Dyslipidemia one of the life style disorder due to the todays faulty life style. It may be manifested by elevation of the total cholesterol the bad low density lipoprotein (LDL) cholesterol and the triglyceride concentrations and a decrease in the good high density lipoprotein (HDL) cholesterol concentration in the blood. Dyslipidemia is widely regarded as a major risk factor for coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD). Every 1% increase in cholesterol level there is 1-2% increase in the incidence of Coronary Heart Disease.
Lipids can be correlated to that of Medo Dhatu. According to the scattered references Dyslipidemia can be correlated to Medo Dosha and subsequently as Medoroga. The treatment principles mainly includes Samshodhana Chikitsa (Bio cleansing), where as in modern statins are first choice of drug.
Looking into the adverse reactions and the limitations in the modern medication clinical trial was carried out in 30 patients having Dyslipidaemia. Lekhana Basti was administered and the effect of treatment on the complete lipid profile i.e., Serum cholesterol, Triglycerides, HDL, S.LDL, VLDL was assessed after the treatment and follow up. As Basti Karma is best treatment for correction of Vata Dosha, which are the basic factors involved in the pathogenesis of Medoroga. Statistical analysis using ANOVA and paired t test showed highly significant result in the lipid profile after the treatment and follow up

B.A, Pooja

Bhatted, Santoshkumar

K.Bhojani, Meera

English

International Journal of Ayurveda and Pharma Research

                   Int. J. Ayur. Pharma Research, 2014; 2(7): 18-21        ISSN: 2322 - 0910   Available online at : http://ijapr.in Page 18 International Journal of Ayurveda and Pharma Research   Research Article  EFFECT OF LEKHANA BASTI IN THE MANAGEMENT OF DYSLIPIDEMIA: A CLINICAL STUDY  Pooja B.A1*, Santoshkumar Bhatted2, Meera K.Bhojani3 *1Ph.D Scholar, 2Associate Professor and Head, Dept. of Panchakarma, National Institute of Ayurveda, Jaipur, Rajasthan, India.  3Professor, Govt. Ayurveda College, Junagadh, Gujarat, India. Received on: 05/11/2014    Revised on: 18/11/2014            Accepted on: 28/11/2014 ABSTRACT                INTRODUCTION The 21st century is an era of tremendous development and innovation in all aspects of life in general and in the field of technology in particular which has made living much more comfortable on one side but on the other side gifted many life style related diseases. Today’s life style mainly includes faulty food habits, minimum physical exercise, maximum mental and intellectual exercise with stress, anxiety and depression resulting into various abnormalities in body composition, one of such gift is Dyslipidemia. Particularly the unhealthy food habits like intake of fast food, convenience food, processed food, high calorie food and irregular timings of meals with sedentary life style is the foremost cause for Dyslipidemia. Its prevalence is increasing, more over is a potential signal for unrecognized comorbidities like Obesity, Metabolic syndrome, Diabetes mellitus, Hypertension, Cardio vascular disease etc., [1] Among the lifestyle disorders Dyslipidemia is the disorder of lipoprotein metabolism manifested by elevation of the total cholesterol the bad low density lipoprotein (LDL) cholesterol and the triglyceride concentrations and a decrease in the good high density lipoprotein (HDL) cholesterol concentration in the blood.  Dyslipidemia is widely regarded as a major risk factor for coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD); for every 1% increase in cholesterol level there is 1-2% increase in the incidence of CHD. Death in female due to CHD is more than all cancer combined. The global Dyslipidemia one of the life style disorder due to the today’s faulty life style. It may be manifested by elevation of the total cholesterol the bad low density lipoprotein (LDL) cholesterol and the triglyceride concentrations and a decrease in the good high density lipoprotein (HDL) cholesterol concentration in the blood. Dyslipidemia is widely regarded as a major risk factor for coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD). Every 1% increase in cholesterol level there is 1-2% increase in the incidence of Coronary Heart Disease. Lipids can be correlated to that of Medo Dhatu. According to the scattered references Dyslipidemia can be correlated to Medo Dosha and subsequently as Medoroga. The treatment principles mainly includes Samshodhana Chikitsa (Bio cleansing), where as in modern statins are first choice of drug.  