A Review of Lekhana Basti: Ayurvedic Management of Obesity and Metabolic Disorders

Introduction

Ayurveda, an ancient Indian system of medicine, is centered on achieving balance between the body’s three doshas—Vata, Pitta, and Kapha—and eliminating toxins (Mala). This holistic approach promotes both the treatment of disease and the maintenance of health. Among its therapeutic techniques, Panchakarma plays a pivotal role in cleansing the body and restoring equilibrium. Within Panchakarma, Basti is regarded as a key treatment modality, especially for Vata disorders, and is considered by the Acharyas as “Ardhachikitsa” (half of all treatments) [1]. It is specifically beneficial for regulating Vata dosha, which governs numerous physiological functions, including metabolic processes.

The Lekhana Basti, a specialized form of Basti, focuses on the reduction of excess fat and the elimination of toxins, particularly in individuals dealing with obesity, hypothyroidism, polycystic ovarian syndrome (PCOS), and other conditions associated with excess Kapha and Meda Dhatu. The term “Lekhana” means “scraping,” reflecting the treatment’s goal to cleanse the body by eliminating undesirable substances. This therapy aids in fat reduction, enhances digestive fire, and supports overall metabolic health. Additionally, it helps restore balance among the doshas, particularly reducing Kapha, which enhances vitality and overall well-being.

In modern times, lifestyle imbalances have led to a rise in conditions like obesity, dyslipidemia, and PCOS, thus renewing the relevance of Lekhana Basti as a therapeutic intervention. The increasing prevalence of these metabolic disorders highlights the importance of exploring holistic treatments like Ayurveda, which offer potential solutions to manage these conditions more effectively.

Materials and Methods

Lekhana Basti, as described by Acharya Sushruta in the Chikitsa Sthana [3] and Acharya Sharangdhara in the Uttara Khanda of the Sharangdhara Samhita [4], is composed of a set of core ingredients, including Triphala Kwatha, Gaumutra, Madhu, Yavakshara, and Ushakadigana Prativapa. These ingredients are chosen for their specific therapeutic properties.

Triphala is known for its ability to balance Kapha and Pitta, stimulate the digestive fire (Agnideepaka), and its Ruksha (drying) properties, making it highly effective for treating obesity [5]. Gaumutra, or cow urine, has Katu (pungent), Tikshna (sharp), and Ushna (hot) qualities, which enhance its ability to aid in fat reduction and metabolic stimulation. Additionally, its Laghu (light) and Kapha–Vata Nashak (removal of Kapha and Vata) properties support the overall therapeutic action of the Lekhana Basti [6].

Ushakadigana, a collection of herbs and minerals including Ushaka, Saindhav, Shilajit, and Tuttha, is described by Sushruta for its role in reducing Kapha and promoting fat elimination [6]. This combination contributes to the Shodhana (cleansing) and Lekhana (scraping) properties of Lekhana Basti.

Acharya Caraka also mentions the use of Ushna and Tikshna Basti for treating Sthaulya (obesity), with similar mechanisms in action. The scraping action of Lekhana Basti aligns with Acharya Caraka’s observations, helping in fat reduction and the restoration of balance in the body’s metabolism [7].

According to Sharangdhara Lekhaniya Dravya is the substance that remove the increased Dhatu & Mala by scraping action.

Table 1: Properties of each ingredient in lekhanabasti

Acharya Caraka further introduces the Lekhaniya Mahakashaya in the Sutrasthana [18], a decoction of which some practitioners use in place of Triphala Kwatha in Lekhana Basti, yielding positive clinical outcomes.

The recommended dose of Niruha Basti is outlined by Acharya Sushruta in the Niruhakramachikitsa chapter, specifying 12 Prasruta (1,152 ml), with precise measurements for each component [19]. The ingredients include Madhu (192 ml), Saindhava (12 gm), Sneha (288 ml), Kalka (96 ml), Kwatha (384 ml), and Avapadrava (192 ml). Acharya Caraka suggests that the dosage should vary based on factors such as Dosha, the nature of the medicine (Ausadha), location, season (Kala), and the patient’s strength (Bala), among others [20]. In the current era, due to reduced individual strength, Avara Matra (reduced dosage) is often employed.

Acharya Sharangdhara’s Uttara Khanda provides specific guidance for individuals with lower strength (Heena Bala), recommending a smaller dose of 3 Kudava (560 ml) [21]

The preparation of Lekhana Basti follows classical methods as described by Acharya Caraka [22]. The required quantities of Madhu, Saindhava, Sneha, Kalka, and Kwatha are carefully measured and mixed in a Khalva Yantra (grinding vessel) to form a uniform mixture. The temperature of the mixture should be Sukhoshna, i.e., slightly above body temperature, for optimal absorption during administration.

