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INTRODUCTION

In the present scientific era, people are fed up with the side effects and after effects of the most effective and fast acting modern drugs, which are lowering the human immunity at the same time when they are suppressing diseases. The use of naturally available substances to relieve the ailment by men as well as animals is as old as beginning of life.

Ayurveda is an age old science of health which gives emphasis on the health than to cure disease. So, now a day’s people are coming back to the nature from synthetics, hence, the Ayurveda will be the future medicinal science of the world, not only in India.

Vata, among one of the tripod of human living being is said to be superior most in all aspects; for every action or movement, strongest in its ability to produce diseases and worst mortality. Diseases related to Vata are innumerable and presentation of it is in the whole body. Even though a large number of symptoms suggest the abnormality of Vata, the cardinal symptom of vitiation of this Dosha is pain and stiffness which is known as Shula and Graha in Sanskrit.

Prushta Trika Kati graha is one such condition caused by vitiated vayu characterized by pain in the trik prushta and kati pradesha. Even though it is not mentioned as a separate disease in Bruhatrayees, ample references are found in other texts like Gada Nigraha by Acharya Shodhala and Sharangadhara Samhita. Sharangadhara has included it under the vataja nanatmaja vyadhis marking its importance.

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Trika prushta kati graha is defines as Vataja naanaatmaja vyadhi, in this grabbing pain along with stiffness is predominant symptom. Due to nidaana sevana vitiated Vata dosha makes sthaana sanshraya in Trika prushta kati bhaga and produces Trika prushta kati graha. It can be compared with Low back pain and stiffness in Contemporary system of medicine.

In a normal daily life, living without ambulation is almost impossible for any human being, from the time immemorial to ultramodern life. The quote

‘A man is as strong as his back’

clearly indicates the importance of back and of course it is the most neglected part in the bod y. The most common disorder, which affects the movement of leg particularly in most productive period of life, is low back pain. The low back, or lumbar area, serves a number of important functions for the human body. These functions include structural support, movement, and protection of certain body tissues. When we stand, the lower back is functioning to support the weight of the upper body. When we bend, extend or rotate at the waist, the lower back is involved in the movement. Therefore, injury to the structures important for weight bearing, such as the bony spine, muscles, tendons, and ligaments, often can be detected when the body is standing erect or used in various movements. Protecting the soft tissues of the nervous system and spinal cord as well as nearby organs of the pelvis and abdomen is also a critical function of the lumbar spine and its adjacent muscles.

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As the medical science recognized the severity, a medicament that relieves the pain, improves the functional ability, restore from functional disability and controls the condition with cost effectiveness is the need of the century.

Everybody experiences backache or back pain and stiffness at some point of time in life and it assumes significance to look into this phenomenon in this age given the change in lifestyle and the increase in deskbound jobs that expect one’s back to be straight and sturdy.

In Ayurvedic classics, description regarding Trika prushta kati graha is very less; these are mentioned in Vataja nanatmaja vyadhis. But symptoms are not mentioned clearly. First time in Bvavaprakasha, Trika prushta kati graha is explained in detail and its specific treatment is also mentioned.

Lacunas in current knowledge:-

Everybody experiences backache or back pain some time in life and it assumes significance to look into this phenomenon in this age given the change in lifestyle and the increase in deskbound jobs that expect one’s back to be straight and sturdy. The spinal cord that actually aches in a backache is an essential and vital bone of the body also known as the life bone and is a composition of muscles, bones and elastic tissue. The spine at the centre of the back is made of 24 block bones, piled one above the other. The spine holds the body upright and ensures mobility of the body. Inter -vertebral discs cushion in between the bony blocks to keep the bones from rubbing each other. Inter- vertebral discs facilitate movement and act as shock absorbers for the back. Different types of backache1 are the common ailments of human body, which if not given its due

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share of attention and concern can create disorder in the most intense manner to the body. The back that keeps the body steady and helps mobility can cause immense difficulty in continuing with routine tasks if not taken care of. Back pain, discomfort and inability to carry routine tasks are common hindrances brought about by a backache. In ayurvedic classics, description regarding Prishtatrikhati graha is very less; Trika graha is mentioned in Vataja nanatmaja vyadhi but symptoms are not mentioned clearly. First time in Vangasen Kati graha is explained instead of katishool in Vataja nanatmaja vyadhi as shoola is the main symptom, and its specific treatment is also mentioned.

Need for the study

Every person in the world likes to live healthy with working. Work is necessary and it is part & partial of the life. Without work no one can achieve anything in the life. To lead good life & to full fill the requirements of the life & to earn livelihood work is the main source.

The area Trika prushta and kati (low back) plays an important role in the movement, without movement one cannot be able to do work. Trika prushta and kati graha (low back pain and stiffness) affects the productivity of the person. It makes a bad effect on Economy as well. Developing countries like India, which is mainly depending on man power other than machines and technology, affects economy of India and up to some extent become as a Global burden.

Low back pain2 and stiffness has prevalence of about 60 to 80 percent of World population. In Modern medicine treatment of low back pain and stiffness includes conservative treatment like exercise, physiotherapy, rest Analgesics & muscle relaxants

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for temporary relief of pain and stiffness. But these medicines just provide temporary relief and serious side effects. Hence, Ayurveda chikitsa, which is basti can give permanent relief from the pain and stiffness as well hault’s the disease progress in Trika prushta kati graha. But in samhita various types of basti and kalpas are mentioned for trik prushta kati graha treatment. As well as compared to easy modern medicine, basti treatment is tedious and time consuming. Basti itself encompasses various types and regimens ranging from days to months. Hence keeping peace with the hectic modern world which treatment is most effective in shortest duration of time in trik prushta kati garah, is important to evaluate.

Hence I think there is the need to evaluate efficacy of various types of basti from fastest efficacy point of view. Hence hereby I have made a small attempt to evaluate efficacy of matra basti and yoga basti in trik prushta kati graha.

Therefore I hope this dissertation will be useful as a guideline for further study.

Research point:

In different universities, considerable research works were done on Trikagraha, katigraha etc (Low back pain) with basti, swedana, and virechana. All these researches reveal that by doing the shodhana procedures there will be considerable decrease in severity of shoola and stiffness in trika bhaga, but the shoola may persist after some time.

By keeping the above consideration and pathogenesis of Trika graha and katigraha (Low back pain), there is need to give comfort and to lead life without pain to

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the patients, it is needed to evaluate a procedure to alleviate the doshic predominance mainly vata, main focus is to reduce pain in Trika graha and kati graha and also to evaluate the effect of yoga basti and matra basti with pipalyadi taila and erundmooladi niruh is the research point.

Hypothesis:-

∑Trikprushtakatigraha is Vataja nanatmaja vyadhi hence by giving basti it does alleviate vata dosha as well as does bruhana.

∑It is mentioned in Ashtanga hridaya sutrasthana 13 chapter that basti is one among the vatopakrama.

∑In the present study, using Pipalyadi taila for basti which is snigdha and mrudu. and Mahavatavyadhinashaka,

∑Vatanashak herbs are the main ingredients in the pipalyadi taila, at the same time mentioned in the Ashtang Hridaya Chikitsasthana Chapter 8, Arshachikitsa as trikprushtakati graha nashak.

Research is mainly focused on bringing comfort to the patient by reducing the shoola or pain and stiffness is the research point.

Hence the present work titled as the “A COMPARATIVE STUDY OF YOGA BASTI AND MATRA BASTI ON TRIK-KATI-PRUSTHA GRAHA” is under taken.

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OBJECTIVES

ÿAim :-

∑To study the efficacy of matra basti and yoga basti in trik prushta kati graha with reference to piplayadi taila.

ÿObjectives :-

∑To collect all the scattered references of “Trik prushta kati grah” from Brihattrayees and Laghuttrayees.

∑To compile & study modern medicine with respect to low back pain and stiffness.

∑To do experimental study by collecting data of volunteers to assess their symptoms of grabbing pain and change is range of motion at hip joint before and after treatment.

∑To compare the efficacy of matra basti and yoga basti with respect to which is better amongst to reduce symptoms of grabbing pain and improving range of motion at hip joint.

Backache, one of the most common ailments, is widely prevalent these days due to sedentary living habits and hazardous work patterns. The psychological conditions associated with emotional stress, which bring about spasm of the muscles, may also cause back ache. As the back bears the weight of the entire body it gives way when it has to

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carry an extra load in the case of persons who are overweight. The backbone forms a protective arch over the vertebrae and spinal cord and protects the spinal nerves that are interwoven through the spinal column. There is a close relationship between the bones, discs, joint muscles and nerves in the back and the slightest problem or injury to the back or neck area can have disastrous effects.

Poor posture results from soft chairs and coaches, which militate slouching and sitting incorrectly. Shoes with high heels place a tremendous strain on the back and other muscles of the body. Sleeping on too soft mattress, which results in an improper back and neck posture, can cause tension, headaches and pain in the upper and lower back.

Another major cause of back problems and tense muscles is lack of exercise. Modem conveniences have made office work easier. The easy life can lead to obesity, which puts a great strain on the back. When muscles are not exercised and remain weak, the chances of injury to them are increased a lot.

Symptoms of backache are easily noticeable for its regularity and troubling conditions. In most cases of backache, the pain is usually felt either in the middle of the back or lower down. It may spread to both sides of the waist and the hips. With acute pain, the patient is unable to move and is bedridden.

Low back pain (LBP) presents a large challenge to the healthcare system despite improving scientific technology, medical insight, and suggested management strategies.

Almost 60 to 80 percent people experience low back pain at some point in their lives. This pain can vary from mild to severe. It can be short-lived or long-lasting. However it happens, low back pain can make many everyday activities difficult to do. Back pain is different from one person to the next. The pain can have a slow onset or

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come on suddenly. The pain may be intermittent or constant. In most cases, back pain resolves on its own within a few weeks. Back pain leads to high cost for the individual, the work place3 and society, because it is a frequent reason for medical care seeking, with estimated 6-7% of the adult population annually consulting a general practitioner for these complaints. Low back pain affects not only the social and economic position of the individual and his family but also leads to draining of national resource due to work hours lost, resulting into diminished production. Low back pain (or lumbago) is a common non specific4 musculoskeletal disorder affecting 80% of people at some point in their lives. It accounts for more sick leave and disability than any other medical condition.

The aims of treatment of Low back pain are therefore multiple: reduction in signs and symptoms, prevention of disability, prevention of structural damage, and induction of remission.

Pain is the major problem for most patients with RA. Many scores have been developed, including numerical and verbal rating scales, the visual analog scale (VAS), questionnaires, and behavioral observation methods.

VAS is most frequently used because of its sensitivity to change, but the technique is difficult to understand for elderly and illiterate patients. The arthritis impact measurement scales (AIMS) is VAS on a continuous 6-cm line, a categorized scale (Likert scale), or a horizontal numerical scale. It is important to specify the aspect of pain that is being assessed (pain at rest or on activity) and the time interval over which pain is evaluated (e.g. last 24 hours, last week, on movement, at rest, at night). Pain evaluation is also part of several multidimensional health status instruments.

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Global Disease Activity:-

Global disease activity can be evaluated in the same way as VAS, on a continuous line of 10 cm, or in a Likert or numerical scale. This can be performed by the patient and by the physician. It is still debatable whether physician global assessment adds to the patient’s global assessment, but the physician can consider additional aspects or may have insight into the patient’s over- or under-perception of symptoms.

Physical/Functional Disability:-

Disability can be measured by several methods, based on clinical judgment, observed patient performances, or self- administered assessments. The most frequently used self reported questionnaire is Brief pain Inventory and also assessed disability by Movements of lumbar spine, Reflexes, walking time, Gait and spinal root examination.

By considering the above aspects and treatment protocols, in the present study an attempt is made to find suitable remedy for Trikaprushtakati graha, keeping the cardinal symptoms i.e. shoola and graha in prushtakati and trik bhaga, the present study intended and selected the following yogas for basti are Erandmuladi Nurhu and pipalyadi taila.

In this regard the objects proposed in the study are:

1.Evaluate the efficacy of Erandmuladi niruha in trikprushtakatigraha.

2.Evaluate the efficacy of Pipalyadi taila in trikprushtakatigraha.

3.Evaluate the Comparative effect of Erandmuladi niruha basti and Pipalyadi taila basti in trikprushtakati graha.

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Trika prushta kati graha is a shoola pradhana vataja nanatmaja vyadhi and hence by giving basti5 is best treatment as described in Ashtanga Hrudaya sutrasthana.

In the study, both groups are having basti treatment in Trikaprushtakati graha with different yogas.

Eranmuladi niruha6, treatment regimen and pipalyadi taila in yoga basti regimen and only pipalyadi tail7 in matra basti regimen.

Further more, though basti has been described to be the best remedy for vata dosha, it is also effective in the vitiated Kapha and pitta dosha also to some extent. So basti in this way appears to be the best Sodhana measure for Trikaprushtakati graha in modern era caused due to sedentary life style.8

Thus basti10 should be preferable in the Chikitsa of Trika prushtakati graha as also indicated by Acharya Charak.11

RESEARCH ON TRIK GRAHA OR SHOOL:

1.A study on the role of baladi yapana basti in the management of Katishoola by Joshi (Ms) Swati, P.G.Thesis, 1995, Gujarat Ayurveda University, Jamnagar.

2.A comparative study on the role of bhaspasveda and pizichil in the management of Katigraha by Bhosekar R.L, P. G. Thesis, 1996, Gujarat Ayur veda University, Jamnagar.

3.Management of Lumbar inter vertebral disc prolapse with special reference to Erandamooladi Niruham by Jonah. S, P.G. Thesis, 1998, Kerala University, Thiruvananthapuram.

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4.“The evaluation of the effect of Ketakyadi Taila as Kativasti in Katigraha” by Shekhargoud Patil, P.G.Thesis, 2001, P.G. Center, D.G.M. Ayurvedic Medical College, Gadag.

5.A Clinical evaluation of kati basti and Nirgundi Erandadi kashaaya in the management of Katigraha by Sarat babu.K, P.G.Thesis, 2006, P.G. Center, Koppa.

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LITERARY REVIEW

ÿ TRIK PRUSHTA KATI GRAHA

iɧÉÉSÉæ uÉÉiÉÌuÉMüÉUÉlÉlÉÑurÉÉZrÉÉxrÉÉqÉ: | iɱjÉÉ lÉZÉpÉåS¶É, ÌuÉmÉÉÌSMüÉ cÉ, mÉÉSzÉÔsɶÉ, mÉÉSpÉëÇzɶÉ, mÉÉSxÉÑmiÉiÉÉ cÉ, uÉÉiÉZÉÑQÒûiÉÉ cÉ, aÉÑsTüaÉëWû¶É, ÌmÉÎhQûMüÉå²å¹lÉÇ cÉ, aÉ×kÉxÉÏ cÉ, eÉÉlÉÑpÉåS¶É, eÉÉlÉÑÌuÉzsÉåwɶÉ, FÃxiÉqpɶÉ, FÃxÉÉS¶É, mÉÉ…¡ÓûsrÉÇ cÉ, aÉÑSpÉëÇzɶÉ, aÉÑSÉÌiÉï¶É, uÉ×wÉhÉÉåi¤ÉåmɶÉ, zÉå:TüxiÉqpɶÉ, uÉXç¤ÉhÉÉlÉÉWû¶É, ´ÉÉåÍhÉpÉåS¶É, ÌuÉXçpÉåS¶É, ESÉuÉiÉï¶É, ZÉgeÉiuÉÇ cÉ, MÑüoeÉiuÉÇ cÉ, uÉÉqÉlÉiuÉÇ cÉ, ̧ÉMüaÉëWû¶É, mÉ׸aÉëWû¶É, ..........||12

- cÉ. xÉÔ. 20/11

It can be seen from the above shloka that Acharya Charak has indicated trikprushtakati graha as nanatmaja vikara of vata. He has not mentioned this as a disease in itself. References are found as symptoms only like in vrikkaja vidhradhi, arsha etc. but trikprushtakati graha has not been mentioned as full blown disease in itself.

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Acharya Sushrut in his Sushrut samhita focuses on surgical disorders mainly. But in chikitsasthana where diseases related to kayachikitsa are mentioned, there also no reference of trikprushtakati graha can’t be identified.

iÉ§É mÉYuÉÉzÉrÉå ¢ÑükS: zÉÔsÉÉlÉÉWûÉl§ÉMÔüeÉlÉqÉç |

qÉsÉUÉåkÉÉzqÉuÉkqÉÉïzÉïÎx§ÉMümÉ׸MüOûÏaÉëWûqÉç ||13

- A. ™. ÌlÉ 15/7

Other brihattrayees like Vagbhatkar’s, Ashtang Sangraha and Ashtang Hridaya has also not mentioned trikprushtkati graha as a disease in itself. Scattered references of these are found in vrikkaj vidhdradi, arsha, pakvashayagat vata etc.

But in these brihattrayee, references of trikprushtakati stambha is manily found in pakvashaya gata vata, amashyagata vata and sandhi-snayugata vata. But stambha and graha cannot be considered same.

aÉëWû: = [aÉëWèû + AcÉç] - mÉMüQûlÉÉ, aÉëWûhÉç MüUlÉÉ

xiÉqpÉ: = [xiÉqpÉç + AcÉç] - ÎxjÉUiÉÉ, MüQûÉmÉlÉ14

As graha indicates stiffness like grabbing and stambha indicates unable to bend or straightness as can be seen from the definition from Hindi Sanskrit Shabdkosha.

Whereas if laghutrayees are considered then the references found about trikprushtakti graha are as follows-

AzÉÏÌiÉuÉÉïiÉeÉÉ UÉåaÉÉ: MüjrÉliÉå qÉÑÌlÉpÉÉÌwÉiÉÉ |

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AɤÉåmÉMüÉå WûlÉÑxiÉqpÉ: FÃxiÉqpÉ: ÍzÉUÉåaÉëWû: ||

oÉɽÉrÉÉqÉÉåÅliÉUÉrÉÉqÉ: mÉɵÉïzÉÔsÉÇ MüÌOûaÉëWû |

15

- zÉÉ. xÉÇ. mÉÔ. 105

Acharya Sharangdhar in poorvakhanda mentions about katigraha only as one of the disorder of vitiated vata dosha. Here reference about trik graha and prushta graha cannot be found.

AurÉ£Çü sɤÉhÉÇ iÉåwÉÉÇ mÉÔuÉïÃmÉÍqÉÌiÉ xqÉ×iÉqÉç |

AÉiqÉÃmÉliÉÑ rÉSèurÉ£üqÉmÉÉrÉÉå sÉbÉÑiÉÉ mÉÑlÉ: ||

xÉÇMüÉåcÉ: mÉuÉïhÉÉÇ xiÉÇqpÉÉå pÉÇaÉÉåxjlÉÉÇmÉuÉïhÉÉqÉÌmÉ |

sÉÉåqÉWûwÉï: mÉësÉÉmÉ¶É mÉÉÍhÉmÉɵÉïmÉ׸MüÌOûaÉëWûÉ: || 16

- qÉÉ. ÌlÉ. uÉÉiÉurÉÉÍkÉÌlÉSÉlÉ 22/6

Acharya Madhavkar in Madhavnidan, which is considered as best text on diagnosis of diseases also mentions about parshvaprushtakatigraha only as one of the symptom of vitiated vata dosha. Here reference about trik graha is not present. Hence here also trikprushtakati graha has not been given importance as a disease in itself.

AurÉ£Çü sɤÉhÉÇ iÉåwÉÉÇ mÉÔuÉïÃmÉÍqÉÌiÉ xqÉ×iÉqÉç |

AÉiqÉÃmÉliÉÑ rÉSèurÉ£üqÉmÉÉrÉÉå sÉbÉÑiÉÉ mÉÑlÉ: ||

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xÉÇMüÉåcÉ: mÉuÉïhÉÉÇ xiÉÇqpÉÉå pÉÇaÉÉåxjlÉÉÇmÉuÉïhÉÉqÉÌmÉ |

sÉÉåqÉWûwÉï: mÉësÉÉmÉ¶É mÉɵÉïmÉ׸MüÌOûaÉëWûÉ: ||17

- uÉÇaÉxÉålÉ uÉÉiÉurÉÉkrÉÍkÉMüÉU 6

Acharya Vangasen, has also mentioned trikprushtakati graha as a symptom of

vitiated vata dosha similar to Madhavnidan as can be inferred from the above shloka.

uÉÉrÉÑ: MüšÉÍ´ÉiÉ: zÉÑkS: xÉÉqÉÉå uÉÉ eÉlÉrÉåSìÓeÉqÉç |

MüÌOûaÉëWû: xÉ LSÉå£ü: mÉ…¡Óû: xÉÎYjɲrÉÉÍ´ÉiÉ: ||18

- uÉÇaÉxÉålÉ AÉqÉuÉÉiÉUÉåaÉÉÍkÉMüÉU 40

But katigraha as a symptom is also mentioned in Aamavata roga as one of its sympom as can be seen from the above shloka cited from Vangasen samhita.

Hence in totality it can be said that all the acharyas of brihattrayees i.e. Charak, Sushrut and Vagbhatt, reference of trikprushtkati graha are scattered as mainly symptoms of various diseases. But mainly all these have considered them as one of the symptom of vitiated vata dosha.

In case of laghtrayees, Madhavnidan, Sharangdhar, etc have also considered them as symptom of vitiated vata dosha. Only Acharya Vangasen has considered katigraha as a disease and provided it with separate treatment also.

