E-ISSN:2456-3110

Case Report

Ulcerative Colitis

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

The role of modified Pichha Basti in the management of Ulcerative Colitis - A Case Study

Chaturvedi P.1, Solanki S.2*, Dhurve M.3
DOI: http://dx.doi.org/10.21760/jaims.8.3.28

1 Preeti Chaturvedi, Reader, Department of Panchakarma, Pandit Khushilal Sharma Govt. Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India.

2* Sonika Solanki, Post Graduate Scholar, Department of Panchakarma, Pandit Khushilal Sharma Govt. Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India.

3 Mamta Dhurve, Post Graduate Scholar, Department of Panchakarma, Pandit Khushilal Sharma Govt. Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India.

Ulcerative colitis (UC) is an inflammatory bowel disease that causes inflammation and ulcer in digestive tract. UC affected the innermost lining of large intestine also called the colon and rectum. In most popular symptoms usually develop over time rather than suddenly. UC can be draining or sometimes lead to life threatening complication. While it has no know cure there are several new treatments that can greatly reduce sign and symptoms of the disease and bring about long term remission. In Ayurveda Raktaatisara, Pitajatisara, Parvahika and Grahani shows symptoms having resemble with UC like blood and bile mixed stool with excessive foul smell, burning sensation, suppuration of colon and anus, colic pain etc. Pichha Basti indicated in Parvahika, Grahani and Atisara by Acharya Charaka and Vagbatta. This Basti reduce inflammation due to its Grahi, Deepandravya and Picchila Guna. It also improves the function of Apanvata. In modern medical science many conventional medicines are used in ulcerative colitis some drug like mesalamine may give relief in sign and symptoms but this drug is not suitable due to their side effects. The patient gradually developed the following symptoms like bilateral joint pain in all major and minor joints, hair loss, reddish discoloration on bilateral medial aspect of thigh and hip etc.

Keywords: Ulcerative Colitis, Grahani, Picchabasti, Ayurveda

Corresponding Author How to Cite this Article To Browse
Sonika Solanki, Post Graduate Scholar, Department of Panchakarma, Pandit Khushilal Sharma Govt. Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India.
Email: 		Preeti Chaturvedi, Sonika Solanki, Mamta Dhurve, The role of modified Pichha Basti in the management of Ulcerative Colitis - A Case Study. J Ayu Int Med Sci. 2023;8(3):149-153.
Available From
https://jaims.in/jaims/article/view/2352

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-01-25 2023-01-27 2023-02-03 2023-02-10 2023-02-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2023by Preeti Chaturvedi, Sonika Solanki, Mamta Dhurveand 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].

Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)149
Chaturvedi P et al: Role of modified Pichha Basti in management of Ulcerative Colitis

Introduction

Ulcerative Colitis is a chronic idiopathic type of irritable bowel disease with an immune mediated chronic intestinal condition with perceive the protected relapsing and remitting course. The aetiology of ulcerative colitis is unknown till known. The rectum mucosa is always affected with inflammation spreading from the distal to the proximal colonic segments. Mucosa is erythematous and has a fine granular surface that looks like newspaper spreading to the proximal colonic segments. In severe phase of disease Mucosa is haemorrhagic, oedematous and ulcerated. In Ayurveda classics Grahani is set to be the principal seat of Agni.[1]

Grahani is the part of the intestine extending from pyloric of stomach to the caecum. It referred mostly to the duodenum part of small intestine where both pancreatic and bile juice come and join together. Ayurveda describes the ingestion, digestion and absorption and assimilation of Ahara by Grahani. Normally it retains the undigested food and release the digested stuff through the side if lumen. Any disturbance in Agni leads to improper digestion of food this also reason of Grahani Roga. Grahani Roga correlated with IBD which is characterized by group of symptoms. The main features of the disease are anorectal bleeding, loose watery discharge, abdominal pain, weakness other symptoms are tenesmus, passage mucous with crampy abdominal pain, malaise, anorexia involvement of rectal mucosa in the frequency of stool. The first attack is most severe and then after the disease is followed by the relapsing and remission. In Ayurveda Grahani, Pravahika and two types of Atisara that is Pittaj Atisara and Raktaj Atisara comes under the disease of Purishavah Srotas having common symptoms blood with stool can be co-related with a symptoms of Ulcerative colitis.

The disease can persist for a year has burden at the health also possesses a big challenge for medical health professionals due to its high morbidity and mortality. Various Panchakarma treatments of modalities for the management of these diseases are mentioned in our classics Pichha Basti is best among there.[2]

Hence there is a need for globalise this type of treatment that can manage such condition satisfactory.

Aim and Objective

To evaluate to efficacy of modified Pichha Basti in the management of ulcerative colitis.

Materials and Methods

Selection and source of patient

Patient was registered from OPD of Panchkarma department and admitted in general IPD ward of Pt. Khushilal Govt. (Auto.) Ayurveda Hospital, Bhopal.

