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<div style='text-align:justify;'>Piccha basti is a classical therapeutic [[Basti|enema]] with decoction (niruha basti). It is indicated explicitly in colorectal disorders like dysentery, bleeding, colitis. It is also helpful in the management of specific complications of niruha basti. This formulation has styptic (sangrahi), healing (ropana), and hemostatic (shonitasthapana) properties. </div>

<div style='text-align:justify;'>Piccha basti is a classical therapeutic [[Basti|enema]] with decoction ([[niruha basti]]). It is indicated explicitly in colorectal disorders like dysentery, bleeding, colitis. It is also helpful in the management of specific complications of [[niruha basti]]. This formulation has styptic (sangrahi), healing (ropana), and hemostatic (shonitasthapana) properties. </div>

{{Infobox

{{Infobox

Following ingredients are used as homogenous mixture for piccha basti:

Following ingredients are used as homogenous mixture for piccha basti:

<ul style='text-align:justify;'><li>Two prastha (1536 ml) processed milk decoction (kshira [[Kashaya|Kashaya]]) made from Yavasa (Alhagi camelorum Fisch.), Kusha (Imperata cylindrical Beauv.), Kasha (Saccharum spontaneum Linn.), flowers of Semul (Bombax ceiba L), and adventitious roots of Nyagrodha (Ficus bengalensis Linn.), Udumbara (Ficus racemosa Linn.), and Ashwattha (Ficus religiosa Linn.) 2 pala i.e. 96 gm each) </li>

<ul style='text-align:justify;'><li>Two prastha (1536 ml) processed milk decoction (kshira [[Kashaya|Kashaya]]) made from Yavasa (Alhagi camelorum Fisch.), Kusha (Imperata cylindrical Beauv.), Kasha (Saccharum spontaneum Linn.), flowers of Semul (Bombax ceiba L), and adventitious roots of Nyagrodha (Ficus bengalensis Linn.), Udumbara (Ficus racemosa Linn.), and Ashwattha (Ficus religiosa Linn.) 2 pala i.e. 96 gm each) </li>

<li>Paste of the resin from Shalmali (mocharasa, Bombax ceiba L), Majishtha (Rubia cordifolia L.), [[Chandana|Chandana (Santalum album L.)]], Utpala (Nymphaea stellata Willd), seeds of [[Kutaja|Kutaja (Holorrhena antidysenterica Wall.)]], Priyangu (Callicarpa macrophylla Vahl.) and Padmakeshar (Nelumbo nucifera Gaertn.) </li>

<li>Paste of the resin from Shalmali (mocharasa, Bombax ceiba L), Manjishtha (Rubia cordifolia L.), [[Chandana|Chandana (Santalum album L.)]], Utpala (Nymphaea stellata Willd), seeds of [[Kutaja|Kutaja (Holorrhena antidysenterica Wall.)]], Priyangu (Callicarpa macrophylla Vahl.) and Padmakeshar (Nelumbo nucifera Gaertn.) </li>

<li>[[Ghee|Ghee]], honey, and sugar. [Cha.Sa. Chikitsa Sthana 14/ 225-229]</li></ul>

<li>[[Ghee|Ghee]], honey, and sugar. [Cha.Sa. Chikitsa Sthana 14/ 225-229]</li></ul>

=== 3. Piccha basti formulation 3: ===

=== 3. Piccha basti formulation 3: ===

<div style='text-align:justify;'>Twenty four pala (1152 ml) processed milk decoction (kshira Kashaya) made from 3 pala (144 gm) of certain drugs?? [Badara (Ziziphus mauritiana Lamk), nagabala (Sida Veroni  caefolia), shleshmataka (Cordia dichotoma G.Forsk.), shalmali (Bombax ceiba L), dhanvana (Coriandrum sativum L.) ankura all in equal quantity] + 4 pala (192gm) of honey + 4 pala (192 ml) of fresh blood </div>

<div style='text-align:justify;'>Twenty four pala (1152 ml) processed milk decoction (kshira Kashaya) made from 3 pala (144 gm) of certain drugs [Badara (Ziziphus mauritiana Lamk), nagabala (Sida Veroni  caefolia), shleshmataka (Cordia dichotoma G.Forsk.), shalmali (Bombax ceiba L), dhanvana (Coriandrum sativum L.) ankura all in equal quantity] + 4 pala (192gm) of honey + 4 pala (192 ml) of fresh blood </div>

