EFFICACY OF ERANDAMOOLADI NIRUHA BASTI IN THE …

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IJRAR19W1279 International Journal of Research and Analytical Reviews (IJRAR) www.ijrar.org 207

EFFICACY OF ERANDAMOOLADI NIRUHA

BASTI IN THE MANAGEMENT OF SCIATICA

AND HYPERLIPIDEMIA: A CASE REPORT 1Dr. Swathi N., 2Dr. Rahul S. Gandhi, 3Prof. Dr. Anup B. Thakar

12nd year PG Scholar, 2Assistant Professor, 3 Prof. and HOD, Director, I/C. Vice-chancellor 1Dept. of Panchakarma,

1IPGT&RA, Gujarat Ayurved University, Jamnagar, Gujarat, India.

ABSTRACT-

INTRODUCTION: Incidences of low back ache is 60-85% in adults of which sciatica contributes about 40%. In

Ayurveda, it’s clinical presentation closely resembles with that of Gridhrasi. Hyperlipidemia is one of the leading

contributors to vascular diseases like coronary heart disease. METHODS: A female patient aged 65 years suffering

from Ruja (pain) and Stambha (stiffness) in low back radiating to right lower limb was taken in this study. On

physical examination, SLR test was 300 on right leg and 700 on left. VAS score was 6 and Oswestry disability index

was 36(72%). Blood Report showed FBS-204mg/dl., PPBS-308mg/dl., Total Cholesterol-280mg/dl., LDL-

175mg/dl., Triglycerides-251mg/dl. and B.M.I.-26.6kg/m2. She was treated with Kala Basti comprising of

Erandamooladi Niruha Basti and Bala Taila Anuvasana Basti. RESULTS: After treatment, VAS score was

reduced to 1 and Oswestry disability index-05(10%). SLR test was negative on bilateral lower limbs. B.M.I.-

25.2kg/m2. Blood Report showed marked improvement in FBS-142mg/dl., PPBS-195mg/dl., Cholesterol-212mg/dl.,

LDL-116mg/dl., Triglycerides-283mg/dl. DISCUSSION: Erandamoola is said to be Agrya Vatahara dravya.

Erandamuladi Niruha Basti is indicated in Janghorupaadatrikaprishtashoola and acts as Lekhaneeya. By which,

significant improvement was found in reduction of cholesterol and blood sugar level.

Keywords: Vatakaphaja Gridhrasi, Sciatica, Hyperlipidemia, Oswestry disability index, Erandamooladi Niruha

Basti.

1. INTRODUCTION:

The most common disorder which affects the movement of leg particularly in the productive period of life is

low back pain. According to WHO, it is one of the leading causes of disability affecting about 540 million people in

the world. Improper sitting and sleeping postures, long driving and jerking movements during travel are the chief

contributing factors to produce low backache. Sciatica is a common entity encountered in daily clinical practice

which affects human beings in a critical manner. It happens due to irritation occurring to the sciatic nerve because of

varied reasons like lumbar spondylosis, herniated disc, degenerative disc disease, spondylolisthesis, or spinal

stenosis. Patients with sciatica may also have neurologic claudication associated with tingling, numbness, or

weakness along the distribution of sciatic nerve in the leg. The major problem in sciatica is pain. This causes debility

of the patients both physically and mentally.

Gridhrasi is a Shoolapradhana Vataja Nanatmaja Vyadhi[1] intervening with the functional ability of low

back & lower limbs. It is of 2 types. Vataja and Vatakaphaja. In Gridhrasi, localization of the vitiated Vata dosha is

described in a particular order in which Ruja (pain) starts from Sphik (Hip) and radiates to Kati (lower back),

Prishta, Uru (Thigh), Janu (Knee), Jangha (Legs) and Pada (Foot) along with Stambha (stiffness) and Toda

(pricking sort of pain). There are some other symptoms like Gaurava (heaviness), Tandra (drowsiness) and Aruchi

(loss of appetite) when associated with the Kapha Dosha.[2]

Hyperlipidemia is elevation of either plasma cholesterol, triglycerides or both. In addition to obesity, risk

factors of Ischemic Heart Disease include diabetes mellitus, hypertension and hyperlipidemia.[3] Bahu Abaddha

Medas mentioned in the context of Samprapti (pathogenesis) of Prameha[4] which has resemblance with

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hyperlipidemia, which is one of the resultants of irregular lifestyle patterns explained under Santarpanottha

Vyadhi.[5]

CASE REPORT:

1. OBJECTIVES:

1. To evaluate the efficacy of Erandamooladi Niruha Basti in the management of Vatakaphaja Gridhrasi

(Sciatica).

