“Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana         kra...
DECLARATION BY THE CANDITATE           I hereby declare that this dissertation / thesis entitled “Evaluation on the effect...
CERTIFICATE BY THE GUIDE        This is to certify that the dissertation entitled “Evaluation on the effect ofMatravasti i...
CERTIFICATE BY THE CO-GUIDE               This is to certify that the dissertation entitled “Evaluation on the effectof Ma...
J.S.V.V. SAMSTHE’S   SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST GRADUATE                   DEPARTMENT OF PANCHAKARM...
COPYRIGHT                       Declaration by the Candidate        I here by declare that the Rajiv Gandhi University of ...
ACKNOWLEDGMENT:          I have constantly witnessed Divine Providence in many instances and experiencesof my life. I than...
I am very much thankful to my teachers Dr. Jairaj Basarigidad           MD (Ayu),   Dr.Yasmeen Paniband MD (Ayu) for their...
Dr. Shakunthala, Dr. Asha, Dr. C.C Hiremath, Dr. S.B. Rotti, Dr. Bupesh, Dr. Gorpade,Dr. Deepa, Dr. Jadav, Dr. Mahantesh S...
LIST OF ABBREVIATIONS USED:             A.H     –    Ashtanga Hrudaya             A.S     –    Ashtanga Samgraha          ...
AbstractABSTRACT:       Sandhigatavata is a disorder where the locomotive functions are affected. InAyurvedic classics it ...
Abstractgroups Group A and Group B. 15 patients of Group A underwent Arohna KramaMatravasti for Nine days. Group B patient...
TABLE OF CONTENTSSI. No.                  Contents     Page No.01        Introduction                   0102        Object...
LIST OF TABLESSI.                                  Tables                                  PageNo                         ...
39   Showing distribution of patients by Economical status:                   14140   Showing distribution of patients by ...
74   Showing the percentage improvement in Clinical Parameters in both    178     Groups75   Showing Demographic data in p...
LIST OF FIGURESSI No                             Figures                             Page No01      Showing the Anatomy of...
39   Showing distribution of patients by different grades of   159     Vedana before Treatment40   Showing distribution of...
Introduction:       Movement is the sign of radiant life but unfortunately in some clinicalconditions this vital factor is...
Osteoarthritis is the most common form of arthritis affecting the weight bearing jointsof the knees, hips, lower spine and...
to Ayurveda and is a primary protocol in all treatments. So Panchakarma can play aprominent and significant role in giving...
not so effective and pose increased risk of gastric erosion, hepatic and nephrotoxicityetc adverse effects. And also it is...
144ml on 9th day. This is the technique explained by Adamalla in his commentary“Deepika” while commenting on Matra vasti e...
ObjectiveObjectives:       Sandhigatavata is a major problem as large percentage of population suffersfrom this malady. Ac...
Objectivean easy as well as convenient for patient as well physician. Hence Matravasti isselected. In Sandhigatavata, wher...
ObjectiveSandhigatavata; Dept of Kayachikitsa and pancha karma; Institute for Post graduateteaching & research in Ayurveda...
Historical review of Vasti KarmaVASTI REVIEW:Historical Review:        Man always struggled with present and attempted for...
Historical review of Vasti KarmaSamhita Kala:Charaka Samhita:       Vasti is a part of Panchakarma which has been describe...
Historical review of Vasti KarmaSangraha Kala:Sharangadhara Samhita:        Matravasti is explained in the Vasti Kalpanavi...
Historical review of Vasti KarmaVangasena:        In Vasti Karmadhikara chapter Acharya described about Vasti. Thedescript...
Etymology of VastiEtymology of Vasti:          Etymology reveals the ‘Origin and Developments’ in the meaning of a word.Th...
Etymology of Vastiwhich contains the organ basti i.e. urinary bladder. Hence the term vasti is used todesignate the proces...
ShareeraShareera:        The word shareera comprises both structural and functional aspects of thebody. Knowledge of Anato...
ShareeraTable No. 01: Showing Rachana shareera &Pramana of Gudhavalis: Sl.No Guda valis         Pramana 1            Prava...
Shareeraabout four angulas65. Which is attached to Sthulantra and through which Vata andPurisha is excreted out66.Pranaayt...
Shareera         Apana vayu does the act of defecation. This is significantly seen with atendency to flow downwards.Modern...
ShareeraTable No. 04: Showing Structure & Function of Rectum: Structure           Action           Function Mucosa        ...
Shareera       Sharangadhara has specified the location of pakwashaya (pavanasaya) asbelow the Tilam i.e. the Yakrut and K...
Shareera        The last stages of chemical digestion occur in the large intestine throughbacterial action. Substances are...
Vasti karmaVasti karma:          Vasti is considered as supreme therapy for Vatavyadhis. (mÉUqÉÉæwÉkÉ). Vastioccupies prim...
Vasti karmanourishing the body very fastly84. Eventhough Vamana and Virechana eliminates thevitiated Doshas form the body,...
Vasti karmaunderstanding of Vasti therapy. So Vastikarma has been brought into the followingclassifications broadly.92Adhi...
Vasti karma2) Dravya bheda:         It is based on the major ingredients of Bastidravya - kwatha or sneha and soclassified...
Vasti karmaTable No. 08: Showing type’s vasti based on its Karma:SI. No      Type of Vasti            Action01          Sh...
Vasti karma According to Kashyapa100: Yoga Vasti            8                   5                      3 Kala Vasti       ...
Vasti karma          i) Rakta Vasti : It is indicated in conditions like adhika rakta srava111.6) Matra bheda:        The ...
Vasti karmaDefinition:        WØûxuÉÉrÉÉ: xlÉåWûqÉɧÉÉrÉÉ qÉɧÉÉuÉÎxiÉ: xÉqÉÉå pÉuÉåiÉç| (cÉ.ÍxÉ.4/53)        According to...
Vasti karmaTable No. 11: Showing indication of Matravasti acc. to Classics: Sl.No       Indications                       ...
Vasti karmaQualities:        The Matravasti promotes strength without any pathyacof diet, causes easyelimination of Mala a...
Vasti karmastated that half pala of sneha can be given in newborn baby; it can be administeredwithout any hesitation and c...
Vasti karma    Arohana Krama Matravasti:             Acharya Adamalla in his commentary on Sharangadhara samhita, explaine...
Vasti karmaQualities of Matravasti:       The Matrabasti is promotive of strength without any demand of strict regimenof d...
Vasti karmaVasti Yantra:The device used for Vasti karma is called as Vastiyantra.It comprises of two parts –              ...
Vasti karma 9               8              8              Black gram             Feather of eagle                         ...
Vasti karma         If good bladder is not available some other materials are recommended for thepurpose. They are the ski...
Vasti karmaTable No. 17: Showing putakadosha of Vasti Putaka: No.          Putakadosha           Features                 ...
Vasti karmaSambara sangraha: It includes collection of Medicine, instruments etc. For MatravastiSneha dravya should be kep...
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Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana krama – A comparative clinical study” BY SANATH KUMAR D.G Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.

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Sandhivata matravasti pk024_gdg

  1. 1. “Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana krama – A comparative clinical study” BY SANATH KUMAR D.G Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfilment of the degree of AYURVEDA VACHASPATI IN PANCHAKARMA Under the guidance of DR. SURESH BABU. S M.D. (AYU), FRAV (GOI, Delhi) Professor P.G. Dept. of Panchakarma And co-guidance of DR. SANTOSH N. BELAVADI M.D. (Ayu) Ast. Professor P.G. Dept. of Panchakarma POST GRADUATE DEPARTMENT OF PANCHAKARMA D.G M.AYURVEDIC MEDICAL COLLEGE AND RESEARCH CENTER GADAG – 582103 2007-2010
  2. 2. DECLARATION BY THE CANDITATE I hereby declare that this dissertation / thesis entitled “Evaluation on the effectof Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama andSadharana krama – A comparative clinical study” is a bonafide and genuine researchwork carried out by me under the guidance of Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI,Delhi) Professor and the co-guidance of Dr. Santosh N. Belavadi M.D(Ayu), Ast.Professor,Post Graduate Department of Panchakarma, Shri D.G.M.Ayurvedic Medical College,Gadag.Date: Signature of the CandidatePlace: Gadag (Sanath Kumar D.G)
  3. 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Evaluation on the effect ofMatravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharanakrama – A comparative clinical study” is a bonafide research work done by SanathKumar D.G in partial fulfillment of the requirement for the degree of AyurvedaVachaspathi. M.D. (Panchakarma).Date: Signature of the GuidePlace: Gadag Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi) Professor P.G. Dept of Panchakarma Shri.D.G.M. Ayurvedic Medical College, Gadag.
  4. 4. CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “Evaluation on the effectof Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama andSadharana krama – A comparative clinical study” is a bonafide research work done bySanath Kumar D.G in partial fulfillment of the requirement for the degree ofAyurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the Co-GuidePlace: Gadag Dr. Santosh N. Belavadi M.D. (Ayu). Ast. Professor P.G. Dept of Panchakarma D.G.M Ayurvedic Medical College, Gadag.
  5. 5. J.S.V.V. SAMSTHE’S SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST GRADUATE DEPARTMENT OF PANCHAKARMA ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana krama – A comparative clinical study” is a bonafide research work done by Sanath Kumar D.G under the guidance of Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi) Professor, and co-guidance of Dr. Santosh N. Belavad M.D. (Ayu), Ast. Professor, Post Graduate Department of Panchakarma, Shri. D.G.M.A.M.C, Gadag and contributed good values to the Ayurvedic research. Dr. Sivaramudu M.D. (Ayu), M.A (San), M.A (Psy) Dr. G. B. Patil Prof. and H.O.D. Principal, P.G. Dept of Panchakarma Shri. D.G.M. Ayurvedic Medical College,Shri. D.G.M. Ayurvedic Medical College, Gadag Gadag.Date: Date:Place: Gadag Place: Gadag
  6. 6. COPYRIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate this dissertation /thesis in print or electronic format for academic / research purpose.Date: Signature of the CandidatePlace: Gadag. Sanath Kumar D.G © Rajiv Gandhi University of Health Sciences, Karnataka.
