Sthoulya bhadradiyapanavasti-pk


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Vijaykumarswamy G. Hiremath
Department of Panchkarma,D.G.M.Ayurvedic Medical College, Hospital and P.G.Research Center, Gadag.

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Sthoulya bhadradiyapanavasti-pk

  1. 1. EVALUATION OF EFFICACY OF BHADRADI ASTHAPANA VASTI IN STHOULYA (OBESITY) By Vijaykumarswamy G. Hiremath DISSERTATION SUBMITTED TO THERAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA In partial fulfillments of the requirements for the degree of AYURVEDA VACHASPATI(M.D) In PANCHAKARMA Under the guidance of Dr.P. Shivaramudu M.D. (Ayu) Under the co-guidance of Dr.Shashidhar H. Doddamani M.D. (Ayu) J.S.V.V. SAMSTHE’S Shri.D.G.M. Ayurvedic Medical College, Hospital & P.G.Research Centre, GADAG - 582103 2004-2007
  2. 2. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled Evaluation of Efficacyof Bhadradi Asthapana Vasti in Sthoulya (Obesity) is a bonafied and genuineresearch work carried out by me under the guidance of Dr. P. Shivaramudu, M.D(Ayu) Professor, Post - Graduate Department of Panchakarma and under the co-guidance of Dr. Shashidhar H. Doddamani M.D (Ayu) Asst Professor, Post – graduateDepartment of Panchakarma.Date: Signature of the CandidatePlace: (Vijaykumarswamy G. Hiremath)
  3. 3. SHRI D.G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF RASASHASTRA. I here by certify that this dissertation entitled Evaluation of Efficacy ofBhadradi Asthapana Vasti in Sthoulya (Obesity) is a bonafide and genuineresearch work done by Vijaykumarswamy G. Hiremath in partial fulfillment ofthe requirement for the degree of Ayurveda Vachaspati (M.D in Ayurveda) inPanchakarma of Rajiv Gandhi University of Health sciences, Bangalore,Karnataka under my Guidance. Guide Date: Dr.P.Shivaramudu M.D (Ayu) Place: Gadag Professor Department of Panchakarma, D.G.Melmalgi Ayurvedic Medical College, Hospital and P.G.Research Center, Gadag - 582103.
  4. 4. CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “EVALUATION OFEFFICACY OF BHADRADI ASTHAPANA BASTI IN STHOULYA (OBESITY)”is a bonafide research work done by Vijaykumarswamy. G. Hiremath in partialfulfillment of the requirement for the degree of Ayurveda Vachaspati. M.D.(Panchakarma). Date: Dr. Shashidhar. H. Doddamanai M.D. (Ayu). Place: Assistant Professor, Post graduate Department of Panchakarma.
  5. 5. ENDORSEMENT BY THE H.O.D. PRINCIPAL OF THE INSTITUTE This is to certify that the dissertation entitled “Evaluation of efficacy ofBhadradi Asthapana Basti in Sthoulya (Obesity)” is a bonafide researchwork done by Vijaykumarswamy G.Hiremath under the Guidance ofDr.P.ShivaramuduMD (Ayu) Professor, Post Graduate Department of Panchakarmaand under the Co-Guidance of Dr.shashidhar H. DoddamaniM.D(Ayu) AsstProfessor, Post Graduate Department of Panchakarma.Dr.Purushothamacharyulu, M.D (Ayu) Dr.G.B.Patil Professor & H.O.D Principal /C.M.O Department of Panchkarma,D.G.M.Ayurvedic Medical CollegeHospital and P.G.Research Center, Gadag.Date: Date:Place: Gadag Place: Gadag
  6. 6. COPY RIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Bangalore,Karnataka shall have the rights to preserve, use and disseminate this dissertation in printor electronic format for academic/research purpose.Date: Vijaykumarswamy G. HiremathPlace: Gadag © Rajiv Gandhi University of Health Sciences, Bangalore.
  7. 7. Acknowledgement Any research is never an individual effort. It is contributory effort of manyhearts, hands and heads. It gives me inexpressible pleasure to offer my sincere thanksto all those who have rendered their wholehearted support, guidance and Co-operationin completing my thesis work. My deep sense of gratification is due for my Parents who are the architects ofmy career, culture and discipline, which i could imbibe, are solely because of theirpainstaking, upbringing and strong moral support. I also cannot forget the love &affection of my younger sister sativa who constantly encouraged me. I express my obligation to my honorable H.O.D, Dr. G.Purushothamacharyulu M.D. (Ayu), H.O.D., P.G. Department of Panchakarma,P.G.S&R, D.G.M.A.M.C, Gadag for his critical suggestions and expert guidance forthe completion of this work. I am extremely happy to express my deepest sense of gratitude to my belovedGuide Dr.P.Shivaramudu.MD(ayu) Professor, P.G. Department of Panchakrma, P.G.S& R, D.G.M.A.M.C, Gadag whose sympathetic, scholarly suggestions and guidanceat every step have inspired me not only to accomplish this work but in all aspects. I express gratitude beyond words to my Co-Guide Dr.Shashidhar. H.Doddamani Asst. Professor, P.G.S & R, D.G.M.A.M.C, Gadag for his constantsupervision, guidance encouragement and wholehearted support during my researchstudy. 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 researchwork. I express my sincere gratitude to Lecturer Dr. Santhosh. N. Belavadi MD(Ayu), Lecturer for their sincere advices and assistance. I take this opportunity to thank HOD’s of other departmentsDr.M.C.Patil MD (Ayu), Dr.Varadhacharyulu MD (Ayu), and Dr.G.V.Mulgund MD (Ayu) fortheir inspiration and valuable suggestions. I am grateful to all the PG teachers Dr.K.S.R.PrasadMD.(AYU), Dr.R.Y.ShetterMD(AYU), Dr.Girish Danappagouder MD(Ayu), , Dr.Jagadeesh. G. Mitti.MD.(AYU), i
  8. 8. Dr.Kuber. SankMD.(AYU), Dr.Dilipkumar.B.MD(Ayu) Dr.Shashidhar NidagundiMD.(AYU)),and other PG Staff. for their valuable suggestions. I extend my immense gratitude to Dr.G.S.Hiremath, Dr.S.A.Patil,Dr.U.V.Purad, Dr.B.G.Swami, Dr.Paraddi, Dr.Sajjana, Dr.A.Samudri Dr.Yasmin, andDr.Shankaragouda, Dr. G. Yarageri, Dr. S.H.Radder, Dr. Mulkipatil and otherteaching staff who helped during my study. My sincere thanks are extended to Dr. Basavaraj SaraganachariMD.(AYU), andDr. P.V.Joshi for their inspiration and valuable suggestions. I cannot move further before thanking to my intimate friends Dr.C.B.Pattanashetty, Dr. S.B.Gouder, Dr. Jagadeesh and Dr. Madhushree who havebeen stood indefatigable with me in each and every circumstance and gave me indepth sense of friendship. I am greatly thankful to my friend cum brother in law, Gururaj and my sisterSuvarna for their ever co-operation and kind hearted support. I am highly under the debt of my beloved friends Dr. Sharnu,Dr. C.B.Pattanashetty, Dr. S.B.Gouder, Dr.V.B.Math Dr.Manjunath, Dr.Anand,Dr.Umesh, Dr.S.B.Patil Shivaprasad, Naveen, Manjunath shedagatagi who havehelped in all the moments during my Post Graduate studies. I would like to express my sincere thanks to LibrarianShri.V.M.Mundinamani, and Asst Librarian Shri.S.B.Sureban and Shri Shavi forproviding valuable books in time throughout the study. I take this moment to express my thanks to all my Departmental Friends Dr.Subin, Dr. Febin, Dr. Satheesh, Dr. Santosh, Dr.Varsha Dr. Shaila, Dr. Hugar, Dr.Chandramouli, Dr. Jayaraj, Dr. Kendadmath, Dr. Hakkandi, Dr. Ashwin,Dr.lingaraddy, Dr. Muttu, Dr. Sibu( Apple), Dr.Payappagouder, Dr.prasanna,Dr.Nataraj, Dr. udayaganesh, Dr adarsh, Dr,Mukta, Dr.Shailej. I take this moment to express my thanks to all my Post Graduate friendsDr.Channaverswami, Dr.Krishna, Dr.Gavi, Dr.Sarvi. Dr.Kalmath, Dr.Ashok,Dr.Kendadmath, Dr.Sajjanar, Dr. Basavaraj Ganti, Dr.Pradeep, Dr.Venkareddy, ,Dr.Sunita, Dr.Bingi, Dr.Ratan, Dr.Uday, Dr.Hugar, , Dr.Ashwini, , Dr.Shalini, Dr.Shivaleela, Dr. Sulochana, Dr.Jayashree Dr.Anita, and other post graduate scholar fortheir support. I am very much thankful to Smt. P. K. Belavadi, Mr. M. M. Joshi, Mr.Shankar, Mr. Biradar, Mr. Dasar and Smt. Sarangamath. ii
  9. 9. Last but not least, I thank to the patients who are pillars of my research work,Khona pathology laboratory staff and Hospital staff and to all those names mymemory fails to recollect. I am very much thankful to M/s Pragati Xerox Center, Gadag for their timelyhelp bringing out this computer print. I express my thanks to all the persons who have helped me directly &indirectly with apologies for my ability to identify them individually. Dr.Vijaykumar.G.Hiremath. iii
  10. 10. LIST OF ABBREVIATIONS USEDAH. - Ashtanga hridayaAS - Ashtanga sangrahaBMI - Body Mass IndexBP - BhavaprakashaCH - CharakaFFA - Free Fatty AcidsGR - Good ResponceHDL - High Density LipoproteinsKa - Kashyapa samhitaLDL - Low Density LipoproteinsLCD - Low Caloric DietMiR - Mild ResponceMN - Madhava nidanaMoR - Moderate ResponseNo. - NumberPt.’s - PatientsRW - Relative WeightSi - Serial numberSu. - SushrutaSD - SharangadharaVa - VagbhataYR - Yogaratnakara iv