ÿ TRIKPRUSHTAKATI GRAHA CHIKITSA

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Ì¢ürÉÉqÉiÉ: mÉUÇ ÍxÉkSÉÇ uÉÉiÉUÉåaÉÉmÉWûÉÇ ´ÉÑhÉÑ | MåüuÉsÉÇ ÌlÉÃmÉxiÉqpÉqÉÉSÉæ xlÉåWæûÃmÉcÉÉUåiÉ || uÉÉrÉÑÇ xÉÌmÉïuÉïxÉÉiÉæsÉqÉ‹mÉÉlÉælÉïUÇ iÉiÉ: |

xlÉåWûYsÉÉliÉÇ xÉqÉɵÉÉxrÉ mÉrÉÉåÍpÉ: xlÉåWûrÉåiÉç mÉÑlÉ: ||

rÉÔwÉæaÉëÉïqrÉÉqoÉÑeÉÉlÉÔmÉUxÉæuÉÉï xlÉåWûxÉÇrÉÑiÉæ: |

mÉÉrÉxÉæ: M×üzÉUæ: xÉÉqsÉsÉuÉhÉæUlÉÑuÉÉxÉlÉæ: || lÉÉuÉlÉæxiÉmÉïhÉæ¶ÉɳÉæ: xÉÑÎxlÉakÉÇ xuÉåSrÉå¨ÉiÉ: ||19

- cÉ. ÍcÉ. 28/75-77

Since trikprushtakati graha has been considered as vataj nanatmaj vikaar mainly occurring due to vitiated vata dosha affecting low back region, the treatment mentioned is also directed towards alleviation of vata dosha in the body. As it can be seen from the above shloka that Acharya Charak has mentioned in chikitsasthana chapter 28, vatavyadhi chikitsa adhyaya, that if the symptom is only due to vata dosha alone then snehana is enough. But if the symptom is associated with some other dosha then along with snehana, swedana, anuvasna, niruh basti, oily unctuous decoctions and food are indicated.

xuÉprÉ£Çü xlÉåWûxÉÇrÉÑ£æülÉÉïQûÏmÉëxiÉUxɃ¡ûUæ: |

iÉjÉÉÅlrÉæÌuÉïÌuÉkÉæ: xuÉåSærÉïjÉÉrÉÉåaÉqÉÑmÉÉcÉUåiÉ

||

xlÉåWûÉ£Çü ÎxuɳÉqÉ…¡Çû iÉÑ uÉ¢Çü xiÉokÉqÉjÉÉÌmÉ uÉÉ

|

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zÉlÉælÉÉïqÉÌrÉiÉÑÇ zÉYrÉÇ rÉjÉå¹Ç zÉÑwMüSÉÃuÉiÉç || WûwÉïiÉÉåSÃaÉÉrÉÉqÉzÉÉåjÉxiÉqpÉaÉëWûÉSrÉ: |

ÎxuɳÉxrÉÉzÉÑ mÉëzÉÉqrÉÎliÉ qÉÉSïuÉÇ cÉÉåmÉeÉÉrÉiÉå ||20

- cÉ. ÍcÉ. 28/78-80

Acharaya Charak has also mentioned in the same chapter that due to proper snehana and swedana in vatavyadhis, symptoms like graha etc subside easily and effectively which can be inferred from the above shloka.

mÉëÌiÉzrÉÉrÉå cÉ MüÉxÉå cÉ ÌWû‚üɵÉÉxÉåwuÉsÉÉbÉuÉå |

MühÉïqÉlrÉÉÍzÉU:zÉÔsÉL xuÉUpÉåSå aÉsÉaÉëWåû || AÌSïiÉæMüÉ…¡ûxÉuÉÉï…¡ûmɤÉbÉiÉå ÌuÉlÉÉqÉMåü |

MüÉå¸ÉlÉÉWûÌuÉoÉlkÉåwÉÑ qÉÔ§ÉÉbÉÉiÉå ÌuÉeÉ×qpÉMåü

||

mÉɵÉïmÉ׸MüOûÏMÑüͤÉxÉÇaÉëWåû ..... ||21

- cÉ. xÉÔ. 14/20-22

Acharaya Charak has also mentioned in the sutrasthana chapter 14 swedanaadhyaya that parshvaprushtakati graha are swedya vyadhis and effective results are visible due to proper swedana.

xlÉåWûxuÉåSxiÉjÉÉÅprÉ…¡ûÉåÇ oÉÎxiÉ: xlÉåWûÌuÉUåcÉlÉqÉç ||22

- xÉÑ. ÍcÉ. 4/21

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Acharaya Sushrut has also mentioned in the chikitsastana chapter 4 that vatavyadhi samanya chikitsa siddhant is snehana, swedana, abhyanga, basti and snehavirechana.

uÉÉiÉxrÉÉåmÉ¢üqÉ: xlÉåWû: xuÉåS: xÉÇzÉÉåkÉlÉÇ qÉ×SÒ | xuÉɲqsÉsÉuÉhÉÉåwhÉÉÌlÉ ÍpÉerÉÉlrÉprÉ…¡û qÉSïlÉqÉç || uÉå¹lÉÇ §ÉÉxÉlÉÇ xÉåMüÉå qÉ±Ç mÉæ̹MüaÉÉæÌQûMüqÉç | ÎxlÉakÉÉåwhÉÉ oÉxiÉrÉÉå oÉÎxiÉÌlÉrÉqÉ: xÉÑZÉzÉÏsÉiÉÉ || SÏmÉlÉæ: mÉÉcÉlÉæ: ÍxÉkSÉ: xlÉåWûɶÉÉlÉåMürÉÉålÉrÉ: |

ÌuÉzÉåwÉÉlqÉå±ÌmÉÍzÉiÉ-UxÉiÉæsÉÉlÉÑuÉÉxÉlÉqÉç ||23

- A. ™. xÉÔ 13/1-3

Acharaya Vagbhatt in his Ashtang Hridaya also mentions the same line of treatment for vataj vyadhis. In sutrasthana chapter 13, doshopkramaniya adhyaya, Vagbhatt indicates treatments like snehana, swedana, deepana, pachana, abhyanaga, mardana, seka, basti etc.

Thus according to the line of treatment mentioned in various authorative texts in Ayurveda, the same line of treatment was considered during my research.

∑Bhaya snehana with til taila.

∑Swedana with nadi sweda with vataghna dravya (Nirgundi patra)

∑Deepana with Shaddharan choorna.

∑Pachana with Shaddharan choorna.

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∑Later on the final & main treatment in vataj roga i.e basti. (Niruha & Anuvasana)

o Niruha by Erandmooladi

o Anuvasana by Pipalyadi taila.

ÿ BASTI

Historical Aspect of Basti:

History study is important to know about the systemic development and progress of the subject to determine the future plans for further establishment and research designing. History and medicine starts from the very moment when the human being came into existence that’s why the ancient treatises are full with description of disease and their treatment.

The evolution of Basti can be traced from Vedic era e.g. Rigveda and Atharvaveda which is considered as the oldest authentic manuscripts.

Veda:

The Kaushika Sutra of Atharvaveda, Basti is indicated as asubstitute for minor

operation. 24

Purana:

In Agnipurana, Basti is indicated as a principle treatment in complaints marked by predominance of Vata.25

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In Ashwa Chikitsa Kathana, Taila Basti is recommended in horses to relieve their fatigue immediately.It is also stated that according to season different Sneha should beused for Basti.

Yogic Literature:

In Gheranda Samhita, Basti is included in Satkarma.

Two kind of Basti are described there.

1)Jala Basti – To be done in water

2)Sushka Basti – To be done always on land.

Charaka Samhita:

The scattered references regarding Basti are available in various chapters of Charaka Samhita, but in Siddhisthana out of 12chapters, 8 chapters contribute to Basti.

First two chapters of Siddhisthana deals with properties of Basti Samyakayoga, Ayoga Lakshanas, indications and contraindications of Basti. This denotes the importance of Basti in the field of Kayachikitsa.

Sushruta Samhita:

In Sushruta Samhita, four chapters have been devoted completely for the description of the Basti in Chikitsasthana. In these chapters, detailed information regarding Bastinetra, indication,contra-indications, complications, classification of Basti etc. are available.Other numerous references of Basti are also available in this Samhita.

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Ashtanga Sangraha:

19th chapter of Sutrasthana has been devoted toBasti only. In this chapter, classification, indication, contra-indication, dosage, process of administration etc. have been described in detail. Also four chapters of Kalpasthana have been contributed to Basti. In these chapters, description regarding importance of Basti, different types of Basti, Sneha Basti Vyapada etc. are available.

Ashtanga Hridaya:

In this Samhita, 19th chapter of Sutrasthana BastiVidhi and 4th and 5th chapter of Kalpasthana named as Basti Kalpa and Basti Vyapada Siddhi explain the every aspect of Basti.

Kashyapa Samhita:

In Kashyapa Samhita, Basti has been explained in detail in Siddhisthana and Khilasthana.

Bhela Samhita:

In Bhela Samhita, description of Basti is available in fourchapters of Siddhisthana namely Bastimatriya Siddhi, Upakalpa Siddhi, Phalamatra Siddhi and Dosha Vyapadika Basti Siddhi.

Harita Samhita:

In this text, only 3rd chapter of Sutrasthana deals with Basti.

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Chakradatta:

In this text, two chapters named Anuvasanadhikara and Niruhadhikara are dealt with Anuvasana and Niruha Basti respectively.

Vangasena:

In Chikitsa Sarasangraha, Vangasena has devoted “BastiKarmadhikara” chapter for description of Basti.

Sharangadhara Samhita:

Three chapters of Uttarakhanda namely BastiKalpana Vidhi, Niruha Basti Kalpana Vidhi and Uttara Basti Kalpana Vidhi described various aspects of Anuvasana Basti, Niruha Basti and UttaraBasti respectively.

Bhavaprakasha:

In this Grantha, 5th chapter of Purvakhanda has been contributed to description of Basti. Vrana Basti – the type of Basti has been explained in this Grantha.

Kalyanakaraka:

In this text, Basti is described in Vatarogadhikara only.

Todarananda:

In this text, Basti is described in this chapter Basti Vidhi.

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DEFINITION

It is defined in two ways:

One indicates the whole of the Karma mainly for purification. Other definition indicates, just the instrument used for the Karma.

Charaka defined the Basti on the basis of Karma Similar to that of Vamana and Virecana.According to Charaka Basti is the Karma in which, the medicine prepared according to classical references is administered through rectal canal reaches upto the Nabhi Pradesh, Kati, Parswa, Kukshi (i.e. upto small intestine, anatomical land marks on the abdomen) churns the accumulated Dosa and Purisa, spreads the unctuousness (potency of the drugs) all over the body and easily comes out along with the churned Purisa and dosha (impurity) is called Basti. 26

Another definition mainly explains the apparatus used for Basti. Theprocedure in which either basti is used for the administration of the drugs or the drugs administered first reaches to the Basti.

The apparatus used for introducing the medicated materials is made up of Basti or animal urinary bladder.

The procedure in which the medicaments are introduced inside the body through the rectum with the help of animal urinary bladder is termed as Basti. 27

Acharya Charaka has defined the Basti as the procedure in which the drug prepared according to classical reference is administered through rectal canal reaches upto the Nabhi Pradesha, Kati, Parshva, Kukshichurns the accumulated Dosha and Purisha spreads the unctuousness (potency of the drugs) all over the body and easily comes out along with the churned Purisha and Doshas is called Basti.

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According to modern science, enema is the procedure in which any liquid preparation is introduced through rectum by means of adequate instruments (Ghosh) or injection as liquid or gas into the rectum.

ENEMA:

Introduction of solutions into the rectum is known as enemas.

a. Evacuant Enemas:

Evacuant enemas are employed for the purpose of the cleansing of the bowel.It can be given as shop water or saline water enema in luke warm condition. It is usually given in constipated patients.

b. Oil Enemas:

Oil enemas are also evacuant enemas but it should be retained for many hours usually overnight.It is used to soften feaces inconstipated patients. It is also used for soothing action, in excess irritability of the colon and rectum, in colitis and in proctitis.

c. Nutrient Enemas:

It is given to maintain nutrition by rectal feeding when per oralfeeding is impossible. Not more than three nutrient enemas should be given in the 24 hours. A daily cleansing enema is advisable before giving the nutrient enema.

d. Medicated Enema:

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It is given to produce local, as well as systemic effects of the given medicine. It should be given after cleansing the bowel by evacuant enemas.

PROBABLE MODE OF ACTION OF BASTI

Absorption of Basti:

First sodium ion in Saindhava actively absorb from colon. High concentration of sodium ion facilitates sugar influx.Increase sodium ion in mucosal membrane generate osmotic gradient.Water follows this osmotic gradients thus passive absorption of water take place.Free fatty acid is easily absorbed by passive diffusion in the colon.From above description, it can be understood that how Saindhava, Madhu, Snehaand kwatha is absorb from the colon. And along with the Sneha (Lipids) and kwatha lipid and water soluble portion is absorbed from the colon.

According to Modern pharmacokinetics, it is also proved that rectal drugs administration might exceed the oral value due to partial avoidance of hepatic first pass metabolism.28

Imporatance of Basti Dravya:

i)Saindhava:

Saindhava lavana is considered best among all the lavana described in Ayurveda.Saindhava play an important role to intiate the absorbtion of Basti as discussed earlier.

ii)Madhu:

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Main role of Madhu is to increase the retention time of Basti by counteract the irritative property of Saindhava.

The retention time of irritative substance in rectum may be favoured by making solution as nearly isotonic as possible by using colloidal fluid such as starch water as diluent.

iii)Sneha :

By using Sneha the fat soluble portion of the drug easily absorbed from the colon. Lipids and Lipid soluble substance can easily enter the cell. In this, way Sneha helps the basti dravya to reach at cellular level.

iv)Kalka :

It gives required thickness to the Basti. Fresh drug and drug containing volatile property can be utilized in the form of Kalka.

v)Kwatha :

It is use to get water soluble part of Kwatha Dravya. Instead of Kwatha asa Drava Dravya Kshira, Gomutra, Amalkanji, Prasanna, Mamsarasa etc. are also used or for the prepration of Kwatha itself.

vi)Avapa Dravya

They are used some time in order to make the Basti either Tikshna or Mrudu and to affect the particular Dosha.

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Action of Basti Dravya

i) Saindhava:

Because of its

1.Sukshma Guna – It reaches up to the Micro channel of the body.

2.Tikshana Guna – It break down the morbid Mala and DoshaSanghata.

3.Snigdha Guna – Liquefies the Dosha.

4.It reduces the Picchila, Bahula and Kashaya properties of Madhu.

5.It becomes helpful for the elimination of Basti due to its irritant property.

6.In excess quantity, it can cause Daha and Atisara, Absence or less quantity of Saindhava is responsible for Ayoga.29

ii) Madhu :

If any drug is administered with appropriate vehicle it can absorbed and assimilated by the body very quickly.Madhu is made of various substances and considered best among the vehicles.30

It forms the homogeneous mixture with the Saindhava.Madhu has predigested sugar and it is easy to digest and are readily absorbed and assimilated by the body. In this way it energized body in very short period. Acharaya Charka says that Basti Dravya containing excess of Madhu when administered to the person makes him extremely virile.

31Moreover, it is considered as best Kaphahara Dravya.

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iii) Sneha

Sneha Dravyas reduces Vata Dushti, softens bodies’ microchannels, destroy the compact Mala, and removes the obstruction in the channels32

Owing the Snigdha Guna it produces unctuousness in body, intern helps for easy eliminations of Dosha and Mala. Sneha increases the permeability of cell membrane and become helpful in elimination of Dosha and Mala.Because of its Guru –Snigdha Guna it liquefies the Dosha and breakdowns the compact Mala.

Apart form this functions it also protects the mucus membrane from the untoward effect of irritating drugs in the Basti Dryava.

iv) Kalka Kwatha and Avapa Dravya

Kalka and Kwatha Dravya are the main constituents of the Basti Dravya.They serve the function of Utkleshana or Dosha harana or Shamana depending upon it contains and are selected accordingly.

They are selected on the basis of Dosha, Dushya and Srotasa so their main action is Samprapti Vighatana of Roga.

Avapa Dravya is also used for elimination of particular Dosha.

MATRA BASTI

Matra Basti is a type of Sneha Basti described by the Acharya. It is termed so because of the dose of Sneha used in it is very less as compared to the dose of Sneha

Basti.33 34 35

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Definition:

Acharya Vagbhatta has defined the Matra Basti as the Basti in which the dose of Sneha is equal to Hrsva Matra of Snehapana.36

Indication:

According to Acharya Charaka, Matra Basti is always applicable to those emaciated due to overwork, physical exercise, weight lifting, wayfaring, journey on vehicles and indulgence in women in debilitated personas well as in those afflicted with Vata disorders.37

Ashtanga Samgrahakara, emphasized on regular administration of the Matra Basti and it can be administered at all times and in all seasons just as Madhu Tailika Basti.

Table No. 1

Indications of Matra Basti

 

Sr.

Indications

Ch.

A.H.

A.S.

 

 

 

 

 

 

 

 

 

1.

Karma karshita

+

-

-

 

 

 

 

 

 

 

 

 

2.

Bhara karshita

+

+

+

 

 

 

 

 

 

 

 

 

3.

Adhva karshita

+

+

+

 

 

 

 

 

 

 

 

 

4.

Vyayama karshita

+

+

+

 

 

 

 

 

 

 

 

 

5.

Yana karshita

+

-

+

 

 

 

 

 

 

 

 

 

6.

Stri karshita

+

+

+

 

 

 

 

 

 

 

 

 

7.

Durbala

+

+

+

 

 

 

 

 

 

 

 

 

8.

Vatarogi

+

+

+

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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9.

Bala

-

+

+

 

 

 

 

 

10.

Vriddha

-

+

+

 

 

 

 

 

11.

Chintatur

-

+

+

 

 

 

 

 

12.

Stri

-

-

+

 

 

 

 

 

13.

Nripa

-

+

+

 

 

 

 

 

14.

Sukumar

-

-

+

 

 

 

 

 

15.

Alpagni

-

-

+

 

 

 

 

 

16.

Sukhatma

-

+

-

 

 

 

 

 

Contraindication:

In classics, there are no major contraindications mentioned for matraBasti, but Ashtanga Sangrahakara has stated that Matra Basti should not be administered in the persons having Ajirna.

Qualities:

The Matra Basti is promotive of strength without any demand of strict regimen of diet, causes easy elimination of Mala and Mutra. It performs the function of Brimhana and cures Vatavyadhi. It can be administered at all times in all seasons and is harmless. 38

Vagbhatta has mentioned that Matra Basti improves Varna and Bala.

Dose:

According to Vagbhatta, Matra Basti is recommended in the dose equal to the dose of Hrsva Snehapana. The Matra which gets digested in 2Yama i.e. 6 hours is called

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as Hrsva Matra of Snehapana, but the dose required to get digested in 2 Yama is not mentioned.

Acharya Sushruta has given the dose as ½ of the dose of AnuvasanaBasti and according to him the dose of Anuvasana Basti is ½ of the dose of Sneha Basti. In Sneha Basti, the dose given is ¼ of the total dose of NiruhaBasti i.e. 6 Pala (24 Tola). Hence, the does of Matra Basti is 1½ Pala =6 Tola = 72ml. 39

According to Chakrapani, commentary on Charaka the dose of SnehaBasti is 6 Pala, dose of Anuvasana Basti is 3 Pala and of Matra basti is 1½Pala.40

On the basis of above references, it can be said that the dose ofMatra Basti is 1½ Pala of Sneha i.e. 6 Tola = 72ml.

Food before Basti Procedure:

Matra Basti should not be given after the patient has consumed excessively Snigdha Ahara because Sneha taken in double quantity gives rise to Mada and Murccha. Before Matra Basti, the patient should avoid the intake of excessively Ruksha Ahara because it causes depletion of Bala and Varna. Therefore, patients should be given low Sneha diet before Matra Basti.41

Pathya – Apathya:

The Matra Basti does not demand any regimen of diet or behaviour.It can be given at all times and in all seasons without any restriction.However, Ashtanga Samgrahakara has restricted the day sleep after being treated with Matra Basti. 42

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Retention of Matra Basti:

The normal Pratyagamana Kala of Sneha Basti is 3 Yama i.e. 9 hours. Being a type of Sneha Basti, the Pratyagamana Kala of Matra Basti is also 3 Yama i.e. 9 hours. There is no harm if Matra Basti retains in the body because, while describing Anuvasana Basti it has been said that it is not harmful to body even in the event of its being retained in the body for a whole day. Also the dose of Sneha in Matra Basti is very small, which can get easily absorbed in the body without coming out. It is believed that Sneha Basti should be retained in the body. If Basti material returns much earlier, it can not produce the desire effect in the body.43

Samyaka Yoga Lakshana of Matra Basti:

Being a type of Sneha Basti, Samyaka Yoga Lakshana of Sneha Basti are to be taken as Samyaka Yoga Lakshana of Matra Basti. The Lakshana of Samyaka Anuvasana are the return of Sneha with the fecal matter without being stuck up anywhere, the clarity of Rakta, Mamsa etc. Dhatusand sense organs, good sleep, lightness of body, increase of strength and regulation of the excretory urges.

Complication of Sneha Basti:

Though it is said that there is no major complication by the use of Matra Basti but sometimes complication may be produced due to obstruction of Sneha by Vata, Pitta, Kapha or by excess of Mala or food and when given to a person on empty stomach. These are six conditions of complications likely to arise during the use of Sneha Basti. 44

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1) Vata Avrita Sneha:

If in a condition of excess of Vata, Sneha is given in cold condition or in small quantity, it gets Avrita by Vata and will not be able to return as its course is obstructed by Vata. Such Sneha produce Agnimandya, Jwara, Adhmana, Stambha, Urupida, Parshvashula.

Treatment:

In this condition Niruha Basti prepared by Rasna, Pitadaru, Tilvak, Sura, Sauviraka, Kola, Kulattha, Yava, Gomutra, Panchamula should be administered to eliminate the Vatavrita Sneha.

