Matravasti sandhivata pk010-gdg

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A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFECT OF MATRABASTI AND PARISHEKA WITH SHATAHVADI TAILA IN SANDHIGATAVATA (OSTEOARTRITIS), Jairaj. P. Basarigidad, Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103.

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Matravasti sandhivata pk010-gdg

  1. 1. A Comparative Clinical Study to EvaluateThe EffectOf Matrabasti and Parisheka with Shatahvadi Taila in Sandhigatavata (Osteoarthirits) By Jairaj. P. Basarigidad 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. G. Purushothamacharyulu, 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. 2005.
  2. 2. Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled “ AComparative Clinical Study to Evaluate The Effect of Matrabasti andParisheka with Shatahvadi Taila in Sandhigatavata (Osteoarthirits)” is abonafide and genuine research work carried out by me under the guid-ance of Dr. G. Purushothamacharyulu, , Professor and H.O.D, M.D. (Ayu)Post-graduate department of Panchakarma and co-guidance of Dr.Shashidhar. H. Doddamani, M.D.(Ayu) , Assistant Professor, Post graduatedepartment of Panchakarma.Date:Place: Gadag. Jairaj. P. Basarigidad
  3. 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “ A Compara-tive Clinical Study to Evaluate The Effect Of Matrabasti and Parisheka withShatahvadi Taila in Sandhigatavata (Osteoarthirits)” is a bonafide researchwork done by Jairaj. P. Basarigidad in partial fulfillment of therequirement for the degree of Ayurveda Vachaspathi. M.D.(Panchakarma).Date:Place: Gadag Dr. G. Purushothamacharyulu, M.D. (Ayu). Professor & H.O.D 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 Compara-tive Clinical Study to Evaluate The Effect Of Matrabasti and Parishekawith Shatahvadi Taila in Sandhigatavata (Osteoarthirits)” is a bonafideresearch work done by Jairaj. P. Basarigidad under the guidanceof Dr.G. Purushothamacharyulu, M.D. (Ayu), Professor and H.O.D, Postgradu-ate department of Panchakarma and co-guidance of Dr. Shashidhar.H.Doddamani, M.D. (Ayu), Assistant Professor, Post graduate department ofPanchakarma.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 “AComparative Clinical Study to Evaluate The Effect Of Matrabasti andParisheka with Shatahvadi Taila in Sandhigatavata (Osteoarthirits)” is abonafide research work done by Jairaj. P. Basarigidad in par-tial fulfillment of the requirement for the degree of AyurvedaVachaspathi. 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 and dissemi-nate this dissertation / thesis in print or electronic format for academic /research purpose.Date: Jairaj. P. BasarigidadPlace: Gadag.© Rajiv Gandhi University of Health Sciences, Karnataka.
  7. 7. I ACKNOWLEDGEMENT “Knowledge is proud that he has learned so much; wisdom is humble that heknows no more.”. This work is the result of the combined effort of a good number ofpeople who include researchers, academicians, friends, colleagues, parents and laymen. I dedicate this work to my respected parents Shri. P. F. Basarigidad andSmt. M. P. Basarigidad who are the prime reasons for all my success. The inspiring forces throughout this research work; was my guideDr. G. Purushothamacharyulu M.D.(Ayu), H.O.D. P.G. Department of Panchakarma,P.G.S & R.C, D.G.M.A.M.C, Gadag, the person who has devoted his life for theupliftment of this ancient system of medicine, who became a source of light whenever Iwas in darkness. I am deeply indebted for his guidance, broadmindedness and affectiontowards me. Words can not express the zeal of ecstasy while depicting my deep source ofgratitude to my proficient co-guide Dr. Shashidhar.H. Doddamani M.D.(Ayu), Asst.Professor, P.G. Department of Panchakarma, P.G.S.& R.C, D.G.M.A.M.C, Gadag. Hisfruitful suggestions, optimistic view shower head on me during this whole period &inspired me to accomplish this work in all aspects. 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 Dr. P. Shivaramudu M.D. (Ayu), Professor andDr. Santhosh. N. Belavadi M.D. (Ayu), Lecturer P. G. Department of Panchakarma for theirsincere advices and assistance. I express my sincere gratitude to a eminent teacher and researchers ofPanchakarma Dr. H. S. Kasture M.D. (Ayu), for his valuable guidelines. I express my sincere gratitude to Dr. V. Varadacharyulu M.D. (Ayu), Dr. M. C. PatilM.D. (Ayu), Dr. Mulgund M.D. (Ayu), Dr. K. S. R. Prasad M.D. (Ayu), Dr. Dilip Kumar M.D. (Ayu),Dr. R.V. Shetter M.D. (Ayu), Dr. Kuber Sankh M.D. (Ayu), Dr. Girish. Danappagoudar M.D. (Ayu),Dr.B.M.Mulkipatil M.D. (Ayu), Dr.Shashikant Nidagundi M.D. (Ayu), Dr.Jagadish Miti M.D. (Ayu),Dr.M.D.Samudri M.D. (Ayu), Dr. Shankaragouda M.D. (Ayu), Dr. Veena M.D. (Ayu) and other PGstaff for their constant encouragement.
  8. 8. II I also express my sincere gratitude to Dr. G. S. Hiremath M.D.(Ayu), Dr.B.G.Swamy,Dr. V.M. Sajjan, Dr. U.V. Purad, Dr. S.D. Yerageri, Dr. S.H. Redder, Dr. Gacchinamathand other undergraduate teachers for their support in the clinical work. I am thankful to Shri. Nandakumar (Statistician), Dr. Arun Baburao Biradar, Shri.V.M. Mundinamani (Librarian), Shri. B.S. Tippanagoudar (Laboratory technician), Shri.Basavaraj (X-Ray technician) and other hospital and office staff for their kind support inmy study. I cann’t move further before thanking to my intimate friends Dr. Santosh, Dr.Shashi, Dr. Jagadish, Dr. Sharanu, Dr. Girish, Dr. Pradeep, Dr. Kendadamath, Dr. V.M.Hugar, Dr. Shaila. B., Dr. P. Chandramouleeswaran, Dr V.S. Hiremath, Dr.Pattanashetti, Dr. Santoji, Dr. Jaggala, Dr. Udaykumar, Dr. Ratnakumar, Dr. KalmathB.L., Dr. Venkareddi, Dr. Bingi, Dr. Sajjan, Dr. Ganti, Dr. Pradeep, Dr. Sobagin, Dr.Shakuntala, Dr. Subin, Dr. Satheesh, Dr. Febin, Dr. Sreenivasa Reddy, Dr. Varsha, Dr.Vijay Hiremath, Dr. Suresh Hakkandi, Dr. Manjunath Akki, Dr. Ashwini Dev, Dr. L.Biradar, Dr. Jagadish. H, Dr. Sharanu, Dr. Anand, Dr. Suvarna, Dr. Anita, Dr. Kumbar,Dr. G. G. Patil, Dr. Sarve, Dr. Jigalur, Dr. Muttu, Dr. Prasannakumar, Dr. Madhushree,Dr. Sibaprasad, Dr. Payappagoudar. and other post graduate scholars for their support. 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. Even though more words can never replace the emotions one feels, still I crave toconvey a cordial thanks to my younger brother cum friend Santosh whose belief & wholehearted co-operation has always remained as the source of energy to me in this world ofuncertainly.Date :Place : Dr. Jairaj. P. Basarigidad.
  9. 9. III LIST OF ABBREVIATIONS⇒ A. H. – Ashtanga Hridaya.⇒ B. P. – Bhavaprakasha.⇒ C. S. – Charaka Samhita.⇒ G. R. – Good response.⇒ M. R. – Moderate response.⇒ N. R. – No response.⇒ P. R. – Poor response.⇒ S. S. – Susruta Samhita.⇒ AS. – Ashtanga sangraha.⇒ BR. – Bhaishajya ratnavali.⇒ MN. – Madhava nidana.⇒ No. – Number.⇒ Pt.’s – Patients.⇒ Sl. – Serial number.⇒ Vag. – Vagbhata.⇒ VS. – Vangasena samhitha.⇒ YR. – Yogaratnakara.
  10. 10. IV ABSTRACT Bastikarma and Swedana are the most important among the Panchakarmas. It hasalready been proved that the karmas are beneficial in managing the Vatavyadhees.Sandhigatavata is the most common joint disorder worldwide. The study “ A comparative clinical study to evaluate the effect of Matrabasti andParisheka with shatahvadi Taila in Sandhigatavata (Osteoarthritis)” is focused onimportant techniques i.e. Parisheka and Matrabasti and also common clinical entitySandhigatavata. Parisheka and Matrabasti with shatahvadi taila are believed to have aappreciable role in the management of such degenerative conditions by impartingstrength to the body musculature and nervous system. The objectives of this study are 1)To evaluate the effect of Parisheka inSandhigatavata (Osteoarthritis), 2) To evaluate the comparative effect of Matrabasti andparisheka in Sandhigatavata (Osteoarthritis), 3) To evaluate the additive efficacy ofMatrabasti in Sandhigatavata (Osteoarthritis). The aim of this study was to find out the effect of Parisheka in the management ofSandhigatavata, and to check its advantage over Parisheka in association with Matrabastiin managing the same disease. Therefore, two groups were made and the results obtainedin both the individual groups were compared. The study design selected for the presentstudy was prospective comparative clinical trial.
