Vasti madhumeha pk011-gdg


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EVALUATION AND EFFICACY OF MADHUTAILIKA BASTI IN THE MANAGEMENT OF MADHUMEHA, S. KENDADMATH (D.S.Swami), Post graduate department of Panchakarma,Shri D. G. Melmalagi Ayurvedic Medical College,Gadag – 582103.

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Vasti madhumeha pk011-gdg

  1. 1. EvaluationofefficacyofMadhutailakaBastikarma inthemanagementofMadhumeha(NIDDM) By D.S.Swami Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M.D. In PANCHAKARMA Under the guidance of Dr. G. Purushothamacharyulu, M.D. (Ayu) And co-guidance of Dr. Shashidhar.H. Doddamani, M.D. (Ayu) Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103. 2006.
  2. 2. Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled “Evaluationof the Efficacy of Madhutailika Bastikarama in the management of (NIDDM)”Madhumeha (NIDDM)” is a bonafide and genuine research work carried outby me under the guidance of Dr. G. Purushothamacharyulu, M.D. (Ayu), Pro-fessor and H.O.D, Post-graduate department of Panchakarma and co-guid-ance of Dr. Shashidhar. H. Doddamani, M.D.(Ayu) , Assistant Professor, Postgraduate department of Panchakarma.Date:Place: D.S.Swami
  3. 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Evaluation ofthe Efficacy of Madhutailika Bastikarama in the management of Madhumeha(NIDDM)” is a bonafide research work done by D.S.Swami in partial fulfillmentof the requirement for the degree of Ayurveda Vachaspathi. M.D.(Panchakarma).Date:Place: Dr. G. Purushothamacharyulu, M.D. (Ayu). Professor & H.O.D Post graduate department of Panchakarma.
  4. 4. ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Evaluation ofthe Efficacy of Madhutailika Bastikarama in the management ofMadhumeha (NIDDM)” is a bonafide research work done by D.S.Swamiunder the guidance of Dr.G. Purushothamacharyulu, M.D. (Ayu), Professor andH.O.D, Postgraduate department of Panchakarma and co-guidance of Dr.Shashidhar.H. Doddamani, M.D. (Ayu), Assistant Professor, Post graduate de-partment of Panchakarma.Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil. Professor & H.O.D, Principal.Post graduate department of Panchakarma.
  5. 5. CERTIFICATE BY THE CO- GUIDE This is to certify that the dissertation entitled “Evaluation ofthe Efficacy of Madhutailika Bastikarama in the management ofMadhumeha (NIDDM)” is a bonafide research work done by D.S.Swamiin partial fulfillment of the requirement for the degree of AyurvedaVachaspathi. M.D. (Panchakarma).Date: Dr. Shashidhar.H. Doddamani, M.D. (Ayu).Place: Assistant Professor, Post graduate Department of Panchakarma.
  6. 6. COPYRIGHT Declaration by the candidate I hereby declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and dissemi-nate this dissertation / thesis in print or electronic format for academic /research purpose.Date: D.S.SwamiPlace:© Rajiv Gandhi University of Health Sciences, Karnataka.
  7. 7. I Acknowledgement By the grace of god, bless of eiders I take this opportunity to express myregards to the persons who helped in completing this work. I express my deep sense of gratitude to his great holiness Jagadguru ShriAbhinava Shivananda mahaswamiji for their divine blessings. Words fail miserably when I try to express my gratitude to my mentor, myguide Dr.G.Purushottamacharylu M.D (Ayu), H.O.D of P.G.Department of Panchakarma.For his incessant, untiring, round the clock guidance with all the diligence. Hissustained fostering and encouragement instilled considerable impetus in me enablingto achieve this milestone which otherwise would have lacked this particular finish. Indeed, I will cherish the affectionate guidance of my co-guide Dr.ShashidharH.Doddamani M.D (Ayu), Asst professor of P.G.Department of Panchakarm. For hisinvincible and radical thinking were very valuable in achieving this research workinvoking scientific spirit throughout the course of the study. I express my sincere and deep gratitude to Dr.G.B.Patil, Principal, D.G.M.A.M.C,Gadag, for his wholehearted encouragement as well as providing all necessary facilitiesfor this research work.I express my sincere gratitude to Dr.P.Shivaramudu M.D (Ayu), Assistant Professor and Dr.Santhosh.N.Belavadi MD (Ayu), Lecturer of P.G.Department of Panchakarma for hisexcellent advices. I also express my sincere gratitude to Dr.S.D.Yargeri R.M.O. for his moralsupport and special care in providing the all the facilities during this trail work. I express my sincere gratitude to Dr.G.S.Hiremath, Dr. Anjaneya murthyDr.V.Varadacharyulu, Dr.M.C.Patil, Dr. Mulgund, Dr.Dilip Kumar, Dr.R.V.Shetter,Dr.Basavaraj Hadapada,Dr. K.S.R.Prasad, Dr.G.Danappa Gowdar, Dr. Kuber Sankh,
  8. 8. IIDr.J.G.Mitti, Dr.Shakanath.Nidagundi, and other PG staff for their constantencouragement. I thank Dr.U.V.Purad, Dr.S.H.Radder, Dr.B.M,Mulkipatil and otherundergraduate teachers for their support in the clinical work. I thank to Shri. Nandakumar(Statistician), Shri.V.M.Mundinamani (Librarian), Mr.Surebana and other hospital andoffice staff for their kind support during my study. Indeed, I will cherish the affectionate of my Father, my elder brother Mr.V.S.Kendadmath, and all my family members who has been a source of inspiration formy entire carrier. I express my sincere thanks to my friends Dr.H.T.Sangamesh, Dr.Basavaraj R.Channappagoudar, Dr.Prakasha.Gunjal, Dr.shrikanth, Dr.Santhosh.L.Y, Dr.V.M.Hugar,Dr.Jayaraj Basarigidad, Dr.Shivakumar.Sajjanar, Dr.Ashok.Bingi, Dr.B.H.Venkaraddi,Dr.B.L.Kalmath, Dr.P.Chandramouleeswaran, Dr.Shaila.B. Dr.Uday Kumar, Dr.RatnaKumar, Dr.Ghanti, Dr.Pradeep, Dr.Babu.Sobagin, Dr.Suresh.Hakkandi,Dr.Manjunath.Akki, Dr.Gavi, Dr.AshwinDev, Dr.V.S.Hiremath, Dr.L.M.Biradar,Dr.Jagadisha.H., Dr.Sharanu, Dr.Anand, Dr.Umesh, Dr.Suvarna, Dr.Devendrappa,Dr.Sibaprasad, Dr.Madhushree, Dr.Ashok.M.J, Dr.Payappagoudar, and other postgraduate scholars for their support. I would like to mention the support and inspiration provided by my uncleShri.Shivashankarayya.S.Hiremath & family for their support and encouragement duringmy stay at Gadag. I acknowledge my patients for their wholehearted consent to participate in thisclinical trial. I express my thanks to all the persons who have helped me directly andindirectly with apologies for my inability to identify them individually. Finally I dedicate this work to my respected patients who are the prime reasonsfor this study.Date : Signature of the scholarPlace : (Dr. D.S.Swami)
  9. 9. IIIABSTRACT The study “Evaluation of the efficacy of Madhutailika Bastikarma in themanagement of Madhumeha (NIDDM)” is focused on an important form of an siddhabasti and a common disease Madhumeha. Madhutailika basti is believed to have a noteworthy role in the management of such impaired metabolic condition by importingequilibrium state of doshasa, nourishes the dhatu and maintains the blood sugar level.Panchakarma is the popular term for shodhana chikitsa, among that Bastikarma is animportant one. In this the doshas are made to pass through the adhomarga i.e.Gudamarga. In the Bastikarma doshas even from the all over body are removed throughgudamarga. In the treatment of Sthoola Madhumeha Bastikarma has great importanceaccording to Ayurveda. In the modern system of medicine Madhumeha can be comparedto diabetes mellitus. And it can be classified as insulin dependent, non insulin dependent,malnutrition related and other types of diabetes mellitus associated with certainconditions and syndromes. Among this non-insulin dependent diabetes mellitusconstitutes 85 % or more of all cases of diabetes. Diabetes has become the disease of themasses. Over 20 million people are reported to be suffering from this “Sweet Disease”.Between 1995 and 2005 India will have about 2-3 crore diabetic patients. Even though the scientific world has conducted extensive studies but couldn’tfind a safe and effective therapy or medicine for this disease. In Ayurveda we can offerseveral treatment modalities among that Bastikarma is a good, result oriented andeconomical therapy which can control the blood sugar level and prevent furthercomplications without any serious side effects. BastiKarma is advised in Madhumeha patients having good body strength andthose who are sthoola in nature. The objective of this study was to assess the efficacy ofBastiKarma in such patients. The study was designed as a prospective clinical trial and 30patients were selected and given Madhutailika Bastikarm The treatment contains the following steps. 01. Deepana pachana 02. Sthanika Abhyanga and mridu sweda by Moorchita tila taila.