  11. 11. Abstract: In Ayurveda chikitsa is broadly classified into two parts shodhana andshamana. Here also shodhana occupies first place. Among five shodhana proceduresVasti is one among them and it has been called as Ardhachikhtsa. Sthoulya is considered under Ashtanidhita purushas. The persons life who issuffering from sthoulya roga becomes miserably pathetic because of the doshas likehampered physical activity, hampered sexual life, extreme lassitude, proneness todangerous diseases, above all decreases the span of life. Obesity is an upcomingburning problem and it is the mother of all the diseases. Hence the present study i.e.evaluation of efficacy of Bhadradi Asthapana vasti in sthoulya is under taken to assessthe effect of this vasti over sthoulya. The objectives of the study are to evaluate the efficacy of Vastikarma insthoulya and evaluation of efficacy of Bhadradi Asthapana Vasti in sthoulya. Thestudy is a prospective clinical trail in a single group of 30 patients where all thepatients received Bhadradi Asthapana Vasti for 8 days in yoga vasti krama and ascomponent of yoga vasti schedule Anuvasana vasti with Murchita tila taila is used.And a parihara kala (follow up) of 16 days is given. Subjective parameters are the chief and associated complaints of sthoulya.And objective parameters are weight, BMI and body circumference. Assessments aredone before and after the treatment. Among 30 patients 2 (6.66%) patients were shown good response i.e. above70% in signs and symptoms, 17 (56.66%) patients responded moderately i.e. 50-70%in signs and symptoms and 11 (36.66%) patients responded mildly i.e. 36.66% insigns and symptoms. all the subjective and objective parameters showed highlysignificant. v
  12. 12. Sthoulya is a medo doshaja vyadhi and also one among the kaphaja nanatmajavyadhis. As kapha and meda are having ashrayashrayi bhava. Vata is considered asupadravakaraka in sthoulya. The vastidravyas are having the property of kaphavatashamaka, lekhaniya, etc. This vasti acts as karshana vasti too. So this Bhadradiasthapana vasti is an apt choice in sthoulya.Key words: Bhadradi asthapana vasti ; sthoulya ; BMI ; obesity ; meda doshja ;lekhaniya ; kaphaja nanatmaja vyadhi ; Ashtanidhita purusha ; yoga vasti ; good,moderate and mild response. vi
  13. 13. TABLE OF CONTENTS Chapters Page No1. Introduction 01 - 032. Objectives 04 - 063. Review of Literature 07 - 1004. Methodology 101 - 1115. Results 115 - 1356. Discussion 136 - 1547. Conclusion 155 - 1578. Summary 158 - 1599. Bibliography 160 - 18010. Annexure vii
  14. 14. List of TablesSI Tables PageNo No1 Showing the Classification of Vasti according to site of application 162 Showing the external Vasti procedures. 163 Showing the Classification of Vasti on sankya 174 Showing the Classification of Vasti on karma 175 Showing the measurements of Vasti Yantra 196 Showing the Netra Doshas and its effects 207 Showing the Putaka Doshas and its Effects 218 Showing contraindications for Anuvasana Vasti. 229 Showing the Dose schedule of Nirooha Vasti 2410 Showing the Patients contraindicated for Aasthapana 26- 2711 Showing the Patients indicated for Aasthapana 27- 2812 Showing the Proper, insufficient & excessive signs and symptoms of 30 Anuvasana Vasti13 Showing the Proper, insufficient & excessive signs and symptoms of 31 Niroha Vasti14 Showing the distribution of fat 4115 Showing plasma lipid values 4316 Showing classification of fatty acids 4717 Showing Aharaja Nidhana 5318 Showing the Viharaja Nidhana 5419 Showing Manasika Nidan 5420 Showing Anya Nidana 5421 Showing Rupas of Sthoulya 6422 Showing Pramana Pariksha 6623 Showing Normal Height & Weight 6724 Showing Grading Pattern as per BMI values 6825 Showing Optimal BMI values 6826 Showing updrava of stoulya 7827 Showing the Sadhyasadhyata of Sthoulya 8128 Showing samshodhana therapies of Sthoulya. 8229 Showing Pathya for Sthoulya 91- 9230 Showing Aharaja Pathyapathya 9331 Showing Viharaja Pathyapathya: 9332 Showing Manasika Pathyapathya 9333 Showing the Drugs of Bhadradi Asthapana VastiYoga 9434 Showing the textule Dose of Bhadradi Asthapana Vasti Yoga 9435 Showing Properties of Trial drugs 95- 9636 Showing Dosh & Roga prabhava, Chemical Comp and karma of Trial 96- drugs 9737 Showing the Materials used for Lipid Profile 107 viii
  15. 15. 38 Showing data related to subjective parameters before and after treatment 11239 Showing data related to objective parameters before and after treatment 11340 Showing Demographical data related to evaluation of efficacy of Bhadradi 114 Asthapana Vasti in Sthoulya.41 Showing the incidence and overall response in age. 11542 Showing the incidence and overall response in sex. 11643 Showing the incidence of religion in the Sthoulya patients 11644 Showing the incidence and overall response in marital status 11745 Showing the incidence and overall response in occupational status 11746 Showing the incidence and overall response in socio-economic status 11847 Showing the incidence of Positive and negative family history in Sthoulya 11848 Showing the incidence of Chronicity of obesity 11949 Showing the incidence of Dietary habits 11950 Showing the incidence of Diet Pattern 12051 Showing the incidence of Aahara guna 12052 Showing the incidence and overall response of Agni of the patient 12153 Showing the incidence and overall response of Koshta of the patient 12154 Showing the incidence of Predominant Rasa 12255 Showing the incidence of Vyaayaama in Sthoulya patient 12356 Showing the incidence of Vyasana in Sthoulya patient 12357 Showing the incidence of Nidra of the sthoulya patient 12458 Showing the incidence and overall response of Prakruti of the patient 12459 Showing the incidence of Sara of the Sthoulya patient 12560 Showing the incidence of Samhanana of the Sthoulya patient 12561 Showing the incidence of Pramana of the Sthoulya patient 12662 Showing the incidence of Satmya of the Sthoulya patient 12663 Showing the incidence of Satva of the Sthoulya patient 12764 Showing the incidence of Abhyavaharana Shakti of the Sthoulya patient 12765 Showing the incidence of Jarana Shakti of the Sthoulya patient 12866 Showing the incidence of Vyayama of the Sthoulya patient 12867 Showing the incidence and overall response of weight 12968 Showing the incidence of height of the Sthoulya patient 12969 Showing the incidence and overall response of BMI in Sthoulya 13070 Showing the incidence and overall response of the nidanas of Sthoulya 13071 Showing the incidence of chief complaints of Sthoulya 13172 Showing retention time of Anuvasana and Nirooha vastii 13173 Showing incidence and result of Serum Cholesterol levels 13274 Showing incidence and result of Serum Triglycerides levels 13275 Showing incidence of Serum HDL levels 13276 Showing incidence of Serum LDL levels 13277 Showing incidence and result of Serum VLDL levels 13378 Statistical results of Lipid profile 13379 Showing the overall assessment 13480 Showing the Individual study of the parameters to show significance 134 effect before and after the treatment ix
  16. 16. LIST OF GRAPHS, FLOW CHARTS, FIGURES AND PHOTOGRAPHS Si Page Title of Graphs No No1 Graph Showing the incidence and overall response in age. 1152 Graph Showing the incidence and overall response in sex. 1163 Graph Showing the incidence of religion in the sthoulya patients 1164 Graph Showing the incidence and overall response in marital status 1175 Graph Showing the incidence and overall response in occupational status 1176 Graph Showing the incidence and overall response in socio-economic 118 status7 Graph Showing the incidence of Positive and negative family history in 118 sthoulya8 Graph Showing the incidence of Chronicity of obesity 1199 Graph Showing the incidence of Dietary habits 11910 Graph Showing the incidence of Diet Pattern 12011 Graph Showing the incidence of Aahara guna 12012 Graph Showing the incidence and overall response of Agni of the patient 12113 Graph Showing the incidence and overall response of Koshta of the 121 patient14 Graph Showing the incidence of Predominant Rasa 12215 Graph Showing the incidence of Vyaayaama in sthoulya patient 12316 Graph Showing the incidence of Vyasana in sthoulya patient 12317 Graph Showing the incidence of in Nidra of the sthoulya patient 12418 Graph Showing the incidence and overall response of Prakruti of the 124 Sthoulya patient19 Graph Showing the incidence of Sara of the sthoulya patient 12520 Graph Showing the incidence of Samhanana of the sthoulya patient 12521 Graph Showing the incidence of Pramana of the sthoulya patient 12622 Graph Showing the incidence of Satmya of the sthoulya patient 12623 Graph Showing the incidence of Satva of the sthoulya patient 12724 Graph Showing the incidence of Abhyavaharana Shakti of the sthoulya 127 patient25 Graph Showing the incidence of Jarana Shakti of the sthoulya patient 12826 Graph Showing the incidence of Vyayama of the sthoulya patient 12827 Graph Showing the incidence and overall response of weight 12928 Graph Showing the incidence of height of the sthoulya patient 12929 Graph Showing the incidence and overall response of BMI in sthoulya 13030 Graph Showing the incidence and overall response of the nidanas of 130 sthoulya31 Graph Showing the overall assessment 134 x
  17. 17. Sl Title of Flow Chart PageNo No1 Flowchart illustrating probable mode of action of vastikarma 372 Showing the schematic representation of samprapti of sthoulya 723 Schematic representation of Upadrava Sthoulya 79 Title of Figure1 Exogenous & Endogenous fat transport pathways are diagrammed 402 Showing classification of lipids 413 Showing causes of obesity 554 Showing etiology of obesity 76 Title of Photo1 Photography showing method of seeing the skin fold thikness2 Photography showing kwatha dravyas3 Photography showing kalka dravyas4 Photography showing prakshepaka dravyas and vasti procedure5 Photgraphy showing the Diagnostic instruments of Obesity xi
