4th World Ayurveda Congress

Guided by : Presenter :
Dr.Niranjan rao Dr.Prakash paltye
MD(Ayu) final year MD Scholar
Professor Dept of Panchakarma,
SDMCA –Udupi
Dept of Panchakarma
drprakash007paltye@gmail.com
SDMCA -Udupi
ReF:No:4WAC/PA-780
4WAC , Bengaluru, 12th Dec 2010 4:30 pm
 INTRODUCTION:
 Pakshaghata is one among the Vatavyadhi consider
as mahagada mentioned by Acharyas and is tricky to
restore to health. Pakshaghata may be correlated with
the stroke phenomena, where in either left or right
side of the body looses its functions in different
degrees.
 Paralysis is the total loss of voluntary motor
function result from severe cortical or pyramidal tract
damage, it can occur with a cerebrovascular disorders
degenerative neuromuscular diseases or CNS
infection. The common brain disorder is
cerebrovascular accidents (CVA) also called a stroke or
brain attack1. Stroke is a leading cause of serious long
term disability in the United states.
 Stroke incidence and mortality rates found to be
higher in developing than in developed countries for
first time 2
 New Data the World Congress of Cardiology BEIJING,
19 JUNE 2010.  There is evidence that stroke
incidence rates in developing countries have increased
by more than 100 per cent during the last four
decades, while they have decreased by 42 per cent in
developed countries over the same time period,
according to new data presented today at the World
Congress of Cardiology (WCC) Scientific Sessions in
Beijing, China.  Over a four decade period, stroke
incidence rates increased from 52 per 100,000 person-
years (1970-1979) to 117 per 100,000 person-years
(2000-2008) in developing countries. 
 May 2007, The burden of stroke, Each year 16 million
people experience a stroke and 5·7 million die. 87%
of global stroke mortality occurs in low- and middle-
income countries3.
 Stroke is the third most common cause of death in
developed countries, behind coronary heart disease
(CHD) and cancer.

 Basti is one of the superlative treatment modality in

morbid vata dosha. 5 Niruha basti considered as one
of the foremost treatment for pakshaghata.6 in which
it is capable of eliminating doshas from the body and
it sustains life, dosha, dhatu and mala.7 Niruhabasti
serves purpose of ellimination of vitiated vata dosha.
Among various types of Niruha basti dravyas, Dwi-
panchamula Niruha basti dravya are also
mentioned.8 so it is considered effective in
Vatavyadhi and also provides additional benefits of
shodhana, bruhmana, Rasayana .Here a sincere
attempt is made to evaluate the efficacy of the same.
 OBJECTIVES OF THE STUDY

 To evaluate the efficacy of Dwi-panchamula Niruha

basti clinically.
 Conceptual study of Dwi-panchamula Niruha Basti
and pakshaghata will be taken up.
 SELECTION OF PATIENTS AND METHODS

  SOURCE OF DATA:
 It is a single blind clinical study with a pre-test and
post-test design where in a minimum of 20 cases but
here attempt to made for present clinical study 60
patients suffering from Pakshaghata were selected.
 Method of data collection:
 It is a clinical study to evaluate the efficacy of Dwi-
panchamula Niruha Basti as Yoga Basti procedure in
Pakshagahta where in, patients of either sex will be
selected randomly.
 A detailed proforma will be prepared considering all
points pertaining to history, signs and symptoms and
examinations as mentioned in our classics and allied
sciences to confirm the diagnosis.

 Patients will be analyzed & selected accordingly

Inclusion criteria :
 Patients suffering from pakshaghata.
 Patients who were fit for Niruha basti.
 Age group between 30-70 yrs.

Exclusion criteria:
Signs and symptoms of Pakshaghata with evidence
of cerebral infection, convulsive disorder, space
occupying lesions and trauma.
Patients with T.I.A and IHD.
Patients with signs and symptoms of Pakshaghata
above 6-months.
 Assessment Criteria :
 Subjective parameters
 Symptoms of Pakshaghata.
 Symptoms of Samyak nirudha and anuvashita
Lakshanas.
 
