Summary & Conclusion

DISCUSSION

To reach up to the depth of the knowledge the discussion is the

most important step which helps in understanding the subject and guides
to conclusion. Before establishment of truth, Discussion is mandatory. In
spite of detailed classical study and experimentation, a theory can be
accepted only after proper reasoning of observations. Hence, the
discussion is very crucial part of any scientific work. It can either support
the hypothesis or it can help in amendment or it may revolutionize the
concept totally.

Pakshaaghaata is a most disabling disease among all the

Vaatavyaadhi. In the Vedic period the disease Pakshaaghaata was under
the broad heading of Vaatavyaadhi. Gradual clinical development of the
disease Pakshaaghaata was observed with the passage of time. In the
Samhitaa Kaala in Charaka Samhitaa the General Sampraapti of
Pakshaaghaata has been mentioned as a separate disease along with its
line of management. Later on the Pakshaaghaata has been classified
considering the Doshaanubandha in Pakshaaghaata and mentioned the
characteristic symptoms of Kaphaanubandha and Pittaanubandha
Pakshaaghaata in Maadhava Nidaana.

The term corresponding to Pakshaaghaata in modern medical

science is hemiplegia. Hemiplegia also gets manifested as a consequence
of a wide variety of pathological condition involving brain like vascular
disorders of brain, infective disorders, tumor, trauma and degenerative
disorders of brain. As the pathological processes in hemiplegia, due to the
above diseases are different, the treatment of hemiplegia also varies in
each condition.

Cerebrovascular accident is the most frequent disease manifesting

as Pakshaaghaata. This disease is enjoying the third leading cause of
death in developing countries. In the present study an effort has been

246
 Summary & Conclusion

made to establish a standard Sampraapti for the Pakshaaghaata due to

cerebrovascular accident.

The risk factors for the stroke are Hypertension, Heart disease
(Heart failure, Atrial fibrillation), Diabetes mellitus, Hyperlipidemia Obesity,
Smoking, Excess alcohol consumption, Polycythemia and the causes are
atherosclerotic thromboembolism, cardiogenic embolism, altered blood
hemodynamics.

Virechana, the main line of treatment cannot be applied in Suddha

Vata condition. Virechana is the line of treatment for Vaata Vyaadhi
condition where Vata is associated with Kapha, Pitta, Rakta and Meda.
Out of all cerebrovascular accidents 80 % are due to ischemia and 20 %
are due to hemorrhage. 20 % of all CVA present as transient ischemic
attack which can be correlated with Mada and Murchchhaa. 80 % patients
of stroke become unconscious and present as comma, this can be
comparable to Sanyaasa. Death occurs in 20 % of the patients, those
present with comma and remaining 60 % survive as a patient of
Pakshaaghaata. Thus the Sampraapti of Mada, Murchchhaa, Sanyaasa
should be understood as basic Sampraapti for Pakshaaghaata due to
CVA with slight modification considering the Nidanaarthakara Roga of
CVA and the condition for the indication of Virechana in Vaatavyaadhi i.e.
in Vaatavyaadhi where Vata is obstructed with Pitta, Rakta, Kapha, Meda.

AGE

In the series of 76 patients of Pakshaaghaata, Patients between the

age group of 30-70 years were selected for present clinical study. The
data reveals that majority of the patients 39.48% were reported in the age
group of 51-60 years followed by 28.94% in the age group of 41-50 years,
19.74% in the age group of 30-40 and 11.84% in the age group 61-70
years respectively.Above data shows that maximum patients were in the
age group of 40to 60 years. This age is the middle age of the life. In this
age there is the dominancy of Pitta followed by kapha.

247
 Summary & Conclusion

Pakshaaghaata due to CVA, manifested due to Aavarana of Vaata

with other Dosha has therefore peak onset period in this age Group. This
age is also the active period in the life of a person and has to act in
accordance with many responsibilities. So this is the period when a person
gets exposed to many stress factors. Due to the stress there is excessive
secretion of stress hormones disturbing the normal metabolism of the
carbohydrate, fat, etc and making the person susceptible to many
diseases like obesity, diabetes, hypertension, atherosclerosis etc which
are the major risk factors for the cerebrovascular accident. Most of the
stress factors are well described in Ayurveda causing the Dushti of Rasa,
Rakta and Manovaha Srotas which are the seat of the disease.

SEX

Higher incidence was observed in males (88.16 %) than females

(11.84%). This supports the statement, “stroke affects males 1.5 times
more often than females. The decreased incidence of CVA is found in the
reproductive age of female. After the reproductive age the incidence is
same in both the sex. This is because the reproductive hormone in female
(Estrogen) prevents atherosclerosis and stroke. The males are also the
highly active counterpart in the society and being exposed to more stress
than the females.

RELIGION

76.32% of patients who opted for study were from Hindu

Community and 23.68% were others. This may be due to demographic
dominance of Hindu so no specific conclusion can be made on this

MARITAL STATUS

In the present study majority of the patients (96.06%) were married.

This data is only the reflection of social pattern of Indian society as all
most all the patients belonged to mature age (above 25 years) and by this
age most of the Indians get married. Nothing specific conclusion can be
drawn from this observation in relation to this morbidity.

248
 Summary & Conclusion

EDUCATIONAL STATUS

In the present study only 11.84 % patients were uneducated and

rest were educated from primary to Post graduate level. In this study,
Primary educated patients were 9.22% Matriculation educated patients
were 27.63% Graduated patients were 36.84%

It may be due to urban habitat of the patients. So, it would be

irrelevant to correlate this finding with epidemiological aspect of the
disease.

