Tikta Ksheera Basti: Uses, Benefits, Ingredients, Preparation, Procedure & Side Effects

Panchakarma is one of the most significant Shodhana Chikitsa (cleansing treatment) in Ayurveda. Basti Karma is a special procedure classified under panchakarma primarily aimed at balancing Vata Dosha. Among its various forms, Tikta Ksheera Basti is a type of Basti Karma that involves using an enema of a decoction of bitter herbs (Tikta Dravyas) and medicated milk (Ksheera). It is administered using Basti yantra (Nowadays a rubber catheter is more common).

Tikta Ksheera Basti is primarily used in treating chronic inflammatory conditions, conditions related to bone tissue (Asthi Dhatu), degenerative disorders, and Vata imbalances. Today we will provide a detailed review of Tikta Ksheera Basti, covering its classical references, benefits, procedures, preparation method, indications, modern research, side effects, and clinical applications.

Basti Karma In Ayurveda

The word “Basti” in Ayurveda is used in two contexts:

Basti means urinary bladder (Mutrashaya).
Basti Karma (Medicated Enema), which is a type of Shodhana Panchakarma therapy.

Basti karma is used independently or in combination with other therapeutic procedures such as Vamana (emesis), Virechana (purgation). Additionally, preparatory treatments such as Snehana (oleation), Abhyanga (massage), and Swedana (sudation) are essential components of Panchakarma therapy. These can also be used as a main therapy.

Basti Karma involve the administration of medicated enemas, decoction, Oils (Sneha), and Medicated Milk (Ksheera) primarily through the rectal (Pakvashaya) route delivering therapeutic effects both locally and systemically. Additionally, it can also be administered via the Genitourinary tract (Mutramarga or vaginal passage) which is called Uttarbasti.

Vata Dosha is considered the chief causative factor in many diseases. It is the primary dosha responsible for the movement of body fluids, excretions and sensory and motor functions. Vata can easily get aggravated and disturb the normal functioning of the nervous system and mind.

According to Charaka Samhita, Basti Karma is considered the best treatment in Vata disorders due to its ability to balance Vata Dosha. Balancing vata Dsha can address a wide range of diseases, even those dominated by Pitta, Kapha and Rakta Dosha (Hematologic disease). ¹

Basti is considered as “Ardha Chikitsa” (half of the total treatment), highlighting its usefulness in Ayurveda. Many Ayurvedic scholars and practitioners consider Vata balance a complete treatment. Acharya Kashyap described Basti Karma as being as beneficial for children as nectar.

Different types of Basti include Niruha Basti (decoction enema), Anuvasana Basti (oil enema), and Basti formulations like Tikta Ksheera Basti and Pancha Tikta Ksheera Basti.

Types of Basti (Basti Karma Types)

Basti Karma is mainly classified into:

Niruha Basti (Decoction Enema): Also called Asthapan Basti or Kashaya Basti, it involves the administration of medicated decoction (Kwatha). It is primarily cleansing in nature, helps eliminate aggravated doshas, stimulates Agni (digestive fire), enhances Bala (strength), and promotes lifespan or longevity (longevity).
- It is suitable for all seasons. It is typically administered before meals. Examples of Niruha Basti are Tikta Ksheera Basti, Pancha Tikta Ksheera Basti, Madhuk Taila Basti, Arandamuladi Niruha Basti, Pichha Basti, and Kshara Basti.
Anuvasana Basti (Oil Enema): It is an Oil Based Enema that is unctuous and considered a Nourishing type of Basti.

Tikta Ksheera Basti and Pancha Tikta Ksheera Basti fall under the category of Niruha Basti (Decoction Enema), but due to its nourishing effects, it also exhibits properties of Anuvasana Basti.

Tikta Ksheera Basti

Tikta Ksheera Basti is described in Charak Samhita Sutrasthana 28/27. It is indicated for disorders involving bones and joints (Asthi Pradoshaja Vikara) and AsthiKshaya (Osteoporosis). According to Ayurveda, Asthi Dhatu (Bones) are considered the primary centres of Vata Dosha, and Vitiation of Vata Dosha leads to Asthi Dhatu Kshaya (Degenerative changes in the Bones).