  11. 11. V In group A (Parisheka and Matrabasti) 8 patients (53.33%) had good response tothe treatment (> 60% improvement in all the parameters) and 7 patients (46.33%) hadmoderate response to the treatment (31-60% improvement in all the parameters) . In group B (Parisheka) 13 patients (86%) had moderate response to the treatmentand 2 patients (13.33%) had poor response to the treatment (1-30% in all the parameters).Among the group A and B the parameters Ruk and Walking time shows highlysignificant, where as other parameters are not significant in the comparative study (Byusing unpaired t-test, p<0.05). At the same time overall treatment response was better in the Parisheka andMatrabasti group as no patient in the Parisheka group got good response. This suggeststhat there was considerable improvement in both the groups but Parisheka and Matrabastigroup got more beneficial effects. Sandhigatavata is a Vatavyadhi affecting people in the vardhakya avastha. Thedisease is characterized by dhatu kshaya and lakshanas reflective of vitiated Vata.Therefore, the agents/therapies of brimhana-shoolahara-stambhahara-balya propertiesshould be used in this disease. Parisheka imparts Snehana and Swedana and opens up thesrotas in the shareera facilitating more nourishment and free movement of Vata dosha.Matrabasti is prime treatment for Vatavyadhees inturn plays vital role in correctingpathology of the disease and gives remarkable results. This results in the relief of symptomatology of the disease, when these twoprocedures performed together by acting locally and systematically. Ingredients ofshatahvadi taila possess properties such as Vedanashamaka, Shotahara and alsoVatanulomaka. Thereby, it is an ideal treatment of choice in SandhigatavataKey words: - Parisheka, Matrabasti, Sandhigatavata, Dhatukshaya, Swedana, Basti,Osteoarthritis, Vardhakya.
  12. 12. VI TABLE OF CONTENTS Chapters Page No.1. Introduction 1-32. Objectives 4-53. Review of literature 6-964. Methodology 97-1135. Results 114-1616. Discussion 162-1777. Conclusion 178-1798. Summary 1809. Bibliography10. Annexure
  13. 13. VII LIST OF TABLESTable Table Showing the Page No. No. 01. Different layers of Twak and diseases originating from each layer 02. Sites of different types of sandhis 03. Contraindicated for Anuvasana 04. Measurements of Bastiyantra 05. Netra dosha and Putaka dosha 06. Indications of Matrabasti 07. Dose of Matrabasti according to Age 08. Samyak, Ati and Heena yoga laxanas of Anuvasana basti 09. Properties of Swedana dravyas 10. Sweda yogyas 11. Sweda ayogyas 12. Samyak swinna lakshanas 13. Ati swinna lakshanas 14. Aaharaja nidana of Sandhigatavata 15. Viharaja nidanas of Sandhigatavata 16. Lakshanas of Sandhigatavata 17. Vyavachedaka nidana between Sandhigatavata and Vataraktha 18. Vyavachedaka nidana between Sandhigatavata and Amavata 19. Vyavachedaka nidana between Sandhigatavata and Kroshtrukasheersha 20. Differential diagnosis between OA, RA, Gout and Rheumatic fever 21. Distribution of patients by Age in both groups 22. Overall response of patients by Age in both Groups 23. Distribution of patients by Sex in both groups 24. Overall response of patients by Sex in both Groups 25. Distribution of patients by Occupation in both groups 26. Overall response of patients by Occupation in both Groups 27. Distribution of patients by Economical status in both groups 28. Distribution of patients by Religion in both groups 29. Distribution of patients by Dietary habits in both groups 30. Distribution of patients by Agni in both groups 31. Overall response of patients by Agni in both Groups 32. Distribution of patients by Koshta in both groups
  14. 14. VIII33. Overall response of patients by Koshta in both Groups34. Distribution of patients by Nidra in both groups35. Distribution of patients by Vyasana in both groups36. Distribution of patients by Deha prakriti in both groups37. Overall response of patients by Deha prakriti in both Groups38. Distribution of patients by Satmya in both groups39. Distribution of patients by Ruk in both groups40. Overall response of patients by Ruk in both Groups41. Distribution of patients by Graha in both groups42. Overall response of patients by Graha in both Groups43. Distribution of patients by Sparsha akshamatva in both groups44. Overall response of patients by Sparsha akshamatva in both Groups45. Distribution of patients by Sandhigati asaamarthya in both groups46. Overall response of patients by Sandhigati asaamarthya in both Groups47. Distribution of patients by Atopa in both groups48. Overall response of patients by Atopa in both Groups49. Distribution of patients by Shotha in both groups50. Overall response of patients by Shotha in both Groups51. Distribution of patients by Presenting complaints in both groups52. Distribution of patients by Chronicity in both groups53. Overall response of patients by Chronicity in both Groups54. Distribution of patients by Mode of onset in both groups55. Overall response of patients by Mode of onset in both Groups56. Distribution of patients by Aharaja nidana in both groups57. Overall response of patients by Aharaja nidana in both Groups58. Distribution of patients by Viharaja nidana in both groups59. Overall response of patients by Viharaja nidana in both Groups60. Distribution of patients by Mansika nidana in both groups61. Distribution of patients by Radiological interpretation in both groups62. Distribution of patients by overall response in both groups63. Before and after treatment values of all parameters in Group – A64. Before and after treatment values of all parameters in Group – B65. Individual study subjective and Objective parameters in Group-A66. Individual study subjective and Objective parameters in Group-B67. Inter-group comparison
  15. 15. IX LIST OF GRAPHSGraph No. Graph Showing the 01. Distribution of Patients by age in both groups 02. Distribution of patients by Sex in both groups 03. Distribution of patients by Occupation in both groups 04. Distribution of patients by Economical status in both groups 05. Distribution of patients by Religion in both groups 06. Distribution of patients by Dietary habits in both groups 07. Distribution of patients by Agni in both groups 08. Distribution of patients by Koshta in both groups 09. Distribution of patients by Nidra in both groups 10. Distribution of patients by Vyasana in both groups 11. Distribution of patients by Deha prakriti in both groups 12. Distribution of patients by Satmya in both groups 13. Distribution of patients by Ruk in both groups 14. Distribution of patients by Graha in both groups 15. Distribution of patients by Sparsha akshamatva in both groups 16. Distribution of patients by Sandhigati asaamarthya in both groups 17. Distribution of patients by Atopa in both groups 18. Distribution of patients by Shotha in both groups 19. Distribution of patients by Presenting complaints in both groups 20. Distribution of patients by Chronicity in both groups 21. Distribution of patients by Mode of onset in both groups 22. Distribution of patients by Aharaja nidana in both groups 23. Distribution of patients by Viharaja nidana in both groups 24. Distribution of patients by Mansika nidana in both groups 25. Distribution of patients by overall response in both groups LIST OF FLOW CHART Flow chart No. Flow chart showing 01. The samprapti of Sandhigatavata LIST OF PHOTOGRAPHSPhotograph No. Photograph showing 01. The anatomy of large intestine and rectum 02. Anatomy of Skin 03. Anatomy of Knee joint 04. Ingredients of Shatahvadi taila, Procedure of Matrabasti and parisheka
  16. 16. Ayurvedic classics narrate the observations of great sages like Charaka, Susruta,Vagbhata and Kashyapa. Their accomplishments are available as authouritive classics ofthis. It emphasizes man as conglomeration of the panchamahabhutas and atma. Thepanchamahabhutas are present in the body in the form of dosha, dhatu and malascomprising various organs and organ systems, these together forms the physical andmaterial aspect of man. A critical, careful and unbiased study of the classical Ayurvedic texts shows thatby the time the samhitagranthas were compiled, the science and art of Ayurveda hadalready passed through the stage of specialiazation. So it is time tested and formulatedafter conducting various reaserches on the basis of criteria’s available on those days.Ayurveda speaks about preservation of health first and then the correction of itsdisturbances, that is diseases. Ayurveda opines disease or vyadhi is a state in which both the mind and bodysuffer from pain, misery and even injury. The causative factors may vary depending onthe different entities but actually Tridoshas (Vata, Pitta and Kapha) are the intrinsiccausative factors, which get vitiated due to extrinsic factors and their balance is disturbed. Ayurveda prescribes various therapeutic measures either in the form ofPurificatory (Samshodhan) or Pacificatory (Samshamna) for the alleviation of the diseaseof both mind and physique. Panchakarma comprises five major preventive and therapeutic procedures amongthe unique achievements of our science; these are Vamana, Virechana, Niroohabasti,Anuvasanabasti and Nasyakarma. Acharya Susruta being first and foremost eminentsurgeon incorporates the Raktamokshana also into the above mentioned list, considering 1 Introduction
  17. 17. the two types of Basti under one. Panchakarma which is considered as five fold therapiesoccupise unique place among all the therapeutic measures list, because of its uniquenature not only to treat the disease radically but also by fulfilling both the basic goals ofAyurveda i.e “swasthasya swasthya rakshanam aturasya vikara prashamanam”. Theterm Panchakarma even the number is five but the word “pancha” gives the meaning“vistara” i.e elobarate procedure. Chakrapanidatta vividly emphasized about therestriction of Panchakarmas number to five, he opined that the term karma denotes theextensive management and pronounced potency for elimination of impurities. Snehanaand Swedana etc does not fulfill this goal and hence these are not included in it. For systematic and successful performance of these procedures it includes threemain aspects to consider which are in the form of poorvakarma, pradhanakarma andpaschatkarma. As Dalhana mentioned Pachana, Snehana and Swedana as poorvakarmas.Pachana is oral administration of certain drugs to relieve ama and strengthens the agni.Snehana is a oleation therapy which is administered through external or internal route.Swedana is a application of heat to the body to make perspire. Eventhough Swedana is included in poorvakarma it stands unique because of itswide spread application and efficacy. Swedana plays prime role in preparing body for theAdaptation of Pradhankarmas or Panchakarmas and also it is considered aspradhanakarma in certain conditions like Swedasadhya vyadhis. Among the varities ofSwedana, Parisheka is also included about which ample descriptions are available inclassics and it governes its own importance due to its systematic application and differentmodes of administration under the headings of Sheka, Parisheka and Dhara etc. 2 Introduction