OCCUPATION

A larger part of the sample comprised of businessmen 40.79%,

followed by service men 35.53 %, Labourers 15.78 %, house hold7.90 %
. The hospital where the study has been carried out lies in urban
area.The high incidences of CVA were reported in urban people due to
stress,smoking,drinking etc.

In case of businessmen, servicemen and housewives the sedentary

lifestyle, irregular diet habit, Vegavidhaarana, financial crisis, and mental
stress may be the contributory factor in the manifestation of the disease.

SOCIOECONOMIC STATUS

In the present study, 68.42 % patients belonged to the middle

class, followed by 19.74 % patients from upper class, 11.84% patients
belonging to lower class, The high incidence of disease in middle and
upper class may be due to the fact that, they face maximum strain
physically and mentally to maintain their living standards.

HABITAT

Urban people found to be more prone than the rural people

due to the life full of hustles and bustles, irregular dietary patterns etc in
the urban area. Distribution of maximum patients 60.52% among
sadharan Desha can be due to geographic location of the institute.

249
 Summary & Conclusion

FAMILY HISTORY

The present study shows that (90.79%) of patients were having

Negative family history followed by 9.21% of patients having positive
family history. Nothing specific conclusion can be drawn from this
observation in relation to this morbidity.

CHRONICITY

A wide variation was observed in chronicity of patients, i.e., the

patients presented from less than 1 week of onset to 2 years of chronicity.
The range of chronicity for the study was less than 2 years. Maximum
patients had a chronicity of 1 – 2 years (48.69 %), followed by chronicity of
6-12 months (23.68%) and Very less number of patients were of the
chronicity less than 3months. This is because of the fact that, the patients
first opt for allopathy treatment and they get switched to the Ayurvedic
treatment only when they realize that there is nothing left in allopathic
treatment to treat their condition.

DIETARY HABITS

In this study, majority of patients (65.78 %) were noticed to take

vegetarian type of Diet, which is a common trend among the Hindus
Intake of Lavana (11.84%) and Madhura Rasa (23.68%) Predominantly
may be considered as factors of vitiation of Pitta and Kapha Dosha, which
in turn vitiates Agni Vyaapaara of Dhaatu like Meda and Rasa-Rakta and
hence produces Aama – the initiator of pathogenesis and can lead to
Maargaavrodha of Vaata leading to the disease Pakshaaghaata.

AGNI & KOSHTHA

While studying the patients in respect to Agni and Koshtha it was

found that maximum no. of patients were having Mandaagni 42.11 %
followed by Vishamaagni (38.16%) and Kostha wise maximum patients
were Madhyama Koshtha (52.64%). This shows the dominance of Kapha
and Vaata in predisposing this condition.

250
 Summary & Conclusion

ADDICTION

Study of addiction reveals 28.94 % of patients were found to be

having addiction of smoking, followed by tobacco 17.11% and alcohol
13.15 %. Nicotine in the smoking makes the arteries thick hypersensitive
and causes spasm. It also causes endothelial injury providing platform for
platelet aggregation and formation of thromboembolism making the
patients more susceptible for CVA. Alcohol consumption causes
excessive lipolysis and increase the serum free fatty acid level rendering
the individual more susceptible for atherosclerosis it also causes
weakness of capillary endothelium.

MENTAL STATUS

Maximum patients had Tensive emotional status (39.47%), followed

by anxious 30.26% and remaining depressive emotional status. The
emotional status of an individual plays a vital role in the manifestation of
disease. The disturbed Agni is the root cause of all the diseases. The Agni
is greatly influenced by the emotional status of an individual. As it is said
by Aachaarya Charaka, that if the mind of an individual is affected with
Krodha, Shoka etc, then the foods taken in proper quantity will also does
not get digested properly. Due to the alteration of Agni there is production
of Aama, both at Jatharaagni and Dhaatwaagni (particularly Meda, Rakta,
and Rasa) level. This causes obstruction of Vaayu to provocate it causing
Pakshaaghaata.

PRAKRITI

All the patients exhibited a Dvandwaja Doshic constitution, with

majority of Pitta-Kaphaja (43.42%), followed by Kapha-Vaata Prakriti
(36.84%) and Vaata-Pitta Prakriti (19.73%). Maximum number of Kapha-
Pitta dominant Prakriti is observed because the disease Pakshaaghaata
due to CVA is a Kapha-Pitta dominant Vyaadhi Pitta Prakriti are more
prone for the vitiation of Kapha and Pitta Dosha and Meda and Rakta as
Dushya. Maanasika Prakriti wise maximum 75.00 % were having

251
 Summary & Conclusion

Raajasika Prakriti and 25.00% patients were having Taamasika Prakriti.

Individuals having Raajasika Prakriti are over reactive they react
abnormally more to a relatively less quantum of stress. So more stress
hormones like catecholamine are secreted in their blood circulation
making them more prone to diseases like hypertension, diabetes mellitus
etc and stroke. A minor stress factor make an individual with Taamasika
Prakriti more distressed and disturbance in their metabolic activities.

SATVA, SARA, SAMHANAN, SATMYA, & VYAYAM SHAKTI

Maximum numbers of patients of this study shows that 59.21%

patients passed twak sara (18.42% )medsara,13.15% raktsara,5.26%
patients were passed of mamsasara and 3.94% patients passed asthisara
Madhyama Satva (67,10 %), Madhyama Saatmya (63.15 %) and
Madhyam samhanana(69.73%),Avara vyayam shakti( 68.42%) This
observation supports the view that weak individual with weak physical and
mental constitution are more susceptible for diseases.