Tikta Ksheera Basti involves the administration of Tikta Dravya (bitter herbs) processed in Ksheera (medicated Milk) which possesses both Vata-pacifying (Vata Shamana) and tissue-nourishing (Brimhana) properties. It pacifies vata Dosha, nourishes and strengthens the Asthi Dhatu, and restores the Dhatu Kshaya (Degeneration).

अस्थ्याश्रयाणां व्याधीनां पञ्चकर्माणि भेषजम्| बस्त्यः क्षीरसर्पींषि तिक्तकोपहितानि च ||२७|| Ca.Su 28/27

Meaning: Panchakarma treatment is considered the cornerstone of treatment for conditions that have their origins in Asthi Dhatu (bone tissue). For disorders rooted in Asthi Dhatu (bone tissue), it is recommended to use Basti prepared with Tikta Dravya (bitter herbs), Ksheera (medicated milk), and Ghrita (ghee). ²

Tikta Ksheera Basti Ingredients

Tikta Ksheera Basti falls under the Category of Niruha Basti. It involves the inclusion of the following ingredients respectively:

A Mixture of Sandhava Lavana (Rock Salt) 15g.
Madhu (Honey) 180ml.
Medicated oil or Ghrita 180ml: It involves Panchatikta Ghrita (Ghee), Dhanavantara Tail, Bala Taila, and Guduchi Taila.
Kalka (Paste) of Tikta Dravyas (Bitter Herbs) 30g: Guduchi (Tinospora cordifolia) Or Panchatikta Like. Neem (Azadirachta indica), Patola (Trichosanthes dioica), Vasa (Adhatoda Vasika), Kantakari (Solanum surattense).
Kwatha Decoction 480ml: Processed with Ksheera (Milk), Like Yashtimadhu Ksheerapaka or Dashamula Ksheerapaka.

Panchatikta Ksheera Basti

Pancha Tikta Ksheera Basti refers to the type of Tikta Ksheera Basti that involves the administration of Pancha Tikta (five bitter herbs) processed with milk (Ksheera) using the Ksheera Paka method. This formulation is primarily indicated for Asthi Pradoshaja Vyadhi (bone disorders) and follows the same preparation method as Tikta Ksheera Basti, as described in Sharangadhara Samhita.

Panchatikta Ksheera Basti Ingredients

Panchatikta content (5 Bitter herbs):

Guduchi (Tinospora cordifolia), Neem (Azadirachta indica), Patola (Trichosanthes dioica), Vasa (Adhatoda Vasika), Kantakari (Solanum surattense).

Rest of the ingredients are the same as the tikta Ksheera Basti.

Tikta Ksheera Basti Preparation

First of all, Honey and Sandhava Lavana are blended and ground until a fine emulsion is formed. Then, Sheha Dravya, such as oil or Ayurvedic Ghrita, is added and further ground. Next, the paste of bitter herbs (Tikta Dravya) is added and thoroughly ground. Once a smooth and homogenous mixture is obtained, Kwatha such as Dashamula Ksheerapaka is gradually added and the mixture is slowly heated with steam. Finally, the prepared formulation is filtered and poured into a Basti Yantra for administration.