  18. 18. IntroductionIntroduction: According to ancient Indians, the treatises that encompass the wholeknowledge of universe are the Vedas. They are four in number viz, Rigveda,Yajurveda, Samaveda, and Atharvaveda. Among these, since the Atharvaveda mainlydeals with different facts of health welfare, it is considered to be the predecessor ofAyurveda. The term Ayurveda is connected to this system because it gives theknowledge of the whole of the ayu (the life) to say in brief, the heralds of each andevery fact of life from birth to death; or, in other words the creations, sustenance anddestruction phenomena are elaborately explained. This was the reason for which theaffix Veda is added to ayurveda only even though a good number of other sciencestoo did exist in ancient India. Ayurveda is the science of life, its main objectives being to relive humansuffering and to import healthful longevity. The ayurveda envisages the means ofprevention and treatment of various ailments and preservation of health. This isachieved through appropriate regimes of ahara, vihara, and aushadhas. Systemicsamshodhana of the body has been conceived to be the prime pre requisite for allkinds of preventive and curative procedures. These purificatory procedures consist ofvariety of physico- physiological measures. Panchakarma therapy represents a similarintegrated procedure. It may be pointed out that besides being of preparatorysignificance, samshodhana karmas form a full therapy in themselves for a variety ofailments. Panchakarma therapy is designed to eradicate the vitiated doshas and tomaintain a state of normalcy and equilibrium, which is the fundamental basis ofhealth. The beauty and power of Ayurvedic purificatory therapy is its system forguiding the toxins to their sites for elimination. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 1
  19. 19. Introduction The term Panchakarma consists of 2 words ‘Pancha’ and ‘Karma’. Panchameans five and also ‘visthara’ i.e. elaborate and karma means method of treatment i.e.five fold therapy ViZ., Vamana, Virechana, 2 types of vastis and Shirovirechana(Nasya). Vasti is further sub divided into two: Anuvasana and Nirooha vasti. Niroohavasti is also known as Asthapana vasti. Sushruta includes Raktamokshana also underthe Panchakarma. Among them acharyas have given prime importance to Vastikarmaand even termed as Ardhachikitsa.1 Vasti enjoys the same significance inpanchakarma therapy as the panchakarma therapy itself enjoys in chikitsa in general.It is praised as Aakeshagranakhagrebhyo vasti naran 2 by kashyapa. In the present days the man has to run with the time and he is trying to leadmechanical life. Though he knows the ill effects of such mechanical life, he madehimself victim to it by suffering with many disorders, among these sthoulya is aglobal problem and more common in modernized man and in present era. This sthoulya is considered as Santarpanajanya vyadhi and one among theAshta nidhita purushas and also as Kaphajananatmaja vyadhi. The obesity is the certainly the mother of dangerous diseases3 and mostburning problem in the present society. Obesity has become an epidemic in 21stcentury.4 It is a bitter truth to swallow about every 4th person on earth is too fat.Obesity is fast becoming one of the worlds leading reason why the people die.5According to WHO this obesity is considered as secondary in the list of dangerousdiseases in the world. And there are so many remedies are put forwarded till now likesurgical lipisection, treatments etc. but their are so many complications are observedwith those. Due to lack of knowledge about the diet & rules for taking the food this isgreatly observed in the developed countries like USA that showing approx one in sixor 39.8 million people and over 300 million adults 2 worldwide (WHO world health Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 2
  20. 20. Introductionreport, 2003) were suffering from obesity6. They are searching for the solutions eitherby dietary things as well as keeping stress on need of exercise. So by observing thesefacts & statistics prevalence of over weight and obesity is also more in India. Solooking for a better management is needed. It is necessary to implement the chikitsa sutras mentioned by our acharyas inreducing the sthoulya / sthulata / medovriddi. So that one can lead a happy lifewithout misery. Vastikarma has doing wonders in the treatment of ayurveda. Though it is theprime treatment for vata, it acts on pitta, kapha, rakta and on sannipataj vyadhis. It hasits effect on shakhagata doshas also and it does its functions on the basis of differentdravya formulations like as Krisham Brimhayati, Sthulam Karshayati, Doshashodhana, Shamana etc. So it is forbidden moral responsible of Ayurvedic scholar to search anyeffective and curative procedure and drug from the Ayurvedic treasure oftherapeutics. In classics so many treatments are said for this sthoulya. There are somany types of vastis are explained for sthoulya like Teekshna vasti, Lekhana vasti etcamong these Bhadradhi Asthapana Vasti is one. So in the present study evaluation ofefficacy of Bhadradi Asthapana Vasti in sthoulya is taken for the study. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 3
  21. 21. ObjectivesObjectives: • In today’s era the people want to leave a luxurious, sedentary life style with an improper dieting habits. Such as over eating, consuming high caloric, highly processed foodstuffs. This may lead to the over accumulation of fat in the body. • By seeing the pathology of Sthoulya i.e., accumulation of fat in different parts of the body it seems to be same as obesity of modern science. • The major risk related with Sthoulya is that, it favors complicated pathologies like Prameha, kushta, shwasa, kasa, vatavyadhi, etc. and it is well established fact that, obesity invites life threatening complications like cardiac diseases, HTN, DM, arterioscleroses, strokes, gallbladder diseases, cancers etc. obesity is a chronic disorder if unchecked will reduces the life expectancy and contributes to the increasing rate of morbidity and mortality. So it is widely said, “Longer is the size of the belt Shorter is the span of life”. • Though Sthoulya is considered as one among the ashtanindita purusha and stated as Sthoolasya Na hi bheshajam. But it is the demand of the time to treat him rationally with positive multidimensional approach, so that life expectancy can be hiked and he can be prevented from dreadful diseases. • In cotemporary medicine the treatment modalities like some appetite suppressants and other surgical modalities are explained among the drugs used in the management of obesity amphetamine has a limited scope because of its benefit for a short-term goal and being contraindicated in coronary heart diseases, HTN etc. secondly Fenfluramine has associated with adverse effects like nausea, diarrhea, lethargy, breathlessness etc.and some complications due to the surgery7.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 4
  22. 22. Objectives • By seeing the above said hazards because of the disease and the complications arising from the drugs used in contramprary medicine, it seems to be good to look at the ayurvedic remedies. Guru cha Apatarpana, Vaatagnha, Sleshmomedoharani, Vyaayama, Rukshana,and Shodhana are the principles of treatment for Sthoulya, Guru cha Apatarpana,Vaatagnha, Sleshma medohara in the form of annapana, form’s a major treatment ofsthoulya. Nidana parivarjana will helps in cessation of further accumulation of meda.Vyaayama that to aerobic exercise helps an individual to reduce weight, Rukshana inthe form of Udvarthana help in mobilization of Sthanika meda. Shodhana in the formof vamana virechana are less stressed upon in treatment of Sthoulya. But most ofVasti yoga’s are much emphasized that to ushna, tikshna, lekhana and karshana vasti,which helps in combating kapha, vata dosha & meda dhatu, considering this aspect inpresent study an attempt is made to find suitable remedy for sthoulya as mentionedspecially by the sushruta samhita i.e.Bhadradi Asthpana Vasti8 is taken andhypothetically the following objectives are evalued • Evaluation of efficacy of vastikarma in Sthoulya. • Evaluation of efficacy of Bhadradi asthapana vasti in Sthoulya1. Evaluation of efficacy of Vastikarma in Sthoulya: Sthoulya is a disease in which the vata gets prakopa by the margavarodha ofati upachita meda and does the agni sandhukshana, which leads to increased intake offood, and in further it produces more complications. So in the samprapti of Sthoulyavata dosha plays a major role. Due to the margavarodha by the meda the vata which is freely moving all overthe body is obstructed and that obstructed vata comes back to the koshta andaggravation of vata takes place when mixes with shamana vata then leads to the agni Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 5
