Introduction

Ulcerative Colitis (UC) is a chronic, idiopathic form of inflammatory bowel disease (IBD), characterized by an immune-mediated inflammation of the intestinal mucosa. It typically follows a relapsing and remitting course. While the exact cause remains unknown, UC is known to be confined to the mucosal and submucosal layers of the colonic wall, with the rectum being the most commonly and initially affected site. In over half of the cases, the disease extends to involve the entire colon.^[1] During severe episodes, the colonic mucosa becomes hemorrhagic, edematous, and ulcerated, leading to significant clinical symptoms.

In Ayurvedic classics, the condition can be correlated with several disorders, primarily Grahani Roga. According to Ayurveda, Grahani is considered the principal seat of Agni (digestive fire) and is responsible for the digestion, absorption, and assimilation of food.^[2] Grahani retains undigested food and only allows digested material to pass through the intestines. Any disturbance in Agni leads to improper digestion, resulting in Grahani Roga.

Acharya Vagbhata describes a subtype, Pitta-Kapha Grahani,^[3] which presents with symptoms closely resembling those of UC - such as recurrent passage of undigested food, alternating constipation and loose stools, sour belching, anorexia, abdominal discomfort, and weakness. Similarly, Madhavakara describes Sangrahani, which also shares comparable features. The main symptoms of UC- anorectal bleeding, watery discharge, abdominal pain, tenesmus, mucous in stools, malaise, and frequent bowel movements - can be found in these conditions.^[4] From an Ayurvedic pathophysiological perspective, UC can also be related to Purishavaha Srotas disorders, including Pravahika, Pittaja Atisara, and Raktaja Atisara, all of which present with blood in stool as a key symptom. Additionally, Arogya Kalpadruma mentions Jathara Vrana, which exhibits similar symptoms and could further help in differential diagnosis.^[5] UC is a long-standing condition that imposes a significant health burden and poses major challenges for medical professionals due to its high morbidity and potential complications.^[6] While modern medicine offers symptomatic relief, it often relies on steroids and, in severe cases, surgical intervention - both of which carry long-term risks.

(7-8/day), mixed with blood and mucuos. Also had loss of appetite and marked weight loss during the period. He was not able to take proper treatment due to his work pressure. 6 months back, the condition aggravated, had severe abdominal pain with vomiting and burning sensation and increased frequency of bowel movements. Had allopathic medications for 3 months got only mild symptomatic relief, so came to our OPD for further treatment.

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 non vegetarian diet with irregular food habits, skipping meals, frequently eating salty, spice, bitter oily food.

General physical examination

No pallor, Icterus, Oedema, clubbing was present.

• Temperature - 37°C
• Pulse rate - 72/min
• Respiratory rate - 16/min
• Blood pressure - 120/80mmHg
• Weight - 50 kg, lean and thin

Criteria for inclusion

• Signs and symptoms of ulcerative colitis
• Colonoscopic diagnosis of ulcerative colitis

Criteria for exclusion

• Patient who had undergone surgeries
• Patient who had complications like anal fistula.

Plan of study and treatments

• Proforma compiled with detailed clinical history and physical examination of the patients.
• Routine clinical investigations before performing study.
• After confirming the diagnosis patient was subjected to Piccha Basti therapy and advised as follow:
• Patient was advised to take Pitta Shamaka, Laghu, Grahi and Pathya Ahara.
• Patient was also advised to follow treatment guideline strictly.

Criteria for assessment

13. Mootravaha Srotas - NAD

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

15. Swedavaha Srotas - NAD

Objective parameters: Hb%, Faecal cal protectin before treatment and after treatment

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

1. Bowel Frequency

2. Weakness

3. Abdominal Pain

4. Blood In Stool

Treatment plan

Piccha Basti

1. Poorva Karma: Sarwang Snehana Swedena with Dhanwantaram Tailam and Mrudu Bhashpa Swedana.

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

Pichha Basti and Anuvasana Basti was given alternative to the patient, Anuvasana Basti was given after food (Ardrapaani) while Pichha Basti was given little empty stomach to the patient.

Pichha Basti and Anuvasana Basti was given on alternative days to the patient, Anuvasana Basti was given after food (Ardrapaani) while Pichha Basti was given on little empty stomach to the patient.

Pichha Basti and Anuvasana Basti Schedule

Sign and symptoms before treatment and after treatment

Laboratory results before treatment and after treatment

Results of colonoscopy before treatment

1. Ascending colon - normal

2. Transverse colon - normal

is considered a major gastrointestinal disorder in Ayurveda and is frequently encountered in clinical practice. It significantly disrupts the daily routine and overall well-being of affected individuals. In modern medicine, drugs such as sulfasalazine, aminosalicylates, corticosteroids, and anti-TNF agents may offer temporary or mild relief during the active phase of the disease⁹. However, over time, these treatments often require increased dosages and may lead to drug resistance, dependency, and a range of side effects. Moreover, a definitive medical cure for this condition is currently lacking, prompting patients to seek alternative therapies that offer more effective and safer outcomes.

Ayurveda presents a holistic approach to managing such chronic disorders. Among various Basti Karmas (therapeutic enemas) described in the classical texts, Pichha Basti is specifically noted for its effectiveness in conditions involving inflammation and ulceration of the gastrointestinal tract, such as ulcerative colitis.

Investigations and clinical experiences suggest that Pichha Basti provides significant symptomatic relief, particularly due to its inherent properties:^[10]

• Sheetala (cooling)
• Pittahara (pacifying Pitta)
• Madhu (antiseptic, soothing)
• Sangrahi (absorbent, stool-binding)
• Sandhana (healing, tissue-repairing)

Named after its “Pichhila” property (meaning sticky or lubricating in nature), Pichha Basti creates a protective layer over the intestinal mucosa, reducing friction and irritation, thereby promoting mucosal healing and comfort.

In the management of ulcerative colitis, a Vata-Pitta based treatment strategy should be employed, complemented with Vrana Ropana (ulcer healing) medications.^[11] The herbs and compounds used in Pichha Basti exhibit a multi-dimensional therapeutic effect, including:

• Vata-Pitta Shamaka (pacifying Vata and Pitta)
• Rakta Stambhana (arresting bleeding)
• Vrana Shodhana (cleansing of ulcers)
• Vrana Ropana (healing of ulcers)
• Furthermore, it enhances the function of Apana Vayu