E-ISSN:2456-3110

Case Report

Niruha Basti’s

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 1 January
Publisherwww.maharshicharaka.in

Systemic analysis of different Niruha Basti’s in Vatavyadhi (Gridhrasi) - A Case Study

Suraksha S1*, Lolashri SJ2
DOI:10.21760/jaims.9.1.54

1* S Suraksha, Post Graduate Scholar, Dept of Panchakarma, Sri Kalabairaveshwaraswamy Ayurvedic Medical College Hospital and Research Centre, Bengaluru, Karnataka, India.

2 S J Lolashri, Associate Professor, Dept of Panchakarma, Sri Kalabairaveshwaraswamy Ayurvedic Medical College Hospital and Research Centre, Bengaluru, Karnataka, India.

Ayurveda is popular holistic science in this present era that deals with scientific evidence-based treatment principles and approaches toward a positive lifestyle. It explains mainly about 2 types of Chikitsa i.e., Shodhana and Shamana. Out of this, Basti Chikitsa is one of the 5 important treatment modalities that are explained under panchakarma and it is often used in the management of different kinds of Vatavyadhi.[1] The different manifestations of Gridhrasi with different cause requires a blended approach of various treatment modalities with Basti Chikitsa as a centre of focus. This Case study includes 3 different presentations of Gridhrasi with Pain in low back region radiating to lower limbs successfully treated with 3 different Niruha Bastis. Assessments of Subjective parameters include Lakshanas of Gridhrasi and Objective parameters include Straight Leg Raising Test and Bragard’s sign.

Keywords: Vatavyadhi, Niruha Basti, Pharmacodynamic action, Ardha Chikitsa, Ayurveda

Corresponding Author How to Cite this Article To Browse
S Suraksha, Post Graduate Scholar, Dept of Panchakarma, Sri Kalabairaveshwaraswamy Ayurvedic Medical College Hospital and Research Centre, Bengaluru, Karnataka, India.
Email: 		Suraksha S, Lolashri SJ, Systemic analysis of different Niruha Basti’s in Vatavyadhi (Gridhrasi) - A Case Study. J Ayu Int Med Sci. 2024;9(1):333-337.
Available From
https://jaims.in/jaims/article/view/3047

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-11-06 2023-11-24 2023-12-06 2023-12-14 2023-12-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared. NIL YES 13.37 NONE

© 2024by Suraksha S, Lolashri SJand 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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Suraksha S. et al. Systemic analysis of different Niruha Basti’s in Vatavyadhi (Gridhrasi)

Introduction

The Vata Vyadhi’s explained under 80 Nanatmaja Vikaras[2] present with different symptoms of various neurological deficits and musculoskeletal deformities especially intolerable pain in most cases. Basti specially considered as Ardha Chikitsa with the combination of various herbal drugs has the capacity to do Dosha Karshana in case of Margavarana and Bruhana in case of Dhatukshaya if manifested by Vata Dushti. An attempt is made to understand 3 different presentations of Gridhrasi with Pain in low back region radiating to lower limbs successfully treated with 3

different Niruha Bastis. Assessments of Subjective parameters include Lakshanas of Gridhrasi and Objective parameters include Straight Leg Raising Test and Bragard’s sign. The Avastha of the Gridhrasi presentation had different Samprapti in all the cases which was treated accordingly by selection of different Basti Chikitsa. The main objective of the study was to analyse the Pharmacodynamic action of Basti in different systems of the body & To analyse the action of Niruha Basti in different cases of manifestations of low back pain.

Case report of 3 different cases:

Case 1: A Male Patient of 52 years hailing from Bengaluru, Karnataka complained of Severe pain in the lower back region radiating to left lower limb (till left foot posterior- lateral) since 15 days along with stiffness in the lower back region and left leg since 15 days. Patient also presented with numbness of bilateral lower limb since 3 months (occasionally).

Past History: Patient had history of long distance travelling for about 20 hours continuously before 4 months and from then onwards the numbness in bilateral lower limbs and gradually started feeling pain in low back region.