  7. 7. ACKNOWLEDGMENT: I have constantly witnessed Divine Providence in many instances and experiencesof my life. I thank Almighty for helping me soar to a new high today. I express my deep sense of gratitude to his great holiness Jagadguru ShriAbhinava Shivananda Mahaswamiji, for their divine blessings. I give my respect at this moment to my father Sri. Guddappa Gowda. D, mymother Smt. Nagaveni for their blessings which gave me enough strength. I thank mysisters Smt. Supriya, Smt. Shwetha and their family for affection and continuousencouragement. The inspiring forces throughout this research work; was my guide Dr. Suresh Babu.S, M.D. (Ayu), FRAV (G.O.I, Delhi). I use this opportunity to express my immense gratitude andheart full thanks for his timely advises, constant encouragement, critical analysis, untiringhelp and rousing clinical knowledge. I would like to avail the opportunity to express my gratitude to my respected co-guide Dr.Santosh N. Belavadi, M.D. (AYU), for his humble nature, indulgence, dynamicsupervision and scholarly suggestions during the course of this research work. I express my gratefulness to professor Dr. P.Sivaramudu, M.D.(Ayu), HOD, Dept ofPanchakarma for his inspiration, critical suggestions, timely help rendered me throughout this work. I am sincerely thankful to professor Dr.G.Purushothamacharyulu, M.D. (Ayu) whowas former H.O.D. of the department, for his scholarly guidance. I express my thankfulness to beloved principal Dr. G. B. Patil, for hisencouragement and support by providing all necessary facilities for this research work. i
  8. 8. I am very much thankful to my teachers Dr. Jairaj Basarigidad MD (Ayu), Dr.Yasmeen Paniband MD (Ayu) for their timely help and suggestions during this study. I express my sincere thanks to Dr. Rajashekar C.V. MD (Ayu), who was formerteacher in the department, for his critical suggestions. I am grateful to all the PG teachers Dr. K.S.R. Prasad, Dr. M. C. Patil, Dr.Mulugund, Dr. G. S. Hiremath, Dr. R. V. Shettar, Dr. Girish Danappa Goudar, Dr.Jagadeesh Mitti, Dr. KuberSankh, Dr. Shashikanth Nidugundi, Dr. B. M. Mulkipatil andDr. M.D. Samudri, for their valuable inputs and suggestions. I extend my immense gratitude to Dr. V. M. Sajjan, Dr.Purad, Dr.Yarageri,Dr.Suvarna Nidugundi, Dr. Shakuntala and other teaching staff who helped during mystudy. I express my sincere thanks to Sri. Nandakumar, for his help in statistical analysisof results. I take the privilege to thank Sri. Mundinamani, Librarian. I also extend mythanks to assistant librarians Mr. Shyavi and Mr. Keroor who provided me all thenecessary books and time for my literary work. I am very much thankful to Sri Tippanagowdar (Lab Technician), and Sri.Basavaraj (X-Ray Technician), for their help during the study. I extend my thanks to SriKulakarni, Sri Nabi, Smt. Sunanda and Smt Renuka for their timely help in trail. I feel extremely thankful to seniors Dr. Ashok M.G, Dr. Prasanna V. Joshi, Dr.Nataraj, Dr. Udaya Ganesha, Dr. Adarsh, Dr. Sanjeev Chaudary, Dr. Shailej, Dr.Madhushree, Dr. Payappa Gowdar, Dr. Devandrappa Budi, Dr. Mukta Hiremath, Dr.Prasanna Kumar, Dr. Siba Prasad and others for valuable suggestions. I pay sincere regards to my fellow colleagues Dr. Sabareesh, Dr. Rajesh, Dr.Jayasankar, Dr. Deepak, Dr. Ishwar Patil, Dr. Praveen Nayak, Dr. Bodke, Dr. Kanti, ii
  9. 9. Dr. Shakunthala, Dr. Asha, Dr. C.C Hiremath, Dr. S.B. Rotti, Dr. Bupesh, Dr. Gorpade,Dr. Deepa, Dr. Jadav, Dr. Mahantesh Swami Hiremath and Dr. Praveen Palyed for theirtruly help and co-operation. I thank my juniors Dr. Joshi George, Dr. Bhagyesh, Dr. Anish, Dr.Raghavendrachar, Dr. Suraj, Dr. Vijay Raj, Dr. Vijay Mahanthesh, Dr. Sateesh, Dr.Vishwajith, Dr. Renukaraj, Dr. Sangamesh, Dr. Jagadeesh, Dr. Maneesh, Dr. Paresh andDr. Shilpa for their support. I thank specially to Internees and UG friends for their help and supports. I am also very much thankful to Mr. Shakthi (Local Guardian), Mr. Salimat,Smt. Lalithamma who made my stay comfort through out my P.G. carrier. Lastly I pay my deepest respect for those patients who took part in the study and Ishare my success with them. “To err is Human” – certain names, who could be directly or indirectly helped inthis work, might have been missed unintentionally. Thanks are due to all of them.Date : Dr. Sanath Kumar D.GPlace : Gadag iii
  10. 10. LIST OF ABBREVIATIONS USED: A.H – Ashtanga Hrudaya A.S – Ashtanga Samgraha B.P – Bhavaprakasha B.S – Bhela Samhita C.S – Charaka Samhita M.N – Madhava Nidana S.S – Sushruta Samhita, V.S – Vangasena Y.R – Yogaratnakara iv
  11. 11. AbstractABSTRACT: Sandhigatavata is a disorder where the locomotive functions are affected. InAyurvedic classics it explained under Sthana visheshakruta Vatavyadhi, under theconcept of Gatavata. Sandhigatavata can be compared with Osteoarthritis as the clinicalfeatures simulate each other. It is also called as degenerative joint disease orosteoarthrosis. Matravasti is very much convenient to administer in present day busy life.Arohana Krama Matravasti is a specific treatment modality where the dose of Matravastiis gradually increased daily for nine days. Kethakyadi Taila is considered fromSahasrayoga, which is indicated in Astigata vata. Here an attempt is made to comparethe efficacy of two varieties of Matravasti with Kethakyadi Taila in Sandhigatavata withthe title “Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyaditaila in Arohana krama and Sadharana krama – A comparative clinical study”.Objectives of the study: • To evaluate the efficacy of Matravasti administered in Arohana krama for 9 days by using Kethakyadi taila in Sandhigatavata. • To evaluate the efficacy of Matravasti administered in Sadharana krama i.e. fixed dose of 1 ½ pala for 9 days by using Kethakyadi taila in Sandigatavata. • To evaluate the adverse- effects of Arohana krama Matravasti if any. • To evaluate the efficacy of Kethakyadi taila administered as Arhohana karma as well as Sadharana karma in Sandhigata vata.Materials and Methods: A total of 30 patients were selected from O.P.D and I.P.D of D.G.M.A.M.C & Hafter fulfilling the inclusion and exclusion criteria randomly. They were divided in to two v
  12. 12. Abstractgroups Group A and Group B. 15 patients of Group A underwent Arohna KramaMatravasti for Nine days. Group B patients underwent Sadharana Krama Matravasti forNine days. Assessment of results was done by considering the base line data of subjective andobjective parameters to pre and post medication and was compared for assessment of theresults. All the results were analyzed statistically for “P” value using Un-paired t-test.Subjective Parameters: Prasarana Aakunchanayoho savedana pravruthihi (Vedana) andSthamba (Morning stiffness)Objective parameters: Sandhi Atopa, Sandhishothaha, Sandigati Asamarthya, Walkingtime to cover 21meters of distance, WOMACResults:The overall results of the study were as follows;Group A: 01 (06.66%) shown Good response to the treatment. 07 (46.66%) were shownModerate response and 07 (46.66%) patients shown Poor response.Group B: 10 (66.66%) were shown Moderate response and 05 (33.33%) patients shownPoor response. From the statistical analyses, all parameters shows non-significant (as P>0.05).i.e., the mean affects of treatment same in all the parameters.All the parameters shows highly significant in both the Groups as P<0.05.Comparative efficacy: Overall the group A (Arohana krama Matravasti) is more effectivethan group B (Sadharana Krama Matravasti) in almost all the parameters.Key words: Sandhigatavata, osteoarthritis, Arohana Krama Matravasti, SadharanaKrama Matravasti. vi
  13. 13. TABLE OF CONTENTSSI. No. Contents Page No.01 Introduction 0102 Objectives 0403 Review of Literature 0904 Materials and Methodology 12205 Observations and Results 13606 Discussion 19007 Conclusion 21808 Summary 21909 Bibliography 22410 Annexures 254 vii
  14. 14. LIST OF TABLESSI. Tables PageNo No.01 Showing Rachana shareera &Pramana of Gudhavalis 1602 Showing Gudha valis kriya karma 1703 Showing Gudha valis Sthana and Modern terminology 1804 Showing Structure & Function of Rectum 1905 Showing Sub divisions of large intestines 2006 Showing Classification of Basti karma based on Route of 24 administration07 Showing types of Anuvasana vasti and its Matra 2508 Showing types vasti based on its Karma 2609 Showing Sankya Bhedha of Vasti Prakara 2610 Showing Matra bheda of Vasti dravya 2811 Showing indication of Matra basti acc. to Classics 3012 Showing Matra of sneha basti mentioned indifferent Classics 3213 Showing Dose of Matra basti according to Age 3214 Showing Dose of Arohana krama Matra vasti 3315 Showing Measurements of Vastiyantra 3516 Showing Netradosha of Vasti netra 3717 Showing putakadosha of Vasti Putaka 3818 Showing Samyak, Heena and Atiyoga yoga of Anuvasana vasti 4219 Showing Type of Sandhi’s and there sites 5720 Showing the Viprakrishta nidana of Sandhigatavata 7021 Showing the Aharaja nidana of Sandhigatavata explained in different 70 treatises22 Showing the Viharaja nidana of Sandhigatavata explained in different 71 treatises23 Showing the Manasika nidana of Sandhigatavata explained in 72 different treatises24 Showing the Anyata nidana of Sandhigatavata explained in different 72 treatises25 Showing the Roopa of Sandhigatavata explained in different treatise 7726 Showing the Samprapti ghataka of Sandhigatavata 8427 Showing the Vyavachedhaka nidana of Sandhigatavata 8628 Showing Chikitsa modalities as mentioned in different classics 9029 Showing the Pathyas of Sandhigatavata 9330 Showing the Apathyas of Sandhigatavata 9431 Showing Clinical features of Osteoarthritis 10832 Showing Differential Diagnosis of Osteoarthritis 11133 Showing Scoring and Interpretation 0f WOMAC 11534 Showing Guna-Karma of Ingredient of Kethakyadi Taila 12335 Showing Guna-Karma of Tila 12436 Showing the distribution of patient’s age group 13837 Showing the distribution of patients according to sex 13938 Showing distribution of patients by Religion 140 viii
