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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 14  |  Issue : 1  |  Page : 108-112

Effect of Panchatikta Ksheera basti with Kati basti in Katishoola w. s. r lumbar disc degeneration – A clinical study


Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India

Date of Submission18-Aug-2020
Date of Acceptance20-Aug-2020
Date of Web Publication09-Feb-2021

Correspondence Address:
Dr. Neelam Kaalia
All India Institute of Ayurveda, New Delhi - 110 076
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_264_20

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  Abstract 

Context: Low back pain is the most common clinical presentation in musculoskeletal disorder due to spinal pathology. Factors such as improper sitting postures, jerky movements in travel, sports activities, aging, and bad sleeping posture are the important factors to produce spinal disorders. Lower back pain has been associated with degeneration of the intervertebral disc.
Aims: This clinical study was carried out to judge the effectiveness of Panchatikta Ksheera Basti (medicated herbal therapeutic enema) with Kati Basti in lumbar disc degeneration-induced Katishoola.
Settings and Design: This was an open-labeled, single-arm, interventional clinical study.
Subjects and Methods: Fifteen diagnosed cases of low backache with lumbar disc degeneration were registered from the outpatient and inpatient departments of All India Institute of Ayurveda, New Delhi, India, and Panchatikta Ksheera Basti as yoga basti followed by Kati Basti for 8 days was administered.
Statistical Analysis Used: The data were statistically analyzed using paired t-test.
Results: Significant (P < 0.05) result was found in all the assessment parameters, namely, pain, stiffness, and fasciculation.
Conclusions: Panchatikta Ksheera Basti with Kati Basti is an effective treatment method for safe and effective management of Katishoola w. s. r lumbar disc degenerative disease.

Keywords: Kati Basti, Katishoola, lumbar disc degeneration, Panchatikta Ksheera Basti


How to cite this article:
Kaalia N, Bhatted SK, Acharya S H. Effect of Panchatikta Ksheera basti with Kati basti in Katishoola w. s. r lumbar disc degeneration – A clinical study. Indian J Health Sci Biomed Res 2021;14:108-12

How to cite this URL:
Kaalia N, Bhatted SK, Acharya S H. Effect of Panchatikta Ksheera basti with Kati basti in Katishoola w. s. r lumbar disc degeneration – A clinical study. Indian J Health Sci Biomed Res [serial online] 2021 [cited 2021 Feb 26];14:108-12. Available from: https://www.ijournalhs.org/text.asp?2021/14/1/108/308958




  Introduction Top


Low backache is a common complaint in clinical practice and may be caused by any types of vertebral disc lesion. It is estimated that 84% of the population suffers from low back pain at some points in their lifetime.[1] The most common cause for low back pain is lumbar disc degenerative disease. Katishoola is mentioned under eighty Vataja Nanatmaja Vyadhis in Charak Samhita and as a symptom in the description of Gridhrasi. In modern medicine, various treatment options such as steroid injection, radicular infiltration, and surgical methods are available, but they have their own limitations. In Ayurveda, Basti with a substance such as milk, ghee, and tikta dravya is best suitable for the Asthi pradoshaja vikara.[2] Hence, Panchatikta Ksheera Basti along with Kati Basti with Dhanwantar taila, followed by 1-month administration of Trayodashanga Guggulu, and 1-month follow-up was given here.


  Subjects and Methods Top


A total of 15 patients were registered for the study from the outpatient and inpatient department of All India Institute of Ayurveda, New Delhi, India, who were diagnosed with lumbar disc degeneration-induced low backache.The Ethical Clearance was approved from The Institutional Ethics Committee of All India Institute of Ayurveda, New Delhi with reference number IEC-AIIA/2018/PG-69 dated 25.03.2019 and registered under Clinical Trials Registry, India (CTRI) and the registration number of the trial was CTRI/2019/07/020353. Informed consent was obtained from the patients before starting the intervention.

Inclusion criteria

  • Age group 25–70 years of either gender
  • Clinical presentation of Katishoola
  • Chronicity of disease <10 years
  • Diagnosed lumbar degenerative disc disease
  • Socioeconomic status – all


Exclusion criteria

  • Any traumatic conditions of spine and hip
  • Rheumatoid arthritis and gout
  • Pregnancy and lactation
  • Other systemic disorders
  • Contraindications for Snehapana or Basti Karma in the respective group.