  18. 18. When we consider Panchakarma procedures for their clinical efficiency andindications, Bastikarma has been placed a prime position by virtue of its wide indicationsand applicability like shodhana, shamana, brumhana and karshana etc basing on theproperties of the drugs employed in the procedure. Even it is considered as“Ardhachikitsa” and mentioned that it eliminates the vitiated doshas from all over thebody because of its wide action like “Aapadatalamastakam”. Swedana and Bastikarma occupies important place in treating Vatavyadhees,Vata is the master of all the doshas and is responsible for all types of functions andmovements in the body because of its Gati and Gandhana properties, so 80 varities ofVatavyadhees are mentioned in the treatises. The ability of any work of every individual is depends upon the ability of usinghis joints. The moment the person looses the power of locomotion the person not onlyfeels themselves a miserable creature but also becomes a burden to respective family andsociety. Sandhigatavata is one such clinical entity among Vatavyadhees which affects thelocomotion of senior citizens of this world in which dhatukshaya is prime factor which ischaracterized by certain symptoms like joint stiffness, joint pain, swelling and difficultyof joint movement etc. Among all the treatment modalities of Sandhigatavata Parisheka and Matrabastiare considered here for the study. 3 Introduction
  19. 19. NEED FOR THE STUDY The principle of Ayurveda chikitsa includes both Swedana and Bastikarma in thetreatment of Vatavyadhees. Swedana being one of the poorvakarma indicated in vatajaand vatakaphaja disorders mainly. Especially Parisheka is one among the Swedana inwhich lukewarm taila, kashaya etc poured in a regular stream on the whole or part of thebody, specifically when taila is used it mitigates Vata by accomplishing both Snehanaand Swedana simultaneously. Bastikarma is pradhanakarma which is mentioned as Ardhachikitsa, Matrabasti isa type of Anuvasanabasti having wide indications. It is well tolerated by the patientsbecause of its dose, no such complications and it can be administered at any time. Sandhigatavata is most common clinical entity among Vatavyadhees encounteredin clinical practice. It can be compared with Osteoarthritis of contemporary science asboth are similar in presentation with the symptometology- Pain, Swelling and Restrictionof joint movements etc of affected joints. According to WHO Osteoarthritis is the secondcommonest musculoskeletal problem in the world population. Many researches havebeen done in modern science to get effective treatment, as NSAIDs (analgesics) aregiving symptomatic relief only and also not safe, but could not found any safe andeffective medicaments. Research is going on even with Ayurvedic therapeutic measuressince 3-4 decades with Guggulu compounds and Shodhana measures. As Sandhigatavata is one among the Vatavyadhees and found very common insenile conditions. Matrabasti and Parisheka are expected to give better results in thisentity, Shatahvadi taila is used for these two procedures which is indicated in Vatavyadhi 4 Objectives
  20. 20. So present study entitled “A COMPARATIVE CLINICAL STUDY TOEVALUATE THE EFFECT OF MATRABASTI AND PARISHEKA WITHSHATAHVADI TAILA IN SANDHIGATAVATA (OSTEOARTHRITIS)” isundertaken.OBJECTIVES OF THE STUDY 1) To evaluate the effect of Parisheka in Sandhigatavata. 2) To evaluate the comparative effect of Matrabasti and Parisheka in Sandhigatavata. 3) To evaluate the additive efficacy of Matrabasti in Sandhigatavata. 5 Objectives
  21. 21. HISTORICAL REVIEW A critical review of the history from the primitive stage to the new millenniumassists one to understand the future in a better way. Man always struggled with presentand attempted for the better future and these can be achieved with a better perspective.when the past and present experiences and truths are checked and planned at proper time.History helps to reveal the hidden facts and ideas of the concerned subject.KARMABASTI KARMA As Matrabasti is a vikalpa of Anuvasana basti which is a variety of Basti, sohistorical review is done along with Basti here. Charaka Samhita1 : The scattered references regarding Basti are available invarious chapters of Charaka Samhita, but in Siddhisthana out of 12 chapters, 8 chapterscontribute to Basti. First two chapters of Siddhisthana deals with properties of Bastisamyak yoga, Ayoga lakshanas, indications and contraindications of Basti. This denotesthe importance of Basti in the field of Panchakarma. Susruta Samhita2 : In Susruta Samhita, four chapters ( 35th-38th ) have beendevoted completely for the description of the Basti in Chikitsasthana. In which detailedinformation regarding Bastinetra, indication, contra-indications, complications,classification of Basti etc are available. Ashtanga Sangraha3 : 28th chapter of Sutrasthana has been devoted to Bastionly. In this chapter, classification, indication, contra-indication, dosage, process ofadministration etc. have been described in detail. Also four chapters of Kalpasthana havebeen contributed to Basti. In these chapters, description regarding importance of Basti,different types of Basti, Sneha Basti Vyapad etc are available. 6 Historical Review
  22. 22. Ashtanga Hridaya4 : In this Samhita, 19th chapter of Sutrasthana Basti Vidhi and4th and 5th chapter of Kalpasthana named as Basti Kalpa and Basti Vyapada Siddhiexplain the every aspect of Basti. Kashyapa Samhita5 : In Kashyapa Samhita, Basti has been explained in detail inSiddhisthana and Khilasthana. He equated Basti to Amruta. Bhela Samhita6 : In Bhela Samhita, description of Basti is available in fourchapters of Siddhisthana namely Bastimatriyasiddhi, Upakalpasiddhi, Phalamatrasiddhiand Dasha Vyapadika Bastisiddhi. Chakradatta7 : In this text, two chapters named Anuvasanadhikara andNiruhadhikara are dealt with Anuvasana and Niruha Basti respectively. Vangasena8 : Vangasena has devoted “Basti Karmadhikara” chapter fordescription of Basti. Sharangadhara Samhita9 : Three chapters of Uttarakhanda namely BastiKalpana Vidhi, Niruha Basti Kalpana Vidhi and Uttara Basti Kalpana Vidhi describedvarious aspects of Anuvasana Basti, Niruha Basti and Uttara Basti respectively. As the time progressed in the recent times authors of Ayurveda has alsocontributed for the Bastikarma by modifying the Bastiyantra, i.e. replacing the olderequipments by rubber or plastic material. 7 Historical Review
  23. 23. SWEDANA KAMRA The time during and after the Samhitakala provide ample descriptions onSwedana. Charaka Samhita10 : Acharya Charaka was the first to describe Swedakarmaunder the Shadupakramas. He explained in detail about definition, classification,indications, contra-indications and benefits of Swedana. Susruta Samhita11 : Susruta also given in detail explanation about it, with slightdifference in classification. Vagbhata12 : He had also allotted separate chapters for Sweda karma inAshtanga sangraha and Ashtanga Hridaya. Bhela Samhita13 : Bhela had also described Swedana in detail in the Swedaadhyaya of sutrasthana. Kashyapa Samhita14 : He added Hastasweda and Pradehasweda too inclassification. Sharangadhara Samhita15 and Chakradatta16 : had also described aboutMridu, Madhya and Mahan Swedana karma. Bhavaprakasha17, Bhaishajyaratnavali18 and Yogaratnakara19 : hademphasized the utility of Swedakarma in various clinical conditions. About Sweda karma various literary works belonging to the Classical Age ofIndian Literature20 like Kasika and Harsacharita had also mentioned its usefulness. We find the ample description about therapeutic use of Parisheka21a-h in major textsof Ayurveda. Charaka considered Parisheka as Bahirparimarjana Chikitsa.22 8 Historical Review
  24. 24. SANDHIGATAVATAVedic Period In the Vedic period, like in Atharvaveda the words “Januni and Ashtivantau”were used to denote knee joints.23 The disease Sandhigatavata had not been mentioned assuch, but Atharvaveda had mentioned Parvashoola and Vateekrita24 two diseases similarto Sandhigatavata. Rigveda while describing various skills of Ashwinikumaras hadrecorded their skill in treating joint diseases too.25 One of the mantras of Rigveda statesthat, “I am removing your diseases from each organ, hair and joint”.26 In Atharvaveda,records about Vatavikaras are mentioned. A mantra says, “destroy the balasa seated inthe organs and joints which is responsible for loosing bones and joints”.27Samhita Kala In that period we find systematic description of the disease according to NidanaPanchaka. Charaka Samhita28 : Acharya Charaka has mentioned the diseaseSandhigatavata under Vatavyadhi Chikitsa (28th chapter) but hasn’t mentioned anyspecific line of treatment for this. Susruta Samhita29 : Acharya Susruta has added one symptom i.e. “HantiSandhi” and described the lakshanas of Sandhigatavata in Nidanastana (1st chaptr) and inChikitsa Sthana (4th chapter) specific line of treatmen has been prescribed. Bhela Samhita30 : There is no explanation about Sandhigatavata. However he hasexplained the asthi-majjagata Vata wherein we find the symptom Sandhi Vichyuthi. 9 Historical Review
  25. 25. Sangraha Kala Astanga Sangraha31 and Astanga Hridaya32 : In Astanga SangrahaNidanasthana (15th chapter) 15 Lakshanas and in Chikitsasthana (21st chapter) 4 varietiesof Chikitsa are explained. The Nidanas are similar to Charaka Samhitha and Chikitsa isas Susruta Samhitha. In Astanga Hridaya Nidanas are explained in Nidana Sthana (15thchapter) and chikitsa in Chikitsa sthana (21st chapter). Madhava Nidana33 : He has mentioned an additional symptom, Atopa in thesymptomatology of Sandhigatavata ( 22 nd chapter) rest are same as in Susruta Samhitha. Bhavaprakash34 and Yogaratnakara35 : Bhavaprakasha explained theLakshanas and treatment of Sandhigatavata in Madhyama khanda Vatavyadhyadhikara(24th chapter). Yogaratnakara : also is not left behind in explaining about Lakshanas andtreatment of Sandhigatavata in Vatavyadhyadhikara of Pooravardha. Chakradutta36 and Bhaisajyaratnavali37 : Description is similar to SusrutaSamhita. Both the texts haven’t dealt with the aspect of Nidana. Osteoarthritis (OA) is the most common joint disorder arising with greaternumber of affected population. Even in giant dinosaurs, osteophytes leading to ankylosiswere detected. In all mammalian species like whales and dolphins and in fish birds andsome amphibians, Osteoarthritis is observed.38 In the early ages, Hippocrates observed the prevalence of OA in aged individuals(Benard, 1944).39 Heberden (1803) studied this disease in detail and the nodes on thefingers in OA disease were named after him.40 Osteoarthritis was differentiated fromRheumatoid Arthritis and named as degenerative arthritis by Nichols and Richardson(1909) on morbid anatomical grounds.41 Although the most ancient of the diseases, OAwas first identified as a distinct entity in the 20th century.42 Gold th ait in 1904 made adistinction between hypertrophic and atrophic arthritis and A. E. Garrod recognized OAas a clinical entity in 1907.43(Rheumatology –Kelly and William). 10 Historical Review
