E-ISSN:2456-3110

Research Article

Rheumatoid Arthritis

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 10 November
Publisherwww.maharshicharaka.in

A clinical study on the combined effectiveness of Pathyadi Churna and Kshara Basti in Amavata (Rheumatoid Arthritis)

Srinivasan N.1*, Girish K.2, Sabasannavar Jinnappa S.3, Sudhakar Powar V.4
DOI: http://dx.doi.org/10.21760/jaims.7.10.5

1* Nehaa Srinivasan, Final Year PG Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 KJ Girish, Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 Sunil Sabasannavar Jinnappa, Final Year PG Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

4 Vibhu Sudhakar Powar, Assistant Professor, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

Background & Objectives: Amavata (Rheumatoid Arthritis-RA) is a disease caused due to deranged Agni leading to Ama formation. The Lakshanas are very similar to Rheumatoid Arthritis (RA), an autoimmune disorder which causes chronic inflammation and symmetric, peripheral polyarthritis. Pathyadi Churna and Kshara Basti are mentioned in the classics for the treatment of Amavata. Methods: Among 33 registered patients, 30 of them completed the course of treatment. They were administered with Pathyadi Churna 1 Karsha (12g) thrice daily before food with Ushnodaka as Anupana (adjuvant) for a period of 15 days along with Kshara Basti in a modified Yoga Basti format for the first 5 days. Friedman's test with Wilcoxon sign rank test as post hoc was used to analyze the significance of change in Ordinal data and Repeated measure ANOVA after applying Bonferroni correction and Paired t test as post hoc was used to analyze the significance of change in Scale data. Results: There was statistically significant improvement in the primary and secondary outcome measures of Amavata. Interpretation and Conclusion: Pathyadi Churna and Kshara Basti are effective in the management of Amavata.

Keywords: Ayurveda, Amavata, Rheumatoid Arthritis, Pathyadi Churna, Kshara Basti

Corresponding Author How to Cite this Article To Browse
Nehaa Srinivasan, Final Year PG Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Nehaa Srinivasan, KJ Girish, Sunil Sabasannavar Jinnappa, Vibhu Sudhakar Powar, A clinical study on the combined effectiveness of Pathyadi Churna and Kshara Basti in Amavata (Rheumatoid Arthritis). J Ayu Int Med Sci. 2022;7(10):29-39.
Available From
https://www.jaims.in/jaims/article/view/2118

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-09-28 2022-09-30 2022-10-07 2022-10-14 2022-10-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by Nehaa Srinivasan, KJ Girish, Sunil Sabasannavar Jinnappa, Vibhu Sudhakar Powarand 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

Ama is an important pathological factor in the body and is the cause for several diseases. Amavata is one such disease caused by Ama. In the disease Amavata, Ama combines with the Prakupita Vata Dosha and spreads all over the body producing symptoms like Sandhi Shotha, Sandhi Shoola, Sandhi Stabdhata and Sandhi Sparsha Asahyata along with other Lakshanas of Ama.

The general principles of treatment for this disease lays emphasis on stimulating and normalizing the impaired Agni by the use of both Shodhana and Shamana Chikitsa. Langana, Swedana, Deepana, Katu and Tikta Rasa Dravyas, Virechana and Basti are recommended. Specifically, Kshara Basti and Anuvasana Basti with Brihat Saindavadi Taila is adviced.[1]

Lakshanas of Amavata have a close resemblance with Rheumatoid arthritis (RA). RA is the most common type of Autoimmune Arthritis. It causes chronic inflammation and symmetric, peripheral polyarthritis. Persistent inflammation leads to erosive joint damage causing significant physical disability. As it is a systemic disease, it presents with a wide range of extra articular manifestations. Factors producing RA include infectious triggers, genetic predisposition and autoimmune response.