MODE OF ONSET

Among all the patients in present study 82.89% patients were

having sudden onset of symptoms while remaining 17.11% patients
showed gradual onset of symptoms. This observation also supports the
concepts of pakshaghata to be the Avaranajanya samprapti. If it had been
due to suddha vataja condition then the vata would get aggravated
gradually through the stages of sanchaya, prokopa, prasara etc.

DOSHANUBANDHA

On observation of Doshaanuvandha 68.42 % patients showed

Kaphaanuvandha Lakshana followed by 31.58 % patients with
Pittaanuvandha Lakshana. The commonest risk factor for CVA is the
atherosclerosis and hypercholesteremia which are the result of impaired
fat metabolism. This can be compared with Rasa, Rakta and Medovaha
Sroto Dushti. The Rasa and Meda belong to the Kapha group of Dhaatu.
Therefore Kaphaanuvandha symptoms are observed in more number of
patients.

252
 Summary & Conclusion

EFFECT OF THEREPIES

In the clinical study 76 patients were registered in three groups

randomly. Patients in Group A were treated with Virechana with castor oil
after samyak snehan and Swedana. Patients in Group B were treated with
basti karma (Erandmooladi Niruhan and Mahamasha tail Anuvasan) in
Group C Virechan followed by basti karma and out of 76 patients 60
completed the trial.

EFFECT ON CHESHTA NIVRITTI (LOSS OF FUNCTION)

Effect of therapy on the cardinal symptom of Pakshaaghaata

Cheshtaa Nivritti was assessed by assessing the following mentioned
parameters like, Distal motor function, Motor function of arm, Motor
function of leg, Muscle power and assessing the improvement in activities
of daily living like Sitting from lying down, Standing from sitting, Increase in
walking capacity, Hand grip power. In all the above mentioned symptoms
the better result was observed in group C as compared to Group B and
Group A. It may be inferred from the above results that virechan followed
by basti karma played a significant role in alleviating Cheshtaa Nivritti This
proves the efficacy of Virechana followed by basti karma in this disease by
its Srotovishuddhi and Indriya-Prasaadana properties. The improvement in
above symptoms is may be due to the relief of the Aavarana of Vaayu
leading to the normal function of Vaayu.

EFFECT ON RUJA (PAIN)

Patients of Group A and group B showed statistically

significant(<0.05) results with percentage relief of 20% and 22.22%
respectively but group C showed statistically Highly significant (<0.01)
results with percentage relief of 23.08%. Ruja might have been checked
due to the fact that the Vaata gets pacified due to the removal of Aavarana
by basti karma and virechan & basti karma combined.

253
 Summary & Conclusion

EFFECT ON VAKSTAMBHA (SPEECH)

The relief observed in Group B and in Group C were statistically

significant (<0.05) with percentage relief of 17.24% and 20% in Group A it
was statistically insignificant (>0.05) with percentage relief of 16.67%.
Basti karma and virechan followed by basti karma by its Srotoshodhana
property might have relieved the Aavarana of Udaana by Kapha and also
might have reduced the Praana Vaayu Dushti which is controller of Vaak
Indriya Moola.

EFFECT ON GURUTAA (HEAVINESS)

The relief observed in Group A, B & C were significant (<0.05) with

percentage relief of 23.53%, 25% & 25% respectively. Hence Gurutaa
might have been checked better by Virechana owing to its Srotosodhana
properties and may be potentiated by the Teekshna, Sookshma, Ushna
and Vata- Kapha Shaamaka properties of the basti karma.

EFFECT ON SHOTHA (OEDEMA)

The relief observed in Group A & C were statistically significant

(<0.05) with percentage relief of 17.39% and 26.32% respectively and in
Group B it was statistically insignificant (>0.05) with percentage relief of
15%. Virechana checks the derangement of Tridosha along with Rakta,
and this property might have enabled it to function more efficiently in
resolving Shotha.

EFFECT ON DAAHA (BURNING SENSATION)

The relief observed in group A was statistically significant (<0.05)

with percentage relief of 18.52% and Highly significant in group C with
percentage of relief 22.22%. Result bestowed in Group A was significant
because virechan is considered as best treatment for pittaj vikar & pitta
avaran is removed and daha is alleviated. In group C Basti is also given
after virechana. It pacifies vata and residual pitta dosha. There for the
result was highly significant in this group.

254
 Summary & Conclusion

EFFECT ON SIRAHSHULA (HEADACHE)

Patients of Group B & C showed statistically significant (<0.05)

results with percentage relief of 13.33% and 20% respectively and in
group A it was statistically insignificant (>0.05) with percentage relief of
9.38%. Significant results were obtained in group B and C vata vitiation is
responsible for headache with the use of basti karma morbid vata is
pacified and it reduces headache

EFFECT ON VIBANDHA (CONSTIPATON)

Group A and in Group B were evaluated to be having significant

(<0.05) results with percentage relief of 20% and 20.83% respectively and
in group C it was statistically Highly significant (<0.01) with percentage
relief of 21.88%.

All the therapies were evaluated to be having significant result in

relieving the constipation but group C showed highly significant result This
shows the Anulomaka property of therapies and supports the action of
therapies on Apaana Kshetra and their role in Apaana Vaayu Dushti.

