Ksr Validation Of Vasti Ksr

Validation of Vasti for futurity

Dr. K. Shiva Rama Prasad M.D.(Ay) COP (German), M.A, Ph.D. (Jyotish)

28-05-2008

[email protected] [email protected]

1

Futurity Vs Futility

• Futurity =The time yet to come • or • The quality of being in or of the future

• Futility = Uselessness as a consequence of having no practical result [email protected] [email protected]

2

• Over loading oral drug administrations making tender stomach to get gastritis & other complications • The alternative Controlled-Release Preparations, Sublingual, Transdermal Subcutaneous, Parenteral, Intravenous, Intramuscular, Intraarterial, Pulmonary, Topical, etc are not equals Ayurveda Panchakarma - Vasti – As it is -

Present trends [email protected] [email protected]

3

Rectal Administration •

•

•

The rectal route often is useful when oral ingestion is precluded because the patient is unconscious or when vomiting is present - a situation particularly relevant to young children. Approximately 50% of the drug that is absorbed from the rectum will bypass the liver; the potential for hepatic first-pass metabolism thus is less than that for an oral dose. However, rectal absorption often is irregular and incomplete, and many drugs can cause irritation of the rectal mucosa. [email protected] [email protected]

4

Practice

• Ayurveda suggests many methods of disease and healthy managements from ages, using the naturally available adopted • It offers Oral route, Trans dermal route, Trans Rectal route, etc • One has to practice for perfection understanding methods properly • Does Ayurveda requires any adoptions and updates in the systems according to the present technology or not is a debate • Change is Unavoidable under any circumstances

[email protected] [email protected]

5

Tunes of Trans Rectal route

Vasti or Basti • The pronunciation of the Technical term itself is first problem • Many times not undergone the concepts • Following colloquially • Not having touch with Instruments / Mechanism /Drug qualities /etc

[email protected] [email protected]

6

7 steps to success 1. 2. 3. 4. 5. 6. 7.

Prepare patient (Physically / Mentally) Follow indications Check the Ingredients (Contents) Prepare medicine methodically Find proper Instruments Standardize the entire situation Administration (Time /Procedure) [email protected] [email protected]

7

Dimensions

&

Definition • uÉÎxiÉÍpÉSÏïrÉiÉå rÉxqÉɨÉxqÉɲÎxiÉËUÌiÉ xqÉ×iÉ:AÉ WÛû xÉÔ 19/1

Charaka Siddhi 1/38-40 No disease is with out Vata No other than Vasti treat Vata

• An injection syringe made of bladder or the injection it self, Kwathas • uÉxÉÑ ÌlÉuÉÉxÉå – uÉxÉÑ AÉcNûÉSlÉå

[email protected] [email protected]

8

• Enema = An injection of a liquid through the anus to stimulate evacuation; sometimes used for diagnostic purposes • Many varieties of nomenclature based upon the site of administration – Shirovasti, Urovasti, Kativasti, Uttaravasti, Vasti = Niruha, Anuvasana [email protected] [email protected]

9

Preparation & Understanding patient (Physically / Mentally) Pareekshya Bhava (C.Su.15/5; C.Ni.3/6; Su.Chi.38/91-92)

1. The patient subjected for examination for assessment of Kaala, Bala, Dosha and Disease in detail. 2. Later looking at the Vasti Dravya Bala the quantity and time of administration is decided. [email protected] [email protected]

10

•

In this course of preparation – – – – –

In Kaala - Rutu kaala, Vayo kaala, Vyadhi Kriyakaala, Ahara kaala In Bala – Rogi bala (Physical /psychological), Roga Bala, Aushadha Bala In Dosha - sansargatwam – Vruddhi, Ksheena, Urdhwa /Adho gati, etc In Vyadhi - Rogamarga - Shakha /Kosta/Marma, Swatantra / Paratantra, Vata vyadhi, Vata sthaana janya vyadhi, Shakha /Kosta janya vyadhi, Pureeshaadhana / srotas janya vyadhi, Shodhanaarha vyadhi, Brumhanadi kramoyogam

[email protected] [email protected]

11

• Based upon the site/ Organ Vasti – Pakwashaya, Mootrashaya, garbhashaya • Based upon the Drug content / material – Nirooha, Anuvasana • Based upon the Quantity of the material – Sneha, Anuvasana, Matravasti • Based upon the function – Shodhana, Shamana • Based upon the number of administrations – Karma, Kala, Yoga • Based upon the utility – Yapana, Siddha, Piccha, Rakta, Prasruta Yogiki, etc • Based upon the Karmukata (purpose /intentions) – Vajikarana, Brumhana, Lekhana, Vandhtwahara, Teekshna, Mrudu, Krimighna, Chakshushya, Malabhedana, etc

Vasti classification [email protected] [email protected]

12

Trayovasti

(Su.Chi.38/92)

• Susruta affirms that – – Utkleshana – Doshahara – Samshamana – are offered discriminatively