Looking into the adverse reactions and the limitations in the modern medication clinical trial was carried out in 30 patients having Dyslipidaemia. Lekhana Basti was administered and the effect of treatment on the complete lipid profile i.e., Serum cholesterol, Triglycerides, HDL, S.LDL, VLDL was assessed after the treatment and follow up. As Basti Karma is best treatment for correction of Vata Dosha, which are the basic factors involved in the pathogenesis of Medoroga. Statistical analysis using ANOVA and paired t test showed highly significant result in the lipid profile after the treatment and follow up. Keywords: Dyslipidemia, Lipid profile, Lekhana Basti.  Pooja B.A et al. Effect of Lekhana Basti in the Management of Dyslipidemia  Available online at : http://ijapr.in Page 19 burden of disease study has estimated that cardiovascular disorders are currently the second leading worldwide cause of disability adjusted life years (the sum of lost life due to mortality and years of life adjusted for the severity of disability) in industrialized countries (Murray, 1997). Based on the above statistics there is little doubt that Dyslipidemia is a major risk factor for morbidity and mortality. It is thus a serious public health problem. There are scattered references available in Ayurveda correlating Dyslipidemia. Lipids can be easily correlated to that of Medo Dhatu. Abnormal composition of Medo Dhatu is considered as Medo Dosha and subsequently as Medoroga. It is a condition caused by derangement of Agni in general and Medodhatvagni in particular leading to improper formation of Medo Dhatu in excess, which subsequently starts accumulating in the Srotas resulting into obstruction to the flow of Vata, in turn aggravating the Vata Dosha which moves back into the Pakvashaya causing further excitation of Agni requiring frequent meals thus the vicious cycle continue resulting into Medoroga.[2] Statins are the first choice in the treatment of Dyslipidemia, however the need for long term, lifelong therapy is associated with several adverse effects like myopathy, increased risk in ARF/CRF, hypothyroidism and memory loss. In Ayurveda basically treatment is based on severity of the disease and virulence of the Dosha. Samshodhana (bio cleansing) Chikitsa for Bahu Dosha (excessively vitiated Dosha) and Samshamana (palliative) Chikitsa for Alpa and Madhyama Bala Dosha (mild to moderately vitiated Dosha and diseases). Medo roga being Bahu Dosha dominant condition Samshodhana Chikitsa is preferred treatment modality.  Among these treatments Basti Karma is best treatment for correction of Vata Dosha, which is the basic factor involved in the pathogenesis of Medoroga. According to Acharya Sushruta by using various combinations of ingredients it is considered good even in other Dosha and Dooshya involvement and beneficial in diseases of all the three paths where most of them are due to involvement of Vata thus said to be Ardha Chikitsa.  Thus with this thought, A randomised clinical study was done to evaluate the efficacy of Lekhana Basti in Dyslipidemia. AIMS AND OBJECTIVES To evaluate the effect of Lekhana Basti in the management of Dyslipidemia (Medoroga) MATERIALS AND METHODOLOGY Patients indicated and fit for trial were selected from outpatient and inpatient department of Panchakarma, National Institute of Ayurveda Hospital, Jaipur, Rajasthan. Diagnostic criteria 1. Abnormal levels of serum lipid profile. 2. Clinical features of Dyslipidemia and Medoroga like Ashaktaha Sarva Karmasu, Kshudra Shvasa, Svedadhikya, Utsahahani, Angagaurava  Inclusion criteria 1. Serum lipid levels ranging  Serum Cholesterol (201mg/dl or more), Serum Triglycerides (161mg/dl or more), Serum HDL (below 40mg/dl), Serum LDL (131mg/dl or more). Serum VLDL (41mg/dl or more). All or any of these.  