Worldwide the annual incidence of RA is approximately 3 cases per 10,000 populations and the prevalence rate is approximately 1%. Indian women are affected three times more than men. The prevalence increases with age peaking between the age 25 and 55 years after which it plateaus until the age of 75 years. Among these, around 40% are registered disabled within 3 years, while around 80% are moderately to severely disabled within 20 years. Family studies indicate a genetic predisposition. Patients with first degree relatives possessing the autoantibody are found to have a 2 to 10 times greater risk of developing severe RA than the general population. Monozygotic twins are four times more likely to develop RA than dizygotic twins.[2]

Various research works have been conducted to solve this clinical enigma. As an effective treatment approach is still required for the management of Amavata, here we intended to assess the combined effectiveness of Pathyadi Churna and Kshara Basti in the management of Amavata.

Methodology

Method of collection of data

Screening: Subjects were screened and a form was prepared with all aspects of history, signs and symptoms of Amavata (Rheumatoid arthritis) and laboratory investigations for adequate diagnosis.

Diagnostic Criteria: Among screened patients, Amavata (Rheumatoid Arthritis) was diagnosed based on the Lakshanas of Amavata - Angamarda (myalgia), Aruchi (anorexia), Trishna (increased thirst), Alasya (laziness), Gaurava (heaviness), Jwara (fever), Apaka (indigestion), Sandhi Shotha (joint stiffness), Sandhi Shoola (joint pain), Sandhi Sthabdata (joint stiffness) and 2010 ACR-EULAR[3] classification criteria for Rheumatoid Arthritis.

Inclusion Criteria: Amavata with features of Rheumatoid Arthritis as specified in 2010 ACR-EULAR classification criteria for Rheumatoid Arthritis with less than 10 years of chronicity, Subjects aged between 20-60 years of either gender, fit for Basti karma and willing to participate in the study and ready to sign informed consent form.

Exclusion Criteria: Subjects with known case of essential hypertension and uncontrolled diabetes mellitus, with impaired renal, hepatic and cardiac function, known case of systemic arthritis, pregnant and lactating women.

Ethical clearance and CTRI registration

Ethics clearance certificate was attained from Institutional Ethics Committee. Trial was registered on Indian clinical trial registry (CTRI/2021/02/031002)

Study Design: The study was an open label, single arm, prospective clinical trial on Amavata (Rheumatoid Arthritis) (n=30) selected using the convenience (non-random) sampling technique with pre and post design conducted in tertiary Ayurveda Hospital attached to Ayurveda Medical College located in district headquarters in Southern India.

Intervention

Pathyadi Churna[4]

Dosage 1 Karsha (12 grams) in divided doses thrice daily before food
Anupana Ushna Jala
Duration 15 days - Internal administration oral route



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Therapy: Kshara Basti[5]

Anuvasana Basti Brihat Saindhavadi Taila[6] 60ml post lunch anal route
Kshara Basti Basti Dravya 450 ml morning on empty stomach anal route
Duration 5 days as per modified Yoga Basti schedule (5 Anuvasana Basti + 3 Kshara Basti)
Assessment Day - 0, 6th day, 15th day

Basti was administered in a modified Yoga Basti schedule

Day 1 Day 2 Day 3 Day 4 Day 5
  N N N  
A A A A A

(A = Anuvasana Basti, N = Niruha Basti)

Assessment Criteria: Signs and symptoms of Amavata (Rheumatoid Arthritis) were assessed by giving suitable scoring at three intervals namely before treatment, 6th day and 15th day of treatment.

Primary Outcome Measures: Angamarda (myalgia), Aruchi (anorexia), Trishna (increased thirst), Alasya (laziness), Gaurava (heaviness), Jwara (fever), Apaka (indigestion), Sandhi Shotha (joint stiffness), Sandhi Shoola (joint pain) and Sandhi Sthabdata (joint stiffness).