== Dose of piccha basti: ==

== Dose of piccha basti ==

1536 ml (32 pala) [Dalhana]<ref name="ref2">Dalhana on Sushrut Samhita Chikitsasthana 38/ 85-86, https://niimh.nic.in/ebooks/esushruta/?mod=read, cited on 1.10.2022</ref> <br/>576 ml (12 pala) [Sharangadhara]* <br/>*However, this particular dose seems specific for the piccha basti having fresh blood as an ingredient. [Su. Sa. Chikitsa Sthana 38/ 85-86]  

Total 1536 ml (32 pala) [Dalhana]<ref name="ref2">Dalhana on Sushrut Samhita Chikitsasthana 38/ 85-86, https://niimh.nic.in/ebooks/esushruta/?mod=read, cited on 1.10.2022</ref> <br/>Total 576 ml (12 pala) [Sharangadhara]* <br/>*However, this particular dose seems specific for the piccha basti having fresh blood as an ingredient. [Su. Sa. Chikitsa Sthana 38/ 85-86]  

== Practical application of piccha basti: ==

== Practical application of piccha basti ==

<div style='text-align:justify;'>In current practices, few practitioners use disease-specific [[Snehana (unction therapy)|sneha]] (unctuous formulation) like shatadhauta ghrita, changeryadi ghrita, nalapamaradi keram instead of plain cow [[Ghee|ghee]] etc.<ref name="ref3">L. Mahadevan, Ayurvedic clinical practice, Dr. Y  Mahadeva iyyar’s Sri Sarada Ayurvedic hospital, 1st edition, 2010; 1: 55</ref> Some researchers have used durva kalka (paste of scutch grass -Cynodon dactylon) and jatyadi taila in piccha basti. <ref name="ref4">Sharma P, Kajaria D. Efficacy of Piccha Basti and immune enhancer medicines in the management of ulcerative colitis. Indian Journal of Ayurveda integrative Medicine 2022; 3:41-6</ref> <br/>The widely used formulation of piccha basti and its dose is as below:  

<div style='text-align:justify;'>In current practices, few practitioners use disease-specific [[Snehana (unction therapy)|sneha]] (unctuous formulation) like shatadhauta ghrita, changeryadi ghrita, nalapamaradi keram instead of plain cow [[Ghee|ghee]] etc.<ref name="ref3">L. Mahadevan, Ayurvedic clinical practice, Dr. Y  Mahadeva iyyar’s Sri Sarada Ayurvedic hospital, 1st edition, 2010; 1: 55</ref> Some researchers have used durva kalka (paste of scutch grass -Cynodon dactylon) and jatyadi taila in piccha basti. <ref name="ref4">Sharma P, Kajaria D. Efficacy of Piccha Basti and immune enhancer medicines in the management of ulcerative colitis. Indian Journal of Ayurveda integrative Medicine 2022; 3:41-6</ref> <br/>The widely used formulation of piccha basti and its dose is as below:  

<ul><li>Honey -200 ml</li>

<ul><li>Honey -200 ml</li>

<li>Saindhava- 12 gm</li>

<li>Saindhava- 12 gm</li>

<li>Goghrita/ Jatyadi Ghrita/ Nalpamaradi Keram (based on condition)- 100 ml</li>

<li>Goghrita/ Jatyadi Ghrita/ Nalpamaradi Keram (based on condition)- 100 ml</li>

<li>The paste of the resin from Shalmali (mocharas, Bombax ceiba L) & madhuka (Glycyrrhiza glabra Linn.- 30 gm</li>

<li>The paste of the resin from Shalmali (mocharas, Bombax ceiba L) & madhuka (Glycyrrhiza glabra Linn.)- 30 gm</li>

