E-ISSN:2456-3110

Case Report

Samsrushta Grudrasi

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Basti as Ardha Chikitsa in the management of Vata-Pitta Samsrushta Grudrasi - A Case Report of Lumbar Spondylosis

Shirahatti S1*, Rajeshwari NM R2
DOI:10.21760/jaims.9.8.34

1* Shreepriya Shirahatti, Final Year Post Graduate Scholar, Department of Ayurveda Basic Principles, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Raja Rajeshwari NM, Professor, Department of Ayurveda Basic Principles, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

Lumbar Spondylosis is the commonly observed chronic degenerative disorder especially in the geriatric age group. This signifies that disorder is majorly due to Dhatu Kshaya (~depletion of body building and sustaining factors). In the present case report of Lumbar Spondylosis, was diagnosed as Vata Pitta Samsrushta Grudrasi (~sciatica formed by Vata and Pitta Dosha in their equal dominance) with the application of Trividha Bodhya Samgraha (~cause, situation and nature of disease). A 53 year housewife hailing from rural sector of Jangala Desha (dry area) reported with severe burning sensation in right foot, low backache, referred pain in right calf associated with numbness. Vata and Pitta were elicited as Sthanika (~functional unit of its own place) and Agantu Dosha (~functional unit entered from other part) respectively through Samsarga Dosha Laxana. Yapana Basti (~Enema Therapy) schedule was designed to pacify Pakvashayagata Vata-Pitta (~Vata and Pitta situated in lower gut). Qualitative assessment done before and after treatment revealed successful outcomes where score reduced from 12 to 2 indicating improved quality of life. Basti acts as Ardha Chikitsa (~half treatment) when proper Yukti (planning) is applied in designing protocol, selecting appropriate formulations by incorporating multiple Chikitsa Siddhanta (~treatment principle) such as Sthanivat Chikitsa.

Keywords: Lumbar Spondylosis, Pakvashayagata Vata, Sthanivat Chikitsa, Vata-Pitta Samsrushta Grudrasi, Yapana Basti

Corresponding Author How to Cite this Article To Browse
Shreepriya Shirahatti, Final Year Post Graduate Scholar, Department of Ayurveda Basic Principles, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Shirahatti S, Rajeshwari NM R, Basti as Ardha Chikitsa in the management of Vata-Pitta Samsrushta Grudrasi - A Case Report of Lumbar Spondylosis. J Ayu Int Med Sci. 2024;9(8):222-230.
Available From
https://jaims.in/jaims/article/view/3521

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-13 2024-07-23 2024-08-03 2024-08-13 2024-08-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.13

© 2024by Shirahatti S, Rajeshwari NM Rand 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

Ayurveda treatment principles are very specific and clinically reliable when applied appropriately. Thorough understanding of Vyadhi Samprapti (~disease pathology) helps in prioritizing the treatment modality depending on the components of Dosha Dushya Sammurchana (~start of disease pathology).[1]

Hence the background knowledge of Ayurveda principles is the fundamental criteria to design successful treatment protocol. The principle of Trividha Bodhya Samgraha i.e. Vyadhi Prakruti (~nature of disease), Adhishthana (~disease affected site) and Samutthana (~cause of the disease)[2] is applied for the diagnosis and management of Vata-Pitta Samsrushta Grudrasi where it is considered as one of the Anukta Vyadhi.

The Samsrushta Avastha of Vata and Pitta refers to the Pradhanata of both Dosha in manifestation of disease due to Svatantra Nidana (~independent cause for aggravation), Svatantra Laxana (~exhibition of specific features) and Svatantra Chikitsa (~getting pacified by the specific treatment) of each Dosha.[3]

Hence the treatment for Vata-Pitta Samsrushta Avastha typically differs from the treatment protocol of individual Dosha. Treatment protocol designed by considering the Dosha involvement without analyzing the Dushya, Ashaya, Roga Marga, Agni and other components of Vyadhi Samprapti often discourage the success rate of Ayurveda treatment modality. Encouraging the principle of Sthanivat Chikitsa which states that the treatment modality should be in accordance with Sthani Dosha to correct Vikruti (~derangement) by assessing Sthani Dosha and Agantu Dosha, provides successful outcomes.[4]

The treatment modality through Basti is described as Ardha Chikitsa in any disease condition because of Vata Dosha being the initiator of Dosha Dushya Sammurchana and is the ultimate line of treatment in the Pakvashayagata Vyadhi irrespective of association of any other Dosha.[5] This case report is intended to throw light on background fundamental principles to be considered for clinical appreciation of Basti as Ardha Chikitsa in the management of Vata-Pitta Samsrushta Grudrasi.

