E-ISSN:2456-3110

Research Article

Lekhana Vasti

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 6 July
Publisherwww.maharshicharaka.in

A clinical study to evaluate the effect of Lekhana Vasti in the management of Sthaulya

Acharyulu K.1*, Padmakiran C.2, Shetty S.3
DOI: http://dx.doi.org/10.21760/jaims.7.6.7

1* Kanduri Ramanuja Acharyulu, Post Graduate Scholar, PG Department of Panchakarma, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

2 C. Padmakiran, Associate Professor, PG Department of Panchakarma, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

3 Sandesh Shetty, Associate Professor, PG Department of Panchakarma, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

Sthaulya is one of the Santarpanotta Vyadhi. It is considered as one among the Ashta Ninditeeya Purusha. It is a Rasa Nimittija and Medo Pradoshaja Vyadhi Avyayama, Athiasana, Athishayana and so on are some of the Nidanas of Sthaulya. Most of the world’s population live in countries where overweight and obesity kills more people than underweight. Apatarpana Chikitsa is main line of treatment in Sthaulya. When there is involvement of Kapha Medas and pathogenesis of Avarana, the condition needs Teekshna Basti with Lekhana properties. The Varanadi Gana Kwatha which is having similar action is selected as Kalka and Kwatha Dravya in the present study. To increase the Teekshnata, the Amla Kanji as Avapa Dravya has been selected. Objectives - Hence, the following study was taken to evaluate the effect of Lekhana Basti in management of Sthaulya. Methodology - 20 patients were taken in the study and were administered. Varanadi Lekhana Basti in Kala Basti format. Matra Basti with Murchita Tila Taila was given. Patients were assessed for weight BMI, biomarkers, bodily circumferences before and after treatment and after follow up.

Keywords: Lekhana Vasti, Sthaulya, Obesity, Overweight, Obese

Corresponding Author How to Cite this Article To Browse
Kanduri Ramanuja Acharyulu, Post Graduate Scholar, PG Department of Panchakarma, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.
Email: 		Kanduri Ramanuja Acharyulu, C. Padmakiran, Sandesh Shetty, A clinical study to evaluate the effect of Lekhana Vasti in the management of Sthaulya. J Ayu Int Med Sci. 2022;7(6):46-51.
Available From
https://jaims.in/jaims/article/view/1859

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-05-30 2022-05-31 2022-06-07 2022-06-14 2022-06-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Kanduri Ramanuja Acharyulu, C. Padmakiran, Sandesh Shettyand 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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Introduction

According to figures of W.H.O in 2008, more than 1.4 billion adults (i.e., age of 20 and older) were overweight. Among these, over 200 million men and nearly 300 million women were obese. The figure showed that 35% of adults (aged 20 and over) were overweight in 2008 and 11% were obese. It was more surprising that in 2011, more than 40 million children under the age of five were overweight. And large more than one in ten was obese in the world’s adult population.[2] In addition, it was found that women more likely to be obese than men. At least 2.6 million people each year die as a result of being overweight or obese. As per W.H.O., overweight and obesity are the fifth leading risk for global deaths. Sthaulya is considered as Santarpanjanya Vyadhi (over nutritional), due to excessive accumulation of Meda in Body. Because of Dietary habits, sedentary life style, stress, technology etc. it has become widespread disease with so many complaints. Though modern system of medicine has their own therapeutic modalities to tackle with obesity, they are associated with many adverse effects. Taking this into consideration, the global population is enthusiastically looking towards effective natural remedies.

While describing the treatment of Sthaulya, Acharya Charaka emphasized on the use of Ruksha, Ushna and mainly Kapha Vata Shamana drugs and use of Madhu Udaka for the management of Sthaulya. Sthaulya is Santarpanajanya Vyadhi and Atarpana is the treatment for Santarpanjanya Vyadhi. Taking into consideration all the treatment modalities in Ayurveda, Basti seems to be the best because it is a fastest Apatarpana, when prepared with Apatarpaka drugs.[1] In Apatarpana also being more specific Lekhana Basti is the treatment which can remove abnormally increased Meda. When there is involvement of Kapha Medas and pathogenesis of Avarana, the condition needs Teekshna Basti with Lekhana properties. The Varanadi Gana Kwatha which is having similar action is selected as Kalka and Kwatha Dravya in the present study. To increase the Teekshnata, the Amla Kanji as Avapa Dravya has been selected. Basti in the course of Yoga Basti is indicated in minimum Dosha involvement and as there is Lekhana and Karshana effect required in the patients of Sthaulya, it has been selected to administer in Kala Basti course.

With this idea in backdrop, present study of Lekhana Basti with Varanadi Gana Kashaya Dravya in the course of Kala Basti has been planned. So, in light of above references from classics, Lekhan Basti was selected for the management of Sthaulya (obesity).