• Where in Charaka enumerates as Dosha Apakarshana in sequence of – – Vata – Pitta – Kapha – are undertaken by the Trayo vasti

(Cha.Si.3/26)

• We are following Charaka statement but not valuing the Susruta • Avapaka/additives such as – (Ch. Vi. 8/175-176, AH Su 10/22-24, Su Chi 38/24) –

Anuvasanopaga, Asthapanopaga, Nirooha Varga, Asthapana Varga, Shadasthapana (Madhuradi) Skandha gana dravyas are not used in practice

[email protected] [email protected]

13

Tridosha & Trayovasti

• One Snigdha & Ushna with Mamsa for Vata • Two swadu & sheeta with Milk for Pitta • Three katu & Ushna, Teekshna with Mootra for Kapha • Never more than the prescribed [email protected] [email protected]

14

Vasti - Discrimination • §ÉrÉ¶É xÉͳÉmÉÉiÉåÅÌmÉ SÉãwÉÉlÉç blÉÇÎliÉ rÉiÉ: ¢üqÉÉiÉç - A WØ xÉÔ 19/59 • lÉ mÉUÇ ÌuÉkÉãrÉÉ – cÉ ÍxÉ 3/69 • xÉqrÉÎglÉÃRûÍsÉlaÉÇiÉÑ mÉëÉmiÉå uÉÎxiÉÇ ÌlÉuÉÉUrÉåiÉç – xÉÑ ÍcÉ 38/7û

•Indications •Vata Vyadhi •Vata Sthaana Janya Vyadhi •Kosta Janya Vyadhi •Pureeshadhaana / Srotas Janya Vyadhi •Shodhanarha Vyadhi •Shodhanadi Krama Rasayana Vidhi •Brumhanadi Kramopayogam [email protected] [email protected]

15

Vasti Poorvakarma

[email protected] [email protected]

16

Sequence of Material • oÉsÉ SÉãwÉ mÉëqÉÉhÉ AlÉÑÃmÉ AÉæwÉkÉqÉç Saindhava = 1 Aksha, Madhu = 2 Prasruti Sneha = 3 Prasruti Kalka = 1 Prasruti Kashaya = 4 Prasruti Avapadravya = 2 Prasruti Total = 12 Prasruti = 1200 ml

[email protected] [email protected]

Su Chi 38/37-3917

Sneha (Lipoprotein)/Kalka quantity • Vata = ¼ = 3 Prasruta, Pitta = 1/6 = 2 Prasruta and Kapha = 1/8 = 1 ½ Prasruta Dosha based sneha quantity • The unctuous substance either oil / Ghee gets digested by the Ushma of Jatharagni and the Kalka Dravya (Shatapushpa) • Kalka dravya in Vasti is a Pachana dravya which assimilates the Vasti draya but not increase the Jatharagni • The ratio of Vasti dravyas are 1:2:3:4 for Kalka, Madhu, Taila, Kashaya respectively to make a solution of mucosal permeable [email protected] [email protected]

18

Cha si 3/23

AS Su 28/42

•

- - UxÉ xÉÇxÉaÉï ÌuÉMüsmÉ ÌuÉxiÉUÉã½åwÉÉÇ AmÉËU xÉÇZrÉårÉ: - xÉqÉuÉåiÉÉlÉÉÇ UxÉÉlÉÉÇ AÇzÉÉÇzÉ oÉsÉ ÌuÉMüsmÉÌiÉ oÉWÒûiuÉÉiÉç

• Avapa dravya = many dravyas based upon Rasa or Gana Dravyas told in – • Dashemaniya, Ksheera, Mamsarasa, Gomootra, Amla varga, etc • Vata = Veerataruvadi, Bhadradarvadi • Pitta = Nyagrodhadi, Kakolyadi • Kapha = Aragwadhadi, Pippalyadi • Quantity = 1: 2 ratio of Avapa : Kashaya (Avapa dravya includes in the quantity told for kashaya)

• – cÉ ÌuÉ 8/175-176 [email protected] [email protected]

19

Sequence Importance • The salt is granular needs grinding • Honey is monosaccharide adds with salt to become amalgam • The amalgam facilitates bonding with – alkaloid bounded lipoproteins of Sneha (Oil /Ghee, etc) to become free ionized negatively charged lipoproteins • These free lipid soluble alkaloid added amalgam freely mixed to become an isotonic solution which is a mucosal barrier [email protected] [email protected]

20

Vasti quantity? • Vasti quantity has to fixed not just by the age factor as told in Samhita but require karshya /Sthoulya, Shareera Dairghya / Pramana, Kosta krura/ Mardavatwa, Aushadha Mardava / Teekshnatwa and Ushna /Sheeta guna along with Aushadha Dravya veerya / Bhajasa Guna samparka • The quantity 1200 ml told for a Purusha of Susruta told 84 Angula = 7 feet – i.e. each Inch of height requires 14.28 ml – According to the height of patient one has to decide the dose of vasti. – i.e. 5 feet 6 inches patient requires 66 x 14.28 = 942.48 ml [email protected] 21 [email protected]