For administration, the patient is placed on a special table (Droni) in the left lateral position with the right leg flexed. The anal region and Bastinetra (enema pipe) are lubricated for smooth insertion. The enema is introduced gradually into the rectum following the direction of the spinal column, up to the first Karnika (marker). Once in place, pressure is applied evenly and steadily to release the Basti fluid, ensuring it is neither too fast nor too slow. Afterward, some fluid is retained in the Basti Putaka to prevent air movement inside the patient. The Basti should be expelled within 1 Muhurata (48 minutes), as described by Sushruta [23].

After the procedure, the patient is advised to refrain from eating until the Basti is expelled. A warm bath and a light, freshly cooked liquid meal are recommended post-procedure.

Discussion

Lekhana Basti possesses multiple therapeutic qualities, including Vata–Kapha Shamaka, Ushna, Tikshna, Deepana, Pachana, Lekhana, Karshana, and Srotoshodhana, which are essential for managing metabolic disorders. The specific ingredients in Lekhana Basti, including Madhu, Saindhava, Yavakshara, Tila Taila, Triphala Kwatha, Gaumutra, and Ushakadigana, work synergistically to address conditions related to excess Kapha and Medodhatu.

Madhu (Honey) is described by Acharya Sushruta as Yogavahi, meaning it acts as a vehicle for enhancing the therapeutic efficacy of the other ingredients. It functions through its Lekhan, Chhedana, and Srotoshodhana properties, helping to remove blockages and cleanse the channels, making it a vital component of Basti therapy [24].

Saindhava (Rock Salt) is known for its Sukshma (fine) and Vyavayi (penetrating) properties, which allow it to spread into the minute channels of the body, facilitating the movement of drug molecules into circulation. It helps in Kaphavilayan (reducing Kapha), Chhedana (scraping), Deepana (stimulating digestion), and Pachana (promoting digestion) [25].

Tila Taila (Sesame Oil) is Kapha and Vata Shamak (balancing) in nature. Due to its Madhura (sweet) and Snigdha (unctuous) properties, it nourishes and softens the channels. This helps in the removal of toxins and clears blockages, contributing to the detoxification process [26].

Triphala, a well-known Rasayana (rejuvenative) formulation, balances the Tridosha and performs Deepana (enhancing digestive fire). It contains Katu, Amla, and Madhura Rasa (tastes) and Ushna Veerya (potent energy), which act as a mild laxative and support lipid metabolism. Its antioxidant properties improve gut motility and support overall digestive health. It also provides rejuvenation and promotes balance in the body’s systems.

Gaumutra (Cow Urine) serves as a powerful Vata–Kapha Shamaka, Kriminashaka (antimicrobial), Vishagna (detoxifying), Deepana, and Pachana (digestive enhancer). Its broad therapeutic actions, such as anti-obesity, bio-enhancement, anti-diabetic, wound healing, anti-inflammatory, and anti-cancer properties, make it an important ingredient in this treatment [27].

Ushakadigana, a group of herbs and minerals described by Acharya Sushruta, has Kapha Shamak and Meda Shoshak (fat-reducing) properties [28]. The pH of Lekhana Basti is alkaline, due to the presence of Gaumutra (pH = 8.5-9.5) and Yavakshara (alkaline substance), which enhances the absorption of the Basti Dravya through the colon. This alkaline nature helps in reducing harmful microbiomes in the gut, thereby improving gut health. The antimicrobial activity of components such as Triphala and Gaumutra aids in maintaining a healthy gut flora, which is essential for digestive health.

Conclusion

Lekhana Basti plays a critical role as a Samshodhana (cleansing) therapy, particularly for managing metabolic disorders related to excess Kapha and Medodhatu, such as obesity, dyslipidemia, PCOS, and other lifestyle diseases. The synergistic action of its ingredients, including Triphala Kwatha, Gaumutra, Madhu, Yavakshara, and Ushakadigana, provides therapeutic benefits such as Vata–Kapha Shamana (balancing), Deepana (enhancing digestive fire), Pachana (promoting digestion), and Srotoshodhana (cleansing channels).

The Lekhan karma (scraping action) of the ingredients helps break down excess fat, reducing srotosanga (channel blockages) and improving the flow of Agni (digestive fire) and Vata (energy). The alkaline nature of Lekhana Basti enhances absorption and promotes healthy gut flora, improving digestion and reducing metabolic dysfunction.

In the modern era, where lifestyle disorders are increasingly prevalent, Lekhana Basti offers a valuable and sustainable approach to improving metabolic health and overall well-being. By adhering to classical preparation and administration protocols, this treatment can yield optimal therapeutic outcomes, making it an essential tool in Ayurvedic medicine for managing chronic metabolic conditions.

References

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