2) Pitta Avrita Sneha:

If excessive Ushna Basti is given in the condition of excess Pitta, it produces Daha, Raga, Trisna, Moha, Tamaka and Jwara.

Treatment:

This condition should be cured with the enema prepared with Madhura and Tikta Dravyas.

3) Kapha Avrita Sneha:

If Mrudu Basti is given in condition of excess Kapha, it causesTandra, Sheeta Jwara, Alasya, Praseka, Aruchi, Gaurva, Murccha and Glani.

Treatment:

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It should be corrected with Basti prepared with Kashaya, Katu, Tikshna and Ushna Dravya and with Sura and Gomutra and mixed with Madana Phala and Amla Dravya.

4) Anna Avrita Sneha:

If Basti prepared with Guru Dravya and given after a heavy meal it gets obstructed by Anna. This Annavrita Sneha, leads to Chhardi, Murccha, Aruchi, Glani, Shula, Nidra, Agnimandya and Ama Lakshanas with Daha.

Treatment:

Such condition is treated by stimulating digestion with decoction and powders of Katu and Lavana Dravyas. Also MruduVirechana and the treatment advised for Ama should be adopted.

5) Purisha Avrita Sneha:

In case of accumulation of Mala, if Basti having Alpa Bala is administered it produces symptoms like Purisha Sanga, Mutra Sanga, VataSanga, Shula Gaurava, Adhmana and Hridaroga.

Treatment:

This condition should be treated with Snehana, Swedana along with Phalavarti. The Anuvasana Basti and Niruha Basti prepared with Shyama, Bilva etc. should be used. Also the treatment indicated in Udavarta should be followed.

6) Abhukta Prani Basti:

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If Basti is given in a person with empty stomach it reaches upwards due to absence of any obstruction. Also if Basti is administered in a person with empty bowel with great force it reaches up very high and from there it may reach the throat and may come out from the upper orifice of the body.

Treatment:

In this condition, Niruha Basti and Anuvasana basti of Sneha prepared with Gomutra, Shyama, Trivritta, Yava, Kola, Kulattha should be given and the condition where it is coming out the throat, it should be treated by Kashaya Dravyas, pressure on the throat and by Virechana and Chhardighna measures.

Anuvasana Basti

Mode of Action of Anuvasana Basti:

The Sneha given in Anuvasana Basti flows in to the channels of the body which have been already cleaned by Niroohana without impedent in the same way as water flows easily in a pipe free of obstruction.45

Effects of Anuvasana Basti:

Anuvasana Basti provides complexion and strength if administered after Asthapana Basti. Raukshya, Laghuta, Shaitya of Vata are suppressed by virtue of Snigdha, Guru, Ushna properties of oil respectively which gives energy, corpulence and freshness of mind. As a tree is irrigated in its root attains big stature and branches with beautiful tender green leaves, flowers and fruits in time, so becomes the man with Anuvasana Basti.46 It has Snehana and Brmhana effect in addition to its Shodhana action.

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NIROOHA BASTI:

'Dosha Nirharnata Nirooha' - which evacuates or eliminates Doshas is Niroohana.47

'Vayah Sthapanat - Ayuh Sthapanat Va Asthapanam'.

Which maintains Vaya or Ayu is Asthapana 48 VayahSthapana here refers to the improvement of the quality of life and prevention of the old age, whereas Ayusthapana refers to the prolongation of the total lifespan of the person.

'Asthapanam Nirooha lti Anarthantaram' i.e. Asthapana and Nirooha are

synonyms.49

Medicaments of this Basti mainly contain decoction. It is called NiruhaBasti because of eradication of morbid humours from the body and promotion of health, prevention of ageing of tissues etc. It has many varieties viz.MadhuTailika Baasti, Yapana Basti, Yuktaratha Basti, Siddha Basti etc.

Mode of action of Nirooha Basti :

When the Basti drugs administered properly in Pakvashaya, the Virya of the drug reaches all over the body through Srotas (channels)in a similar way as water poured in the root of the plant is absorbed from the roots and reaches to entire plant. The Virya acts on the lesion and breaks Dosha Sanghata and brings the Mala to Pakvashaya from the entire body i.e.from head to toe by virtue of its Virya as the sun situated in the sky dries up the water of earth by virtue of its rays50.

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Effects of Niroohana Basti:

Asthapana Basti maintains life, provides strength, Agni, voice, complexion, intellect and enables to body to perform regular functions. It can be given to all age groups i.e. young, adult and old age patients alike and is free from complications and alleviates all disorders by eliminating the Doshas accumulated all over the body. 51 It has mainly Shodhana effect.

METHOD OF ADMINISTRATION OF BASTI

Basti is praised by all the Acharya for its significant results. In order to achieve these results, to its maximum extent care must be taken at all the steps starting from selection of the patient until the completion of the Basti therapy Basti Karma can be classified into three phases viz. Purvakarma, Pradhanakarma and Paschata Karma. They can be explained as follows:

1. Purva Karma:

Selection of the patients:

Befor administration of the Basti physician must examine the patient whether the patient is Basti Yougya and Ayogya.

Asthapana Basti Yogya52 53 54

Sarwanga roga, Ekanga roga, Kuksi roga , Vatasanga, Mutrasanga,Malasanga, Sukrasanga, Balaksaya, Mamsaksaya, Dosa Ksaya, Sukra

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Ksaya,Adhmana, Angasupti, Krmikosta, Udavarata, Suddhatisara, Parswa bheda,Abhitapa, Plihadosa, Gulma, Sula, Hrdroga, Bhagandara, Unmada, Jwara,Bradhna, Sirah-Sula, Karna Sula, Hrdaya Sula, Parswa Sula, Prstha sula, Katisula,Kampa, Aksepa, Anga Gourawa, Atilaghawa, Rajayaksma, Visamagni, Sphigasula, Janusula, Jangha sula, Urusola, Gulpha sula, Parswa sula, Prepada, sula, Yoni sula, Bahu sula, Anguli sula, Stana sula, Nakha sula, Parswa-asthi- sula,Danta sula, Sopha, Stambha, Antra-kujana, Parikartika, Vata Vyadhi Jwara,Timir, Pratisaya, Adhimantha, Ardita, Paksaghata, Asmari, Upadansa, Vata Rakta, Arsa, Stanya Ksya, Manyagraha, Hanugraha, Mudha Garbha,Mutrakrcchra

Asthapana Basti Ayogya:54 56 57

Ajirna, Atisneha, Pitasneha, Utklista Dosas, Alpagni, Yanaklanta,Atidurbala, Ksudharta, Trsnarta, Sramarta, atikrsa, bhuktabhakta, Pitodaka,Vamita, Virikta Krtanasyakatma, Kruddha, Bhita, Matta, murcchita, Chardi, Prasakta, Nisthiwana Prasakta, Swasa Prasakta, Kasa Prasakta, Hikka- prasakta,Baddha Gudodara, Chidrodara, Dakodara, Adhmana, Alasaka, Visuciks,Amadosa, Amatisara, Prameha, Kustha, Arsa, Pandu, Bhrama, Arocaka,Unamada, Sokagrasta, Sthoulya, Kanthasosa, Ksataksina, Garvini, Bala, Vrddha,Gudasotha, Alpavarca, Amaprajata, Sopha,

Examination of patients:

Charka has mentioned that the Basti prepaired and administered after examination of Dosha, Aushadha, Desha, Kala, Satmya, Agnl, Satva, Oka, Vaya

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and Bala, is certainly capable of providing the significant results, the benefits of all the Karma and ultimately success.

After the selection of the patient and the drug, comes the preparation of the patient and the Basti dravya.

Dose Fixation:

In general the quantitiy of each ingradiants mentioned by Sushruta specifically under Dvadasha Prasrtika Basti is as follow.

o Madhu - 2 Prasriti

o Saindhava - 1 Aksha

o Sneha - 3 Prasriti

o Kalka - 1 Prasriti

o Kwatha - 4 Prasriti

o Avapadravya - 2 Prasriti

But physician must consider factor mentioned by Acharya Charaka which are given above, while considering the Matra of the Basti.

Preparation of the patient:

Snehana:

As the Abhyantara Sneha Pana is contraindicated, the Abhyantara Snehanais to be done by administering the Anuvasana Basti, one day prior to Niruha Basti Particularly in those who are fit for Anuvasana Basti. If the patient is having more Ruksata then initially 2-3 Anuvasana Basti can be given and if the patient is not fit for Anuvasana Basti and is

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having much more Snigdhata and mala Sanchayathan Niruha Basti may be directly administered after subjecting the patient for abhyanga & Swedana.

Bahya Snehana is to be performed by Sthanika Abhyanga.

Swedana :

Preferably Sthanika Sveda is advised for Basti.

Preparation of the Basti

It plays significant role in getting the expected results.

Mixing of the ingredients of the Basti Dravya:

First of all the ingredients are to be taken in the required quantity by measuring them. The ingredients should be mixed by triturating in the order of Madhu, Saindhava, Sneha, Kalka, Kwatha and then Avapa Dravya one by one gradually until it becomes a homogeneous mixture. Than it should be churned further to make it more fine and homogeneous and heated in water bath to make it Sukhoshna i.e. nearer to the normal body temperature. 58

Characteristics of a well prepared Basti Dravya:

A well prepared Basti Dravya should not run quickly out of the hand nor should it stick/coat or remain steady on the hand. It should be uniform mixture without separation (Samhata) of its contents. After preparing the Basti Dravya, it is to be filled in the Basti putaka which is clean and devoid of Putaka Dosha then the Bastinetra which is clean and

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devoid of Dosha is to be tied with the Basti Putaka in such a way that air will not be present in the putaka, than a cotton piece is to be kept in the hole of the BastiNetra.

Pradhana Krama

It includes advice to the patient, Basti Pranidana, Basti Pratyagamana and observing the Samyaka yoga, Ayoga and Atiyoga laksana.

Advise to the patient:

Patient is to be asked to pass his natural urges before Basti Pranidana and not to laugh, cough, sneeze and take the yawning while administering Basti.

Basti Pranidana:

Basti is to be administered when the patient is having the symptoms of jirnahara and is not very much hunger. After performing Abhyanaga and BaspaSweda, the patient is asked to lie down in the left lateral position on the Basti table. Table should be cleaned and covered with the bed sheet. Then patient is asked to keep his left hand below the head as a pillow, to extend the left leg completely and to flex the right leg at the knee joint, keeping on the left leg by flexing the hip joint. Then Sukhosna Sneha is to be applied in the anal region andon the Bastinetra, remove the cotton piece and the air bubble if any and keep the thumb on the Netra while introducing it. Then introduce the Bastinetra gradually in the parallel direction to that of the vertebral column up to ¼ part of the Netra until the nearer Karnika fixes over the anus. Then hold the Basti Putaka in the left hand and keep the right hand on the Putaka. After this press it gradually with the constant

45 | P a g e

pressure, neither too fast not to slow without tremoring the hand. By asking the patient to breath in, push the Bastidravya into the rectum till a little quantity remains in the Putaka otherwise Vayu enters into the Pakvasaya, and then withdraw the Netra gradually. Then the patient is asked to lie down in the supine position gradually and Sphikatadana is to be done slowly and softly 3-4times slowly.After this the patient is asked to lie in a comfortable position with a pillow below the hips till he gets the urge for defecation and when he/she gets the urge ask him/her to sit in Utkatasana and pass the urge.

Basti Pratyagamana:

One Muhurta (48 mts) is the maximum period of time with in which the pratyagamana of Basti should occur. If it does not occur then it causes untoward consequences like Vata Pratilomata, Vistabdhata, Shula, Arati, Jvara and even death. 59

Hence if it does not comes out within the stipulated time period certain measures are to be undertaken for the Basti Pratyagamana like administration of the Tikshna Basti, Phalavarti, Swedana over the pelvic region,Utrasana (Showing fear) and administration of Virechana Aushadhi. Until the pratyagaman takes place, the physician should observe the patient. However, Kashyapa opines that Yapana Basti owing to its Mrudu nature, retains for longer time and Tikshna Basti comes out in 100 Matra period, hence Atitikshna Basti should not be administered.

Yoga-Ayoga-Atiyoga Lakshana

Samyaka Yoga Lakshana:

46 | P a g e

Prasrista Vitakata, Prasrista Mutrata, Prasirsta Vata, Kramena – Mala, Pitta, Kapha & Vayu Visarjana, Laghuta, Ruci, Agnidipti, Ashaya Laghuta, Rogopashamana, Prakrtisthitata, Bala Vrddhi. 60

Ayoga Lakshana:

Shiro – Hrit – Guda – Basti – Medhra Vedana, Shotha, Pratishyaya, Parikartika, Hrillasa, Vatasanga, Mutrasanga, Swasakricchrata, Alpa Vega, Alpa Basti Pratyagamana,Alpa Mala – Anil Pratyagamana, Aruchi, Gaurava. In Ayoga, Measures for BastiPratyagamana should be undertaken. 61

Atiyoga Lakshana:

These Lakshanas are similar to that of Virecana Atiyoga. i.e. Angasupti, Angamarda, Klama, Kampa, Nidra, Daurbalya, Tamapravesha, Unmada, Hikka. In Atiyoga, Grahi, Dipana, Pachana Aushadhi are to be administered and according to symptoms it is to be managed.62

Paschat Krama:

If samyaka Nirudhita Lakshana are not observed, than again Basti may be administered preferably after administering an Anuvasana Basti and further 3rd or 4thNiruha Basti may be administered on next day till getting the samyaka

Nirudhita Lakshana.63

Pathya Ahara –Vihara and administration of Anuvasana Basti:

47 | P a g e

After observing the Samyaka Nirudhita Lakshna the patient is advised to take hot water bath and light diet in accordance with the dominance of Dosha. i.e. Yusha, Kshira& Mamsarasa in Kapha, Pitta and Vata dominant conditions respectively or in general,Mamsarasa with rice is to be taken. The hot water bath and food taken prevents the occurance of diseases produced by agitated and moving Mala caused by Basti.

The patient should also be advised for not doing heavy laborious work, daysleep,Sexual intercourse etc. and in the evening Anuvasana Basti is to be administered.

Parihara Vishaya:

Certain things are strictly prohibited, both during the Basti course. Even after the Basti course for a time period twice the time Basti has been given (Parihara Kala)

The things to be avoided are as follows.

Atyasana, Asthanasana, Ativachana, Divasvapana, Yanagamana,

Atapasevana,Shoka, Krodha, Ahitabhojana.

Basti Vyapada:

Vyapada are produced due to the defects in the Bastinetra, Bastiputaka, abnormal position of the patients while administering Basti and improper administration. These Vyapadas can be rectified by taking precautions and proper

48 | P a g e

care. But certain other Vyapada that occurs are of serious nature and which are iatrogenic should be effectively managed. They are as follows.

Ayoga, Atiyoga, Klama, Adhmana, Hikka, Hritprapti, Urdhavaprapti, Pravahika,Siroarti, Angarti, Parikartika and Parisrava.64

ÿ BASTI TREATMENT IMPORTANCE

oÉÎxiÉ ´Éå¸iÉÉ :-

zÉÉZÉÉaÉiÉÉ: MüÉå¸aÉiÉÉ¶É UÉåaÉÉ qÉqÉåïkuÉïxÉuÉÉïuÉrÉuÉÉ…¡ûeÉÉ¶É |

rÉå xÉÎliÉ iÉåwÉÉÇ lÉ ÌWû MüͶÉSlrÉÉå uÉÉrÉÉå: mÉUÇ WåûiÉÑUÎxiÉ ||

ÌuÉhqÉÔ§ÉÌmɨÉÉÌSqÉsÉÉzÉrÉÉlÉÉÇ ÌuɤÉåmÉxɆ¡ûÉiÉMüU: xÉ rÉxqÉÉiÉç |

iÉxrÉÉÌiÉuÉ×kSxrÉ zÉqÉÉrÉ lÉÉlrÉSè oÉÎxiÉÇ ÌuÉlÉÉ pÉåwÉeÉqÉÎxiÉ ÌMüÎgcÉiÉç ||

iÉxqÉÉΊÌMüixÉÉkÉïÍqÉÌiÉ oÉëÑuÉÎliÉ xÉuÉÉïÇ ÍcÉÌMüixÉÉqÉÌmÉ oÉÎxiÉqÉåMåü ||65

- cÉ. ÍxÉ. 1/38-39

Basti is considered the main line of treatment in the research also. And at the same time efficacy of two types of basti has been evaluated through the study. The importance we have given to basti treatment in our study can be found from the above shloka.

49 | P a g e

Acharaya Charak indicates in siddhisthana chapter 1 i.e. bastisiddhi adhyaya the importance of basti chikitsa in vata vyadhis. He indicated that whether the dosha are present in shaka, marma, asthi sandi or koshta gata then also basti is the only treatment which is able to alleviate the vitiated vata dosha from the body.

xlÉåWûxuÉåSxiÉjÉÉÅprÉ…¡ûÉåÇ oÉÎxiÉ: xlÉåWûÌuÉUåcÉlÉqÉç ||66

- xÉÑ. ÍcÉ. 4/21

Acharaya Sushrut has also emphasizes on basti treatment for vitiated vata dosha which can be observed from the above shloka of chikitsasthana chapter 4, vatavyadhi chikitsa adhyaya.

oÉÎxiÉ ´Éå¸ÉiÉÉ :-

xÉuÉÉï…¡ûaÉiÉqÉåMüÉ…¡æûÎxjÉiÉÇ uÉÉÅÌmÉ xÉqÉÏUhÉqÉç

|

ÃhÉÎkS MåüuÉsÉÉå oÉÎxiÉuÉÉïrÉÑuÉåaÉÍqÉuÉÉcÉsÉ: ||67

- xÉÑ. ÍcÉ. 4/20

Acharaya Sushrut dictates that whether the dosha is present in whole body or any part of the body even though basti is powerfull most treatment regimen to alleviate the symptoms of vitiated vata dosha.

uÉÉiÉÉåsoÉhÉåwÉÑ SÉåwÉåwÉÑ uÉÉiÉå uÉÉ oÉÎxiÉËUwrÉiÉå |

EmÉ¢üqÉÉhÉÉÇ xÉuÉåïwÉÉÇ xÉÉåÅaÉëhÉÏÎx§ÉÌuÉkÉxiÉÑ xÉ: ||68

- A. ™. xÉÔ 19/1

50 | P a g e

xlÉåWûzÉÉåkÉlÉrÉÑY¨rÉæuÉÇ oÉÎxiÉMüqÉï ̧ÉSÉåwÉÎeÉiÉç ||69

- A. ™. xÉÔ 19/67

Acharaya Vagbhatt also in Ashtang Hridaya indicates the importance of basti chikitsa in vata vyadhis. He also indicates that whether the disease or symptom is due to vata dosha alone or due to combination of other doshas also then also basti chikitsa is sufficient as complete treatment regimen.

From all the above references it can be concluded that basti treatment is the best possible treatment regimen in vitiated vata dosha. This may be due the cause that vata dosha sthana in the body is pakvashya and basti is also administered in pakvashaya.

But in basti treatment also various types are mentioned hence it is important to understand these types from various Acharyas point of view.

The word Basti is derived from the root 'vas' by adding 'Tich' Pratyaya and it belongs to masculine gender.

oÉÎxiÉ= [uÉxÉç + AcÉç]70

According to Vachaspatyam, meanings of the root 'vas' means to reside, to stay, to

dwell.

Basti is defined in 2 ways –

i.One indicates the whole of the Karma mainly for purification.

ii.Other definition indicates, just the instrument used for the Karma.

51 | P a g e

Charaka defined the Basti on the basis of Karma similar to that of Vamana and Virecana. According to Charaka Basti is the Karma in which, the medicine prepared according to classical references is administered through rectal canal reaches upto the Nabhi Pradesh, Kati, Parswa, Kukshi (i.e. upto small intestine, anatomical land marks on the abdomen) churns the accumulated Dosa and Purisa, spreads the unctuousness (potency of the drugs) all over the body and easily comes out along with the churned Purisa and dosha (impurity) is called Basti.

vCLASSIFICATION OF BASTI:

Basti is the procedure and method of drug administration. So it can be

administered through various routes with the use of different drugs, for different period and for various purposes.

Classification is the thing, which can helpful to understand any subject in a well explorative manner. It helps to highlight each and every aspect of the subject with various angles.

Basti can be classified as follows:

1. On the Basis of Special Purpose with Special Indications:

1.Madhutailika Basti

2.Siddha Basti

3.Yuktaratha Basti

4.Yapana Basti

5.Piccha Basti

52 | P a g e

6.Picchila Basti

7.Vaitrana Basti

2. On the Basis of Chief action:

1.Snehana Basti.

2.Brimhana Basti.

3.Shamana Basti.

4.Lekhana Basti.

5.Shodhana Basti.

6.Sangrahika Basti.

7.Rasayana Basti.

8.Vajikarana Basti.

9.Balavarnakrta Basti.

10.Chakshushya Basti.

11.Dipana Basti.

3. On the Basis of Action on the Dosha and Dushya:

1.Vatahara Basti.

2.Pittahara Basti.

3.Kaphahara Basti.

4.Sonita Dosahara Basti.

5.Dosa Sansargahara Basti.

6.Utklesana Basti.

7.Sodhana Basti.

8.Samana Basti.

53 | P a g e

9. Dosahara Basti.

4. On the Basis of Specific indications:

1.Pramehahara Basti.

2.Visarpahahara Basti.

3.Raktapittahara Basti.

4.Kusthahara Basti.

5.Vataraktahara Basti.

6.Gulmahara Basti.

7.Abhisyndahara Basti.

8.Krmihara Basti.

9.Dahaghna Basti.

10.Mutrakrcchrahara Basti.