Diagnostic criteria

  1. Clinical examination
  2. Low back pain
  3. Bragard's sign
  4. Radiological evidences such as magnetic resonance imaging of lumbar spine (if available) to assess the degenerative changes in the lumbar disc
  5. S. L. R. test.


Investigations

  • Hemoglobin
  • Total leukocyte count
  • Differential leukocyte count
  • Erythrocyte sedimentation rate
  • Routine urine examination.


Treatment

The treatment is described in [Table 1].
Table 1: Treatment given

Click here to view


Study duration

The study lasted 90 days with 8-day Ksheera Basti, 7-day Parihar Kala followed by 8-day Kati Basti and 1 month administration of Trayodashanga Guggulu along with 1-month follow-up.

Methods

Basti administration

Poorva Karma

  • Preparation of Ksheera Basti: First, Madhu (honey) was taken, in which Saindhava Lavana (rock salt) was added and triturated thoroughly with the help of a wooden churner, then warm Panchatikta Ghrita was added slowly. Once the ghee was mixed, proportionately Kalka made of Shatapushpa Choorna (along with warm water) was added, and mixture was again triturated thoroughly. In the next step, plain Ksheera (milk) was made lukewarm and added. All the ingredients were thoroughly mixed, and a colloidal solution was prepared
  • Preparation of patients: The patients were advised to be in empty stomach, after confirming the digestion of previously taken food, and before developing hunger, they were given Sarvanga Abhyanga with lukewarm Tila Taila, followed by Vashpa Swedana with Dashamoola Kwatha.


Pradhana karma

The patients were asked to lie on the Droni in Vama Parshwa (left lateral position with right leg flexed). After lubricating the anal ridge and tip of rubber catheter, one-fourth of the catheter was inserted into the anal canal, and lukewarm Basti Dravya was administered slowly with the help of enema can. Enema can was held high to prevent any obstruction. Catheter was removed with little Basti Dravya remaining in the rubber tube of enema can. Extreme care was taken to avoid Basti Vyapad.

Paschata karma

The patients were asked to lie in the supine position and to defecate on developing urge. After evacuation of Basti, they were advised to take hot water bath and light meal.

Kati Basti

Purva Karma

The patient was advised to pass natural urges of urine stool if present. The patient was also advised to remove the cloths and expose the Kati (low back) area and lie down in a prone position. It was done early in the morning or with the conveyance of the patient.

Pradhana Karma

The prepared dough was fixed on the lumbosacral area in a circular shape, taking care to prevent any leakage of oil. Dhanwantar taila was heated passively. Required quantity of oil (sufficient enough to fill the space within the ring of wet flour) was taken in a small bowl. Oil was poured into the compartment (space within the constructed ring of wet flour). Its uniform temperature was maintained throughout the process by replacing warm oil. The oil was kept for 30 min. After the prescribed time, oil was removed by dipping cotton and squeezing in a container or with the help of a spoon.

Pashchat Karma

Dough was removed afterward, and the area was wiped off. The patient was given light oil massage over lumbar region for 5 min. Thereafter, the patient was advised to take rest for 10–15 min in a comfortable position. The patient was advised to take light diet and drink hot water after the procedure.

Assessment criteria

The assessment parameters used in the study are presented in [Table 2]. The low back outcome score scale of Greenough and fraser for low back pain and Maine seattle back questionaire - for quality of life assessment[4] was used to assess the quality of life in patients .
Table 2: Assessment parameters

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Assessment of effect of therapy

The assessment was carried out two times, one before the treatment and second after the end of the follow-up period. Percentage improvement in each parameter was assessed using the following formula:

(BT mean - AT mean) ÷100 × BT mean

BT = before treatment; AT = after treatment

Observations

The maximum number of patients was males (60%), having chronicity between 1 and 10 years (46.66%), patients were having bilateral sciatica (60%), involvement of L4-L5-S1 area (80%), having pain as a chief complaint (100%), followed by paresthesia (40%), pain aggravated by standing (53.3%), Hindu (100%), married (86.66%), educated till higher secondary (46.66%), middle-class category socioeconomic status (53.3%), in-service (40%), vegetarian (53.33%), having Samyaka Nidra (66.6%), Madhyama Koshtha (66.6%), and Sama Agni (53.3%).