<li>Shalmali and Mustadi siddha kshira (milk)- 200 ml</li></ul></div>

<li>Shalmali and Mustadi siddha kshira (milk)- 200 ml</li></ul></div>

=== General guidelines: ===

=== General guidelines: ===

<div style='text-align:justify;'>[[Asthapana basti|Asthapana basti]] is contraindicated in diarrhea with ama (amatisara). It is indicated in diarrhea without ama (nirama atisara). Hence in cases of chronic diarrhea and where there is no relation of ama, piccha basti can be utilized ideally. [Cha.Sa. Siddhi Sthana 1/ 14-16]  Piccha basti may be given in any of the schedules of [[Basti|basti]] therapy or as per the state of [[Dosha|dosha]] (avastha) combined with suitable [[Anuvasana|anuvasana]] basti.</div>

<div style='text-align:justify;'>[[Asthapana basti|Asthapana basti]] is contraindicated in diarrhea with [[ama]] (amatisara). It is indicated in diarrhea without [[ama]] (nirama atisara). Hence in cases of chronic diarrhea and where there is no relation of ama, piccha basti can be utilized ideally. [Cha.Sa. Siddhi Sthana 1/ 14-16]  Piccha basti may be given in any of the schedules of [[Basti|basti]] therapy or as per the state of [[Dosha|dosha]] (avastha) combined with suitable [[Anuvasana|anuvasana]] basti.</div>

== Mode of action of piccha basti: ==

== Mode of action of piccha basti: ==

<div style='text-align:justify;'>Shalmali i.e. Salmalia malabarica (DC.) Schott & Endl is the primary and common ingredient in all the classical formulations of piccha basti. This herb is included in purishavirajaniya, shonitasthapana, vedanasthapana kashaya. [Cha. Sa. Sutra Sthana 4/46-50] Gum resin and stem of shalmali both are used to prepare piccha basti. It has antibacterial, antioxidant, anti-inflammatory, anti-carcinogenic, immunomodulatory, hypolipidemic, antihyperglycemic and analgesic properties.<ref name="ref6">https://www.easyayurveda.com/2012/10/03/shalmali-silk-cotton-tree-ayurveda-use-formulations-home-remedies/ cited on 1.10.2022</ref> It has specific activities such as anti-HIV activity & anti-Helicobacter pylori activity.<ref name="ref7">Sarita Karole*, Dr. Greindra Gautam, Dr. Shailsh Gupta, Pharmacognostic And Pharmacological Profile Of Bombax Ceiba, Asian Journal of Pharmaceutical Education and Research, 2017, 6(3): 16-27</ref> <br/>Tannins and gallic acids present in mocharasa acts as astringents which precipitate proteins that are helpful in restoring the damaged epithelial mucosal lining of the ulcerated mucosa.<ref name="ref8">Jagtap AG, Niphadkar PV, Phadke AS. Protective effect of aqueous extract of Bombax malabaricum DC on experimental models of inflammatory bowel disease in rats and mice. Indian J Exp Biol 2011;49:343-51</ref> A gum resin rich in starch contents, mocharasa forms a mucilaginous layer that protects the inflamed and damaged intestinal mucosa. <br/>Nyagrodha (Ficus bengalensis Linn.), Udumbara (Ficus racemosa Linn.), and Ashwattha (Ficus religiosa Linn.) are used in piccha basti formulation. These are contents of panchavalkala with wound healing properties.