2. To evaluate the lipid lowering action of Erandamooladi Niruha Basti in a case of hyperlipidemia.

2. MATERIALS AND METHODS-

An over built female patient of age 65 years was admitted in IPD(No.4239) female general ward of Dept. of

Panchakarma, I.P.G.T.&R.A., Jamnagar presenting with the chief complaints of Ruja (pain) and Stambha (stiffness)

in low back radiating to right lower limb up to the dorsum of foot since 4 years and got aggravated since 3 months.

Patient also had complaints of Supti (numbness) and Gaurava (heaviness) in bilateral lower limbs and Aruchi (loss

of appetite) Vibandha (Incomplete evacuation of bowel) as well as Alasya (lethargy). She is on anti-diabetic

medication for 5 years. In the last 3 months she was feeling difficulty in day to day activities and pain was

preventing her from sitting or standing for more than 10 minutes.

Table 1: History and Examination of the Patient

1. History General Examination Locomotor System Examination

Pain- Onset-Gradual

Duration-4 years

Location-Low back

Radiation- to right lower limb

Quality-Pricking, Tingling

Severity- Severe, more at morning

and night hours.

Aggravating factors- Movement

of low back.

Relieving factors-Rest

Associated symptoms- Stiffness,

heaviness and numbness.

Past History- No history of fall,

surgery.

K/c/o. Type 2 Diabetes mellitus

since 5 years.

Treatment History-

Tab. Metformin Hydrochloride

500mg. 1 BD for 5 years.

Tab. Dynapar SR 75 SOS

Personal History-

Appetite- Reduced

Bowel-Consistency-Hard, once in

1-2 days, feeling of incomplete

evacuation.

Micturition- 6-8 times/day,

1-2 times at night.

Sleep- Disturbed due to pain.

Menstrual History-

Menopause attained before 12

Appearance- Normal

Pallor, Icterus,

Clubbing, Cyanosis,

Lymphadenopathy,

Oedema- Absent.

Built- Over built

Height-162cms.

Weight-70kgs.

B.M.I.-26.6kg/m2

Vital Examination:

Pulse- 76/min.

B.P.- 130/80 mm/Hg.

Temperature-98.60 F

Respiratory rate-

16/min.

Gait- Antalgic.

Inspection of Back-

No swelling, discoloration, scar

marks.

Curvature of Spine- Lumbar

scoliosis.

Palpation-

Tenderness- Positive in L3- L4 and

L4-L5 intervertebral region.

SLR Test-

Right lower limb- 300

Left lower limb- 700

Crossed SLR Test-

Positive in Right leg i.e. pain felt in

right leg when left leg is raised.

Lasegue’s Sign- Positive in bilateral

lower limbs.

Femoral nerve stretch test-

Negative in bilateral lower limbs.

Flip Test- Positive in right lower

limb.

Schober’s Test- No changes in the

distance of upper mark from the

lower.

Heel walking- Not possible.

Toe walking- Possible.

Sensory Examination- Superficial

and Deep Sensations are intact.

Claudication distance-100 meters.

VAS Score for Pain[6]- 6/10




years. Oswestry Disability Index[7]- 36

(72%) out of 50.

2. Investigations- HAEMOGRAM- Within normal limit. DIABETIC PROFILE- FBS-204mg/dl., PPBS-

308mg/dl., LIPID PROFILE- Total Cholesterol-280mg/dl., HDL-55mg/dl., LDL-175mg/dl., VLDL-50mg/dl.,

Triglycerides-251mg/dl. RENAL FUNCTION TEST- Serum Creatinine-1.5mg/dl., Blood Urea-22mg/dl., Uric

Acid-5mg/dl. HEPATIC PROFILE- Within normal limit. HIV, HBsAg, VDRL-Negative.