11.Parikartikahara Basti.

5. On the basis of Nature of the Basti Dravya:

1.Mridu Basti

2.Madhyama Basti

3.Tikshna Basti

6. On the Basis of Rasa predominance in the Basti Dravya:

1.Madhura Rasa Skandha Dravya Basti.

2.Amla Rasa Skandha Dravya Basti.

3.Lavana Rasa Skandha Dravya Basti.

4.Katu Rasa Skandha Dravya Basti

54 | P a g e

5.Tikta Rasa Skandha Dravya Basti.

6.Kashaya Rasa Skandha Dravya Basti

7. On the Basis of Chief Drug:

1.Kshira Basti.

2.Mamsa Rasa Basti.

3.Gomutra Basti.

4.Rakta Basti.

5.Kshara Basti.

6.Dadhimastu Basti.

7.Amlakamji Basti.

8.Prasannakrita Basti.

9.Surakrita Basti.

10.Asavakrita Basti.

8. According to the Dose of the Basti:

1.Dvadasa Prasrita Basti.

2.Ekadasa Prasrita Basti

3.Nava Prasrita Basti.

4.Asta Prasrita Basti

5.Sapta Prasrita Basti

6.Sada Prasrita Basti.

7.Pancha Prasrita Basti.

8.Chatuh Prasrita Basti.

9. On the Basis of Adhisthana:

55 | P a g e

1.Pakvashayagata Basti

2.Garbhasayagata Basti

3.Mutrasayagata Basti

4.Vrana Basti

A. Pakvashayagata Basti :

According to the type of Dravyas it is further classified in to two sub type

a. Snehaik Basti :

In this type the mainly four types of Sneha in the form medicated

i) Taila, ii) Ghruta, iii) Vasa and iv) Majja

are administered through the Rectal canal into the colon.

This Snehaika Basti is classified into three types according to the dose.

(i) Sneha Basti :

The quantity of Sneha Basti is decided ¼th to the quantity of the Niruha. So, 6 pala (288 ml ) Sneha is administered.

(ii) Anuvasana Basti :

SåWåû ÌlÉÃWåûhÉ ÌuÉzÉÑkSqÉÉaÉåï xÉÇxlÉåWûlÉÇ uÉhÉïoÉsÉmÉëSÇ cÉ |

lÉ iÉæsÉSÉlÉÉiÉç mÉUqÉÎxiÉ ÌMüÎgcÉSè SìèurÉÇ ÌuÉzÉåwÉåhÉ xÉqÉÏUhÉÉiÉåï ||71

- cÉ. ÍxÉ. 1/29

56 | P a g e

Anuvasana term can be used for the Snehaika Basti too. The Sneha Basti which will not cause any harm even if it is retained for one day and can be administered every day after taking food.

The quantity of this basti is half to the Sneha Basti i.e. 3 pala (144 ml).

(iii) Matra Basti :

In this type minimum quantity of Sneha i.e. ½ Pala (72ml) is administered.It can be given without code of conduction.

¾ûxuÉrÉÉ xlÉåWûmÉÉlÉxrÉ qÉɧÉrÉ rÉÉåÎeÉiÉ: xÉqÉ: | qÉɧÉÉoÉÎxiÉ: xqÉ×iÉ: xlÉåWû: zÉÏsÉlÉÏrÉ: xÉSÉ cÉ xÉ: || oÉÉsÉuÉ×kSÉkuÉpÉÉUx§ÉÏurÉÉrÉÉqÉÉxÉ£üÍcÉliÉMæü: | uÉÉiÉpÉalÉÉoÉsÉÉsmÉÉÎalÉlÉÚmÉåµÉUxÉÑZÉÉiqÉÍpÉ: || SÉåwÉblÉÉå ÌlÉwmÉËUWûÉUÉå oÉsrÉ: xÉ×¹qÉsÉ: xÉÑZÉ: |72

- A. ™. xÉÔ 19/68-69

Signs and symptoms of Ati Yoga of Anuvasana Basti according to Brihat Trayi

have been shown in Table - 2.

Table - 2

Atiyoga of Anuvasana Basti

Sr. No.

Signs and Symptoms

Ch. Si.1/45

A.H. Sutra 19/52

 

 

 

 

1.

Ghrana Srava

-

+

 

 

 

 

2.

Guda Srava

-

+

 

 

 

 

3.

Hrllasa

+

-

 

 

 

 

57 | P a g e

4.

Klama

+

-

 

 

 

 

5.

Moha

+

-

 

 

 

 

6.

Moorcha

+

-

 

 

 

 

7.

Mukha Srava

-

+

 

 

 

 

8.

Pandu

-

+

 

 

 

 

9.

Sada

+

-

 

 

 

 

10.

Vikartika

+

-

 

 

 

 

The signs and symptoms of Hina Yoga (inadequate act) of Anuvasana Basti

according to Brihat Trayi have been shown in Table No.-3.

Table – 3

Hina Yoga of Anuvasana Basti

Sr. No.

Signs and Symptoms

Ch. Si.1/45

A.H. Sutra 19/52

 

 

 

 

1.

Agnimandya

-

+

 

 

 

 

2.

Adhahsarira Ruka

+

-

 

 

 

 

3.

Bahu Ruka

+

-

 

 

 

 

4.

Khara Gatrata

+

-

 

 

 

 

5.

Mutragraha

+

-

 

 

 

 

6.

Parshva Ruka

+

-

 

 

 

 

7.

Ruksha Gatrata

+

+

 

 

 

 

8.

Samirana Graha

+

+

 

 

 

 

9.

Udara Ruk

+

-

 

 

 

 

58 | P a g e

10.

Vit Graha

+

-

 

 

 

 

11.

Vit Rukshaand Kathina

-

+

 

 

 

 

The signs and symptoms of Samyaka Yoga (adequate act) of Anuvasana Basti

according to Brihat Trayi have been shown in Table No.4.

Table - 4

Samyak Yoga of Anuvasana Basti

Sr. No.

Signs and

Ch. Si.

Su. Chi. 37/67

A.H. Su.

 

Symptoms

1/44

& 38/14

19/52

 

 

 

 

 

1.

Agnidipti

-

-

+

 

 

 

 

 

2.

Balavriddhi

+

+

-

 

 

 

 

 

3.

Indriya Grahana Shakti Vriddhi

-

+

-

 

 

 

 

 

4.

Indriya Svachhata

+

-

-

 

 

 

 

 

5.

Klama

-

-

+

 

 

 

 

 

6.

Laghuta

+

-

-

 

 

 

 

 

7.

Mala Snighda

-

-

+

 

 

 

 

 

8.

Manah Prasanna

-

+

-

 

 

 

 

 

9.

Nidra Samyak

+

-

-

 

 

 

 

 

10.

Rakta Dhatu Svachhata

+

-

-

 

 

 

 

 

11.

Samya Mala Pravarti

+

-

-

 

 

 

 

 

12.

Sneha passes out with Purish

+

+

-

 

and Vayu without Vedana

 

 

 

 

 

 

 

 

13.

Sneha passes with Purisha

+

-

-

 

 

 

 

 

59 | P a g e

 

without any obstruction

 

 

 

 

 

 

 

 

14.

Sneha Udvega

-

-

+

 

 

 

 

 

15.

Snigdhata

-

+

-

 

 

 

 

 

16.

Vatanulomana

-

-

+

 

 

 

 

 

17.

Vyadhi Shamana

-

+

-

 

 

 

 

 

b. Niruha Basti :

In this type of Basti, Kasaya is the dominant content. The Basti which eliminates the vitiated dosha from the body. Which increases the strength of the body because of its potency is called Niruha Basti.

oÉÎxiÉuÉïrÉ:xjÉÉmÉÌrÉiÉÉ xÉÑZÉÉrÉÑoÉïsÉÉÎalÉqÉåkÉÉxuÉUuÉhÉïM×üŠ |

xÉuÉÉïjÉïMüÉUÏ ÍzÉzÉÑuÉ×kSrÉÔlÉÉÇ ÌlÉUirÉrÉ: xÉuÉïaÉSÉmÉWû¶É ||

ÌuÉOèzsÉåwqÉÌmɨÉÉÌlÉsÉqÉÔ§ÉMüwÉÏï SÉžÉïuÉWû: zÉÑ¢üoÉsÉmÉëS¶É |

ÌuÉwuÉÎYxjÉiÉÇ SÉåwÉcÉrÉÇ ÌlÉUxrÉ ÌuÉMüÉUÉlÉç zÉqÉrÉåͳÉÃWû: ||73

- cÉ. ÍxÉ. 1/27-28

Asthapana Basti :

60 | P a g e

The meaning of this Basti can be understood easily by its name. Stabilizes the Age (Vaya) or Ayu, stabilizes the normal functions of dosa, dhatu and stabilizes deha i.e strength of the body so called Asthapana Basti.

The signs and symptoms of excessive act of Asthapana Basti according to Brihat Trayi have been shown in Table No.5

Table - 5

Atiyoga of Asthapana Basti

 

Sr.

Signs and

Ch. Si.

Su. Chi.

A.H. Su.

 

No.

Symptoms

1/43

38/9

19/49

 

 

 

1.

Angamarda

+

-

-

 

 

 

 

 

 

 

 

2.

Bala Kshaya

+

-

-

 

 

 

 

 

 

 

 

3.

Bhrama

-

+

+

 

 

 

 

 

 

 

 

4.

Chandrikavat

-

+

+

 

 

 

 

 

 

 

 

5.

Guda Bhramsha

-

+

+

 

 

 

 

 

 

 

 

6.

Hikka

+

-

-

 

 

 

 

 

 

 

 

7.

Kapha Kshaya

+

-

-

 

 

 

 

 

 

 

 

8.

Klama

+

-

-

 

 

 

 

 

 

 

 

9.

Krishna Shonita Srava

-

-

+

 

 

 

 

 

 

 

 

10.

Moorcha

-

+

-

 

 

 

 

 

 

 

 

11.

Netra Praveshanam

-

-

+

 

 

 

 

 

 

 

 

12.

Nidraabhava

+

-

-

 

 

 

 

 

 

 

 

13.

Pitta Kshaya

+

-

-

 

 

 

 

 

 

 

 

14.

Rakta Kshaya

+

-

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

61 | P a g e

15.

Supti

+

-

-

 

 

 

 

 

16.

Tamah Pravesha

+

-

-

 

 

 

 

 

17.

Trishna

-

+

+

 

 

 

 

 

18.

Unmada

+

-

-

 

 

 

 

 

19.

Vepana/Kampa

+

-

-

 

 

 

 

 

20.

Vikrita DravahPhenavat

-

-

+

 

 

 

 

 

21.

Virikta Drava Raktavat

-

-

+

 

 

 

 

 

22.

Yatah Kramah Kapha Sravah

-

+

+

 

 

 

 

 

23.

Yatah KramahPitta Sravah

-

-

+

 

 

 

 

 

24.

Yatah Kramah Rakta Sravah

-

-

+

 

 

 

 

 

25.

Yatah Kramah udaka Sravah

-

-

+

 

 

 

 

 

26.

Yatah Kramah Vata Sravah

-

-

+

 

 

 

 

 

27.

Yatah kramah Vit Sravah

-

-

+

 

 

 

 

 

The signs and symptoms of inadequate act of Asthapana Basti according to Brihat

Trayi have been shown in Table No.6.

Table - 6

Hinayoga of Asthapana Basti

Sr.

 

Signs and

Ch.Si.

Su.Chi.

A.H. Su.

No.

 

Symptoms

1/41

38/10 & 38/14

19/49

 

 

 

 

 

 

1.

Alpa Vega

 

-

+

-

 

 

 

 

 

 

2.

Aricjo

 

-

+

+

 

 

 

 

 

 

3.

Ashuddhihrit

 

-

-

+

 

 

 

 

 

 

62 | P a g e

4.

Ashuddha Kukshi

-

-

+

 

 

 

 

 

5.

Basti Ruka

+

-

-

 

 

 

 

 

6.

Guda Ruka

+

-

-

 

 

 

 

 

7.

Hina Anilah

-

+

-

 

 

 

 

 

8.

Hina Malah

-

+

-

 

 

 

 

 

9.

Hrid Ruka

+

-

-

 

 

 

 

 

10.

Hrllasa

+

-

-

 

 

 

 

 

11.

Jadyam

-

+

-

 

 

 

 

 

12.

Kandu

-

-

+

 

 

 

 

 

13.

Linga Ruka

+

-

-

 

 

 

 

 

14.

Maruta Sangah

+

-

+

 

 

 

 

 

15.

Mutra Ruka

-

+

-

 

 

 

 

 

16.

Pinasa

-

-

+

 

 

 

 

 

17.

Peetakah

-

-

+

 

 

 

 

 

18.

Pratishyayah

+

-

-

 

 

 

 

 

19.

Siro Ruka

+

-

-

 

 

 

 

 

20.

Shvasa

+

-

-

 

 

 

 

 

21.

Utklesha Pitta

-

+

+

 

 

 

 

 

22.

Utklesha Shleshma

-

+

+

 

 

 

 

 

23.

Vikartika

+

-

-

 

 

 

 

 

24.

Vidaha

-

+

+

 

 

 

 

 

25.

Vidgraha

-

+

+

 

 

 

 

 

63 | P a g e

The signs and symptoms of adequate act of Asthapana Basti accordingto Brihat

Trayi have been shown in Table No.7

Table - 7

Samyak Yoga of Asthapana Basti

 

Sr.

Signs and

Ch.Si.

Su.Chi.

A.H. Su.

 

No.

Symptoms

1/41

38/10 & 38/14

19/49

 

 

 

 

 

 

 

 

 

1.

Agni Vriddhi

+

-

-

 

 

 

 

 

 

 

 

 

2.

Bala Vriddhi

+

-

-

 

 

 

 

 

 

 

 

 

3.

Bhojane Ruchih

+

-

+

 

 

 

 

 

 

 

 

 

4.

Daha Shamana

-

-

+

 

 

 

 

 

 

 

 

 

5.

Doshotklesha Shamana

-

-

+

 

 

 

 

 

 

 

 

 

6.

Hrid Shuddhi

-

-

+

 

 

 

 

 

 

 

 

 

7.

Indriya Grahana Shakti Vriddhi

-

+

-

 

 

 

 

 

 

 

 

 

8.

Kandu Shamana

-

-

+

 

 

 

 

 

 

 

 

 

9.

Mala, Pitta, Kapha, Vata moves out serially

-

+

-

 

 

 

 

 

 

 

 

 

10.

Manah Prasanna

-

+

-

 

 

 

 

 

 

 

 

 

11.

Nirabadha Gati of mala

+

-

+

 

 

 

 

 

 

 

 

 

12.

Nirabadha Gati of Vata

+

-

+

 

 

 

 

 

 

 

 

 

13.

Pakvashayadi Ashaya Laghuta

+

-

-

 

 

 

 

 

 

 

 

 

14.

Peetakah Shamana

-

-

+

 

 

 

 

 

 

 

 

 

15.

Pinasa Shamana

-

-

+

 

 

 

 

 

 

 

 

 

16.

Prasrishta Mutra Pravati

+

-

-

 

 

 

 

 

 

 

 

 

17.

Sharira Laghava

-

+

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

64 | P a g e

18.

Snigdhata

-

+

-

 

 

 

 

 

19.

Svasthata

+

-

-

 

 

 

 

 

20.

Udara Shuddhi

-

-

+

 

 

 

 

 

21.

Vyadhi Shamana

-

-

+

 

 

 

 

 

10. Classification According to the fixed schedule:

According to the disease and condition of the patient we can use one of the

following schedule.

̧ÉÇzÉlqÉiÉÉ: MüqÉï lÉÑ oÉxiÉrÉÉå ÌWû MüÉsÉxiÉiÉÉåÅkÉåïlÉ iÉiÉ¶É rÉÉåaÉ: |

xÉÉluÉÉxÉlÉÉ ²ÉSzÉ uÉæ ÌlÉÃWûÉ: mÉëÉMçü xlÉåWû LMü: mÉUiÉ¶É mÉgcÉ ||

MüÉsÉå §ÉrÉÉåÅliÉå mÉÑUiÉxiÉjÉæMü: xlÉåWûÉ ÌlÉÃWûÉliÉËUiÉÉ¶É wÉOèû xrÉÑ: |

rÉÉåaÉ ÌlÉÃWûÉx§ÉrÉ LuÉ SårÉÉ: xlÉåWûÉ¶É mÉgcÉæuÉ mÉëÉÌSqÉkrÉÉ: ||74

- cÉ. ÍxÉ. 1/47-48

xÉÉluÉÉxÉlÉÉÌlÉ MüqÉæïuÉÇ oÉxiÉrÉÎx§ÉÇzÉSÏËUiÉÉ: |

MüÉsÉ: mÉgcÉSzÉæMüÉåÅ§É mÉëÉMçü xlÉåWûÉåÅliÉå §ÉrÉxiÉjÉÉ ||

wÉOèû mÉgcÉ oÉxirÉliÉËUiÉÉ: rÉÉåaÉÉåŹÉæ oÉxiÉrÉÉåÅ§É iÉÑ |

65 | P a g e

§ÉrÉÉå ÌlÉÃWûÉ: xlÉåWûÉ¶É xlÉåWûÉuÉɱliÉrÉÉåÃpÉÉæ ||75

- A. ™. xÉÔ 19/63-65

(i)Karma Basti :

In this schedule 30 Basti are being administered out of which 18, Anuvasana and

12 Niruha. Initially one Anuvasan is administered then 12 Niruha and 12 Anuvasana are given alternately and at last 5 Anuvasan should be given.

Every day one Basti can be given. Kashyypa having different opinion he scheduled 30 Basti.like 24 Anuvasan and 6 Niruha. At first 5 Anuvasana should be given then 1 Niruha and 3 Anuvasana alternately given and at last 4 Anuvasana should be administered given.

(ii)Kala Basti:

Charaka mentioned that it includes half number of Basti to that of Karma Basti.

But Chakrapani opined that it includes 16 Basti. According to Vagbhata it includes 15 Basti. He missed out one Anuvasana in this Schedule. Day first 1Anuvasana can be given then Afterwards 6 Anuvasana and 6 Niruha given alternatively and at last 3 Anuvasana are administered.

Kasayapa mentioned, 12 Anuvasana and 3 Niruha, 3 Anuvasana in the beginning then 1 Niruha and 3 Anuvasa alternately and at last 3 Anuvasana are given. He also mentioned that this schedule can be used in the patients having moderate strength and in the disease where along with Vata, Pitta also a vitiated dosa.

(iii)Yoga Basti :

66 | P a g e

Charaka mentioned that it includes 8 Basti out of which 5 Anuvasana and 3 Niruha. First day 1 Anuvasa then 3 Niruha and 3 Anuvasana alternatively and at last 1 Anuvasana should be given Kashyapa indicates same number of Basti with same Niruha and Anuvasana schedule. According to Kasayapa due to less use of Sneha it is mild in Action. This Basti schedule called yogabasti. It is used in the patients having Kapha Sansarga along with Vata vitiation.

According to Dalhana this Basti schedule i.e. Karma, Kala and Yoga for Vata, Pitta and Kapha predominance respectively.

Gayadasa also mentioned the schedule according to the indication like

1. Karma Basti :

It can be used when there is a marked vitiation of the Dosha due to the Balavadvigraha.

2. Kala Basti :

It is to be given in the patients where moderate vitiation of Dosas due to seasonal changes occurs.

3. Yoga Basti :

Is to be given in the patients where. Mild vitiation of Dosa is there, It can be given in swastha for attainment of Vrsyatva.

DESCRIPTION OF YOG AND MATRA BASTI

Table - 8

67 | P a g e

Contra Indications of Anuvasana Basti According to Brihat Trayi

Sr.

Diseases

C. Si.2/17

Su. Ci.35/22

A.H. Su.19/7, 8.

No.

 

 

 

 

 

 

 

 

 

1.

Abhishyandi

-

-

+

 

 

 

 

 

2.

Abhuktabhukta

+

-

+

 

 

 

 

 

3.

Ajirna

-

+

-

 

 

 

 

 

4.

Anasthapya

+

+

+

 

 

 

 

 

5.

Apachi

+

-

+

 

 

 

 

 

6.

Arochaka

+

+

-

 

 

 

 

 

7.

Arsha

+

+

-

 

 

 

 

 

8.

Atisara

-

-

+

 

 

 

 

 

9.

Durbala

+

-

-

 

 

 

 

 

10.

Galaganda

+

-

+

 

 

 

 

 

11.

Garapita

+

-

+

 

 

 

 

 

12.

Gurukoshta

+

-

+

 

 

 

 

 

13.

Kamala

+

-

+

 

 

 

 

 

14.

Kaphabhishyanda

+

-

-

 

 

 

 

 

15.

Kaphodara

+

-

+

 

 

 

 

 

16.

Krimikoshta

+

-

+

 

 

 

 

 

17.

Krisha

-

-

+

 

 

 

 

 

18.

Kushta

-

+

-

 

 

 

 

 

19.

Mandagni

+

-

-

 

 

 

 

 

20.

Navajvara

+

-

-

 

 

 

 

 

68 | P a g e

21.

Pandu

-

+

+

 

 

 

 

 

22.

Pinasa

-

-

+

 

 

 

 

 

23.

Pittabhishyanda

+

-

-

 

 

 

 

 

24.

Plihodara

-

-

+

 

 

 

 

 

25.

Pratishyaya

+

-

-

 

 

 

 

 

26.

Premaha

+

+

=

 

 

 

 

 

27.

Shlipada

+

-

+

 

 

 

 

 

28.

Sthaulya

-

+

+

 

 

 

 

 

29.

Udara Roga

-

+

-

 

 

 

 

 

30.

Urusthambha

+

-

+

 

 

 

 

 

31.