2. Having clinical features of Dyslipidemia and Medoroga Exclusion criteria  Patients below 20 years & above 60 years, with other systemic diseases like cardiovascular diseases, associated with any rectal pathology like Haemarrhoids, Fissure etc., not fit for Lekhana Basti were excluded from the study. Laboratory investigation  Routine hematological and urine investigations, lipid profile, liver function test were carried out before and after the treatment. Assessment criteria  Complete Lipid profile including serum cholesterol, serum triglycerides, serum HDL, serum LDL, serum VLDL were assessed before starting the treatment, after completion of treatment and after follow up (As the parameters are in the measurements no scoring pattern was adopted). Lekhana Basti procedure In this group Lekhana Basti was administered as Kala Basti in modified schedule. Int. J. Ayur. Pharma Research, 2014; 2(7): 18-21  ISSN: 2322 - 0910   Available online at : http://ijapr.in Page 20 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Basti A N N N A N N N A N N N A N N A The Basti was administered in the following steps.                The patient was subjected to Sarvanga Abhyanga with Dashamoola Taila followed by Bashpa Svedana. Then the patient was asked to have rice with green gram dal in lesser quantity than regular consumption, attend natural urges and walk a few steps before reaching the Basti room. On the day of Niruha Basti patient was asked to come in empty stomach.  After recording the vitals patient was advised to lie comfortably in left lateral position on Basti table with left leg straight and the right leg flexed at knee and hip joints, head resting on left hand with the right hand resting on the right leg. Preparation of Basti Dravya  Anuvasana Basti 60 ml of Triphala Taila[3] was made lukewarm by keeping it in a hot water bath. Then Shatapushpa Choorna and Saindhava Lavana (each 1 gram) added and mixed till a homogenous mixture was obtained, again Basti Dravya was luke warmed, administered with enema syringe fitted with rubber catheter (no.08). Niruha Basti[4] Makshika (Honey) 60ml, Saindhava Lavana 5grams, Triphala Taila 90 ml, Yastimadhu Kalka 20grams, Triphala Kvatha 240ml, were added accordingly and stirred well to get homogenous mixture. Lastly Gomutra 50ml, Yavakshara and Ooshakadi Gana Dravya (Hingu, Tutta, Kaseesa, Shilajatu) 2 gram each added administered through Basti Putaka. Follow up: Follow up of the patients was done once in fortnight up to 2 months. OBSERVATIONS AND RESULT Out of 30 patients maximum 63.33% patients were male, 83.33% patients in between the age group 25-50 yrs.53.33% patients were Hindu, 76.66% patients were married, 80% patients were having the history of strainous work, 53.33%were VataKapha Prakriti, 53% were Kroora kosta, 78% patients were non vegetarians. Table 1: Showing the effect of treatment on complete lipid profile      Pair wise significance Lipid Profile BT AT  % AF BT-AT BT-AF AT-AF Serum Cholesterol 267.57± 21.15 167.17± 22.10 37.53% 172.33± 21.83 <0.001** <0.001** <0.001** Serum Triglycerides 218.83± 34.25 166.77± 22.00 23.79% 172.23± 21.30 <0.001** <0.001** <0.001** Serum HDL 56.43± 8.26 56.50± 5.06 0.12% 58.80± 5.87 0.943 0.020* <0.001** Serum LDL 167.70± 14.65 77.27± 19.24 54% 78.62± 20.36 <0.001** <0.001** 0.347 Serum VLDL 43.79± 6.87 33.35± 4.40 23.85% 34.42± 4.27 <0.001** <0.001** <0.001** DISCUSSION Dyslipidemia can be studied under the broad umbrella of Sthaulya in Brihatrayi. Atisthaulya is at first mentioned by Acharya Charaka as one of the Kaphaja Nanatmaja Vikara in Maharoga Adhyaya and is later on elaborated upon in the subsequent Ashtau Ninditiya Adhyaya. On further contemplation it is evident that Atisthaulya is physiology predominant disorder which eventually gets converted into a pathological state. The progression from a physiology to pathology is so prompt that it cannot be pointed out distinctly.  A review of the Laghutrayi bears certain references to Dyslipidemia. Adhamalla while commenting on Sharangdhara Samhita has tried to differentiate between the two types Medo Roga viz; Sthaulya and Medo Dosha. According to the distinction made by him, the former is characterized by Udaravriddhi where as the later is characterized by morbid changes occurring due to obstruction of the channels. In the present study a modified Kala Basti schedule was adopted, in order to have maximum Lekhana effect, more number of Niruha Basti and less number of Anuvasana Basti were administered as Kala Basti Schedule. The effect of Lekhana Basti in Serum Cholesterol can be studied under two headings. 