<ref name="ref9">Dhurve, V., & Dudhamal, T. (2020, September 29). Wound healing potential of three forms of Panchavalkala in post-operative fistula wounds- Case Series. International Journal of AYUSH Case Reports, 4(3), 189-197.</ref> It also possesses antimicrobial and anticancer properties.<ref name="ref10">Aphale S, Pandita S, Raina P, Mishra J N, Kaul-Ghanekar R. Phytochemical standardization of panchavalkala: An ayurvedic formulation and evaluation of its anticancer activity in cervical cancer cell lines. Phcog Mag 2018;14:554-60</ref> Manjishtha (Rubia cordifolia L.), [[Chandana|chandana (Santalum album L.)]], utpala (Nymphaea stellata Willd), madhuka (Glycyrrhiza glabra Linn.) used in piccha basti are cold in nature and pacify [[Pitta dosha|pitta dosha]], which is vital for the reduction of inflammation. Badara (Ziziphus mauritiana Lamk)<ref name="ref11">https://www.iafaforallergy.com/herbs-a-to-z/badara-ziziphus-jujuba/ cited on 25.09.2022</ref>, nagabala (Sida Veronicaefolia)<ref name="ref12">https://www.easyayurveda.com/2012/10/03/nagabala-full-ayurvedic-details-usage-health-benefits-formulation/#properties cited on 25.09.2022</ref>, shleshmataka<ref name="ref13"> https://www.easyayurveda.com/2016/12/21/lasoda-cordia-dichotoma-shleshmataka/ cited on 25.09.2022</ref> (Cordia dichotoma G.Forsk.) are also helpful for pacifying [[Pitta dosha|pitta dosha]] and checking to bleed. Rakta basti (enema with fresh blood) is beneficial formulation that significantly improves hemoglobin level.<ref name="ref14">Abhijit Dinkarrao Shekhar, Role of Raktabasti In Pandu (Mycrocytic Hypocromic Anemia), World Journal Of Pharmaceutical And Medical Research, 2017,3(5), 146-151</ref> The use of [[Rakta dhatu|rakta]] in [[Basti|basti]] formulation may be useful to overcome the anemia caused by blood loss through the colonic bleeding. Due to antibacterial and healing properties, pichha basti can be well deployed in fissure in ano. Piccha basti probably removes the accumulated secretions in the fissure bed, promotes healing and reduces secondary infection too. <br/>Honey and [[Ghee|ghee]] together relieve the wound's warmth showing anti-inflammatory actions.<ref name="ref15">Charde MS, Fulzele SV, Satturwar PM, et al. Wound healing and anti-inflammatory potential of madhu-ghrita. Indian J Pharm Sci. 2006;68:26–31.</ref> Ghrita is a well-known remedy for vitiated pitta. Research has proven the wound-healing potential<ref name="ref16">Subrahmanyam M. Topical application of honey for burn wound treatment – an overview. Ann Burns Fire Disasters. 2007;20:137–140.</ref> of honey and its inhibitory effect on most strains of pathogenic bacteria. Also, the increase in resistant bacterial species has stressed using natural antibacterial agents.<ref name="ref17">Cooper RA, Molan PC, Harding KG (1999) Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. J Roy Soc Med 283–285</ref>  </div>