H/O Haemorrhoids 6 years back

Family History: Nothing Contributory

Personal History:

Diet: Mixed Appetite: Reduced Sleep: 4-5 hrs night, Disturbed Bowel: Once/day

Micturition: 2-3 Times/Day, once/night

Addictions: Tea (twice), Smoking since 6 years.

Case 2: A Female Patient of age 32 years hailing from Tumkuru, Karnataka presented with the main complaints of Pain in the lower back region radiating to right lower limb (till the right little finger of foot) Since 2 months, C/o Stiffness and Heaviness of right lower limb since 1month. Patient also complains of Fatigue since 2 months and Reduced appetite since 2 weeks. Patient had History of lifting heavy weight 1 week back.

Family History: Nothing Contributory

Personal History:

Diet: Mixed, non veg (chicken) monthly once, Fish weekly once, Appetite: Reduced

Sleep: 5- 6 hrs night, Disturbed Bowel: Once/day

Micturition: 2-3 Times/Day, once/night, Addictions: Coffee (thrice)

Case 3: A female patient of age 53 years who is not a k/c/o Hypertension/Diabetes Mellitus hailing from Bengaluru. Presents with main complaints of Pain in the lower back region since 20 days & Pain radiating to right lower limb since 10 days. Patient met with an accident from two-wheeler that resulted in minor fracture of the lumbar vertebrae 4 months back (reports not available, as words by patient) & Patient had History of Fall 20 days back. From the she also presents with Pain in the right shoulder joint since 20 days

Family History: Father K/C/O HTN since 15 years.

Personal History:

Diet: Vegetarian, Appetite: Good, Sleep :7-8 hrs night, Bowel: 2 times/day

Micturition: 3-4 Times/Day, 2 times/night

Findings

Assessment of the clinical study was done on the basis of subjective and objective parameters using different grading and scoring methods before and after treatment.

Subjective Parameter[3]Objective Parameters[4]
§ Ruk
§ Toda
§ Sthambha
§ Muhuspandana
§ Tandra
§ Arochaka
§ Gourava		§ SLR Test
§ Bragard’s Sign

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Suraksha S. et al. Systemic analysis of different Niruha Basti’s in Vatavyadhi (Gridhrasi)

MRI of All 3 cases were taken and it showed following impression:

Case 1: Disc degenerative changes in L4-L5 with osteophytes and Disc desiccation in L3-L4, L4-L5, L5-S1 and Disc Bulge in L4-L5, L5-S1.

Case 2: Mild Disc bulge in L1-L2, L2-L3, L3-L4 level, Disc desiccation and diffuse disc bulge with central protrusion in L5-S1 level. Posterior annular tear in L4-L5 level.

Case 3: Anterior wedging of S1 vertebrae with mild disc bulge at L5-S1 level.

Treatment Plan

Case 1Case 2Case 3
09.05.2022- 12.05.2022
§ Agnikarma was done on 09.05.2022
§ Kati Basti - Moorchita Taila
§ Sarvanga Abhyanga - Moorchita Taila
§ Sarvanga Parisheka - Dashamoola Kwatha
Orally
§ G.H. Taila 20 ml with Milk (Empty Stomach Early Morning)
13.05.2022- 20.05.2022
§ Erandamooladi Niruha Basti was added in Yoga Basti Pattern.		04.05.2022- 17.05.2022
§ Kati Basti - Mahavishagarbha Taila
§ Sarvanga Abhyanga - Moorchita Taila
§ Adhoshaka Jambeera Pinda Swedana
§ Sthanika Nadi Swedana (Low Back region)
§ Bashpa Swedana
§ Vaitarana Basti Matra Basti with Sahacharadi Taila 30 ml		30.04.2022-15.05.2022
§ Sthanika Manjishtadi Lepa
§ Sthanika Parisheka with Murivenna Taila
Orally
§ Gandha Taila 1tsp-0- 1 tsp (Before Food)
§ Lakshadi Guggulu 1-1-1 (After Food)
§ Tikta Ksheera Basti from 5th Day

Observations

Case 1Case 2Case 3
After Agnikarma pain in the lower back region radiating to the left lower limb had reduced comparatively (40%). Numbness and heaviness have reduced slightly after the 7 days of treatment. Sleep quality had improved.
Pain was reduced by 90% after Yoga Basti.
Now patient is able to walk without any difficulty, no stucking feeling while walking, Weakness have reduced.		Stiffness and heaviness in the lower back region radiating to the right lower limb had slightly increased for first 4 days and comparatively after 6 days of treatment, pain slightly reduced.
Tiredness and fatigue have reduced after 5 days of treatment.
Pain of right lower limb have reduced (80%) after 14 days of Vaitarana Basti Chikitsa.		Pain in the lower back have reduced after 5 days of treatment by 60%, Radiating pain have reduced after 9 days of treatment.
Patient condition was improved at the time of discharge. Pain and difficulty in walking reduced by 80%.