  15. 15. 39 Showing distribution of patients by Economical status: 14140 Showing distribution of patients by Occupation 14241 Showing distribution of patients by Type of diet 14342 Showing distribution of patients by Marital Status 14443 Showing distribution of patients by Mode of Onset: 14544 Showing distribution of patients by Vihara (Nature of work) 14645 Showing distribution of patients by Agni 14746 Showing distribution of patients by Kosta 14847 Showing distribution of patients by Nidra 14948 Showing distribution of patients by Vyasana 15049 Showing distribution of patients by Deha Prakruti 15150 Showing distribution of patients by Samhanana 15251 Showing distribution of patients by Satmya 15352 Showing distribution of patients by Vyayama Shakti 15453 Showing distribution of patients by Vaya 15554 Showing distribution of patients by Joint Involvements 15655 Showing the distribution of patients by duration of the disease 15756 Showing the distribution of patients by different grades of Vedana 158 before Treatment:57 Showing the distribution of patients by different grades of Vedana 159 after Follow-up:58 Showing the distribution of patients by different grades of Sandhi 161 Atopa before Treatment59 Showing the distribution of patients by different grades of Sandhi 162 Atopa after follow-up60 Showing the distribution of patients by different grades of Sandhi 163 shothaha before treatment:61 Showing the distribution of patients by different grades of Sandhi 164 shothaha after follow-up62 Showing the distribution of patients by different grades of Sthamba 165 before treatment63 Showing the distribution of patients by different grades of Sthamba 166 after follow-up:64 Showing the distribution of patients by different grades of Sandhigati 167 Asamarthya65 Showing the distribution of patients by different grades of Sandhigati 168 Asamarthya after follow-up66 Showing the distribution of patients by different grades of Walking 169 Time before treatment:67 Showing the distribution of patients by different grades of Walking 171 Time after follow-up:68 Showing the distribution of Overall Response to the treatment 17369 Comparative Study of Group A and Group B after treatment 17470 Individual study of the Group A 17471 Individual study of the Group B 17572 Showing the Clinical Parameters before treatment and After Follow- 176 up of Group A73 Showing the Clinical Parameters before treatment and After Follow- 177 up of Group B ix
  16. 16. 74 Showing the percentage improvement in Clinical Parameters in both 178 Groups75 Showing Demographic data in patients of Group A (Arohana Krama) 17976 Showing Demographic data in patients of Group B (Sadharana 180 Krama}77 Showing Vayaktika vruttanta of patients (Group A – Arohana Krama 18178 Showing Vayaktika vruttanta of patients (Group B – Sadharana 182 Krama)79 Showing data related to Dashavidha pareeksha (Group A – Arohana 183 Krama)80 Showing data related to Dashavidha pareeksha (Group B - Sadharana 184 Krama)81 Showing data related to Disease in patients of Group A (Arohana 185 Krama)82 Showing data related to Disease in patients of Group B (Sadharana 186 Krama)83 Showing data related to Nidana in patients of Group A (Arohana 187 Krama)84 Showing data related to Nidana in patients of Group B (Sadharana 188 Krama)85 Showing average time of Vasti Dravya Retention in patients of both 189 Groups86 Showing response in patients of both Groups 19087 Showing the Percentage Improvement of Parameters in each patient 20988 Showing the Percentage Improvement of Parameters 21189 Indicating retention time of Arohana krama Matravasti 217 x
  17. 17. LIST OF FIGURESSI No Figures Page No01 Showing the Anatomy of Large Intestine 2002 Showing types of Sandhi 5703 Showing types of Joints 5804 Showing Anatomy of Knee Joint 6105 Showing Anatomy of Knee Joint 6106 Showing the Minisci of Knee joint 6307 Showing the Ligaments of Knee joint 6408 Showing Knee joint in Flexion and Extension 6509 Showing Samprapti of Dhatukshaya Janya Sandhigatavata 8110 Showing Samprapti of Avarana Janya Sandhigatavata 8311 Showing the Commonly effecting area of Osteo arthritis 9812 Showing Osteoarthritis of Knee 10313 Showing Radiological aspect of Osteoatrhritis 11014 Showing Exercise for Osteoarthritis 11915 Showing Exercise for Knee Osteoarthritis 12016 Showing Ingredients of Kethakyadi Taila 12617 Showing Ingredient of Vasti Pranidana 12618 Showing Vasti Procedure 13619 Showing the distribution of patient’s age group. 13820 Showing the distribution of patient’s sex group. 13921 Showing distribution of patients by religion 14022 Showing distribution of patients by Economical status. 14123 Showing distribution of patients by occupation. 14224 Showing distribution of patients by type of diet. 14325 Showing distribution of patients by Marital Status 14426 Showing distribution of patients by Mode of Onset 14527 Showing distribution of patients by Vihara (Nature of work) 14628 Showing distribution of patients by Agni: 14729 Showing distribution of patients by Kosta: 14830 Showing distribution of patients by Nidra: 14931 Showing distribution of patients by Vyasana: 15032 Showing distribution of patients by Deha Prakruti 15133 Showing distribution of patients by Samhanana 15234 Showing distribution of patients by Satmya: 15335 Showing distribution of patients by Vyayama Shakti 15436 Showing distribution of patients by Vaya 15537 Showing distribution of patients by Joint Involvements 15638 Showing distribution of patients by duration of the disease 158 xi
  18. 18. 39 Showing distribution of patients by different grades of 159 Vedana before Treatment40 Showing distribution of patients by different grades of 160 Vedana after follow up41 Showing distribution of patients by different grades of 161 Sandhi Atopa before Treatment42 Showing distribution of patients by different grades of 162 Sandhi Atopa after follow-up43 Showing distribution of patients by different grades of 163 Sandhi shothaha44 Showing distribution of patients by different grades of 164 Sandhi shothaha45 Showing distribution of patients by different grades of 165 Sthamba46 Showing distribution of patients by different grades of 166 Sthamba after follow-up47 Showing distribution of patients by different grades of 168 Sandhigati Asamarthya48 Showing distribution of patients by different grades of 169 Sandhigati Asamarthya after follow-up48 Showing distribution of patients by different grades of 170 Walking Time before treatment50 Showing distribution of patients by different grades of 172 Walking Time after follow-up51 Showing the distribution of Overall Response to the 173 treatment52 Showing the Percentage Improvement of Parameters 212 xii
  19. 19. Introduction: Movement is the sign of radiant life but unfortunately in some clinicalconditions this vital factor is affected and such person feels himself as a miserablecreature as he depends on others for daily activities. Sandhigatavata is one suchdisorder where in these locomotive functions are affected. In Ayurvedic classics itexplained under Sthana visheshakruta Vatavyadhi, under the concept of Gatavata1. Sandhigatavata can be compared with Osteoarthritis as the clinical featuressimulate each other. Osteoarthritis (OA) is the most common type of arthritis, and isseen especially among older people. It is also called as degenerative joint disease orosteoarthrosis. The upset in the fine balance among the bio regulating factors of the body –vata, pitta and kapha, make the person fall prey to diseases. If one can take care tomaintain the balance among these bio regulating factors, he is assured of good health. The term Sandhi means ‘sandhana’ i.e. the union of two or more structurestogether. According to commentator Dalhana the word Sandhi means Asthisandhi2.Here, specifically the union of two or more asthis takes place. Asthi is the dhatuwhich makes the dharana of the deha. This asthi dhatu and vata dosha are havingashraya ashrayee sambandha3. When the vata dosha is increased it is prone to getlodged in the asthis and sandhis. In old age, all Dhatus are deranged leading to VataPrakopa and making the individual prone to many vataja diseases. Sandhigata vata isone of such disease commonly affecting a large number of individuals. This disease can be compared with Osteoarthritis of contemporary medicalscience. According to World Health Organization (W.H.O) Osteoarthritis is thesecond commonest musculoskeletal problem in the world population (30%) after backpain (50%). The reported prevalence of O.A from a study in rural India is 5.78 %4. 1