  23. 23. Objectivessandhukshana. So this derangement of the vata may be corrected by this vasti, as vastiis the prime and important treatment modality for vata. So it may helps to avoid thecomplications. Depending upon the different dravya formulations in vasti yoga, it carries outthe functions like dosha shodhana, brimhana in krisha and karshana in sthoola.Being an important chikitsa for vata this vasti will act on other doshas also like pittakapha rakta it does the karshana in sthoola it may help in reducing the lipidvalves. The action of vasti is also seen on asthivaha and majjavaha srotases, as saraktameda is considered as majjagata meda it may helps in reduction of meda and lipidvalues. This vasti is having the effect over shakhagata doshas, so it may relieve themargavarodha caused by ativruddha meda.2. Evaluation of efficacy of Bhadradi Asthapana Vasti in Sthoulya: As Sthoulya is formed by taking kaphakara ahara viharas. And Sthoulya ismedodoshaja vyaadhi. Kapha and meda are having ashrayashrayi bhava and in thesamprapti vata is also one of the pathological entity. So it is necessary to subside bothkapha and vata In this Bhadradi asthapana vasti most of the drugs are having the properties ofalleviating the kapha vata doshas. Which may helps to check the samprapti ofSthoulya. And some of the drugs like devadaru, vacha, madanaphala etc. are havingthe qualities of doing lekhana karma. Tailas used in this vasti i.e. tila taila andsarshapa taila are having the property of doing the karshana of meda the prakshepakadravyas like gomutra, kanji etc. will do karshana of meda and helps to reduce thedeposition of meda and in turn this vasti may check the pathology of Sthoulya. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 6
  24. 24. Historical reviewHistorical Aspect of Vasti: All classical treatises of Ayurveda have emphasized the importance ofVastikarma as the most effective therapeutic measure than any other such methodsprescribed for various ailments especially in the diseases occurring due to vatadosha.Charaka Samhita9: Charaka has described Vasti elaborately and out of twelvechapters of Siddhi Sthana, 8 are contributed to Vasti and explained about Vastikarma,uses, complications, advantages of vasti. First two chapters of Siddhisthana deals withproperties of Vasti Samyakayoga, Ayoga Lakshanas, indications and 10contraindications of Vasti. Teekshna type of vasti is indicated for sthoulya . Thisdenotes the importance of Vasti in the field of panchakarma.Sushruta Samhita: He advised lekhana type of vasti in sthoulya11. In SushrutaSamhita, four chapters have been devoted completely for the description of the Vastiin Chikitsa sthana. In which he has elaborately described the Vastikarma procedures,about vastiyantra, types of vastis, classification, complications, management, etc12Ashtanga Sangraha13: 28th chapter of Sutra Sthana has been devoted to Vasti only.In addition four chapters of Kalpa Sthana also deal with Vasti.Ashtanga Hridaya14: In this text, 19th chapter of Sutrasthana-Vasti Vidhi and 4th and5th chapter of Kalpasthana named as Vasti Kalpa and Vasti Vyapada Siddhi explainthe every aspect of Vasti.Kashyapa Samhita15: In Kashyapa Samhita, Vasti has been explained in detail inSiddhisthana and in 8th chapter of Khilasthana. He equated the vastikarma as A«dm£d«dŠbecause of its wide applications even in both infants and old age.Sharngadhara samhitha16: He has given much importance to vastikarma with theprevious acharyas methods of explanations in 3 chapters, including uttaravasti. And the acharyas like Yogaratnakara, Bhavaparakasha and Vangasena17 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 7
  25. 25. Historical reviewexplained about the vasti karma beautifully and mentioned newer combinations inthe Ayurvedic world for a better practice.Historical aspect of Sthoulya : “ The entire core of the universe is enlightened, in its true form, by the lampof history, the destroyer of veil of ignorance” - Mahabharata adiparva 1:27.Historyabout Sthoulya can be reviewed as following,Veda kala (1000-500 BC): Veda is called as Dean of science. And it is the firstsource of literature and knowledge that narrates the medical science logically.Though, detail description regarding sthoulya (obesity) is not available, somescattered references are available they are listed below, In Rigveda18 the words Meda and Vasa are mentioned. In Yajurveda19 Upachita a name of the disease has been mentioned. In Atharva veda the words like medina20, pivasi21, and medas22are available forSthoulya. It has been advised to strengthen and harden the body like a stone, i.e.expressed the hazards of flabbiness of the body and Sthoulya23.Samhita kala: (200B.C – 400 A.D)Charaka samhita (2 B.C): He is praised as father of medicine the sthoulya isconsidered as Sleshma Nanatmaja vikara.24 Santarpana Nimittaja vikara25 &Adhikadoshayukta Roga26. Beeja swabhavaja is considered as one of the cause forstoulya27. Detailed Anthropometry is described under the caption of PramanaPariksha28 As Samshodana yogya,29 Taila sevana yogya,30 It’s Nidana, Rupa,Samprapti, Chikitsa is been explained in 21st chapter of sutrastana.Sushruta Samhita (2 A.D.): The father of surgery. Nidana, Rupa, Samprapti,Chikitsa of Sthoulya are narrated.31 It is the resultant of vitiated Meda Dosha.32 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 8
  26. 26. Historical reviewIt is described as a Rasa Nimittaja Vyadhi.33. And a new synonym Jatharya has beenused for Sthoulya34Ashtanga Samgraha (6 A.D), Ashtanga Hridhaya (6A.D.): Sthaulya is consideredas a disorder of Shleshmadosha seated in Medodhatu35. Classification of Sthoulya andtheir management36. Pathogenesis and symptoms of Sthoulya are highlighted37.Vitiation of Meda in pathogenesis of Arsa38. A new Paryaya Sthavima is explainedfor sthoulya.39Kashyapa Samhita: (6A.D):Rakta mokshana specially Siravyadha is indicated forthe medhasvidhatri.40Sthoulya is considered as one among the ashtanidhita pururshawhile explaining the anthropology41.Bhela Samhita (7 A.D.): In Bhela samhita Sthoulya is described as a disorder ofvitiated Meda 42Madhava Nidan (7 A.D): Madhavakar has elaborated the pathophysiology of thisdisease based on fat tissue and fat depot site.43 The clear symptomatology of sthoulyaincluding some additional symptom like moha, has been elaborated.44Sharangadhara Samhita (13th Century): He described Sthoulya by nameMedodosha and Medodosha is only one type and it is due to vitiation of Vata.45 He isthe pioneer to described the role of vrikka (renal & suprarenal glands) in thenourishment of Jatharastha meda (abdominal fat and omentum).46Samgraha kala and commentators:Chakrapani (11th Century):In line of treatment of Sthoulya he has commented thatguru and Apatarpana property helps to alleviate Kshudha and reduce Medarespectively.47 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 9
  27. 27. Historical reviewDalhana (12th Century): Explains regarding Ama formation in tikshnagni,Regarding line of treatment he has interpreted virukshana as medoghna andchhedaniya as sroto vishodhana.48Indu (13th Century: He has given explanation of Saktu, Loha etc. words used in theline treatment of Sthoulya.49Arunadutta (13th Century): The word “sthavima” has been used for the sthoulya,explained on the basis of etymology in sarvanga sundari commentary in AstangaHridaya.50Hemadri: (13th Century): He had advised to take choorna of Yavani, Madukajalamas Madhu mishrita udaka Dandahata as Takra, Agnimantha as Tarkari, Kshara asYavakshara, while management of Sthoulya in his Ayurveda Rasayana commentaryon Astanga Hridaya.51Adamalla (14th century) & Kashiram (17th century): He explained definition ofSarakthameda is the one which is situated inner to the majja of the sthulasthi.52 Medodosha is of only one type and it is of vata pradhana is explained in kashirams gudarthadeepika.53Vangasena (12th century): Explains Karana, Samprapti, laxana, Chikista of Sthoulyain Medorogadhikara.54Bhava Prakasha (16th century): He explains about the nidana laxana andcomplications of Sthoulya in the chapter named as Sthoulyadhikara.55Yogaratnakara :(17th century): Explains Sthoulya under Medoroga nidanachikitsaadhyaya. Various herbo-mineral preparations been prescribed in the management ofSthoulya roga.56Review of previous work: Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 10
  28. 28. Historical review Number of research works on the sthoulya under taking as various titles likesthoulya, obesity, Medoroga, Hypercholesteremia, Hyperlipidemia etc. Anti Cholesterolaemic effect of fenugreek (methi). – By Chakravarti. S. And Mitra .S. Dept of Home science, Calcutta submitted in national conference conducted on 2-4 April 1998. Effect of boiled Barley-rice-feeding in Hypercholesterimic and Normolipidaemic. -By Ikegami.S, Tomita. M., Honda.S, Yamaguchin, Muzukajya from National Institute of Health and Nutrition. Suinjuko, Tokio published in plant foods for human nutrition, volume – 49, – 317-328, 1996. Medodhatvagni ka Sthoulya Roga ke Sandarbha mein Saindhantika Evam Prayogika Adhyayan, by Vasudeva, Department of Basic Principles, Jamnagar, 2001. 4) The role of certain Ayurvedic anorexiant drugs in the management of Sthoulya (obesity), by Pandya Amrish (Ph.D.), Department of Kayachikitsa, Jamnagar, 1999. A Clinical study on the management of Sthoulya by Panchtikta and Lekhana Vasti by. Rekha Savajani, Department of Kayachikitsa, Jamnagar, 2001. Aetiopathological study of sthoulya (obesity) and assessment of the effect of the Devadarvyadi vati and virechana karma, by Sarika Mehta, Department of Kayachikitsa, Jamnagar, 2003. A comprehensive study of “Chakramarda” with special reference to “Sthoulya”, by Zala Jyotsanaba, Department of Dravyaguna Jamnagar, 1998. A comprehensive study on Madhu & its role in the management of medoroga, by Charushila Giri, Department of Dravyaguna Jamnagar, 2000. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 11