Case Report

Patient information

A female patient aged 53 years, not K/C/O DM and HTN, hailing from Jangala Desha, approached outdoor patient department on 3/7/2023 with OPD no. 289434 having complaints of severe burning sensation in the right foot, dragging type of pain in right calf region, low backache associated with numbness in right foot. Complaint of mild low backache was noted after few months of undergoing surgery of Pan Hysterectomy in the year 2015. Gradually pain aggravated since 2018 due to excessive physical exertion. Hence, she consulted allopathy doctor in her residential area and she was advised to undergo routine blood investigation. Then she was prescribed with analgesics and vitamin supplements. Dragging pain in right calf was eventually associated due to continued physical exertion in her lifestyle. In further clinical conditions, it was associated with limping gait and burning sensation in the right foot and hence restricting the movement and reducing walking speed. Even after internal medication, pain and burning sensation continued to aggravate especially in the mid night. Hence patient received medical aid from higher centre in which MRI- LS was done and advised to undergo Spine surgery. There were no other co-morbidities and relevant family history. Daily routine of patient was dominated with Vatakara (~causes for Vata increase) and Pittakara Nidana (~cause for Pitta increase) such as Katu (~spicy), Ruksha Ahara (~dry food), Kshobha (~crisis of strength), Shrama (~tiredness), Kalatita Bhojana (~consuming food after long gap of hunger) etc. which contributed to Rasavaha, Asthivaha and Majjavaha Srotas (~channels of nourishment of plasma, bone and bone marrow). It is also supported by predisposing factors in terms of Desha, Kala, Prakruti.

Clinical findings

Patient had limping gait, uneasiness while walking. Systemic examination not revealed any abnormal findings. Vitals were normal. Different clinical examinations were done and recorded during the course of treatment as mentioned in the Table 1. Qualitative assessment done was scored (Table 3) according to the grading mentioned for different symptoms[6] shown in Table 2.


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Table 1: Clinical examinations related to right leg conducted during course of treatment

Clinical examinationBefore treatmentAfter SadyovirechanaAfter Anuvasana BastiAfter Yapana Basti
SLRTPositive at 40°30°40°Negative
Coin pick testPositivePositivePositiveNegative
FABER’s testPositivePositiveNegativeNegative

1(a) SLRT- straight leg raising test; 1(b) FABER- Flexion, Abduction and External Rotation

Table 2: Grading of symptoms

Visual analogue scaleNo Pain (0)0
Mild (1-3)1
Moderate (4-6)2
Severe (7-10)3
Low backacheNo Pain0
Mild pain with no difficulty in walking1
Moderate pain with slight difficulty in walking2
Severe pain with severe difficulty in walking3
StiffnessNo Stiffness0
Stiffness of mild grade, need no intervention1
Stiffness relieved by topical medicaments2
Stiffness not relieved by topical medicaments3
Difficulty in walkingNo pain, normal movements0
Mild pain with normal gait1
Moderate pain with limping gait2
Severe pain with limping gait3
Complete restriction of movements4
Burning sensation in footNo burning sensation, no Sparsha Asahishnuta, no need of intervention0
Mild grade burning sensation, no Sparsha Asahishnuta, no need of intervention1
Moderate grade of burning sensation, no Sparsha Asahishnuta, needs intervention2
Severe burning sensation, Sparsha Asahishnuta, subsides with topical medicaments3
Most severe burning sensation, Sparsha Asahishnuta of air, not subsided by topical medicaments4

