E-ISSN:2456-3110

Review Article

Manjishtadi Kshara Basti

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan-Feb
Publisherwww.maharshicharaka.in

A conceptual study on effect of Manjishtadi Kshara Basti in the management of Thromboangitis Oblitarens

Nagaraja K.1*, Katti A.2
DOI:

1* K Nagaraja, Post Graduate Scholar, Dept. of Shalya Tantra, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India.

2 Anand Katti, Associate Professor, Dept. of Samhita Samhita, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India.

Thromboangitis Obliterans (TAO) is a non-atherosclerotic inflammatory disorder of unknown aetiology that affect small and medium-sized vessels of the extremities and has a strong association with smoking. The incidence is more in population who are under 45 years of age, current or recent history of tobacco use. It is noticed by presence of distal-extremity ischemia indicated by claudication, pain at rest, ischemic ulcers or gangrene. In the management of TAO various drugs like Analgesics, Vasodilators, Anticoagulants have been tried with questionable value which have drawbacks like bleeding tendencies, systemic adverse effects and most of the times the disease ends up with major or minor amputations. Hence in TAO, a holistic, natural mode of management under the Vatarakta line of treatment is to be adopted. Even though Vatarakta management encompasses wide range of treatment modalities; Basti is exemplarily useful.

Keywords: Manjishtadi Ksharabasti, Thromboangitis Obliterans (TAO), Vatarakta, Basti

Corresponding Author How to Cite this Article To Browse
K Nagaraja, Post Graduate Scholar, Dept. of Shalya Tantra, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India.
Email: 		K Nagaraja, Anand Katti, A conceptual study on effect of Manjishtadi Kshara Basti in the management of Thromboangitis Oblitarens. J Ayu Int Med Sci. 2022;7(1):267-270.
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https://jaims.in/jaims/article/view/1639

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-20 2022-01-22 2022-01-29 2022-02-05 2022-02-12
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by K Nagaraja, Anand Kattiand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Nagaraja K. et al: A conceptual study on effect of Manjishtadi Kshara Basti

Introduction

Thromboangitis Obliterans (TAO), an inflammatory vasculopathy also known as Buerger’s disease, is a variety of disease where inflammatory endarteritis hampers the proper blood supply. The condition has strong association with tobacco use. The onset of Buerger's disease occurs between 40 and 45 years of age, and men are most commonly affected. It begins with ischemia of the distal small vessels of the arms, legs, hands and feet. Involvement of the large arteries is unusual and rarely occurs in the absence of occlusive disease of the small vessels.[1]In Modern medicine, Analgesics, vasodilators, anti-platelet aggregators are some choices for conservative management. Lumbar Sympathectomy provides short-term pain relief and promotes ulcer healing in patients with Buerger's disease but carries no long-term benefit.[2]Vatarakta also known as Vatasonita is caused by the vitiated Vata Dosha and Rakta which impedes the Gati (movement) of each other. This condition mainly affects people who are not physically active and indulge in factors that vitiate Rakta. People of Pitta Prakriti are more prone to this condition. Vatarakta is a group of inflammatory disorders which include gouty arthritis, rheumatoid arthritis, connective tissue disorders, inflammatory polyarthritis, vasculitis, etc. The causative factors for Vatarakta are in table 1.

Table 1: Showing various Nidanas of Vatarakta[3]

Aharaja Nidana Viharaja Nidana
Excessive intake of Kashaya, Katu, Tikta, Amla, Lavana and Ksara Rasas Pradhana Aahara Mithya Vihara
Snigdha, Ushna, Ruksha Gunayukta Ahar Sevana in excess. Ativyayam, Vibhrama, Avyavaya.
Alpabhojana, Abhojan, Adhyashana, Virudhashana, Mishtanna Sukhbhojana, Mithya Ahara Sevana Sthula, Achankramansheelata, Divaswapna, Aswapna.
Rutu Satmya Viparyasat Snehadi Sevana Adhva, Hasti, Ashva, Ushtrayana, Krodha, Prajagarana
Klinna Shushka Mamsa Sevana Abhighata, Ambukrida, Plavana, Langhana
Excessive intake of Pinyaka, Mulaka Kulatha, Masha, Nishpav, Shaka, Palal, Ikshu, Dadhi, Hyaranala. Sukumaranam
Excessive use of Sauvira, Shukta, Takra, Sura and Asava preprations. Ushnakaleatyadhwa, Veganigrahana, Sthulanam, Sukhinam.