Plan of study: The drug required for Basti Karma were procured and prepared in Prakalpa of Panchkarma theatre in Pt. Khushilal Govt. Ayurveda Hospital, Bhopal.

Case Study

A married female patient age of 45 years, Hindu house wife, graduate, economic status is lower middle, diagnosed case of ulcerative colitis visited OPD on date 07/09/2022. Complaining of blood with faeces, abdomen pain, mucus discharge and generalised weakness since 4 year.

Personal history: No family history along with no history of any other major illness such as hypertension, diabetes mellitus, tuberculosis, Hyperthyroidism, liver disease etc. No history of any type of past surgery. Had vegetarian diet with regular food habit, frequently eating salty, spice, bitter oily food.

General physical examination

No pallor, Icterus, Oedema, clubbing was present.

MRI abdomen report date 06/09/2022 shows few Nabothian cysts, rest pelvic organs unremarkable, Mild free fluid is seen in the pouch of Douglas.

  • Temperature - 37°C
  • Pulse rate - 74/min
  • Respiratory rate - 18/min
  • Blood pressure - 130/80mmHg
  • Weight - 40 kg lean and thin
  • Height - 5.3ft

Systemic examination

  • GIT - pain and tenderness in lower abdomen.
  • Respiratory - NAD
  • Cardio vascular - NAD

Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)150
Chaturvedi P et al: Role of modified Pichha Basti in management of Ulcerative Colitis

Criteria for inclusion: Sign and symptoms of ulcerative colitis alone with colonoscopy / endoscopy diagnosed case.

Parameters

Subjective parameters

  • Bowel frequency with loose stool.
  • Abdominal pain.
  • Blood with stool.
  • Weakness
  • Loss of weight

Ashtavish Pariksha (eight-fold examination)

  • Pluse rate - 76/min, Rhythm - Regular, volume - normal, tension - normal, force - normal.
  • Stool - Appearance - bloody mixed stool defecation.
  • Urine - Amount - 3 to4 times/day and one time at night.
  • Tongue - Normal in shape & sized.
  • Touch - Afebrile
  • Eye - Normal in vision
  • Appearance - Lean & thin body
  • Voice - Normal voice with clarity.

Dashavidha Pariksha (ten-fold examination)

1. Prakriti - Vata-Pittaja

2. Vikriti - Dosha-Dushya Samoocchana

3. Sara - Madhyama

4. Samhanana - Madhyama

5. Pramana - Madhyama

6. Satva - Madhyama

7. Saatmya - Madhyama

8. Ahara-Shakt i- Aawara

9. Vyayaam Shakti – Aawara

10. Vaya- Madhyama

Srotas examination

1. Pranavaha Srotus - NAD

2. Udakavaha Srotas - NAD

3. Annavaha Srotas - Avipaka (indigestion)

4. Rasavaha Srotas - NAD

5. Raktavaha Srotas - NAD

6. Mansvaha Srotas - NAD

7. Medovaha Srotas - Alasya (lethargy)

8. Ashtivaha Srotas - NAD

9. Majjavaha Srotas - NAD

10. Shukravaha Srotas - NAD

11. Manovaha Srotas - NAD

12. Artavaha Srotas - NAD

13. Mootravaha Srotas - NAD

14. Purishavaha Srotas - Raktvayukta Purish Tyaga (blood mixed stool defecation)

15. Swedavaha Srotas - NAD

Objective parameters: Hb%

Assessment criteria: Improvement was assessed on the basis of relief in subjective and objective parameters.

1. Bowel frequency

0 1 or 2 times in a day
1 3 or 4 times in a day
2 5 or 7 times in a day
3 8 or 12 times in a day
4 More than 12 times a day

2. Weakness

0 No weakness
1 Tolerable weakness
2 Mild weakness
3 Moderate weakness
4 Sever weakness

3. Abdominal pain

0 No pain
1 Tolerable pain
2 Mild pain
3 Moderate pain
4 Sever pain

4. Blood in stool

0 No bleeding
1 Occasional bleeding in stool (not daily)
2 Bleeding daily but less than 4 times / day
3 Bleeding daily but less than 8 times /day
4 Bleeding daily more than 8 times / day

Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)151
Chaturvedi P et al: Role of modified Pichha Basti in management of Ulcerative Colitis

Treatment plan

Piccha Basti

1. Poorva Karma: Sarwang Snehana Swedena with Moorchit Tila Tail and Mrudu Vashpa Swedana.

2. Pardhan Karma: Patient was made to lie in left lateral position for administration of Basti.

Content of Piccha Basti[3]

a. Salmali Vrinta Kashaya

b. Ghrita

c. Madhu (honey)

d. Kalka Darvya

  • Manjista Choorna
  • Mocharasa Choorna
  • Lodhra Choorna
  • Nagkeser Choorna
  • Yastimadhu choorna
  • Rasanjan Choorna

Other Requirements

  • Syringe
  • Catheter 8 no.
  • Gloves

3. Pashchata Karma

a. Patient is asked to keep lying for 3-4 minutes for better absorption of Basti

b. Patient is advised to take light diet.

c. Patient is advised to avoid fast foods and spicy foods.

d. After complication of complete cycle patient is advised to follow the Sansarjan Karma.