  26. 26. VYUTPATTI AND PARIBHASHABastiThe word Basti is derived form ‘vas + tich’ and is masculine gender.“Vasu nivase”44 - Means residence.“Vas-aachadane” - That which gives covering“Vas vasane surabhikarane” - That which gives fragrance“Vasti vaste aavrunothi moothram” - That which covers the urine.“Nabheradhobhage mootradhare” - The position of basti is just below the nabhi (umbilicus) and is the collecting organ of urine in the body i.e. urinary bladder. In the context of Panchakarma the term basti is used in different meaning.“Vastina deeyate iti vasti”45“Vastibhir deeyate yasmat tasmat vastiriti smritha”46“Vastina deeyate vastini va Purvamanyattavasto vasti”47Matrabasti“Hraswaya snehapanasya matrayaha yojitaha samaha”48 Matrabasti is a type of Anuvasana which is having main ingredient sneha which isadministered in the hraswamatra. The word Basti gives the meaning of urinary bladder.As it is used as a device for Bastikarma. In Panchakarma therapy the term Basti is usedto designate the procedure. 11 Vyutpatti & Paribhasha
  27. 27. Swedakarma Sweda49 : - Sweda is a word of masculine gender. Sweda word is coined by thecombination of “Swit” dhathu and “Dhanj” pratyaya. Sweda is a shareeramala, which isassociated with body heat mechanism. Karma50 : - Karma word is derived from the dhathu “Kru”. Performance of anact is called karma. Here, swedakarma means the act of producing sweda and it is oneamong the Shadupakramas and poorvakarma.Parisheka51 Pouring of the regular stream of Vasa, Taila, Grita, Kshreera, Mutra, Kanji etc inlukewarm state.Sandhigatavata The word “Sandhigatavata” is comprised of three words, viz. Sandhi, Gata andVata. Sandhi52 :- Sandhi is a word of masculine gender. Sandhi is coined from threeparts ‘Sam’, ‘Dha’ and ‘Kihi’. “Sandhaanamiti, asthidvayasamyogasthanam”- The placeof union of something together is called sandhi. Here, it means the union of bones. Gata53 : - Gata word exists in all the three genders and it is derived from ‘Gama’dhathu and ‘Ktin’ pratyaya. “Gachati, janaati, yaateeti va” - That which has went orreached. Hence, gata word may be used to denote an initiation of movement, carryingsomething along with, to reach a particular site, through any particular pathway orleading to occupancy at a particular site. Here, in the context of Sandhigatavata, theoccupancy is at asthi-sandhis in the body. 12 Vyutpatti & Paribhasha
  28. 28. Vata54 : - Vata is a word of masculine gender. The word is coined from “Vaa”dhathu and “Ktin” pratyaya. Vata is derived from “Va gati gandhanayoho” i.e. to move,to make know, to become aware of. The term Gati means prapti, Jnana. Gandhana is likeUtsaha, Prakashana. Considering different meaning of Gati and Gandhana it isunderstood that the term Vata act as receptor as well as stimulator. It is one among thetridoshas. Thus, collectively the word Sandhigatavata means the disease resulting fromthe settling of vitiated Vata dosha in the bony joints of the body. The word “Osteoarthritis” is a combination of three words. “Osteon”, “arthron”and “itis” respectively means bone, joint and inflammation55. The meaning of this wordis “inflammation to the bony joint”. In fact, there is no inflammation in this disease;hence, the disease is also known as Osteoarthrosis and Degenerative joint disease. 13 Vyutpatti & Paribhasha
  29. 29. SHAREERA The word shareera comprises both structural and functional aspects of the body.As focus of this study is on Bastikarma and Parisheka, a discussion on the anatomy andphysiology of skin and also rectum where these procedures are applied, is necessary priorto the discussion on the anatomy and physiology of joints which are the site of thisdisease.Guda Shareera In the context of Arsaroga Susruta has explained in detail about the anatomicalstructure of guda. Guda is a part, which is the extension of sthoolantra with 41/2 angulain length. It has got 3 valis (parts) named as Gudavalitrayam.56 Pravahini – That which does pravahana. Visarjini – That which does visarajana. Samvarani – That which does samvarana. Gudostha is a structure present about a distance of 1½ yavapramana from the endof hairs. The first vali samvarani starts at a distance of 1 angula from gudostha. The widthof each vali will be 1 angula and of the colour of elephant’s palate.57 Charaka considered uttaraguda and adharaguda while describing about thekoshtangani. The modern commentators consider them as rectum and anus respectively.58All acharyas have considered guda as one among the dashajeevitha dhamani and also oneamong the bahyasrotas.59-61 The rectum forms the last 15cm of digestive tract and is an expandable organ forthe temporary storage of fecal material. Movement of fecal material into the rectumtriggers the urge to defecate. 14 Shareera
  30. 30. The last portion of the rectum, the ano-rectal canal, contains small longitudinalfolds, the rectal columns. The distal margins of rectal columns are joined by transversefolds that mark the boundary between columnar epithelium of the proximal rectum and astratified squamous epithelium like that in the oral cavity. Very close to the anus or analorifice, the epidermis becomes keratinized and identical to the surface of the skin. There is a network of veins in the lamina propria and submucosa of the ano-rectalcanal. The circular muscle layer of the muscularis externa in the region forms the internalsphincter and is not under voluntary control. The external anal sphincter guards the anusand is under voluntary control. Pudental nerves carry the motor commands.62Pakwashaya / Large intestine Susrutha63 and Vagbhata64 opine pakwashaya as one of the ashaya. According toArunadatta pakwashaya is the seat of pakwa anna i.e. that which attains pureeshatha.65Charaka and Vagbhata considered this as one among the koshtangas.66,67 Sharangadharahas specified the location of pakwashaya (pavanasaya) as below the Tila i.e. the liver.68 The horseshoe shaped large intestine or large bowel begins at the end of ileumand ends at anus. Average length of about 1.5 meters and width of 7.5cms. It is dividedinto 3 parts: - Caecum – T portion (pouch like) Colon – Large portion. Rectum – The last – 15 cm portion. The caecum collects and stores the chyme and begins the process of compaction.Colon is being subdivided into ascending, transverse, descending and sigmoid colon. Themajor characteristics of colon are the lack of villi. The abundance of goblet cells,presence of distinctive intestinal glands and mucosa does not exist produces anyenzymes. The reabsorption of water is an important function of large intestine (75%) andalso absorbs number of other substances that remain in the fecal matter or that weresecreted into the digestive tract along its length like Vit. K, B5, biotin, urobilinogen, bilesalts and toxins.69 15 Shareera
  31. 31. Twak shareera According to Ayurveda twak is an upadhatu of mamsa.70 In the foetal stage ofdevelopment of the Garbha, the different layers of the skin are formed due to themodification of mamsadhatu.71 Susruta72 appreciated the seven layers of twak and thediseases arising from it.Table No. 1. Showing the different layers of twak. Sl. Layer of twak Size Diseases arising from each layer 1 Avabhasini 1/18 Vrihi Sidhma, Padmakantaka 2 Lohitha 1/16 Vrihi Tilakalaka, Nyaccha, Vyanga 3 Swetha 1/12 Vrihi Charmadala, Ajagalli, Mashaka 4 Tamra 1/8 Vrihi Kilasa, Kushta 5 Vedinee 1/5 Vrihi Kushta, Visarpa 6 Rohinee 1 Vrihi Granthi, Apachi, Arbuda, Shlipada, Galaganda 7 Mamsadhara 2 Vrihi Bhagandara, Vidradhi, Arshas Susruta, stated that how the cream forms layer after layer in the boiling milk, likethat seven layers of skin forms. Charaka73 had described only six layers of twak without naming them they are –1) Udakadhara, 2) Asrigdhara 3) Sidhma-kilasa sambhavadhishthana, 4) Dadrukushtasambhavadhishthana, 5) Alaji-vidradhi sambhavadhishthana and 6) Arumshikaadhishthana patient goes into shock and develops a very serious skin disease calledarumshika, if injury occurs at the innermost layer i.e arumshika adhistana. Bhrajakapitta is located in the twak takes up and metabolizes the drugs applied inthe form of abhyanga, parisheka, avagaha, alepa etc.74 16 Shareera
  32. 32. Modern View Skin is a Large, Highly Complex Organ and as a Structuraly Integrated OrganSystem. It includes skin and the associated hairs, nails and exocrine glands. The systemaccounts for about 16% of ones body weight.75 Cutaneous membrane has two components – the superficial epithelium orepidermis and the underlying connective tissues of the dermis. The associated oraccessory structures are located in the dermis and protrude through the epidermis to theskin surface.General functions of the skin ◊ Protection of underlying tissues and organs. ◊ Excretion of salts, water and organic wastes. ◊ Maintenance of normal body temperature. ◊ Synthesis of a steroid, vitamin D3 that is subsequently converted to the hormone calcitriol, important to normal calcium metabolism. ◊ Storage of nutrients. ◊ Detection of touch, pressure, pain and temperature stimuli and the relay of that information to the nervous system.Epidermis It provides mechanical protection and keeps microorganisms outside the body;this layer consists of a stratified squamous epithelium. The most abundant epithelial cells,called kertinocytes, form several different layers. Five layers of epidermis, beginning at the basement membrane and travelingtoward the free surface, are stratum germinativum, stratum spinosum, stratumgranulosum, and stratum lucidum and stratum corneum. Keratinization or cornificationoccurs on all exposed skin surfaces except the anterior surface of the eyes. 17 Shareera
