Piccha basti

Piccha basti is a classical therapeutic 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.

Contributors

Section/Chapter/topic	Concepts/Basti/Piccha basti
Authors	Auti Swapnil1
Reviewer	Basisht G.2,
Editor	Deole Y.S.3
Affiliations	1 Department of Panchakarma, All India Institute of Ayurveda, Goa, India 2 Rheumatologist, Orlando, Florida, U.S.A. 3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails	swapn.punarvasu19@gmail.com, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	December 16, 2022
DOI	10.47468/CSNE.2022.e01.s09.124

Etymology and derivation

Piccha basti formulation has sticky or slimy (picchila) properties. The word 'piccha’ is derived from picchila (पिच्छिल) that means slimy touch, gummy, sticky, sliminess. Hence the basti formulation having such properties is called ‘Piccha basti’.

Table 1. Specific indications of piccha basti:

Sr.No.	Indications	Reference
1.	In the management of bleeding piles (raktarsha)	Cha. Sa. Chikitsa Sthana 14/ 224
2.	In management of diarrhoea (atisara)	Cha. Sa. Chikitsa Sthana 19/ 63
3.	In management of dysentery (pravahika)	Cha. Sa. Chikitsa Sthana 19/ 94, Su. Sa. Chikitsa Sthana 37/ 41-42
4.	In the management of obstructed Vata and kapha in the gastrointestinal tract (mahasrotas), excessive evacuation of kapha (mucus) with colic pain	Cha. Sa. Chikitsa Sthana 19/ 117
5.	In management of parisrava (rectal oozing), a basti complication	Cha. Sa. Siddhi Sthana 7/ 60
6.	Use of fresh blood in piccha basti	Su. Sa. Chikitsa Sthana 38/ 85-86, Sharangdhara Samhita 6/23

Classical formulations of piccha basti

1. Piccha basti formulation 1

Following ingredients are used as homogenous mixture for piccha basti:

• Two prastha (1536 ml) processed milk decoction (kshira 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)
• Paste of the resin from Shalmali (mocharasa, Bombax ceiba L), Manjishtha (Rubia cordifolia L.), Chandana (Santalum album L.), Utpala (Nymphaea stellata Willd), seeds of Kutaja (Holorrhena antidysenterica Wall.), Priyangu (Callicarpa macrophylla Vahl.) and Padmakeshar (Nelumbo nucifera Gaertn.)
• Ghee, honey, and sugar. [Cha.Sa. Chikitsa Sthana 14/ 225-229]

2. Piccha basti formulation 2

• One pala (48 gm) paste of green stalks of Shalmali (Bombax ceiba L) prepared by putapaka method mixed with one prastha (768 gm) of boiled milk
• Oil, ghee
• Paste of madhuka (Glycyrrhiza glabra Linn.)

Specific indications: Pitta dominant diarrhea, fever, edema, gulma (abdominal lumps), chronic diarrhea, grahani (digestive disorders), and the acute complications of purgation and asthapana basti. [Cha.Sa. Chikitsa Sthana 19/ 64-68]

3. Piccha basti formulation 3

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

Dose of piccha basti

Total 1536 ml (32 pala) [Dalhana]
Total 576 ml (12 pala) [Sharangadhara]*
*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

In current practices, few practitioners use disease-specific sneha (unctuous formulation) like shatadhauta ghrita, changeryadi ghrita, nalapamaradi keram instead of plain cow ghee etc. Some researchers have used durva kalka (paste of scutch grass -Cynodon dactylon) and jatyadi taila in piccha basti.
The widely used formulation of piccha basti and its dose is as below:

• Honey -200 ml
• Saindhava- 12 gm
• Goghrita/ Jatyadi Ghrita/ Nalpamaradi Keram (based on condition)- 100 ml
• The paste of the resin from Shalmali (mocharas, Bombax ceiba L) & madhuka (Glycyrrhiza glabra Linn.)- 30 gm
• Shalmali and Mustadi siddha kshira (milk)- 200 ml

General guidelines

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 therapy or as per the state of dosha (avastha) combined with suitable anuvasana basti.