  10. 10. IV 03. Madhutailika basti in yogabasti pattern. 04. Sixteen days Parihara kala. 05. Follow-up for one month. As a result of the proper administration of Madhutailika basti it was noted that, itgives immediate and lasting results, both in sugar levels as well as in other complaints.Among the 30 patients taken for the study, 17 patients (56.6%) responded well, 11patients (36.6%), responded moderately and 2 patient’s (6.6%) showed poor response. Aclose perusal of observation and inference that can be drawn leads to the conclusionssuch as, Madhutailika basti is an effective treatment in Sthoola Madhuneha and it alsoshows lasting results. In mild and moderate type of Sthoola Madhumeha classicalMadhutailika basti alone is enough to control it. Even though only Virechana wasadministered in this study, it was also noted that along with Madhutailika basti,administration of pathya ahara vihara and shamanoushadis might help more.Key words – Shodhana karma ; Madhutailik Bastikarma ; Sthoola Madhumeha ; Prameha ;Diabetes mellitus ; Insulin resistance ; Obesity; Blood sugar.
  11. 11. VLIST OF ABBREVIATIONS ⇒ C. S _ Charaka Samhitha. ⇒ A. H. – Ashtanga Hridaya. ⇒ B. P. – Bhavaprakasha ⇒ K.S _ Kashyapa Samhita ⇒ G. R. – Good response. ⇒ M. R. – Moderate response. ⇒ N. R. – No response. ⇒ P. R. – Poor response. ⇒ S. S. – Sushruta Samhita.
  12. 12. VITABLE OF CONTENTS Chapters Page No. 1. Introduction 1-4 2. Objectives 5-7 3. Review of literature 8-108 4. Drug review 109-114 5. Methodology 115-121 6. Results 122 -139 7. Discussion 140-152 8. Conclusion 153-154 9. Summary 155 - 156 10. Bibliography 157- 170 11. Annexure 171 - 178
  13. 13. VIILIST OF TABLES Page No.1. Table showing patients showing indicated for matrabasti 372. Table showing showing ingredients of madhutailika basti 423. Table showing Measurements of Bastiyantra 454. Table showing Netra dosha and Putaka dosha. 465. Table showing patients showing indicated for anasthapya 476. Table showing patients showing indicated for asthapya 497. Table showing patients showing contra indicated for Anuvasana. 508. Table showing proper dose according to age 529. Table showing ahara samandi nidanas 7010. Table showing vihara sambandi nidanas 7011. Table showing the types kaphaja prameha 7612. Table showing the types pittaja prameha 7713. Table showing the types vataja prameha 7714. Table showing the poorvaroopa of prameha 8215. Table showing the roopa of prameha 8516. Table showing the Prameha pidakas 10615. Table showing the grades of blood sugar level 121Table showing the Data of Age Group Incidence and Response 12518. Table showing the distribution of sex group Incidence and Response 12619. Table showing the Chronicity and response 12720. Table showing the incidence of religion and response 12821. Table showing the socioeconomic status and response 12922. Table showing the incidence of religion and response 13023. Table showing the incidence of occupation and response 13124. Table showing the Family history and response 13225. Table showing the Treatment history and response 13326. Table showing the habits of the patients and response 13427. Table showing the Nature of mala pravrithi and response 13528. Table showing the Nidana status and response 13629. Table showing the Nature of kostha and response 13730. Table showing the Status of agni and reponse 138
  14. 14. VIII31. Table showing the Prakruti of patient and response 13932. Table showing the Statistical data 0f the study 140LIST OF FIGURES, PHOTOGRAPHS Title Page No. 1. Figure showing dilated anatomy of the rectum and anus 18 2. Figure grass anatomy of large intestine 20 3. Figure grass anatomy of intestinal villi 20 4. Figure grass anatomy of Pancreas 23 5. Figure anatomy and orientation of Pitutary 27 6. Figure grass anatomy of Adrenalin gland 29 7. Figure grass anatomy of liver 30 8. Photo of drugs used in Mdhutailika Bastikarma 118LIST OF GRAPHS Title Page No. 1. Graph showing distribution of age 125 2. Graph showing distribution of sex 126 3. Graph showing distribution of Chronicity and response 127 4. Graph showing distribution of religion and response 128 5. Graph showing distribution of socioeconomic status and response 129 6. Graph showing distribution of religion and response 130 7. Graph showing distribution of occupation and response 131 8. Graph showing distribution of Family history and response 132 9. Graph showing distribution of Treatment history and response 133 10. Graph showing distribution of habits of the patients and response 134 11. Graph showing distribution of Nature of mala pravrithi and response 135 12. Graph showing distribution of Nidana status and response 136 13. Graph showing distribution of Nature of kostha and response 137 14. Graph showing Status of agni and reponse 138 15. Graph showing Prakruti of patient and response 139
  15. 15. Introduction INTRODUCTION Ayurveda the life science; embedded with the treasure of ancient knowledgeunfolding the mystery of health and disease. It is a compilation of observation,experience and research of so many mentors, and moreover it is a cross section of thescientific thoughts of many generations. Due to its simplicity and scientific nature,Ayurveda has drawn the attention of the global population. It is well known for its role inthe management of the chronic and incurable diseases. It survived all the downfalls andfought with unfavorable conditions, flourished during favorable time and still holds itsplace in the mainstream. Research begins with doubts and ends with facts; facts which serve as new data tobe verified again. Thus the process of research never ends, but at the end of it theresearcher would have become wiser with plans to counter newer challenges. Recurrentmodeling and remodeling by time is inevitable for the fulfillment of this destination.Ayurveda is one such attainment by the perspiration of many eminent Acharyas of thepast. The time tested science Ayurveda has its own everlasting principles regarding bothlife and disease. It is applicable in every facet of human life, with its own uniqueprinciples in understanding a disease by both preventive and curative view. This may bethe fact due to which this science is persisting through centuries beginning from timeimmemorial. Scientific and technological progress has made man highly sensitive and critical;they’re by giving rise to different types of health problems. The advancement ofindustrialization and communication is contributing towards sedentary life styles, in turncausing chronic non- communicable diseases like diabetes mellitus, etc. In fact it is thefirst life science, which identified diagnosed and managed diabetes (the Greek word forsiphon) while claiming it is incurable much earlier to famous Greek physician Aerated 1“Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  16. 16. Introduction(1-2 AD). In spite of all sorts of advancement of science man is not able to stay himselfin the boat of happy and healthy life, so it is a disadvantage rather than an asset; of theindividual by imposing an extra burden on all the systems of body. Then the persons arevery much likely to acquire an infirmity by name: Madhumeha; Mother’s name: Kapha;Father’s name: Vata; Ancestry: Sahaja & Apathya nimittaja; Qualification: Mahagada;Character: Anushangi; Expertise: Dhatu karshana; Identification with: Prabhoota Avilamootrata and tanu madhurya; Status: impairment in multi systems of the body;complexity Vidradi, Alaji etc; ultimate result: Pranahani. Madhumeha is a disease known to the mankind since Vedic period and it ismentioned as one of the 20 obstinate urinary disorders. It is the present burning issuealarming the world. With synonym of Richman’s disease,’ it is present particularly thepersons who are able to enjoy the pleasure of life with a machine power. Most of thesrotas are involved in the manifestation of the madhumeha. At the outset it becomespertinent to discuss the following issues related to Madhumeha. Whether Madhumeha &Prameha are synonyms? Yes. Charaka has used the words Prameha & Madhumeha assynonyms and Chakrapani has clarified this fact more than once. The term Prameha has abroader connotation, indicating the increased quantity and quality of urination whereasMadhumeha more specifically means a condition where the patient passes urine likehoney. Yet, both the terms convey the nature of the same disease. Madhumeha is anAnushangi vyadhi, which means it is punarbhavi. In other words the disease has atendency to re-occur. It is sadhya vyadhi only in the initial stages where Vata is stillanubandha (secondarily associated) and Kapha is dominant, in a sthoola and balavan rogi. 2“Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  17. 