Varchobheda

+

-

-

 

 

 

 

 

32.

Vata Rakta

-

-

+

 

 

 

 

 

33.

Vidbheda

-

-

+

 

 

 

 

 

34.

Visapita

-

-

+

 

 

 

 

 

35.

Urusthambha

+

-

+

 

 

 

 

 

PREPARATION OF THE PATIENTS:

First patient should pass his urine and stool, thereafter Abhyanga andSvedana should be given to the patient. In case of Anuvasana Basti patient is advised to take food according to Doshas, disease and thereafter patient should be asked to walk for few steps. Asthapana Basti is given empty stomach.

69 | P a g e

PREPARATION OF BASTI DRAVYAS:

The drugs, dose, quantity of Basti contents should be selected according to the Doshas, Bala of the disease and the patient. In case of Anuvasana Basti medicated oil is taken. But in case of Nirooha Basti the ingredients should be mixed in the following manner:

1.First Madhu and Lavana should be mixed.

2.Then Sneha (oil or ghee) is added to it and mixed.

3.Thereafter Kalka is added and again mixed well.

4.Liquid prakshepa like milk, Kanji, Mamsa Rasa etc.are added if required.

5.In the last Kvatha is added and mixed well.

The whole Basti thus prepared is put on water bath to make it warm equal to body temperature i.e. 370 C. and then it should be filled in Bastiyantra.76 77 78

PRADHANA KARMA :

Pradhana Karma consists of following steps :

1.Basti Pranidhana

2.Basti Pratyagama and Nirikshana

3.Samyakyoga, Hinayoga, Atiyoga Lakshana.

1. Basti Pranidhana:

The prepared Nirooha Basti Dravyas and medicated oil in case of Anuvasana Basti should be kept ready in enema cane or syringe. Now patientis advised to lie down

70 | P a g e

in left lateral position. The left leg of the patient should be straight and right semi flexed leg is to be kept over it. Patient is not allowed to keep pillow under head instead of pillow he is asked to keep flexed left arm below the head like a pillow. The right hand should be kept straight over the body. The head end of the cot should be slight down than the leg end. The body should be kept in relaxed position. For the present study enema cane with plastic pipe with nozzle were used for Nirooha Basti and enema syringe for Anuvasana Basti.The tip of the nozzle (netra) is lubricated by oil. The Guda is also lubricated by the same. The nozzle is inserted into the rectum keeping parallel to vertebral column. The nozzle may be inserted up to 4 fingers i.e. 3-4 inches according to the age of the patient. Then enema cane is kept at the height of 3-4 feet from the bed of the patient so that by the gravitational force the drug of Nirooha Basti enters into the Pakvashya. In case of Anuvasana Basti piston of the syringe is to be pressed slowly with rythmic force. During administrationof the Basti patient is asked to take deep breath with mouth opened, so that drug easily gets entered into the large intestine. When some liquid is left in the syringe / enema cane, the nozzle is slowly removed from the rectum so that air may not enter.

Thereafter few taps are given over the thigh region and on buttock and then patient is asked to lie down on supine position of 5-10 minutes.

2. Basti Pratyagmana and Nirikshana:

The time taken for the contents of the Basti to come out after its administration is called as Basti Pratyagamana Kala. The maximum allowed time for Nirooha Basti is 48 minutes. If it does not come out within this stipulated period and if symptoms like

71 | P a g e

Pakvashaya Shula, Adhmana, Mutrashula, Jvara, Arti, Vishtambha etc. arise then following immediate step should be taken:

o Svedana should be given on the areas of Pakvashaya, pelvis, and thigh.

o Another Basti should be given containing Gomutra, Yavakshara, Amla Dravyas, Tikshna and Ushna drugs to evacuate the earlier Basti.

oPhalavarti (suppositories) should be administered in Guda so that earlier Basti may come out.

oShodhana - Trivrat Churna, Triphala Churna or castor oil should begiven for Virechana.

The maximum retention time period for Anuvasana Basti is 12 hours. If it does not come out within this period and it does not create any problem to the patient then it can be ignored and can wait for 24 hours to come out. But if it creates any harm to the patient then it should be removed by Tikshna Basti or Phala Varti.

v PIPALYADI TAILA

ÌmÉmmÉsÉÏÇ qÉSlÉÇ ÌoÉsuÉÇ zÉiÉÉÀûÉÇ qÉkÉÑMÇü uÉcÉÉqÉç |

MÑü¸Ç zÉOûÏÇ mÉÑwMüUÉZrÉÇ ÍcɧÉMÇü SåuÉSÉà cÉ ||

ÌmÉwOèuÉÉ iÉæsÉÇ ÌuÉmÉ£üurÉÇ Ì²aÉÑhɤÉÏUxÉÇrÉÑ£üqÉç |

AzÉïxÉÉÇ qÉÔRûuÉÉiÉÉlÉÉÇ iÉcNíåû¸qÉlÉÑuÉÉxÉlÉqÉç ||

aÉÑSÌlÉ:xÉUhÉÇ zÉÔsÉÇ qÉÔ§ÉM×ücNíÇû mÉëuÉÉÌWûMüÉqÉç |

72 | P a g e

MüšÔÃmÉ×wPèSÉæoÉïsrÉqÉÉlÉÉWÇû uÉXç¤ÉhÉÉ´ÉrÉqÉç

||79a

- A. ™. ÍcÉ. 8/90-92

The reference of pipalyadi tailam is available in Vagbhatkar Ashtang Hridaya and Bhaishajya Ratnavali79b which is considered the latest and most practical samhita for kayachikitsa and followed by many practitioners all over world. Hence I chose this kalpa as it is indicated in kati, uru, prushta weakness associated with low back pain.

The contents of this taila are as follows -

vPipali (Piper longum) – 1 tola

vMadanphala (Randia spinosa) – 1 tola

vBilwa (Agle marmelous) – 1 tola

vShatavaha (Anethum sowa) – 1 tola

vMadhuk (Glycyrrhiza glabra) – 1 tola

vVacha (Acorus calamus) – 1 tola

vKustha (Sausarea lappa) – 1 tola

vShathi (Hedychium spicatum) – 1 tola

vPushkarmula (Inula racemosa) – 1 tola

vChitrak (Plumbago zyelanicum) – 1 tola

vDevdaru (Cedrus devdar) – 1 tola

vTaila-til taila (Sesamum indicum) – 44 tola

vMilk-cow milk (double quantity of taila) – 88 tola

Method of preparation:

73 | P a g e

Take all the raw material of herbs in 1 tola quantity and grind it fine to make kalka. Then take 44 tola of till taila and 88 tola of cow milk. Add all these in utensil and heat till the time all the milk evaporates and the final product is called as pipalyadi taila.

v ERANDMULADI NIRUHA

qÉkÉÑiÉæsÉå xÉqÉå MüwÉï: xÉælkÉuÉÉÌSÌmÉcÉÑÍqÉïxÉÏ: | LUhQûqÉÔsÉYuÉjÉålÉ ÌlÉÃWûÉå qÉÉkÉÑiÉæÍsÉMü:

||

UxÉÉrÉlÉÇ mÉëqÉåWûÉzÉï: M×üÍqÉaÉÑsqÉÉl§ÉSØkSÏlÉÑqÉ ||80

- A. ™. Mü. 4

The reference of Erandmuladi niruha is available in Vagbhatkar Ashtang Hridaya which is considered the latest and most practical samhita for kayachikitsa and followed by many practitioners all over world. Hence I chose this kalpa as it is indicated in kati, uru, prushta weakness associated with low back pain.

The contents of this taila are as follows -

vMadha (Honey)

vTaila (Oil)

vSaindhav (Salt) – 1 tola

vBadishep (Anethum sowa) – 2 tola

74 | P a g e

v Erandmula kwath (Ricinus communis)

Method of preparation:

Take Erandmula kwath and badishep in a utensil.Heat a little and add oil, salt, honey respectively to make Erandmuladi kwath for niruha basti.

ÿConcept of Pain & Stiffness from Modern Medicine :-

INCIDENCE AND PRELEVANCE:

The word 'prevalence' of Back pain usually means the estimated population of people who are managing “Back

75 | P a g e

pain” at any given time (i.e. people with Back pain). The term 'incidence' of Back pain means the annual diagnosis rate, or the number of new cases of Back pain diagnosed each year (i.e. getting back pain). 6 million cases annually (unreliable estimate) approx 1 in 45 or 2.21% or 6 million people in USA.

1,993,000 women self-reported having back pain or disc disorders in Australia 2001.

A few interesting facts about back pain:

∑One-half of all working Americans81 admit to having back pain symptoms each year. Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper- respiratory infections.

∑Most cases of back pain are mechanical or non-organic-meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.

∑Americans spend at least $50 billion each year on back pain - and that’s just for the more easily identified costs.

∑Experts estimate that as many as 80% of the population will experience a back problem at some time in our lives.

∑In India, occurrence of low back pain is alarming; nearly 60 percent of the people in India have had significant back pain at some time or the other in their lives.

76 | P a g e

Weight gain during pregnancy, physical stress, inappropriate sitting and standing

postures and poor sleeping position also contribute to low back pain.

∑We are all aware of the statistics – 70% of chronic low back pain is classified as non-specific on the basis of absent definitive diagnosis.

OBJECTIVES

All parts of the body which have a function, if used in Moderation, and exercised in labors to which each is accustomed, becomes healthy and well developed and age slowly; but if unused and left idle, they become liable to disease, defective in growth and age quickly. This is especially so with joints and ligaments if one does not use them.

Sedentary lifestyle accelerates the aging process, and causes or contributes to many chronic diseases. Good evidence now exists that the observations of Hippocrates were correct.

Sedentary lifestyle leads to accelerated aging and the following physiological changes:

o Reduced insulin sensitivity.

o Increased visceral fat mass and intramuscular lipid accumulation

oDecreased aerobic capacity, cardiac contractility, stroke volume, and Cardiac output.

o Increased arterial stiffness and blood pressure (BP). o Decreased bone mass, strength, and density.

o Decreased muscle strength, power, and endurance.

77 | P a g e

oDecreased tissue elasticity, thinning of cartilage, decreased tendon length and tendon weakness.

Decreased gait stability secondary to impaired proprioception and balance. Some of the changes are age-related and others are secondary to lack of use. There is also overlap between changes related to aging and those related to lack of use and/o r sedentary lifestyle.

Backache, one of the most common ailments, is widely prevalent these days due to sedentary living habits and hazardous work patterns. The psycho logical conditions associated with emotional stress, which brings about spasm of the muscles, may also cause backache. As the back bears the weight of the entire body it gives way when it has to carry an extra load in the case of persons who are overweight.

The backbone forms a protective arch over the vertebrae and spinal cord and protects the spinal nerves that are interwoven through the spinal column. There is a close relationship between the bones, discs, joint muscles and nerves in the back and the slightest problem or injury to the back or neck area can have disastrous effects.

Poor posture results from soft chairs and coaches, which militate slouching and sitting incorrectly. Shoes with high heels place a tremendous strain on the back and other muscles of the body. Sleeping on too soft mattress, which results in an improper back and neck posture, can cause tension, headaches and pain in the upper and lower back.

Another major cause of back problems and tense muscles is lack of exercise. Modem conveniences have made office work easier. The easy life can lead to

78 | P a g e

obesity, which puts a great strain on the back. When muscles are not exercised and remain weak, the chances of injury to them are increased a lot.

Symptoms of backache are easily noticeable for its regularity and troubling conditions. In most cases of backache, the pain is usually felt either in the middle of the back or lower down. It may spread to both sides of the waist and the hips. With acute pain, the patient is unable to move and is bedridden.

Low back pain (LBP) presents a large challenge to the healthcare system despite improving scientific technology, medical insight, and suggested management strategies.

Almost 60 to 80 percent people experience low back pain at some point in their lives. This pain can vary from mild to severe. It can be short-lived or long-lasting.

However it happens, low back pain can make many everyday activities difficult to do. Back pain is different from one person to the next. The pain can have a slow onset or come on suddenly. The pain may be intermittent or constant. In most cases, back pain resolves on its own within a few weeks. Back pain leads to high cost for the individual, the work place and society, because it is a frequent reason for medical care seeking, with estimated 6-7% of the adult population annually consulting a general practitioner for their complaints. Low back pain affects not only the social and economic position of the individual and his family but also leads to draining of national resource due to work hours lost, resulting into diminished production.

ROM82

79 | P a g e

Motion at a joint occurs as a result of movement of one joint surface in relation to another. Arthro-kinematics is the term used to refer to the movement of joint surfaces. The movements at the joint surfaces are described as slides (glides), spins, and rolls. These three usually occur in combination with each other and result in movement of the shafts of the bones. Osteo-kinematics refers to the movement of the shafts of the bones. These are usually described in terms of rotary movement about an axis of motion. Goniometry measures the angles created by the rotary motion of the shafts of the bones. Some translatory motion will take place with shaft rotation, but we will deal with this at another time. Osteo-kinematic motions are classically described as taking place in one of the three cardinal planes of the body (sagittal, frontal, and transverse) around three corresponding axes (medial-lateral, anterior-posterior, and vertical). The three planes lie at right angles to one another whereas the three axes are both at right angles to the corresponding plane and to each other.

The amount of motion available about a joint is call Range of Motion or ROM. The starting position for measuring all ROM, except rotations in the transverse plane, is the anatomic position. We will use a system of measurement on a scale from 0- 180 degrees. However, you should be aware that other systems are used (180-0, and 0- 360 degrees).

Several factors will affect the range of motion recorded. Newborns up to age two have considerably more motion in hip flexion, hip abduction, hip lateral rotation, ankle dorsiflexion, and elbow flexion than in adults. Some authors have found that wrist flexion and extension, hip rotation and shoulder rotation decrease with increasing age compared with adults. Women have some motions that are generally greater than seen in

80 | P a g e

men but other motions appear greater in men than in women. There appears to be few standard comparisons for gender differences. Active range of motion (AROM) refers to the amount of joint motion attained by a subject during unassisted voluntary joint motion. Having a subject perform active ROM provides the examiner with information about the subject's willingness to move, coordination, muscle strength, and joint ROM.

The structures involved with movement of the bones as well as the bony arrangements are the factors in limiting motion. Also, pain is a limiting factor. The pain that occurs during motion may be due to contracting or stretching of "contractile" tissues and their attachments to bone, or it may be due to stretching or pinching of non- contractile "inert" tissues. This is a good screening technique to help focus a physical examination. Passive range of motion (PROM) is the amount of motion gained by the examiner without assistance from the subject. PROM is usually slightly greater than AROM because each joint has a small amount of motion available that is not under voluntary control. The additional amount of motion available to joints at the end range helps to protect joint structures by absorbing extrinsic forces. Passive testing provides the examiner with information about the integrity of the articular surfaces and the extensibility of the joint capsule, associated ligaments and muscles.

The ROM testing should be completed before a Manual Muscle Examination because this later testing depends on AROM. When pain limits PROM, it is often due to moving, stretching, or pinching of inert tissues. Pain that occurs at the end of PROM may be due to stretching of contractile as well as inert structures. Further clarifying contractile structures through isometric contractions, or clarifying inert structures through passive joint play testing, and end-feel adds to the information about

81 | P a g e

structures that are limiting ROM. We will deal with passive joint play at a later time. The end-feel is a feeling of the examiner as a barrier to further motion at the end of a PROM. The amount of PROM is unique for each structure of the joint tested. Some joints are structured so that the joint capsule limits the ROM in a particular direction, whereas other joints are structured so that ligaments limit the end of motion. Other limits to the end of movement include passive muscle tension, soft tissue approximation, and contact of joint surfaces. These normal end-feels have been described as soft, firm, and hard. The same terms are used to describe abnormal end-feels with the addition to "empty". Cyriax has proposed that pathologic conditions involving the entire joint capsule cause a particular pattern of limitation involving all or most of the passive motions of the joint. This pattern of limitation is called a capsular pattern. The limitation involves a fixed proportion of one motion relative to another motion and these vary with each joint. A limitation of passive motion that is not proportioned similarly to a capsular pattern is called a non-capsular pattern of limitation. This is usually caused by structures other than the entire joint capsule. Internal joint derangement, adhesion of part of a joint capsule, ligament shortening, muscle strains, and muscle contractures are examples. Non-capsular patterns usually involve one or two motions of a joint, in contrast to capsular patterns that involve all motions of a joint.

Although other aspects to ROM testing will be conducted as part of examination technique, the following are usual contraindications to ROM testing: a dislocation or unhealed fracture in the region, immediately following surgery, presence of myositis ossificans, on meds for pain or muscle relaxants (careful), in regions of

82 | P a g e

osteoporosis or bone fragility, patients with hemophilia, in joints where bony ankylosis is suspected, and immediately after an injury where disruption of tissue is present.

GONIOMETER

The goniometer83 is a standard device for measuring angles and is relatively inexpensive. Bubble inclinometers are gaining in popularity for ease of use, but are more expensive and lack research for its validity and reliability.

Image 2. Goniometer scale

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Goniometers come in various sizes for use with different joints.

Goniometer has three components. The circular or semi-circular base with degree markings is called the body. Goniometers also have two arms. The stationary arm is fixed to the body. The moving arm is moved in concert with the patient’s joint movement and points to the readings on the goniometer body.

Image 3. Goniometer dial

Bubble inclinometers have a circular tube partially- filled with a colored fluid that moves with motion, and is gravity dependent. It has a moveable circular dial with degree markings.

∑Each measure device requires knowledge of placement and expected measurement.

∑The measurement should include which device was used. Ideally, each time a patient is re-measured the same device type would be used.

∑For left and right sided movements, both sides should be measured and compared.

Image 4 Goniometer accessory

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Before the use of the goniometer and the bubble inclinometer, a tape measure was used for certain range of motion measurements. It is still used for measuring torso girth, and well as diameter of limbs for left-right comparisons (for muscle wasting, edema, etc.).

Range of Motion Measurement Values and Norms

The ranges of motion measurements for different movements vary considerably in the literature.

Range of motion values often decline with age without detriment to a person’s quality of life or ability to do activities of daily living (ADL).84

More important than which set of ROM values to use as criteria, consider the following:

∑What does the ROM limitation have on the quality of the patient’s life?

∑How does the ROM limitation affect general movements and ability to do tasks in the person's life (ADLs: Activities of Daily Lives)?

∑How close is the patient's ROM to an expected full range of motion?

∑How does a left-sided movement compare to a right-sided movement?

∑What are the ROM measurements on the same patient over time, over the course of several treatments?

85 | P a g e

It is recommended that measurements be taken at initial evaluation, and after every four to six weeks of treatment. The idea is that four to six weeks are the expected tissue healing time.

Documentation

ROM provides objective, reproducible outcome measurements. Documentation of ROM can help determine the effectiveness of treatment. It can promote continuous patient care between practitioners: this means that when a patient is seeing two different practitioners or interns for the same condition, such as shoulder pain, documented ROM can help them determine the progression of treatment. Either the shoulder is getting better or worse (or no change) through treatment.

Proper ROM documentation needs to include date, joint measured, active or passive movement, types of ROM (flex, extend, etc.), testing position, equipment used, and the range measurement.

Example:

∑Cervical AROM (Active ROM) sitting with goni

∑Flexion (Flex) 0-600 Extension(Ext) 0-450

∑Left Sidebend (LS) 0-450 Right Sidebend (RS) 0-450

∑ Left Rotation (LR) 0-800 Right Sidebend (RS) 0-800

Measuring Hip Flexion with a Goniometer

Image 5 Supine position

86 | P a g e

1.Patient in supine position. Locate the greater trochanter of the femur and the lateral epicondyle of femur.

2. Place the

center

of

the

goniometer

body

over

the

greater trochanter. Align the

stationary

arm

with

the

lateral mid-line of the pelvis.

Align the moving arm with lateral epicondyle of femur.

3.Stabilize pelvis and have patient flex hip bringing thigh close to the trunk with knee bent. Align moving arm with lateral epicondyle of femur. Read the angle.

Normal ROM: 110-1200

Image 6 Goniometer placement

Image 7 Measuring flexion angle

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Measuring Hip Extension with a Goniometer

Image 8 Prone position

1. Patient in prone position. Locate the greater trochanter of the femur and the lateral epicondyle of the femur.

2.Place the center of goniometer body over the greater trochanter. Align the stationary arm with the lateral mid-line of the pelvis.

Image 9 Extension angle measurement

3. Stabilize pelvis and have patient extend hip by lifting the leg upward. Align moving arm with lateral epicondyle of femur. Read the angle.

Normal ROM: 10-150

Measuring Hip Abduction with a Goniometer

Image 10 Supine lateral position

88 | P a g e

1.Patient in supine position, with toes pointing up (no rotation). Locate the anterior superior iliac spine (ASIS) on both sides and the midline of the femur.

Place the center of goniometer body over the ASIS of the side

being measured and point the stationary arm to the opposite ASIS.

Align the moving arm with the with the midline of the femur, using the midline of the patella for reference.

Image 11 Measuring abduction angle

2.Stabilize pelvis and have patient abduct the leg, moving laterally outward. Read the angle.

Normal ROM: 30-500

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MATERIAL & METHODS

This study is carried out under two headings. They are as follows:-

ÿ PHASE I – Literary Research

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i)Conceptual study.

ÿPHASE II – Clinical Research v Conceptual study :-

The disease Trikprushtkati graha is very common because Vataprakopa

karanas like jerks, irregular posture, carrying heavy objects,engaging in sternous physical work falls etc. are seen in daily life. These affect the skeleton and muscles mainly in the trik kati prustha region. If it is not treated in time, it may lead to serious complications like paralysis or pain in the lower limb and back region.

Many medicines are prescribed in Ayurveda for treatment of Vata rogas. Among them basti with pipalyadi taila is effective for the treatment of.trik kati prustha graha.