Materials and Methods

Study type: Interventional

Design: Treatment, Efficacy, Quality of life trial

Plan of study: An open label clinical trial was conducted on the patients, where the patients were given treatment with specific duration with fortnightly follow up. Patients were given specific instructions on diet and life style modifications.

Ethical committee clearance

Freely given informed written consent had been obtained from every subject prior to research participation in accordance with the applicable law. As this is a clinical research, Institutional Ethical Committee (IEC) approval was requested for the protocol prior to initiation of research.

Then the available data was assessed using suitable statistical analysis method i.e., paired ‘t’- test where ever required.

Selection of patients: Patients who report to OPD and IPD of Shree Dharmasthala Manjunatheshwara Ayurveda Hospital, Udupi.

Drug source

Shree Dharmasthala Manjunatheshwara Ayurveda Pharmacy, Udupi.

Diagnostic criteria: Symptoms of Sthaulya like:

  • Chala - Sthana, Udara, Sphik
  • Kshudha Adhikya
  • Atipipasa
  • Nidradhikya
  • Daurgandya
  • Gourava
  • Patient with BMI > 25

Inclusion criteria

  • Patients presenting with diagnostic criteria
  • Patients aged 18 - 70 years
  • Patient who are eligible for Asthapana Basti.

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Exclusion criteria

  • Obesity due to endocrinal abnormalities
  • Patients of complication like cardiovascular and cerebrovascular disease
  • Psychiatric illness
  • Pregnant women

Selection of the drug/medicines

Ingredients of Niruha Basti

Ingredients of Kashaya Dravya (quantity - 250ml)

Sanskrit Name Latin Name
Varuna Crateva magna (Lour.) DC.
Saireyaka Barleria strigosa Willd.
Shatavari Asparagus racemosus Willd.
Chitraka Plumbago zeylanica L.
Murva Chonemorpha fragrans (Moon) Alston
Bilwa Aegle marmelos (L.) Correa
Kitamari Aristolochia bracteolata Lam.
Brihati Solanum anguivi Lam.
Nidigdhika Solanum surattense Burm. f.
Karanja Pongamia pinnata (L.) Pierre
Putikaranja Holoptelea integrifolia Planch.
Agnimantha Premna corymbosa Rottler and Willd.
Haritaki Terminalia chebula Retz.
Akshiva Moringa concanensis Nimmo
Darbha Desmostachya bipinnata (L.) Stapf

Ingredients of Kalka (herbal paste) (quantity - 40 gms)

Remaining ingredients

Sankrit name English term Proportion
Moorchita Tila Taila Sesame oil 75 ml
Saindhava Lavana Rock salt 5gms
Madhu Honey 150 ml

Total amount of Niruha Basti Dravya is 600 ml

Ingredients of Anuvasana Basti

  • Murchita Tila Taila - 35ml
  • Saindhava Lavana - 5gms

Methodology

Drug, Dosage and duration

Intervention and dosage pattern Abhyanga with Murchita Tila Taila, Nadi Swedana with plain steam. Basti (600ml) and Matra Basti (35ml) on alternate days following the Kala Basti schedule (15days).
Duration of the therapy 7 days (Kala Basti) - Niruha Basti and Anuvanasa Basti was given on the same day
Follow-up After 15 days (increased accordingly)

Method of application of Basti therapy

Purva Karma: Patient was given local massage with Sesame oil and fomentation with plain steam after observing for symptoms of well digested previous meal.

Pradhana Karma

After clearing natural urges, patient was instructed to lie on left lateral position and after per rectal examination to eliminate rectal pathologies, luke warm Basti material was administered per rectum. Anuvasana Basti was administered with disposable glycerine syringe (35ml) and Niruha Basti was administered with plastic enema can (600ml).

The patient was asked to lie down in supine position gradually and buttocks were tapped slowly and gently 3-4 times. Patient was instructed to evacuate the material when urge arises. The patients were given a questionnaire after careful instructions, which was to be duly filled up after each Basti session. Samyak Lakshana was assessed and observed daily.

Pashcat Karma

Evacuation time of Basti material and any untoward effects were observed and noted. One Muhurta (48 min) and three Yaama (9 hours) is the maximum period of time in which the evacuation of Niruha and Anuvasana Basti respectively should occur. The patients were explained and instructed to adhere to Pariharya Vishaya (code of conduct) specifically indicated for Basti.

Assessment criteria

Symptoms was assessed based on the following criteria before the treatment, after the treatment and after 18 days of follow up using standard grading

Subjective parameters

  • Symptoms of Samyak Niruha Basti
  • Symptoms of Sthaulya
  • Medomamsa Ativruddhi
  • Chalasphik
  • Chalaudara
  • Chalastana
  • Ayathaopachaya
  • Anutsaho

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Objective parameters

  • Sthaulya Lakshana
  • BMI: >25kg/m2
  • Body weight
  • Anthropometric features (measuring skin fold thickness by using slide callipers), Triceps, Biceps, Subscapular, Abdomen and thigh

Complete remission: 100% relief in chief complaints, relief in associated symptoms along with more than 20 points decrease in numerical pain scale, more than 5 points reduction in VAS and slight changes in X- ray (if needed), with normal range of serum uric acid.