3. X-Ray LS Spine (AP, Lateral View)- Narrowing of Intervertebral Spaces at L3- L4 and L4-L5 region, scoliosis of

lumbar spine.

4. MRI LS Spine- There is lumbar scoliosis with convexity to the left. There is severe disc degeneration at the

level of L3- L4 and L4 -L5 and there is lateral subluxation of L3 over L4. All these narrowed disc spaces show vacuum

phenomenon.

Table 2: Roga Rogi Pareeksha

5. Dashavidha Pareeksha Vikriti- Samprapti Ghataka

1.Prikriti- Vatakaphaja

2.Vikriti-Vatakaphaja

3.Sara-Madhyama

4.Samhanana-Madhyama

5.Pramana-Pravara

6.Satmya-Madhyama

7.Satwa-Avara

8.Aharashakti-Avara

9.Vyayamashakti-Avara

10.Vaya- Vriddha

1.Dosha-Vata, Kapha

2.Dooshya-Rasa, Meda, Asthi

3.Srotas-Rasavaha, Medovaha, Asthivaha.

4.Srotodushti Prakara- Sanga,

Vimargagamana

5.Udbhavasthana- Ama Pakwashaya

6.Vyaktasthana- Kati, Ubhaya Pada

7.Adhishtana-Asthi, Sandhi

8.Rogamarga-Madhyama

9.Vyadhi Swabhava- Chirakari

10.Sadhyasadhyata- Krichrasadhya

6. Diagnosis- Vata Kaphaja Gridhrasi

-Sciatica and Hyperlipidemia

7. Treatment Plan-

1. Kala Basti [8] comprising of-

Erandamooladi Niruha Basti [9] -760ml.

Anuvasana Basti with Bala Taila[10] -120ml.

Purvakarma-

Sthanika Abhyanga with Bala Taila.

Nadi Swedana with Dashmoola Kwatha.

Table 3: Schedule of Kala Basti

Days

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

Basti

A

A

N

A

N

A

N

A

N

A

N

A

N

A

A

A




A- Anuvasana Basti, N- Niruha Basti

Contents of Niruha Basti:

Makshika- 120ml.

Saindhava lavana- 12g.

Sneha (Bala Taila)- 180ml.

Kalka (Shatapushpa, Hribera, Priyangu, Pippali, Yashtimadhu, Bala, Rasanjana, Indrayava, Musta) - 60g.

Kashaya (Eranda, Palasha, Rasna, Ashwagandha, Atibala, Guduchi, Punarnava, Aaragwadha, Devadaru,

Madanaphala, Laghu Panchamoola) - 280ml.

Aavapa- Gomutra- 120ml.

Total-760ml.[11]

3.RESULTS: After the completion of treatment, results were assessed based on following parameters-

Table 4: Effect of therapy on Subjective Parameters

Subjective Parameters Before Treatment After Treatment 7 days after the

treatment

1. Stiffness in morning 1-2 hours 15-20 minutes Absent

2.Numbness and

Heaviness in bilateral

lower limbs

Present Absent Absent

3. VAS Score for Pain 6/10 2/10 1/10

4.Oswestry Disability

Index

36/50 (72%) 10/50 (20%) 05/50 (10%)

5. Appetite Poor Good Good

6. Bowel Feeling of Incomplete

evacuation,

Unsatisfactory

Feeling of complete

evacuation,

Satisfactory

Feeling of complete

evacuation,

Satisfactory

Table 5: Effect of therapy on Objective Parameters

Objective Parameters Before treatment After treatment 7 days after the

treatment

1. Gait Antalgic Normal Normal

2.Palpation Tenderness-

Positive

Negative Negative

3.SLR Test- Right leg 300 800 Negative

Left leg 700 Negative Negative

4.Crossed SLR Test Positive in Right leg Negative in bilateral

legs

Negative in bilateral

legs

5. Lasegue’s Sign Positive Negative Negative

6. Flip test Positive in Right leg Negative in bilateral

legs

Negative in bilateral

legs

7. Schober’s Test No change in the

distance of upper

mark from the lower.