Samprapti of Vatarakta

Vatarakta is caused by above said Aharaj & Viharaj Nidana Sevana i.e., Vataprakopaka Hetu & Rakta Prakopaka Hetu. In the initial stage, vitiated Vata gets obstructed by vitiated  Rakta; later further vitiated Rakta in turn gets obstructed by further vitiated Vata resulting in mutual obstruction. This is told as Anyonya Avarana by Chakrapani.

Hence, Vatarakta is considered as Avaranjanya Vatavyadhi. Due to properties of Sukshmatva and Saratwa of Vayu, Dravatwa and Saratwa of Rakta, they spread all over the body. The spreading is facilitated by Vyana Vayu. The Doshas get lodged in Sirayanas. The main and first site of manifestation is Pada or Hasta and from there onwards spread upwards. The process of spreading of manifestations can be understood by the similar nature to that of rat poison.[4]

The symptoms of TAO can be well correlated with Vatarakta in Ayurveda is in table 2.

Table 2: Showing similarities between Vatarakata and TAO in clinical features. 

SN Clinical Features      In Vatarakta [5] In TAO[6]
1. Asweda (anhydrosis) Present Present
2. Karshnata (blackish discolouration) Present Present
3. Sparshaghnatwa (parasthesia) Present Present
4. Kshate Ati Ruk (tenderness) Present Present
5. Supti (numbness) present Present
6. Sheetalata (coldness in limbs) present Present
7. Daha (burning sensation) present Present
8. Khanjathwa (lamness) present Present
9. Dhamani Anguli Sandhi Sankocha (constriction of vessels and fingers) present Present
10. Sheeta Pradwesha (aversion towards cold) present Present
11. Prashosha (atrophy) present Present
12 Mamsakotha (gangrene) as a complication present Present

Manjisthadikshara Basti is an Anubhuta Yoga (established through empirical use) and is effective in management of Srotavarodha (blocked channels).

Manjishtadi Kshara Basti is a combination of two Bastis, that is;

  1. Manjishtadi Kwatha Basti - explained by Acharya Sharangadhara.[7]

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  1. Kshara Basti - explained by Acharya Chakradatta.[8]

Table 3: Showing Dravyas with their actions

SN Dravyas Actions
1. Manjishtadi Kwatha Rakata Shodaka, Rakta Prasadaka and Tridoshahara.
2. Kshara Basti Srotoshodaka

Preparation of Manjishtadi Kshara Basti

Materials required are Saindhava Lavana, Manjishtaditaila, Madhu, Manjishtadi Kwatha, Gomutra, Kanji, Khalwa Yantra, Basti Yantra.

Method of preparation of Basti

Preparation of Manjishtadi Kshara Basti

The different components of Basti should be mixed in following pattern:

  • Gomutra
  • Madhu
  • Saindhava Lavana
  • Manjishtadi Taila
  • Manjishtadi Kwatha
  • Kanji

Manjishtadi Kwatha drugs with their botanical names are.[9]

  • Manjishta - Rubia cardifolia
  • Amalaki - Emblica officinallis
  • Hareetaki - Terminalia chebula
  • Bibhitaki - Terminilia bellerica
  • Bhunimbha - Andrographis paniculata
  • Nimbha - Azharidachta indica
  • Haridra - Curcuma longa
  • Guduchi - Tinospora cardifolia

All ingredients are thoroughly mixed and a preparation in the form of emulsion was obtained, this was made Sukhoshna by keeping it inside the Ushnajala.

Method of administration of Basti

Purvakarma

Procedure will be explained to patients in advance and written consent will be taken. Prior to Anuvasana Basti, Laghu Bhojana will be advised.

Pradhana Karma

Anuvasana Basti: Patients will be subjected to Mridu Abhyanga with lukewarm Taila and Nadisweda locally over abdomen, buttocks and on the thighs. After Abhyanga and Sweda, Patients will be asked to lie on the Droni in Vamaparshwa (left lateral position with right leg flexed) and asked to take deep breath. Sukoshna Anuvasana Dravya will be administered slowly with the help of Basti syringe.

Niruha Basti

Patients will be advised to come in empty stomach, after confirming digestion of previously taken food and before developing hunger Mridu Abhyanga with lukewarm Tila Taila and Nadi Sweda locally will be done over abdomen, buttocks and on thighs. Patients will be asked to lie on Droni in Vamaparshwa (left lateral position with right leg flexed) and asked to take deep breath; Sukoshna Basti Dravya will be administered slowly with the help of enema can fitted with a rubber catheter. Extreme care will be taken to avoid all the possible Basti Vyapat.