The maximum patients were of Vata-Pittaja Prakruti (60%), Madhyama Sara (60.00%), Madhyama Samhanana (46.6%), normal as per body mass index (53.33%), Pravara Satmya (60.00%), Pravara Satva (40%), Madhyama Jarana Shakti (73.3%), Madhyama Abhyavarana Shakti (60%), and age between 25 and 34 years (46.6%).


  Results Top


The results obtained were highly significant (P < 0.05) with percentage relief obtained was 51.11% improvement in pain (Ruk), 51.11% improvement in stiffness (Stambha), 27.77% improvement in fasciculation (Spandana), 35.39% improvement in lumbar spine mobility with 44.44% improvement in low back outcome score, and 60% improvement in Maine–Seattle back questionnaire [Table 3].
Table 3: Effect of therapy on all assessment parameters

Click here to view



  Discussion Top


Discussion on disease

Lumbar disc degeneration is one of the most common causes of Low backache (Katishoola). It is estimated that as much as 84% of the population suffers from low back pain at some points in their lifetime,[1] while 10% are chronically disabled.

Katishoola (low back pain) is described as the most common joint disorder. In this condition, Sandhi is primarily affected due to the provocation of Vata Dosha. Sandhi (joint) is a joint between two Asthi lined by Sleshmadhara Kala, which secretes Sleshaka Kapha for lubrication and reducing the friction during movements of Sandhis. Various Snayu and Peshi are responsible for the stability of the joints and support its functions.

Marmas are vital points located in the Sandhis, and protection of that from injuries is utmost important in maintaining the normal functions of Sandhis. Vayu is an important functional unit to maintain range of movements of any Sandhi. The functions of Shleshaka Kapha and Sleshmadhara Kala can be correlated with annulus fibrosus and nucleus pulposus, which work as cushion and helps for proper functioning of the vertebral joints. The Marmas can be considered the various important structures such as nerves, vessels, and ligaments, which are vital for the functioning of the joints. Functions of the Peshi and Snayu are similar to that of muscles and ligaments related to the joints. All Vata prakopaka Nidanas and Dhatu Kshaya in Vardhakya Avastha (Old age) are responsible for Katishoola. The physical activities such as Pradhavana (excessive physical labor) and Abhighata due to Prapatana (fall), Marma Abhighata (injury), Dukha Shayya (faulty bed), and Dukha Asana (faulty position) are being considered Vata prakopaka Nidana for Katishoola.

Due to exposure of these Nidanas, vitiated Vata Doha is localized at Katipradesha and reduces functions (Karma Hani) of the Kati Sandhi.

Simultaneously, Kaphavrita Vyana Vayu restricts the Rasa Rakta Samvahana (blood circulation). Thereby, the process of getting nutrition and waste removal is hampered.

Gradually, nucleus pulposus loses its normal water imbibing abilities, and it can be correlated with a decrease of Shleshaka Kapha between the Sandhi due to an increase in Ruk?ha property of Vayu.

Discussion on procedure

When Vata gets exceedingly aggravated, there is no remedy other than Basti for its alleviation. Basti has been glorified as the definitive therapy to treat the vitiated Vata and Vatapradhana Vyadhies (AS. Su. 28/12). Basti removes Mala, Pitta, and Kapha and does Vatanulomana to relieve the disorders situated in all over the body. Basti performs various actions such as Samshodhana, Samshamana, Samgrahana, Vajeekarana, Brumhana, Karshana, Chakshushya, and Vayahsthapana. Basti is “Param Vatahara,” and as Vata is the causative factor of Katishoola; hence, here Basti Chikitsa was opted.

In Katishoola, Ruja and Stabdhta are observed, and according to Ayurvedic classics, Basti is advocated in Shakhagata Vyadhies and in patients having Stambha, Sankocha, pain, severe constipation, fracture, etc., (Ch. Si. 1/32-34).

It is clear that there is the involvement of Asthi – Majja Vaha Srotas in Katishoola. Ksheera Basti is described as the main line of treatment in Asthi gata Vikaras by Acharya Charaka. The Basti, which has Ksheera or milk as the main ingredient is known as Ksheera Basti. Ksheera is the ingredient which can be used in the Basti preparation as per the condition and Doshik involvement. As per the quantity of this Basti and use of Ksheera as a main ingredient, Ksheera Basti serves dual function, i.e., Niruha and Anuvasana; hence, it acts as Shodhana as well as Snehana. Ksheera Basti relieves the Margavarodha and produces Brimhana effect. In this study, Ksheera Basti is used as Yapana Basti continuously for 8 days.