Method of preparation of Piccha Basti[4]

To prepare the mixture for decoction enema. One must follow a sequence of mixing various ingredients. First add honey and rock salt and mix properly than add ghee, again mixing properly than add to be fine Manjisthadi Kalka of herbs and finally add to it Shalmali Vrintadi Kashaya. The whole mixture when thoroughly mixed. Should be heated to body. Temperature over water vapour then pours these contents into an enema bag.


Duration of Treatment: Pichha Basti is a type of Yapana Basti, given with increasing order starting dose of 120 ml increases up to 250ml (14days). Prior to Pichha Basti 3 Shodhan Basti were given.

SN Pichha Basti Matra Pratyagaman Kala Agman Kala Retention Complication
1. 120ml 10:30am 10:50am 20min No
2. 130ml 11:15am 12:00pm 45min No
3. 140ml 10:30am 11:00am 30min No
4. 150ml 11:15am 11:40pm 25min No
5. 160ml 10:45am 11:00am 15min No
6. 170ml 10:00am 10:50am 50min No
7. 180ml 11:00am 11:45am 45min No
8. 190ml 10:30am 11:00am 30min No
9. 200ml 10:00am 10:45am 45min No
10. 210ml 11:00am 11:30am 30min No
11. 220ml 10:50am 11:30am 40min No
12. 230ml 10:50am 1130am 40min No
13. 240ml 11:30am 12:05pm 35min No
14. 250ml  10:00am 10:45am 45min No

Duration of follow up Periods: 15 days

Result

SN Sign and symptoms BT AT
1. Bowed frequency 3 0
2. Weakness 3 1
3. Abdominal pain 3 0
4. Blood in stool 3 1

HB% report

SN BT AT
1. 10.3gm 13.6gm

Discussion

Grahni Roga is a chronic disease of Annavaha Strotas which occur in organ Grahni due to vitiation of Agni.

Grahni Roga is the prime disease of GIT which is most aften found in clinical practice. It disturbs daily routine of individuals. In modern medical science drug like sulfasalazine, amino salicylates, corticosteroids, antitumor necrosis etc. will not subside the active phase may give mild relief but after some time the doses may be high and drug resistance, drug dependency and side effects of their drugs are high. Patient is always seeking some alternative therapy promising more effective and safer outcome. Currently there is no medical cure Ayurveda approaches are helpful in such diseases.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)152
Chaturvedi P et al: Role of modified Pichha Basti in management of Ulcerative Colitis

Various types of Basti Karma are mentioned in classics based on their action one among them is Pichha Basti. It is named of its Pichhila property which means sticky or lubricant in nature Because of this Property it forms a protective layer over the intestinal mucosa to avoid friction and reduction intestinal irritation.

The ingredients used in Pichha Vasti were Salmali Niryasa, Ghrita, Taila, Madhu and Dugdha. All ingredients are having similar properties like Madhura Rasa, Sheeta Veerya and Madhura Paka.

Mode of action

  • Shothahara and Vrana Ropaka (Anti Inflammatory and Ulcer Healing).
  • Raktasthambhaka (Haemostatic Agent)
  • Sangrahi / Stambhan (Anti Diarrheal & Anti Dysenteries)
  • Pitta Shamaka
  • Agnideepaka

Conclusion

Piccha Piccha Basti was prepared from easily available herbs and after administration gave good symptomatic relief. Sangrahi and Sodhana property of Piccha Basti facilitate healing in colon mucosa. The Hb level also increases after the Parihar Kala of Basti so the general condition of the patient also improved.

Reference

1. Shastri K. Charak Samhita part2; Chikisasthana; Atisarachikitsa 19/63-66 pg no. 570; Publication: Chaukhamba Bharti Academy; Varanasi; Edition-2011.

2. Shastri K. Charak Samhita part 2; Chikisasthana; Atisarachikitsa 19/63-66 pg no. 570; Publication: Chaukhamba Bharti Academy; Varanasi; Edition-2011.

3. Agnivesh, Charaka Samhita Chikitsastana Elaborated by Charaka and Drudhabala, commentary by Sri Chakrapanidatta, edited by Vaidya Trikamji Acharaya, prologued by prof. R H Singh; Chuakahamba Subharti Prakasan Varanasi 2017; 552: 19-70.


4. Sushruta. Sushruta Samhita, Uttar Sthana, Elaborated BY Sri Dalhan and Sri Gayadash, hindi Commentry by Dr Kebal Thakral; Chaukhamba Orientalia, Varanasi second 2016 ;298: 40-10.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)153