Mode of action of piccha basti

Chronic diarrhoea is a feature of malabsorption, excessively rapid entry of chyme into the small or large intestine generates propulsive motor patterns leading to accelerated transit. Inflammation is associated with decreased mixing motor patterns, but increased propulsive motility including high amplitude propagated contractions. Hence treatment of inflammation and correcting the excessive abnormal peristalsis is the treatment principle in certain chronic diarrhoea mostly associated with irritable bowel syndrome, Crohn’s disease & ulcerative colitis. Contents in piccha basti have anti-inflammatory and antidiarrheal properties. Moreover, basti treatment itself can set in the reverse peristaltic waves, which can slow down the high amplitude propagated contractions in the colon. Basti has direct access to the colon and rectum, thus drugs used in basti can directly reach the site of inflammation or ulcers without any alteration due to gastric contents. The small intestine is the excretory organ for the pitta & colon for vata in natural course. But diseases associated with the intestine can hamper the pitta and vata excretion. Pitta is excreted through small intestine by virechana therapy and vata from colon by basti. This brings dosha from shakha and marma to koshtha. Thus inflammation to these organs makes the patient ineligible for panchakarma therapy. Koshtha has to be capable of excreting dosha. Thus, it is inevitable to treat and heal the gut (koshtha) on priority either by drug or by basti treatment.

Properties of commonly used drugs in piccha basti

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. It has specific activities such as anti-HIV activity & anti-Helicobacter pylori activity.
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. A gum resin rich in starch contents, mocharasa forms a mucilaginous layer that protects the inflamed and damaged intestinal mucosa.
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. It also possesses antimicrobial and anticancer properties. Manjishtha (Rubia cordifolia L.), chandana (Santalum album L.), utpala (Nymphaea stellata Willd), madhuka (Glycyrrhiza glabra Linn.) used in piccha basti are cold in nature and pacify pitta dosha, which is vital for the reduction of inflammation. Badara (Ziziphus mauritiana Lamk), nagabala (Sida Veronicaefolia), shleshmataka (Cordia dichotoma G.Forsk.) are also helpful for pacifying pitta dosha and checking to bleed. Rakta basti (enema with fresh blood) is beneficial formulation that significantly improves hemoglobin level. The use of rakta in 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.
Honey and ghee together relieve the wound's warmth showing anti-inflammatory actions. Ghrita is a well-known remedy for vitiated pitta. Research has proven the wound-healing potential 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.

Indications of piccha basti

1. Ulcerative colitis
2. Irritable bowel syndrome
3. Crohn’s disease
4. Chronic diarrhoea
5. Colorectal cancer
6. Bleeding piles
7. Celiac disease
8. Dysentery
9. Drug induced colitis
10. Enteropathic arthritis
11. Fissure in ano

Further reading

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

1. 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
2. Daberao, M. Role Of Piccha Basti In The Management Of Celiac Disease W.S.R To Grahani: A Review. IJ-RIM 2020, 4.
3. Sankal, Gurdipsingh and Behera (2018): Clinical Study on role of Piccna Basti in management of chronic colitis. Journal of Ayurveda Physicians and Surgeons July 2018 Volume 5(3) : 77
4. Dabas R, Gupta S, Kar AC. Picchabasti and Nilotpaladi yoga in the management of Ulcerative colitis. J AyuCaRe 2017;1(2): 10-15
5. Lovekrishna Pal Singh Rathore and Lakshman Singh, World Journal of Pharmaceutical Research, 2021, 10(13): 1290-1296
6. Bhausaheb A. Patange, Clinical Efficacy Of Piccha Basti Inparikartika (Fissure-In-Ano), Aayushi International Interdisciplinary Research Journal (AIIRJ), 2019, 6(12): 38-43
7. Dr. Aparna K., & Dr. Ananta S Desai. (2020). Ayurvedic management of Enteropathic arthritis : A Case Study. Journal of Ayurveda and Integrated Medical Sciences, 5(05), 501-504.
8. Pankaj Kumar, Sumit Kumar, Ragini Kumari, & Vijay Bahadur Singh. (2022). Ayurvedic Management of Ulcerative Colitis: A Case Study. International Journal of Ayurveda and Pharma Research, 10(6), 45-48.
9. Jha Shailesh Arunkumar, Pallavi A. Hegde, & M. M. Salimath. (2022). Lateral Fissure-In-Ano - A Case Study. Journal of Ayurveda and Integrated Medical Sciences, 6(6), 291 - 295.
10. Varsakiya JN, Goyal M, Kathad D, Kumari R. Efficacy of Ayurveda modalities in the management Raktaja pravahika (ulcerative colitis): A case report. J Ayurveda Case Rep 2021;4:115-20

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