  29. 29. Historical review An assessment of activities of Ruksha guna with special reference to Sthoulya, by Anand Buchake, Department of Dravyaguna Jamnagar 2002. A comparative pharmaceutico-clinical study on Shilajeet (Triphala shodhita and Gomutra shodhita) and its effect on Medoroga, by Jagdev S.R., Department of Rasashastra and Bhaishajya, Jamnagar 2002. A Pharmaceutico - Pharmaco clinical study on guggulu w.s.r. to its medohara effect, by Rajput Anurag Singh, Department of Rasashastra and Bhaishajya, Jamnagar 2003. Conceptual and clinical study of “Sthoulya” Roga and its management with a selected indigenous compound, by Shah Hema A., Govt. Ayurveda College, Dept. of PGKC of Kayachikitsa , Ahmedabad, 1998. Comparative study of Lekhana therapies in the management of Sthoulya, by Ananda Prasad Nayak, Govt. Ayurveda College, Dept. of PGKC of Kayachikitsa , Ahmedabad, 2003. Study on inter-relationship between Medoroga and Prameha, by Priyadarshini, Banaras Hindu University Dept. of Kayachikitsa, Varanasi, 1999. A clinical study of Medoroga (obesity) with herbomineral compound, by Roy Krishna, Dept. of Kayachiktsa, Calcutta, 1999. Clinical evaluation of Bala Haritaki on serum cholesterol, by Sood Rajiv, Dept. of Kayachikitsa, Jaipur, 1999. Sthoulya vyadhi par Navayas loha ka parinam – Ek Adhyayan, by Pathan S. K., Dept. of Kayachikitsa, Nanded, 1998. Amrutadi Guggulu nirman Evam uske medovah karma ka aturalayin Adhyayan, by Kanholkar N.T., Dept. of Kaya Chikitsa, Nagpur, 2000.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 12
  30. 30. Historical review To study the efficacy of the Lekhan Vasti in Sthoulya, by Sabde M.S, Dept. of Panchkarma, Pune, 1999. The study of Lukewarm water (Koshna Jala) on obesity, by Velhal A.R., Dept. of Swasthvritta, Pune, 2000.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 13
  31. 31. VastikarmaVastikarma: Vasti is the major procedure among Panchakarma therapy. Vasti enjoysthe same significance in panchakarma therapy as the panchakarma therapy itselfenjoys in chikitsa in general. Vasti is mainly indicated in vata – predominantdiseases. The two types of abnormalities of vata namely, Avarana andDhatukshaya can be treated by vasti karma. Direct application of this kind oftreatment to pakwashaya (colon) helps not only in regulating and co-ordinatingvata dosha in its site, but also controls the other doshas involved in thepathogenesis of the disease. The term vasti means bladder it is used as a device forvastikarma. Hence, the term vasti has been used in Panchakarma therapy todesignate the process. It is also said that medicine administered through vastiyantra, first it reachs the lower abdominal area of the patient which contains theorgan vasti (urinary bladder). Due to these reasons the term vasti is used inPanchakarma. In modern medicine, enema is mainly given to remove the faces from thelarge intestine while in Ayurveda; Vasti is given as a route of administration ofthe drugs for multiple actions, which acts locally on large intestine as well assystematically on the body tissue.Etymology of vasti: According to Vachaspatyam, the word ‘Vasti’ has its origin from the root‘Vas’ with the suffix of Pratyaya ‘Tich’ to give raise the word ‘Vasti’ and it belongs to masculine gender. • ‘®d±dg e¦d®dd±dy’ 57 - Means residence. • ‘®d±dŠ-AdŸŸddQ¦dy’ - That which gives covering. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 13
  32. 32. Vastikarma • ‘®d±dŠ ®dd±d¦dy ±dgTeªdI¶TPdî’ - That which gives fragrance. • ®de±£d ®d±£dy Ad®dm¦ddye£d «dgÎd«d - That which covers the urine. • ‘¦ddeªdTŠ A¥ddyªdd›dy «dgÎd¥ddTy’ - The position of vasti is just below nabhi (umbilicus) and is the collecting organ of urine in the body i.e. urinary bladder.Definition of Vasti: 1) ‘®de±£d¦dd QfSd£dy Be£d ®de±£d ’ 58 2) ‘®de±£deªdTŠ QfSd£dy Sd±«dd£dŠ £d±«dd£dŠ ®de±£dTŠ Be£d ±«d g£d:’ 59 3) ‘®de±£d¦dd QfSd£dy ®de±£de¦d ®dd §dg®d‰«d¦SddÏd®d±£ddy ®de±£d’ 60 As the apparatus used for introducing the medicine is made up of Vasti(animal urinary bladder), therefore it is known as Vasti. The medicine, which maybe, medicated decoctions, milk, oil, ghee, mamsarasa of prescribed quantities aretaken in the Vasti and administered through gudamarga by means of a deviceVastinetra after proper pre-treatment procedures. 4) Though in general the term vasti is applied for all kinds vastis such asnirooha vasti, anuvasana, uttara, shiro vasti etc.the charakas description of vasti,as interpreted by chakrapani and jejjata, appears specific for nirooha vasti.61 5) Charaka defines Vasti as the procedure in which the properly prepareddrug is administered through rectum, reaches up to the Nabhi Pradesha, Kati,Parshva and Kukshi, churns the accumulated Dosha and Purisha, spreads theunctuousness (potency of the drug) all over the body and easily comes out alongwith the churned Purisha and Doshas is called Vasti.62 According to modern medicine, enema is the procedure in which anyliquid preparation is introduced through rectum by means of adequate instruments(Ghosh) or injection as liquid or gas into the rectum. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 14
  33. 33. VastikarmaImportance of Vastikarma: - Different acharyas appreciated this form oftreatment considering the efficacy it generates. No other elimination therapy isequal to vasti because of its quick action to produce the desired effects likeshodhana or tarpana without causing any adverse effects. It is evident that the oraladministration medicines for virechana therapy may produce the symptoms likeabdominal distress, nausea and distaste due to the katurasa, ushnaguna andteekhsna gunas the drugs used for this purpose.63 Moreover, virechana cannot beused as a method of shodhana in children and very elderly persons.64 In suchcondition vasti is the only treatment, which can produce the same effect as that ofvirechana.65 Among all the treatment modalities vasti is superior because it has gotmultidimensional therapeutic effect. By mixing with different drugs it willperform the actions like, samshodana, samshamana, krisham brimhayati, sthulamkarshayati etc.66 it is considered as one of the apt treatment for vata predominantdisease and designated as Ardhachikitsa .67 Vasti is not only best for Vata disorders it also equally effective incorrecting the morbid Pitta, Kapha and Rakta.68 While explaining the mode ofaction of nirooha vasti kashyapa explained as“AdIy¶¯dd›T¦dšdd›TyªSddy ©de±£d ©TŠ«UµSd£dy ¦dTd¦dŠ||” means it gives nourishment from the siras of kesha to the nakhagra i.e itnourishes whole body.69 It might be the reason why he equated the vastikarma as‘Amrutam’ because because of its wide application even in both infants and oldage.70Classification of vasti karma: In Ayurveda, wide scope of vasti therapy iscovered by many varieties of Vastis that can be applied in different states. Thefollowing classification of vasti may highlight this fact. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 15
  34. 34. Vastikarma 711. Adhishtana bheda: According to the site of application, vasti is mainly classified into two: -A) Internal: Table no 1: showing the Classification of Vasti according to site of application The administration of medicine 1 Pakwasayagata vasti via ano-rectal route to pakwasaya The drug applied through 2 Garbhasayagata vasti vaginal route (Yonimarga) to the garbhashaya. The administration of medicine 3 Mutrasayagata vasti via urethral route to mootrasaya. The medicine administered 4 Vranagata vasti through the vranamukha by the process of vastikarma. Garbhasayagata & Mutrasayagata vastis are considered under Uttaravasti. B) External: In certain diseases, medicated oil is retained over the body part for a prescribed time and such method is also known as vasti in general. Table no 2: showing the external Vasti procedures. 1 Shiro vasti Allowing the oil to stay on the scalp for a stipulated time by using cap. 2 Kati vasti Allowing the oil to stay in the lumbo sacral region for a stipulated time by using flour paste. 3 Uro vasti Allowing the oil to stay in the chest region for a stipulated time by using flour paste.2) Sankhya bheda: It is stated that neither snehavasti nor niroohavasti can beapplied alone.72 So; Charaka has made this classification based on the number ofsnehavastis and niroohavastis in a treatment.73 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 16
  35. 35. Vastikarma Table no 3: showing the Classification of Vasti on sankya bedaType of vasti No of Sequence of vasti Indication vastiKarma vasti 30 12 Niruha & 18 Anuvasna Uttama bala and Vata Vasti predominant (ka.khi.8/7)Kala vasti 16 6 Niruha & 10 Anuvasana Madhyama bala and vata Vasti Pitta predominant (ka.khi.8/8)Yoga vasti 8 3 Niruha & 5 Anuvasana Kapha predominant Vasti (ka.khi.8/9) 3) Karma bedha: Sushruta and Vagbhata have made the following classification according to their action.74, 75 Table no 4: showing the Classification of Vasti on karma beda 1 Shodhana vasti Contains shodhana dravyas and removes doshas and malas from the body. 2 Lekhana vasti Reduces medodhatu and produces lekhana in the body. 3 Sneha vasti Contains more of sneha and produces sneha in the body 4 Brimhana vasti Increases the rasadi dhathus and indirectly it helps in the growth of the body. 5 Utkleshana vasti Causes utklesha of malas and doshas by increasing its Pramana. 6 Doshahara vasti Purificatory or eliminating type 7 Shamana vasti Produces shamana of doshas. Sharangadhara added, shodhana vasti, lekhana, brimhana, deepana and pachana types of vastis.76Vataghna vasti, pittanashaka vasti, kaphanashaka vasti, balavarnakrita vasti, snehaneeya vasti, sukrakrit vasti, krimighna vasti, vrushatvakrit vasti has been explained by Charaka.77 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 17