Upper mark distance

increases by 3 cms.

Upper mark distance

increase by 5 cms.




8.Claudication

distance

100 meters 300-500 meters. More than 500 meters.

9. Heel Walking Not possible Possible Possible

10.Body mass index 26.6kg/m2 25.3kg/m2 25.2kg/m2

Table 6: Effect of therapy on Biochemical Parameters

PARAMETERS Before

treatment

After

treatment

7 days after

the treatment

Reference

Range

1.DIABETIC PROFILE-

FBS 204 mg/dl. 156 mg/dl. 142 mg/dl. 70-100 mg/dl.

PPBS 308 mg/dl. 224 mg/dl. 195 mg/dl. 100-140 mg/dl.

2.LIPID PROFILE-

Total Cholesterol 280 mg/dl. 213 mg/dl. 212 mg/dl. 140-250 mg/dl.

HDL 55 mg/dl. 41 mg/dl. 39 mg/dl. 35-50 mg/dl.

LDL 175 mg/dl. 117 mg/dl. 116 mg/dl. 0-100 mg/dl.

VLDL 50 mg/dl. 55 mg/dl. 57 mg/dl. 0-25 mg/dl.

Triglycerides 251 mg/dl. 277 mg/dl. 283 mg/dl. 25-160 mg/dl.

3.RENAL FUNCTION

TEST-

Serum Creatinine 1.5 mg/dl. 1.2 mg/dl. 1.1 mg/dl. 0.7-1.4 mg/dl.

Blood Urea 22 mg/dl. 24 mg/dl. 27 mg/dl. 15-40 mg/dl.

Uric Acid 5 mg/dl. 4.7 mg/dl. 4.5 mg/dl. M-3.5-7.2,

F-2.6-6 mg/dl.

4. DISCUSSION:

In the Samprapti of Vatakaphaja Gridhrasi, important components are vitiated Vata and Kapha[12] which

gets lodged in Katipradesha (low back region) causing Ruja (pain) beginning from Sphik (hip region) gradually

radiates down to Kati, Prishta (back), Uru (Thigh), Janu (Knee), Jangha (Legs) and Pada (Foot region). Patient was

suffering from the symptoms like Stambha (stiffness), Ruk (pain), Toda (pricking pain) due to Dooshita Vata and

Tandra (drowsiness), Gaurava (heaviness), Arochaka (loss of appetite) due to Kapha Dosha. In Vatavyadhi, Basti

Chikitsa is considered to be a prime treatment modality and is also quoted as Ardha Chikitsa by Acharya Charaka[13]

. The multifaceted action of Basti can be ascribed to the permutation and combination of the drugs used for

preparing Bastidravya[14].

Erandamoola is said to be a Shreshta Vatahara dravya.[15] Erandamuladi Niruha Basti is indicated in Trika,

Prishta Shoola (pain in low back) and acts as Maruta Nigraha (controls Vata). Anti-inflammatory, anti-oxidant,

central analgesic, antinociceptive and bone regeneration activity are found in Ricinus communis[16] (Eranda) which

is the main content of Erandamooladi Niruha Basti.

This Basti contains 34 drugs in which most of the drugs are having Ushna Veerya and are Vatakaphahara

in nature. Drugs are also possessing Ushna (hot), Teekshna (~sharp) and Sukshma (~subtle) Guna (qualities) which

helps in the elimination of obstruction of Srotas (channels) which further helps in the formation of Prakrita Dhatu. It

is also indicated in Kaphavrita condition, by which it played major role in pacifying the Kapha Dosha and reducing

the symptoms like Stambha (stiffness) and Gaurava (heaviness). Most of the drugs are Agni Deepaka which helped

to improve the Agni (digestive fire) of the patient, there by increase in appetite was observed.




Hyperlipidemia has become burning issue now a days which is the primary cause for vascular diseases like

metabolic syndrome, myocardial infarction and cerebrovascular accident. It is usually asymptomatic and undetected.