1. Action at the level of Liver This could be because of the chief drugs of Lekhana Basti like Honey, Triphala, Gomutra, Yavakshara, Ooshakadi Gana Dravya are having  Pooja B.A et al. Effect of Lekhana Basti in the Management of Dyslipidemia  Available online at : http://ijapr.in Page 21 Kaphahara, Medohara activity which might have been absorbed by the superior haemorroidal veins reach directly to the liver there by correcting liver metabolism which might have reduced the synthesis of cholesterol and increasing its excretion, and 2/3rd directly enters systemic circulation through inferior and middle haemorroidal veins resulting into significant availability of drugs bypassing first pass metabolism which may be the cause in reduction in serum level.  2. Correcting Vata Dosha The corner stone in the treatment of reducing cholesterol is inhibiting the action of Acetyl Co-A reductase which may be considered as part of Vata Dosha. Basti Karma regulates the production and function of Vata Dosha. The effect obtained by Lekhana Basti in Serum Triglycerides may be due to the following reasons. The drugs used in Basti Karma are mainly Medohara (hypolipidaemic) and Lekhana in nature hence they might have reduced the level of TGL. Apart from this the basic causative factor for Dyslipidemia (Medoroga) is the abnormal movement of Vata Dosha which in turn increases the appetite there by in turn result in increased calorie intake. Hence to reduce the calorie intake the corner stone of the treatment could be regulating the movement of Vata Dosha which was achieved by successful administration of Basti. The improvement in the Serum HDL level after the Basti was observed. As Basti Karma corrects the Vata Dosha which is responsible for the proper transportation of Poshaka Rasa and formation of good quality Dhatu.  Lekhana Basti drugs are having Medohara action, it cleanses the channels of transportation their by eliminates the accumulated Dosha and Malarupi Medo Dhatu which may be the reason for the better reduction of Serum LDL and VLDL level.   CONCLUSION Dyslipidemia is an abnormal amount of lipids in the blood due to impaired lipid metabolism, can be correlated with abnormal Medo Dhatu (Medo Dosha). In Medoroga primarily there is Agni Vaishamya and Vata Dushti, among Samshodhana Basti Karma is best to correct Vata Dosha and further corrects the Agni.  Lekhana Basti effect showed mean decrease of 37.53% in cholesterol, 23.79% in triglycerides, 54% in LDL, 23.85% in VLDL and increase of 0.12% in HDL levels after the treatment. Further after the follow up period showed mean reduction of 33.46% in cholesterol, 20.52% in triglycerides, 52.26% in LDL, 20.65% in VLDL and 4.07% of increase in the HDL levels. Lekhana Basti was highly effective in reducing of cholesterol level which was statistically highly significant even after the follow up. REFERENCES 1. Harrisons, Harrison: Principles of Internal Medicines, edited by Eugene Braunwald, Anthony S. Fanci, Stephen L. Hauser, Dennis L. Kasper, Dan L. Longo, J. Larry Jameson and McGraw-Hill – Medical Publishing Division; Vol.- 2. 15th International Edition, 2012, pg.no. 2249 2. Madhavakara, Madhava Nidana with Madhukosha commentary of Vijaya rakshita and Shrikantadatta, Medoroga Nidanam, published by Varanaseya Sanskrit Samsthana; Varanasi. 1993. Pg.No 28. 3. Agnivesha, Revised by Charaka and Dridhabala, Charaka Samhita with Ayurveda Deepika Commentory of Chakrapanidatta, Sootrasthana 13th chapter, Sneha Adhyaya 92th sloka edited by Yadavakji Trikamaji Acharya, published by Chaukambha Sanskrit Samsthana; Varanasi. 2004, pg.no.87. 4. Sushrutha, Sushrutha Samhita with Nibhandha Sangraha Commentory of Dalhana, Chikitsasthana, 37/8 edited by Yadavakji Trikamaji Acharya, published by Chaukambha Sanskrit Samsthana; Varanasi. 2004, pg.no.87.  *Address for correspondence Dr. Pooja B.A Ph.D Scholar Dept. of Panchakarma National Institute of Ayurveda Jaipur, Rajasthan, India. Email:  drpoojaba@gmail.com   Ph: +919902209309 Cite this article as:  Pooja B.A, Santoshkumar Bhatted, Meera K.Bhojani. Effect of Lekhana Basti in the Management of Dyslipidemia. Int. J. Ayur. Pharma Research. 2014;2(7):18-21. Source of support: Nil, Conflict of interest: None Declared  

EFFECT OF LEKHANA BASTI IN THE MANAGEMENT OF DYSLIPIDEMIA: A CLINICAL STUDY

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EFFECT OF LEKHANA BASTI IN THE MANAGEMENT OF DYSLIPIDEMIA: A CLINICAL STUDY

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