Tikta Ksheera Basti Uses, Benefits and Indications

Bone Degeneration & Disorders

Asthi Kshaya (Bone Degeneration): Effective in osteoporosis, osteopenia, and brittle bones. A clinical study shows the effectiveness of Tikta Ksheera Basti in managing osteoporosis (Asthigata Vata). Key Findings include reduced pain, stiffness, and mobility problems. Improved bone mineral density (BMD), Serum ALP levels, Reduction in ESR and increase in serum calcium levels. Findings obtained are encouraging and suggest its efficacy in osteoporosis. ³
Asthigata Vata: Addresses bone-related degeneration, pain, and fragility.
Asthimajjagata Vata (Ankylosing Spondylitis): Helps manage inflammatory and degenerative changes in the spine.
Avascular Necrosis: Avascular Necrosis (AVN) also referred to as osteonecrosis is necrosis of bone tissue due to injury or a condition that causes disruption of blood supply to the bone leading to bone degeneration and joint impairment. It can be correlated with Asthi-Majjagata Vata in Ayurveda. Tikta Ksheera Basti Supports bone health by improving circulation and nourishment.
- A Study on Tikta Ksheera Basti for AVN of the neck of femur indicates Tikta Ksheera Basti along with other palliative regimes shows significant results. ⁴
- A Study on Krimighna Vasti and Manjisthadi Ksheera Basti for Avascular Necrosis (AVN) clearly indicates the effective therapeutic benefits of Krimighna Vasti and Manjisthadi Ksheera Basti in treating avascular necrosis (AVN) of the femoral. ⁵
- A case study on Avascular Necrosis (AVN) of the hip joints treated with Panchatikta Kshira Basti, Shashtika Pinda Sweda, and oral Ayurvedic medicines showed significant improvement. MRI scans confirmed bone regeneration, with AVN grades reducing over 23 months, highlighting Ayurveda’s potential in AVN management. ⁶

Joint & Spine Disorders

Sandhigata Vata (Osteoarthritis): Beneficial in joint degeneration and cartilage wear.
Katigata Vata (Lumbar Spondylosis): Helps manage lower back pain and stiffness. A Case Study shows effective symptomatic management of Katigata Vata. ⁷
Greeva Sandhigata Vata (Cervical Spondylosis): Effective in neck pain and cervical spine degeneration.
Greeva Stambha (Neck Stiffness): Helps in reducing rigidity and restricted movement in the cervical region.
Kati Shula (Low Back Pain): Relieves chronic lower back pain and stiffness. A clinical study suggests Panchatikta Ksheera Basti and Kati Basti along with other regimes as a choice of treatment in low back pain (Katishoola) induced by lumbar disc degeneration. ⁸
Parva Bheda (Joint Pain): Useful in generalized joint pain and discomfort.
Greeva Stambha (Neck Stiffness): Manyagraha (Stiffness of the Neck)

Neurological & Autoimmune Disorders

Sciatica (Gridhrasi): A Vataja Vyadhi caused by aggravation of Vata Dosha that results in Ruka (Severe pain), Toda (Pricking or piercing pain), Stambha (Stiffness and rigidity) of the lower back to the legs. To address this condition, Ksheera Basti (Medicated Milk Enema) or Pancha Tikta Ksheera Basti and Dashamoola Niruha Basti are indicated, which helps alleviate pain, inflammation, and stiffness in the lower back and legs. Provides nourishment to Asthi Dhatu (bone tissue) and Majja Dhatu (nervous tissue), reduces nerve inflammation and prevents degenerative changes in the spine.
- A study on Pancha Tikta Ksheera Basti for Gridhrasi (Sciatica) found significant relief in pain, stiffness, and mobility, proving effective in reducing Vata imbalance. ⁹
- In a comparative clinical study, Dashamoola Niruha Basti in the management of Sciatica ( Gridhrasi) also showed similar effects as Tikta Ksheera Basti. ¹⁰
Tingling and numbness: Loss of sensation or burning sensation in the affected leg.
Difficulty in movement: Trouble in standing, walking, or bending due to pain and weakness.
Degenerative Neurological Disorders: Supports conditions like multiple sclerosis, Stroke and motor neuron diseases.
Chronic Autoimmune Diseases: Beneficial in managing rheumatoid arthritis, systemic lupus erythematosus (SLE), and ankylosing spondylitis.

Tikta Ksheera Basti Procedure

Before proceeding to Tkta Ksheera Basti Karma, the patient undergoes fasting as the Niruha Basti is given before food or after the previous meal is fully digested. Informed written consent is obtained before proceeding with the therapy.