Since trik kati prustha graha is a disease affecting the trik kati prustha region, this yoga of drugs is expected to give good response in the treatment of this disease.

This study aims to assess the efficacy of pipalyadi taila in yaoga basti and matra basti and compare the efficacy of both the bastis in trik prustha kati graham.

iɧÉÉSÉæ uÉÉiÉÌuÉMüÉUÉlÉlÉÑurÉÉZrÉÉxrÉÉqÉ: | iɱjÉÉ lÉZÉpÉåS¶É, ÌuÉmÉÉÌSMüÉ cÉ, mÉÉSzÉÔsɶÉ, mÉÉSpÉëÇzɶÉ, mÉÉSxÉÑmiÉiÉÉ cÉ, uÉÉiÉZÉÑQÒûiÉÉ cÉ,

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aÉÑsTüaÉëWû¶É, ÌmÉÎhQûMüÉå²å¹lÉÇ cÉ, aÉ×kÉxÉÏ cÉ, eÉÉlÉÑpÉåS¶É, eÉÉlÉÑÌuÉzsÉåwɶÉ, FÃxiÉqpɶÉ, FÃxÉÉS¶É, mÉÉ…¡ÓûsrÉÇ cÉ, aÉÑSpÉëÇzɶÉ, aÉÑSÉÌiÉï¶É, uÉ×wÉhÉÉåi¤ÉåmɶÉ, zÉå:TüxiÉqpɶÉ, uÉXç¤ÉhÉÉlÉÉWû¶É, ´ÉÉåÍhÉpÉåS¶É, ÌuÉXçpÉåS¶É, ESÉuÉiÉï¶É, ZÉgeÉiuÉÇ cÉ, MÑüoeÉiuÉÇ cÉ, uÉÉqÉlÉiuÉÇ cÉ, ̧ÉMüaÉëWû¶É, mÉ׸aÉëWû¶É, ..........||85

- cÉ. xÉÔ. 20/11

It can be seen from the above shloka that Acharya Charak has indicated

trikprushtakati graha as nanatmaja vikara of vata.

iÉ§É mÉYuÉÉzÉrÉå ¢ÑükS: zÉÔsÉÉlÉÉWûÉl§ÉMÔüeÉlÉqÉç |

qÉsÉUÉåkÉÉzqÉuÉkqÉÉïzÉïÎx§ÉMümÉ׸MüOûÏaÉëWûqÉç ||86

- A. ™. ÌlÉ 15/7

Other brihattrayees like Vagbhatkar’s, Ashtang Sangraha and Ashtang Hridaya has also not mentioned trikprushtkati graha as a disease in itself. Still prevalence of this symptom now a days has increased and effected most of the population. Modern medicine only provides short term relief by used of steroids, NSAID’s etc. with no permenant relief. Hence it was decided through thos research to explore the Ayurvedic treatment and its efficacy viz a viz trik prushta kati graha correlated as low back pain in today’s world.

vSurvey study :-

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v Sample size:-

The sample size undertaken for this study was 60 volunteers divided into two groups suffering from trik prushta kati graha.

∑Group I.

30 volunteeers were given matra basti for 8 days.

Pipalyadi taila was used in rhasiyasi matra.

ßMATRA BASTI GROUP TREATMENT REGIMEN

∑Dipana pachana by Shaddharan churna 10-15 gm for 3-5days.

∑Abhanga with tila taila

∑Swedan by nadi sweda for 15 minutes.

∑Matra basti by pipalyadi taila ( 1-2 pal)

Ingrediants of pipalydi tailam-

∑Pipali, madanphala, bilwa, shatavaha, madhuk, vacha, kustha, shunthi, pushkarmula, chitrak, devdaru.

∑Taila-til taila

∑Milk-cow milk (double quantity of taila)

∑Group II.

30 volunteers were given yoga basti for 8 days.

Yoga Basti (schedule of 8 Bastis:- 5 Anuvasan + 3 Niruh)

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o Day 1 – Anuvasan with Pipalyadi Taila. o Day 2 – Niruh with Erandmuladi Kwath o Day 3 – Anuvasan with Pipalyadi Taila. o Day 4 – Niruh with Erandmuladi Kwath o Day 5 – Anuvasan with Pipalyadi Taila. o Day 6 – Niruh with Erandmuladi Kwath o Day 7 – Anuvasan with Pipalyadi Taila.

oDay 8 – Anuvasan with Pipalyadi Taila.

ßYOGA BASTI GROUP TREATMENT REGIMEN

∑Dipana pachana by shaddharan churna 10 gm-15gm for 3-5 days

∑Abhanga with tila taila (given daily just before basti karma)

∑Swedan by nadi sweda

∑Nirooha by erandmuladi (50-90 tolas)

∑Anuvasana by pipalyadi taila (1-2pal)

Ingrediants of Erandmuladi Niruh:-

∑Erandmool, Madhu, Siandhav.

∑Taila-til taila

∑Milk-cow milk (double quantity of taila)

vSampling method:-

∑Random Sampling. 87

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This method is applicable when the population is small, homogeneous and readily available. It is used in experimental medicine or clinical trials like testing the efficacy of a particular drug.

The principle here is that every unit of the population has an equal chance of being selected. Hence, this method is also sometimes called as unrestricted random

sampling.

In this survey all volunteers are considered and then a homogeneous group is formed by selecting all volunteers who are between age group of 30-60 years and suffering from trik prushta kati graha.

v Source of data:

 

Patients attending O.P.D and I.P.D of

the college hospital will be

selected for the study.

 

vMethod of data collection:

∑Study will be carried out in the patients fulfilling the criteria of Trik-kati- prustha graham.and visiting OPD and IPD of college hospital.

ÿ Inclusion criteria.

∑Volunteers between 30 to 60 years.

According to Acharya Charak individuals belonging to the age group of 30-60 years are mature. Whereas above age group of 60 years adults belong to old age group where vata dosha is any how predominant, which might make the study bias.

∑Volunteers irrespective of sex and religion.

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∑Patients presenting with the signs and symptoms of Trik-kati- prustha graha will be selected.

∑Patients of either sex with the age group between 18- 60 years will be selected.

∑Patients who are fit for asthapan and anuvasan basti will be selected.

∑Trik-Kati-prustha graha due to mis-management of labour.

∑Trik-kati-prustha graha along with gridhrasi.

ÿExclusion criteria.

∑Volunteers less than 18 years.

∑Volunteers more than 60 years.

In Charak Samhita it has been said that above 60 years of age i.e. old age there is already predominance of vata dosha.

∑Major illness like tuberculosis, pneumonia etc.

∑Syndromes like AIDS, Cancer.

Volunteers suffering from tuberculosis, pneumonia and bronchiectasis are excluded. As well syndromes like AIDS, Cancer are also excluded as in these disorders vataj kasa is a secondary symptom and not a disease in itself.

∑Patients who are not fit for basti.

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∑Trik-kati-prustha graha in udara roga, vataja arsha, bhagandara, asthi bhagna, sarpa, visha, vrukkaja vidhradi, vataja jwara, vataja atisara, amavata.

∑Patients having systemic disorders, cardiac and diabetic patients.

∑Patient having lumbar disc herniation, spinal stenosis, spondilolisthesis.

∑Patient with history of any surgery, trauma, cancer structural deformity.

∑Degenerative segmental instability.

∑Referred pain in pyelonephritis, renal calculi, Prostatism and pregnancy.

v Scaling/Gradation of symptoms:-

Graphic Rating Scale

The scale used to grade the symptoms in order to get the data for analysis, graphic rating scale was used. In this, the patients rate their symptoms by placing a mark at the appropriate position on a line that runs from one extreme of the criterion variable to another.

This line can be vertical or horizontal and scale points may be provided. No other indication is there on the continuous scale. A range is provided. To quantify the responses to question that “indicate the patients symptoms by placing

97 | P a g e

a tick mark at appropriate position on the line”, we measure the physical distance between the left extreme position and the response position on the line; the greater the distance, the more severity of the symptom in the patient.

v Scale for Grabbing Pain88

0

2

4

6

Minimum

 

 

Maximum

No Pain

Mild Pain

Moderate Pain

Severe Pain

Scaling

Table No 9.

Grading of pain symptom.

No

Severity of Grabbing pain in

Grade

 

patients words

 

 

 

 

1

0 on scale

No pain

 

 

 

2

2 on scale

Mild Pain

 

 

 

3

4 on scale

Moderate Pain

 

 

 

4

6 on scale

Severe Pain

 

 

 

Methodology of instruments for analysis :-

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Goniometer: Gonio means angle and meter means to measure. This consists of two arms, one which can be fixed while the other is freely movable. It mounted on a 180 degree scale which indicates the restriction of the movement at the concerned joint compared to normal one.

Assessment of trik, kati, prustha viz; flexion, extension, lateral movements are done before and after treatment to find efficacy of the treatment procedure.

Table No 10.

Grading of ROM.

 

Angle

Stiffness

 

 

 

 

 

 

FLEXION

 

 

 

 

 

 

 

< 80

Full Restriction

 

 

 

 

 

 

81-90

Severe Restricted

 

 

 

 

 

 

91-100

Moderate Ristricted

 

 

 

 

 

 

101-110

Mild Restricted

 

 

 

 

 

 

111-120

Free movement

 

 

 

 

 

 

EXTENSION

 

 

 

 

 

 

 

< 7

Full Restriction

 

 

 

 

 

 

7 only

Severe Restricted

 

 

 

 

 

 

 

 

 

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8 only

Moderate Ristricted

 

 

9 only

Mild Restricted

 

 

10 and +

Free movement

 

 

ABDUCTION

 

 

 

< 15

Full Restriction

 

 

16 to 20

Severe Restricted

 

 

21 to 25

Moderate Ristricted

 

 

25 to 30

Mild Restricted

 

 

30 >

Free movement

 

 

v Analysis of data:-

The collected data from the survey is analyzed by statistical methods using SPSS software. Since the data is qualitative, mean and standard deviation cannot be derived, hence 2 non parametric tests89 are used.

i) MANN WHITNEY TEST

 

The Mann-Whitney test is used to test

the null hypothesis H0 according to which

2 independent samples were drawn from the

same population (or identical populations).

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Mann-Whitney test is the alternative test to the t-test. Mann-Whitney test is a non- parametric test that is used to compare two population means that come from the same population. Mann-Whitney test is also used to test whether two population means are equal or not. It is used for equal sample sizes, and is used to test the median of two populations. Usually Mann-Whitney test is used when the data is ordinal. Wilcoxon rank sum, Kendall’s and Mann-Whitney test are similar tests and in the case of ties, Mann- Whitney test is equivalent to the chi-square test.

Assumptions in Mann-Whitney U test:

Mann-Whitney test is a non-parametric test, hence it does not assume any assumptions related to the distribution. There are, however, some assumptions that are assumed in Mann-Whitney test.

The

following are

the

assumptions

for Mann-Whitney

Test:

1.Mann-Whitney test assumes that the sample drawn from the population is random.

2.In Mann-Whitney test, Independence within the samples and mutual independence is assumed.

3.Ordinal measurement scale is assumed in Mann-Whitney U test.

Calculation of Mann-Whitney U test:

To calculate the value of Mann-Whitney U test, we use the following formula:

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Where:

U=Mann-Whitney test

N1 = sample size one

N2= Sample size two

Ri = Rank of the sample size

ii) WILCOXON TEST

The Wilcoxon signed-rank test is a non-parametric statistical hypothesis test for the case of two related samples or repeated measurements on a single sample. It can be used as an alternative to the paired Student's t-test when the population cannot be assumed to be normally distributed. The test is named for Frank Wilcoxon (1892–1965) who, in a single paper, proposed both it and the rank-sum test for two independent samples (Wilcoxon, 1945).

Like the paired or related sample t-test, the Wilcoxon test involves comparisons of differences between measurements, so it requires that the data are measured at an interval level of measurement. However it does not require assumptions about the form of the distribution of the measurements. It should therefore be used whenever the distributional assumptions that underlie the t-test cannot be satisfied.

Suppose we collect 2n observations, two observations of each of the n subjects. Let i denote the particular subject that is being referred to and the first observation measured on subject i be denoted by xi and second observation be yi. For each i in the observations, xi and yi should be paired together.

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Assumptions

Let Zi = Yi – Xi for i = 1, ... , n.

1.The differences Zi are assumed to be independent.

2.Each Zi comes from the same continuous population, and is symmetric about a common median θ.

3.The values of Xi and Yi represent are ordered, so the comparisons "greater than", "less than", and "equal to" are meaningful.

Test procedure

The null hypothesis tested is H0: θ= 0. The Wilcoxon signed rank statistic W+ is computed by ordering the absolute values |Z1|, ..., |Zn|, the rank of each ordered |Zi| is given a rank of Ri. Denote the positive Zi values with fi = I(Zi > 0), where I(.) is an indicator function. The Wilcoxon signed ranked statistic W+ is defined as

It is often used to test the difference between scores of data collected before and after an experimental manipulation, in which case the central point under the null hypothesis would be expected to be zero.

Scores exactly equal to the central point are excluded and the absolute values of the deviations from the central point of the remaining scores are ranked such that the smallest deviation has a rank of 1. Tied scores are assigned a mean rank. The sums for the ranks of scores with positive and negative deviations from the central point are then

103 | P a g e

calculated separately. A value S is defined as the smaller of these two rank sums. S is then compared to a table of all possible distributions of ranks to calculate p, the statistical probability of attaining S from a population of scores that is symmetrically distributed around the central point.

iii) CHI-SQUARE TEST

The chi-square (I) test is used to determine whether there is a significant difference between the expected frequencies and the observed frequencies in one or more categories. Do the number of individuals or objects that fall in each category differ significantly from the number you would expect? Is this difference between the expected and observed due to sampling error, or is it a real difference?

Chi-Square Test Requirements

1.Quantitative data.

2.One or more categories.

3.Independent observations.

4.Adequate sample size (at least 10).

5.Simple random sample.

6.Data in frequency form.

7.All observations must be used.

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X2 = (O - E)2

where :

O

-

Is the Observed Frequency in each category.

E- Is the Expected Frequency in the corresponding category is sum of

df is the "degree of freedom" (n-1).

X2

-

Is Chi Square.

The steps in using the chi-square test may be summarized as follows:

Chi-Square Test Summary

1.Write the observed frequencies in column O

2.Figure the expected frequencies and write them in column E.

3.Use the formula to find the chi-square value:

4.Find the df. (N-1)

5.Find the table value (consult the Chi Square Table.)

6.If your chi-square value is equal to or greater than the table value, reject the null

hypothesis: differences in your data are not due to chance alone

105 | P a g e

106 | P a g e

RESULTS

ÿ DATA FROM SURVEY

i) Patients treated with Yoga Basti (30 patients).

 

 

Symptoms before treatment

 

Symptoms after Yoga basti treatment

 

No

 

 

 

 

 

 

 

 

 

 

Grabbing

Gonimeter ROM (Hip Joint)

 

Grabbing

Gonimeter ROM (Hip Joint)

 

 

Pain

 

 

 

 

Pain

 

 

 

 

 

Flexion

Extension

Abduction

 

Flexion

Extension

Abduction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

6

79

6

17

 

2

112

12

29

2

6

76

7

19

 

0

109

13

37

 

 

 

 

 

 

 

 

 

 

3

4

85

7

13

 

0

115

14

45

4

4

87

5

14

 

0

117

9

28

 

 

 

 

 

 

 

 

 

 

5

6

7

6

12

 

2

116

9

33

 

 

 

 

 

 

 

 

 

 

6

6

74

5

23

 

4

105

15

27

7

4

96

8

15

 

0

106

15

44

 

 

 

 

 

 

 

 

 

 

8

2

98

6

24

 

0

113

15

48

 

 

 

 

 

 

 

 

 

 

9

4

97

7

18

 

0

113

15

46

10

2

84

7

14

 

0

107

13

42

 

 

 

 

 

 

 

 

 

 

11

4

92

7

19

 

0

116

9

26

 

 

 

 

 

 

 

 

 

 

12

6

75

6

18

 

2

105

9

26

13

4

85

5

14

 

2

114

9

28

 

 

 

 

 

 

 

 

 

 

14

6

78

6

13

 

4

113

9

38

 

 

 

 

 

 

 

 

 

 

15

4

90

8

13

 

0

114

9

40

16

6

80

6

13

 

0

116

13

47

17

6

79

6

14

 

2

120

9

49

 

 

 

 

 

 

 

 

 

 

18

6

76

5

23

 

0

110

14

25

19

6

73

7

14

 

0

110

9

30

 

 

 

 

 

 

 

 

 

 

20

4

94

7

13

 

0

120

14

45

 

 

 

 

 

 

 

 

 

 

21

6

87

6

17

 

2

120

13

30

22

4

77

7

18

 

0

110

14

29

23

4

82

8

14

 

2

108

9

43

 

 

 

 

 

 

 

 

 

 

24

4

76

8

22

 

0

119

8

46

25

6

77

6

18

 

2

118

8

47

 

 

 

 

 

 

 

 

 

 

26

4

79

5

20

 

0

103

9

28

 

 

 

 

 

 

 

 

 

 

27

6

84

7

15

 

2

120

13

42

28

6

76

6

14

 

0

119

14

25

29

6

89

6

13

 

0

117

15

36

 

 

 

 

 

 

 

 

 

 

30

4

77

7

16

 

0

108

9

38

Table No 11. Patient treated with Yoga basti

107 | P a g e

 

ii) Patients treated with Matra Basti (30 patients).

Table No 12. Patient treated with Matra basti

 

Symptoms before treatment

 

Symptoms after Matra basti treatment

 

 

 

 

 

 

 

 

 

 

No

Grabbing

Gonimeter ROM (Hip Joint)

 

Grabbing

Gonimeter ROM (Hip Joint)

 

Pain

 

 

 

 

Pain

 

 

 

 

Flexion

Extension

Abduction

 

Flexion

Extension

Abduction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

4

80

6

17

 

4

89

8

21

 

 

 

 

 

 

 

 

 

 

2

6

78

6

14

 

4

92

7

17

 

 

 

 

 

 

 

 

 

 

3

6

89

5

13

 

4

98

7

17

 

 

 

 

 

 

 

 

 

 

4

6

84

7

16

 

2

99

8

18

 

 

 

 

 

 

 

 

 

 

5

6

76

8

12

 

6

90

9

15

 

 

 

 

 

 

 

 

 

 

6

6

73

6

12

 

4

94

7

13

 

 

 

 

 

 

 

 

 

 

7

6

97

7

14

 

4

117

7

16

 

 

 

 

 

 

 

 

 

 

8

4

96

7

14

 

2

118

7

17

 

 

 

 

 

 

 

 

 

 

9

2

94

5

14

 

2

103

6

30

 

 

 

 

 

 

 

 

 

 

10

2

86

5

18

 

0

90

6

21

 

 

 

 

 

 

 

 

 

 

11

4

94

6

14

 

2

98

6

33

 

 

 

 

 

 

 

 

 

 

12

2

75

8

20

 

0

84

8

25

 

 

 

 

 

 

 

 

 

 

13

4

88

7

20

 

2

98

7

27

 

 

 

 

 

 

 

 

 

 

14

2

74

7

14

 

0

95

8

18

 

 

 

 

 

 

 

 

 

 

15

4

88

5

18

 

2

102

6

37

 

 

 

 

 

 

 

 

 

 

16

6

77

4

14

 

4

95

6

48

 

 

 

 

 

 

 

 

 

 

17

4

72

5

23

 

4

93

7

43

 

 

 

 

 

 

 

 

 

 

18

6

74

6

14

 

4

95

6

33

 

 

 

 

 

 

 

 

 

 

19

4

79

7

19

 

2

104

7

26

 

 

 

 

 

 

 

 

 

 

20

4

92

6

19

 

4

120

7

27

 

 

 

 

 

 

 

 

 

 

21

2

82

7

13

 

2

118

8

18

 

 

 

 

 

 

 

 

 

 

22

4

76

6

12

 

2

102

7

17

 

 

 

 

 

 

 

 

 

 

23

6

83

8

24

 

4

99

8

29

 

 

 

 

 

 

 

 

 

 

24

6

80

7

17

 

4

93

7

30

 

 

 

 

 

 

 

 

 

 

25

6

77

8

14

 

4

103

8

19

 

 

 

 

 

 

 

 

 

 

26

6

73

8

13

 

2

94

8

19

 

 

 

 

 

 

 

 

 

 

27

4

86

6

12

 

4

98

7

17

 

 

 

 

 

 

 

 

 

 

28

6

75

7

14

 

4

93

7

36

 

 

 

 

 

 

 

 

 

 

29

6

84

7

16

 

4

95

7

23

 

 

 

 

 

 

 

 

 

 

30

6

78

5

23

 

2

86

7

23

 

 

 

 

 

 

 

 

 

 

108 | P a g e

ÿSTATISTICAL ANALYSIS

The collected data from the survey is analyzed by statistical methods using SPSS

software. Since the data is quantitative, mean and standard deviation cann be derived, hence 2 non parametric tests are used.

∑Mann Whitney test.

∑Wilcoxon sign test.

∑Chi square test.

ÿMANN WHITNEY TEST

The Mann-Whitney test is used to test the null hypothesis H0 according to which 2 independent samples were drawn from the same population (or identical populations).

Mann-Whitney test is the alternative test to the t-test. Mann-Whitney test is a non-parametric test that is used to compare two population means that come from the same population. Mann-Whitney test is also used to test whether two population means are equal or not. It is used for equal sample sizes, and is used to test the median of two populations. Usually Mann-Whitney test is used when the data is ordinal. Wilcoxon rank sum, Kendall’s and Mann-Whitney test are similar tests and in the case of ties, Mann-Whitney test is equivalent to the chi-square test.