The rectum has rich blood and lymph supply, and drugs can cross the rectal mucosa such as other lipid membrane. Thus, unionized and lipid-soluble substances are readily absorbed from the rectal mucosa. In Basti Karma, a homogeneous emulsion of Honey, Saindhava, Sneha Dravya, Kalka, and decoction mixed in remarkable combination after proper churning may break the large and middle chain fatty acid to small chain fatty acids. The mixture given facilitates absorption better than a single drug per rectum.

Kati Basti is a combination of Snehana and Svedana, which is the first line of treatment for Vata Dosha. It overcomes the accumulation of Vata at the site of the pathology and nourishes the underlying tissues through the medicated oil used.

Discussion on drugs

Panchatikta Ghrita was used as the main content of Ksheera Basti. Tikta Dravya Siddha Ksheera and Ghrita Basti are specially advised in Asthi Vikara by Acharya Charaka. Panchatikta Ghrita is dominant of Tikta Rasa and Ushna Virya. Tikta Rasa increases the Dhatvagni (metabolic stage). As Dhatvagni increase, nutrition of all the Dhatus will be increased. As a result, Asthi Dhatu and Majja Dhatu may get stable, and Asthi Dhatu and Majja Dhatu Kshaya will be decreased. Hence, degeneration in the Asthi Dhatu may not occur rapidly. It can be inferred it slows down the degeneration processes. Panchatikta Ghrita is a predominant of Prithvi, Akasha, and Vayu Mahabhuta, which helps in the preservation of the normal health of Asthi Dhatu. Ghrita is Vata-pittashamaka, Balya, Agnivardhaka, Madhura, Saumya, Sheeta Virya, Shula, Jwarahara, Vrishya, and Vayasthapaka also. Thus, it pacifies Vata, improves the general condition of the body, and acts as a rejuvenator of the body. Ghrita also contains Vitamin D, which plays an important role to utilize calcium and phosphorous in blood and bone building.

Ksheera possesses Snigdha, Brimhana, Balya, and Sandhaneeya property and hence used for Dhatuposhana purpose. The milk constitutes high-quality proteins; in addition, the Whey proteins have been demonstrated to increase the bone strength in experimental animals. The lactose that enters the colon favors calcium and possibly phosphorus absorption in human and strengthens the nervous system.

Dhanwantar taila was used externally for Kati Basti. It contains Vatashamak ingredients and is considered “Sarvavatavikarajit.” Its effects are more observed on pain and numbness as sesame oil is used as a base in it.

Trayodashanga Guggulu was used as an oral medication for 1 month. It is the specific Guggulu described for the treatment of Katigraha. It has been described to use in Sandhiashritvata, Asthiashritvata also Majjaashritvata. As Katishoola itself is an Asthi and Sandhiashrita Vikara hence, Tryodashanga Guggulu was used here.


  Conclusions Top


Statistically significant improvement was noticed among all the assessment parameters such as pain, stiffness, and fasciculation using Panchatikta Ksheera Basti, followed by Kati Basti with Dhanwantar taila and oral administration of Trayodashanga Guggulu. From the outcomes, the aforementioned clinical trial, we can conclude that Panchatikta Ksheera Basti along with Kati Basti and oral administration of Trayodashanga Guggulu can be a choice of treatment for the management of lumbar disc degeneration-induced low backache (Katishoola).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Walker BF. The prevalence of low back pain: A systematic review of the literature from 1966 to 1998. J Spinal Disord 2000;13:205-17.  Back to cited text no. 1
    
2.
Sharma RK, Dash B. editor. Charaka Samhita, Sutrasthana. Ch. 28, Ver. 27, Vol. 6. Varanasi: Chaukhamba Sanskrit Series Office; 2013.  Back to cited text no. 2
    
3.
Greenough CG, Fraser RD. Assessment of outcome in patients with low-back pain. Spine (Phila Pa 1976) 1992;17:36-41.  Back to cited text no. 3
    
4.
Atlas SJ, Deyo RA, van den Ancker M, Singer DE, Keller RB, Patrick DL. The Maine-Seattle back questionnaire: A 12-item disability questionnaire for evaluating patients with lumbar sciatica or stenosis: Results of a derivation and validation cohort analysis. Spine (Phila Pa 1976) 2003;28:1869-76.  Back to cited text no. 4
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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