Secondary Outcome Measures: DAS 28 score, RAPID 3 score, ACR EULAR score

Observations

Table 1: Demographic profile of 33 patients of Amavata

Observation Predominance Percentage %
Age 51-60 years 14 (42.4%)
Gender Female 29 (87.9%)
Education Primary school 19 (57.6%)
Locality Rural 20 (60.6%)
Family History Absent 26(78.8%)
BMI Normal weight 29 (87.9%)

Table 2: Baseline distribution of Lakshanas of Amavata

Lakshana (Present) Percentage %
Angamardha 33 (100%)
Aruchi 27 (81.8%)
Trishna 18 (54.5%)
Alasya 32 (97%)
Gourava 32 (97%)
Jwara 25 (75.8%)
Apaka 30 (90.9%)
Sandhi Shoola 33 (100%)
Sandhi Shotha 33 (100%)
Sandhi Sthabdata 33 (100%)
Sandhi Sparsha Asahyata 33 (100%)

Table 3: Baseline distribution of Laboratory Parameters

Parameter Mean (+/-SD)
RA (IU/ml) 63.36
CRP (mg/dl) 28.43
ESR (mm/hour) 62.39

Results

Effect of therapy on Lakshanas of Amavata

Table 4: Effect of therapy on Lakshanas of Amavata (n=30)

Lakshana Mean Rank Z P Remarks
BT 6th 15th
Angamardha 2.82 2.02 1.17 49.515 <.05 S
Aruchi 2.80 1.83 1.37 44.744 <.05 S
Trishna 2.53 1.78 1.68 30.471 <.05 S
Alasya 2.90 1.92 1.18 51.864 <.05 S
Gourava 2.90 1.83 1.27 50.531 <.05 S
Jwara 2.70 1.83 1.47 39.027 <.05 S
Apaka 2.85 1.92 1.23 48.887 <.05 S
Sandhi Shoola 2.97 1.82 1.22 54.229 <.05 S
Sandhi Shotha 2.77 1.90 1.33 43.628 <.05 S
Sandhi Sthabdata 2.70 1.92 1.38 39.975 <.05 S
Sandhi Sparsha Asahyata 2.88 1.92 1.20 50.871 <.05 S

Freidman’s Test

Table 5: Effect of therapy on Lakshanas of Amavata (n=30)

Parameters   N   Sum of ranks Z P Remarks
NR PR T Total
Angamardha                
BT-6th Day 22 0 8 30 253.00 4.600 <.016 S
6th day- 15th day 23 0 7 30 276.00 4.630 <.016 S
BT- 15th day 27 0 3 30 378.00 4.696 <.016 S
Aruchi                
BT-6th Day 23 0 7 30 276.00 4.630 <.016 S
6th day- 15th day 13 0 17 30 91.00 3.606 <.016 S
BT- 15th day 25 0 5 30 325.00 4.507 <.016 S
Trishna                
BT-6th Day 15 0 15 30 120.00 3.873 <.016 S
6th day- 15th day 2 0 28 30 3.00 1.414 >.016 NS
BT- 15th day 17 0 13 30 153.00 4.123 <.016 S
Alasya                
BT-6th Day 25 0 5 30 325.00 4.914 <.016 S
6th day- 15th day 20 0 10 30 210.00 4.472 <.016 S
BT- 15th day 29 0 1 30 432.00 4.862 <.016 S
Gourava                
BT-6th Day 26 0 4 30 351.00 5.014 <.016 S
6th day- 15th day 16 0 14 30 136.00 4.000 <.016 S

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BT- 15th day 28 0 2 30 406.00 4.768 <.016 S
Jwara                
BT-6th Day 18 0 12 30 171.00 4.243 <.016 S
6th day- 15th day 8 0 22 30 36.00 2.828 <.016 S
BT- 15th day 24 0 6 30 300.0 4.735 <.016 S
Apaka                
BT-6th Day 24 0 6 30 300.00 4.811 <.016 S
6th day- 15th day 19 0 11 30 190.00 4.119 <.016 S
BT- 15th day 27 0 3 30 378.00 4.678 <.016 S
Sandhi Shoola                
BT-6th Day 28 0 2 30 406.00 5.292 <.016 S
6th day- 15th day 17 0 13 30 153.00 4.123 <.016 S
BT- 15th day 30 0 0 30 465.00 4.930 <.016 S
Sandhi Shotha                
BT-6th Day 18 0 12 30 171.00 4.243 <.016 S
6th day- 15th day 12 0 18 30 78.00 3.464 <.016 S
BT- 15th day 28 0 2 30 406.00 5.135 <.016 S
Sandhisthabdata                
BT-6th Day 17 0 13 30 153.00 4.123 <.016 S
6th day- 15th day 12 0 18 30 78.00 3.464 <.016 S
BT- 15th day 25 0 5 30 325.00 4.716 <.016 S
Sandhi Sparsha Asahyata                
BT-6th Day 23 0 7 30 276.00 4.796 <.016 S
6th day- 15th day 18 0 12 30 171.00 4.243 <.016 S
BT- 15th day 30 0 0 30 465.00 4.964 <.016 S