Table 3: Changes observed in different symptoms during treatment

FeaturesBefore treatmentAfter SadyovirechanaAfter AnuvasanaBastiAfter Yapana Basti
Visual analogue scale3320
Low backache3321
Stiffness2321
Difficulty in walking3430
Burning sensation2430
Overall1317122

Investigations

Blood investigation done on 5/4/2023: Serum calcium value noted 8.6 mg/L (Figure 1). This can be interpreted border line serum calcium level which indicates the initiation of Calcium depletion in body or poor nourishment of body. Serum titre of CRP test was noted as 1.74mg /dl (Figure 2) which shows negative remark for CRP analysis. Blood routine investigation findings were within normal range (Figure 3). Patient had MRI- Lumbar spine recently dated on 30/5/2023 (Figure 4).

Figure 1: Serum calcium report indicating border line values
jaims_3521_01.JPG

Figure 2: CRP test report
jaims_3521_02.JPG


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Figure 3: Blood routine report exhibiting normal values
jaims_3521_03.JPG

Figure 4: MRI-LS report indicating degenerative changes at L5-S1 level resulting in L5 nerve root compression on right side.
jaims_3521_04.JPG

Time line

The timeline for the case is shown in Figure 5.

Figure 5: Timeline chart describing the history of illness and treatment received
jaims_3521_05.JPG

Diagnostic assessments

Dosha predominance in the clinical condition was ascertained where Svatantra Laxana of Vata and Pitta Dosha were exhibited by the patient. Its retrospective analysis was done by eliciting Svatantra Nidana of Vata and Pitta in her lifestyle through history taking. Hence the Dosha Avastha was decided as Vata-Pitta Samsrushta Avastha. Limping gait with reduced walking speed elicited in clinical findings along with SLRT positive in right leg was comparable with classical reference of Laxana of Grudhrasi i.e. Grudhravat Gati and Dhruta Vilambita Gati respectively.[7] The degenerative changes noted from MRI report are also suggestive of Dhatu Kshaya that causes Vata Prakopa.[8] Hence the Ayurveda diagnosis of Vyadhi is suggestive of Vata-Pitta Samsrushta Grudrasi. Another classical diagnosis Vata Rakta was considered for diagnosis of the condition because of having more common clinical features. Differential diagnosis was done as the Svatantra Nidana for Rakta Dushti was not elicited in patient but is the major criteria to diagnose Vata Rakta.[9]

Therapeutic interventions

It is mentioned in Table 4. Total 12 days of treatment was given in IP admission which included Sadyo Virechana and Yapana Basti treatment.


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Drugs and dose of Basti medicines are mentioned in Table 5. Qualitative assessment of the patient condition was done and score was noted. Mahatiktaka Ghruta external application to foot was advised SOS and no internal medications were prescribed during IP admission. Table 6 describes the plan of Yapana Basti.

Table 4: Therapeutic intervention

DurationProcedures and medicines DoseObservations
July,03,2023- -
July, 04, 2023Sarvanga Abhyanga (~oil massage) with Mahavishagarbha Taila[10], Nadi Sweda (Sudation), Sadyovirechana (~instant purgation) with Avipattikara Churna 40g+ honeyCondition exacerbated leading to general weakness after total 16 Vega.
July, 05, 2023Samsarjana Krama with Peya (~porridge) for 1 Annakala (~food time) and Mudga Yusha (~horse gram soup) for next two AnnakalaGeneral weakness increased, Uneasiness
July, 06, 2023Sarvanga Abhyanga, Sarvanga Pariseka (~ medicated water sprinkling over) with Dhanyamla + Dashamula Kwatha, Kati Basti with Mahavishagarbha Taila, Anuvasana Basti with Panchatiktaka Guggulu Ghruta[11] 45ml+ Sahacharadi Taila[12] 45mlBasti retained for 90 minutes. SLR-positive at 40degree in right leg.
July, 07, 2023- July, 14, 2023Kati Basti, Sarvanga Abhyanga, Sarvanga Pariseka, Yapana Basti (one administered before food[13] and other administered after food[14])Burning sensation and pain reduced after complete treatment