  20. 20. Osteoarthritis is the most common form of arthritis affecting the weight bearing jointsof the knees, hips, lower spine and peripheral joints of fingers and toes. Only 25-30%of OA are symptomatic even though prevalence rate is about 80% at age of 65 years5. Chikitsa is mainly of two types –Shodana and Shamana. Shodana is concernedwith malas, while Shamana deals with doshas. Shodana strikes at the root of malasand eradicates them and as such the disorders – treated with Samshodana do notreoccur, while those treated with other methods like Shamana might re-appear6.Shodana measures eliminate the unwanted/vitiated doshas from the body through thenearest out lets and purify the system. The Samshodana therapy is an unique concept of Ayurvedic science. Itenvisages not only the visceral cleaning rather it aims at the total bio-purification uptomolecular level. A suitable administrated Samshodana karma is expected to cleansethe hollow organs, cells, cell membranes and their pores effecting the bio-purity ofintracellular contents and structures. If the body is biologically purified and cleansedthe physiology is restored optimally and pathology reversed. The nutrients reach theirdesired destinations easily and their bio-availability is enhanced. The entire process ofDhatu poshana and Dhatu Parinama is accelerated and the mechanism of Kedarakulya Nyaya, Khale-Kapota Nyaya and Kshira-Dadhi Nyaya are accomplished well.Similarly the medicaments administered in Samshuddha sharira reach their sites easilyand effectively and possibly even a relatively smaller dose of a medicine may producegreater effect. Shamana therapies include diet and medicine may not be effective unless thesrotas are cleaned and the vitiated doshas and malas are removed from the body soShodhana is first among all treatments and the most important. This concept is unique 2
  21. 21. to Ayurveda and is a primary protocol in all treatments. So Panchakarma can play aprominent and significant role in giving a new impetus in shaping the life style andcan provide answers to many diseases of the modern era. Vamana, Virechana, Asthapana vasti, Anuvasana vasti and Nasya are the fiveprocedures comprising Panchakarma7, 8, 9. Some Acharyas included Rakthamokshanaand both varieties of Vasti consider as one karma10. Among these, Vastikarma hasbeen placed a prime position by virtue of its wide indications and applicability likeshodhana, shamana, brumhana and karshana etc basing on the properties of the drugsemployed in the procedure11. Sandhigatavata is a Dhatukshayajanya Vyadhi and occurs usually after midlife stage. Here mainly Astivaha and Majjavaha srotodusti were observed. Prakopitavata dosha creates Sandhishoola, while due to Kapha kshaya particularly decrease ofShleshmaka Kapha, Sandhi Garshana take place and Symptoms like sandhi shotha,Vedana etc occurs. So considering all these above factors here in Sandhigata vata therequired drug should be having two characters like supportive and Supplementary. Insupportive aspect it gives relief in symptoms of sandhigata vata. So the drug which ishaving Vatahara properties and Snigda, Picchila etc Kaphavardhaka guna is useful inbetter way. In supplementary aspect the drug which is Rasayana-Asti specific isuseful for prevention or to stop further degenerative changes in the body. In contemporary medical science, treatment of Osteoarthritis is aimed at • Reducing pain • Maintaining mobility • Minimizing disability In contemporary medical science potent Analgesics, Anti-inflammatory drugsand also corticosteroids are generally prescribed for this disease. But these drugs are 3
  22. 22. not so effective and pose increased risk of gastric erosion, hepatic and nephrotoxicityetc adverse effects. And also it is clearly said that, current treatment of Osteoarthrosisis purely to control symptoms because there is no disease modifying Osteoarthrosisdrug yet. Intra articular steroids are widely used in OA particularly for the knee, theseinjections may provide marked symptomatic relief for weeks to month. Becausestudies in animal models have suggested that gluco corticoids produce cartilagedamage, and frequent injections of large amounts of steroids have been associatedwith joint breakdown in humans, the injection should generally not be repeated in agiven joint more often than every 4 to 6 months. In Ayurveda, all Acharyas have given prime importance to Snehana Chikitsain the management of Sandhigatavata. Snehana can be performed both Bahya andAbhyantara12. Bahya snehas include abhyanga, tarpana, murdhni taila etc andAbhyantara snehas include bhojana, pana, nasya and Vasti. Since sandhigata vata is a degenerative disease it requires some regenerativetherapies. Sneha (Kethakyadi Taila) used in this tril contains Kethaki mula, Bala andatibala, are Madhura rasa pradhanya dravyas, Madhura is Tarpana dravya which actsin regeneration of degenerated tissue including Asti dhatu. Moreover these are havingsnigdha guna which also regeneratives. The drugs Bala and Atibala are of Sheetaveerya which are also considered as jeevaneeya or regeneratives. Ushna veerya ofKethaki may help in penetrating the sheeta veerya Bala and Atibala into the tissues.All these are generally Tridosha shamaka. Hence the broad spectrum of action. “xlÉåWûxÉUÉå ArÉÇ mÉÑÂwÉÈ....|” i.e., man is nothing but essence of sneha13. Hencesneha’s role is important one. In vasti karma, generally it is used in Sadharana karmai.e in fixed dosage, but there is another method i.e. Arohana karma where in sneha isadministered in a accending order dully increasing dose of sneha 12ml every day upto 4
  23. 23. 144ml on 9th day. This is the technique explained by Adamalla in his commentary“Deepika” while commenting on Matra vasti explained by Acharya Sharghadara14.Since this technique appears to be innovative, it has been adopted in the present studyexpecting some good results than sadharana karma. Final results also strengthenedthis opinion as per clinical and statistical observation made after the study. 5
  24. 24. ObjectiveObjectives: Sandhigatavata is a major problem as large percentage of population suffersfrom this malady. Acharya Charaka has explained Sandhigatavata as one among theVatavyadhi and characterized by “Vatapurnadrutisparsha, Shotha, PrasaranaAkunchanayoho Savedana Pravrutti”15. This can be compared with Osteoarthritis of contemporary medical science.There is a steady rise in prevalence from age 30 such that by 65, 80% of people haveradiographic evidence of OA16. According to Ayurveda in this age, Vata is inPravrudhavastha and may cause degenerative diseases like Sandhigatavata etc. Only 20-30% of OA are symptomatic even though prevalence rate is about80% at age of 65 years17. In contemporary medical science potent Analgesics, Anti-inflammatory drugs and also corticosteroids are prescribed for this disease. But thesedrugs are not so effective and pose increased risk of gastric erosion, hepatic andnephrotoxicity etc adverse effects. In view of this, designed a clinical study based on the Samanya Vatavyadhichikitsa as described by Acharya Charaka18 and Sandhigatavata chikitsa described byAcharya Sushrutha19. The procedure of Matravasti is selected with the KethakyadiTaila (Sahasrayoga) 20 for the proposed study. The Arohana krama of Mathavasti asexplained by Acharya Adamalla in his commentary “Deepika” on Sharangadharasamhita21 is taken into consideration in planning the study. Kethakyadi Taila consists of drugs like Kethaki mula, Bala and Atibala, whichare considered as safe for Vasti karma. Hence selected for this trial work. In Ayurveda Vasti is one of the important line of treatment for Vatayadhis.Matravasti, a type of Snehavasti, which does not requires strict follow up22. So this is 6
  25. 25. Objectivean easy as well as convenient for patient as well physician. Hence Matravasti isselected. In Sandhigatavata, where the degeneration of the bone is seen, the proposedtreatment is expected to give the utmost results, because the Ketakyadi Taila isspecially indicated in Asthigata vata. By keeping the hypothesis that, Kethakyadi tailais not used in Arohana karma Mathravasti, so chosen the research topic to use sameKethakyadi taila for the two procedure vise in Sadharana karma and Arohana karmato evaluate the efficacy over the management of Sandhigathavata with reference toruk and shotha in affected joint. And undertake this trial with the title, “Evaluation onthe effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana kramaand Sadharana krama – A comparative clinical study”Previous researches on the same diseases: Many numbers of studies have been done in many P.G. Centers all over Indiaunder various universities. Different therapeutic modalities like, Shamana drugs andShodhana procedures have been tried. Some of these are -i) Shayer Latha B: Role of Snehana (Anuvasana) Vasti in the management ofSandhigatavata; Dept of Shalya tantra, Govt. Ayurvedic Medical College, Bangalore;R.G.U.H.S. Bangalore; 1991.ii) Rajashekhara K: The effect of Gudoochi ksheera- Vasti in Sandhivata; Dept. ofKayachikitsa, Dr. B.K.R.R. Government Ayurvedic college Hyderbad, AP University,Vijayawada; 1998.iii) Bharathi A.P: The role of Matravasti in management of Sandhigatavata ; Dept ofkaya chikitsa, Govt Ayurvedic medical college, Mysore; RGUHS, Bangalore; 1999.iv) Shinde kalpana: A clinical study on the role of Pancha tiktha Gritha Matravastiand Pancha tiktha ksheera paka with shuddha gritha in the management of 7
  26. 26. ObjectiveSandhigatavata; Dept of Kayachikitsa and pancha karma; Institute for Post graduateteaching & research in Ayurveda; Gujarata Ayurveda University, Jamnagar; 2000..v) Madhushree H. S: Evaluation of the comparative efficacy of Matra vasti & Januvasti with Bala Taila in sandhigatavata; Dept of Panchakarma, D.G.M.A.M.C Gadag;RGUHS, Bangalore; 2005.vi) Natraj C: Evaluation of the efficacy of Panchachatikthaksheera vasti insandhigatavata; Dept of Panchakarma, D.G.M.A.M.C Gadag; RGUHS Bangalore;2006.Objectives of the study: a) To evaluate the efficacy of Matravasti administered in Arohana krama for 9 days by using Kethakyadi taila in Sandhigatavata. b) To evaluate the efficacy of Matravasti administered in Sadharana krama i.e. fixed dose of 1 ½ pala for 9 days by using Kethakyadi taila in Sandigatavata. c) To evaluate the adverse- effects of Arohana krama Matravasti if any. d) To evaluate the efficacy of Kethakyadi taila administered as Arhohana karma as well as Sadharana karma in Sandhigata vata. 8
