Panchatiktha Basti For Osteoporosis

Panchatiktha Basti For Osteoporosis

Role of Panchatikta Ghrita enema in prevention and cure of asthi kshaya i.e. osteoporosis & osteopenia – a hypothesis

Since we are discussing about the bones, I shall prefer discussing this topic from the ‘root source of bone and bone marrow formation’ according to Ayurveda.

Like all tissues of the body, the bones and bone marrow tissues are also formed from –

·        The nutritional essence derived from ahara rasa i.e. nutritional juice

·   From their precursor tissue in the Ayurvedic chronology of formation of tissues i.e. dhatu poshana krama

The asthivaha srotas i.e. channels responsible for bone tissue formation lay in fat tissue and hip bones. This is because according to Ayurveda chronology, bones are formed by their precursor tissue i.e. fat tissue. The hip bones and the pelvis seem like holding the entire upper skeleton and the lower limb bones. Therefore they may be considered as roots of bone formation.

Similarly the majjavaha srotas i.e. channels responsible for formation of bone marrow tissue lay in the bones and joints of the body. This is because the bone marrow, according to the chronology of tissue formation, if formed from its precursor tissue i.e. bone tissue. The same bone marrow later fills in the bone tissue.

To sum up – the bones are formed from the fat tissue and form bone marrow tissue. The bone marrow is formed from the bone. Therefore in the roots of both channels responsible for formation of bone and bone marrow, one common thing is the bone. In the first context i.e. when bone is formed from the fat, bone is the effect of fat metabolism. In the later context i.e. when the bone involves in bone marrow formation, bone is the cause for formation of marrow.

Bone is the common link.

Now for the next part of our discussion, this basic discussion was needed.

Here it is interesting to observe that asthivaha & majjavaha are the only channels in which a tissue’s precursor tissue has been mentioned.

Fat, the precursor of bone has being mentioned in asthivaha srotas and bone, the precursor of bone marrow being mentioned in majjavaha srotas.

Sanskrit Verses

 (Cha. Vi.5/8)

What does this show?

This shows a strong connection between fat forming, bone forming and bone marrow forming channels. Incidentally these are also the tissues formed in that chronology i.e. fat – bone – bone marrow in that order

Case 1

The bone tissue is formed from ‘the portions of fat tissue that take part in nurturing and formation of the bone tissue’.

If there is deficit functioning and reduced strength of medo dhatvagni i.e. tissue fire of fat, the bone will be formed inadequately. The weak ‘fat tissue fire’ will not take part in the proper formation of bone. As a result lot of fat tissue is formed. This increased fat blocks all the

channels in the body. This leads to deficit formation of all tissues and excessive formation and deposition of fat in the body. This will eventually impact bone formation also.

Similarly accumulation of ama and many intermediate products of tissue metabolism in fat tissue and other channels occurs. This also leads to deficit bone formation.

This shows that an impairment of fat metabolism and consequent block of bone forming channels leads to deficit formation of bone. This may also lead to formation of weak and immature bone tissue. The bone health will deteriorate. All these events will lead to manifestation of asthi kshaya i.e. osteopenia or osteoporosis.

Case 2

The toots of bone marrow forming channels lie in the bones and joints. Bones and joints are affected and damaged in osteoporosis and osteopenia.

If bone precursors are not formed adequately due to deficit ‘fat tissue fire’, the ‘bone tissue fire i.e. asthi dhatvagni’ may get exacerbated through chain of formation, as a reflex or feedback mechanism.

This might cause loss of bone and consequent increase in Vata.

This again will not allow proper formation of bones and joints which are roots or sources of bone marrow. Consequentially bone marrow is not formed to optimum. These set of events too lead to the manifestation of osteopenia or osteoporosis.

Logic of using tikta ghrita in enema or as one of the ingredient of bitter milk enema in reating osteoporosis and its probable mode of action

Panchatikta Ghrita / Guggulutiktakam Ghrita can be effectively used in treatment of osteoporosis. This is because –

·        It is highly beneficial in correcting the roots of bone tissue channels located in the fat tissue. This enables proper and optimum formation of bone.

·  It corrects the fat-bone-bone marrow formation axis as these tissues and their sequential formation are interrelated. The basis of this has been explained in cases 1 & 2 above. This correction of related tissue metabolism at root level enables stoppage of further bone destruction and enables optimum formation of bone tissue. This eventually combats or prevents osteopenia or osteoporosis.

