneha. Hence it is favor to adopt the principal ofSharangadhara that the dose of sneha should be decided as Heena, Madhyama, or Uttamamatra depending on the condition of Dosha, Kala, Agni, and Vyadhi of the patient. Eventhe Chakrapani while commenting on Charaka opines that there is no fixed dosage ofdrugs, but the dose is to be prescribed by considering the state of Doshas, Agni balabalaand nature of disease. 38 Review of Sneha
  55. 55. The author of the Ayurvediya Panchakarma Vigynana Dr. H. S. Kasture haswritten the administration of Sneha as 6 tolas in 3 divided doses in a day for Shamanapurpose.161KALA PRAKARSHA IN SHAMANA SNEHA There is no standard duration for Shamana sneha advocated by Acharyasregarding duration of administration. But, Kasyapa while describing the effects of thesnehana considers the vyadi shamana laxanas like “Karnakshi Pranabalam”, “SmritiKesha Ojasam”, “Shaanteesta Vyadhinam” as the prime factor. This observation ofKashyapa suggests that Shamansneha should be continued till the alleviation of thedisease irrespective of any time limitations.162Table No. 09 Showing indications of Shamanasneha. 163,164,165. Sl. Indications Ch. Su. A.S. 1 Gulma + - + 2 Sarpadamshtra + - + 3 Visarpa + - + 4 Unmatta + - + 5 Mutrakricchra + - + 6 Gudavarcha + - - 7 Kuushta - + - 8 Visha - + - 9 Unmada - + - 10 Graha - + - 11 Apasmara - + - 12 Udavartta - - + 13 Shabi peeditah - - + 39 Review of Sneha
  56. 56. Table No.10 This table shows General Contraindications of Snehana.166,167,168,169,170. Sl. Asnehya C.S. S.S. A.H. K.S. Sh.S. 1 Rukshana, Samshodhanadrute + - - - - 2 Utsanna Kapha Medasa + - - - - 3 Kapha prakopa, Dagdha - - - + - 4 Abhishyanna anana guda + - - - - 5 Nitya Mandagni + - + - - 6 Shleshma Pittopahata antaragni - - - + - 7 Tikshnagni - - + - - 8 Durbala + + + - + 9 Pratanta (Klamayukta) + - - - - 10 Shranta - + - - - 11 Shramanvita, Akala Prasuta - - - - + 12 Garbhini + - - + - 13 Prasuta - - - + - 14 Apaprasuta, Urustambha, Udara - - + - - 15 Kshirapa, Ativriddha, Jadya, Glani - - - + - 16 Madatura, Murcha, Trishna + - - - - 17 Talu Shoshi + - - - - 18 Sneha Glani + - - - - 19 Garardita + - - - - 20 Amajahara + - - - - 21 Annadvesha + - + - - 22 Arochaka - + - + - 23 Ajirna - + - - + 24 Chardi + + + + + 25 Atisara - - + - - 26 Vit Prakopa - - - + - 27 Taruna Jvara - + - + + 28 Sthula - + + - - 29 Gala roga - - + + - 30 Akala datta Vireka, - + + - - 31 Akala Datta Basti + + + + - 32 Akala Datta Nasya + - + + - 33 Durdina - + - - + 40 Review of Sneha
  57. 57. SUITABLE RITUS FOR SNEHA Oil is to be used in Pravrut (First rainy season) Ghee at the end of Varsha (Season of heavy rain) Vasa and majja during maadhava (Vasant , spring ) These are when the doshas are in the normal state (in a healthy person) 171ACCORDING TO DOSHA When there is Kapha associated with Vata or Kapha alone Sneha has to beadministered in day time. When the aggravation of Pitta and Vata, Pitta associated with Vata or Pittaassociated with Kapha sneha should be given at night.172SHAMANA SNEHA PANA VIDHI The administration of sneha in three different stages (1) Poorvakarma (2)Pradhana karma and (3) Pachyat karmaPoorvakarmaAthura siddatata For Shamananga snehapana is no specific preparatory regimens are needed. Butcare should to be taken about Sama and Niramavastha of the patient before givingShamana sneha. In Samavastha Snehapana is contraindicated. Doshas have permeatedthrough out the dhatus of the body such an attempt seldom gives the desired effect. Shamana sneha should be administered when the doshas are in Paripakwa avastha“Paripakweshu, Dhosheshu, Sarpihi, Panam Yataambrutum.”173Ch. Su. 13/72) Ashtangasamgraha and Hridayakara advised mridu bhojana prior night of Shamana snehapana.Because his previous food should digest completely and should feel hunger (bubbukshita)then only he is fits for Shamana snehapana. When the patient is not having properappetite the administered sneha will not be able do its desired effect and may leads todoshotklesha. So one must be very particular about the appetite while administeringShamana sneha.174,175 41 Review of Sneha

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