  27. 27. Historical review of Vasti KarmaVASTI REVIEW:Historical Review: Man always struggled with present and attempted for the better future andthese can be achieved with a better perspective. So, critical review of the history fromthe primitive stage to the new millennium assists one to understand the future in abetter way. History helps to reveal the hidden facts and ideas of the concerned subject.Even though it is really a difficult task to go in to the fathomless ocean of history ofAyurveda, it is an interesting task.MATRAVASTI Matrabasti is a type of Anuvasanavasti, “iÉxrÉÉÌmÉ ÌuÉMüsmÉÉåÅkÉÉïkÉïqÉɧÉÉuÉM×ü¹ÉåÅmÉËUWûÉrÉÉåïqÉɧÉÉoÉÎxiÉËUÌiÉ ||” (Su.Chi.35/18) which is quite relevant in present day living condition.Veda – Purana: There is some description about Vasti karma in Veda and Puranas. Vastikarmais indicated as a substitute for minor operation in Kaushika Sutra of Atharvaveda23. In Agnipurana, vastikarma is indicated as a principle line of treatment invataja aliments24. In Ashwa Chikitsa Kathana, Taila Vasti is recommended in horses to relievetheir fatigue immediately25. It is also stated that according to season different Sneha dravyas should beused for Vastikarma26.However, direct reference on Matravasti is not visible. 9
  28. 28. Historical review of Vasti KarmaSamhita Kala:Charaka Samhita: Vasti is a part of Panchakarma which has been described for first time insecond chapter of Charaka Samhita (Apamargatanduleeya adhyaya) where Acharyaexplaines that Panchakarma chikitsa should be adopted by considering Matra, Kalaetc27. This gives us the some idea about Matravasti. Later Acharya Charaka explainedabout Matravasti in detail in fourth chapter of Siddhi sthana, Snehavyapat SiddhiAdhyaya where he described about its indications, qualities and dose28. CommentatorChakrapani added his contribution by clarifying dose of Matravasti.Sushruta Samhita: In Netravasti pramana pravibhaga Adhyaya (thirty fifth chapter ofChikitsasthana), Acharya explained about Matravasti as it’s a variety of Snehavastibased on vasti dravya pramana29.Ashtanga Sangraha: Matravasti is described in Vastividhi Adhyaya (twenty eighth chapter ofSutrasthana). Acharya explained that indication of Matravasti is similar toMadhutailika Vasti. Along with the dose, indications and qualities of Matravasti, hehas specifically mentioned the contraindication of Matravasti30.Ashtanga Hridaya: In Vastividhi Adhyaya (nineteenth chapter of Sutrasthana), Acharya explainedMatravasti. Description is similar to the Ashtanga Sangraha, but the contraindicationsof Matravasti are not found in this text31. 10
  29. 29. Historical review of Vasti KarmaSangraha Kala:Sharangadhara Samhita: Matravasti is explained in the Vasti Kalpanavidhi (5th chapter of uttarakhanda).He has explained Matravasti as an Anuvasanavasti bheda. He has described the doseas 2 pala or even half of it32.Bhavaprakasha:In this, fifth chapter of Purvakhanda has been contributed to describe Basti whereAcharya stated that Matravasti as a variety of Anuvasana Vasti. Here Acharyaexplained the Uttama, Madyama and Avara Matra of Anuvasana Vasti and gradualincrease in its dose33.Kashyapa Samhita: Here Matravasti is described in Vastivisheshaneeya Adhyaya (eighth chapterof Khilasthana), Where Acharya descibed the uttama, madhyama and kaniyasi matraof Matravasti. He has also described the dose of Matravasti in children having givenup breast feeding (Annaja) 34.Bhela Samhita: The description of Vasti is available in four chapters of Siddhisthana namelyBastimatriyasiddhi, Upakalpasiddhi, Phalamatrasiddhi and DashavyapadikaVastisiddhi. But, description of Matravasti is not found in the available chapters35.Chakradatta: In these text two chapters named Anuvasanadhikara and Niruhadhikara aredealt with Anuvasana and Niruha Vasti respectively. Matravasti is not mentioned, buthe has described the three doses of anuvasana and their administration in arohanakarma36. The Kaniyasi matra explained in this script can be equated with Matravasti. 11
  30. 30. Historical review of Vasti KarmaVangasena: In Vasti Karmadhikara chapter Acharya described about Vasti. Thedescription is similar to Chakradatta. He also described three doses for AnuvasanaVasti37.Kalyanakaraka: In this text, Vastikarma is described in Vatarogadhikara only.Todarananda: In this text, Vastikarma is described in the chapter Vasti Vidhi adhyaya.AROHANA KRAMA MATRAVASTI: Acharya Adhamalla on commenting Shargandhara samhita Uttara Khanda,Vasti vidhi Adhyaya (Fifth chapter) described the Arohana krama of matravasti38. Acharya Bhavamishra in 5th chapter of Purva Khanda39, Acharya Chakradattain Anuvasanadhikara40 (72th) and Acharya Vangasena in Vastikarmadhikara chapter41explained the three doses for Anuvasana vasti and gradual increasing in dose. From technological point of view certain modified versions like Plastic bags,Plastic syringe etc are being used in Vasti therapy for easy administration and bettersterilization keeping with the present day need based requirements 12
  31. 31. Etymology of VastiEtymology of Vasti: Etymology reveals the ‘Origin and Developments’ in the meaning of a word.The word ‘Vasti/Basti’ is derived from the root word “Vas/Bas” and “Chit” pratyayaand belonging to masculine gender.According to Siddhanta Kaumdi, the root ‘Vas’ gives following meaning:“uÉxÉÑ ÌlÉuÉxÉå |” - Means to stay, to reside and to dwell.“uÉxÉç AÉcNûÉSlÉå |” - Means to wrap“uÉxÉç uÉÉxÉlÉå xÉÑUÍpÉMüUlÉå | ” - Give fragrance.“uÉÎxiÉ uÉxiÉå AÉuÉëÑlÉÉåÌiÉ qÉÔ§ÉqÉç ” - That which covers the urine.“uÉÎxiÉ lÉÉÍpÉUç AkÉÉå pÉÉaÉ xjÉlÉå ” - Reservoir of urine situated in sub Umbilical area (Site of Bladder)Paribhasha: The term basti in the context of Panchakarma can be used in differentsense, it gives the following meaning. “uÉÎxiÉlÉÉ SÏrÉiÉå uÉÎxiÉÇ uÉÉ mÉÔuÉïqÉluÉåirÉiÉÉå uÉÎxiÉÈ |” (A.xÉ.xÉÔ.28/3)42 “uÉÎxiÉÍpÉSÏïrÉiÉå rÉxqÉÉiÉç iÉxqÉiÉç uÉÎxiÉËUÌiÉ xqÉ×iÉÈ |” (zÉÉ.E.ZÉ.5/1)43 The bag made by animal bladder is termed as “Vasti”. The bladders ofanimals were used as the device for bastikarma in olden days. It is also said thatmedicines like Kashaya, Ksheera, Tail,Ghritha etc administered through gudamargaby a basti netra of bastiyantra, first reaches the lower abdominal area of the patient 13
  32. 32. Etymology of Vastiwhich contains the organ basti i.e. urinary bladder. Hence the term vasti is used todesignate the process in panchakarma. Acharya Charaka has defined the Bastikarma as the procedure in which thedrug prepared according to classical reference and administered through gudamargawhich reaches Nabhi Pradesha, Kati, Parshva, Kukshi and churns the accumulatedDosha and Purisha spreading the veerya of the aushada dravya to whole shareera,extracting the doshas from whole body by the virtue of veerya of the aushada towardsguda which later is expelled along with the purisha44.Matravasti: “WØûxuÉrÉÉ xlÉåWûmÉÉlÉxrÉ qÉɧÉrÉÉ rÉÉåÎeÉiÉ: xÉqÉ:|” (A.¾û.xÉÔ.19/67) Matravasti is a type of Anuvasana vasti which is having main ingredientsneha. The dose of Matravasti is equal to Hruswa sneha pana Matra45.Arohana Krama Matravasti: It’s a coined term. The word Arohana is derived from root word “AÉýiÉåÅlÉålÉ”and defined as “lÉÏcÉÉSÕkSïaÉqÉlÉÍqÉÌiÉ”46 means “The act of Rising” or “ascending” or“mounting”. As the dose of Matravasti is gradually increased in this procedure, theword is coined as “Arohana Krama Matravasti”.Sadharana Krama Matravasti: The word Sadharana is used to indicate the Usual or Common. The wordmeaning of xÉÉkÉÉUhÉ given in Shabdakalpadhruma as “xÉqÉÉlÉ:”, “xÉSØzÉ:”, “xÉÉqÉÉlrÉqÉç”etc47.As the dose of Matravasti administered in a fixed dose which is usually practiced isconsidered, so the procedure is termed as Sadharana karma Matravasti. 14
  33. 33. ShareeraShareera: The word shareera comprises both structural and functional aspects of thebody. Knowledge of Anatomy and physiology of Rectum and Large intestine isessential for the Panchakarma specialist, where in the Vasti dravya is administered.The Guda is defined as “qÉsÉirÉÉaÉ ²ÉUqÉç|”48 As focus of this study is on Vastikarma, a discussion on Shareera of Guda andalso contemporary approach in the form of the anatomy & physiology of rectum andlarge intestine where this procedure is applied is described below.Guda Shareera: Acharyas have considered guda as one among the Dasha pranayatanas, 49, 50Sadhyo pranahara Marma51, Bhahirmukha srotas52.Paryaya nama of Guda: 1. Apanam, Payu - Amarakosha53 (Shabdakalpa Dhruma) 2. Guhyam, Gudavartma - Shabdakalpa Dhruma54 3. Apana - Vagbhata55 4. Gudantram - Dalhana56 5. Vitmarga - Vachaspati.Rachana shareera & Pramana of Gudhavalis: Acharya Sushruta in the context of Arshoroga has explained elaborately on theanatomical structure of guda. It is a part, which is the extension of sthoolantra withfour and half angula in length. It has got 3 valis (parts) named as Gudavalitrayam57. 15