Shape of abdomen for Vasti quantity fixation Apple Vs Pear shape Apart from this another point of interest is the shape of the abdomen in patient also requires for the assessment of Vasti quantity

• Colonic flexures in Apple are wide open and facilitates easy movements and rapid evacuation • Pear colonic flexures are acute angled requires full pressure and that [email protected] restricts the evacuation [email protected]

22

Left lateral position (for Niruha)

• Tailakta gatram – • kruta mootra vitkam Charaka Siddhi 3/17 • Na ati Kshuda artam (Na ati bubukshita) • Savya parshwa shayanam • Na Ati unnata Charaka Siddhi 3/24-25 sheersham • Vaamam prasarya • as – Grahani and Guda are vamashraya. [email protected] [email protected]

23

• Traditional Vasti netra is a 6” long with three whorls – the first 3” from tip to insert in anus • The second & third at other edge to tie the Vasti Putaka – the leather bag for Vasti dravya • Instrument – Material, Model, Mechanism, where it reach, problems of insufficiency / excessive insertion (Normal = 1/4th length)

Vasti netra • Modified Vasti putaka is with 3” nozzle to insert in anus • The second part of Putaka which bears the kashaya is attached connected to nozzle [email protected] [email protected]

24

• Unctuous rectum (Tailakta gatram) facilitates the insertion of nozzle • 3” nozzle is administered inside anus • A regulated forceful squeeze of Putaka helps the Vasti Dravya to reach high colon • An anti clock wise massage on abdomen facilitate the reverse peristalsis for – Na Ati Bhukta patient • Wait for the muhurtha (48 minutes) for evacuation • An clock wise massage on abdomen facilitate the active peristalsis • If not evacuated after 2 muhurtha, forcible evacuation required • If Vata increases – Anuvasana is required or Sneha orally also administered

Vasti Adana

[email protected] [email protected]

25

Samyagyoga / Ayoga • Aushadha Vyapakata samyak/ Vedana • Dosha kshaya (Vilodya) / Shotha • Shakrut Kshaya (vilodya)/ Sanga • Samsnehya Kayam / Hrullasa • Anaayaasa Pureesha, Dosha [email protected] nirharana / Swasa [email protected]

26

Paschat karma • Pratyaagamana kaala = 1 Muhoorta (Su chi 38/18) • If retains more may cause – Shoola, Anaha, Jwara, Marana, etc • Parihaara kaala is 3 days • ÌuÉMüÉUÉ rÉå ÌlÉÃWûxrÉ pÉuÉÇÌiÉ mÉëcÉsÉæqÉïsÉæ: iÉå xÉÑZÉÉãwhÉÉÇoÉÑÍxÉ£üxrÉ rÉÉÇÌiÉ pÉÑ£üuÉzzÉqÉqÉç AjÉuÉÉiÉÉÍkÉïiÉÇ pÉÔrÉxxɱ LuÉÉlÉÑuÉÉxÉrÉåiÉç (A H su 19/51-52) • Sukhoshna snaana • Bhojana “Tribhaaga” (Su chi 38/12) – Teekshna – ¾ – Madhya – ½ – Alpa – ¼

• Anuvasana Vasti on same day (if vata nipeedita) – Vata = Bilwa Taila – Pitta = Jeevaneeya Taila – Kapha = Phala Taila

• xÉuÉÉïÎluÉMüÉUÉlÉç zÉqÉrÉåͳÉÃWû: - - - AlÉÑuÉÉxrÉ mÉËUoÉ×ÇWûhÉÉjÉïqÉç - cÉUMü [email protected] [email protected]

27

Nireekshana • Sequence of – Mala – Vata – Pitta – Kapha is noticed • Examination of the content • If Vasti not evacuated than Teekshna Niruha or Phala varti is administered • If Vasti is evacuated with out eliminating Dosha 2 - 4 Niruha are given till the “SuNiruda” is obtained [email protected] [email protected]

28

Vyapat

Prateekaara [email protected] [email protected]

29

Pharmaco-dynamics

24 May 1887

• The isotonic solute bears the buffers (Satapushpa) to enhance the alkaloid bonded lipids • The broken small lipid chains cross mucosal barrier and bypass the Liver to reach site of disease through systemic circulation • The action potential negatively charged lipoprotein bonded alkaloids regulate the systemic damage and restore to normal • At the same time pressure on nerve endings in the hypo gastric & sacral plexus relived by removal of faecal & flatus [email protected] [email protected]

30

[email protected] [email protected]

31

[email protected] [email protected]

32

[email protected] [email protected]

33

At the interest of developing Utility based Value added Panchakarma • [email protected] • [email protected] [email protected] [email protected]

34