Marked improvement: Above 75% relief in chief complaints, relief in associated symptoms along with more than 20 points.

Moderate improvement: Above 50% but less than 75% relief in the chief complaints, relief in associated symptoms.

Improved: More than 25% but less than 50%relief in the chief complaints with slight presence of associate symptoms.

Mild Improvement: Less than 25% relief in the chief complaints with slight improvement in associate symptoms.

Unchanged: No relief in any of the signs and symptoms.

Observations and Results

Nidana

Ahartmaka Nidana: In this study Ati Bhojana was observed as Aharatmaka Nidana in 63.88%, Ati Guru Bhojana 77.77%, Ati Madhur 66.66%, Ati Sheeta 75.00%, Ati Snigdha 66.66%, Dadhisevana 38.88%, Mamsarasa 25.00% and Ikshauvikara in 19.44%. All these Nidana increase Kapha and Meda according to Ayurvedic principle (Ch. Su.1/44).

Vihartmaka Nidana: Viharatmaka Nidana observed in present study were Diwaswapana 66.66%, Avyayama 44.44%, Bhojnotar Nidra 63.88%, Sukhshaiyasevana 38.58%. Patients’ energy expenditure is most valuable factor related to obesity. Consumption of more energy and less energy expenditure leads to obesity. Lack of physical activity diminished metabolism leads to fat

deposition. Excessive sleep also decreases metabolic rate. In Ayurveda Avyayam, Diwaswapna are considered as Nidana of Sthaulya because Diwaswap is Abhishyandi, which leads to formation of Ama. Bhojanotar Kala is Kapha Pradhana and again Diwaswap in this Kala increases Kapha. In this way both the factors by increasing Kapha and Meda leads to Sthaulya.

Manas Nidana: In this study Harshanityatvat was observed in maximum 66.66% patients, Mansonivrutti 19.44%, Achnintanat 36.11% which are mentioned as causative factor of the disease sthaulya in Ayurvedic literature.

Anya Nidana: In Anya Nidana, Beejaswabhava was observed in 66.66% patients Beejswabhava has been mentioned as one of the causative factors of Sthaulya by Charaka Samhita (Ca. Su. 21/3). In 1994 a specific gene named Ob-gene has been identified and its secretion leptin plays pivotal role in regulation of weight.

Chief complains and associated complains

In the present study 100% patient reported Bhararvriddhi, 80-90% had complaint of Angachaltva and Atikshudha, 85% Kshudraswasa, 70% patients Daurgandhya. In the associated complains 80% patients reported Alasya, 95% Gatrasada, 95.0% Nidradhikya, 70.0% Daurbalyata and 95.0% Snigdhangata.

Dosha Dushti: In this study it was observed that all the patients had Kapha Dushti followed by 80.55% Vata Dushti and Pitta Dushti. This data shows that in pathogenesis of Sthaulya all three Doshas are involved.

Sroto Dushti: In present study all the patients had Dushti Lakshnas of Medovaha and Rasavaha Srotas. It was followed by 80.55% Udakvaha and 75% Swedavaha Srotodushti.

BMI: In present series 30% patient was having B.M.I in range of 30-35 kg/m2 followed by 70% patients in range of 25-30 kg/m2. In present study maximum patients were having BMI between 27-32. The B.M.I of 25 to 29 kg /m2 is considered as overweight and above 30 kg /m2, BMI considered as Obese. As the B.M.I increases patients falls into higher grade of Obesity.

Biochemical investigation: In present study 41.66 % patient were have serum


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cholesterol in the range of 170-210 followed by 25.00%, in the range of 130-170, 27.77% In the range of 210-240, 2.77% patient each were observed to have serum cholesterol in the range of 100-130, and > 240. In present study 80.55 % patient were having S. Triglyceride, > 150, 16.66 % patient were having S. Triglyceride in the range of 150-200, 2.77% patient were having S.triglyceride > 200.

In this series 86.11% patient were have S.HDL < 50, 11.11 % patient were having S.HDL in the range of 50-60, 2.77% above 60. Desirable S. Cholesterol level in adult is 140-200 mg/dl., S.Triglyceride < 160 mg/dl. and HDL > 60 mg/dl. Thus, above data suggest that disturbance in lipid metabolism may have direct correlation with obesity.

Observation of Basti: Maximum 73.68% patients retained Basti for 10-15 min. While 100 % patients showed Prasrishta Purisha as Samyaka Niruha Lakahna in classics it is explained Niruha can be retained upto 45 min. but now a days it is not seen. Even then, with the above observation fruitful results were obtained.