  34. 34. ShareeraTable No. 01: Showing Rachana shareera &Pramana of Gudhavalis: Sl.No Guda valis Pramana 1 Pravahini 1 angula that which does pravahana.(contraction of intestine) 2 Visarjini 11/2 angula that which does viasrajana(Evacuation) 3 Samvarani 11/2 angula that which does samvarana (Contraction of Sphincters) There is another structure called as Gudostha, which is about a distance of 1½yavapramana from the end of hairs. The first vali samvarani starts at a distance of 1angula from gudostha. The width of each vali will be 1 angula and of the colour ofelephant’s palate58.Uttara Guda – Adhara Guda: Acharya Charaka while describing Panchadasha Kostangas, he had consideredUttaraguda and Adharaguda59. On commenting this Acharya Chakrapani clarifies that,Uttara guda helps for storage of Pureesha, where Adhara guda helps in expulsion ofPureesha. (E¨ÉUaÉÑSÈ rÉ§É mÉÑUÏwÉqÉuÉÌiɹiÉå, rÉålÉ iÉÑ mÉÑUÏwÉÇ ÌlÉw¢üÉqÉÌiÉ iÉSkÉUaÉÑSqÉç | ). The modern commentators consider them as rectum and anus respectively.Marma: Marmas are the vital parts of body. Acharya Sushruta explained such 107marma sthanas in body60 and Acharya Vagbhata also explained same number ofMarmas61. Knowledge of these vital parts is essential to avoid possible injuries duringPanchakarma procedures. According to Anatoimical distribution Guda marma comes under Udaramarma62. According to anatomical structure, explained as Mamsa Marma63.According to effect of injury most importently Sadhyo Pranahara marma64. Its size is 16
  35. 35. Shareeraabout four angulas65. Which is attached to Sthulantra and through which Vata andPurisha is excreted out66.Pranaaythana: Pranayathanas are the vital spots where Prana or life resides. Acarya Charakaexplained such Ten points which includes “Guda”67.Physiological concept of Guda: Guda is one of the Pancha karmendriyas and its function is to excrete the malafrom the body68. Guda is on of the site for Apanavata and this sub type of vata helps in the mainfunction of Guda i.e. expulsion of shakrut69. Pakwashaya is also considered as thesthana for Apanavata by Acharya Sushruta70. In this context after administration of basti karma, Apanavata helps inevacuation of basti dravya along with vitiated vatadosha. According to Gananath sen Mechanism of defecation through Guda vali andApanavata can be understood as below.Table No. 02: Showing Gudha valis kriya karma: Sl.No. GudaVali Action 1. Pravahini Helps in compression and pushing the stool downwards 2. Visarjini Relaxes during this process and allows stool to pass further down 3. Samvarani Expels the stool out and constricts immediately, so that the continuity of the stool cut out and falls downPhysiology of Defecation: Samana Vayu influences digestion of food separation of nutrients and wasteproducts, Absorption of nutrients and elimination of waste products71. (A.H Su. 12/8) 17
  36. 36. Shareera Apana vayu does the act of defecation. This is significantly seen with atendency to flow downwards.Modern View: Elimination of feces from the rectum is called defecation. Defecation is areflex action aided by Voluntary contractions of the diaphragm and abdominalmuscles and relaxation of the external anal sphincter. The rectum forms the last 15cm of digestive tract and is an expandable organfor the temporary storage of fecal material. Movement of fecal material into therectum triggers the urge to defecate. The last portion of the rectum, the Ano-rectal canal, contains smalllongitudinal folds, the rectal columns. The distal margins of rectal columns are joinedby transverse folds that mark the boundary between columnar epithelium of theproximal rectum and a stratified squamous epithelium like that in the oral cavity. Veryclose to the anus or anal orifice, the epidermis becomes keratinized and identical tothe surface of the skin. There is a network of veins in the lamina propria and submucosa of the ano-rectal canal. The circular muscle layers of the muscularis externa in the region formsthe internal Sphincter and is not under voluntary control. The external anal sphincterguards the anus and is under voluntary control. Pudental nerves carry the motorcommands72.Table No. 03: Showing Gudha valis Sthana and Modern terminology: Sl.No Guda Valis Situation Modern Terminology 1. Pravahini Proximal Middle Houston’s Valve 2. Visarjini Middle Inferior Houston’s Valve 3. Samvarani Distal Dentate line 18
  37. 37. ShareeraTable No. 04: Showing Structure & Function of Rectum: Structure Action Function Mucosa Secretes mucosa, Lubricates colon and protects mucosa. absorbs water and Maintains water balance Solidifies Faeces. other soluble Vitamins and electrolytes are absorbed and compounds toxic substances are sent to the liver for detoxification. Lumen Bacterial activity Breaks down Undigested Carbohydrates Proteins and amino acids into products and amino acids into products that can be expelled through faeces or absorbed and detoxified by liver certain B vitamins and Vitamin K are synthesized. Haustral Churning Contents moved from haustrum to haustrum by muscular contractions. Peristalsis Contents moved along the length of colon Muscularis by contractions of circular and longitudinal muscles. Mass Peristalsis Contents forced into Sigmoid colon and rectum by strong Peristaltic Waves. Defeacation Faeces eliminated by contractions in the sigmoid colon and rectumPakwashaya / Large intestine: Pakwashaya is considered as one among the ashaya’s by Acharya Sushrutha73.Arunadatta comments as pakwashaya is the seat of pakwa anna i.e.that which attainspureeshatha74. Charaka and Vagbhata considered this as one among theKoshtangas75,76. 19
  38. 38. Shareera Sharangadhara has specified the location of pakwashaya (pavanasaya) asbelow the Tilam i.e. the Yakrut and Kloma77. The horseshoe shaped large intestine or large bowel extends from theileocaecal valve to the anus. Average length is about 1.5 meters and width of 7.5cms.Figure No 1: Showing the Anatomy of Large Intestine:Its Sub division includes:Table 05: Showing Sub divisions of large intestines: 1. Cecum T portion (pouch like) 2. Colon Large portion 1.5m 3. Rectum 5 inches. 4. Anal canal 4cms Intestinal mucosa contains many Goblet cells, and Muscularis consists oftaenia coli. Mechanical movements of the large intestine include Haustral churning,Peristalsis and Mass Peristalsis. 20
  39. 39. Shareera The last stages of chemical digestion occur in the large intestine throughbacterial action. Substances are further broken down and some vitamins aresynthesized. Large intestine also absorbs water, electrolytes and vitamins. Faecesconsist of water, inorganic Salts, epithelial cells, bacteria and undigested food.Absorption in the Large Intestine: The re-absorption of water is an important function of the large intestine.Although roughly 1500 ml of material enters the colon each day, only about 200 ml offaeces is ejected. The remarkable efficiency of digestion can best be appreciated byconsidering the average composition of faecal wastes 75% water, 5 % bacteria, andthe rest a mixture of indigestible materials, small quantities of inorganic matter, andthe remains of epithelial cells.78 In addition to reabsorbing water, the large intestineabsorbs a number of other substances that remain in the fecal material or that weresecreted into the digestive tract along its length. 21
  40. 40. Vasti karmaVasti karma: Vasti is considered as supreme therapy for Vatavyadhis. (mÉUqÉÉæwÉkÉ). Vastioccupies prime place among Panchakarma keeping in view the present day’s needs asmost of the diseases pertaining to neurological and locomoter disorders are beingtreated with Vasti chikitsa successfully. Even our ancient Acharyas are stressed thesame in quotations like oÉsÉSÉåwÉMüÉsÉUÉåaÉmÉëM×üiÉÏÈ mÉëÌuÉpÉerÉ rÉÉåÎeÉiÉÉÈ xÉqrÉMçü | xuÉæÈ xuÉæUÉæwÉkÉuÉaÉæïÈ xuÉÉlÉç xuÉÉlÉç UÉåaÉÉͳÉrÉcNûÎliÉ || MüqÉÉïlrɯÎxiÉxÉqÉÇ lÉ ÌuÉkrÉiÉå zÉÏbÉëxÉÑZÉÌuÉzÉÉåÍkÉiuÉÉiÉç | AɵÉmÉiÉmÉïhÉiÉmÉïhÉrÉÉåaÉÉŠ ÌlÉUirÉrÉiuÉÉŠ || (cÉ. ÍxÉ.10/5) Acharya Bhela states that, life exists as long as “Vata” lasts in thebody. (rÉÉuĘ́ɸÌiÉ uÉÉiÉÉå ÌWû SåWûÏ iÉÉuɨÉÑ eÉÏuÉÌiÉ|)79. Acharya Sharangadhara states that Vatacan influence other doshas, dhatu, malas due to his Chala or Chetana guna80. Acharyavagbhata considered Vata as “Prabala”among Doshas (...SÉååwÉÉhÉÉÇ mÉëoÉsÉÉåÅÌlÉsÉÈ) 81 . Sovitiation vata leads to vitiation of other doshas and disarrangement of body systems.Basti is supposed to be chikitsa principle for vata vyadhi82. Acharya Arunadatta statesclearly that “iÉålÉ uÉÉiÉxrÉ oÉÎxiÉaÉÑïSmÉëÍhÉkÉårÉxlÉåWûYuÉÉjÉÉÌS mÉUqÉÉæwÉkÉqÉç|”83Importance of Vasti Karma: All major texts of Ayurveda emphasized this treatment considering itsefficacy. It stands unique among all the shodhana therapies because it expels thevitiated Doshas rapidly and easily from the body and also causes reducing as well as 22
  41. 41. Vasti karmanourishing the body very fastly84. Eventhough Vamana and Virechana eliminates thevitiated Doshas form the body, the drugs used in these therapies contain Katu rasa,Ushna guna and Teekshna gunas, which cannot be taken easily by children or olderpeople. But Vasti can be given in all age groups without any hesitation85. Vasti is not only indicated in Vataja Vyadhi. It can be used even in pittaja,kaphaja, rakthaja, samsargaja, sannipataja vyadhis86. Acarya Charaka considered Vasti as Ardha chikitsa and even as Purna chikitsain siddhisthana of Charaka samhita87. In sutrasthana in the context of Agrya dravyas,Vasti is considered as Agrya for Vata88. Apart form this it has multidimentonal effect by possessing various therapeuticactions like Samshodhana, Samshamana and Sangrahana of doshas on the basis ofdravyas used in it89. Vasti 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 man90. Kashyapa equated the Vastikarma as‘Amrutam’, because of its widespread applications even in both infants and in old agepeople.91Classification of Vasti: Since vasti can be of many types according to its Karma, Dravya used, numberof Vasti to be given and many other factores like Vaya, Bala, Satva etc factores of theAtura. Hence one cannot find any uniformity in classification of Vasti foot fourth bydifferent Acharyas. Knowledge of the classification is very essential for the better 23