Table 5: Ingredients of Yapana Basti

Administered morning in empty stomach
Madhu (honey)50ml
Saindhava (rock salt)10g
Gudapaka (jiggery syrup)50ml
Panchatiktaka Guggulu Ghruta60ml
Sahacharadi Taila60ml
Balamula Churna (powder of Sida cordifolia)10g,
Kapikacchu Churna (Mucuna prurita)5g
Yashtimadhu Churna (Glycerrhiza glabra)5g
Ksheera (Cow milk)200ml
Administered after food
Madhu (Honey)50g
Saindhava (rock salt)6g
Panchatiktaka Guggulu Ghruta50g
Shatapushpa Kalka (powder of Anethum sowa)12g
Ksheera (cow milk)50g

Table 6: Plan of Yapana Basti

DayDose (ml)Time of administrationRetention periodObservationsComplications if any
14209.16 am1minNausea, pt. is hesitant towards procedure, significant reduction in burning sensation, two bowel evacuationNone
1502.20 pm1 minSingle bowel evacuation, good sleep, SLRT-positive at 60 degree
24209.02 am1minA bowel evacuation, lightness of body present, mild relief in low backache
1201.37 pm6 minA bowel evacuation, lightness of body present, burning sensation reduced by 60%, referred pain in calf increased, Appetite reduced and disturbed sleep.
34009.50 am7minPt. became comfortable with procedure, feeling lightness of body, mild relief in calf pain
1202.35 pm30 minOnly medicine evacuated, after 2 hours bowel passed, Sheeta Kamita (desire of having cold item) noted.
43509.30 am5 minReferred pain and stiffness reduced
1201.50 pm20 minTwo bowel movements, pain in right foot, occasional burning sensation, sleeplessness
53509.01 am6 minSingle bowel evacuation, lightness of body, mild reduction in foot pain
1202.04 pm8 min
63509.00 am7 minTwo bowel evacuations, considerable relief in stiffness, walking speed improved and no limping gait.
1203.00 pm7 minMild stiffness in right toe
73509.30 am5 minPain and stiffness in right toe reduced by 40 %, no burning sensation
1202.40 pm7 minPain in foot reduced by 60%

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Medicine on discharge

Panchatiktaka Guggulu Ghrita 5ml once in empty stomach with warm milk at 7am, Rasnaerandadi Kashaya[15] 10ml with warm water after food at 9am and 8pm, Gokshuradi Guggulu[16] and Ossigen capsules each 2 tablets after food at 10am and 9pm, Anuloma tablet 1hs 2hours after dinner and Vishagarbha Taila for external application SOS advised along with Pathya. Follow up visit is advised after 1 month.

Follow-up and outcomes

First follow up assessment was conducted on August 10, 2023. The sufficient gap provided was to nourish Dhatu, resolve the remaining symptoms and to arrest the progression of symptoms. During the assessment, grading of features was done and total score was noted as 1 due to low backache during long duration of sitting. Next follow up assessment was done after 2 months of first follow up assessment i.e., on 9th October 2023. Within two month gap patient had no fresh complaints and quality of life was considerably improved. Patient totally gained 5kg weight within 3 months.

Discussion

The case of Vata-Pitta Samsrushta Grudrasi diagnosed by considering the Ayurveda principle of Trividha Bodhya Samgraha[2] and Chikitsa planned by considering the principle of Sthanivat Chikitsa[4] proved successful. The quick relief in the burning sensation of foot after administration of “Yapana Basti” proved the clinical effectiveness of Basti as Ardha Chikitsa. Textual references mention that Basti is the ultimate line of treatment for Vata Prashamana.[17] In present study, the clinical applicability of principle of Basti as Ardha Chikitsa is appreciated because the drugs and formulations used for Basti administration are selected by considering the Dosha, Dushya, Ashaya, Rogamarga and other constituents of Vyadhi Samprapti. The multidimensional action of Basti line of medicine administration is due to the nature of Vata which gets involved in the initiation of Dosha-Dushya Sammurchana of every disease. It is due to its role in the Samyoga and Vibhaga. When Vyadhi is Pakvashaya Samuttha and involves Vata Dosha as Pradhana Dosha either alone or Samsrushta with other Dosha, Basti is the only line of treatment.[5]