1. Kapha: In 73.94 % was observed in at statistically highly significant level (P<0.001).

2. Vata: In Vatadushti Lakshna significant relief 65.34 % in Basti at statistically highly significant level. (P<0.001).

3. Pitta: In highly significant relief was observed in Pitta Dushti Lakshna, Basti at statistically significant level. (P<0.001).

Overall effect of Basti: In the present study, total assessment of the therapy was done based on relief in the signs and symptoms as well as objective criteria Weight, B.M.I, Skin fold thickness, Body circumference and Biochemical parameters. In this study, total 20 patients were treated, out of them 45% patients were markedly improved, 45% patients showed moderate improvement, 10% showed minor improvement and 0% patients remain unchanged.

  • 10-20% - 2 patients - Minor Improvement
  • 30-40% - 4 patients - Moderate Improvement
  • 60-70% - 5 patients - Moderate Improvement
  • 71-80% - 7 patients - Marked Improvement
  • 81-90% - 2 patients - Marked Improvement

Discussion

According to the modern science, obesity precipitates the disease like Hypertension, Osteoarthritis, Coronary heart disease, Diabetes mellitus etc. Acharya Charaka included Atisthula Purusha under the eight verities of impediments, which are designated as Ashta Nindita Purusha. More than 190 PG. and Ph.D. thesis have been submitted throughout India so far, but still there is enough scope for management of Sthaulya with the help of Panchkarma therapy.

Regarding causative factors, it is observed that most of the exogenous type Nidana are mentioned by Acharya Charaka, while endogenous type Nidana are mentioned by Sushruta. Beejadosha Swabhava is only mentioned by Acharya Charaka. In the Sthaulya etiological factors mainly vitiate the Meda-Kapha. This vitiated Meda obstructs the path of Vata, which results in to provocation of Vata. In the Samprapti two factors are of prime importance, Tikshna Jatharagni and Medodhatvagnimandya.

Irrationality between two levels of Agni makes the disease Krichhra Shadhya, but Panchkarma therapy can give better solution for this problem. Lekhana Basti was selected for the management of Sthaulya. It has been already discussed in concerned chapter why Lekhana Basti was selected for this study. 20 patients were treated under single group - Lekhana Basti (20). The different aspects of this study in detail are being presented here. Basti provided better result in improvement of sign and symptoms, Dosha Dushti Lakshna, Sroto Dushti Lakshna and in objective parameters i.e., Weight, B.M.I, Circumference and Skinfold thickness. Moreover, it showed better result in overall effect. Probable reasons for better result of the Lekhana Basti. Basti not only eliminates Dosha from the body but through the colon (Pakvasaya) drug is absorbed and reaches up to the micro channels of the body, which performs the action of Samprapti Vighatana at cellular level. It is also supported by our classics. (Su. Chi. 35: 26)

Conclusion

Sthaulya is a Dushya dominant Vyadhi. There is an involvement of all the three Doshas in Sthaulya but the vitiation of Kapha-Vata and Meda of prime importance. Etiological factor mainly vitiate Kapha-Meda.


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This vitiated Meda obstruct the path of Vata and causes its Avarana which results in to provocation of Vata. Thus, remaining in the Kostha Vata causes Atikshudha, which increases gravity of the disease and make the Sthualya Kritchhsadhaya. Due to obstruction by Meda Vyana Vayu could not transport nutrient to other Dhatu so Medadhatu is increased and Uttardhatu decreased. So, treatment modality should be planed considering vitiated Meda, Kapha and Vata. Lekhana Basti is amongst them. Sedentary life, lack of exercise, faulty food habits, and urbanization precipitate the disease. Genetic predisposition, Kapha predominant Prakriti increases the prevalence of Sthaulya. Females are more prone to obesity due to feminine factor like menopause and aggravating factors like delivery, I.U.C.D., oral contraceptive pills, miscarriage. Basti provided better result in almost all the parameters because it eliminates Doshas from the body and simultaneously absorbed drug perform their action of Samprapti Vighatana at cellular level.

Reference

1. Acharya YT, editor, (1 st ed.). Charaka Samhitha of Agnivesha, siddhisthana; Uttarabasti Siddhi Adhyayam: Chapter 12, Verse 54. Varanasi: Chowkamba Sanskrit Series, 2011; Pp: 738 p 738.

2. Who.int [Internet]. Geneva: Obesity and overweight, 3 March 2020; [cited 2020 march 12]; Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.

3. Acharya YT, editor, (1 st ed.). Susruta Samhita of Susruta, Chikitsa sthana; Niruhakrama Chikitsa: Chapter 38, Verse 82. Varanasi: Chowkamba Sanskrit Series, 2012; Pp 824; p 545


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