EFFECT ON SANKOCHA (MUSCLE TONE)

Rigidity or increased muscle tone is relieved significantly (<0.05) by

41.67% in upper limb and 42.86% in lower limb in group A ;by 50% in
upper limbs & 57.14% in lower limbs in group B and by 53.85% in upper
limb and 45.45% in lower limb in group C. The therapeutic interventions by
virechana and Basti might have regulated the aavrita vata by clearing the
aavaran and thus strengthening the functional aspect of vata .The
cumulative effect of virechan and basti are better seen in group C.

EFFECT ON REFLEXES

The effect of virechan in group A is insignificant (>0.05) in knee,

ankle, triceps & biceps reflexes. The effect of basti in group B showed
significant (<0.05) results in knee and biceps reflexes and showed
insignificant (>0.05) result in ankle and triceps reflexes.

255
 Summary & Conclusion

The cumulative effect of virechan and basti has shown significant

results in knee and biceps reflexes and insignificant results in ankle and
triceps reflexes.

The aggravation of reflexes, which is the manifestation of chalguna

of vitiated vata is regulated and significantly normalized as the treatment
modalities subdued the vata and controlled the vitiation.

INVESTIGATIONS ON LIPID PROFILE & RANDOM BLOOD SUGAR

Serum cholesterol level was reduced significantly in Group A &

Group B but better recovery was reported in Group C.

In group A virechana was given which might have caused cleansing

of intestine (Srotosuddhi) there by reducing cholesterol.

In Group B basti was given which might have improved the

intestinal flora with subsequent obsorption and assimilation of fats
reducing Serum cholesterol.

In Group C virechana karma was followed by Basti karma the

combined action of both by doing srotosuddhi, removing obstruction in
channels and maintaining flora of intestine showed Highly significant
results in Serum cholesterol.

HDL level was insignificant in group A & B i.e. virechana & Basti
karma.

HDL level was significant in group C i.e. virechana karma followed

by Basti karma it is also due to improvement in fat, metabolism.

LDL & Triglyceride level were lowered significantly in Group A i.e.

virechana karma. It is supposed to be due to Srotosuddhi and cleansing of
alimentary gut.

LDL & Triglyceride was lowered significantly in Group B, Basti

karma also it is supposed to be due to maintenance of flora and
improvement in Dhatwagni & Bhutagni.

256
 Summary & Conclusion

LDL & Triglyceride were improved significantly in Group C due to

combined effect of virechana and Basti karma.

VLDL showed significant changes in Group C due to combined

effect of virechana and Basti karma which might have improve the fat
metabolism at cellular level.

Blood sugar level showed insignificant change in their value in all

the group i.e. A virechana, Group B Basti karma & Group C i.e. virechana
followed by Basti karma.

CBC (Complete blood count) level showed insignificant changes in

all the groups i.e. A virechana, Group B Basti karma & Group C i.e.
virechana followed by Basti karma.

TOTAL EFFECT OF THERAPIES

In Group A, complete remission found in 0.0% patients marked

improvement found in 20.00% patients, moderate improvement found in
45.00% patients while no improvement was observed in 35.00% of
patients.

In Group B, complete remission found in 5.00% patients, marked

improvement found in 20.00% patients, moderate, improvement found in
55.00% patients while no improvement was observed in 20.00% of
patients.

In Group C, complete remission found in 10.00% patients, marked

improvement found in 50.00% patients, moderate improvement found in
30.00% patients, while no improvement was observed in 10.00% patients.

So the total effect of therapies shows that in comparision to Group A, B &

C shows better results which could be due to the cumulative effect of
virechan & Basti karma.

257
 Summary & Conclusion

PROBABLE MODE OF ACTION INTERNAL SNEHANA (TILA TAILA)

Here, three function are attributed to snehana.

Lusgksfuya gfUr e`nw djksfr nsga eykuka

fofugfUr l›e~ A
(Ch. Si. 1/7)
 Sneha pacifies the vata Dosha.

 Sneha softens various body organs

 Sneha helps in disintegrating the cumulated Dosha or mala.

with the help of above three properties neha brings the cumulated
Dosha from shaakhaa to koshtha for their easy removal. just as
water rinse out smoothly on an oil applied utensil in the same
manner, Dosha also rinse out smear easily in the snigdha body and
are easily subjected for entry in the kostha.

 Snehana liquiefies the Dosha sticked in the srotas to bring to

kostha ensuring proper circulation of vata.

 Intake of high quantity of fat stimulate the secretion of GIT hormone

GIP which has direct metabolic effect on liver, muscle and brain.

 Tila taila reduces serum & liver cholesterol and also liver LDL which
are responsible for the initiation of atherosclerosis leading to
thromboembolism.

 It is also effective in lowering blood pressure.

 It protects the blood vessels against lipopolysaccharide stimulated

oxidative stress.

PROBABLE MODE OF ACTION SWEDANA

Swedana pacifies the vaayu which causes rigidity, contracture due

to its Ruksha and shita guna and swedana removes it by its ushna guna.
Sweda also increases the dhatvaagni level, thus digesting aama dosha

LrEHkxkSjo 'khra ?kz Losnua Losn dkjde~ A

258
 Summary & Conclusion

(Ch.su.22/11) Swedana also has an inherent property of decreasing the

gaurava and stambha. gururtaa is caused by both prithvi and jala
mahabhoota. This jala mahabhoota is discarded in form of sweat during
swedana, which also has direct effect on vata Dosha.

okrL;ksiØe% LUsg% Losn% la'kks/kua

e`nq A (A.H.Su. 13/1)

Of all the three Dosha vata is a chief offender. swedana pacifies

vata dosha and thus terminates the disease pathology to a great extent.