Studies show that for each 1mg/dl. decrease in LDL cholesterol in the plasma, there is about a 2% decrease in

mortality from atherosclerotic heart disease.[17] In the present Case Report, Total Cholesterol was decreased from

280 to 212mg.dl and LDL from 175 to 116mg/dl. But the level of triglycerides got increased from 251 to 283 mg/dl.

and also, HDL got decreased from 55 to 39 mg/dl. because of lack of physical activity throughout the course of

treatment which is said to be secondary cause of hypertriglyceridemia.[18]

In the Samprapti (pathogenesis) of Prameha, Bahu (increased in quantity), Abaddha or Asamhata Medas

(loss of compactness) is one among the Dushya vishesha.[19] This Basti is having Lekhaneeya action. According to

Acharya Dalhaņa, “Lekhanaha Pattaleekaranaha”[20] i.e. Lekhana Guna performs the action of thinning. He also

opines “Lekhanaha Kapha Medaso” which means Lekhana does scraping of Kapha and Medas. Hence, significant

decrease in the cholesterol level of the patient was achieved by Lekhana property of Basti.

Pharmacodynamics of Basti:

Basti acts through Veerya. Active principles of the drug are generally considered as Veerya. Active principle

is an ingredient of a drug that is actively involved in its therapeutic effect. Nipata (contact) and Adhivasa (inherent

residing) are the two chief modes by which Basti Veerya can affect the body[21].

Action of Basti Veerya by Nipata:

Basti administered in the Pakvashaya affects the whole body by its Veerya similarly as the sun in the sky

affects the Bhurasa (water) though it is far away. This example shows action of Basti is not only dependent upon

absorption of the active principle but also it affects the body as soon as these active principles comes in contact with

the Pakvashaya proving the action of Bastiveerya by Nipata.[22]

Action of Basti Veerya by Adhivasa:

When Basti administered in the Pakvashaya, its Veerya (probably active principles) is taken up by Samana

Vayu with the help of Apana Vayu. Then it reaches other Vayu also, and affects them by its action. It also keeps Pitta

and Kapha in their proper places. The transport of Basti Veerya is by Kedarakulya Nyaya which makes it spread all

over the body by virtue of different Vayu. This quotation supports the theory of absorption of Basti active principles

i.e. phytochemicals of the Basti as the action is dependent upon Guna which are the properties in Dravya.[23]

Action of Basti through Enteric nervous system (ENS):

This action can be explained in modern parlance by the direct action of active principles of drug on receptors

in the gastrointestinal tract related to the enteric nervous system. ENS is substantial group of neurons, it is capable of

Autonomous reflex without influence of central nervous system. More than 500 million neurons present in the ENS

(Enteric Nervous System) so it’s called “second brain.”[24] There are so many similarities between CNS-ENS

regarding cellular structure, neuropeptide secretion and specific functions and recent studies have shown that there is

great influence of CNS and ENS on each other.[25]

Basti may act over the receptors of the ENS to stimulate the CNS causing secretion of required hormones or

other chemicals. Hence the effect of Basti may also be associated with “Touch & Go Theory” causing activation of

ENS receptors. It is recognized that the enteric nervous system has a unique ability to mediate reflex activity

independently of input from the brain or spinal cord.[26]

5. CONCLUSION:

Sciatica is the major cause of morbidity making the person disable from daily routine activities which in turn

leads to lack of physical exercise. This may contribute to the development of hyperlipidaemia. In contemporary

medicine, conservative treatment is only for pain management which includes analgesics or NSAID. Surgical

management of these cases is expensive and has its own pros and cons. This case study showed Erandamooladi

Niruha Basti is safe and effective in the management of sciatica and hyperlipidemia and results of subjective and




objective parameters indicate that patient improved in presenting features and significant improvement found in

quality of life of the patient. Since this study was conducted in only in a single patient, further Randomized clinical

trial with sufficient number of patients will be required to get reproducible observations.

6. CONSENT AND A.D.R.:

Written informed consent from the patient was taken prior to the initiation of treatment. There were no adverse

drug effects during and after the course of treatment.

REFERENCES:

[1] Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana, Ch.20, Ver.11. Varanasi: Chaukambha Sanskrit Sansthan; 2013. p. 113.