Wilcoxon Signed rank test

Table 6: Effect of therapy on Number of Joints with Sandhi Shoola

Number of joints with Sandhi Shoola N Mean Greenhouse-geisser Greenhouse- geisser error df Remarks
Df F value P value
BT 30 18.0 2 116.024 <.05 39.510 S
6th day 11.93
15th day 6.00

Repeated measure ANOVA test

Table 7: Pair wise comparison of Number of Joints with Sandhi Shoola

Gross Score I Gross Score J Mean Difference (I-J) Std.error Sig. 95% confidence interval for difference Remarks
Lower Upper
1 2 6.067 0.769 <.016 4.114 8.019 S
3 1 -12.000 1.001 <.016 -14.544 -9.456 S
2 -5.933 0.518 <.016 -7.251 -4.616 S

Table 8: Effect of therapy on Number of Joints with Sandhi Shotha

Number of joints with Sandhi Shotha N Mean Greenhouse-geisser Greenhouse- geisser error df Remarks
Df F value P value
BT 30 13.53 2 82.641 <.05 39.336 S
6th day 9.53
15th day 5.30

Repeated measure ANOVA test

Table 9: Pair wise comparison of Number of Joints with Sandhi Shotha

Gross Score I Gross Score J Mean Difference (I-J) Std.error Sig. 95% confidence interval for difference Remarks
Lower Upper
1 2 4.000 0.597 <.016 2.483 5.517 S
3 1 -8.233 0.823 <.016 -10.325 -6.142 S
2 -4.233 0.444 <.016 -5.361 -3.106 S

Table 10: Effect of therapy on Number of Joints with Sandhi Sthabdata

Number of Joints with Sandhi Sthabdata N Mean Greenhouse-geisser Greenhouse- geisser error df Remarks
Df F value P value
BT 30 17.13 2 101.556 <.05 43.703 S
6th day 12.20
15th day 7.33

Repeated measure ANOVA test

Table 11: Pair wise comparison of Number of Joints with Sandhi Sthabdata

Gross Score I Gross Score J Mean Difference (I-J) Std.error Sig. 95% confidence interval for difference Remarks
Lower Upper
1 2 4.933 0.681 <.016 3.202 6.665 S
3 1 -9.800 0.843 <.016 -11.943 -7.657 S
2 -4.867 0.493 <.016 -6.119 -3.614 S

Table 12: Effect of therapy on Number of Joints with Sandhi Sparsha Asahyata

Number of Joints with Sandhi Sparshaasahyata N Mean Greenhouse-geisser Greenhouse- geisser error df Remarks
Df F value P value
BT 30 17.0 2 128.222 <.05 40.576 S
6th day 11.80
15th day 6.03

Repeated measure ANOVA test

Table 13: Pair wise comparison of Number of Joints with Sandhi Sparsha Asahyata

Gross Score I Gross Score J Mean Difference (I-J) Std.error Sig. 95% confidence interval for difference Remarks
Lower Upper
1 2 5.200 0.617 <.016 3.633 6.767 S
3 1 -10.967 0.877 <.016 -13.195 -8.739 S
2 -5.767 0.509 <.016 -7.060 -4.473 S