17. IntroductionIt is asadhya when Vata begins to dominate either as a result of beeja upatapa or as asequel to a long-standing, Kapha pradhana Madhumeha. In Ayurveda chikitsa has been explained under two folds; they are langhana andbrimhana, due to Shodhana in nature Panchakarma comes under the langhana category.Panchashodhanas well known and effective treatment modalities in the management ofmany chronic diseases like Madhumeha, Kustha, etc shodhana techniques are acts as aweapon’s, due to its simplicity panchakarmas will helps in attaining both the aim ofAyurveda i.e. Swasthasya urjaskara and arthasya roganut again the treatment is broadlydivided into two categories: Shodhana and Shamana. Curing the disease by cleaning outthe impurities is called Shodhana chikitsa, which is the principle of Panchakarma. Itinvolves the clearing of vitiated doshas (vata, pitta and kapha) which cause the diseaseand thereby the restoration of equilibrium of doshas. Vamana Virechana, Bastikarma, Nasya karma and Raktamokshana are consideredas the five folded theropies.In brief the term panch means “Vistara” or mangalakar that iselaborate .In classics our Acharyas have given prime importance to Basti karma. Basti isa prosses by which doshas are eliminated through the Adhomarga.Acharyas also givenprime importance to it. Even it termed as Ardhachikitsa and it removes the vitiateddoshas from all systems of the body. Though Basti has been indicated for almost all the disease, some specific types ofBasti have been explained in the management of Madhumeha. As the vata dosha is one ofthe main contributing factors. The best way to analyze Bastikarma is by checking itseffect over multisystemic dissordes like Madhumeha. 3“Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  18. 18. Introduction The whole study has been distributed into two major divisions - the conceptualstudy & the clinical study. The conceptual study is grouped into a literary review of(Basti and Madhumeha) drug review; the clinical study contains the Observations,Results, Discussion and Conclusion and Bibliography. 4“Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  19. 19. NEED FOR STUDY Diabetes mellitus is the third largest killer in the world behind the cardiacailments and cancer. It is becoming a great national catastrophe with a current prevalencerate of 2.4% to 11.6% in urban dwellers. The danger of this epidemic disease is not only confined to individual’s mortalityand morbidity but also extends to affect the national health care system and economy. In spite of many advances in contemporary science, the management of diabetesis still unsatisfactory. Consequent to such projections alarm bell are already ringing in thecircle of health care institutions. In spite of more and more chemical molecules floodingthe market with claims of better efficiency in the management of diabetes mellitus, butthe over all treatment scenario is not of confidant, drug related resistance and toxicity etcare creating a opinion for provision of safe anti-diabetics. There is no doubt that attentionis coming back to our ancient Indian heritage of Ayurveda to explore its rich literatureand come out with some efficacious remedies, to co-fight the challenge of diabetes.Among that madhutailik vasti is one of the jewel of Ayurveda, which gives tremendousresult in many diseases including madhumeha (Stoola Madhumeha), Even though it isclassified under Niroohabasti, Siddabasti. In this types of vasti patients need not followmuch restriction as in the case of Niroohabasti.
  20. 20. OBJECTIVES Number of research works has already been conducted on evaluation of the effectof some indigenous drugs on madhumeha. Only few research works have beenconducted on efficacy of Samshodhana karmas in the management of Madhumeha. It isone of the multi systemic disorders where the maximum numbers of Srotases areinvolved in the manifestation of the disease. So treating such disease with some timetested and effective therapies like vasti is the better option. No studies are conducted onthe effect of madhutailika vasti in the management of sthoola madhumeha so for. THE AIMS AND OBJECTIVES OF THE STUDY To evaluate the efficacy of madhutailika vasti in the management of madhumeha. To evaluate the hypoglycemic effect of Madhutailika vasti.
  21. 21. INCIDENCE AND PREVELENCE Diabetes is a disease of the masses. The incidence and prevalence rate of diabetesitself suggests that it is burning issue alarming the world. As per recent WHO assessmentthere are 150 million people are reported to be suffering from this Rich man’s sweetdisease. Among them 35% are living in India (>55 million). It is reported that at the endof 2025, the incidence of diabetes in Indian continent is rising very fast at a rate of >3times the entire world. The disease prevalence was 2.4% in rural and 4% -11.6% in urban dwellers.In world: -150 million persons are now affected and the expected prevalence will be 5.4% by the year 2025. There are 50% in developed countries 10% in developing countries.In India: - There were 102000 persons died because of this disease in theYear 1997.
  22. 22. Review of Literature Historical view REVIEW OF LITERATURE History in other words a function of a historian is neither to love the past nor toemancipate himself from the past, but to master and understanding of the present. E. H. CarrHistory of medicine in India in ancient period is actually the history of science of lifedeveloped by the ancient seers & later systematized into carefully woven treatisesA careful insight into ancient treasure of knowledge makes a good beginning for anystudy since we become proud to belong to be part of a heritage, which traces its roots intotimes immemorial. Historical background itself base and back bone for the presentprogressive development of Ayurveda. A critical review of the history from the primitive stage to the new millenniumassists one to understand the future in a better way. Struggle and attempt made by a manfor the better future can achieve only with good prospective past and present experiences,truths and planned in a proper time. History helps to reveal the hidden facts and ideas ofthe concerned subject. BASTI KARMA Vyadhi has been defined as the state in which imbalance of three Dosha-the three basic constituents of the living body, saptha dhatu and three malas. Themeasures undertaken to restore these Doshika equilibrium is called as Chikitsa.1 theayurvedic approach to the treatment of a disease comprises mainly under the two foldsviz 8 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  23. 23. Review of Literature • Shodhana • ShamanaShodhana Chikitsa is supposed to eliminate vitiated Doshas completely and thus preventsthe recurring of the diseases. On the other hand Shamana is the conservative treatment asit doesn’t eliminate vitiated Dosha but it farcifies them. It is believed that there is nopossibility of relapse of the disease cured by Shodhana Chikitsa if followed propersamsarjana karmas and pathyapathya during parihara kala, while the disease cured byShamana; may reoccur as explanation given by Charaka2 i.e.The term Panchakarma is frequently used as synonyms of Shodhana. It consists ofVamana, Virechana, Anuvasana Basti, Niruha Basti and Nasya Karma. Due to itsmultiple effects Basti is the most important constituent among the Panchkarma.According to Ayurvedic physiology Kapha and Pitta are depends on Vata, as it governstheir functions. Basti alleviates morbid Vata dosha from the root level along with otherassociated Doshas, in addition it nourishes the body tissue.3 Therefore, Basti therapycovers more than half of the treatment of all the disease, 4 while some authors consider itas the complete remedy for all the ailments. Therefore, Basti is considered the bestremedy for morbid Vata, but it can also be used in Kapha and Pittaja disorders by usingdifferent ingredients.5 Though the rout of drug administration in Basti karma and enemaof modern science is same but actions are entirely different, Basti posesses bothSamshodhana and Samshamana effects along with this it does the functions ofshukradharana, Brimhana in emaciated person; Karshana in obese person, Chakshushya,prevents the aging, improves the luster, strength and helps longevity by acting locally aswell as systematically at cellular level. Thus, it has a wide application in treatment aspect. 9 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  24. 24. Review of LiteratureIn contemporary science mainly enema is given to remove the mala from the largeintestine.KarmaHistory and medicine starts from the very moment when the human being came intoexistence that’s why the ancient treatises are stands with description of disease and theirtreatment.The evaluation of Basti can be traced from Vedic era viz Rigveda andAtharvaveda which is considered as the oldest authentic manuscripts of the world.Veda: - The Kaushika Sutra of Atharvaveda, Basti is indicated as a substitute for minoroperation.6Purana: - In Agnipurana, Basti is indicated as a principle treatment in complaintsmarked by predominance of Vata.7 It is also stated that according to season differentSneha should be used for Basti.8 in Ashwa Chikitsa Kathana, Taila Basti is recommendedin horses to relieve their fatigue immediately.9Yogic Literature: - In Gheranda Samhita, Basti is included in Satkarma. Two kind ofBasti’s has been described on the bases of their application.Jala Basti – To be done in water.Sushka Basti – To be done on land.In samhita All the classical treatises of Ayurveda have emphasized the importance and wideapplication of Bastikarma as the most effective therapeutic measures than the other. Acharya Charaka has nicely described the uses, advantages and complications ofBastikarma, “shareera shreshta” Shusruta elaborately described about Bastiyantra,Netra, Types of bastis, complications and its management in kalpasthana. Avasthanusara 10 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  25. 