Hence the precise diagnosis of the disease done in present case study through eliciting Sthanika Dosha and Agantu Dosha provided guideline to design treatment protocol. The initial treatment plan involved Virechana to get the effect of Vatanulomana and Pitta Rechana was failed to yield expected results because of not eliciting Sthani Dosha and Agantu Dosha. Instead of relief it exacerbated the condition of patient even though Virechana is the best to treat Pitta Dosha. The retrospection of case history helped to elicit Vata as Sthanika Dosha and Pitta as Agantu Dosha. Then treatment was modified by incorporating the principle of Sthanivat Chikitsa[4] eventually including Basti Chikitsa in the protocol.

Yapana Basti were selected from the text with specifications to Phalashruti to rectify the Vikruta Gati of Vata and to counteract the condition of Dhatu Kshaya.[18] Yapana Basti selected to administer in empty stomach is indicated in Vruddha[11] to do Vikruta Dosha Nirharana and Yapana Basti administered after food addressed the condition of Vata-Pitta Samsrushta Doshavastha.[12] Hence Dhatu Kshaya due to Sthavira and Vata Prakopa controlled through Brumhana Karma. The control over Vikruta Vata automatically helped to suppress the excessive Pitta Laxana which were due to Yogavahi Guna of Vata.[19] It provided immediate relief to patient by reducing Daha in her right foot and other complaints. The Rasayana effect of Yapana Basti helped her to cope up her strength eventually enhancing her quality of life.[20]

The ultimate success of treatment is due to the Yukti of Vaidya where he plans treatment by considering Matra, Kala, Dosha, Desha, Prakruti, Satmya, Satva and other factors.[21] Hence the integrated approach of fundamental principles in management of Vata-Pitta Samsrushta Grudrasi through Basti proved speedy recovery of disease condition through Ayurveda management. Its clinical reliability can be more appreciated through studies involving case series which finds scope for further researches.

Conclusion

Basti acts as Ardha Chikitsa in every disease condition when appropriate drugs and formulations are selected based on the Dosha, Dushya and other factors involved in Vyadhi Samprapti.


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Vata Dosha being the Anubandhya Dosha along with any other Dosha should be managed through Basti Chikitsa when Samutthana is Pakvashaya. It signified the role of Sthanivat Chikitsa principle in clinical effectiveness of Basti as Ardha Chikitsa. Hence the fundamental principles of Ayurveda are mutually cohesive and their integrated approach leads to clinical success. In reciprocation, the studies of clinical successful cases enhance the knowledge of fundamental principles and their clinical utility.

Conflict of interest

All the authors declare that there is no known conflict of interest in publishing the case report and the informed consent for the treatment and publication of the case report was obtained by the patient and submitted to the editors.

Patient’s perspective

In July month of 2023 I visited the physician with severe burning sensation in right foot, low backache associated with other complaints. I was in humble condition as it got progressed in spite of continuous medications. I was suggested to undergo Spine surgery to get relief from my complaints.

But I and my family were not willing to undergo surgery and enquired for the better options in Ayurveda system of medicine. Then my local doctor recommended me to visit this Physician and he gave surety of improvement. With hope and optimistic thoughts, I visited the Ayurveda Physician after travelling 12 hours journey.

Ayurveda physician counseled me about medical history and time duration. I confirmed the better quality of life with 0 side effects after consuming medicines. I got irritated after receiving purgation therapy as my complaints increased. But physician and her team managed to console and continue the treatment. Initially I was hesitant to receive the enema therapy.

But I was very comfortable after experiencing immediate relief provided by enema therapy. Gradually I could feel the improvements in my behaviors and my ability to conduct routine activities. During my discharge I could walk without any pain and burning sensation. During my further follow-up visits I was very happy and more comfortable than previous to illness.

Declaration of patient consent

Authors certify that they have obtained patient consent form where the patient has given her consent for reporting the case along with the images and other clinical information in the journal. The patient understands that her name and initials will be made to conceal her identity, but anonymity cannot be guaranteed.

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