·       The bitter tasting herbs have ‘depleting effect’ on fat tissue. They also kindle the tissue fire and rectify the fat and bone metabolism. The bitter taste also has an important role in cleansing and clearing the clogged channels of transportation and nutrition i.e. srotoshodhaka. The ghee and milk used as base of formulation are highly effective in combating vitiated vata and pitta which are responsible for bone destruction and inflammation. Thus the panchatikta ghrita, provides tri-phasic action i.e. depletion of excess fat and enabling proper bone formation, providing nourishment and support to the bone tissue and balancing the tissue fires of fat, bone and bone marrow. These roles of the medicated ghee help treating osteoporosis effectively.

·   Since bitter taste has fat (precursor) and marrow (successor) depleting property, it destroys excessive fat and immature marrow formed in the body. It also doesn’t allow the accumulation of mentioned tissues. Thus, bitter taste reduces the burden on bone tissue. It also keeps the pathways of formation and maintenance of bone tissue clear and intact.

·    Ghee base of the preparation helps in combating vata. Actually oil base need to be used since oil is the best anti-vata fat. But the inclusion of ghee in this instance might probably be to combat associated pitta too.

·      Bitter medicines might be thought of as vata disturbing’. But here we need to see that ‘bitter herbs alone’ are not administered. They are processed in ghee and later with milk. This probably dilutes the vata disturbing properties of bitter taste. Also according to Ayurveda principles, the compound or formulation will have a different action (due to combination and processing) in comparison to the individual compounds. Therefore the final medicine which is administered as enema, panchatikta ghrita in this instance will have a bone supporting, anti-bone-destruction and vata-pitta balancing action. Thus it has

disease modifying role in treatment of osteoporosis.

·   Bitter herbs act as bio-availability enhancers and transporters of ghee to the target tissue i.e. bone and bone marrow. Bones and marrow are considered as gambhira dhatus i.e. deep seated tissues. They also belong to the intermediate pathways of diseases. The diseases arising in these tissues are difficult to handle. Similarly to make the medicines reach these tissues too is difficult. Ghee, with its supportive role to the bone and bone marrow and having a rasayana effect i.e. rejuvenating and anti-ageing effect on these tissues will prevent degeneration. It also combats vata and pitta. The bitter herbs have minuteness and deep penetrating properties. Only the properties of bitter taste can reach the deeper tissues. Therefore the ghee processed with bitter herbs is administered as enema. In presence of bitter taste, the ghee will not only be transported to the deeper tissues but also will be used to optimum.

·    The channel cleansing action i.e. sroto shodhana property of bitter taste also will come in handy. As we have already discussed that increased fat and marrow might occlude the channels of nutrition and hence impair bone formation in osteoporosis. The bitter taste available in the ghee medium will clear the pathways by removing the obstruction along

with supporting and nurturing the bone and marrow.

·   Bitter taste increases pitta, hence increases the tissue fire. This rectifies the tissue metabolism. Bone and bone marrow are formed in optimum quantity and good quality. This helps in halting the bone destruction and relieves symptoms of osteoporosis.

Why should these medicines be administered as enema?

Vasti or enema is said to be the best treatment for vata disorders. Bone destruction as in osteopenia and osteoporosis will eventually lead to vata increase. This increased vata may tend to destroy the other tissues too. This will eventually lead to many vata disorders. At the same

time the symptoms of osteoporosis like joint pains, back and neck pain etc might increase due to vata increase. Rectum / colon is the governing center of vata. When the medicines are administered into the colon in the form of enema, the vata will be quickly controlled in comparison to the medicine given in oral route. Thus, it is ideal to administer Panchatikta ghrita alone or in the form of milk enema in the treatment of osteoporosis. The painful symptoms of osteoporosis and osteopenia too will be relieved in quick time with administration of enema. Bone tissue is also one of the main vata seats.

 Vata and bone share the resident and residence relationship. Even in this perspective it is ideal to administer the medicines in the form of enema.

Can these medicines be administered through oral route?

Yes. If we consider Vata, and pathological imbalances in its seats, enema is an ultimate choice. But it can be administered through oral route.

·        in those who are not fit to undergo enema treatment,

·        in those who are reluctant or hesitate to undergo enema treatment

·   in conditions where we want our medicine to pass through the digestive fire, get digested. absorbed and act, and

·        as supportive medicine in the follow up of treating osteoporosis

I have seen good results with these medicines when administered through oral route too.

Some related research studies One study showed that Panchatikta Ksheera Basti was effective in the treatment of asthikshaya vis-a-vis osteopenia and osteoporosis, especially in relieving the symptoms like pelvic-pain, bone pain and joint pain. Improvement in BMD T score was also found to be encouraging.