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Piccha basti (view source)

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<div style='text-align:justify;'>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. </div>

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

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| style="text-align:center;" | 2.

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| In management of diarrhoea (atisara)

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| In management of [[Atisara Chikitsa|diarrhoea (atisara)]]

| Cha. Sa. Chikitsa Sthana 19/ 63

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| style="text-align:center;" | 4.

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| In the management of obstructed Vata and kapha in the gastrointestinal tract (mahasrotas), <br/>excessive evacuation of kapha (mucus) with colic pain

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| In the management of obstructed [[Vata dosha|Vata]] and [[Kapha dosha|kapha]] in the gastrointestinal tract (mahasrotas), <br/>excessive evacuation of [[Kapha dosha|kapha]] (mucus) with colic pain

| Cha. Sa. Chikitsa Sthana 19/ 117

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=== 1. Piccha basti formulation 1: ===

Following ingredients are used as homogenous mixture for piccha basti:

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<ul style='text-align:justify;'><li>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) </li>

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<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>

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<li>Paste of the resin from Shalmali (mocharasa, Bombax ceiba L), Majishtha (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.) </li>

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

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

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

=== 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>

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<li>Paste of madhuka (Glycyrrhiza glabra Linn.)</li></ul>

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'''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] </div>

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'''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: ===

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<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>

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

== Dose of piccha basti: ==

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== Practical application of piccha basti: ==

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

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

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

<li>Saindhava- 12 gm</li>

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=== General guidelines: ===

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<div style='text-align:justify;'>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.</div>

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<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: ==

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<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 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. </div>

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<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: ==

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