  36. 36. Vastikarma4) Matra bedha: The quantity may vary from person to person and it depends onrogi bala, roga bala and vaya of the patient. a) Dvadashaprasruta vasti – In nirooha, the maximum dose or quantityof vastidravya prescribed is dvadashaprasruta i.e. 24 palas.78 b) Prasritayogika vasti – Charaka has prescribed various types of niroohain different doses considering the strength of the patient and condition of thedisease.79 c) Padaheena vasti – matra of this vasti is 9 prasruthi.805) Anushangika bheda: - a) Yapana vasti – Enhances bala, shukra and mamsa. In treating the vyapats produced by excessive coitus. It can be practice daily.81 b) Siddha vasti – It increases the bala, varna, and prasanata.82 c) Yuktaratha vasti – Mainly indicated for travelers on vehicles etc.83 d) Vaitharana vasti –It is mainly concentrating on the elimination of doshas.84 e) Kshara vasti – Explained for shoolam, vitsangam, anaha, and mootrakrichra.85 f) Ardhamatrika nirooha vasti– snehana and swedana karmas are not required. Mainly it is indicated in rajayakhsma, shoola, and krimi and in vatarakta. It improves sukrha and ojus. 86 g) Picha vasti – It is given with pichhila dravyas like Shalmaliniryasa and lajjalu. It is indicated in pichhalasrava and jeevashonita. It acts as Sangrahi.87 h) Mutra vasti – It is Gomutra pradhana vasti it is mridu in nature, safe and pacifies the doshas.88 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 18
  37. 37. Vastikarma i) Rakta vasti – It is indicated in adhika rakta srava.89Dravya bheda:90 Depending up on the nature of Vasti drugs i.e. Kashaya andSneha the Vasti is mainly sub-classified as • Anuvasana Vasti. • Niruha VastiVasti Yantra The device used for vasti karma is called as vastiyantra. Itcomprises by two parts – • Vastinetra • Vastiputaka Vastinetra The netra should be made of gold, silver, and copper or withother higher metals, alloys, long bones, bamboo, wood etc. Generally netra mustresemble like tail of cow with a tapering end and a wider base, or like pyramidshape with round ends and smooth surfaces.91 The dimensions are different fordifferent age group.Measurements of Vasti netra:92 93 Table no 5: showing the measurement of Vasti YantraAge Length Narrow end Base endBelow 1 year 5 angula Size of a wild green gram 1 angula1 - 6 years 6 angula Size of green gram 1 angula7 – 11 years 7 angula Size of black gram 1½ angula12 – 15 years 8 angula Size of kalayam 2 angula16 – 19 years 9 angula Size of soaked kalaya (chik pea) 2½ angula20 years and 12 angula Size of a karkandhu seed 3 angulaabove Uttaravasti yantra 12-14 Size of a sarshapa beejaAccording to susruta 94 1 6 Green gram Feather of kanku bird must pass through. 8 8 Black gram Feather of eagle must pass through. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 19
  38. 38. Vastikarma 16 10 Kalayam Feather of peacock must through. >25 21 Kolasthi Feather of vulture must pass through.Pramana of vranavasti netra: The hole should be of a mudga pramana, with 8angulas of length.95Karnika: In order to prevent undue penetration of the vastinetra deep in to therectum, a karnika or rim has to be made. It is to be placed at a required pointabove the distal end. Two karnikas are provided on the netra at distance of 2angulas between one, another at proximal end to tie the vastiputaka properly.96Netra doshas and its effects. Charaka 97Table no 6: showing the Netra Doshas and its effectsNo. Netradosha Features Effect1. Hraswata Too short Aprapti (Dravya will not reach pakwasaya)2. Deerghata Too long Atigati (Dravya go beyond the pakwasaya)3. Tanuta Too thin Kshoba (Produces irritation in the rectum)4. Sthoolata Too big Karshana (brussing the wall of the rectum)5. Jeernata Old dhatu used Kshanana (Injury to guda)6 Shithilabandhana Not fixed properly Srava (Dravya comes out) to the putaka7. Parshwachhidra Hole on side Guda pida (because of Leakage of dravya pain in the rectum will be observed)8. Vakrata Curved / irregular Jiwha gati (drava gati becomes irregular)Netra doshas and its effects. Acc. to sushruta, 98 1 Assannakarnika Karnika too near Karma becomes of no use 2 Prakrustakarnika Karnika too far Causes raktasrava by gudamarma peedana 3 Anusrotata Small hole Cannot perform properly 4 Mahasrotrata Broad hole Cannot perform properly Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 20
  39. 39. VastikarmaVastiputaka: The container or bag used to carry the vastidravya, ready forapplication is known as vastiputaka. In ancient days the urinary bladder ofmatured animals like cow, buffalo, dear, pig, goat etc were used. It was thenprocessed to make soft and colorful by removing the blood vessels and otherimpurities. The container of the vastidravya is known as vastiputaka. And it should bemade suitable for well fitting with the vastinetra and should not have any badsmell. If good bladder is not available oter materials like skin of lower limb orneck of monkeys or other animals; thick cloth with sufficient strength and size arerecommended for the purpose.99 As the technology advances the development various types of materialsare available to make up of vastiputaka. The rubber bladder and polythene bagsare best choice these materials are disposable, safe and easy to perform. Vasti putaka doshas and its effects:100 Table no 7: showing the vasti Putaka Doshas and its EffectsNo. Putakadosha Features Effect1. Vishama Shape not in Gati vishamya (irregular flow of enema uniform fluid)2. Mamsala Muscular tissue Visratva (Produces offensive smell) present3. Chinnachidrayukta Presence of hole Srava (Dravya comes out)4. Sthoola Thick one Dourgrahya (difficulty in handling)5. Jalayukta Anastamosis Nisrava (exudation of enema fluid from present the receptacle)6. Vatala Excess air space Phenila (Frothy type of dravya)7. Ati Snigdha Unctuous Chyuti (Slip away form the hand)8. Klinnata Wet Adharyata (inability to hold the receptacle)A) Anuvasana vasti: -Definition:101“A¦dg®dd±d¦d Ae§d ¦dd Qg°Sd£Sd¦dgeQ®d±d«dŠ ®dd QfSd£dd B£Sdd¦dg®dd±d¦dd ||” Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 21
  40. 40. Vastikarma It is Sneha pradhana vasti hence auvasana is named as sneha vasti. Thepeculiarity of this vasti is no adverse effects, it is safe, can be practice daily.Types:Based on the sneha matra it is of three types.102 1) Sneha Vasti: - 6 Pala (298ml) i.e.1/4th of the quantity of Nirooha. 2) Anuvasana Vasti: - 3 Pala (144ml) i.e. half of the Sneha Vasti. 3) Matra Vasti: - 1½ Pala (72ml) and this is the minimum quantity of Sneha Vasti.103Anuvasana yogya: 104,105,106 Anuvasana is indicated in patients who are indicated for asthapana, butspecial mention has been given to certain conditions like rooksha, kevala vatarogaand atyagni where anuvasana is more beneficial.Anuvasana ayogya: 107,108,109Table no 8: showing contraindications for Anuvasana Vasti.No. Contraindications Ch. Su. Va Complications1. Anasthapya + + +2. Abhuktabhakta + - + Sneha moves upwards3. Navajwara + - -4. Kamala + - + Leads to udara5. Prameha + - +6. Arshas + - - Leads to aadhmana7. Pratishyaya + - -8. Pandu + + +9. Arochaka + - - Leads to more annabhilasha10. Mandagni + - -11. Durbala + - - Increases the condition12. Pleehodara + + +13. Kaphodara + + + Leads to more dosha vardhana14. Oorustambha + - +15. Garapeeta + - +16. Kaphabhishyanda + - +17. Gurukoshta + - +18. Shleepada + - +19. Galaganda + - +20. Apachi + - +21. Krimikoshta + - +22. Prameha - + +23. Kushta - + +24. Sthoulya - + + Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 22
  41. 41. Vastikarma25. Peenasa - - +26. Krushna - - +27. Varchobheda + - +28. Vishapeeta + - +B) Nirooha vasti:Definition: 110 ±dQdy°d e¦dTŠUµTPddŸJµTfTe¦dTdyUµPddÙd e¦déUµ || The Vasti, which eliminates the vitiated Dosha, thus provides strength tothe body, is called Niruha Vasti . ®dSd: ±¤dd§d¦ddQdSdg: ±¤dd§d¦dÙd Ad±¤dd§d¦d«dŠ || Its other important synonym is Asthapana. As it stabilizes the young age(Vaya Sthapana) and provided longevity (Ayu Sthapana), so it is called asAsthapana Vasti Nirooha vasti posseses varied therapeutic effects like shodhana;it makes the apakarshana of vit, sleshma, pitta and anila. It restores the dridata,bala Varna, shukra and it prevents the aging process.111Drugs used in Nirooha Vasti Karma: - Acharya susruta has mentioned numberof drugs used in the nirooha vasti. They are as follow, dugdha, amla, mautra,mamsasrasa, and lavana triphala, madhu, shatavha, sarshapa, vacha, ela, trikatu,rasna, devadaru, rajani, madhuka hingu, etc.112Contents of niroohavasti: 113,114,115The usual contents of nirooha vasti are: - 1.Makshika (honey) 2.Lavana (rock salt) 3.Sneha (oil/ghee/taila) 4.Kalka (medicines made as paste) 5.Kwatha (decoction) According to the condition of patient and disease other ingredients likemilk, mamsarasa, amla dravya, mutra and guda are also used.116Taila is selected Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 23