  33. 33. Epidermal growth factor (EGF) is one of the peptide growth factors produced bythe salivary glands and glands of the duodenum. This has wide spread effects onepithelia, especially the epidermis. Its effects include – Promoting the divisions of germinative cells in the stratum germinativum and stratum spinosum. Accelerating the production of keratin in differentiating epidermal cells. Stimulating epidermal development and epidermal repair after injury. Stimulating synthetic activity and secretion by epithelial cells. The colour of the skin is due to an interaction between pigment (carotene and melanin) composition and concentration and the dermal blood supply.Dermis The dermis lying beneath the epidermis has two major components – a superficialpapillary layer and a deeper reticular layer. The papillary layer consists of looseconnective tissue. This region contains the capillaries and the sensory neurons that supplythe surface of the skin. The reticular layer consists of an interwoven meshwork of denseirregular connective tissue. Accessory organs of epidermal origin, such as hair folliclesand sweat glands, extend into the dermis. The reticular and papillary layers of the dermiscontain networks of blood vessels, lymph vessels and nerve fibers.Dermal circulation Arteries supplying the skin form a network in the subcutaneous layer along itsborder with the reticular layer of the dermis. This network is called the cutaneous plexus.Tributaries of these arteries supply the adipose tissues of the subcutaneous layer and thetissues of the integument. As small arteries travel toward the epidermis, branches supplythe hair follicles, sweat glands, and other structures in the dermis 18 Shareera
  34. 34. Nerve supply Nerve fibers in the skin control blood flow, adjust gland secretion rates andmonitor sensory receptors in the dermis and the deeper layers of the epidermis. Theepidermis also contains the extensions of sensory neurons that provide sensations of painand temperature. The dermis contains similar receptors as well as other more specializedreceptors.Hypodermis The connective tissue fibers of the reticular layer are extensively interwoven withthose of the subcutaneous layer. Although the hypodermis is not a part of the integument,it is important in stabilizing the position of the skin in relation to underlying tissues, suchas skeletal muscles or other organs, while permitting independent movement.76Sweat glands77 Among the associated structures of the skin, only sweat glands are discussed heredue to their contextual relevance. The skin contains two different types of sweat glands orsudoriferous glands – apocrine glands and merocrine sweat glands. Apocrine sweat glands communicate with hair follicles in the armpits (axillae),around the nipples and in the groin. These are coiled tubular glands that produce a sticky,cloudy and potentially odorous secretion. Apocrine sweat glands begin secreting atpuberty. The sweat produced is a nutrient sources for bacteria, which intensity its odour.The secretary activities of the glands cells and the contractions of myoepithelial cells arecontrolled by the nervous system and by circulating hormones. 19 Shareera
  35. 35. Merocrine sweat glands, (eccrine sweat glands), are far more numerous andwidely distributed than apocrine glands. These are coiled, tubular glands that dischargetheir secretions directly onto the surface of the skin. The sweat produced by merocrine sweat glands is called sensible perspiration.Sweat is 99 percent water, but it also contains some electrolytes (chiefly sodiumchloride), organic nutrients and waste products. It has a pH of 4-6.8 and the presence ofsodium chloride gives sweat a salty taste. The functions of merocrine sweat glandinclude: (1) cooling the surface of the skin to reduce body temperature, (2) excretion ofwater and electrolytes and (3) protection from environmental hazards.Sweda and Swedavahasrotas During dhatuparinama Sweda is produced from medodhathu78. The udaka thatcomes out from the romakupas when body becomes hot is called sweda79 which is anapyadravya80. Sweda is brought to the surface of the skin through the swedavaha srotasesby the action of vyanavata.81 The excretion of the sweda bestows moisture and delicatenature to the skin.82 Hemadri opines that the hair on the skin is supported by the sweda.83Swedavaha srotas moola are medas and romekoopa.84 The vitiating factors areativyayama, atisantapa, indiscriminate indulgence in cold and heat, krodha, shoka andbhaya85. Their vitiation produces the following lakshanas- aswedana (anhydrosis),atiswedana (hyperhydrosis), parushya (roughness of the body), atislakshnata (excessivesmoothness of the body), paridaha (general burning sensation) and lomaharsha(horripulations).86 20 Shareera
  36. 36. SANDHISHAREERA The term sandhi means ‘sandhana’ i.e. the union of two or more structurestogether. Here, specifically the union of two or more asthis including taruna asthis anddantas. Saltshaker kapha87:- Among the five varities of kapha, situated in the sandhis. Itkeeps the joints firmly, protects their articulaton opposes their seperation and disunion. Vyanavata 88:- Vata is responsible for every movement in the body. Which is oneamong the varities of vata resides in hrudaya and controls most of the motor fuctions.Vagbhata states that Vata is located in asti, with relation to ashrayaashrayi sambhanda. Shleshmadharakala89:- It is fourth Kala, resides in all the joints of living being.Joints functions properly by the support of kapha as wheel moves on well by lubricatingthe axis. It is responsible for proper alignment and movements of all joints. Functionally, Susruta had classified sandhis into two varieties90 chesthavantasandhi (movable) and (2) sthira sandhi (immovable). Cheshtavanta sandhis are present insakhas (upper and lower limbs), hanu (temporomandibular joint) and kati (hip). All theremaining i.e. cranial sutures, intervertebral, costovertebral, sternoclavicular, sternocostaland dental are sthira type of variety (immovable or slightly movable joints).According to Susruta structurally joints are of eight types.91 21 Shareera
  37. 37. Table No: 2 showing the sites of different sandhis. Sl. Name of Sandhis Sites 1 Kora (resembling In anguli (interphalangeal joints), budding flower) manibandha (wrist), gulpha (ankle), janu (knee) & kurpara (elbow) 2 Ulookhala (resembling Kaksha (shoulder), vankshana (hip), a mortar) & danta (alveolar sockets & teeth) 3 Saamudga (as it fitted Amsapeetha (sternoclavicular), One another) guda (sacrococcygeal), bhaga (symphysis pubis), & nitamba (lumbosacral) 4 Pratara (floating) Greevaprishta (intervertebral) 5 Tunnasevani (sutural) Shira, kati & kapala (sutural joints) 6 Vaayasatunda (crows beak Hanusandhi (temporomandibular) like portion of a bone ente- rs similarly shaped hole) 7 Mandala(rounded) Kantha (tracheal rings) 8 Sankhaavarta(looks like Shrothra (cochlea) Circles of snail) According to Ayurveda total no of sandhis in the body are 210. 92MODERN VIEW The human skeleton is designed with a number of individual bones that arearticulated at joints to allow the movements in different directions, angles and positions.93In this particular study, only cases with Osteoarthritis of knee have been considered. So,the descriptions of these are being dealt with in detail here. 22 Shareera
  38. 38. Knee Joint 94 The knee is structurally complex and subjected to severe stresses in the course ofnormal activities. Although the knee functions as a hinge joint, the articulation is far morecomplex than that of the elbow or even the ankle. The rounded femoral condyles rollacross the top of the tibia, so the points of contact are constantly changing. The jointpermits flexion and extension and very limited rotation. There is no single, unifiedcapsule at the knee joint, nor is there a common synovial cavity. A pair of fibro cartilagepads, the medial and lateral menisci, lies between the femoral and tibial surfaces. Themenisci – (1) act as cushions, (2) conform to the shape of the articulating surface as thefemur changes position and (3) provide lateral stability to the joint. Prominent fat padscushion the margin of the joint and assist the many bursae in reducing the frictionbetween the patella and other tissuesLigaments Seven major ligaments stabilize the knee joint. They are the patellar ligament, twopopliteal ligaments, the anterior cruciate and posterior cruciate ligaments, the tibialcollateral ligament and the fibular collateral ligament.Muscles Associated Flexors of the knee -biceps femoris, semimembranosus, semitendinosus and thesartorius. The flexion of knee and rotation (lateral) of the thigh is done by sartoriusmuscle. The first three flexors are collectively known as hamstring muscles. Collectively,the knee extensors are known as the quadriceps femoris (Vastus muscles). 23 Shareera
  39. 39. Blood Supply Genicular branches of the popliteal artery. The descending genicular branch of the femoral artery. The descending branch of the lateral circumflex femoral artery. Recurrent branches of the anterior tibial artery. The circumflex fibular branch of the post-tibial artery.Nerve Supply Femoral nerve – Through its branches to the basti especially the vastus medialis Sciatic nerve – Through the genicular branches of the tibial and common peroneal nerve. Obturator nerve – Through its posterior division.Snayu95 Totally there are 900 snayus in the body; among them 600 are in the extremities,10 in the janu. The pratanavati type of snayus is located in the sandhis of the body. Allthe joints are attached with snayus that are responsible for their compactness.Peshishareera96 There are 500 peshis in body; among them, 400 are in the extremities (upper andlower), 5 in the janu. All the siras, snayus, asthis, parwas and sandhis are covered bypeshis that protects them.Marmas97 Marmas are the vital anatomical points in the human body. The janu marma islocated between jangha and urvi and if injured causes khanjata. It is a sandhi marma of 3angula measurement and is a vaikalyakaramarma. 24 Shareera
  40. 40. Sira and Dhamanis98 The kaphavaha siras carrying prakrita Kapha, maintains the sandhi, ensures itssthirata, increases its bala etc. One of the functions of vatavaha siras is pancha cesta suchas Prasarna Akunchana etc. the raktavaha siras does dhatu purana brings about sthirataand does poshana. Asthi is one of the dhatus; hence these functions are applicable forAsthi dhatu poshana also. The Sparshavaha dhamanis are spread in the upward direction and these have thefunction of carrying the sparsha jnana. The sparsha may be sukhakara or dukhakara.Synovial fluid Synovial membrane secretes a liquid, the synovial fluid. It has many functions -serves as a lubricant, a shock absorber and a nutrient carrier. This belongs to a ratherunusual group of liquids known as dilatent liquids. These liquids are characterized by therare quality of becoming thicker when shear is applied to them. Thus, the synovial fluidin our knees and hips assume a very viscous nature at the moment of shear in order toprotect the joints, and then it thins out again to its normal viscosity instantaneously toresume its lubricating function between shocks. Synovial fluid is the liquid that mustcarry the raw materials from the blood to the cartilage. 25 Shareera
  41. 41. Figure No. 03. Showing the anatomy of Knee joint.