25. Review of Literaturebasti vyapath has been beautifully explained by Acharya Vagbhata. Sharangadhara alsohas given much importance to bastikarma and he explained Uttaravasti. Yogaratnakar,Bhavaprakasha and Vangasena also dealt the bastikarma by adding newer combinationslike vaitharana vasti, ksheera basti, etc. Kashyapa equated the word “Amrutam” to the Basti, 10 and he indicated basti inchildren’s. The present renowned author of Ayurveda have also elaborately explained thepossible modification of equipments this is definitely encouraged us and helps in easypractice less tedious work with minimized complication.MADHUMEHA The knowledge of madhumeha is very familiar to Indians since prevedic periodthere is ample of descriptions are found in this period.Prevedic period: - The lord Ganesha was a stoola pramehi. He suffered from prameha due to excessintake of “Moodaka” and lack of strenuous work. His father Lord Shiva advised him totake ‘Kapitta, jambu, and Shiva Gutika’ as a treatment of stoola pramehi.Vedic period: - A study of ancient literature indicates that diabetes was fairly well known andwell conceived as an entity in ancient India. The knowledge of the system of diabetesmellitus, as the history reveals, existed with the Indians since prehistoric age. Its earliestreference (1000 BC in the Ayurvedic literature) is found in mythological form where it issaid to have originated by eating Havisha, a special food that used to be offered at thetimes of yagna organized by Dakshaprajapati. The disease was known as ‘Asrava’ during 11 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  26. 26. Review of Literaturevedic era (6000 BC) Vedas are the oldest literature of the universe. In Kousika su.26/6-10 ofAtharvaveda, we find a reference of Asravana and Prameha. In Atharvaveda Asrava vyadhis are mentioned, in which some symptoms likerasasrava, atimootra, atisara etc are included. The Vedic Commentators Sayana andKeshava described Asrava as mootratisara i.e. excessive urination. Later in 1962 whinteyinterpreted Aasrava as flux, while Griffith named it as morbid flow. The word Pramehe is used so many times in Kautilya’s Arthashastra (321-296BC) in the context of inducing Prameha to the enemies as a part the criminal customs ofthe kings, to dominate over the opposite. Mentioned a method of producing prameha, i.e.the spot is obtaining from burning Chan lion (Krukalaka) and house lizard (GruhaGoulika) together with the intestines of mottled frog (Chitra bheka) and honey, ifadministered it causes prameha. In Atharvaveda 6/44/3 Vishanaka drug is indicated in Vatavyadhis, one of thecommentators Keshava commenting on this, he explained “Vaikruta nashani as vaikrutaasravya nashani.” In the mantra 23-1-3 of Atharvanaveda the drug emerged from valmika areindicated in atisara, atimootra and nadivranam.SAMHITA PERIOD: -The golden age of Ayurvedic history is Samhita Kala. The main classical texts of this eraare Brihatrayis.Charaka samhita: - 12 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  27. 27. Review of LiteratureMaharshi Atreya - the father of Indian Medicine conducted earliest scientific study onmadhumeha It is a point of historical importance that in Charaka samhita nidana sthana4/37, he mentioned the loss of sweet substance from urine. In Sutrasthana 17/78, he hasdescribed prameha as Anusangi, and the stoola madhumeha occurs due to avritatwa ofvayu and Samprapthi of madhumeha in the same chapter.Sushruta samhita: - Sushruta, the father of surgery has narrated the aetiopathogenesis of prameha onthe basis of an endogenous entity being caused due to “Dhatvagnimandya”. The courseand complications of the disease along with different line of treatment are discussed atvarious places in Sushrutaa Samhita The most notable contribution from Sushruta is seen; he dedicated a separatechapter for the management of madhumeha. He has described nivritti lakshanas ofmadhumeha, on the basis of pathogenesis. Madhumeha of two types dhatukshayajanyaanssd Avaranajanya madhumeha.Astanga hridaya: -Vagbhata has described some specific drugs like Dhatri, nisha for the treatment ofPrameha.Astanga sangraha: -He expressed the similar opinion of the Charaka and Sushruta; later he quoted thesymptom Tanu madhuryata.Kashyapa samhita: -In vedana adhyaya of Sutrasthana Acharya Kashyapa mentioned the signs and symptomsrelated to Bala pramehi.11 13 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  28. 28. Review of LiteratureBhela samhita: -Two types of prameha are given in Nidanasthana swakritija prameha and prakritijaprameha.12Harita samhita: -Acharya Harita enumerated 13 types of prameha with different nomenclature like puyaprameha, Takra prameha, Rasa prameha, Ghrita prameha etc.13MEDIEVAL PERIOD: - In this period no more classics have been written but this period of history ofIndian medicine is known as period of commentators.Madhavakara: -Madhavakara (9th century A.D) in his work madhava nidana compiled the thoughts of hisearlier acharyas without adding any thing new to the knowledge on madhumehaGayadas: - Gayadas (11th century A.D) commentators of sushruta samhita elucidated that thesymptoms of Avilatwa of urine in prameha is due to the presence of dooshya like meda,mamsa etc (Su.Ni. 6/6)Chakrapanidatta: -Chakrapanidatta in 35th chapter he documented the treatment of prameha.DallhanaAnother 12th centurion commentator of Sushruta samhita; while commenting on Sushruta 14 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  29. 29. Review of Literaturesamhita nidanasthana 6/3; he contributed a myth that females do not suffer frommadhumeha.Sharangadhara13th century A.D he belongs to 12th century, he described 20 types of prameha with somenew recipes for the management.BhavamishraAcharya Bhavamishra added some new herbo-mineral preparations for the management.Yogaratnakara: - Specific yogas are vividly explained.AgnipuranaThe Kshoudra and Kshoudraprameha are quoted; also some specific treatment ismentioned for prameha.Valmiki ramayana: - There is a reference that the monkeys who were serving Rama, suffered frommadhumeha due to madhura Ahara sevana.Ayurveda is well aware about the extent in which all the body tissues are involved in thepathogenesis of Prameha. The outstanding pioneers of Ayurved Charaka, Sushruta andVagbhata better known as the holy triad made the earliest reference to diabetes as a“diseased flow of urine” and “honey urine.” It seems, during this period no Greco-Romanphysicians were acquainted with symptoms of abnormal urine. 15 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  30. 30. Vyutpatti Etymology of Basti The word ‘Basti’ has its origin from the root ‘Vas’ with the suffix of Pratyaya‘Tich’ gives rise to the word ‘Basti’ and it belongs to masculine gender. According to Siddhanta Kaumdi, the root ‘Vas’ gives following meaning: 1) “Vasu Nivase”13 - this means to stay, to reside and to dwell. 2) “Vas-aachadane” – which gives covering. 3) “Vas vasane surabhikarane”– Fragrance. 4) “Vasti vaste aavrunothi mootram” – which covers the urine. 5) “Nabheradhobhage mootradhare” – urinary bladder. Paribhasha: - The term basti can be used in different sense, in the context of Panchakaram; itgives the following meaning. 1) “Vastinam deeyate vasti.”14 “Vastirabhideeyate yasmat tasmat vastiritismrita.”15 Basti means bladder and it is used as the measure devise for the bastikarma. Themedicines like decoction, Milk, oil, Ghee etc are taken in the basti and administeredthrough gudamarga by a basti netra. Hence the term basti is used to designate the processin panchakarma.Hence, Basti conveys the following meanings. Medicine stays in large intestine for sometime after its introduction through the rectum, which causes movements in large intestine and waste materials there in which are begged for their elimination. An organ where urine is collected i.e. urinary bladder, which is situated below the umbilicus. An instrument, which is used to introduce Basti drugs in the rectum. 16 “Evaluation of efficacy of Madhutailika basti In themanagement of Madhumeha”
  31. 31. Vyutpatti Definition of Basti: 1) The apparatus used for introducing the medicated materials is made up of Basti or animal urinary bladder16 2) The procedure in which the medicaments are introduced inside the body through the rectum with the help of animal urinary bladder is termed as Basti17. 3) The bag made by animal bladder is termed as Basti. 4) Acharya Charaka has defined the Basti as the procedure in which the drug prepared according to classical reference and administered through rectal canal reaches upto the Nabhi Pradesha, Kati, Parshva, Kukshi churns the accumulated Dosha and Purisha and spreads the potency of the drugs to all over the body and easily comes out along with the Purisha and Doshas is called Basti.18 According to modern science, enema is the procedure in which any liquid preparation is introduced through rectum by means of adequate instruments (Ghosh) or injection as liquid or gas into the rectum. 17 “Evaluation of efficacy of Madhutailika basti In themanagement of Madhumeha”