  42. 42. Vastikarmaconsidering the disease and condition of patient. The paka of vasti taila should bestrictly mentioned as cikkanna paka.117 Drugs for kalka, if no drug is specificallymentioned shatapushpi choorna can be used.118Kwatha is the decoction made asper the ingredients selected rationally to suit the condition of the patient. madanaphala is the useful drug.Nirooha Vasti dravya yojana krama: Acharya vridda vagbhata has explainedthe mixing process of vasti dravya as in the order of makshika - lavana – sneha –kalka – kwatha – other prakshepaka dravyas. And this will be the procedure ofpreaping the solution of nirooha vasti.119Advantage of proper mixing: Honey, being auspicious, is first of all poured forauspiciousness. The salt disintegrates by its shrpness the sliminess, densenes andastringentness present in honey and thus a compound is formed, that is why afterhoney salt is added, then oil is poured. It brings uniformity (the content areproperly mixed together) and then put paste, it gets mingeled quickly and thedecoction brings homogeneity in this oligineous substance paste and decoctionmixed together then add urine it brings sharpness and increases its virya.120Dose schedule 121,122,123The adult dose of nirooha vasti is dvadasaprasrita i.e. 24 palas.Table no 9: showing the Dose schedule of Nirooha Vasti Sl Age in Dose No Years Ch Va Su 1. 1 ½ prasrita 1 pala 2 anjalis of patients hand i.e. 1 pala 2. 2 2 pala 2 pala 3. 3 3 pala 3 pala 4. 4 4 pala 4 pala 5. 5 5 pala 5 pala 6. 6 6 pala 6 pala 7. 7 7 pala 7 pala 8. 8 8 pala 8 pala 4 anjalis of patients hand 9. 9 9 pala 9 pala 10. 10 10 pala 10 pala 8 anjalis of patients hand Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 24
  43. 43. Vastikarma 11. 11 11 pala 11 pala 12. 12 12 pala 12 pala 13. 13 14 pala 14 pala 14. 14 16 pala 16 pala 15. 15 18 pala 18 pala 16. 16 20 pala 20 pala To be fixed based on netra, 17. 17 22 pala 22 pala dravya pramana, age, bala 18. 18 – 70 24 pala 24 pala and saralaswabhava 19. Above 70 20 pala 20 pala 20. Above 25 12 prasthaContents and quantity of nirooha vasti: The quantity of nirooha is 12 prasrita,out of these 5-prasrita kwatha i.e. 10 palas. The sneha should be 1/6th, 1/4th and1/8th i.e. 4 pala, 6 pala, 8 pala in pitta, vata and kapha dosha respectively.124Innirooha. 24 palas of nirooha dose may be adjusted as follows: 1.Makshika – 4 palas. 2.Lavana – 1 karsha 3.Sneha – 4 palas. 4.Kalka – 2 palas. 5.Kwatha – 10 palas. 20 palas. The remaining portion should be made up by avapa dravyas (orprakshepaka dravyas) like gomutra, mamsarasa etc. i.e. 4 palas totals it to 24palas.According to Sushrutha 125 1.Makshika – 4 palas. 2.Lavana – 1 karsha. 3.Sneha – 6 palas. 4.kalka – 2 palas. 5.Kwatha – 8 palas. 6.Avapadravya – 4 palas Total quantity is 24 palas. This is the uttama matra of nirooha. It can be reduced upto 1prasrutaaccording to the need.126 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 25
  44. 44. VastikarmaIndications and contraindications of Nirooha Vastikarma: As vasti is one ofthe prime treatment modality of Ayurveda, the knowledge of the indication andcontraindication will make the success in the treatment. A brief description hasbeen made here.Asthapana ayogya: 127,128,129Table no 10: Showing the Patients contraindicated for AasthapanaNo. Type of patient Cha. Su. Vag. Complication1. Ajeerna + + -2. Atisnigdha + - + Dooshyodara, Moorchha, Shotha.3. Peetasneha + - -4. Utklishtadosha + - - Teevra aruchi5. Alpagni + + +6. Yanaklanta + - -7. Atidurbala + + - Shaeerashosha, pranaparodha,8. Kshudhaarta + - - Kruchraswasa9. Trishnaarta + + -10. Sharmaarta + - -11. Atikrisha + + + More karshya, utklesha of dosha12. Bhuktabhakta + - + happens13. Pitodaka + - -14. Vamita + - + More rookshata happens15. Virikta + - +16. Krita nasyakarma + - + Manovibhrama, Srotonirodha17. Krudha + - - Vastidravya moves up18. Bheeta + - -19. Matha + + - Samnjanasha and20. Moorchita + + - Hrudayopaghata21. Prasaktachhardi + + +22. Prasaktanishteeva + - + Vastidravya moves up because of23. Swasaprasakta + + + the existing urdhwagati of vata24. Kasaprasakta + + +25. Hikkaprasakta + - +26. Baddhagudodara + - + Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 26
  45. 45. Vastikarma27. Chhidrodara + - + Leads to death by causing severe28. Dakodara + - + distension of abdomen29. Adhmana + - +30. Alasaka + - -31. Visoochika + - - Causes teevra amavastha of the32. Asmadosha + - - body33. Amatisara + - +34. Madhumeha, + + + Vyadhi vardhakam Prameha35. Kushta + + +36. Arshas - + +37. Pandu - + -38. Bhrama - + -39. Arochaka - + -40. Unmad - + -41. Shokagrastha - + -42. Sthoulya - + -43. Kandhashosha - + -44. Kshathaksheena - + +45. Saptamasa - + + garbhini46. Bala, Vruddha - + -47. Alpavarcha - - +48. Gudashodha - - +49. Amaprajatha + - -50. Shopha - - -Asthapana yogya: 130,131,132 Table no 11 : Showing the Patients indicated for AasthapanaNo. Indication Ch. Su. Va No. Indication Ch. Su. Va1. Sarvangaroga + + - 37. Rajakshaya + + +2. Ekangaroga + + - 38. Vishamagni + - -3. Kukshiroga + - - 39. Spikshoola + - -4. Vatasanga + + + 40. Janushoola + - -5. Mutrasanga + + + 41. Janghashoola + - -6. Malasanga + + + 42. Urushoola + - -7. Shukrasanga + - + 43. Gulphashoola + - -8. Balakshaya + - - 44. Parshnishoola + - - Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 27
  46. 46. Vastikarma9. Mamsakshaya + - - 45. Prapadashoola + - -10. Doshakshaya + - - 46. Yonishoola + + -11. Shukrakshaya + + - 47. Bahushoola + - -12. Aadhmana + + + 48. Angulishoola + - -13. Angasupti + - - 49. Sthanashoola + - -14. Krimikoshta + - - 50. Dantashoola + - -15. Udavarta + + - 51. Nakhashoola + - -16. Sudhatisara + + + 52. Parvasthishoola + - -17. Parvabheda + - - 53. Shopha + - -18. Abhitapa + - - 54. Sthmaba + - -19. Pleehadosha + - + 55. Aantrakoojana + - -20. Gulma + + + 56. Parikartika + - -21. Shoola + + + 57. Maharogoktavatavyadhi + - +22. Hridroga + - - 58. Jwara - + +23. Bhagandara + - - 59. Timira + + -24. Unmad + - - 60. Pratishaya - + -25. Jwara + - + 61. Adhimantha - + -26. Bradhna + + + 62. Ardita + + -27. Shirashoola + + + 63. Pakshaghata + + -28. Karnaroga + - - 64. Ashmari - + -29. Hritshoola + - - 65. Upadamsha - + -30. Parshwashoola + - - 66. Vatarakta - + -31. Prushtashoola + - - 67. Arshas - + -32. Katishoola + - - 68. Stanyakshaya - + -33. Vepana + - - 69. Manyagraha + + -34. Aakshepa + + - 70. Hanugraha + + -35. Angagaurava + - - 71. Ashmari - + +36. Atilaghava + - - 72. Moodhagarbha - + +Amlapitta, hridroga, asrugdhara133Amlapitta, hridroga, asrugdhara and Vishamanajwara 134Preparation and procedures of vastikarma: Generally, these procedures andpreparations are classified into three parts: - 1.Poorvakarma (pre-treatment) 2.Pradhanakarma (treatment) 3.Paschatkarma (post-treatment) Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 28
  47. 47. Vastikarma The patients selected for vasti therapy has to undergo through clinicalexaminations to ascertain the physical as well as the mental conditions. Thefollowing ten factors are to be considered.1351.Dosha 2.Oushada 3.Desa 4.Kala 5.Satmya6.Agni 7.Satwa 8.Vaya 9.Bala The critical study of the above factors will enable the physician to decide,the type of vasti, number of vastis, vasti dravya, etc to be administered in theparticular patients.Procedure of Anuvasanavasti1.Poorvakarma (pre-treatment): The patient should pass is natural urges thenbody of the patient should be anointed with suitable sneha and mrudu sweda withhot water. He is advised to have his prescribed meal it is madyama matra andmade to take a short walk. Patient is asked to lie over vasti droni, which is notvery high, and the head must be at lower level. The patient should be on his leftside drawing up the right leg and straightening the left leg.136, 137,1382.Pradhanakarma (treatment): The prescribed amount of taila should be takenin the vastiputaka and tied well placing the vastinetra in position. Air is trappedfrom vastiyantra by gently pressing the vastiputaka. Then the anal region and thenetra should be smeared with oil to minimize the pain and irritation. Gently probethe anal orifice with the index finger of the left hand and introduce the vastinetrathrough it into the rectum up to the mark of first karnika. Keeping in the sameposition press the vastiputaka by putting the adequate force then withdraw fromthe sight, release carefully the vastinetra when a little quantity of snehare3maiuned inside the vastiputaka.1393.Paschatkarma (post-treatment): The patient is kept in same position as longas it would take to count up to hundred. The patient should be gently struck three Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 29