Table 14: Effect of therapy on Assessment Parameters 

Parameter N Mean Greenhouse-geisser Greenhouse- geisser error df Remarks
BT 6th Day 15th Day Df F value P value
DAS28 30 7.1523 6.0833 4.5507 2 247.807 <.05 41.087 S
RAPID 3 6.8033 4.5567 2.8567 2 411.531 <.05 49.809 S
ACR-EULAR 8.3333 7.8667 6.733 2 41.031 <.05 48.706 S

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Repeated measure ANOVA test

Table 15: Pair wise comparison of Assessment Parameters

Gross Score I Gross Score J Mean Difference (I-J) Std. error Sig. 95% confidence interval for difference Remarks
Lower Upper
DAS28              
1 2 1.069 0.071 <.016 0.888 1.250 S
3 1 -2.602 0.140 <.016 -2.957 -2.246 S
2 -1.533 0.129 <.016 -1.861 -1.204 S
RAPID 3              
1 2 2.247 0.130 <.016 1.917 2.576 S
3 1 -3.974 0.163 <.016 -4.361 -3.533 S
  2 -1.700 0.117 <.016 -1.998 -1.402 S
ACR EULAR              
1 2 0.467 0.157 <.016 0.068 0.866 S
3 1 -1.600 0.218 <.016 -2.153 -1.047 S
  2 -1.133 0.164 <.016 -1.551 -0.716 S

Table 16: Effect of therapy on Laboratory Parameters

Parameter N Mean Greenhouse-geisser Greenhouse- geisser error df Remarks
BT 6th Day 15th Day Df F value P value
RA Factor 30 68.5600 59.3033 55.5700 2 6.409 <.05 42.837 S
ESR 65.5667 54.1667 39.5000 2 19.761 <.05 44.320 S
CRP 30.3167 20.9900 16.2367 2 13.628 <.05 36.108 S

Repeated measure ANOVA test

Table 17: Pair wise comparison of Laboratory Parameters

Gross Score I Gross Score J Mean Difference (I-J) Std. error Sig. 95% confidence interval for difference Remarks
Lower Upper
RA Factor              
1 2 9.257 3.969 <.016 -0.828 19.341 NS
3 1 -12.990 4.482 <.016 -24.377 -1.603 S
2 -3.733 2.458 <.016 -9.978 2.511 NS
ESR              
1 2 11.400 3.364 <.016 2.852 19.948 S
3 1 -26.067 5.175 <.016 -39.216 -12.917 S
  2 -14.667 3.708 <.016 -24.088 -5.245 S
CRP              
1 2 9.327 2.857 <.016 2.068 16.585 S
3 1 -14.080 3.502 <.016 -22.978 -5.182 S
  2 -4.753 1.472 <.016 -8.493  -1.014 S



Discussion

Effect of therapy on Ama Lakshanas

Angamardha, Aruchi, Trishna, Alasya, Gourava, Jwara and Apaka are the Lakshanas of Ama. Shunti, Ajamoda and Haritaki are the ingredients of Pathyadi Churna. Shunti is Katu Rasa, Ruksha, Tikshna and Laghu Guna, Ushna Virya and has Deepana Karma.[7] Ajamoda is Tikta Katu Rasa, Laghu, Ruksha and Tikshna Guna, Ushna Virya, Katu Vipaka and has Deepana Karma.[8] Haritaki is Kashaya Pradhana Pancharasa, Laghu, Ruksha, Ushna and Tikshna Guna, Katu Vipaka and has Amulomana, Lekhana, Deepana and Pachana Karmas.[9] All these Gunas are responsible for destroying the Ama in the body thereby reducing the symptoms. Kshara Basti is specifically beneficial in Amavata as it tackles both Vata and Kapha which are responsible for the disease formation. Due to its Usha Virya, Tikshna, Sukshma, Lekhana and Deepana Gunas, it reduces Ama and its Lakshanas.[10] Brihat Saindhavadi Taila has ingredients which are predominantly Vata Kaphahara and Deepana, hence reducing Ama and its Lakshanas.[11] There was significant reduction in Ama Lakshanas after treatment.