  42. 42. Figure No. 01. Showing the anatomy of Large intestine and Rectum.
  43. 43. Figure No. 02. Showing the anatomy of skin.
  44. 44. BASTI KARMA Among the Shodhana therapies Bastikarma is considered as the most importantone due to its wide spread application and effect. It is the procedure in which the drugprepared according to classical reference is administered through rectal canal reachesupto the Nabhi Pradesha, Kati, Parshva, Kukshi churns the accumulated Dosha andPurisha spreads the unctuousness (potency of the drugs) all over the body and easilycomes out along with the churned Purisha and Doshas. Even though it has a resemblancewith the enema therapy, it differs in many aspects like principle, mode of application andthe advantages it renders. As the term Basti means bladder but it is used as a device forBastikarma. Hence, it is used as a name in Panchakarma therapy to designate the process.It is also said that the medicine in suspension, administered through the Bastiyantra, firstreaches the lower abdominal part of the patient. The lower abdominal area or the pelvisalso contains the organ basti (urinary bladder). Due to these reasons the term Basti is usedin Panchakarma.IMPORTANCE OF BASTIKARMA All major texts of Ayurveda emphasized this treatment considering its efficacy. Itstands unique among all the shodhana therapies because it expels the vitiated Doshasrapidly and easily from the body and also causes reducing as well as nourishing the bodyvery fastly.99 Eventhough Vamana and Virechana eliminates the vitiated Doshas form thebody, the drugs used in these therapies contain Katu rasa, Ushna guna and Teekshnagunas, which cannot be taken easily by children or older people. But Basti can be givenin all age groups without any hesitation.100 26 Bastikarma
  45. 45. Bastikarma is the prime treatment for Vata and Vata dominating other vikaras asVata being the chief controller among the causative forces of disease.101 According tobasic principles of Ayurveda, Vata is responsible for each and every movements andactivities in the body whether it is of constructive or of destructive nature. On the otherhand Vata is functionally required to co-ordinate with Pitta and Kapha in order toaccomplish various duties assigned to them in the organization of life.102 As the main seat of Vata is considered as Pakwasaya by the adminstation of Bastiinto it, the proper regulation and co-ordination of the functions of Vata dosha occurs in itsown site and also control the related Doshas which are involved in the pathogenesis ofdisease.103 Hence, Basti is also called as Ardhachikitsa by Vagbhata.104 Apart form this ithas multidimentonal effect by possessing various therapeutic actions like Samshodhana,Samshamana and Sangrahana of doshas on the basis of drugs used in it.105 Basti accomplishes rejuvenation, happiness, longevity, strength, improvingmemory, voice, digestive power and complexion. It removes noxious matters form thetissues, pacifies the Doshas. Consequently it affords stability and thus indirectlystrengthens the reproductive capacity in man.106 Kashyapa equated the Bastikarma as‘Amrutam’, because of its wide application even in both infants and in old age people.107Classification of Basti One cannot find any uniformity in classification of Basti among the authors ofclassical texts. As Basti is an important method of therapy in Ayurveda, it can beclassified in various ways for better understanding. Generally the term basti has beenused for all types of Bastikarma, which includes Nirooha, Anuvasana, Uttarabasti etc. But 27 Bastikarma
  46. 46. Charaka has used this term Basti exclusively for Nirooha as per the commentary ofChakrapani.108 Similarly the term Basti has also been referred to the method ofShirobasti, Urobasti and Vrinabasti etc. So a rational thinking on various aspects ofBastikarma has brought about the following classification.1091) Adhishtana bheda : According to the site of application of Basti it is classified into two types – a. Internal b. External a. Internal Pakwashayagata The administration of medicine via Gudamarga to Pakwashaya basti Garbhasayagata The administration of medicine via Yonimarga to Garbhashaya basti Mutrasayagata basti The administration of medicine via Mutramarga to Mutrasaya. Vranagata 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 snehaand so classified into two types: - i) Nirooha basti – In Niruha Basti, Kashaya (decoction) is the predominantcontent with the Kashaya, Madhu, Saindhava, Sneha and Kalka are the ingredientscommonly used. Its synonyms are Asthapana Basti,110 Kashaya Basti etc. Its action in thebody is beyond the perception of physician.111 28 Bastikarma
  47. 47. 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. Morever, this type of Basti can be practiced daily without any seriousprecautionary measure, as it is less harmful than nirooha.1123. Karma bheda: Susruta and Vagbhata have made the following classificationaccording to their actions.113-114Shodhana Contains Shodhana dravyas and removes vikrita Doshas andbasti Malas from the bodyLekhana Reduces Medodhatu and produces Lekhana in the bodybastiSneha basti Contains more of Sneha and produces Snehana in the bodyBrumhana Increases the Rasadi dhathus and indirectly it helps in the growth ofbasti body.Utkleshana Causes Utklesha of malas and doshas by increasing its Pramana andbasti causes dravabhoothaDoshahara Purificatory or eliminating type.bastiShamana Causes Shamana of Doshas.basti Sharangadhara added, Shodhana basti to it also he has added Lekhana, Brimhana,Deepana-pachana types of bastis.115 Vataghna basti, Balavarnakrita basti, Snehaneeyabasti, Sukrakrit basti, Krimighna basti, Vrishatvakrit basti has been explained in variouscontexts by Charaka.1164. Sankhya bheda: It is stated that neither Snehabasti nor Niroohabasti can be appliedalone.117 So, Charaka has made this classification based on the number of Snehabastisand Niroohabastis in a treatment.118 viz. a) Karma basti119 b) Kala basti120 c) Yogabasti.121 29 Bastikarma
  48. 48. 5. Matra bheda: This classification of basti is based on the quantity of Bastidravyaprescribed. The quantity may vary according to the age, strength of the patient andseverity of the disease.• Dvadashaprasruta basti – In nirooha, the maximum dose or quantity of Bastidravya prescribed is Dvadashaprasruta i.e. 24 palas.122• Prasritayogika basti – Charaka has prescribed various types of Nirooha in different doses like 4,5,6,7,8,9, and 10 prasrutas, considering the strength of the patient and condition of the disease.123• Padaheena basti – In this type of basti, 3 Prasrutas i.e. ¼ of Dvadashaprasruta is less form from the total quantity of Nirooha used i.e. 9 prasruthis.124Anuvasana : is also classified into 3 according to the differ quantity of sneha used • Sneha basti 125 – 6 palas (¼of total quantity of Nirooha) • Anuvasana basti 126 – ½ of the quantity of Snehabasti. • Matra basti 127 – The quantity of sneha that will be digested within 6 hrs.6. Anushangika bheda (Miscellenious)a) Yapana basti.128 b) Siddha basti129 c) Yuktaratha basti 130d) Vaitharana basti 131 e) Ksheera basti 132 f)Ardhamatrika nirooha basti133g) Picha basti 134 h) Mutra basti 135 j) Rakta basti 136 In general approximately 216 kinds of Basti are mentioned by Acharya Charakain various chapters of Siddhisthana. 30 Bastikarma
  49. 49. Indications and contraindications of Anuvasana Bastikarma Basti is one of the prime treatment of Ayurveda, hence the knowledge of thesuitability and unsuitability of patients should be kept in mind. All the acharyas havebeen clearly explained as presented below. 137-139 Indications for Anuvasana Basti : Anuvasana is indicated in patients whoare already indicated for asthapana, but special mention has been given to certainconditions like Rooksha, Kevala vataroga and Atyagni where Anuvasana is morebeneficial.Table No; 3 Persons unfit for the Anuvasana basti 140-142 No. Contraindications Ch. Su. Vag. Complications 1. Anasthapya + + + 2. Abhuktabhakta + - + Sneha moves upwards 3. Navajwara + - - 4. Kamala + - + Leads to udara 5. Prameha + - + 6. Arshas + - - Leads to aadhmana 7. Pratishyaya + - - 8. Pandu + + + 9. Arochaka + - - Leads to more annabhilasha 10. Mandagni + - - 11. Durbala + - - Increases the condition 12. Pleehodara + + + 13. Kaphodara + + + Leads to more dosha vardhana 14. Oorustambha + - + 15. Garapeeta + - + 16. Kaphabhishyanda + - + 17. Gurukoshta + - + 18. Shleepada + - + 19. Galaganda + - + 20. Apachi + - + 21. Krimikoshta + - + 22. Prameha - + + 23. Kushta - + + 24. Sthaulya - + + 25. Peenasa - - + 26. Krushna - - + 27. Varchobheda + - + 28. Vishapeeta + - + 31 Bastikarma