109 | P a g e

Assumptions in Mann-Whitney U test:

Mann-Whitney test is a non-parametric test; hence it does not assume any assumptions related to the distribution. There are, however, some assumptions that are assumed in Mann-Whitney test.

The

following are

the

assumptions

for Mann-Whitney

Test:

1.Mann-Whitney test assumes that the sample drawn from the population is random.

2.In Mann-Whitney test, Independence within the samples and mutual independence is assumed.

3.Ordinal measurement scale is assumed in Mann-Whitney U test.

Calculation of Mann-Whitney U test:

To calculate the value of Mann-Whitney U test, we use the following formula:

Where:

U=Mann-Whitney test

N1 = sample size one

N2= Sample size two

Ri = Rank of the sample size

110 | P a g e

ÿ Sex * group Analysis

 

 

 

 

 

Table No. 13.

 

 

 

 

 

Group

 

 

 

 

Matra

Yoga

Total

 

F

Number

12

11

23

Sex

 

%

40.0%

36.7%

38.3%

M

Number

18

19

37

 

 

 

%

60.0%

63.3%

61.7%

 

Total

Number

30

30

60

 

 

%

100.0%

100.0%

100.0%

Graph No 1.

We can see that from the above analysis there were 12 female volunteers and 18 male

volunteers involved in the Matra basti group for study where as 11 female volunteers and

19 male volunteers involved in the Yoga basti group. It can also the said the in totality 37

males were affected as compared to 23 females with trik prushta and kati graha which

indicates its prevalence more in male population.

111 | P a g e

ÿ Occupation wise Analysis

Occupation

Table No 14.

 

 

 

 

 

 

Group

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Matra

 

Yoga

 

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

Bank Manager

 

Number

 

2

 

1

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

6.7%

 

3.3%

 

5.0%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Housewife

 

Number

 

3

 

3

 

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

10.0%

 

10.0%

 

10.0%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Labourer

 

Number

 

5

 

2

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

16.7%

 

6.7%

 

11.7%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Maid

 

Number

 

2

 

6

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

6.7%

 

20.0%

 

13.3%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office Clerk

 

Number

 

5

 

4

 

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

16.7%

 

13.3%

 

15.0%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Police

 

Number

 

3

 

4

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

10.0%

 

13.3%

 

11.7%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Truck Driver

 

Number

 

4

 

3

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

13.3%

 

10.0%

 

11.7%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Worker

 

Number

 

6

 

7

 

13

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

20.0%

 

23.3%

 

21.7%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

Number

 

30

 

30

 

60

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

100.0%

 

100.0%

 

100.0%

 

 

 

 

 

 

 

 

 

 

 

 

 

Form the above table, it can be noted that people from different occupation industry are

all suffering from trik prushta and kati graha. It is also indicative that people who have

such type of job where excess pressure comes on lower back region are suffering from

the symptom. It can be seen that people from occupation like bank managers, office

clerks who sit whole day or having desk job also suffer which might be associated with

the wrong sitting postures or long period of sitting hours.

112 | P a g e

Graph No 2.

ÿ Socio economic status wise Analysis

Status

Socio economic

Table No 15.

Group

 

 

 

Matra

Yoga

Total

Lower

Number

16

18

34

 

 

 

 

 

 

 

 

 

%

53.3%

60.0%

56.7%

 

 

 

 

 

 

 

 

 

 

Middle

Number

10

11

21

 

 

%

 

33.3%

 

35.0%

 

 

 

36.7%

 

 

 

 

 

 

 

 

Upper

Number

 

4

1

5

 

 

 

 

 

 

 

 

%

 

13.3%

3.3%

8.3%

 

Total

Number

 

30

30

60

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

100.0%

100.0%

100.0%

 

 

 

 

 

 

 

 

We can see that from the above analysis there were 16 volunteers and 18 volunteers

involved in the both basti group from Lower strata of society for study where as 10

volunteers and 11 volunteers involved in the both basti groups from middle strata of

113 | P a g e

society. It can also the said the in totality lower and middle class people suffer more from

trik prushta kati graha may be due to the working style.

Graph 3

ÿ Education wise Analysis

Table No 16

Group

Education

 

 

Matra

Yoga

Total

Illiterate

Number

0

1

1

 

 

 

 

 

 

%

.0%

3.3%

1.7%

 

 

 

 

 

Below 10th

Number

17

18

35

 

 

 

 

 

 

%

56.7%

60.0%

58.3%

 

 

 

 

 

Graduate

Number

10

10

20

 

 

 

 

 

 

%

33.3%

33.3%

33.3%

 

 

 

 

 

Post

Number

3

1

4

Graduate

 

 

 

 

%

10.0%

3.3%

6.7%

Total

Number

30

30

60

 

 

 

 

 

 

%

100.0%

100.0%

100.0%

 

 

 

 

 

114 | P a g e

Graph 4

Form the above graph it can be said that the prevalence of low back pain is more in labourer and worker types of people as these are less educated which is observed from above table and graph.

ÿ Trauma wise Analysis

 

 

 

 

 

Table No 17

 

 

 

 

 

Group

 

 

 

 

Matra

Yoga

Total

Trauma

No

Number

26

25

51

 

%

86.7%

83.3%

85.0%

Yes

Number

4

5

9

 

 

 

 

 

 

 

%

13.3%

16.7%

15.0%

 

Total

Number

30

30

60

 

 

%

100.0%

100.0%

100.0%

115 | P a g e

Medically speaking people having met accident involving low back should suffer from

low back pain in their lifetime. But this data iis inconclusive as can be seen from the bale

and graph.

Graph 5

ÿ Nature of Work wise Analysis

 

 

 

 

 

 

 

 

 

 

 

 

 

Work

 

 

Sitting

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Travel

 

 

of

 

 

 

 

 

 

 

 

 

Nature

 

 

 

 

 

 

 

 

 

 

 

 

Vigorous

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

 

 

 

 

 

Table No 18

 

 

Group

 

 

 

 

 

 

 

 

 

 

Matra

 

Yoga

 

Total

 

 

 

 

 

Number

 

18

 

15

 

33

% 60.0% 50.0% 55.0%

Number

 

1

 

7

 

8

% 3.3% 23.3% 13.3%

Number

 

11

 

8

 

19

% 36.7% 26.7% 31.7%

Number

 

30

 

30

 

60

% 100.0% 100.0% 100.0%

116 | P a g e

It can be noticed from the above table that people having either prolonged sitting job or those who work vigorously like labours and workers suffer from trik prusht kati graha. As 96% volunteers in matra basti group and 86% people in yoga basti group belong to these categories of work style.

Graph 6

117 | P a g e

SYMPTOM WISE EVALUATION BETWEEN BOTH GROUPS

ÿ Analysis of Pain symptom

Table No 19

Ranks

 

Group

Sample

Mean Rank

Sum of Ranks

 

 

 

 

 

Pre_pain

Matra

30

29.75

892.50

 

 

 

 

 

 

Yoga

30

31.25

937.50

 

 

 

 

 

 

Total

60

 

 

 

 

 

 

 

Post_pain

Yoga

30

40.57

1217.00

 

 

 

 

 

 

Matra

 

 

 

 

30

20.43

613.00

 

 

 

 

 

 

Total

60

 

 

 

 

 

 

 

Table No 20

Test Statistics

 

 

 

Pre_pain

 

Post_pain

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mann-Whitney U

 

427.500

 

148.000

 

 

 

 

 

 

 

 

 

Wilcoxon W

 

892.500

 

613.000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Z

 

-.368

 

-4.730

 

 

 

 

 

 

 

 

 

P-value

 

0.713

 

0.000

 

 

 

 

 

 

 

 

Graph 7

118 | P a g e

From the above table it can be seen that the sample size for both the groups is 30 i.e. matra basti group and yoga basti group.

Symptoms of grabbing pain were scaled of 30 patients from both the groups were noted on day 1 with follow up on day 8. Using the SPSS software the mean ranks were calculated for the above days. From the mean ranks it was observed that both the groups are comparable which makes both the samples comparable to each other. Form the p value it can be seen that it is 0.000 which makes it highly significant indicating that before treatment in both the groups pain was there which was reduced in both matra basti as well as yoga basti group after treatment.

T-Test with group = Matra

ÿ Pre and post treatment comparisons

Paired Samples Statistics

 

 

Table No 21

 

 

 

 

 

 

Std.

Std. Error

 

 

Mean

N

Deviation

Mean

Pair 1

pre_symp1

82.00

30

7.497

1.369

 

pst_symp1

98.50

30

9.258

1.690

Pair 2

pre_symp2

6.40

30

1.102

.201

 

pst_symp2

7.13

30

.776

.142

Pair 3

pre_symp4

15.90

30

3.487

.637

 

pst_symp4

24.43

30

8.740

1.596

119 | P a g e

Paired Samples Test

Table No 22

t

P value

Pair 1

pre_symp1 - pst_symp1

-11.983

.000

Pair 2

pre_symp2 - pst_symp2

-5.430

.000

Pair 3

pre_symp4 - pst_symp4

-5.846

.000

The above paired t test is used to find whether the symptoms of ROM i.e. range of

movement has increased or not. This also indicates that that if ROM has increased then

stiffness has also decreased. You can see that in matra group post treatment ROM has

increased i.e is p value is significant which points that after treatment with matra basti

also the stiffness in joints has reduced which is measured by the angle of ROM.

Wilcoxon Signed Ranks Test

Ranks

Table No 23

 

 

 

 

 

 

Mean

Sum of

 

 

 

 

 

N

Rank

Ranks

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

pst_pain - pre_pain

 

Negative Ranks

 

30a

 

15.50

 

465.00

 

 

 

 

 

 

 

 

 

 

 

Positive Ranks

 

0b

 

.00

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ties

 

0c

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

30

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table No 24

Test Statistics

pst_pain - pre_pain

120 | P a g e

Z

-4.919a

 

 

 

 

 

P VALUE

 

.000

 

 

 

 

 

Here also the data suggest that post treatment matra basti patients have shown improvement as p value is significant.

ÿ WILCOXON TEST

The Wilcoxon signed-rank test is a non-parametric statistical hypothesis test for the case of two related samples or repeated measurements on a single sample. It can be used as an alternative to the paired Student's t-test when the population cannot be assumed to be normally distributed. The test is named for Frank Wilcoxon (1892–1965) who, in a single paper, proposed both it and the rank-sum test for two independent samples (Wilcoxon, 1945).

Like the paired or related sample t-test, the Wilcoxon test involves comparisons of differences between measurements, so it requires that the data are measured at an interval level of measurement. However it does not require assumptions about the form of the distribution of the measurements. It should therefore be used whenever the distributional assumptions that underlie the t-test cannot be satisfied.

Suppose we collect 2n observations, two observations of each of the n subjects. Let i denote the particular subject that is being referred to and the first observation measured on subject i be denoted by xi and second observation be yi. For each i in the observations, xi and yi should be paired together.

Assumptions

Let Zi = Yi – Xi for i = 1, ... , n.

121 | P a g e

1.The differences Zi are assumed to be independent.

2.Each Zi comes from the same continuous population, and is symmetric about a common median θ.

3.The values of Xi and Yi represent are ordered, so the comparisons "greater than", "less than", and "equal to" are meaningful.

Test procedure

The null hypothesis tested is H0: θ= 0. The Wilcoxon signed rank statistic W+ is computed by ordering the absolute values |Z1|, ..., |Zn|, the rank of each ordered |Zi| is given a rank of Ri. Denote the positive Zi values with fi = I(Zi > 0), where I(.) is an indicator function. The Wilcoxon signed ranked statistic W+ is defined as

It is often used to test the difference between scores of data collected before and after an experimental manipulation, in which case the central point under the null hypothesis would be expected to be zero. Scores exactly equal to the central point are excluded and the absolute values of the deviations from the central point of the remaining scores are ranked such that the smallest deviation has a rank of 1. Tied scores are assigned a mean rank. The sums for the ranks of scores with positive and negative deviations from the central point are then calculated separately. A value S is defined as the smaller of these two rank sums. S is then compared to a table of all possible distributions of ranks to calculate p, the statistical probability of attaining S from a population of scores that is symmetrically distributed around the central point.

122 | P a g e

This test is conducted to see the result difference in the same group i.e. matra basti group and same symptom, but the comparison is done to evaluate the treatment efficacy in comparison with days related to pain symptom and ROM improvement.

EVALUATION BETWEEN BOTH GROUPS

Magnitude of change in angle and pain score

Now form the above statistical data it can be said that in both the groups i.e. matra basti as well as yoga basti given patients showed improvement in their symptoms. Pain was reduced and ROM of the respective joint increased which indicated reduction in stiffness as then joint. But to find out in which group the results were better as compared to one another following independent t tests, Mann Whitney tests were done.

T-Test Group Statistics

Graph 8

123 | P a g e

ÿ FLEXION ROM

Table No 25

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Std.

Std. Error

 

 

 

 

 

Group

N

 

 

 

 

Mean

 

Deviation

Mean

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

diff_ang1

 

 

M

 

30

 

 

 

 

16.5000

 

 

 

7.54184

 

 

 

1.37694

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

 

30

 

 

 

 

32.8000

 

 

 

16.40101

 

 

 

2.99440

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Independent Samples Test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table No 26

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

t-test for Equality of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Means

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

t

 

 

 

p-value

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

diff_ang1

 

 

 

-4.946

 

 

 

.000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From the above table it can be seen that the data has been analyzed by using independent t test. The data is compared for change in magnitude of ROM angle between matra basti and yoga basti group to find out treatment effectiveness. In above tests, flexion angle is measured pre treatment and post treatment. Their means are calculated and it can be seen that post treatment mean in yoga basti group is almost twice in increasing the flexion angle and reducing the stiffness which indicated that yoga basti is more effective than matra basti. And p value is also highly significant.

124 | P a g e

ÿ EXTENSION ROM

Table No 27

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Std.

 

 

Std. Error

 

 

 

 

 

 

 

Group

N

 

 

Mean

 

 

 

Deviation

 

 

Mean

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

diff_ang2

 

 

 

 

M

 

30

 

 

.7333

 

 

 

.73968

 

 

.13505

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

 

30

 

 

5.1000

 

 

 

2.82049

 

 

.51495

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Independent Samples Test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table No 28

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

t-test for Equality of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Means

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

t

 

 

p-value

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

diff_ang2

 

Equal variances

 

 

-8.202

 

 

.000

 

 

 

 

 

 

 

 

 

 

 

assumed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From the above table it can be seen that the data has been analyzed by using independent t test. The data is compared for change in magnitude of ROM angle between matra basti and yoga basti group to find out treatment effectiveness. In above tests, extension angle is measured pre treatment and post treatment. Their means are calculated and it can be seen that post treatment mean in yoga basti group is almost six times in increasing the extension angle and reducing the stiffness which indicated that yoga basti is more effective than matra basti. And p value is also highly significant.

125 | P a g e

ÿ ABDUCTION ROM

 

 

 

 

 

 

 

Table No 29

 

 

 

 

 

 

Std.

Std. Error

 

Group

N

Mean

Deviation

Mean

diff_ang4

M

30

8.5333

7.99454

1.45960

 

Y

30

20.2333

9.56172

1.74572

Independent Samples Test

Table No 30

 

 

t-test for Equality of

 

 

 

Means

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

t

 

p-value

 

 

 

 

 

 

 

 

 

 

 

 

diff_ang4

 

-5.142

 

.000

 

 

 

 

 

 

 

From the above table it can be seen that the data has been analyzed by using independent t test. The data is compared for change in magnitude of ROM angle between matra basti and yoga basti group to find out treatment effectiveness. In above tests, abduction angle is measured pre treatment and post treatment. Their means are calculated and it can be seen that post treatment mean in yoga basti group is almost twice in increasing the abduction angle and reducing the stiffness which indicated that yoga basti is more effective than matra basti. And p value is also highly significant.

126 | P a g e

Mann-Whitney Test

Table No 31

Ranks

 

 

Group

 

N

 

Mean Rank

 

Sum of Ranks

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

diff_pain

 

M

 

30

 

19.00

 

570.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

 

30

 

42.00

 

1260.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

60

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table No 32

Test Statisticsa

 

 

 

diff_pain

 

 

 

 

 

 

 

 

 

 

 

 

Mann-Whitney U

 

105.000

 

 

 

 

 

 

 

 

 

 

 

 

Wilcoxon W

 

570.000

 

 

 

 

 

 

 

 

 

 

 

 

Z

 

-5.458

 

 

 

 

 

 

 

 

 

 

 

 

Asymp. Sig. (2-tailed)

 

.000

 

 

 

 

 

 

From the above table it can be seen that the data has been analyzed by using Wilcoxon signed rank test and Mann Whitney test to evaluate effectiveness of yoga abasti and matra basti treatment in reducing grabbing pain symptom. The data is compared for same symptom but against day 1, and day 8 for pain reduction in between two groups.

From the above table it can be seen that the data has been analyzed by using independent t test. The data is compared for reduction of grabbing pain between matra basti and yoga basti group to find out treatment effectiveness. Their means are calculated and it can be seen that post treatment mean in yoga basti group is almost three times better in reducing the pain which indicated that yoga basti is more effective than matra basti. And p value is also highly significant.

127 | P a g e

128 | P a g e

DISCUSSION

Form the results following outcomes are available for discussion –

Since trik prushta kati graha being nanatmaja vata vyadhi, vata dosha is predominant as the eitiological factor. All the hetus like prolonged sitting postures, wrong habbits of sitting and standing, labourous job, stress on lower back, trauma etc aggravate vata dosha only in the body.

For treatment of vata dosha vataj upkrama has been mentioned, which includes -

∑Snehana

∑Swedana

∑Madhur, Amla, Lavana Rasa sevan

∑And most important basti.

Ì¢ürÉÉqÉiÉ: mÉUÇ ÍxÉkSÉÇ uÉÉiÉUÉåaÉÉmÉWûÉÇ ´ÉÑhÉÑ |

MåüuÉsÉÇ ÌlÉÃmÉxiÉqpÉqÉÉSÉæ xlÉåWæûÃmÉcÉÉUåiÉ

||

uÉÉrÉÑÇ xÉÌmÉïuÉïxÉÉiÉæsÉqÉ‹mÉÉlÉælÉïUÇ iÉiÉ: |

xlÉåWûYsÉÉliÉÇ xÉqÉɵÉÉxrÉ mÉrÉÉåÍpÉ: xlÉåWûrÉåiÉç mÉÑlÉ: ||

rÉÔwÉæaÉëÉïqrÉÉqoÉÑeÉÉlÉÔmÉUxÉæuÉÉï xlÉåWûxÉÇrÉÑiÉæ: |

129 | P a g e

mÉÉrÉxÉæ: M×üzÉUæ: xÉÉqsÉsÉuÉhÉæUlÉÑuÉÉxÉlÉæ:

||

lÉÉuÉlÉæxiÉmÉïhÉæ¶ÉɳÉæ: xÉÑÎxlÉakÉÇ xuÉåSrÉå¨ÉiÉ: ||90

- cÉ. ÍcÉ. 28/75-77

Vata dosha main stahana in the body is pakvshaya & kati. And medication directly given in the pakvashaya i.e basti is most effective from treatment point of view.Hence all the patients were provided with basti treatment.

Basti in Ayurveda is mentioned of different types, so exactly what is the difference for efficacy point of view, is mentioned now where in detail. Hence it was decided to understand which type of basti is really effective and economical.

Hence both the groups were given same type of treatment i.e.

∑Snehana

∑Swedana

∑Aampachana

∑And basti.

∑Only basti were of 2 different types, viz. matra basti and yoga basti.

Since Yoga basti is of 8 days duration, and no specific duration is mentioned for matra basti, it was decided that to avoid study bais, matra basti regimen will be of also eight days.

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So finally the only difference in both the treatment regimen was same except in yoga basti, 3 niruh bastis were given and 5 anuvasan basti were given. Whereas in matra basti all the eight bastis were of anuvasana type.

From the result it can be observed that yoga basti was more effective as compared to matra basti regimen. This might be due to the factor that in yoga basti 3 niruh bastis were administered with vatanashak herbs.

oÉÎxiÉuÉïrÉ:xjÉÉmÉÌrÉiÉÉ xÉÑZÉÉrÉÑoÉïsÉÉÎalÉqÉåkÉÉxuÉUuÉhÉïM×üŠ |

xÉuÉÉïjÉïMüÉUÏ ÍzÉzÉÑuÉ×kSrÉÔlÉÉÇ ÌlÉUirÉrÉ: xÉuÉïaÉSÉmÉWû¶É ||

ÌuÉOèzsÉåwqÉÌmɨÉÉÌlÉsÉqÉÔ§ÉMüwÉÏï SÉžÉïuÉWû: zÉÑ¢üoÉsÉmÉëS¶É |

ÌuÉwuÉÎYxjÉiÉÇ SÉåwÉcÉrÉÇ ÌlÉUxrÉ ÌuÉMüÉUÉlÉç zÉqÉrÉåͳÉÃWû: ||91

- cÉ. ÍxÉ. 1/27-28

These niruh basti must have played that extra role of reducing the vata dosha from the body as compared to all the anuvasan basti in matra basti. Niruh basti in itself is one of the most powerful basti as can be understood from the above shloka. It can be seen from the words useds like sarvagadapaha (alleviating all diseases) and bala prada (enery and stability providing).

SåWåû ÌlÉÃWåûhÉ ÌuÉzÉÑkSqÉÉaÉåï xÉÇxlÉåWûlÉÇ uÉhÉïoÉsÉmÉëSÇ cÉ |

131 | P a g e

lÉ iÉæsÉSÉlÉÉiÉç mÉUqÉÎxiÉ ÌMüÎgcÉSè SìèurÉÇ ÌuÉzÉåwÉåhÉ xÉqÉÏUhÉÉiÉåï ||92

- cÉ. ÍxÉ. 1/29

The same has been explained by Acharya Charak in definition of anuvasan basti and niruh basti as can be inferred from the above shlokas. Above shloka also indicates that after the body has been purified by niruh basti treatment, anuvasan basti works better.