  48. 48. Vastikarmatimes on each of the soles and over the buttocks. The distal part of the cot shouldbe raised thrice. Allow him to lie for sometime in the same position, if givensneha passed immediately; another anuvasanavasti should be adopted. Afterpassing the motion with sneha in proper time the patient is allowed to take lightfood if he feels hungry.140,141 9 hours is the maximum time for vastipratyagamana.Proper, Insufficient and excessive signs and symptoms of Anuvasana vasti.142 Table no 12: Showing the Proper, insufficient & excessive signs and symptoms of Anuvasana VastiProper Insufficient ExcessiveExpulsion of complete oil Low backache Palpitationwith faecesTissues, senses becomeclear and functioning Dry skin FaintingnormalSleep becomes usual Dry stool ConvulsionsBody becomes light and Parikartikastrengthens Obstruction of natural urges Cutting pain inProper flow of natural urges gudaComplications of Snehavasti 143Six types of complications may arise in snehavasti and are due to: - 1.Vata 4.Atibhukta 2.Pitta 5.Pureesha 3.Kapha 6.Abhukta Specific signs and symptoms with treatments are mentioned.Procedure of Niroohavasti:Purvakarma: Niroohavasti is indicated to be administered in noon, in a patientwho has an empty stomach. Abhyanga with suitable sneha and mild swedanashould be done prior to the process and the patient is advised to be on the cot asprescribed for anuvasanavasti. Vastidravya prepared as per the direction should be Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 30
  49. 49. Vastikarmataken in vastiyantra and introduced into pakwasaya. The procedures followed foranuvasana during its applications are the same for nirooha. 144Paschatkarma: After giving the vasti the patient should use pillows and lie insupine position. Application of pressure on buttocks and other proceduresfollowed in anuvasana should not be done. When he gets up urges for defecationhe may do the same in squatting posture. After passing motion he may be advisedto take bath in hot water and have some solid food along with yusha, mamsarasaor milk in kapha, vata and pitta predominant diseases respectively. It is generallyseen that the adverse symptoms are produced if any, during the therapy willsubside after taking bath and their food. The maximum time allowed for passingout the motion after the administration of the nirooha vasti is one muhurtha (48minutes). If it did not pass out, giving vasti, which consists of sneha, kshara,mutra and amla dravyas, can bring it out. It should have snigdha, Ushna, andteekshna properties. Phalavarti may also be used for this purpose. If the nirooha ispassed out instantly and the patient is not showing desired symptoms and signsagain 2 or 3 vastis can be given. But if the patient shows excited symptoms ofvata, snehavasti should be given immediately. No particular regimen ofsamsarjanakarma is needed for vasti karma. 145Proper, Insufficient and excessive signs and symptoms of Nirooha vasti.146Table no13: Showing the Proper, insufficient & excessive signs andsymptoms of Niroha VastiProper Insufficient ExcessivePassing urine, stool, flatus Headache Passing stoolusually number of timesLightness in the body Pain in the heart, umbilicus, Dullness in the bladder, anus, penis or vagina bodyFeeling tasty Body acheIncreased digestive power Oedema Tiredness Coryza Tremors Cutting pain Sleep Anuria Weakness Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 31
  50. 50. Vastikarma Dyspnoea Drowsiness Anorexia Insanity Heaviness HiccupComplications of niroohavastiDefects of physician147 1.Sa vata vastidana– Entry of an air into rectum leads to pain in abdomen and Colic, abdomen and colic. 2. Druta praneeta – Quick administration of vasti dravya leads to pain in hip, Anus, thigh, calves and retention of urine. 3. Tiryak praneeta – Horizontal introduction leads to blockage at the tip of vastinetra. Introduction of vastidravya by pressing vasti putaka more than once leads to chat pains, headache, and pain in thighs. 4.Ullipta – Introduction of vastidravya by pressing vastiputaka more than once leads to chat pains, headache, and pain in thighs. 5. Sakampa vastidana – Shivering while administration leads to erosion, burning and swelling at anal region. Not deeply introduced leads to burning pain in intestines. 6. Apraneeta – Not deeply introduced leads to burning pain in intestines. 7. Atimanda data – If done too slowly drug does not reach till intestines. 8. Ativega data– Forceful introduction leads to the dravya reaching up to koshta and sometimes may come out through upper orifices.Vasti vyapats 148 1.Ayoga – Due to the administration of less quantity of vasti dravya, rock salt, add oil leads to heaviness in abdomen, obstruction of flatus stool and urine, burning sensation, inflammation at anal region, itching, anorexia, dyspepsia. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 32
  51. 51. Vastikarma2.Atiyoga – Administration of teekshna vasti to mridu koshta person leads to atiyoga and symptoms are similar to vamana-virechana atiyoga.3.Klama – Conduction of mridu vasti in ama state, pitta and kapha gets vitiated and block the channels, which leads to dyspepsia. There after vata also become vitiated and causes fatigue, syncope, burning sensation, colic, chest pain, heaviness.4.Adhmana – Due to administration of low potency drugs to strong person, dry bodies and costive bowel, the drugs not able to expel vitiated doshas and vata gets vitiated leads to adhmana causing pain in vasti and hridaya, severe burning sensation, pain in testicles and groin.5.Hikka – Hiccup results in administering teekshna vasti to weak person and mridu koshta with excessive expulsion of doshas.6.Hrit prapti – Vastidravya reaches the heart by entering into deeper levels due to complete squeezing or improper handling of vastiputaka and causes pain in chest and the surroundings.7.Urdhwagamana – Suppression of urges before or after vastikarma and squeezing vastiputaka with high pressure leads to the upward movement and may come out through mouth.8.Pravahika – Administration of less potent and insufficient quantity of vastidravya to the person suffering form intensive vitiated doshas leads to pravahika.9.Shiroarti – Includes symptoms of headache, earache, deafness, tinnitus and coryza, eye disorders due to administration of less potent sheetaveerya dravyas with insufficient quantity to weak persons.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 33
  52. 52. Vastikarma 10.Angarti – Administration of teekshna vasti without conducting pre-operative procedures like abhyanga and sweda leads to angarti with upward movement of vata and twisting and pricking pain in the body. 11.Parikartika – Administration of ruksha and teekshna vasti in excessive quantity to the person having mridukoshta and in conduction of less vitiated doshas leads to the excessive expulsion of doshas causing parikartika. 12.Parisrava – Administration of teekshna and ushna vastis to the person suffering from pitta roga / raktapitta leads to parisrava and causes burning sensation, erosion and cutting pain in anal region, severe bleeding and fainting.Drugs used in Vasti Karma: Number of drugs belonging to animal and plantorigin has been described in the classics, which are used in vastikarma. Forexample, herbs, milk, mutton juice, eggs, urine, alkalis, salts etc. The above listssuggest that almost all available drugs can be used for vastikarma. 1. Phalini drugs- Drugs useful for emesis can be used in asthapanavasti also. e.g:- phala, eemutaka, ikshwaku, dhamargava, kutaja, and kritavedhana.149 2. Sneha drugs - Ghrita, taila, vasa, majja.150 3. Mutravarga - Aja, avi, go, mahisha, hasti, ushtra, haya, etc.151 4. Asthapana & anuvasana gana - Dasamoola, bala, eranda, punarnava, yava, kola, kulatha, guduchi, madanaphala, palasa etc.152 5. Adjuants for asthapanavasti - Trivrit, bilwa, pippali, kushta, sarshapa, vacha, kutaja, satahwa, yashtimadhu, madanaphala. 6. Adjuants for anuvasanavasti - Rasna, devadaru, bilwa, madanaphala, satahwa, swetapunarnava, raktapunarnava, gokshura, agnimandha, syonaka.153 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 34
  53. 53. VastikarmaVasti karmukata: Vastikarma having mulitidimentional therapeutic effects asearly mentioned for better understanding it can be studied under the followingheadings.The procedural effect: The rationality behind the left lateral position is the gudvalees becomes relaxed there by it helps in the administration of vasti.Pakwashaya resides in the given left side so the given vasti dravya reaches thepakwasaya, as it is the main seat of vata; hence the given drugs will counter actthe vatadosha. He also mentions that the grahani is situated in the left side.154Chakrapani states that Agni will be in the natural state in the posture whileGangadhara says; Agni, grahani and nabhi are present in the left side. Jejjatacomments Agni is present left side over the nabhi, guda has got a left sidedrelation with sthoolantra. So vastidravya can reach to the large intestine andgrahani, as they are present in the sequence.155Action based on drug effect: Action of vastidravya is due to itsAnupravanabhava, which contains sneha along with other dravyas like makshika,saidhavaSneha easily moves up to grahani by anupravanabhava guna similar tothat of dravya, which freely moves in the utensil. Charaka says vastidravya reachnabhi, katipradesha and kukshi.156The Shodhana effect: The action of vasti is mainly depends on its veerya. Thedrug used in the vasti karma will however spread in the body from pakwasaya dueto their veerya; through the appropriate channels and draws the vitiated doshas topakwashaya. It is like sun in the sky draws the water from earth. The veerya isdrawn into the body by vata dosha i.e. first by apana, then udana and throughoutthe body by vyana. In charaka siddi he gives a simily like water sprinkled at theroot of tree circulates all over the tree and nourishes the body by its own specific Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 35