  50. 50. Basti Yantra : The instrument or device used for basti karma is called as bastiyantra. Itcomprises of two parts – 1.Bastinetra 2. BastiputakaBastinetra (Nozzle/Cannula) : The general meaning of netra is eye, but here netrameans nalika (tube). It can be made of gold, silver, copper or such other higher metals oralloys, long bones of animals, bamboo, wood etc. were used in ancient times. Generally,it must resemble the tail of cow with a tapering end and a wider base. But, according toCharaka it is tubular apparatus with round ends and smooth surfaces143. The dimensionsare different to suit the patients of different age group. The following table furnishes themeasurement of bastiyantra.Table No: 4 Measurements of Bastiyantra144-146 No. Age in Length in Lumen of netra Diameter of narrow end Diameter of broad end years Angula 1. <1 5 1 angula 2. 1-6 6 Size of green gram 1 angula 3. 7- 11 7 Size of black gram 1½ angula 4. 12-15 8 Size of kalayam 2 angula 5. 16- 20 9 Size of wet kalaya 2½ angula 6. > 20 12 Karkandhu 3 angula Susrutha’s opinion 8. 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. 32 Bastikarma
  51. 51. Karnika : In order to prevent undue penetration of the bastinetra deep in to therectum, a karnika or rim has to be made. It is to be placed at a required point above thedistal end. Two karnikas are provided on the netra at distance of 2 angulas between one,another at proximal end to tie the bastiputaka properly.147 Bastiputaka : The container or bag used to carry the bastidravya, ready forapplication is known as bastiputaka. In ancient days the urinary bladder of maturedanimals like cow, buffalo, dear, pig, goat etc were used. It was then processed to makesoft and colorful by removing the blood vessels and other impurities. It should be made suitable for well fitting with the bastinetra and should not haveany foul smell. If good bladder is not available some other materials are recommendedfor the purpose. They are the skin of lower limb or neck of monkeys or other animals,thick cloth with sufficient strength and size may also be used.148 Now a days, due to technological development various types of materials areavailable to make up of bastiputaka and even disposable bastinetra are available. Therubber bladder and polythene bags are best choice. Presently in most Panchakarmatheaters the disposable bastiyantras with polythene bags are in use. 33 Bastikarma
  52. 52. Table No: 5 Netradosha and putakadosh 149-150No. 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 ShithilabandhanaNot fixed properly to the Dravya comes out putaka 7. Parshwachhidra Hole on side Leakage of dravya happens 8. Vakrata Curved / irregular Dravyagati becomes irregular 9. Assannakarnika 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 properlyNo. Putakadosha Features Effect 1. Vishama Shape not in uniform Gati vishamata happens during pressing 2. Mamsala Muscular tissue present Produces offensive small 3. Chinnachidrayukta 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 through The procedures and preparations are classified into three parts: - 1.Poorvakarma(pre-treatment) 2.Pradhanakarma (treatment) 3.Paschatkarma. (post-treatment) The physician who is administering basti should have good theoretical knowledgeand sufficient practical experiences in the therapy. The classical books have explained somany complications that are produced due to improper and in efficient administration. 34 Bastikarma
  53. 53. ANUVASANABASTI PROCEDUREPoorvakarma : The body of the patient should be anointed with suitable sneha and gentlyfomented with hot water. Then he is advised to have his prescribed meal and made totake a short walk. Having passed stool and urine he is laid on a couch, which is not veryhigh, and the head must be at lower level. No pillows are used. The patient should lie onhis left side drawing up the right leg and straightening the left leg.151-153Pradhana karma : The oil prescribed for Anuvasana taken in the bastiputaka and tied well placingthe bastinetra in position. The trapped air in bastiyantra is expelled by gently pressing thebastiputaka. Then the anal region and the netra should be smeared with oil. Gently probethe anal orifice with the index finger of the left hand and introduce the bastinetra throughit into the rectum up to first karnika. Keeping in the same position press the bastiputakawith right hand with adequate force. Release carefully the bastinetra when a little quantityof sneha remained inside the bastiputaka.154Paschatkarma : The patient is kept lying on his back as long as it would take to count up tohundread. The patient should be gently struck three times on each of the soles and overthe buttocks. The distal part of the cot should be raised thrice. Allow him to lie forsometime in the same position. If he gets the urge for defecation he may do it. But in theevent of sneha passed immediately another Anuvasanabasti should be given. Afterpassing the motion with sneha in proper time the patient is allowed to take light food if hefeels hungry.155-156 Maximum duration of the withdrawal of snehabasti is 3 yama i.e. 9hours. 35 Bastikarma
  54. 54. MATRABASTI Matrabasti is a type of Sneha Basti described by the Acharyas. It is termed sobecause of the dose of Sneha used in it is very less as compared to the dose of SnehaBasti.157-159 If we make an effort to understand the meaning of the term Matra, it gives variousmeaning with respect to different context, such as Measurement, Quantity, Size,Duration, Number, Degree, Movement, Unit of time. It also stated it as prosodial instanti.e. the length of time to pronounce a short vowel. In the present context the term Matragives the meaning for the unit of measurement i.e for the quantity of Bastidravya. Basti also having different meaning according to various context but in presentcontext it is considered as therapeutic procedure of Panchakarma as discussed earlier indetail. Acharya Vagbhata has defined the Matrabasti as the Basti in which the dose ofSneha is equal to Hraswa matra of Snehapana.160-161Indications : According to Charaka, Matrabasti is always applicable to those emaciated due tooverwork, physical exercise, weight lifting, way faring, journey on vehicles, indulgencein women, in debilitated person as well as in those afflicted with Vata disorders.Ashtanga Sangraha, 162 emphasized on regular administration of the Matrabasti and it canbe administered at all times and in all seasons just as Madhu Tailika Basti. 36 Bastikarma
  55. 55. Table No: 6 showing indications of Matrabasti 163-165 Sl. No. Indications Ch. A.H. A.S. 01. Karma karshita + - - 02. Bhara karshita + + + 03. Adhva karshita + + + 04. Vyayama karshita + + + 05. Yana karshita + - + 06. Stree karshita + + + 07. Durbala + + + 08. Vata Rogi + + + 09. Bala - + + 10. Vriddha - + + 11. Chintatur - + + 12. Stree - - + 13. Nripa - + + 14. Sukumar - - + 15. Alpagni - + + 16. Sukhatma - + - Contraindication :165 In classics, there are no major contraindications mentionedfor Matrabasti, but Ashtanga Sangraha has stated that Matrabasti should not beadministered in the persons having Ajirna. Qualities : The Matrabasti is promotive of strength without any demand of strictregimen of diet, causes easy elimination of Mala and Mutra. It performs the function ofBrimhana and cures Vatavyadhi. It can be administered at all times in all seasons and isharmless.166 Vagbhata has mentioned that Matrabasti improves Varna and Bala. Headds that it can be given regularly, which is indicated for bala, vriddha, and alpagniperson. No need of parihar after adminstration of Matrabasti, no such complicationsarises. He mentioned it as Varnya, doshaghna etc.165 Acharya Hemadri commenting onthe term sukha stated that, it is devoid of complications.167 37 Bastikarma
  56. 56. Dose : “Hraswayaha snehamatrayaha matrabastihi samo bhaveth”168 Matrabastithe term is popular because of its dose only, because sneha is administered in thehraswamatra. According to Vagbhata, Matrabasti is recommended in the dose equal tothe dose of Hraswa Snehapana.169 The Matra which gets digested in 2 Yama i.e. 6 hoursis called as Hraswa Matra of Snehapana, but the dose required to get digested in 2 Yamais not mentioned.165 Susruta has given the dose as ½ of the dose of Anuvasana Basti and according tohim the dose of Anuvasana Basti is ½ of the dose of Sneha Basti. In Sneha Basti, the dosegiven is ¼ of the total dose of Niruha Basti i.e. 6 Pala (24 Tola). Hence, the does ofMatraBasti is 1½ Pala = 6 Tola = 72ml.170 According to Chakrapani, the dose of SnehaBasti is 6 Pala, dose of Anuvasana Basti is 3 Pala and of Matrabasti is 1½ Pala.171Acharya Kashyapa prescribed the quantity of Matrabasti as 2 palas as uttamamatra, 1 ½pala as madhyama matra and 1 prakuncha as hraswa matra. He even stated that half palaof sneha can be given in newborn baby, it can be administered without any hesitation andcomplication too.172 Sharangandhara mentioned sneha matra of Matrabasti as 2 palas (8tolas).173 On the basis of above references, it can be said that the dose of Matrabasti is 1½Pala of Sneha i.e. 6 Tola = 72ml.Table No: 7 Dose of Matra basti according to Age Sl. Age in Years Matra in Tola Sl. Age in Years Matra in Tola 1 1 1/4 11 11 2¾ 2 2 1/2 12 12 3 3 3 3/4 13 13 3½ 4 4 1 14 14 4 5 5 11/4 15 15 4½ 6 6 1½ 16 16 5 7 7 1¾ 17 17 5½ 8 8 2 18 18 6 9 9 2¼ 19 19-70 6 10 10 2½ 20 70 and above 5 38 Bastikarma