PROBABLE MODE OF ACTION VIRECHANA

 It is helpful in those vaatik disorders where the vata is obstructed by

kapha, pitta, Meda & Rakta. So it will proves very useful in the
management of Pakshaaghaata due to cerebrovascular accident in
which there is obstruction of vaata with Kapha, Pitta, Rakta And
Meda.

 In addition to this it also improves the intellect, the strength of

sense organs, potentiates all Dhaatus, increases body strength,
improves Agni & delayes old age.

 There is a close relationship between GIT & Nervous system.

Peptide hormones produced by the GIT are also produced by
neurons in the brain. A Hormone released by the GIT on stimulation
by Virechana drugs may act on the brain, modulating higher neural
functions like autonomic function, regulating body temperature and
higher neural functions e.g. Learning, memory, vigilance etc.

 CCK (Cholecystokinin) a hormone released by stimulation of

Virechana drugs have role in including sleep, alalgesia and
memory.

 Hormone Substance P (Pancriozimine) secreted by GIT on

stimulation with Virechana drugs lowers arterial BP is one of the
most potent vasodilator, it also increases pancreatic secretion.

259
 Summary & Conclusion

CASTOR OIL AS A PURGATIVE

The process of Virechana karma is regulated and controlled by a

special centre situated near medulla oblongata in the brain. This centre is
close to respiratory and vomiting center. The virechan drugs stimulate
purgation center and indirectly the vomitting center is relaxed. Sacral
plexus (situated in the sacral region) of the spinal cord also helps in
controlling and regulating the act of purgation. The act of purgation is also
controlled and regulated by local reflex action of the concerned body
parts. During the act of defecation the respiration is arrested momentarily,
diaphragm is activated and it presses transverse colon. Simultaneously
the accessory muscles of the abdomen are also activated and they also
help in propelling the faecal matter towards anus along with the stimulates
lock nerve plexuses and then the enforced peristalsis. Further helps in
expelling contents of intestine towards rectum and finally to anal canal.
When the voluntary or involuntary act of defecation starts, the ultimate
result is evacuation of bowels.

Thus we can say that the castor oil has dehydrating property. In this
way it can be compared with glyerine which is a clear sweet viscous liquid.
Glycerine is used as suppository to induce evacuation and is used orally/
per rectum to reduce intra ocular / intra cranial tension.

In the same way castor oil if used in optimum dose can help to
reduce intra cranial tension and having improvement in functions of the
patient of CVA by reducing intra cranial tension.

(Chapter No 60) demulcents essentials of medical pharmacology) K.

D. Tripathi

More over toxins of body and due to indigestion, damages,

formations of glycoprotein, the communicating structures virechana can
remove this. In Ayurveda kaphant virechana is appreciated. Kapha may
be correlated to the mucous that is secreted by goblet cells of intestine.
Mucous, nothing but a glycoprotein can be assumed that dushita kapha

260
 Summary & Conclusion

dosha or glycoprotiens comes in goblet cells during snehana and

swedana and they are excreted during virechana. The removal of morbid
communicating structures may improve whole body functions which intern
have the patients recover fast from the disease.

PROBABLE MODE OF ACTION OF BASTI (AYURVEDIC VIEW)

ofLroZ;% LFkkif;rk lq[kk;qcZykfXu

es/kkLojo.kZd`Pp A

lokZFkZdkjh f'k'kqo`);wuka fujR;;%

loZxnkig'p AA

foV~'ys"efiÙkkfuyew=d"khZ nk<~;kZog%
'kqØcyizn'p A

fo"od~ fLFkra nks"kp;a fujL; lokZu~

fodkjku~ 'ke;sfUu:g% AA
(Ch. Si. 1/27-28)

The Niruha – Basti is Vayahsthapana, Sukhayukara and promotes

strength, appetite, intellect and body luster. It is useful in all kind of
diseases, in all kind of patients including children, old and young. It
regulates vit, shleshma, pitta, Vata and Mootra etc. It gives strength to all
the body specially to Shukra Dhatu removing the accumulation of Doshas
from the body.

According to Acharya Chakrapani and Parashara, Guda (Anus and

Rectum) is considered as the Moola (Base) of the body and also the seat
of Shiras. Other concept is that the oil after being introduced in the form of
Basti reaches the Nabhi pradesha which is the moolasthana of Shira and
Dhamani and along with these channels it nourishes the entire body.

ewya xqna 'kjhjL; fljkLr= izfrf"Brk%A loZa

'kjhja iq".kfUr ew/kkZaua ;konkfJrk %AA (Parashar)

261
 Summary & Conclusion

This phenomenon is compared with the distribution of water from

the roots of tree that results in proper growth of trunk, bark, flowers and
fruits etc. properly administered basti stays in Pakvashaya. Shroni and
Nabhi Pradesha. The Basti Dravyas reach the entire body at the level of
various srotas and produces Shamanadi Karmas. After the administration
of Basti, it comes out of anal canal due to influence of Apan-Vayu. It
causes Shodhana of Doshas from Pada to Shiras. As Acharya states…

ukfHkizns'ka dfVik'oZdqf{ka xRok

'kd`n~nks"kp;a foyksM~; A
laLusá dk;a liqjh"knks"k% lE;d~ lq[ksuSfr p ;%
l cfLr A
(Ch. Si. 1/40)

The Basti Dravya located in Pakvashaya removes the sanchita

Doshas from the prishtha, Kati and Koshtha Pradesha.