 Objective parameters
 It was assessed by Neurological mapping
 Interventions:
 Duration of treatment -8 days.
 Dosage of Dwi-panchmula Niruha basti dravya:
 Shat-prasrutika matra i.e.576ml (Approxi:600ml)
 Dosage of Matra basti: 30 ml of Moorchita taila
 Mode of administration:- All the drugs will be
given perectum.
 Poorvakarma:
 Sthanika Abhyanga with Moorchita tila taila & Nadi
sweda with ushna jala.
 Pradhana karma:
  In this study Dwi-Panchamula Niruha basti was
administered in Yoga basti course. Therefore, on 1st,
3rd, 5th, 7th, 8th, day Matra basti with Moorchita taila
was given. And on 2nd, 4th, 6th, day Dwi-Panchamula
Niruha basti was given.
 Assessment will be done before administration of Basti
Chikitsa (BT)
 At the end of Yoga Basti course assessment will be
done after 8 days (AT)
 After 16 days followup will be done [pariharakala of
basti] (FU)
 Total duration of study will be maximum of 24 days.

 Paschatakarma:
 Parihara kala of Niruha basti i.e 16 days.
 Total 60 patients diagnosed as pakshaghata were randomly
selected & studied
Distribution of patients according to age:
Analysis of age incidence of 60 patients
shown the more number of patients are in
the group of 61 –70yers of age.
Marital status

Among 60 patients 58 patients in the

study were married peoples and 2 patients
were un married.
Diet
Maximum no of patients were of mixed diet (51).

Distribution of patients according to duration of illness

Analysis of duration of illness incidence of
60 patients shown the, more number of
patients are in the group of 10-20 days
history of illness i.e-22 patients.
Distribution of patients according to religion

Analysis of religion incidence of 45

patients shown the more number of
patients(75%) were in the group of
Hindu.
Occupation
Analysis of occupation incidence of 60
patients shown the more number of
patients(30%) housewife, were in the
group moderate work group of
occupation.
Distribution Of Patients According To Side Affected

Maximum numbers of patients56.66% of

patients had right side affected while
43.33% had left side involvement.
 EFFECTS OF DWI-PANCHAMULA
NIRUHA BASTI ON DIFFERENT
NEUROLOGICAL PARAMETERS

 The analysis was done statistically using version

SPSS statistics 17.0 software.
 Paired t- test was used for comparing the results.
 BT- Before the initiation of Dwi-panchamula Niruha
Basti therapy.
 AT-Immediately after the completion of Dwi-
panchamula Niruha Basti therapy.
 AF- After the completion of follow up of 16 days.
•Over All Effect Of Treatment
Analysis Of Subjective Criteria:
Effect of treatment on Karma kshya
n BT Follow up Diff % Paired ‘t’ test
Mean SD SE ‘t’ P
Me “d”
an

15 2.86 AT 1.93 0.93 32.5 0.258 ± 14.00 P<0.0

1 0.066 05
AF 1.46 1.40 48.9 0.507 ± 10.69 P<0.0
5 0.013 7 01

Statistical analysis revealed that there was 32.51%

improvement in karma kshya soon after treatment and
was further increased to 48.95% after the follow up.
This change that occurred with the treatment is
statistically significant (P<0.001) with degree of
freedom 14.
Effect of treatment on karma hani :
n BT Follow up Diff % Paired ‘t’ test
Mean SD SE ‘t’ P
Me “d”
an

45 2.8 AT 2.24 0.58 20.5 0.449 ± 7.760 P<0.

2 6 0.744 001
AF 1.84 0.98 34.7 0.583 ± 11.24 P<0.
5 0.869 8 001

Statistical analysis revealed that there was 20.56%

improvement in karma hani soon after treatment
and there was further improvement to 34.75%
after the follow up. This change that occurred with
the treatment is statistically significant (P<0.001)
with degree of freedom 44.
 Effect of treatment on vak-stambha :
n BT Follow Diff % Paired ‘t’ test
up Mean
Me “d”
SD SE ‘t’ P
an

27 2.9 AT 2.3 0.5 19. 0.242 ± 6.325 P<0.0

8 9 9 79 0.421 01

AF 1.9 1.0 34. 0.358 ± 11.79 P<0.0

6 2 22 0.798 6 01

 Statistical analysis revealed that there was

19.79% improvement in vak-stambha soon after
treatment and was further increased to 34.22%
after the follow up. This change that occurred with
the treatment is statistically significant (P<0.001)
with degree of freedom 26.
Effect
: of treatment on Sandhi bhandha vimoksha :
n Follow up Diff % Paired ‘t’ test
BT Mean SD SE ‘t’ P
“d”
Me
an