  32. 32. ShareeraShareeraFocus of this study is on Madhutailika Basti. Therefore, a discussion on the anatomy andphysiology of guda and pakwashaya where the Basti is administered is necessary prior tothe discussion on the anatomy and physiology of Pancreas, pituitary gland, adrenalingland and liver, these are the sites of this disease.The word shareera composes both structural and functional aspects of the body. As bastiin considered importantly in the subject certain anatomical features of rectum and largeintestine is also described.Guda / RectumSynonyms:Amarkosha - Aapanam, PayuJatadharam – Guhyam, GudavartmaVijayarakshita – Apanah, MahatsrotasGangadhara – BradhanamVachaspati – Vitmarga Other words that are mentioned in contact to Guda various Acharyas areCharaka – Uttaraguda, Adharaguda, Sthulaguda (C. V5/4, Si 9/3), GudamukhaSushruta – Gudamandhala, Gudavalaya, Payuvalaya, Gudaustha.Vagbhatta – GudamargaDalhana – Gudantram Sushrutha has explained elaborately on the anatomical structure of gudawhile describing Arsoroga. Guda is a part, which is the extension of sthoolantra with 41/2angula in length. It has got 3 valis (parts) named as Gudavalitrayam.19 18 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  33. 33. Shareera1.Pravahini – that which does pravahana.2.Visarjini – that which does viasrajana3.Samvarani – that which does samvaranaThere 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 palate. 20Charaka when described about the koshatagni has considered uttaraguda and adharaguda.The modern commentators consider them as rectum and anus respectively.21 all Acharyashave considered guda as one among the bahyasrotas and one among the dashajeevithadhamani. 22, 23, 24The rectum forms the last 15cm of digestive tract and is an expandable organ for thetemporary storage of fecal material. Movement of fecal material into the rectum triggersthe urge to defecate.The last portion of the rectum, the Ano-rectal canal, contains small longitudinal folds, therectal columns. The distal margins of rectal columns are joined by transverse folds thatmark the boundary between columnar epithelium of the proximal rectum and a stratifiedsquamous epithelium like that in the oral cavity. Very close to the anus or anal orifice, theepidermis becomes keratinized and identical to the surface of the skin.There is a network of veins in the lamina propria and submucosa of the ano-rectal canal.The circular muscle layers of the muscularis externa in the region forms the internal 19 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  34. 34. Shareerasphincter and is not under voluntary control. The external anal sphincter guards the anusand is under voluntary control. Pudental nerves carry the motor commands. 25Pakwashaya / Large intestine Pakwashaya is considered as one among the ashaya by Sushrutha,Vagbhata.26,27 Arunadatta comments as pakwashaya is the seat of pakwa anna i.e. thatwhich attains pureeshatha.28 Charaka and Vagbhata considered this as one among the 29, 30koshtangas. Sharangadhara has specified the location of pakwashaya (pavanasaya)as below the Tila i.e. the liver.31 The horseshoe shaped large intestine or large bowel begins at the end ofileum and ends at anus. Average length is about 1.5 meters and width of 7.5cms. It isdivided into 3 parts: -1.Cecum – T portion (pouch like)2.Colon – large portion.3.Rectum – the last – 15 cm portion. 20 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  35. 35. ShareeraAbsorption in the Large IntestineThe re-absorption of water is an important function of the large intestine. Althoughroughly 1500 ml of material enters your colon each day, only about 200 ml of feces isejected. The remarkable efficiency of digestion can best be appreciated by consideringthe average composition of fecal wastes: 75 percent water, 5 percent bacteria, and the resta mixture of indigestible materials, small quantities of inorganic matter, and the remainsof epithelial cells.32In addition to reabsorbing water, the large intestine absorbs a number of other substancesthat remain in the fecal material or that were secreted into the digestive tract along itslength:Diabetes mellitus is a chronic disease due to the disordered carbohydrate metabolism andresults due to deficiency of insulin secreted by the beta cells of Islets of Langer Hans ofpancreas. But the hormones of pituitary and adrenal glands are also intimately related tothe development of this state. Apart form this liver had its own role in the manifestationof this disease, because it stores the glucose in the form of glycogen under the influenceof insulin. Any alteration in this leads to diabetes. So following glands are involved in thepathology of the diabetes mellitus – Pancreas Pituitary Adrenal Liver 21 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  36. 36. ShareeraPancreas33The pancreas lines within the abdomino-pelvic cavity in the ‘J’ shaped loop between thestomach and the small intestine. It is a slender, plane organ with a nodular consistency.The adult pancreas is 20 –25 cm long and weights about 80 gm. The broad head of thepancreas lines within the loop formed by the duodenum as it leaves the pylorus. Theslender body extends transversely towards the spleen and the tail is short and bluntlyrounded. The pancreas is retroperitoneal and is firmly bound to the posterior wall ofabdominal cavity.The surface of the pancreas has a lumby, lobular texture. A thin, transparent connectivetissue capsule wraps the entire organ. You can see the pancreatic lobules, associatedblood vessels and excretory ducts through the anterior capsule and the overlying layer ofperitoneum.Arterial blood reaches the pancreas by way of branches of the splenic, superiormesenteric and common hepatic arteries. The pancreatic arteries and Pancreaticoduodenalarteries are the major branches from these vessels. Splenic vein and its branches drain thepancreas.The pancreas is primarily an exocrine organ producing digestive enzymes and buffers.The large pancreatic duct delivers these secretes to the duodenum. A small accessoryduct, or duct of Sanforini, may branch from the pancreatic duct. The Pancreatic ductextends within the attached mesentery to reach the duodenum, where it meats thecommon bile duct from the liver and gall bladder.The pancreas has two distinct functions, one endocrine and other exocrine. The exocrinepancreas roughly 99 percent of the pancreatic volume consists of clusters gland cells, 22 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  37. 37. Shareerapancreatic acini, and their attached ducts. Together the gland and duct cells secrete largequantities of an alkaline, enzyme rich fluid. This secretion reaches the lumen of thedigestive tract by traveling along a network of secretary ducts.The endocrine pancreas consists of small groups of cells scattered among the exocrinecells. The endocrine clusters are known as pancreatic Islets, or the Islets of Langer Hans.Pancreatic islets account for only about 1 percent of the pancreatic cell population.Nevertheless, a typical pancreas contains roughly 2 million pancreatic Islets.Each Islet contains four different cell types.Alpha cells –Produces the hormone Glucagon, it raises blood glucose levels by increasing the rates ofglycogen break down and glucose release by the liver.Beta cells – Produce the hormone insulin. Insulin lowers blood glucose by increasing therate of glucose uptake and utilization by most body cells and increasing glycogensynthesis in skeletal muscles and the liver. Beta cells also secrete amylin, a recentlydiscovered peptide hormone whose role is uncertain.Delta cells – Produce a peptide hormone identical to somatostatin, a hypothalamicregulatory hormone. Somatostatin produced in the pancreas suppresses glucagon andinsulin release by other islet cells and slows the rates of food absorption and enzymesecretion along the digestive tract. 23 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  38. 38. ShareeraF cells –Produce the hormone pancreatic polypeptide. It inhibits gallbladder contractions andregulates the production of some pancreatic enzymes. It may help to control the rate ofnutrient absorption by the digestive tract.Here focus is made on insulin and glucagon, the hormones responsible for the regulationof blood glucose concentrations, which are given below. These hormones interact tocontrol blood glucose levels. When blood glucose levels rise, beta cells secrete insulin,which then stimulates the transport of glucose across cell membranes. When bloodglucose levels decline, alpha cells secrete glucagon, which stimulates glucose release bythe liver.InsulinInsulin is a peptide hormone released by beta cells when glucose levels rise above normallevels (70 to 110 m/c). Elevated levels of some amine acids, including arginine andleucine, also stimulate insulin secretion. Insulin exerts its effects on cellular metabolismin a series of steps that begins when insulin binds to receptor proteins on the cellmembrane. Binding heads to the activation of the receptor which functions as a kineaseand attaches phosphate groups to intracellular enzymes. Phosphorylation of enzymes thenproduces Primary and secondary effects within the cell, the biochemical details remainunresolved.One of the most important effects is the enhancement of glucose absorption andutilization. Insulin receptors are present in most cell membranes. Such cells are called 24 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  39. 39. Shareerainsulin-dependent. However, cells in the brain and kidneys, cells in the lining of thedigestive tract, and red blood cells lack insulin receptors. These cells are called insulinindependent, because they can absorb and utilize glucose without insulin stimulation.Effects of insulin on its target cells –01. Acceleration of glucose up takesThis effect results from an increase in the number of glucose transport proteins in the cellmembrane. These proteins transport glucose into the cell by facilitated diffusion.02. Acceleration of glucose utilization and enhanced ATP productionThis effect occurs for two reasons –(a) The rate of glucose use is proportional to its availability. when more glucose entersthe cells, more is used.