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|title=Piccha basti
|title=Piccha basti
|titlemode=append
|titlemode=append
|keywords= Piccha basti, carakasamhitaonline, charak samhita, caraka samhita, ayurved, Piccha basti in ayurveda, Auti Swapnil, Basisht G., Deole Y.S., Piccha basti formulation, indications of piccha basti, Dose of piccha basti
|keywords= Piccha basti, carakasamhitaonline, charak samhita, caraka samhita, ayurved, Piccha basti in ayurveda, Auti Swapnil, Basisht G., Deole Y.S., Piccha basti formulation, indications of piccha basti, Dose of piccha basti, Indian system of medicine. treatment of ulcerative colitis, irritable bowel syndrome, gut health in ayurveda, basti, therapeutic enema
|description=Piccha basti is a classical therapeutic enema with decoction (niruha basti)
|description=Piccha basti is a classical therapeutic enema with decoction (niruha basti)
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
== Classical formulations of piccha basti ==
== Classical formulations of piccha basti ==
=== 1. Piccha basti formulation 1: ===
=== 1. Piccha basti formulation 1 ===
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>[[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>
=== 2. Piccha basti formulation 2: ===
=== 2. Piccha basti formulation 2 ===
<div style='text-align:justify;'><ul><li>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 </li>
<div style='text-align:justify;'><ul><li>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 </li>
<li>Oil, [[Ghee|ghee]]</li>
<li>Oil, [[Ghee|ghee]]</li>
'''Specific indications:''' Pitta dominant diarrhea, [[Jwara|fever]], edema, [[Gulma Nidana|gulma (abdominal lumps)]], chronic diarrhea, [[Grahani Chikitsa|grahani (digestive disorders)]], and the acute complications of purgation and [[Asthapana basti|asthapana basti]]. [Cha.Sa. Chikitsa Sthana 19/ 64-68] </div>
'''Specific indications:''' Pitta dominant diarrhea, [[Jwara|fever]], edema, [[Gulma Nidana|gulma (abdominal lumps)]], chronic diarrhea, [[Grahani Chikitsa|grahani (digestive disorders)]], and the acute complications of purgation and [[Asthapana basti|asthapana basti]]. [Cha.Sa. Chikitsa Sthana 19/ 64-68] </div>
=== 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>
<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;'>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.<ref name="ref5">Spiller R. Role of motility in chronic diarrhoea. Neurogastroenterol Motil. 2006 Dec;18(12):1045-55</ref> 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 [[Vyadhi|disease]] & ulcerative colitis. Contents in piccha basti have anti-inflammatory and antidiarrheal properties. Moreover, [[Basti|basti]] treatment itself can set in the reverse peristaltic waves, which can slow down the high amplitude propagated contractions in the colon. [[Basti|Basti]] has direct access to the colon and rectum, thus drugs used in [[Basti|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|pitta]] & colon for [[Vata dosha|vata]] in natural course. But [[Vyadhi|diseases]] associated with the intestine can hamper the [[Pitta|pitta]] and [[Vata dosha|vata]] excretion. [[Pitta|Pitta]] is excreted through small intestine by [[Virechana|virechana]] therapy and [[Vata dosha|vata]] from colon by [[Basti|basti]]. This brings [[Dosha|dosha]] from shakha and [[Marma|marma]] to [[Koshtha|koshtha]]. Thus inflammation to these organs makes the patient ineligible for [[Panchakarma|panchakarma]] therapy. [[Koshtha|Koshtha]] has to be capable of excreting [[Dosha|dosha]]. Thus, it is inevitable to treat and heal the gut ([[Koshtha|koshtha]]) on priority either by drug or by [[Basti|basti]] treatment. </div>
<div style='text-align:justify;'>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.<ref name="ref5">Spiller R. Role of motility in chronic diarrhoea. Neurogastroenterol Motil. 2006 Dec;18(12):1045-55</ref> 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 [[Vyadhi|disease]] & ulcerative colitis. Contents in piccha basti have anti-inflammatory and antidiarrheal properties. Moreover, [[Basti|basti]] treatment itself can set in the reverse peristaltic waves, which can slow down the high amplitude propagated contractions in the colon. [[Basti|Basti]] has direct access to the colon and rectum, thus drugs used in [[Basti|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|pitta]] & colon for [[Vata dosha|vata]] in natural course. But [[Vyadhi|diseases]] associated with the intestine can hamper the [[Pitta|pitta]] and [[Vata dosha|vata]] excretion. [[Pitta|Pitta]] is excreted through small intestine by [[Virechana|virechana]] therapy and [[Vata dosha|vata]] from colon by [[Basti|basti]]. This brings [[Dosha|dosha]] from shakha and [[Marma|marma]] to [[Koshtha|koshtha]]. Thus inflammation to these organs makes the patient ineligible for [[Panchakarma|panchakarma]] therapy. [[Koshtha|Koshtha]] has to be capable of excreting [[Dosha|dosha]]. Thus, it is inevitable to treat and heal the gut ([[Koshtha|koshtha]]) on priority either by drug or by [[Basti|basti]] treatment. </div>
== Properties of commonly used drugs in piccha basti: ==
== Properties of commonly used drugs in 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>