[2] Acharya YT, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana, Ch.28, Ver.56. Varanasi: Chaukambha Sanskrit

Sansthan; 2013. p. 619. [3] Jameson, Fauci, Dennis Kasper, Hauser, Longo, Loscalzo - Harrison's Principle of Internal medicine 20th edition. Vol. 2,

chapter 267, page no.-1859

[4] Acharya YT, editor. Charaka Samhita of Agnivesha, Nidanasthana. Ch.4, Ver. 07. Varanasi: Chaukambha Sanskrit Sansthan; 2013. p.212

[5] Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana, Ch.23, Ver.5. Varanasi: Chaukambha Sanskrit

Sansthan; 2013. p. 122.

[6] Michael ogon et al, Chronic low back pain measurement with visual analogue scales in different settings, Pain, Volume 64, Issue 3, March 1996, p.425-428

[7] Fairbank JCT, Pynsent PB. The Oswestry Disability Index. Spine. 2000; 25:2940-2953.

[8] Acharya YT, editor. Charaka Samhita of Agnivesha, Siddhisthana. Ch.1, Ver. 48. Varanasi: Chaukambha Sanskrit Sansthan; 2016. p. 684.

[9] Acharya YT, editor. Charaka Samhita of Agnivesha, Siddhisthana. Ch.3, Ver. 38-42. Varanasi: Chaukambha Sanskrit

Sansthan; 2016. p.696. [10] Dr. D.V. Panditrav, Sahasrayoga, Panchama Prakaranam, 118 Tailayoga, p.290

[11] Pt. Parashuram Shastri Vidyasagar, editor. Sharangadhara Samhita of Sharangadhara, Uttara Khanda, Ch.6, Ver. 3.

Varanasi: Chaukambha Sanskrit Series Office; p.330

[12] Acharya YT, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana, Ch.28, Ver.57. Varanasi: Chaukambha Sanskrit Sansthan; 2013. p. 619. [13] Acharya YT, editor. Charaka Samhita of Agnivesha, Siddhisthana. Ch.1, Ver. 40. Varanasi: Chaukambha Sanskrit

Sansthan; 2016. p.684. [14] Acharya YT, Kavyatirtha Narayanram Acharya, editor. Sushruta Samhita of Sushruta, C hikitsasthana. 9th ed., Ch.35,

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[15] Acharya YT, editor. Charaka Samhita of Agnivesha, Sutrasthana. Ch.25, Ver. 40. Varanasi: Chaukambha Sanskrit

Sansthan; 2016. p.131. [16] ManpreetRana, Hitesh Dhamija, Bharat Prashar, ShivaniSharma. Ricinus communis L. – A Review. Department of

Pharmacy, ManavBharti University, Solan H.P. International Journal of Pharm Tech Research, (IJPRIF) CODEN (USA); Oct-

Dec 2012. ISSN: 0974-4304; 4(4):1706-1711. [17] Guyton and Hall Textbook of Medical physiology, 12th Edition, Ch.68, p.829 [18] NHLBI.

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[19] Acharya YT, editor. Charaka Samhita of Agnivesha, Nidanasthana. Ch.4, Ver. 07. Varanasi: Chaukambha Sanskrit Sansthan; 2016. p.212

[20] Acharya YT, editor. Sushruta Samhita of Sushruta, Sutrasthana, Ch. 46, Ver. 519, Dalhana Teeka, Varanasi:

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Pawan Lekurwale, Smita Mekhale, Suraj Rathod, Danga SK, Chetan Gulhane, A Critical review on Pharmacodynamics of Basti Chikitsa and its action on Enteric Nervous System, Review Article, IJAM, ISSN No. 0976-5921

[22] Bende Yogita, Pawan Lekurwale, Smita Mekhale, Suraj Rathod, Danga SK, Chetan Gulhane, A Critical review on

Pharmacodynamics of Basti Chikitsa and its action on Enteric Nervous System, Review Article, IJAM, ISSN No. 0976-5921 [23] Bende Yogita, Pawan Lekurwale, Smita Mekhale, Suraj Rathod, Danga SK, Chetan Gulhane, A Critical review on

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[25] Enteric nervous system, available from http:// www.scholarpedia.org/article/ Enteric_nervous_ system #ENS-CNS_

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