(b) Second messengers activate a key enzyme involved in the initial steps of glycolysis.03. Stimulation of glycogen formation (skeletal muscles and Liver cells)When excess glucose enters these cells, it is stored in the form of glycogen.04. Stimulation of amino acid absorption and protein synthesis05. Stimulation of triglyceride formation in adipose tissuesInsulin stimulates the absorption of fatty acids and glycerol by adipocytes. The adiposecells then store these components as triglycerides. Adipocytes also increase theirabsorption of glucose; excess glucose is used in the synthesis of additional triglycerides.As whole (summary) insulin secreted when glucose is abundant and this hormonestimulates glucose utilization to support growth and the establishment of carbohydrate(glycogen) and lipid (tryglyceride) reserves. The accelerated use of glucose soon bringscirculating glucose levels with in normal limits. 25 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  40. 40. ShareeraGlucagonWhen glucose concentrations fall below normal, alpha cells release glucagons, andenergy reserves are mobilized. When glucagons binds to a receptor in the cell membrane;it activates adenylate cyclase, and cAMP acts as a second messenger that activatescytoplasmic enzymes. The primary effects of glucagons are – Stimulation of glycogen breakdown in skeletal muscle and liver cells. Stimulation of triglyceride breakdown in adipose tissues. Stimulation of glucose production at the liver.GluconeogenesisIt is a process of glucose synthesis in the liver; the liver cells absorb amino acids fromblood stream, convert into glucose, and release the glucose into the circulation. Theresults are a reduction in glucose use and the release of more glucose into the bloodstream consequently; blood glucose concentrations soon rise towards normal glycemiclevel.Pancreatic alpha cells and beta cells monitor blood glucose concentrations, and thesecretion of glucagon and insulin occur without endocrine or nervous instructions. Yet,because the alpha cells and beta cells are very sensitive to changes in blood glucoselevels, any hormone that affects blood glucose concentration will indirectly affects theproduction of insulin and glucagon. Insulin production is also influenced by autonomicactivity. Parasympathetic stimulation inhabits it.Pituitary Gland 34It is an important ductless gland with lot of functions, including the control of the otherductless glands and of body growth. This gland measures 1.5 cm in the coronal plane, 1 26 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  41. 41. Shareeracm in the sagittal plane and 0.75 cm in vertical form. It lies within the cella tarsica of thesphenoid bone and the posterio-superior to the sphenoid air sinuses, below the opticchiasma. It is flattened ovoid laying the hypophysial fossa and connected to the inferiorsurface of the hypothalamic part of the brain by the infundibulum.Structurally it can be dividedinto 2 parts –1) Anterior lobe2) Posterior lobePosterior lobe of the hypophysis is the expanded end of the infundibulum and isdeveloped from the brain. The anterior lobe is much larger than the posterior lobe andconsists of three parts, which partly surrounds that lobe and the infundibulum. The distalpart forms most of the anterior lobe. It is separated from the posterior lobe by the thinseat of glandular tissue applied to the posterior lobe. The infundibular part is a narrowupward projection of the distal part. The anterior lobe develops from the ectoderm andhas only vascular connection with brain.Anterior lobe is the master gland of the endocrine system, because it produces proteintropic hormones, which affects the other ductless glands. In these secretions twohormones are having direct action on carbohydrate metabolism, which leads tohyperglycemia or hypoglycemia. The two hormones are –Growth Hormone or Somatotrophic hormone – (GH or STH) 27 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  42. 42. ShareeraAdrenocorticotrophic hormone (ACTH)The pituitary effect of STH on carbohydrate metabolism is to stimulate its storage.Administration of growth hormone will produces hyperglycemia and glycosuria. Thehigh blood glucose level leads to its exhaustion and atrophy. So the growth hormone hasdiabetogenic effect especially in man. The hormone is however increasing the glycogencontent of cardiac muscles.Administration of ACTH possesses similar effects as induced by growth hormone. BothSTH and ACTH increase gluconeogenesis and diminish the rate of oxidation of glucose.Thus the anterior pituitary has a diabetogenic role. GH is also known as Somatotrophinand somatotrophic hormone causes cells to grow and multiply and it increases the rate ofprotein synthesis. GH accelerates the rate at which glycogen stored in the liver isconverted to the glucose and released in the blood. GH raises blood glucose level and theraise in the glucose, triggers insulin secretion. ACTH by stimulating secretion of gluco-corticoids brings about hyperglycemia and also directly stimulates the release of GHIFand inhibits the secretion of insulin. One stimulus that inhibits GH secretion ishyperglycemia. An abnormally high blood sugar level stimulates the hypothalamus tosecret the regulating factor GHIF and it inhibits the release of GHAF and thus thesecretion of GH. As a result blood sugar level decreases.Adrenal Gland 35Adrenal glands are situated on the upper poles of the kidneys. Each gland weights about 4gms. A distinct connective tissue capsule surrounds the parenchyma of the gland.Beneath the capsule the cortex is arranged in three layers – 28 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  43. 43. ShareeraZona glomerulosa – Secretes mainly aldeosterone and it secretes less amount of gluco-corticoids and sex hormones.Zone fasciculata –It secretes mainly gluco-corticoides.Zona reticularis – Secretes the sex hormoneand glucocorticoids,All the three zones of the adrenal gland cansynthesis the gluco-corticoids. The chief actionof the gluco-corticoids is to increaseglyconeogenesis in the liver and stimulates formation of glycogen in the liver andmuscles. The adrenal cortex also asserts diabetogenic affects. Proteins are converted intocarbohydrates i.e. glyconeogenesis occur through the action of gluco-corticoids.Therefore, constant production of carbohydrates and the insulin is required to metabolizethe excess of carbohydrates. The excessive glyconeogenesis exerts continued strain uponthe cells of Islets leads to hyperglycemia. When it is severe, it damages the beta cells andpermanent insulin deficiency results. The adrenal action however depends upon theaction of anterior pituitary.Liver 36The liver is the largest gland in the body. The greater part of the liver lies under thecovering of the ribs and costal cartilage. The liver is a dark brown highly vascular softorgan. It is approximately 1/50th of the body weight in the adults, but larger in thenewborn. The liver lies normally in the right hypochondrial and epigastric regions. The 29 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  44. 44. Shareerasurrounding organs determine the shape of the liver; it retains the shape of a blunt wedge.It has two surfaces – diaphragmatic surface and visceral surface.Lobes of liver – The main lobes of liver rightand left are demarcated form one anotherabove and in front by the falciform ligamentand below and behind by the fissures for theligamentum teres and ligamentum venosum.The right lobe includes two subsidiary lobes. The liver plays a central and crucial role in the regulation of carbohydratemetabolism. Its normal functioning is essential for the maintenance of blood glucoselevels and of a continued supply to organs that require a glucose energy source. Thiscentral role for the liver in glucose homeostasis offers a clue to the pathogenesis ofglucose intolerance in liver diseases but little insight into the mechanisms of liver diseasein diabetes mellitus. The Role of the Liver in Glucose Homeostasis An appreciation of the role of the liver in the regulation of carbohydrate homeostasis isessential to understanding the many physical and biochemical alterations that occur in theliver in the presence of diabetes The liver uses glucose as a fuel and also has the ability tostore it as glycogen and synthesize it from no carbohydrate precursors (gluconeogenesis). Underscoring the important role the liver plays in maintaining normoglycemia. 30 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  45. 