According to Acharaya Vagbhatta Basti therapy has major scope in

all kind of ailments implicating different types of Doshas, Dooshya and
Adhisthanas. Basti is supposed to be the principal treatment for Vatic
disorders.

okrksYo.ks"kq nks"ks"kq okrs ok

cfLrfj";rs A
miØek.kka losZ"kka lks·xz.khfL=fo/kLrq
l% AA (A.H. Su. 19-1)

The relative importance of Vata is already known as it has

predominant influence on three principal routes of the disease namely
Shakha, Koshtha and Marma-Asthi-Sandhi. Moreover Vayu is responsible
for the spread of Sweda, Mala, Mootra, Kapha and other biological
substances in the body. Basti being the principal treatment of such an
important factor, is considered the therapeutic procedure of maximum
importance.

262
 Summary & Conclusion

'kk[kkxrk% dks"Bxrk'p
jksxkeeksZ/oZlokZo;ok›tk'p]
;s lfUr rs"kka ufg df'pnU;ks ok;ks% ija
tUefu gsrq jfLr**
fo.ew=fiÙkkfneyk'k;kuka fo{ksila?kkrdj% l
;Lekr~ A
rL;kfro`)L; 'kek; ukU;}fLr fouk Hks"ktefLr
fdf×pr~ AA
(Ch.Si. 1/38-39)

Thus the verses given above prove that Basti Chikitsa is half of the
whole Chikitsa (treatment).

PROBABLE MODE OF ACTION OF BASTI (Modern view)

A. Through Blood

In the liver the blood passes through millions of fine liver sinusoids
and finally leaves the liver by way of the hepatic veins that empty in to the
vena cava of the general circulation. This secondary flow of blood through
the liver allows the reticuloendothelial cells lining the liver sinusoids to
remove becteria and other particulate matter that might enter the blood
from the GI tract. Most of the absorption in the large intestine occurs in the
proximal half of the colon giving this portion the name absorbing colon.
Absorption through the GI Mucosa occurs by active transport and by
diffusion. Water is transported through the intestinal membrane entirely by
the process of diffusion. Furthermore, this diffusion obeys the usual law of
osmosis therefore when the chyme is dilute, and water is absorbed
through the intestinal mucosa into the blood of the villi by osmosis. On the
other hand, water can also be transported in the opposite direction form
the plasma into the chyme. This occurs especially when hyperosmotic
solutions are discharged from the stomach.

263
 Summary & Conclusion

The rectum has rich blood and lymph supply and the drugs can
cross the rectal mucasa like other lipid membranes. Thus unionized and
lipid soluble substances are readily absorbed from the rectal mucosa.
Small quantities of short chain fatty acids such as those from butter fat are
absorbed directly into portal blood rather than being converted into
triglycerides. This is because short chain fatty acids are more water
soluble and allows direct diffusion from the epithelial cells in to the
capillary blood of the villi.

The active principles of Basti drugs may also be absorbed because

they are mainly water soluble. It may be considered that niruha Basti is
hyperosmotic which facilitates absorption of morbid factors in to the
solution whereas the sneha Basti and other nourishing basti contains
hypoasmotic solution facilitating absorption into the blood.

Moreover following factors of physiochemical nature help in its absorption.

1. Differences in concentrations and therefore of the diffusion

pressures between crystalloid in the blood and in the intestinal
lumen.

2. Absorption varies directly with the intra intestinal pressure the

absorption rate increases in proportion to the increase in intra-
intestinal pressure.

3. The osmotic pressure of the plasma proteins in excess of the

hydrostatic pressure of the capillary blood is an important factor in
attracting water and crystalloids into the blood stream.

4. The above mentioned factor explains how the active principle of

drugs given in Basti may reach the brain and act their.

B. Through direct stimulation

As told earlier there is a rich supply of neurons in colon and

intestine. The drugs given through Basti may put effect on the neurotrans
mitter acetylcholine and tachykinin, which in turn sends signal to the
cerebrum via spinal cord probably in this manner acts as like the cognition

264
 Summary & Conclusion

enhancers cerebro spinal axis stimulants and by excitation of central

neurons.

Following points can be considered

1. It may increase regional blood flow in the cerebrum and finally to

the affected area.

2. It may directly support the neuronal metabolism.

3. It may increase in the improvement of descrete cerebral function.

Thus in above manner Basti helps to give relief in the patients
suffering from pakshaghata CVA (chapter no. 32 CNS stimulants
and congnition enhancers clinical pharmacolgy, KD tripathi)

265
 Summary & Conclusion

PROBABLE MODE OF ACTION OF BASTI (Modern View)

A. Basti Administered P/R (Local action)

(750-960 ml)

Irritation of gut mucosa, excessive distension of gut

Parasympathetic system stimulates

Secretion of Neurotransmitter Acetyl choline, tachykinin by enteric neurons

Excites gastro-intestinal activity

Send signal via spinal cord

Cerebrum

A. Improves blood flow in cerebrum

B. Improves neuronal matabolism
C. Improves functional activities

266
 Summary & Conclusion

B. Basti administered P/R (Systemic action)

(750-960 ml)

Irritation of Gut mucosa, excessive distension of Gut

Parasympathetic system stimulates

Secretion of neurotransmitter acetyl choline, tachykinin by enteric neurons

Excites Gastro intestinal activity

Secretion of Peptide hormones Cholecystokinin Vasoactive intestinal

peptide Gastrin

Secretion of two kinins Kallidin

Bradykinin

Decreases oxygen concentration

Powerful vasodilators

Enhanced absorption of Basti (Active Principle)

Enter blood stream

Via portal vein

Liver

Heart

Cerebrum

267
 Summary & Conclusion

PROBABLE MODE OF ACTION ON DRUGS

Most of the drugs in Erandmuladi Basti are Usna Veerya, Katu,

Tikta, Kasaya Rasa Pradhana.