Effect of therapy on Sandhi Lakshanas

Rheumatoid arthritis is an inflammatory arthritis and shows signs of inflammation in the joints. Pain and swelling is one among them. Shunti and Ajamoda present in Pathyadi Churna have Shoolahara and Shothahara properties. Their Ushna Virya and Katu Rasa works on pain caused due to aggravated Vata and Kapha. The Ruksha Guna works on swelling caused due to Ama.[7],[8] In Kshara Basti, Gomutra is Anulomana and Shothahara,[12] Amlika and Shatapushpa are Shoolahara.[13],[14] Most of the ingredients in Brihat Saindhavadi Taila are Ushna Virya, Shoolahara and Shothahara.[11] There was significant reduction in Sandhi Lakshanas after treatment.

Effect of therapy on functional ability (RAPID 3)

RAPID 3 is an assessment of the patients physical function and pain before and after treatment. As there was significant reduction in Sandhi Shoola, Sandhi Shotha and Sandhi Sthabdata, the overall physical function of the patient also improved.


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Effect of therapy on disease activity (DAS 28, ACR EULAR)

DAS 28 Score is based on the number of swollen and painful joints, ESR and VAS Score. There was noticeable reduction in Sandhi Shotha, Sandhi Shoola, ESR value and pain in all 3 intervals, thus making it significant.

Parameters in ACR-EULAR criteria include duration of symptoms, joint distribution, serology and acute phase reactants. As there was considerable reduction in the number of joints affected with pain and swelling and as there was reduction in RA factor (serology), CRP and ESR (acute phase reactants) levels within 15 days, this score has been significant.

Discussion on probable mode of action of drug

Pathyadi Churna: Pathyadi Churna is a combination of Haritaki, Shunti and Ajamoda in equal proportions. All the drugs are predominantly Ushna Virya and have Agni Deepana and Ama Pachana properties which are required for the management of Amavata.

Haritaki is Kashaya Rasa Pradhana Pancharasa (except Lavana), Laghu and Ruksha Guna, Ushna Virya, Madhura Vipaka and is Tridoshahara. It is also Anulomana, Lekhana, Deepana, Pachana, Shothahara and has Rasayana action.[15] Its chemical constituents such as chebulagic acid acts as cox inhibitor which suppresses the inflammatory mediators like TNF-alpha, IL-1beta, IL-6. It also consists of flavonoids, alkaloids, tannins, saponins, glycosides and phenolic compounds which acts as immune modulators.[16]

Shunti is Katu Rasa, Ruksha, Tikshna and Laghu Guna, Ushna Virya, Madhura Vipaka and is Vata Kaphahara. Other Karmas include Deepana, Shophahara, Shoolahara and Ruchikara.[7] Shunti has a proven analgesic and antipyretic action. Its chemical constituents such as gingerols and gingerdiols are anti-inflammatory by suppressing the pro inflammatory cytokines. Paradols found in ginger have antioxidant effects.[17]

Ajamoda has Tikta and Katu Rasa, Laghu, Ruksha and Tikshna Guna, Ushna Virya, Katu Vipaka and is Kapha Vatahara. Other Karmas include Deepana, Shoolahara and Ruchikara.[8] Chemical constituents such as furanocoumarins and flavones present in Ajamoda have anti-oxidant and anti-inflammatory

properties. It also contains trace elements such as sodium, potassium, calcium and iron.[18]

Kshara Basti

Kshara Basti has Kapha Vata Shamaka properties. Due to its Deepaniya and Lekhaniya properties, it is specifically indicated in conditions like Amavata.