45. ShareeraGlucose absorbed from the intestinal tract is transported via the portal vein to the liver.Although the absolute fate of this glucose is still controversial, some authors suggest thatmost of the absorbed glucose is retained by the liver so that the rise in peripheral glucoseconcentration reflects only a minor component of postprandial absorbed glucose.Therefore, it is possible that the liver plays a more significant role than does peripheraltissue in the regulation of systemic blood glucose levels following a meal.37 Katz andassociates, 38 however, suggest that most absorbed glucose is not taken up by the liver butis rather metabolized via glycolysis in the peripheral tissues.Many cells in the body, including fat, liver, and muscle cells, have specific cellmembrane insulin receptors, and insulin facilitates the uptake and utilization of glucoseby these cells. Glucose rapidly equilibrates between the liver cytosol and the extracellular fluid. Transport into certain cells, such as resting muscle, is tightly regulated byinsulin, whereas uptake into the nervous system is not insulin-dependent.Glucose can be used as a fuel or stored in a macromolecular form as polymers: starch inplants and glycogen in animals. Glycogen storage is promoted by insulin, but the capacitywithin tissues is physically limited because it is a bulky molecule.Insulin is formed from a precursor molecule, preproinsulin, which is then cleaved toproinsulin. Further maturation results in the conversion of proinsulin into insulin and asmaller peptide called C-peptide.A small amount of proinsulin enters the circulation. It has a half-life 3–4 times longerthan that of insulin because it is not metabolized by the liver. However, proinsulin has<10% of the biological activity of insulin. 31 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  46. 46. ShareeraInsulin is metabolized by insulinase in the liver, kidney, and placenta. About 50% ofinsulin secreted by the pancreas is removed by first-pass extraction in the liver. Insulinpromotes glycogen synthesis (glycogenesis) in the liver and inhibits its breakdown(glycogenolysis). It promotes protein, cholesterol, and triglyceride synthesis andstimulates formation of very-low-density lipoprotein cholesterol. It also inhibits hepaticgluconeogenesis, stimulates glycolysis, and inhibits ketogenesis. The liver is the primarytarget organ for glucagon action, where it promotes glycogenolysis, gluconeogenesis, andketogenesis.39, 40 32 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  47. 47. Bastikarma BASTIKARMA: - Among the shodhana Chikitsa basti has its unique importance in treating the major disease like madhumeha, Vatavyadhis etc. due to the power and advantages it confers on patients. It differs in many aspects like in principle, mode of application and in wide advantages it renders. The term basti means bladder; it is used as a major device for bastikarma. It is also said that the medicine in suspension, administered through the bastiyantra, first reaches the lower abdominal part of the patient. The lower abdominal area or the pelvis also contains the organ basti i.e.urinary bladder, due to these reasons the term basti is used in Panchakarma. Importance of Bastikarma: - All the acharyas were appreciated basti has a unique form of treatmentmodality considering the efficacy it generates in remodeling the hampered doshas. It isuncomparable elimination therapy than the other because it expels the vitiated doshasrapidly as well as it nourishes the body.41 It can be easily perform in all the age grouppersons; where other shodhana procedures are difficult to perform.42 Bastikarma is thebest choice of treatment for vatadosha and vata associated with kapha and pitta. As vatabeing chief among the three doshas and it is functional requirement for both kapha andpitta, if once co-ordination gets disturbed then the disease is going to manifest.43 inmadhumeha kapha is arambhaka and vata is the preraka. Vata is responsible for gatigamana, which is much requiring for shreera vyapara.44 Charaka very specifically given importance to treat the sthanika dosha first andsthanantara dosha, Pakwasaya is said to the main seat of vata dosha. By adoptingtreatment modality like bastikarma will helps in bringing vata into its normalsy, vata 33 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  48. 48. Bastikarmamainly involved in the pathogenesis of mandhumeha and ohter diseases.45 Hence, it is tobe considered as one of the suitable treatment for vata dosha predominant diseases,supporting to this Vagbhata named it as “Ardhachikitsa.”46 Apart form this it isconsidered as superior then the other therapeutic measures; on account of its variedactions like samshodhana, samshamana and samgrahana, etc.47 Charaka explained nirooha Basti is contraindication in udara vyadhi,48 againwhile explaining yogya for nirooha basti; he indicated in Bala, Varna, Mamsa andShukrakshaya condition nirooha basti can be given,49 it is clear that nirooha iscontraindicated in specific conditions like were excessive rookshatha is present in suchcondition it versions the condition. Madhumeha is a condition; were the detoriation ofbala, varna and ojas are roetinly noticed. For maintaining Bala and Varna of a patient;basti can be given in madhumeha patient. Classification of Basti: - Knowledge of the classification is very essential for the better understanding pointof view. In classics different types of Basti are explained based on the amount of thedrug, the quality of the substance and the expected action of the Basti, etc. there isdifference of opinion in classification. The term basti has been used for all types ofbastikarma, which includes nirooha, anuvasana, uttarabasti etc. Charaka used the termbasti exclusively for nirooha eventhough he is considred both nirooha and anuvasana asshodhana procedures.50 finely bastikarma has been brought into the followingclassifications.511) Adhishtana bheda : - The site of application viz abhyantara and bahya2) Dravya bheda: - on the bases of medicine used viz madhutailika basti, kashaya basti, taila basti, ksheera basti, pichha basti3) Karma bheda: - on the bases the action it does viz shoadhana basti, shamana basti, lekhanabasti, brihmana basti, etc4) Sankhya bheda: - The number of bastis given as a course yaga basti i.e. 8 in number, kala basti i.e. 16 in number 34 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  49. 49. Bastikarma5) Anushangika bheda: - miscellanios verities.6) Matra bheda: - Based on quantity of vasti dravya used. 1. Adhishtana bheda: - According to the site of application of basti it is of two types – a. Internal b. External a. Internal i) Pakwasayagata basti: - The administration of medicine via ano-rectal route to pakwasaya. ii) Garbhasayagata basti – The administration of medicine through the vaginal route to garbhasaya. iii) Mutrasayagata basti – The administration of medicine via urethral route to mootrasaya. iv) Vranagata basti – The medicine administered through the vranamukha by the process of bastikarma. b. External In certain diseases the medicated oil is kept over the part of the body using a cap or with flour paste for prescribed period of time and named after the site of application of oil such as – Shirobasti, katibasti, urobasti, etc. 2. Dravya bheda: - It is of two types a) Nirooha basti (Evacuative or Un-unctuous Enema): - The propornity of kwath is more, and it is the main ingredient among other four common ingredients I.e.makshika, lavana, sneha and kalka. Nirooha basti 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; 52, it is named as asthapana basti, as it acts like a vaya and ayusthapaka. 35 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  50. 50. Bastikarma Madhutailika basti is the vikalpa of Nirooha; the synonyms of madhutailika vasti are sidda basti, yapana basti and yuktarata basti.53 The effect of nirooha will spread all over the body; the potency of drug reaches at the cellular cellular level thus it helps in eliminating the vitiated doshas from all the srotases54,55.ii) Anuvasana basti (Unctuous Enema): - It is Sneha pradhana vasti hence auvasana is named as sneha basti. “Anuvasan api na dushyatyanudivasam va deeyata ityanuvasana:” the peculiarity of this basti is no adverse effects, it is safe, can be practice daily.56 Types Based on the sneha matra it is of three types571) Sneha Basti: - 6 Pala (298ml)i.e.1/4th of the quantity of Nirooha.2) Anuvasana Basti: - 3 Pala (144ml) i.e. half of the Sneha Basti.3) Matra Basti: - 1½ Pala (72ml) and this is the minimum quantity of Sneha BastiMATRA BASTI Definition: “Hrisvaya: sneha matraya: matrabasti: samo bhaveth” It is a type of Sneha Basti.The Sneha matra is very less as compared to the Sneha Basti so it is named as matra basti,56, 57, and .58Indication: 36 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  51. 51. Bastikarma Ashtanga Samgrahakara emphasized on regular administration of the Matra Bastiand it can be administered at all times and in all seasons just as Madhutailika Basti,vaitarana basti. Table.No-1 Sr. Indications Ch. 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 - + + Sr. Indications Ch. A.H. A.S. 14) Sukumar - - + 15) Alpagni - + + 16) Sukhatma - + -Contraindication: 37 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  52. 