26 2.9 AT 2.64 0.32 10.8 0.486 ± 6.325 P<0.0

6 1 0.63 01
AF 1.96 1.00 33.7 0.593 ± 13.57 P<0.0
8 0.77 9 01

Statistical analysis revealed that there was 10.81%

improvement in Sandhi bhandha vimoksha soon after
treatment and there was further improvement to
33.78% after the follow up. This change is
statistically significant (P=0.001) with degree of
freedom 25.
 Effect of treatment on Ruja
n BT Follow up Diff % Paired ‘t’ test
Mean
Mea
SD SE ‘t’ P
n “d”

33 2.00 AT 1.26 0.74 37.0 0.383 ± 22.279 P<0.0

0 0.903 01
AF 1.12 0.88 44.0 0.331 ± 15.232 P<0.0
0 0.577 01

Statistical analysis revealed that there was

37.00% improvement in ruja soon after
treatment and was further improvement 44.00%
after the follow up. This change that occurred
with the treatment is statistically significant
(P<0.001) with degree of freedom 32.
 Effect of treatment on Shotha
n BT Follow up Diff % Paired ‘t’ test
Mean
Mean “d” SD SE ‘t’ P

AT 2.12 0.66 23.74 0.540 ± 0.094 7.091 P<0.001

33 2.78
AF 1.72 1.06 38.12 0.243 ± 0.421 25.886 P<0.001

Statistical analysis revealed

that there was 23.74%
improvement in shotha soon
after treatment and there was
further improvement 38.12%
after the follow up. This
change is statistically
significant (P=0.001) with
degree of freedom 32.
 EFFECT OF TREATMENT ON DIFFERENT OBJECTIVE
CRITERIA:
Effect Of Treatment On Knee Reflex

3.77
n BT Follow Diff % Paired ‘t’ test 4 3.08
up Mean 3
2.45
Me “d”
an SD SE ‘t’ P 2

60 3.7 AT 3.08 0.69 18.3 0.469 ±0.61 11.73 P<0.0

7 0 3 01 BT AT AF

AF 2.45 1.32 35.0 0.567 ±0.73 17.98 P<0.0

1 0 01

Statistical analysis revealed that there was 18.30%

improvement in knee reflex score immediately
after the treatment and after follow up it was
further increased to 35.01% . This change is
statistically significant (P<0.001).
Effect of treatment on Finger nose test
n BT Follow up Diff % Paired ‘t’ test
Mean SD SE ‘t’ P
Me “d”
an

60 1.8 AT 1.60 0.22 12.0 0.415 ± 0.54 4.040 P<0.0

2 8 01
AF 0.82 1.00 54.9 0.487 ± 0.63 15.90 P<0.0
4 1 01

Statistical analysis revealed that there was 12.08%

improvement in Finger nose test soon after
treatment and later on improvement was further
increased to 54.94 % after the follow up. This
change is statistically significant (P<0.001).
Effect of treatment on Finger movement of hand
n BT Follow up Diff % Paired ‘t’ test
Mean
Mea “d”
n SD SE ‘t’ P

60 1.83 AT 1.63 0.20 10.9 0.415 ± 0.54 4.040 P<0.0

2 01

AF 0.82 1.01 55.1 0.390 ± 0.50 29.182 P<0.0

9 01

Statistical analysis revealed that there was 10.92 %

improvement in Finger movement hand soon after
treatment and was further increased to 55.19 %
after the follow up. This change that occurred with
the treatment is statistically significant (P<0.001).
 Maximum retention time for Dwi-panchamula niruha
basti was 48 min.
 Minimum retention time for Dwi-panchamula niruha
basti was 5 min.
 Maximum retention time for MATRA BASTI was
9hrs(540 min)
 Minimum retention time for MATRA BASTI was 10min
MEAN RETENTION TIME OF BASTI FOR EACH DAY IS AS
FOLLOWS
DAY 2nd 4th 6th