BT & AT Outcome Comparison[5]

ParametersCase 1Case 2Case 3
Subjective ParametersBTATBTATBTAT
Ruk304141
Toda312020
Sthambha204130
Muhu
Spandana		203031
Tandra003100
Arochaka004100
Gourava003000
Objective ParametersBTATBTATBTAT
SLR Test30°90°40°75°50°90°
Bragard’s
Test		+ve-ve+ve-ve+ve-ve

Discussion

This article mainly depicts 3 different presentations of Low back pain due to 3 different causes. In the first case, Due to the presence of Nidanas such as long distance travelling along with the Katu Rooksha Pradhana Ahara Sevana which has led to the vitiation of Vata Dosha where the vitiated Vata has taken the Sthana Samshraya in Kati Pradesha where the Kha Vaigunyata is present.

In addition to this, Ati Ruksha Katu Ahara Sevana has led to the Mamsa Shithilata due to which there is Vimunchana of Sandhi that is degeneration in lumbar spine further causing inflammation which can be considered as Dahana of Rakta.[6]

This inflammation is main reason for causing irritation to the sciatic nerve. This presentation mainly involves Vata Dosha vitiation leading to Vataja Gridhrasi. Where as in second case, a female patient mainly presents with Agnimandyata along with pain in low back region which is caused due to the Ama present in the body because of Vata Kaphaja Nidanas that are present like excess intake of Matsya, Anupa Mamsa along with lifting heavy weights.

In this case, the Ama Rasa has led to the vitiation of Kapha and Vata Dosha further doing Shoshana of Kandaradi Avayavas leading to Vata Kaphaja Gridhrasi.[7]

3rd case mainly presents with Nidana of Abhighata where Injury to Sira, Snayu, Kandara, Mamsa at Kati Pradesha lead to Vata Prakopa and Shitilata at the site which in turn causes Snehadi Guna Kshaya, thus causing the Compression fracture.


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Suraksha S. et al. Systemic analysis of different Niruha Basti’s in Vatavyadhi (Gridhrasi)

Erandamooladi Niruha Basti along with all other Snehana Chikitsa has given good improvement in first case where the different combination of Drugs used in Erandamooladi Basti which has properties of Vatahara, Vedanashamaka and it is Balya in nature.[8]

This helps in strengthening the Mamsa Shitilata that has occurred at the Sandhi Pradesha and thus reduces the pain in low back and lower limbs. In case of 2nd Patient, Vaitarana Basti is given which helped in correcting the vitiated Vata Kapha Dosha. The drugs that are used in the form of Guda, Saindhava, Taila, Chincha Jala, Gomutra are having Teekshna, Ushna, Vatakapha Shamaka property thus it helped in Vedanasthapana and Vatanulomana. Vaitarana Basti also does the function of Nadibalakara[9]

which clearly states that it strengthens the sciatic nerve that is being compressed as a result of Disc Herniation. In case no 3, The compression fracture clearly indicates the involvement of Asthi, Mamsa and Majja Dhatu. Thus, the Chikitsa explained in the context of Asthi Pradoshaja Vikara is done here. Tikta Ksheera Basti does the Vatashamana and it provides the Poshana to the Asthi Dhatu that is very much required in case of Fractures.[10]

As Asthi Dhatu is hallow that is made up of Akasha and Vayu Mahabhoota, Tikta Dravya which has the same composition easily helps the Dravyas to reach the targeted site and Ksheera that is used nourishes the bones thus preventing deterioration and prevents further degeneration that might occur as a result of Fracture.