<div style='text-align:justify;'>Shalmali i.e. Salmalia malabarica (DC.) Schott & Endl is the primary and common ingredient in all the classical formulations of piccha basti. This herb is included in purishavirajaniya, shonitasthapana, vedanasthapana kashaya. [Cha. Sa. Sutra Sthana 4/46-50] Gum resin and stem of shalmali both are used to prepare piccha basti. It has antibacterial, antioxidant, anti-inflammatory, anti-carcinogenic, immunomodulatory, hypolipidemic, antihyperglycemic and analgesic properties.<ref name="ref6">https://www.easyayurveda.com/2012/10/03/shalmali-silk-cotton-tree-ayurveda-use-formulations-home-remedies/ cited on 1.10.2022</ref> It has specific activities such as anti-HIV activity & anti-Helicobacter pylori activity.<ref name="ref7">Sarita Karole*, Dr. Greindra Gautam, Dr. Shailsh Gupta, Pharmacognostic And Pharmacological Profile Of Bombax Ceiba, Asian Journal of Pharmaceutical Education and Research, 2017, 6(3): 16-27</ref> <br/>Tannins and gallic acids present in mocharasa acts as astringents which precipitate proteins that are helpful in restoring the damaged epithelial mucosal lining of the ulcerated mucosa.<ref name="ref8">Jagtap AG, Niphadkar PV, Phadke AS. Protective effect of aqueous extract of Bombax malabaricum DC on experimental models of inflammatory bowel disease in rats and mice. Indian J Exp Biol 2011;49:343-51</ref> A gum resin rich in starch contents, mocharasa forms a mucilaginous layer that protects the inflamed and damaged intestinal mucosa. <br/>Nyagrodha (Ficus bengalensis Linn.), Udumbara (Ficus racemosa Linn.), and Ashwattha (Ficus religiosa Linn.) are used in piccha basti formulation. These are contents of panchavalkala with wound healing properties.<ref name="ref9">Dhurve, V., & Dudhamal, T. (2020, September 29). Wound healing potential of three forms of Panchavalkala in post-operative fistula wounds- Case Series. International Journal of AYUSH Case Reports, 4(3), 189-197.</ref> It also possesses antimicrobial and anticancer properties.<ref name="ref10">Aphale S, Pandita S, Raina P, Mishra J N, Kaul-Ghanekar R. Phytochemical standardization of panchavalkala: An ayurvedic formulation and evaluation of its anticancer activity in cervical cancer cell lines. Phcog Mag 2018;14:554-60</ref> Manjishtha (Rubia cordifolia L.), [[Chandana|chandana (Santalum album L.)]], utpala (Nymphaea stellata Willd), madhuka (Glycyrrhiza glabra Linn.) used in piccha basti are cold in nature and pacify [[Pitta dosha|pitta dosha]], which is vital for the reduction of inflammation. Badara (Ziziphus mauritiana Lamk)<ref name="ref11">https://www.iafaforallergy.com/herbs-a-to-z/badara-ziziphus-jujuba/ cited on 25.09.2022</ref>, nagabala (Sida Veronicaefolia)<ref name="ref12">https://www.easyayurveda.com/2012/10/03/nagabala-full-ayurvedic-details-usage-health-benefits-formulation/#properties cited on 25.09.2022</ref>, shleshmataka<ref name="ref13"> https://www.easyayurveda.com/2016/12/21/lasoda-cordia-dichotoma-shleshmataka/ cited on 25.09.2022</ref> (Cordia dichotoma G.Forsk.) are also helpful for pacifying [[Pitta dosha|pitta dosha]] and checking to bleed. Rakta basti (enema with fresh blood) is beneficial formulation that significantly improves hemoglobin level.<ref name="ref14">Abhijit Dinkarrao Shekhar, Role of Raktabasti In Pandu (Mycrocytic Hypocromic Anemia), World Journal Of Pharmaceutical And Medical Research, 2017,3(5), 146-151</ref> The use of [[Rakta dhatu|rakta]] in [[Basti|basti]] formulation may be useful to overcome the anemia caused by blood loss through the colonic bleeding. Due to antibacterial and healing properties, pichha basti can be well deployed in fissure in ano. Piccha basti probably removes the accumulated secretions in the fissure bed, promotes healing and reduces secondary infection too. <br/>Honey and [[Ghee|ghee]] together relieve the wound's warmth showing anti-inflammatory actions.<ref name="ref15">Charde MS, Fulzele SV, Satturwar PM, et al. Wound healing and anti-inflammatory potential of madhu-ghrita. Indian J Pharm Sci. 2006;68:26–31.</ref> Ghrita is a well-known remedy for vitiated pitta. Research has proven the wound-healing potential<ref name="ref16">Subrahmanyam M. Topical application of honey for burn wound treatment – an overview. Ann Burns Fire Disasters. 2007;20:137–140.</ref> of honey and its inhibitory effect on most strains of pathogenic bacteria. Also, the increase in resistant bacterial species has stressed using natural antibacterial agents.<ref name="ref17">Cooper RA, Molan PC, Harding KG (1999) Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. J Roy Soc Med 283–285</ref>  </div>

== Clinical indications of piccha basti: ==

== Indications of piccha basti ==

<ol><li>Ulcerative colitis</li>

<ol><li>Ulcerative colitis</li>

<li>Irritable bowel syndrome</li>

<li>Irritable bowel syndrome</li>

<li>Fissure in ano</li></ol>

<li>Fissure in ano</li></ol>

== Further reading: ==

== Further reading ==

Following research works have been done to study effect of piccha basti as treatment modality.  

Following research works have been done to study effect of piccha basti as treatment modality.  

<ol style='text-align:justify;'><li>Sharma P, Kajaria D. Efficacy of Piccha Basti and immune enhancer medicines in the management of ulcerative colitis. Indian Journal of Ayurveda integrative Medicine 2022; 3:41-6</li>

<ol style='text-align:justify;'><li>Sharma P, Kajaria D. Efficacy of Piccha Basti and immune enhancer medicines in the management of ulcerative colitis. Indian Journal of Ayurveda integrative Medicine 2022; 3:41-6</li>