MEAN RETENTION 8min 12min 18min

TIME FOR NIRUHA

BASTI

DAY 1st 3rd 5th 7th 8th

MEAN
RETENTION 150min 180min 240min 480min 540min

TIME FOR
MATRA BASTI
 DISCUSSI
Pakshaghata is oneONamong the Vatavyadhi
characterized by cheshtanivruti. But this Mahagada is
having much more drastic expression on human life .
The tragedy of the Cerebro Vascular Accidents lies in the
fact that it does not always kill rapidly in fact it is the
chief and most crippling diseases destroying body and
mind alike.
Chikitsa in Ayurvedic terms not only aims at the
radical removal of the disease but also guides for the
restoration and maintenance of normal health . Niruha
Basti is one among the treatment modality for
Pakshaghata.
Dwi-Panchamula Niruha basti has been selected for
the study. While screening the literatures it can be found
that this particular Basti pacifies the vitiated Vata dosha
i.e.sarva anila vyadhihara and provides Bruhmana
also.Reference: cha. si .3/35 and As.H.kalp: 4/4
 PLAN OF STUDY:
 The patients for the study were selected from the
IPD section of SDMAH, Udupi. 80 patients fulfilling
the inclusion criteria and presented with Prayatma
Lakshana of Pakshaghatha were registered.
 Total number of patients registered – 80
 Completed Present clinical study – 60
 Pilot study – 20
 Reason for pilot – we tried basti with different
kalkas, as satapushpa kalka,ashwagandha
kalka,and administrate basti in different dose with
respect to beyond 70 yr age also. for further
evaluation of retention time and benefits etc..
Hence the statistical data could not be done and put
under the category of pilots study.
 CLINICAL STUDY :
 A single blind clinical study was conducted on
Patients suffering from Pakshaghata. Patients were
randomly selected. In this study Dwi-Panchamula
Niruha basti was administered in Yoga basti course.
Therefore, on 1st, 3rd, 5th, 7th, 8th, day Matra basti
with Moorchita taila was given. And on 2nd, 4th, 6th,
day Niruha basti was given. The following
observations are made.
 CONCEPTUAL STUDY  
 Age and Moola chidra pramana relation is given in
Sushruta Samhita and in Astanga Sangraha, while
Relation of Basti yantra pramana and Moola chidra
pramana is given in Astanga hrudaya. From this one
can draw relation between Age and Basti yantra
pramana.
 OBSERVATIONS AND RESULTS:
 Age: This study describe maximum number of
patients belonged to the age group of 61-70 yrs
40%, followed by 51-60years 28.33%, and then
21.66 % of patients belonged to the age group of 41
to 50 years ,and a minimum number 0f patients
shown in the table 10% of the patients belonged to
the age group of 30 to 40 years, After 40yrs up to
70yrs it is considered as Parihani state, which is
characterized by Vataprakopa, Bhrishyamana Dhatu,
Kshiyamana Dhatu awastha and because of the
etiological factors when they indulging in
vataprakopaka Ahara-Vihara led to morbid status of
Vata, hence led to pakshaghata.
• Sex: In this study most of patients in the study
were Males 66.66% and Female patients were
33.33%.However outstanding to exceptionally small
sample it cannot be concluded that Male are more
prone to Pakshaghata.
• Religion: Most of the patients included in the study
were Hindus 75%, followed by Muslims 16.66%
and Christians 8.33% This may be due to Hindu
dominant population in this area.
• Desha: In the present study that 86.66 %
patients hailed from Anupa desha and 13.33 %
from sadharana desha,as most of patients are from
areas near by udupi which is anupa desha.
• Duration: 18.33% of patients gave the history of
more than one and half months, (i:e upto 6
months) and 15% gave the history of 31-40days,
followed by 30% the history of 21-30 days and
36.66% Of the patient gave the history of 10-20
days were the maxim no: of cases observed in
study. The patients in whom acute phase was
over were more in the study.
EFFECT OF TREATMENT: ON CLINICAL PARAMETERS