Conclusion

Basti Karma is the treatment of choice specially in case of Vata Dushti and also in Samsrushta Doshas like Pitta and Kapha. Basti acts on the Apana Vayu first, later all other forms of Vata along with correction of Dushita Kapha and Pitta in sequential order,[11]

helping in absorption of active principles of Niruha Basti, thus playing an important role as Ardha Chikitsa in most of Vata Vyadhi’s including Gridhrasi. Basti acts at the level of multisystem especially encolonic and endocolonic further acting at cellular level due to its Veerya helping out in excretion of vitiated toxins and absorption of required nutrients into the circulation.

Different modifications pertaining to formulation and course of Basti can be made in treating various other Vata Vyadhis based on Nidana of disease, type of Dosha and Dhatu vitiated, site of pathology, severity and intensity of disease, this study paves a way for further research of various other Niruha Basti’s on larger sample.

References

1. Vagbhata, Arundatta, Hemadri, Sutra sthaha Chapter Ayushkameeyamadhyaya Adhyaya,Verse 25 In : Pt . Hari Sadashiva Shastri Paradakara Bhishag, Acharya Astanga Hridaya with Sarvanga Sundari and Ayurveda Rasayana Commentary. Edition: 2016.Varanasi Chaukhamba Subharti Prakashana. p.16.

2. Agnivesha, Charaka, Dridhabala, Chakrapanidatta, Sutra Sthana, Chapter Maharoga Adhyaya, verse 11, In Acharya Charaka Samhita with Ayurveda Deepika commentary. Reprint Edition: 2017.Varanasi: Chaukhambha Published.p.113.

3. Agnivesha, Charaka, Drdhabala, Chakrapanidatta, Chikitsa Adhyaya, Vatavyadhi Chikitsa Adhyaya, Verse 56-57, In Acharya Charaka Samhita with Ayurveda Deepika commentary. Reprint Edition: 2017. Varanasi: Chaukhambha Published.p.619.

4. Manipal Manual of Clinical Medicine; Second Edition, BA Shastry, CBS Publishers& Distributors; p.251-52.

5. Triveni Manju, Thesis entitled “An Open Label Double Arm Randomised Study To Compare The Effect Of Kati Basti With Moorchita Taila And Kati Basti With Erandakarkati Taila In Gridhrasi Vis-à-vis Sciatica”; 2019-22.

6. Agnivesha, Charaka, Drdhabala, Pranakameeya Rasyana chikitsasthana chapter, Verse 3, In Acharya Charaka Samhita with Ayurveda Deepika commentary. Reprint Edition: 2017. Varanasi: Chaukhambha Published.p.381.

7. Agnivesha, Charaka, Drdhabala, Chakrapanidatta, Chikitsa Adhyaya, Vatavyadhi Chikitsa Adhyaya, Verse 57, In Acharya Charaka Samhita with Ayurveda Deepika commentary. Reprint Edition: 2017. Varanasi: Chaukhambha Published.p.619.


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8. Agnivesha, Charaka, Drdhabala, Chakrapanidatta, Siddi sthana, chapter Bastisutriya siddi Adhyaya, Verse 38 In Acharya Charaka Samhita with Ayurveda Deepika commentary. Reprint Edition: 2017. Varanasi: Chaukhambha Published.p.696.

9. Chakradatta, chakrapanidatta, chapter Niruha Adhikara, Verse 32 In Acharya Chakradatta Samhita with chakapaindatta commentary Reprint Edition :2014 varanasi chaukhamba subharti prakashana p.701-710.

10. Agnivesha, Charaka, Dridhabala, Chakrapanidatta, Sutra Sthana, Chapter Vividhaasheeta Peetiya Adhyaya, verse 27, In Acharya Charaka Samhita with Ayurveda Deepika commentary. Reprint Edition: 2017.Varanasi: Chaukhambha Published.p.180.

11. Sushruta, Dalhana, Gayadas, Chikitsa sthana chapter Netrabastipramana pravibhaga chikitsa Adhyaya, Verse 06, In: Acharya YT, Narayana Sushrutha samhitha with Nibandhasangraha, Nyayachandrika commentary. Reprint Edition: 2014. Varanasi Chaukhamba Sanskrit Sansthaan.p.525.


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