132 | P a g e

133 | P a g e

CONCLUSIONS

From a study of “A comparative study of yoga basti and matra basti on trik-kati- prustha graha” following conclusion were drawn after discussion on the data observed and analysed –

1.All 60 patients were divided into 2 groups each with 30 patients of trik prushta kati graha. 30 patients in matra basti group and 30 in yoga basti group.

2.All patients were included with symptoms of grabbing pain and trik prushta kati graha i.e. stiffness.

3.It was found that grabbing pain symptoms in both the groups were substantially reduced which means that both types of basti treatment works in trik prushta kati graha.

4.But grabbing pain subsided far better in yoga basti group as compared to matra basti group which indicates that yoga basti is much better in efficacy. This might be attributed to extra niruh bastis which are present in yoga basti regiment and not in matra basti regimen.

134 | P a g e

5.While ROM (Range of Movement) of hip joint measured through flexion, extension and abduction movement was correlated to its stiffness. Less the ROM more the stiffness.

6.It was later seen that ROM was increased in both the basti groups indicating that both types of bastis are effective in trik prushta kati graha for reducing stiffness by increasing ROM at hip joint.

7.It was later seen by Wilcoxon signed rank test that ROM was increased in substantially in yoga basti group as compared to matra basti group indicating that yoga basti is much more effective in trik prushta kati graha for reducing stiffness by increasing ROM at hip joint.

8.Later on Mann Whitney test was also done independently to find out the effective change in ROM separately for each angle and compared against each other group.

9.In short post ROM and pre ROM for flexion at hip joint was calculated from matra basti group and yoga basti group independently. Later on these two values were compared to find out in which group magnitude of change of angle was more and by the statistical test it was found out that change of magnitude of angle for flexion was more in yoga basti group as compared to matra basti group.

10.Also post ROM and pre ROM for extension at hip joint was calculated from matra basti group and yoga basti group independently. Later on these two values were compared to find out in which group magnitude of change of angle was more and

135 | P a g e

by the statistical test it was found out that change of magnitude of angle for flexion was more in yoga basti group as compared to matra basti group.

11.Also post ROM and pre ROM for abduction at hip joint was calculated from matra basti group and yoga basti group independently. Later on these two values were compared to find out in which group mabnitude of change of angle was more and by the statistical test it was found out that change of magnitude of angle for flexion was more in yoga basti group as compared to matra basti group.

12.No patients from the 60 number showed all the symptoms subsiding. From this it can also be concluded that pipalyadi taila, given by both the methods did help in subsiding the symptom of grabbing pain in all the patients. It indicates that pipalyadi taila is better medicine. But yoga basti showed better results as compared to matra basti group which can be attributed to extra niruh basti which were not administered in matra basti group. Hence it can be said that pipalyadi sneha is not the complete medicine in itself for treating trik prushta kati graha. It has to be given adjuant with other formulations like vata shamak dravyas in form of niruh basti, internal oral medication and likewise.

13.Hence, in totality it can be said thatyoga basti is much better than matra basti in trik prushta kati graha for reducing the symptom of grabbing pain and increasing the range of motion at the hip joint for flexion, extension and abduction angle ehcich can be co-related to reduction in stiffness.

136 | P a g e

137 | P a g e

SUMMARY

1.The subject of dissertation is “A comparative study of yoga basti and matra basti on trik-kati-prustha graha”. For this study complilation was done of all the references regarding trik prushta kati graha, basti and pipalyadi taila from the Brihattrayees, and Laghuttrayees.

2.All the Ayurvedic texts including Charak Samhita, Sushruta Samhita, Vagbhatt Samhita, Sharangdhar Samhita, Bahvprakash samhita etc was studied and various references of regarding trik prushta kati graha, and were sorted out for discussion.

3.All the Ayurvedic texts including Charak Samhita, Sushruta Samhita, Vagbhatt Samhita, Sharangdhar Samhita, Bahvprakash samhita etc was studied and various references of regarding basti and were sorted out for discussion.

4.All the Ayurvedic texts including Charak Samhita, Sushruta Samhita, Vagbhatt Samhita, Sharangdhar Samhita, Bahvprakash samhita etc was

138 | P a g e

studied and various references of regarding pipalyadi taila were sorted out for

discussion.

5.References were sorted and compiled in following heads.

∑Trik prushta kati graha.

∑Basti – Matra and Yoga especially.

∑Pipalyadi tailam.

6.Also References were sorted and compiled in following heads from modern medicine.

∑Goniometer.

∑Grabbing pain.

∑ROM at hip joint.

7.Also a survey was done to find out in which the efficacy of matra basti and yoga basti is better in trik prushta and kati graha.

8.For this 60 patients were contacted and data was collected regarding the symptom of grabbing pain and ROM at hip joint for flexion, extension and abduction.

9.Similarly the symptoms of trik prushta kati graha were identified and their gradation was done.

10.Data was collected by random sampling method from patients and their symptoms were noted.

139 | P a g e

11.Then these patients were divided into 2 groups of 30 patients each.

12.Then out of these 60 patients, 30 patients were given matra basti and remaining 30 were given by yoga basti. Duration for both the bastis were 8 days.

13.The data was analyzed properly and the conclusions were presented accordingly.

14.Discussions were done on the collected data and the conclusions were made in such a way that the thesis will be useful for further reference.

140 | P a g e

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43.Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Sutrasthana chapter 19, sholka 29, page 137

44.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 4, shloka 25 page 831

45.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 35, shloka 20

46.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 29-31 page 784

47.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 35, shloka 58

48.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 35, shloka 18

49.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 35, shloka 18

146 | P a g e

50.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 35, shloka 124-27

51.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 28, page 784

52.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 2, shloka 16, page 802

53.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 35, shloka 5

54.Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Sutrasthana chapter 19, sholka 23, page 137

55.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 2, shloka 14, page 801

56.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 35, shloka 21

57.Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Sutrasthana chapter 19, sholka 4- 6, page 134

58.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 3, shloka 23, page 815.

59.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 38, shloka 18

147 | P a g e

60.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 40, page 787

61.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 40, page 787

62.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 40, page 787

63.Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Sutrasthana chapter 19, sholka 49, page 137

64.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 7, shloka 5 page 856

65.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 38, page 787

66.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 4, shloka 21

67.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 4, shloka 20

68.Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Sutrasthana chapter 19, sholka 1, page 133

69.Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Sutrasthana chapter 19, sholka 67, page 137

148 | P a g e

70.Tarkavachaspati Bhattacharya- Vachaspatyam, Chaukhmbha Sanskrit Series, Varanasi, 2nd Edition, page 563

71.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 29, page 783

72.Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Sutrasthana chapter 19, sholka 68, page 137

73.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 27, page 783

74.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 47, page 788

75.Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Sutrasthana chapter 19, sholka 63, page 137

76.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 3, shloka 23, page 815

77.Dr. Anantram Sharma-Sushrut Samhita- Choukhambha Orientalis, Varanasi, Edition 3rd, 2006, Chikitsasthana 38, shloka 33, 34.

78.Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Sutrasthana chapter 19, sholka 44, page 136.

149 | P a g e

79.a) Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Chikitsasthana chapter 8, sholka 90, page 451.

b)Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Chikitsasthana chapter 8, sholka 90, page 451

80.Kaviraj Ambikadutt Shastri, Bhaishajya Ratnavalli, Chouknhambha Prakashan Hindi Translation, 22nd Edition, Arsha Rogadhikar, Chapter 9, Page 320, Shloka 207-210.

81.Vallfors B. Edited. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J. Rehab. Med Suppl 1985; 11: 1-98.

82.ROM Booklet, AOMA 2012 ROM reference: Magee, D. 2006. Orthopedic Physical Assessment. 4th ed. Elsevier Sciences. Goniometer and Bubble inclinometers and patient position reference: Norkin C, White D. 2003.

Measurement of Joint motion. A guide to Goniometry. 3rd edition. Philadelphia. F.A. Davis Company.

83.ROM reference: Magee, D. 2006. Orthopedic Physical Assessment. 4th ed. Elsevier Sciences. Goniometer and Bubble inclinometers and patient position reference: Norkin C, White D. 2003. Measurement of Joint motion. A guide to Goniometry. 3rd edition. Philadelphia. F.A. Davis Company.

84.Norkin C, White D. 2003. Measurement of Joint motion. A guide to Goniometry.

3rd edition. Philadelphia. F.A. Davis Company.

150 | P a g e

85.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Sutrasthana, Chapter 20, shloka 11, page 262

86.Sri Taradattpant Ayurvedacharya, commented Ashtang Hrudaya, Bhagirathi Commentary, Choukhambha Series Prakashan, Nidansthana chapter 15, sholka 7, page 351

87.B. K. Mahajan, Biomedical Statistics, Jaypee Publications, New Delhi, 3rd Edition 1981, page 45.

88.Cooper and Schindler – Marketing Research, Tata MacGraw Hill 5th Edition 1992.

89.B. K. Mahajan, Biomedical Statistics, Jaypee Publications, New Delhi, 3rd Edition 1981, page 103

90.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Chikitsasthana, Chapter 28, shloka 75, page 637

91.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 27, page 783

92.Vaidya Y. G. Joshi – Charak Samhita, Vaidyamitra Prakashan 1st Edition 2003, Volume 2, Siddhisthana, Chapter 1, shloka 29, page 783

151 | P a g e

152 | P a g e

Questionnaire

1.

Name of the patient

-: ---------------------------------------------------------------

2.

Age

-: ---------------------------------------------------------------

3.

Sex

-: ---------------------------------------------------------------

4.

Occupation

-: ---------------------------------------------------------------

5.

Nature of Work

-: ---------------------------------------------------------------

6.

Address

-: ---------------------------------------------------------------

7.

Education

-: ---------------------------------------------------------------

8.

Previous History

-: ---------------------------------------------------------------

9.

Trauma/Accident

-: ---------------------------------------------------------------

10.

Surgery History

-: ---------------------------------------------------------------

11.

Present Complaints

-: ---------------------------------------------------------------

 

 

---------------------------------------------------------------

 

 

---------------------------------------------------------------

 

 

---------------------------------------------------------------

12.

Medications (If any)

-: ---------------------------------------------------------------

 

 

---------------------------------------------------------------

 

 

---------------------------------------------------------------

13.

Gradation of Symptoms

 

 

---------------------------------------------------------------

153 | P a g e

∑Scale for Grabbing Pain

 

No

Mild

Moderate

Severe

 

 

 

 

 

 

 

 

 

 

 

0

 

2

 

 

4

 

 

6

 

 

 

 

 

 

Minimum

 

 

 

 

 

 

 

 

Maximum

Note :- This scale is called as dichotomous scale or simple category scale

Ref – Cooper & Schindler (9th edition TATA MCGRAW HILL PUBLICATION)

Scaling

No

Severity of Grabbing Pain

Grade

 

 

 

1

0 on scale

No Pain

 

 

 

2

2 on scale

Mild Pain

 

 

 

3

4 on scale

Moderate Pain

 

 

 

4

6 on scale

Severe Pain

 

 

 

ÿ

Goniometric Measurements of ROM at Hip Joint before treatment.

∑

Hip Flexion

-: -------------------------------------

∑

Hip Extension

-: -------------------------------------

∑

Hip Abduction

-: -------------------------------------

154 | P a g e

Scaling

No

 

ROM

Stiffness Grade

HIP FLEXION

 

 

1

 

< 80

4

2

 

81-90

3

3

 

91-100

2

4

 

101-110

1

5

 

111-120

0

HIP EXTENSION

 

1

 

< 7

4

2

 

7 only

3

3

 

8 only

2

4

 

9 only

1

5

 

10 and +

0

HIP ABDUCTION

 

1

 

< 15

4

2

 

16 to 20

3

3

 

21 to 25

2

4

 

25 to 30

1

5

 

30 >

0

155 | P a g e

Effect of Treatment

Day

Grabbing

GONIOMETRIC ROM

Oral

Snehana

Swedana

Anuvasan

Niruha

 

Pain

 

 

 

 

 

 

/ Matra

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Angle

Grade

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Flexion

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

Extension

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Abduction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Angle

Grade

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Flexion

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

 

Extension

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Abduction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

156 | P a g e

PATIENTS TREATED WITH YOGA BASTI

 

Patient

 

 

 

Socio-

 

 

Nature of

No

Sex

Age

Occupation

economic

Education

Trauma

Name

Work

 

 

 

 

class

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

M

49

Worker

Lower

< 10

No

Vigorous

 

 

 

 

 

 

 

 

 

2

 

M

42

Worker

Lower

< 10

No

Vigorous

3

 

M

55

Office Clerk

Middle

Graduate

Yes

Sitting

4

 

F

31

Housewife

Middle

Graduate

No

Sitting

5

 

F

32

Maid

Lower

< 10

No

Sitting

6

 

M

47

Worker

Lower

< 10

No

Vigorous

7

 

M

46

Worker

Lower

< 10

No

Vigorous

 

 

 

 

 

 

 

 

 

8

 

F

53

Maid

Lower

< 10

No

Sitting

9

 

M

49

Labourer

Lower

< 10

Yes

Vigorous

10

 

F

33

Maid

Lower

< 10

No

Sitting

11

 

M

45

Police

Middle

Graduate

Yes

Travel

12

 

M

37

Truck Driver

Lower

< 10

No

Travel

13

 

M

49

Police

Middle

Graduate

No

Travel

14

 

M

42

Worker

Lower

< 10

No

Sitting

 

 

 

 

 

 

 

 

 

15

 

F

49

Bank Manager

Upper

Post Graduate

Yes

Sitting

16

 

M

40

Labourer

Lower

< 10

No

Vigorous

17

 

F

40

Housewife

Middle

 

No

Sitting

18

 

F

39

Maid

Lower

< 10

No

Sitting

19

 

F

43

Maid

Lower

< 10

No

Sitting

20

 

M

50

Police

Middle

Graduate

No

Travel

 

 

 

 

 

 

 

 

 

21

 

M

55

Truck Driver

Lower

< 10

No

Travel

22

 

M

40

Truck Driver

Lower

< 10

No

Travel

23

 

F

46

Housewife

Middle

Graduate

No

Sitting

24

 

M

39

Office Clerk

Middle

Graduate

No

Sitting

25

 

M

36

Office Clerk

Middle

Graduate

No

Sitting

26

 

F

41

Office Clerk

Middle

Graduate

Yes

Sitting

 

 

 

 

 

 

 

 

 

27

 

M

50

Worker

Lower

< 10

No

Vigorous

28

 

M

47

Worker

Lower

< 10

No

Vigorous

29

 

M

42

Police

Middle

Graduate

No

Travel

30

 

F

39

Maid

Lower

< 10

No

Sitting

157 | P a g e

PATIENTS TREATED WITH YOGA BASTI

 

Symptoms before treatment

 

Symptoms after Yoga basti treatment

No

Grabbing

Gonimeter ROM (Hip Joint)

 

Grabbing

Gonimeter ROM (Hip Joint)

 

Pain

Flexion

Extension

Abduction

 

Pain

Flexion

Extension

Abduction

 

 

 

 

 

 

 

 

 

 

 

 

110

10 to 15

30 to 50

 

 

110

10 to 15

30 to 50

 

 

to120

 

 

to120

 

 

 

 

 

 

 

 

1

6

79

6

17

 

2

112

12

29

2

6

76

7

19

 

0

109

13

37

3

4

85

7

13

 

0

115

14

45

4

4

87

5

14

 

0

117

9

28

5

6

7

6

12

 

2

116

9

33

6

6

74

5

23

 

4

105

15

27

7

4

96

8

15

 

0

106

15

44

8

2

98

6

24

 

0

113

15

48

9

4

97

7

18

 

0

113

15

46

10

2

84

7

14

 

0

107

13

42

11

4

92

7

19

 

0

116

9

26

12

6

75

6

18

 

2

105

9

26

13

4

85

5

14

 

2

114

9

28

14

6

78

6

13

 

4

113

9

38

15

4

90

8

13

 

0

114

9

40

16

6

80

6

13

 

0

116

13

47

17

6

79

6

14

 

2

120

9

49

18

6

76

5

23

 

0

110

14

25

19

6

73

7

14

 

0

110

9

30

20

4

94

7

13

 

0

120

14

45

21

6

87

6

17

 

2

120

13

30

22

4

77

7

18

 

0

110

14

29

23

4

82

8

14

 

2

108

9

43

24

4

76

8

22

 

0

119

8

46

25

6

77

6

18

 

2

118

8

47

26

4

79

5

20

 

0

103

9

28

27

6

84

7

15

 

2

120

13

42

28

6

76

6

14

 

0

119

14

25

29

6

89

6

13

 

0

117

15

36

30

4

77

7

16

 

0

108

9

38

158 | P a g e

PATIENTS TREATED WITH MATRA BASTI

 

Patient

 

 

 

Socio-

 

 

Nature of

No

Sex

Age

Occupation

economic

Education

Trauma

Name

Work

 

 

 

 

class

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

F

58

Maid

Lower

< 10

No

Sitting

2

 

F

49

Worker

Lower

< 10

No

Vigorous

 

 

 

 

 

 

 

 

 

3

 

M

38

Office Clerk

Middle

Graduate

No

Sitting

4

 

F

55

Housewife

Middle

Graduate

No

Sitting

5

 

F

32

Office Clerk

Middle

Graduate

Yes

Sitting

6

 

M

47

Worker

Lower

< 10

No

Vigorous

7

 

M

44

Police

Middle

Graduate

No

Vigorous

8

 

M

43

Truck Driver

Lower

< 10

No

Sitting

 

 

 

 

 

 

 

 

 

9

 

M

42

Labourer

Lower

< 10

No

Vigorous

10

 

M

37

Truck Driver

Lower

< 10

No

Sitting

11

 

M

42

Police

Middle

Graduate

No

Sitting

12

 

F

39

Bank Manager

Upper

Post Graduate

No

Sitting

13

 

F

54

Bank Manager

Upper

Post Graduate

No

Sitting

14

 

M

59

Worker

Lower

< 10

No

Vigorous

 

 

 

 

 

 

 

 

 

15

 

F

53

Office Clerk

Upper

Post Graduate

No

Sitting

 

 

 

 

 

 

 

 

 

16

 

M

41

Labourer

Lower

< 10

No

Vigorous

17

 

F

36

Housewife

Middle

Graduate

No

Sitting

18

 

M

49

Worker

Lower

< 10

No

Vigorous

19

 

M

43

Worker

Lower

Graduate

No

Vigorous

20

 

F

57

Housewife

Middle

< 10

No

Sitting

 

 

 

 

 

 

 

 

 

21

 

F

55

Maid

Lower

< 10

Yes

Sitting

 

 

 

 

 

 

 

 

 

22

 

M

39

Truck Driver

Lower

< 10

Yes

Travel

23

 

M

46

Police

Middle

Graduate

No

Sitting

24

 

M

40

Office Clerk

Upper

Graduate

No

Sitting

25

 

F

37

Office Clerk

Middle

Graduate

No

Sitting

26

 

M

42

Truck Driver

Lower

< 10

Yes

Sitting

 

 

 

 

 

 

 

 

 

27

 

M

49

Worker

Lower

< 10

No

Vigorous

 

 

 

 

 

 

 

 

 

28

 

M

47

Labourer

Lower

< 10

No

Vigorous

29

 

F

42

Labourer

Middle

< 10

No

Vigorous

30

 

M

46

Labourer

Lower

< 10

No

Sitting

159 | P a g e

PATIENTS TREATED WITH MATRA BASTI

 

Symptoms before treatment

 

Symptoms after Matra basti treatment

No

Grabbing

Gonimeter ROM (Hip Joint)

 

Grabbing

Gonimeter ROM (Hip Joint)

 

Pain

Flexion

Extension

Abduction

 

Pain

Flexion

Extension

Abduction

 

 

 

 

 

 

 

 

 

 

 

 

110

10 to 15

30 to 50

 

 

110

10 to 15

30 to 50

 

 

to120

 

 

to120

 

 

 

 

 

 

 

 

1

4

80

6

17

 

4

89

8

21

2

6

78

6

14

 

4

92

7

17

3

6

89

5

13

 

4

98

7

17

4

6

84

7

16

 

2

99

8

18

5

6

76

8

12

 

6

90

9

15

6

6

73

6

12

 

4

94

7

13

7

6

97

7

14

 

4

117

7

16

8

4

96

7

14

 

2

118

7

17

9

2

94

5

14

 

2

103

6

30

10

2

86

5

18

 

0

90

6

21

11

4

94

6

14

 

2

98

6

33

12

2

75

8

20

 

0

84

8

25

13

4

88

7

20

 

2

98

7

27

14

2

74

7

14

 

0

95

8

18

15

4

88

5

18

 

2

102

6

37

16

6

77

4

14

 

4

95

6

48

17

4

72

5

23

 

4

93

7

43

18

6

74

6

14

 

4

95

6

33

19

4

79

7

19

 

2

104

7

26

20

4

92

6

19

 

4

120

7

27

21

2

82

7

13

 

2

118

8

18

22

4

76

6

12

 

2

102

7

17

23

6

83

8

24

 

4

99

8

29

24

6

80

7

17

 

4

93

7

30

25

6

77

8

14

 

4

103

8

19

26

6

73

8

13

 

2

94

8

19

27

4

86

6

12

 

4

98

7

17

28

6

75

7

14

 

4

93

7

36

29

6

84

7

16

 

4

95

7

23

30

6

78

5

23

 

2

86

7

23

160 | P a g e