•Effect on Reflexes:
Statistical analysis revealed that there was
improvement in all reflexes viz ‘Biceps’, ‘Triceps’,
‘Brachioradialis’, ‘Knee’ and ‘Ankle reflexes’ soon
after the treatment which was further improved
during parihara kala.
 This improvement was seen in the patients who
were suffering from Karma kshya, where as in
patients suffering from Karma hani there was less
change in reflex score soon after treatment, but
further significant change in reflex score during
fallowup period i.e basti parihara kala. so it can be
concluded that Dwi-panchamula Niruha Basti is
having more benefits in Karma kshya in addition
to Karma hani.
 Effect of treatment on Finger Movement in Hand and Toe Movement in leg:
 Statistical analysis revealed that there was
Significant improvement in Finger and Toe
movement, Initially there was no movement in
most of the patients and the improvement seen
afterwards was slight movement and unable to
hold the object in many of the patients and few
patients were able to hold the object gently.
• Effect of treatment on lakshanas:
 absolute relief was seen in symptoms like
karmakshya, Vichetana , Ruja , and there was
significant relief seen in Vakastambha, Shotha.,
Sankocha . were as minimum relief was seen in
case of Karma hani,. Sandhi bandhana vimoksha,
and were as toda symptom subsided soon after
treatment but persist during fallow up period. as
time period for the study was only 24 days , may be
more course of basti is needed to see result in this
lakshana.
DWI-PANCHAMULA NIRUHA BASTI IS BENEFICIAL IN
PAKSHAGHATA BECAUSE OF THE FOLLOWING REASONS:
•It pacifies Vitiated Vata Dosha.
•It acts as Yapana as all its contents holds the qualities of
Rasayana & Shodhana brumhana.
•Improvement results seen after treatment and
maintained further upto parihara kala
•Reflexes : Lakshanas :
Triceps reflexes Karma kshya
Brachioradialis reflexes Ruja,
Knee reflexes Vakastambha
Ankle reflexes Toda, Shotha
Power with respect to movement –
Upper Limb — Shoulder, Elbow, Wrist.
Lower Limb — Hip, Knee, Ankle,.
Finger movement in Hand. Loss of Speech
Standing from Sittingposture Hand - grip power
Wrist Paper holding in Finger.
drooping,Footdrooping
• Results seen after treatment were less
improvement and later changed to significant
during parihara kala:
 Romberg’s test & Finger nose test
 Heel shin test
 Sitting from Lying down posture
 Muscle tone in upper and lower limbs
 Muscle strength in upper and lower limbs
 Walking time.
• Lakshanas –
 Sankocha,Sandhi bandha vimoksha
Karma hani.
 Were as Toda symptom persist during fallow up
period.
 CONCLUSION
 CONCEPTUAL STUDY:  
 Dwi-Panchamula Niruha Basti can be considered
as Mridu Basti , Bruhmana Basti, Siddha Basti,
Vataghana Basti, Shodhana Basti,Shamana
Basti,Rasayana Basti, and On the basiss of
Prasruta – yogiki Basti we can consider as shat
prasrutika matra i.e. 576ml.
 Ingredients of this Basti varies from usual Niruha
Basti , were as in Dwi-panchamula Niruha basti,
Makshikam, Lavanam, Trya-snehas i.e. Indukanta
ghrita, Moorchita taila, ,Varaha vasa,and
Ashwagandha kalka is added and
Dasamulakwatha , chagala Mamsarasa, and
Aamlakaanji is taken into consideration.
 OBSERVATION:
 28.33. % of patients in this study belonged to
Parihani awastha and 40% belonged to vrudha
awastha , which is characterized by Vataprakopa,
Bhrishyamana Dhatu, Kshiyamana Dhatu awastha.
 Risk factors like Hypertension and Diabetes mellitus,
Smoking, Tobacco Chewing.
 RESULTS:
 Motor parameters in Neurological maping showed 2
to 4 folds of improvement. However, this
improvement is recording after the completion of
therapy & specifically after pariharakala.
 Finer movements restored very slowly and
percentage of improvement is comparatively less to
that of gross.
 Speech and sensory aspects improved ,but it is not
up to the mark of gross motor movements.
 Reduced strength improved is in faster pace when
compared to complete loss of strength.
 It has certain limitation in the treatment of chronic
patients above age 70-90 yrs which is observed
during pilot study.
 The author is putting forward a combination of
Shodhana, Rasayana, relevant shamana will yield,
maximum benefit in the patients.
• References:
• Tortora /Grabowski, Principles of Anatomy & Physiology ninth
edition pp: 1055 page no;479.
• http:// www.worldcardiocongress.org/ 19.06.2010 08:30.
• http://www.world-heart-federation.org/ 19.06.2010 08:30.
• http://www.strokeassociation.org/ 19.06.2010 08:30.
• Sushruta,Sushruta Samhita edited by Jadavji Trikamji
Acharaya reprint 2003 Chaukamba Sura Bharati prakashana
Varanasi 2003 Pp:824page no:525.
• Agnivesha Charaka Samhita, edited by Jadavji Trikamji
Acharya,5th edition Chaukamba publication Varanasi 2001.Pp :
738 page no:619.
• Vagabhata, Ashtanga Hridaya edited by Kaviraj Atridev Gupta
14th edition Chaukamba Sanskrit Samsthan Varanasi Pp:616
page no:278
• http://www.enemakit.com/enema_history.html
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