In pakshaghata Avarana of vata due to kapha and pitta is the main

cause. The drug with above properties removes the avarana and Basti
due to its veerya. Pacifies the vitiated vata.

Erandmool is the main component which is virshya Rasayana &

vatahara. Its helps in bringing dhatu shamyata. Basti also acts as
vayahsthapana and increases shukha Arogya, Medha Agni Bala & Varna
and help in proper excretion of stool, urine and flatus and removes all
disorders without any complication.

MAHAMASHA TAIL

Mahamasha tail ingredients are usually Tikta, Kashaya Rasa

Pradhana, Ruksha, Laghu guna Pradhana usna veerya and katu vipaka.
Therefore are kaphavata samaka. Some of them are anti inflammatory,
analgesic, Nervine tonic, heart tonic. So they improve conduction of nerve
and strength of the tissue by acting at dhatuvagni and Bhutagni level. Oil
in it self vatahara & balya. So mahamasha tail improves the over all health
of the patients.

268
 Summary & Conclusion

SUMMARY AND CONCLUSION

The thesis entitled-

"The comparative study of virechana karma and Basti karma in

the management of Pakshaghata W.R.S. to C.V.A.

Comprises of five parts viz conceptual study, Drug Review, Clinical

study, Discussion, Summary and Conclusion.

The first part designated as conceptual study comprises of four

chapters viz. Disease review (Ayurvedic) Disease review (Modern),
Virechana review, Basti review.

The second part termed as "Drug Review" describes the properties

along with Pharmacodynamics of the drugs selected for the study in brief.

The third part entitled "Clinical study" describes in the beginning the
selection of patients and methods adopted for the research work. There
after results obtained and its statistical analysis are presented in the form
of tables along with brief description of the same.

The forth part entitled "Discussion" describes the logical

interpretation of the results obtained in the clinical study based on
Ayurvedic and Modern principles.

The summary and conclusion drawn from the observations and

results are presented here under.

76 patients of pakshaghata were studied in this series. In the

present study, majority of the patients were, from the age group 51-60
year (39.48%), majority of the patients were male (88.16%), 76.32%
patients were Hindu, 96.06% were married, 36.84% patients were
graduated, 40.79% patients were businessmen, 68.42% patients were
belonging to middle class, 60.52% patents were belonging to sadharan
desha, 65.78% patients were vegetarian, 67.10% patients were having
habit of adhyasana, 32.90% patients were not having any Dominancy of
Rasa in Diet 61.84% patients were having irregular bowel habit, 39.47%
patients were addicted to tea/coffee.

269
 Summary & Conclusion

Majority of the patients of the present study were of Dvandvaja

Prakriti with maximum having pittakkaphaja 43.42%, followed by
vatakaphaja 36.84%, 75% patients were having Rajashika manasa
Prakriti. Most of the patients reported Twaksara 59.21% followed by Meda
sara 18.42% rakta sara 13.15%.

Most of the patients reported Madhyam Samhana 69.73% followed

by Madhyam satva 67.10%, Madhyam saatmya 63.15%, Avara vyayama
shakti 68.42%, madhyam Abhayavaharana shakti 69.73%, Madhyam
Jarana shakti 71.05% ,Madhayama Kostha 52.64%, Mandagni 42.11%.

Maximum number of patients 48.69% had chronicity 1-2 years,

90.79% patients were having negative family history. 82.89% patients
were having sudden onset of the disease. 84.21% patients were having
nature of Lesion – Infraction.

In Doshanubandha, 68.42% patients were having kaphanubandha,

followed by pittanubandha 31.58% patients. In Dushya 100% patients
were having majja dhatu, followed by 71.05% patients rakta, meda dhatu
dusty, 67.10% patients rasa dhatu dusti.

 Group A

Group A (Virechana karma), statistically significant (P<0.05) result

found in Ruja, Achetanta, Guruta, Vivandha, Shotha and Daha with the
percentage relief of 20%, 28.57%, 23.53%, 20.00%, 17.39% and 18.52%
respectively while statistically insignificant (P>0.05) results were observed
in vakstambha (16.67%) and Shirahshula (9.38%).

Improvement in Chesta Nivritti (Loss of Function) of lower

extremities was statistically insignificant (>0.05) results. Improvement in
Chesta Niviritti (Functional) of upper extremities in pressing power, was
statistically significant (P<0.05) with the percentage relief of 17.86%, while
remaining upper extremities were statistically insignificant (>0.05).

Improvement in power (Upper & Lower Limb) was statistically

insignificant (P>0.05).

270
 Summary & Conclusion

Improvement in reflex (Upper & Lower Limb) was statistically

insignificant (P>0.05).

Improvement in tone of upper Limb (hand) was statistically

significant (P<0.05) with the percentage relief of 41.67%, while in Lower
limb (Leg) was statistically insignificant (P>0.05) with the percentage relief
42.86%.