Probable mode of action of Manjishtadi Kshara Basti in TAO

In TAO the blood vessels get inflamed and obstructing the lumen with clots

↓

Leads to reduced blood flow to the body parts below the obstruction

↓

The Manjishtadi Kshara Basti by its Raktashodaka and Rakta Prasadaka property reduces the inflammation and purifies blood

↓

The Kshara Basti by its Srotoshodaka property helps in clear the obstruction in lumen and improves circulation to affected part

↓

There by both combining helps in reduce the inflammation and clots and enhance good circulation to affected body part.

Based on the above-mentioned views Manjisthadi Kshara Basti was considered for a treatment modality for Thromboangitis Obliterans (TAO).


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Discussion

TAO is one of the most painful vascular disease. The long-term management of it is challenging for the modern surgeons too.

The sign and symptoms of TAO can be well correlated with Vatarakta in Ayurveda (table 1) In Vatarakta. due to the diet and lifestyle aggravating the Rakta (blood) gets vitiated and it does the Avarana (covering) of Vata. Vata Prakopa (aggregation) happens and it gets localized on different parts of the body manifesting the signs and symptoms of aggravated Vata like pain etc. In Ayurveda, Manjistha (Rubia cordifolia) is a renowned Rakta Prasadaka (Blood purifier), Tridoshahara (balancing the 3 Doshas) and Srotosodhaka (cleansing the channels). So, use of Manjisthadi Kvatha (decoction) and Manjisthadi Taila (oil) purifies the Rakta (blood), pacifies the Vata and makes the proper flow inside the channels (Srotosodhaka). Kshara Basti (Alkaline Enema) has the fast-spreading activity which helps to clean the peripheral vascular channels. Hence, the combination Basti is very effective on Peripheral Vascular Diseases like TAO.

Conclusion

Thromboangitis obliterans (TAO) is a painful disease of mainly medium sized blood vessels. It is progressive and associated with severe pain according to ischaemic changes. It is directly associated with tobacco smoking. The symptoms of TAO can be well correlated with Vatarakta in Ayurveda. Ayurvedic enema (Manjisthadi Ksharabasti) is an Anubhuta Yoga (established by empirical use) showing promising results in TAO.  Ksharabasti is mentioned by Chakradatta and decoction of Rubia cordifolia (Manjisthadi Kvath) is mentioned by Sarangadhara. Rubia cordifolia (Manjistha) is renowned blood purifier (Rakta Sodhaka), channel cleansing (Srotosodhaka) and the Ksharabasti removes the Avarana of Vata (blocking activity of Vata). Hence, TAO can be successfully managed by Ayurvedic Enema therapy (Manjisthadi Kshara Basti)͘.

Reference

  1. Sriram Bhat M, SRB’S manual of surgery, 5th edition page no. 178-179.
  1. K Rajagopal Shenoy, Manipal Manual of Surgery, 2nd edition, page no -56-63.
  2. Acharya Charaka, Charaka Samhita with English translation by R K Sharma & Bhagavan Dash, volume 5, edited in 2005, Choukamba Orientalia, Chikitsa Stana, Ch 29, verse -23.
  3. Acharya Charaka, Charaka Samhita with English translation by R K Sharma & Bhagavan Dash, volume 5, edited in 2005, Choukamba Orientalia, Chikitsa Stana , Ch – 29.
  4. Acharya Charaka, Charaka Samhita with English translation by R K Sharma & Bhagavan Dash, volume 5, edited in 2005, Choukamba Orientalia, Chikitsa Stana, Ch – 29.
  5. K Rajagopal Shenoy, Manipal Manual of Surgery, 2nd edition, page no -56-63.
  6. Acharya Sharangadhara, Sharangadhara Samhita Sanskrit text with English Translation by Dr G Prabhakar Rao. Madhyama khanda, first edition 20013, ch 02, verse 136.pg no-100.
  7. Chakradatta Samhita Sanskrit text with English translation by Priyavrat Sharma, edition 2003, Ch-73, verse29-31.pg no-628
  8. Acharya Sharangadhara, Sharangadhara Samhita Sanskrit text with English Translation by Dr G  Prabhakar Rao. Madhyama Khanda, first edition 20013, Ch 02, verse 136.pg no-100.

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