  42. 42. Vasti karmaunderstanding of Vasti therapy. So Vastikarma has been brought into the followingclassifications broadly.92Adhishtana bheda : The site of application viz abhyantara and bahyaDravya bheda : On the basis of medicine used viz Niroha vasti, Anuvasana vasti etcKarmukata bheda : On the basis of action viz shodana vasti, lekhana vasti etcSankhya bheda : The number of vasti’s given as a courseAnushangika bheda : Here the some vasti yogas explained in classics with specific name are considered.Matra bheda : Based on total quantity of vasti dravya1) Adhishtana bheda : According to the site of application of Vasti, it is classified asfollows Pakvashayagata Vasti Garbhashayagata Vasti Mutrashayagata Vasti Vranagata VastiTable 06: Showing Classification of Basti karma based on Route of administration i Pakwasayagata vasti: The Vasti dravya administered through Gudhamarga (ano-rectal route) to reach Pakwasaya. ii Garbhasayagata vasti The Vasti dravya administered through Yonimarga to reach Garbhashaya. iii Mutrasayagata vasti The Vasti dravya administered through urethral route to reach Mootrasaya iv Vranagata vasti The Vasti dravya administered through the Vranamukha . 24
  43. 43. Vasti karma2) Dravya bheda: It is based on the major ingredients of Bastidravya - kwatha or sneha and soclassified into two types: - Niroha Vasti Anuvasana Vasti i) Nirooha vasti – In Niruha Basti, Kashaya (decoction) is the predominantcontent. Along with the Kashaya Madhu, Saindhava, Sneha and Kalka are usedcommonly. Its synonyms are Asthapana Basti, Maadhutailika, Yaapana vasti,Yuktaratha vasti, Siddha vasti93, Kashaya vasti etc. ii) Anuvasana vasti – Sneha is the chief ingredient of Anuvasana. Literally theterm Anuvasana refers to Vasti that can be administered every day with no risk94. On the basis of Matra, Anuvasana vasti is sub classified into three types95.Table No. 07: Showing types of Anuvasana vasti and its MatraSI. No Anuvasana vasti Bheda Vasti Dravya Matra01 Snehavasti 6 pala02 Anuvasana vasti 3 Pala03 Matra vasti 11/2 Pala3) Karmukata bheda: Susruta and Vagbhata have made the following classification according totheir actions96, 97. 25
  44. 44. Vasti karmaTable No. 08: Showing type’s vasti based on its Karma:SI. No Type of Vasti Action01 Shodhana vasti Contains Shodhana dravyas and removes vikrita Doshas and Malas from the body02 Lekhana vasti Reduces Medodhatu and produces Lekhana in the body03 Sneha vasti Contains more of Sneha and produces Snehana in the body04 Brumhana vasti Increases the Rasadi dhathus and indirectly it helps in the growth of body.05 Utkleshana vasti Causes Utklesha of malas and doshas by increasing its Pramana and causes dravabhootha06 Doshahara vasti Purificatory or eliminating type.07 Shamana vasti Causes Shamana of Doshas. Vataghna vasti, Balavarnakritavasti, Snehaneeyavasti, Sukrakritvasti,Krimighnavasti, Vrishatvakritvasti has been explained in various contexts byCharaka98.4) Sankhya bheda: On the basis of total number of Vasti administration, Vasti is classified asfollows99Table No. 09: Showing Sankya Bhedha of Vasti Prakara: Vasti Prakara Sankya Anuvasana Sankya Nirooha Sankya Yoga Vasti 8 5 3 Kala Vasti 16 10 6 Karma Vasti 30 18 12 26
  45. 45. Vasti karma According to Kashyapa100: Yoga Vasti 8 5 3 Kala Vasti 15 12 3 Karma Vasti 30 24 65) Anushangika bheda:Here the some vastis yogas explained in classics with specific name are considered. a) Yapana vasti: Which promotes the life and restores the health101. b) Siddha vasti: It increases the bala, varna, and prasannatha102, 103. c) Yuktaratha vasti: Mainly indicated for travelers on vehicles etc104. d) Vaitharana vasti: It is mainly indicated in Katigraha, Shula, Anaha, Amavata and does the lekhana105. e) Ksheera vasti: Explained for shoolam,vitsangam, anaha, & mootrakrichra106. f) Ardhamatrika nirooha vasti: Snehana and swedana karmas are not required. Mainly it is indicated in rajayakhsma,shoola,krimi and in vatarakta. It improves Shukra and ojus107. g) Piccha Vasti : It is given with pichhila dravyas like Shalmaliniryasa and lajjalu. It is indicated in pichhalasrava and jeevashonita. It acts as Sangrahi108. (Vangasenasamhitha, Bastikarmaadhikara - 186-190) h) Mutra Vasti: It is Gomutra pradhana basti it is mridu in nature, safe and pacifies the doshas109. 27
  46. 46. Vasti karma i) Rakta Vasti : It is indicated in conditions like adhika rakta srava111.6) Matra bheda: The quantity may vary from person to person and it depends on rogi bala, rogabala and vaya of the patient112, 113.Table No. 10: Showing Matra bheda of Vasti dravya: Sl.No. Vasti Quantity of Vasti Dravya 01. Dvadashaprasruta Vasti 12 Prasrutha 02. Prasritayogika Vasti 4,5,6,7,8,9&10 Prasrutha (Acc. strength of the patient) 03. Padaheena Vasti 1/4th less than Dvadashaprasruta vasti i.e. 9 PrasruthaMatravasti: Matravasti ia a type of Anuvasana vasti based on Matra of vasti dravya. AllAcharyas explained about Matravasti and considered safe and useful in manyconditions where other varities of Vastis are contraindicated. The term Matra, gives various meaning with respect to different context, suchas Measurement, Quantity, Size, Duration, Number, Degree, Movement, Unit of time.It also stated it as prosodial instant i.e. the length of time to pronounce a short vowel.In the present context the term Matra gives the meaning for the unit of measurementi.e for the quantity of Vastidravya. Vasti also having different meanings in various contexts but in present contextit is considered as therapeutic procedure of Panchakarma. 28
  47. 47. Vasti karmaDefinition: WØûxuÉÉrÉÉ: xlÉåWûqÉɧÉÉrÉÉ qÉɧÉÉuÉÎxiÉ: xÉqÉÉå pÉuÉåiÉç| (cÉ.ÍxÉ.4/53) According to Acharya Charaka, Basti in which the dose of Sneha is equal toHraswa matra of Snehapana is called as Matravasti. Acharya Sushruta, Vagbhata alsodefined matravasti, which also gives same meaning114, 115,116. (Su.Chi.35/18, A.S.Su.28/8, AH.Su. 19/67) qÉɧÉÉM×üiÉpÉåSiuÉÉlqÉɧÉÉuÉÎxiÉ:| (SÏÌmÉMü-zÉÉ.E.5/4)Acharya Adamalla clearly mentioned that Matravasti is variety of Vasti based on theMatra of Vasti dravya.Indications: According to Acharya Charaka, Matravasti is always applicable to thoseemaciated due to overwork, physical exercise, weight lifting, way faring, journey onvehicles, and indulgence in women, in debilitated person as well as in those afflictedwith Vata disorders117. Vruddha Vagbhata has emphasized on regular administration of the Matravastiand it can be administered at all times and in all seasons just like Madhu TailikaVasti118. 29
  48. 48. Vasti karmaTable No. 11: Showing indication of Matravasti acc. to Classics: Sl.No Indications C.S A.H A.S 1 Karma karshita + - - 2 Bhara karshita + + + 3 Adhva karshita + + + 4 Vyayama karshita + + + 5 Yana karshita + - + 6 Stri karshita + + + 7 Durbala + + + 8 Vata Rogi + + + 9 Bala - + + 10 Vriddha - + + 11 Chintatur - + + 12 Stri - - + 13 Nripa - + + 14 Sukumar - - + 15 Alpagni - + + 16 Sukhatma - + -Contraindication: In classics, there are no major contraindications mentioned for matra Basti, butAshtanga Sangrahakara has stated that Matra Basti should not be administered inAjeerna condition and to those who resort to Diwaswapna. 30
  49. 49. Vasti karmaQualities: The Matravasti promotes strength without any pathyacof diet, causes easyelimination of Mala and Mutra. It performs the function of Brimhana and curesVatavyadhi. It can be administered at all times in all seasons and is harmless119. Vagbhata has mentioned that Matravasti improves Varna and Bala. He addsthat it can be given regularly, which is indicated for bala, vriddha, and alpagni person.No need of parihar after adminstration of Matravasti, no such complications arises. Hementioned it as Varnya, doshaghna etc120. Acharya Hemadri commenting on the termsukha stated that, it is devoid of complications.Dose: The term Matravasti is popular because of its dose only, because sneha isadministered in the hraswamatra. Acharya Charaka mentioned as “Hruswa snehaMatra” but not mentioned exact quantity121. Whereas Acharya Vagbhatarecommended the dose, equal to the dose of Hruswa Snehapana122, 123 . The Matrawhich gets digested in Ardhaha i.e. 2 yama (6 hours) is called as Hruswa Matra ofSnehapana124, but the dose required to get digested in 2 Yama is not mentioned. Sushruta has given the dose as half of the dose of Anuvasanavasti andaccording to him the dose of Anuvasanavasti is half of the dose of Snehavasti. InSnehavasti, the dose given is half of the total dose of Niruhavasti i.e. 6 Pala (24 Tola).Hence, the does of Matravasti is 1½ Pala125 = 6 Tola = 72ml. According toChakrapani, the dose of Snehavasti is 6 Pala, dose of Anuvasanavasti is 3 Pala and ofMatravasti is 1½ Pala126. Acharya Kashyapa prescribed the quantity of Matravasti as 2 palas asuttamamatra, 1 ½ pala as madhyama matra and 1 prakuncha as hraswa matra. He even 31