52. Bastikarma In classics, there are no major contraindications mentioned for matra Basti, butAshtanga Sangrahakara has stated that Matra Basti should not be administered in Ajirnacondition.Qualities: The Matra Basti is promotive of strength, helps in easy elimination of Malaand Mutra. Brimhana nature this basti helps in pacifying the Vata dosha.Dose: According to Vagbhata the dose of Hrsva Snehapana is recommended for matraBasti. The matra which gets digeste in two Yama (i.e. 6 hours) is called as Hrsva matra.Sushruta has explained the dose as ½ of the dose of Anuvasana Basti and according tohim the dose of Anuvasana Basti is ½ of the dose of Sneha Basti Hence, the does ofMatra Basti is 1½ Pala = 6 Tola = 72ml61. According to Chakrapani the dose of Sneha Basti is 6 Pala, dose of AnuvasanaBasti is 3 Pala and of Matra basti is 1½ Pala47 (Ch. Si. 4/54). On the basis of above references, it is clear that the dose of Matra Basti is 1½ Pala i.e. 6 Tola = 72ml.3. Karma bheda: - This classification is made baased on their action62, 63a) Shodhana basti – Contains shodhana dravyas and removes dosha and malas from the body.b) Lekhana basti – Reduces medodhatu and produces lekhana in the body.c) Sneha basti – Contains more of sneha and produces snehana 38 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  53. 53. Bastikarma in the body. d) Brumhana basti – Increases the rasadi dhathus and indirectly it helps in nurishing the body. e) Utkleshana basti – Causes utklesha of malas and doshas by increasing its Pramana.f) Doshahara basti – Purificatory or eliminating type.g) Shamana basti – Produces shamana of doshas. Sharangadhara added, shodhana basti, lekhana, brimhana, deepana andpachana types of bastis.64 Vataghna basti, balavarnakrita basti, snehaneeya basti,sukrakrit basti, krimighna basti, vrushatvakrit basti has been explained by Charaka.654. Sankhya bheda: - Charaka has made this classification based on the number of snehabastisand niroohabastis in a treatment. That is totle 8 basti in yaga basti, 16 in kala basti and 30in karma basti.665. Matra bheda: - The quantity may vary from person to person and it depends onrogi bala, roga bala and vaya of the patient. a) Dvadashaprasruta basti – In nirooha, the maximum dose or quantity of bastidravya prescribed is dvadashaprasruta i.e. 24 palas.67 b) Prasritayogika basti – Charaka has prescribed various types of nirooha in different doses considering the strength of the patient and condition of the disease.68 c) Padaheena basti – matra of this basti is 9 prasruthi.696. Anushangika bheda: - 39 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  54. 54. Bastikarma a) Yapana basti – Enhances bala, shukra and mamsa. In treating the vyapats produced by excessive coitus. It can be practice daily.70 b) Siddha basti – It increases the bala, varna, and prasanata.71 c) Yuktaratha basti – Mainly indicated for travelers on vehicles etc.72 d) Vaitharana basti –It is mainly concentrating on the elimination of doshas.73 e) Ksheera basti – Explained for shoolam, vitsangam, anaha, and mootrakrichra.74 f) Ardhamatrika nirooha basti –snehana and swedana karmas are not required. Mainly it is indicated in rajayakhsma, shoola, krimi and in vatarakta. It improves sukrha and ojus.75 g) Picha basti – It is given with pichhila dravyas like Shalmaliniryasa and lajjalu. It is indicated in pichhalasrava and jeevashonita. It is acts as Sangrahi.76 h) Mutra basti – It is Gomutra pradhana basti it is mridu in nature, safe and pacifies the doshas.77 i) Rakta basti – it is indicated in adhika rakta srava.78Drugs used in Basti Karma: - Number of drugs belonging to animal and plant origin has beendescribed in the classics, which are used in bastikarma. For example, herbs, milk,mutton juice, eggs, urine, alkalis, salts etc. The above lists suggest that almost allavailable drugs can be used for bastikarma.801. Phalini drugs - Drugs useful for emesis can be used in asthapanabasti. e.g: -phala, jeemutaka, ikshwaku, dhamargava, kutaja, and kritavedhana.2. Sneha dravyas - Ghrita, taila, vasa, majja. 40 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  55. 55. Bastikarma3. Mutravarga dravyas - Aja, avi, go, mahisha, hasti, ushtra, haya, etc.4. Asthapana & anuvasana gana - Dasamoola, bala, eranda, punarnava, yava, kola, kulatha, guduchi, madanaphala, palasa etc.5. Adjuants for asthapanabasti - Trivrit, bilwa, pippali, kushta, sarshapa, vacha, kutaja, satahwa, yashtimadhu, madanaphala.6. Adjuants for anuvasanabasti - Rasna, devadaru, bilwa, madanaphala, satahwa, swetapunarnava,raktapunarnava,gokshura, agnimandha, syonaka. , 83, 84Contents of niroohabasti82 The usual contents of nirooha basti 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.85 Taila is selectedconsidering the disease and condition of patient. Drugs for kalka, if no drug isspecifically mentioned shatapushpi choorna can be used.86 Kwatha is the decoction madeas per the ingredients selected rationally to suit the condition of the patient.Contents and quantity of nirooha basti The quantity of nirooha is 12 prasrita, out of this 5 prasrita kwatha i.e. 10palas. The sneha should be 1/6th, 1/4th and 1/8th i.e. 4 pala, 6 pala, 8 pala in pitta, vata and 41 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  56. 56. Bastikarmakapha dosha respectively.87 in nirooha. 24 palas of nirooha dose may be adjusted asfollows: 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 24 palas. According to Sushrutha88 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. MADHUTALIKA BASTINirukti: -This unique basti contains madha and taila in equal proportionate hence this basti isnamed as madhutailika basti89.Paryaya: -90 Yapana basti Yuktarata basti 42 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  57. 57. Bastikarma Doshahara basti Siddha bastiTypes of madhutailika basti All the Acharyas have been explained, different types of madhutailika basti’s withdifferent ingredients, those are as follows: -According to sushruta: -91Table No-2 Ingredients Dose 1 Madhu 1-karsha 2 Saindhava 1-tola 3 Taila 1-karsha 4 Shatapushpi choorna 1-tola 5 Erandamoola kwatha 1-karshaImportance of madhutalika vasti.92 This basti can be practice even in female, sukumaras, etc Dosha niraharanartha, bala, varnartha, it can be continuously given with ought any marked complications, easy administration, 43 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  58. 58. BastikarmaDashamoola madhutailika basti: -93 Vagbhata explains it in Astanga samgraha and in Astanga hridaya. The key ingredientsare as follows: -Each 1 pala of Panchamoola and Gokshura,Ksheera 1 adakaYastimadhu 1 prasthaMadhu, Taila, Seedhu, Sareeva, Bala, Sahachara, Darbha, etcIt is very mild and it is indicated in bala, sukumara, vrudda, and in female withoutcomplication.Vangasena also explained madhutailika basti and he mentioned its properties they are asfollows: -Ingredients: -Madhu 1 PrakunchaTaila 1 PrakinchaEranda kashaya 6 PrakunchaSaidhava 1 karshaShatapushpi ½ PhalaMadhutailika ksheera basti 94 It is explained by sangrahakara, considered as ksheerabasti. It is mainly indicatedin sukumara, sthree and mrudu persons.Content of this basti are: - ksheera, guduchi, brihateedvaya and magadi (pippali)Yastimadhu is used as kalka. 44 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  59. 59. BastikarmaBasti YantraThe device used for basti karma is called as bastiyantra. It comprises by two parts –1.Bastinetra2.BastiputakaBastinetra The netra should be made of gold, silver, and copper or with other higher metals,alloys, long bones, bamboo, wood etc. Generally netra must resemble like tail of cowwith a tapering end and a wider base, or like pyramid shape with round ends and smoothsurfaces.95 the dimensions are different for different age group. 45 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  60. 60. BastikarmaTable No: - 3Measurements of Bastiyantra.96, 97,98.No. Age Length Lumen of netra in in Diameter of narrow Diameter of broad end years Angula end1. <1 5 1 angula2. 1-6 6 Size of green gram 1 angula3. 7- 11 7 Size of black gram 1½ angula4. 12-15 8 Size of kalayam 2 angula5. 16- 20 9 Size of wet kalaya 2½ angula6. > 20 12 Karkandhu 3 angulaUttarabastiyantra7. - 12 – 14 Sarshapa size -Susrutha’s opinion8. 1 6 Green gram Feather of kanku bird must pass through.9. 8 8 Black gram Feather of eagle must pass through.10. 16 10 Kalayam Feather of peacock must through.11 >25 21 Kolasthi Feather of vulture must pass through.Pramana of vranabasti netra The hole should be of a mudga pramana, with 8 angulas of length.99Karnika In order to prevent undue penetration of the bastinetra deep in to therectum, a karnika or rim has to be made. It is to be placed at a required point above the 46 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  61. 61. Bastikarmadistal end. Two karnikas are provided on the netra at distance of 2 angulas between one,another at proximal end to tie the bastiputaka properly.100Bastiputaka The container of the bastidravya is known as bastiputaka. And itshould be made suitable for well fitting with the bastinetra and should not have anybad smell. 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 purpose101 As the technology advances the development various types ofmaterials are available to make up of bastiputaka and even disposable bastinetra areavailable. The rubber bladder and polythene bags are best choice these materials aredisposable, safe and easy to perform.Table No: -4Netradosha and putakadosha102,103No. Netradosha Features Effect1. Hraswata Too short Dravya will not reach pakwasaya2. Deerghata Too long Dravya go beyond the pakwasaya3. Tanuta Too thin Produces kshobha4. Sthoolata Too big Produces lakshana5. Jeernata Old dhatu used Injury to guda6 Shithilabandhana Not fixed properly to the Dravya comes out putaka7. Parshwachhidra Hole on side Leakage of dravya happens8. Vakrata Curved / irregular Dravyagati becomes irregular9. Assannakarnika Karnika too near Karma becomes of no use 47 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”