Improvement in serum cholesterol, LDL, & Triglyceride were

statistically significant (P<0.05) with the percentage changes 3.51%,
3.64% and 4.89%. Insignificant (P>0.05) changes were found in HDL,
VLDL and Random blood sugar.

In this group, No patient showed complete Remission, 20% patients

were markedly improved, moderate improvement is found in 45% patients
and No improvement was observed in 35% of patients.

 Group B

Group B (Erand mooladi Niruhan Basti & Mahamasha tail

Anuvashana Basti), statistically significant (P<0.05) result found in Ruja,
Vakstambha, Achetanta, Guruta, Vibandha, Daha and Shirashula with the
percentage relief of 22.22%, 17.24%, 31.25%, 25%, 20.83%, 20% and
13.33% respectively, while statistically insignificant (P>0.05) result was
observed in shotha (15%).

In Chesta Nivritti (Loss of Functional) of lower extremities,

statistically significant (P<0.05) results were found in Ability to stand from
sitting position, Ability to get down from bed and Time required to walk 10
mtr, With the percentage relief of 23.81%, 21.74% and 21.74%
respectively, while statistically insignificant (P>0.05) results were observed
in Ability to sit on the bed (15.79%) Ability to walk (13.04%).

In Chesta nirviritti (Functional improvement) of upper extremities,

statistically significant (P<0.05) results were found in Strength of grip,
Pressing power and Ability to handle the book. With the percentage relief
of 19.23%, 18.52% and 17.86% respectively, while statistically
insignificant (P>0.05) results were observed in Ability to wear dress
(11.11%) and Ability to pick pin (10.71%).

271
 Summary & Conclusion

In Reflex (Upper & Lower Limb) statistically significant (P<0.05)

results were found in knee and Biceps with the percentage relief of
22.22% and 20% respectively, while statistically insignificant (P>0.05)
results were observed in Ankle (17.24%) and Triceps (9.68%).

Improvement in tone (Upper limb) was statistically highly significant

(P<0.01) with the percentage relief of 50% and statistically significant
(P<0.05) was found in (lower limb) with the percentage of relief of 57.14%.

Improvement in Serum cholesterol LDL and Triglyceride were

statistically significant (P<0.05) with the percentage changes 3.43%,
4.90% & 5.36%.

Insignificant (P>0.05) changes were found in HDL, VLDL and

Random Blood sugar.

In this group 5% patients showed complete remission 20% patients

were markedly improved, moderate improvement was found in 55%
patients and No improvement was observed in 20% of patients.

 Group C

Group C (Virechana & Basti karma) statistically Highly significant

(P<0.01) result found in Ruja, Achetanta Vibandha and Daha with the
percentage relief of 23.08%, 34.78%, 21.88%, and 22.22% while
statistically significant (P<0.05) results were observed in Vakstambha
(20.00%), Guruta (25%), Shotha (26.32%) and Shirahshula (20%).

Improvement in ChestaNiviritti (Loss of Function) of lower

extremities were statistically Highly significant (P<0.01) in Ability to get
down from bed with the percentage relief of 22.22% while statistically
significant (P<0.05) result were observed in ability to sit on the bed
(18.52%), ability to stand from sitting position (30.43%), ability to walk
(25.93) and Time required to walk 10 mtr (22.58%).

Improvement in Chesta Niviritti (Functional Improvement) of upper

extremities in Strength of grip, Pressing power and Ability to handle the
book were statistically significant (P<0.05) with the percentage relief of
21.21%, 19.35% and 17.86% respectively, and statistically insignificant

272
 Summary & Conclusion

(P>0.05) results were observed in Ability to wear dress (12.12%) and

Ability to pick pin 11.11%.

In Power (Upper & Lower Limb), statistically significant results

(P<0.05) in Shoulder, Elbow, Wrist, Hip and Knee with the percentage
relief of 9.72%, 10%, 8.45%, 7.14% and 9.86% respectively, while
statistically insignificant (P>0.05) results were observed in Mcp & IP
(6.85%), Ankle (7.46%) and Metatarsals (4.35%).

In Reflex (Upper & Lower Limb), statistically significant (P<0.05)

results were found in knee and Biceps with percentage relief of 23.33%
and 21.88 while statistically insignificant (P>0.05) results were observed in
Ankle (19.35%) and Triceps (16.13%).

Improvement in Tone (Lower & Upper Limb), were statistically

significant (P<0.05) with percentage relief of 53.85% & 45.45%.

Improvement in serum cholesterol and VLDL were Highly

significant (P<0.01) with the percentage changes of 3.82% and 4.74%.

Significant (P<0.05) changes found in HDL, LDL and Triglyceride.

Insignificant (P>0.05) changes found in Random Blood sugar.

In this group, 10% patients showed complete Remission. 50%

patients were markedly improved, moderate improvement found in 30%
patient and No improvement was observed in 10% of patients.

So, the Total effect of therapies shows that in comparison to Group

A and Group B, Group C shows better results which could be due to the
cumulative effect of Virechana & Basti karma.

273
 Summary & Conclusion

NEED OF FURTHER RESEARCH

1. Long Duration of Therapy should be carried out for more

significant results.

2. Acute cases should be involved to see the efficacy of the

procedures the chances of recovery increases, if the treatment
is started as early as possible.

3. Results obtained clinically are Significant, to see pathological

improvement MRI / CT scan should be conducted in all patients
which could not be done because of non availability of these
facilities in the Hospital.

274