  50. 50. Vasti karmastated that half pala of sneha can be given in newborn baby; it can be administeredwithout any hesitation and complication too127, 128. Sharangandhara mentioned sneha matra of Matravasti as 2 palas (8 tolas)129.On the basis of above references, it can be said that the dose of Matravasti is 1½ Palaof Sneha i.e. 6 Tola = 72ml.Table No. 12: Showing Matra of snehavasti mentioned indifferent Classics: Sl Author Matra 1 Charaka Sneha vasti is 6 Pala, dose of Anuvasana vasti is 3 Pala and of Matra vasti is 1½ Pala (6 Tola = 72ml) 2 Sushruta Anuvasana vasti is ½ of the dose of Sneha vasti Hence, the does of Matra vasti is 1½ Pala (6 Tola = 72ml) 3 Vagbhata Hrsva Snehapana is recommended for matra vasti. The matra which gets digested in 2 Yama (i.e.6 hrs) is called as Hrsva matra.Table No. 13: Dose of Matravasti 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 32
  51. 51. Vasti karma Arohana Krama Matravasti: Acharya Adamalla in his commentary on Sharangadhara samhita, explained the Arohana krama of Matravasti130. Table No. 14: Showing Dose of Arohana krama Matravasti: Start 1 day 2 day 3 day 4 day 5 day 6 day 7 day 8 day 9 dayUttama 2 2 Pala 2 ½ Pala 3 Pala 3 ½ 4 Pala 4 ½ Pala 5 Pala 5 ½ Pala 6 Palamatra Pala Pala 96 ml 120 ml 144 ml 168 ml 192 ml 216 ml 240 ml 264 ml 288 mlMadyama 1 1 Pala 1 ¼ Pala 1 ½ Pala 1 ¾ 2 Pala 2 ¼ Pala 2 ½ 2 ¾ Pala 3 Palamatra Pala Pala Pala 48 ml 60 ml 72 ml 84 ml 96 ml 108 ml 120 ml 132 ml 144mlHrusva ½ 0.5Pala 0.625 0.75 0.875 1 Pala 1.125 1.25 1.375 1.5matra Pala Pala Pala Pala Pala Pala Pala Pala 24 ml 30 ml 36 ml 32 ml 48 ml 54 ml 60 ml 66 ml 72 ml In Chakradatta131 and in Vangasena samhita132 three doses are descrbed for Anuvasana vasti.6 pala is considered as the jyeshtha matrra, 3 pala is madhyama matra and 1½pala as kaneeyasi matra. In jyeshtha matra 2 pala (96 ml) is administered in the beginning and then increased by ½ pala (24 ml) everyday and it becomes 6 pala on the 9th day, in madhyama matra starting dose is 1 pala (48 ml) increased by ¼ (12 ml) everyday and it will reach to 3 pala on the 9th day and in the kaneeyasi matra initial dose is ½ pala (24 ml) and increased by 6 ml everyday and on the 9th day it becomes 1½ pala. 33
  52. 52. Vasti karmaQualities of Matravasti: The Matrabasti is promotive of strength without any demand of strict regimenof 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 andis harmless133. Vagbhata has mentioned that Matravasti improves Varna and Bala. He addsthat it can be given regularly, which is indicated for bala, vriddha, and alpagni person.No need of parihar after adminstration of Matrabasti, no such complications arises. Hementioned it as Varnya, doshaghna etc134. Acharya Hemadri commenting on the term sukha stated that, it is devoid ofcomplications135.Indications: According to Charaka, Matravasti is always applicable to those emaciated dueto overwork, physical exercise, weight lifting, way faring, journey on vehicles, andindulgence in women, in debilitated person as well as in those afflicted with Vatadisorders. Vruddha Vagbhata has emphasized on regular administration of theMatravasti and it can be administered at all times and in all seasons just like MadhuTailika Vasti.136Contraindication: In classics, there are no major contraindications mentioned for Matravasti, butAshtanga Sangraha has stated that Matravasti should not be administered in thepersons having Ajirna and to those who resort to Diwaswapna137. 34
  53. 53. Vasti karmaVasti Yantra:The device used for Vasti karma is called as Vastiyantra.It comprises of two parts – 1. Vastinetra 2. VastiputakaVastinetra: The netra should be made of gold, silver, and copper or with other highermetals, alloys, long bones, bamboo, wood etc. Generally netra must resemble like tailof cow with a tapering end and a wider base with round ends and smooth surfaces thedimensions are different for different age group138, 139.Table No. 15: Showing Measurements of Vastiyantra140, 141 S.l no Age in years Length in Lumen of netra Angula Diameter of narrow Diameter of end broad end 1 <1 5 1 angula 2 1-6 6 Size of green gram 1 angula (Mudga) 3 7- 11 7 Size of black gram 1½ angula (Masha) 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 Uttara vastiyantra 7 - 12 – 14 Sarshapa size - Susrutha’s opinion142 8 1 6 Green gram Feather of kanku bird must pass through. 35
  54. 54. Vasti karma 9 8 8 Black gram Feather of eagle must pass through. 10 16 10 Kalayam Feather of peacock must through. 11 >25 21 Kolasthi Feather of vulture must pass through.Pramana of vrana vasti netra: The hole should be of a mudga pramana, with 8 angulas of length143.Karnika: In Vasti netra, there should be Three Karnikas. One Karnika should be at arequired point from the tip of the netra, to prevent excessivbe entrey. Remaining twoat the base of the Netra with two angulas distance each other, this used to tie the Vastiputaka144.Vastiputaka: The word Vasti is indicats the urinary bladder. Acharya Chakrapani stated as“Vastirithi mutrashaya putakam”145 where as Acharya Hemadri defined this as“Mutradhara charma peshim”146. In this context, the container or bag used to carry thevastidravya, ready for application is known as vastiputaka. In ancient days the urinarybladder of matured animals like cow, buffalo, dear, pig, goat etc were used. It wasthen processed to make stong, thin, soft, devoid of blood vessels and bad odor. Itshould be made suitable for well fitting with the vastinetra and appropriate toadminister vasti dravya147, 148. 36
  55. 55. Vasti karma If good bladder is not available some other materials are recommended for thepurpose. They are the skin of neck of plava or thick cloth with sufficient strength andsize. Now a day, various types of materials are available to make up of vastiputakaand even disposable vastinetra are available. The rubber bladder and polythene bagsare best choice. Presently in most of the Panchakarma centers, the disposablevastiyantras with polythene are used.Vasti netra & Vasti putaka Dosha: In classics, Acharyas explained different improper features of Vasti netra andVasti putaka and their advese effects149, 150.Table No.16: Showing Netradosha of Vasti netra:No. Netradosha Adverse Effect1. Hraswata Too short Dravya will not reach pakwasaya2. Deerghata Too long Dravya go beyond the pakwasaya3. Tanuta Too thin Produces kshobha4. Sthoolata Too big Produces lakshana5. Jeernata Old dhatu used Injury to guda6 Shithilabandhana Improperly fixed to Dravya comes out putaka7. Parshwachhidra Hole on side Leakage of dravya happens8. Vakrata Curved / irregular Dravyagati becomes irregular9. 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 properly 37
  56. 56. Vasti karmaTable No. 17: Showing putakadosha of Vasti Putaka: No. Putakadosha Features Effect 1. Vishama Shape not in Gati vishamata happens uniform during pressing 2. Mamsala Muscular tissue Produces offensive small present 3. Chinnachidrayukta Presence of hole Dravya comes out 4. Sthoola Thick one Does not push dravya 5. Jalayukta Anastamosis Produces leakage present 6. Vatala Excess air space Frothy type of dravya 7. Snigdha Unctuous Slip form the hand 8. Klinnata Wet Difficult to pass throughMATRAVASTI PROCEDURE As the procedure of Matravasti is not explained separately in classics, theprocedure of Anuvasana Vasti is adopted. The procedures and preparations areclassified into three parts: - 1.Poorvakarma 2.Pradhanakarma 3.Paschatkarma.Poorvakarma: The Purvakarma includes Rogi pareeksha, Sambara sangraha and Aturasiddhata. Rogipareeksha: Selected patients for Vasti therapy have to undergothoroughly clinical examinations to ascertain the physical as well as the mentalconditions.Following factors are to be considered for clinical examination151.1. Dosha 2.Oushada 3.Desa 4.Kala 5.Satmya6. Agni 7.Satwa 8.Vaya 9.Bala This will enable the physician to decide, the type of Vasti, number of Vastis,Vasti dravya, etc to be administered in the particular patient. 38
  57. 57. Vasti karmaSambara sangraha: It includes collection of Medicine, instruments etc. For MatravastiSneha dravya should be kept ready in a clean vessel. The instruments needed areVasti netra, Vasti Putaka are should be clean and ready.Atura siddhata: The body of the patient should be anointed with suitable sneha andgently fomented with hot water. Then he is advised to have his prescribed meal i.e ¼less than normal quantity and it should not be excessive snigda or rooksha and shouldbe Laghu. Then should ask the patient to take a short walk (hundred yards). Vastishould be administered when the patient is ardrapani which means we should notdelay much time after the intake of food. Having passed stool and urine he is laid on acouch, which is not very high, and the head must be at lower level. No pillows areused. The patient should lie on his left side drawing up the right leg and straighteningthe left leg152, 153, 154.Pradhanakarma: The proper amount of sneha prescribed for Matravasti is filled in thevastiputaka and tied well placing the vastinetra in position. The trapped air invastiyantra is expelled by gently pressing the vastiputaka. Then the anal region andthe netra should be smeared with oil for easy entery of vasti netra. Gently probe theanal orifice with the index finger of the left hand and introduce the vastinetra throughanal orifice into the rectum up to first karnika in the direction parallel to vertebralcolumn (Anuprustavamsha). In the same position press the vastiputaka with righthand with adequate force. Remove carefully the vastinetra when a little quantity ofsneha remained inside the vastiputaka155.Paschatkarma: After the administration of oil, the sphik of the patient should be tapped withthe palms to prevent early return of the recipe from the anus. The patient should lie on 39

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