  57. 57. Food before Basti Procedure: Matrabasti should not be given after the patienthas consumed excessively Snigdha ahara because Sneha taken in double quantity givesrise to Mada and Murccha. Before Matrabasti, the patient should avoid the intake ofexcessively Ruksha ahara because it causes depletion of Bala and Varna. Therefore,patients should be given low Sneha diet before Matrabasti.174 Pathya – Apathya :175 The Matrabasti does not demand any regimen of diet orbehaviour. It can be given at all times and in all seasons without any restriction.However, Ashtanga Sangraha has restricted the day sleep after being treated withMatrabasti. Retention of Matrabasti : The normal Pratyagamana Kala of Sneha Basti is 3Yama i.e. 9 hours. Being a type of Sneha Basti, the Pratyagamana Kala of Matrabasti isalso 3 Yama i.e. 9 hours. There is no harm if Matrabasti retains in the body because,while describing Anuvasana Basti it has been said that it is not harmful to body even inthe event of its being retained in the body for a whole day. Also the dose of Sneha inMatrabasti is very small, which can get easily absorbed in the body without coming out.It is believed that Sneha Basti should be retained in the body. If Basti material returnsmuch earlier, it cannot produce the desire effect in the body.176 Samyaka Yoga Lakshana of Matrabasti : Being a type of Sneha Basti,Samyaka Yoga Lakshana of Sneha Basti are to be taken as Samyaka Yoga Lakshana ofMatrabasti. The Lakshana of Samyaka Anuvasana are the return of Sneha with the fecalmatter without being stuck up anywhere, the clarity of Rakta, Mamsa etc. Dhatus andsense organs, good sleep, lightness of body, increase of strength and regulation of theexcretory urges.177 39 Bastikarma
  58. 58. Complication of Sneha Basti : Though it is said that there is no majorcomplication by the use of Matrabasti but sometimes complication may be produced dueto obstruction of Sneha by Vata, Pitta, Kapha or by excess of Mala or food and whengiven to a person on empty stomach. These are six conditions of complications likely toarise during the use of Sneha Basti.17801) Vata Avrita Sneha179 –180 : If in a condition of excess of Vata, Sneha is given in coldcondition or in small quantity, it gets Avrita by Vata and will not be able to return as itscourse is obstructed by Vata. Such Sneha produce Agnimandya, Jwara, Adhmana,Stambha, Urupida, Parshwashula. Treatment: In this condition Niruha Basti prepared by Rasna, Pitadaru, Tilvak,Sura, Sauviraka, Kola, Kulattha, Yava, Gomutra, Panchamula should be administered toeliminate the Vatavrita Sneha. 18102) Pitta Avrita Sneha : If excessive Ushna Basti is given in the condition of excessPitta, it produces Daha, Raga, Trasa, Moha, Tamaka and Jwara. Treatment: This condition should be cured with the enema prepared withMadhura and Tikta Dravyas. 18203) Kapha Avrita Sneha : If Mrudu Basti is given in condition of excess Kapha, itcauses Tandra, Sheeta Jwara, Alasya, Praseka, Aruchi, Gaurva, Murccha and Glani. Treatment: It should be corrected with Basti prepared with Kashaya, Katu,Tikshna and Ushna Dravya and with Sura and Gomutra and mixed with Madana Phalaand Amla Dravya. 40 Bastikarma
  59. 59. 04) Anna Avrita Sneha 183 : If Basti prepared with Guru Dravya and given after a heavymeal it gets obstructed by Anna. This Annavrita Sneha, leads to Chhardi, Murccha,Aruchi, Glani, Shula, Nidra, Agnimandya and Ama Lakshanas with Daha. Treatment: Such condition is treated by stimulating digestion with decoction andpowders of Katu and Lavana Dravyas. Also Mrudu Virechana and the treatment advisedfor Ama should be adopted. 18405) Purisha Avrita Sneha : In case of accumulation of Mala, if Basti having AlpaBala is administered it produces symptoms like Purisha Sanga, Mutra Sanga, Vata Sanga,Shula, Gaurava, Adhmana and Hridaroga. Treatment : This condition should be treated with Snehana, Swedana along withPhalavarti. The Anuvasana Basti and Niruha Basti prepared with Shyama, Bilva etc.should be used. Also the treatment indicated in Udavarta should be followed. 18506) Abhukta Pranita Basti : If Basti is given in a person with empty stomach itreaches upwards due to absence of any obstruction. Also if Basti is administered in aperson with empty bowel with great force it reaches up very high and from there it mayreach the throat and may come out from the upper orifice of the body. Treatment : In this condition, Niruha Basti and Anuvasana basti of Snehaprepared with Gomutra, Shyama, Trivritta, Yava, Kola, Kulattha should be given and thecondition where it is coming out the throat, it should be treated by Kashaya Dravyas,pressure on the throat and by Virechana and Chhardighna measures. 41 Bastikarma
  60. 60. Table No: 8 Showing Samyak, Heena and Atiyoga yoga of Anuvasana basti186 Samyak yoga Heena yoga AtiyogaExpulsion of complete oil Low backache Palpitationwith faecesTissues, senses become Dry skin Faintingclear and functioningnormalSleep becomes usual Dry stool ConvulsionsBody becomes light and ParikartikastrengthensProper flow of natural urges Obstruction of natural urges Cutting pain in gudaImportance Of Matrabasti We can summarize the importance of Matrabasti by considering its advantagesby following points It can be given to bala, vrudha, sukumara, stree, and everybody. There are no restrictions of vihara, even one can perform routine works after administration of Matrabasti. It does not give any complications as other bastis leads, eventhough matra is less it has widespread action throughout the body. Niroohabasti and anuvasanbasti can be administrated alternatively, but Matrabasti alone can be administered everyday continuously without any complications. Matrabasti has no restrictions as of Asthapana and Anuvasana. Matrabasti can be administered anytime irrespective of age, day, and time. No such ahara sevanakrama before or after the administration of Matrabasti. It can be administered to durbala purusha where other bastis are contraindicated in them. It eliminates vitiated dosas along with mala from the body it acts as shodana, shamana, brumhana, vatahara and even balya. 42 Bastikarma
  61. 61. Basti Karmukata As it is said that “Guda moolam hi shareeram”, By maintaining the left lateralprocedure, when lying at the time of basti procedure, the Bastidravya reaches thePakwashaya resides in the left side. Charaka opines by attaining this posture, Gudavaleeswill be relaxed. He also mentions that the Grahani is situated in the left side. Chakrapani states that Agni will be in the natural state in the posture whileGangadhara says; Agni, Grahani and Nabhi are present in the left side. Jejjata commentsAgni is present left side over the Nabhi, Guda has got a left sided relation withSthoolantra. So Bastidravya can reach to the large intestine and Grahani, as they arepresent in the same level. Action of basti is possible by Anupravaranabhava of bastidravya i.e. Sneha easilymoves up to grahani, which freely moves in the intestine. Charaka, says bastidravya reachnabhi, katipradesha and kukshi. The action of Basti is mainly due to the Veerya. The drug used in the basti karmawill however spread in the body from Pakwashaya due to their veerya, through theappropriate channels. The veerya is drawn into the body by apanadi vatas i.e. first byApana, then Udana and throughout the body by vyana. Also as water sprinkled at the rootof tree circulates all over the tree by its own specific property. So Bastikarma eliminatesthe morbid Doshas and Dooshyas from the entire body (by Srotosuddhi) whether lodgedin any part. 43 Bastikarma
  62. 62. Basti acts mainly on Asthi and Majjavaha srotas. Asthi is the seat of Vata dosha.Dalhana says that Pureeshadharakala and Asthidharakala are one another the same. So wecan assume that if Pureeshadharakala gets purified and nourished; the Asthivaha srotaswill also be purified and nourished. Also another factor is about the relation betweenPittadharakala and Majjadharakala, Pittadharakala and Grahani. As an opinion says aboutthe spread of Bastidravya till Grahani and Grahani is the seat of Agni, the nutrients mayget absorbed and thereby nourishes the Majjadharakala, which is having a strong bondwith vata and the nervous system.Probable Mode of Action It is practically seen that after appropriate administration of Bastikarma the signsand symptoms of Vatavyadhi will be reduced. Left lateral position is the best posture for better and effective administration ofbasti as anal canal turns to left side to rectum, sigmoid colon and descending colon wheremore mala to be dissolved and is present. Moreover, medicines stay at these surfaces, getabsorbed more and show their best effect, especially in Matrabasti. The absorptive area ofmucosa is more on this side. On left side colon area is easily approachable through anusrather than on the right side and this posture relaxes the ileo-ceacal junction and makesthe easy flow into the sigmoid colon. According to modern science, as per Basti/Enema concerned, in trans-rectal route,the rectum has a rich blood and lymph supply and drugs can cross the rectal mucosa likeother lipid membrane. Thus, unionized and lipid soluble substances are readily absorbedfrom the rectum. The portion absorbed from the upper rectal mucosa is carried by thesuperior haemorrhoidal vein in to the portal circulation, whereas that absorbed from thelower rectum enters directly into the systemic circulation via the middle and inferiorhaemorrhoidal veins. 44 Bastikarma

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