Kshara Basti comprises of Gomutra in maximum proportion which is Katu, Tikta and Lavana Rasa, Laghu and Tikshna Guna, Ushna Virya, Katu Vipaka and have Karmas such as Agni Deepana, Lekhana, Ama Pachana, Anulomana and Malashodhaka.[12]

It is proven to have antioxidant and immunostimulatory properties due to its free radical scavenging activity. It enhances the immunocompetence by facilitating the synthesis of interleukin-1 and 2, B and T lymphocytes blastogenesis and IgA, IgM and IgG antibody titers.[19]

Amlika has Amla and Madhura Rasa, Laghu, Ushna and Ruksha Guna, Ushna Virya, Amla Vipaka and is Vata Kapha Hara. It is also Shopha Hara and Shoola Hara. Its fruit contains tamarindienol which augments digestion. It is also a good source of antioxidants.[13]

Guda has Madhura and Lavana Rasa, Guru and Snigdha Guna, Ushna Virya, Madhura Vipaka and is Vata Pitta Hara. It is also Anabhishyandi and Agni Vardhaka. It is rich in sucrose, protein, minerals such as calcium and iron and contain traces of vitamins and amino acids therefore helps to maintain electrolyte balance.[20]

Saindava Lavana has Lavana and Madhura Rasa, Laghu, Snigdha and Ruksha Guna, Anushna Sheeta Virya and Madhura Vipaka. It is Tridoshagna and have Deepana and Rochana properties. Due to its Sukshma and Tikshna properties, it helps to pass the drug molecule into the systemic circulation through mucosa. It helps the Basti Dravya to reach upto the molecular level.[21,22]

Shatapushpa has Katu and Tikta Rasa, Laghu, Tikshna and Ruksha Guna, Ushana Virya, Katu Vipaka and is Kapha Vata Hara. It is also said to be Deepana, Jwaragna, Shoola Hara and Rochaka. It is rich in flavonoids thereby being a strong antioxidant.

In Basti, it helps transfer the phyto chemicals of the enema into the system of the patient.[14]



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Brihat Saindhavadi Taila Anuvasana Basti

Brihat Saindhavadi Taila has a potent pharmacological action on Amavata due to its ingredients. Its ingredients include Saindhava Lavana, Sauvarchala Lavana, Vida Lavana, Sarjikshara, Triphala, Rasna, Pippali, Gajapippali, Maricha, Kushta, Shunti, Yavani, Pushkaramoola, Jiraka and Ajamoda. Majority of these drugs have Lavana, Katu and Tikta Rasa. Lavana and Katu Rasa are Vata Shamaka and Tikta Rasa is Pitta Kapha Shamaka. These have Agni Deepana and Ama Pachana qualities. Majority of the ingredients are of Ushna Virya thereby relieving the Shotha, Shoola and Sthabdata in the joints. Eranda Taila is the base used in this preparation. It has Katu Rasa, Snigdha Guna, Ushna Virya and Kapha Vata Hara. Is has Deepana, Bhedana, Krimigna, Amashodana and Srotovishodana properties. Having anti-inflammatory and laxative properties, it is benefitial in RA. Overall Brihat Saindhavadi Taila is Vata Kapha Shamaka, Agni Deepana, Bhedana, Amashodana, Srotovishodhana, Shothahara and Shoolahara thereby beneficial in Amavata.[6],[22]

Probable mode of action of Basti

Basti is considered the best treatment in balancing Vata Dosha. Depending on the combinations in the Basti Dravya, it has Shodana, Shamana, Lekhana or Brimhana effects. Basti is considered to be Ayushya, Sukha, Balakrit, Agnikrit, Dhaardyakrit etc. Pakvashaya is the Sthana of Vata Dosha and administering Basti directly to the Sthana terminates the vitiated Vata from its root. There are various theories regarding its mode of action. A probable mode is based on its Virya. Though Basti is administered to the Pakvashaya, the Virya of the medicines in the Basti Dravya spread throughout the body by means of Srotas and brings about the desired action. According to modern pharmacokinetics, it is proven that rectal drug administration exceeds the oral value due to its partial avoidance of hepatic first pass metabolism.[23]

Conclusion

Pathyadi Churna and Kshara Basti is beneficial in the management of Amavata (Rheumatoid Arthritis).

No ADR was recorded during the study, both the formulations seem to be clinically safe.


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