Material Required

Basti Yantra: It is composed of Bastiputaka, a polythene bag containing the medicated decoction for enema, and Basti Netra (Nozzle), a hollow tube made of Gold, Silver, Copper, bronze or brass. The length of Basti Netra (Nozzle) can range anywhere between 6 to 12 fingers according to age.
Medicated Decoction Enema: Tikta Dravyas (bitter herbs) and Ksheera (medicated milk) as prescribed. As we discussed in the preparation method.

Purva Karma (Preliminary Measures)

When all the essential materials such as Enema and the types of equipment required, such as (Basti Yantra), are arranged. The person is then subjected to Snehana or Abhyanga (Oil Massage) and Swedana (Sudation Therapy) to prepare the body. In emaciated patients, Anuvasana Basti (Oil Enema) is administered first, followed by Niruha Basti (Decoction Enema).

Pradhana Karma (Main Procedure)

The patient is positioned in the left lateral pose, oil is applied to the anal region and the nozzle then the Basti Netra (Nozzle) is gently inserted through the anal canal into the rectum to a specific depth and the Bastiputaka (polythene bag) containing Medicated Decoction is slowly squeezed, allowing the enema to enter the rectum gradually. The nozzle is carefully removed and the patient is advised to lie in a supine position for optimal absorption of the enema.

Retention Time (Basti Pratyagamya Kala)

The time for the expulsion of Basti Dravya and faeces from the body is called Basti Pratyagamya Kala. The expected time for the evacuation of Basti Dravya and fecal matter is up to 48 minutes. If the Basti is not expelled within this period, the patient is given another Basti. Phalavarti (Ayurvedic Suppository) and Virechana (purgation) with Triphala Churna can also be given for the same purpose. Normal Evacuation of flatus, Feeling of lightness in the body, and increased appetite are the symptoms of well-administered basti.

Pashchat Karma (Post-Treatment Care)

After the Basti procedure, the patient is advised to rest and take a bath with lukewarm water later. Easily digestible food such as rice gruel (Peya), gram soup (Yusha), Milk, and light vegetable preparations are recommended, followed by an Anuvasana Basti (oil enema) in the evening.

Parihara Kala (Recovery Phage):

Parihara Kala refers to the restorative period after Panchakarma, during which specific dietary and lifestyle practices must be followed. This phase ensures the body gradually regains strength, stabilizes digestion, adapts to normal functioning and ensures the therapeutic effects of the treatment are fully integrated while preventing imbalances. The Restorative period should be followed for double the number of days the therapy was administered.

It is crucial to:

Avoid excessive physical exertion to prevent Vata aggravation.
Refrain from prolonged standing and sitting.
Limit travel to prevent Vata aggravation.
Avoid daytime sleeping, which can aggravate Kapha Dosha.
Not suppressing natural urges (Vega Dharana).
Minimize stress, as mental well-being is essential for recovery.
Avoid cold exposure, including cold weather and foods.
Follow timely and wholesome meals

Tikta Ksheera Basti Side Effects and Complications

Tikta Ksheera Basti is generally safe when administered with proper caution and adherence to Ayurvedic guidelines. However, if not performed correctly (Ayoga) or given in excess (Atiyoga), it may lead to undesirable effects and complications. Acharyas have clearly described Basti Vyapada (complications of Basti) due to improper administration.

While Tikta Ksheera Basti is well-tolerated, some common side effects include:

Mild pain in the anal region, inflammation, heaviness in the abdomen, weakness, nausea, headache, burning sensation at the anal area, and generalized body ache.
Pain or tearing in anal region due to inapropriate insertion of Basti Netra (Nozzle), in this case Application of Jatyadi ghrita or taila is recommended.
During Tikta Ksheera basti, air may enter the rectum due to Improper administration technique, leading to pain and discomfort. To prevent this, Abhyanga (massage) with Ksheer bala taila and Soft Swedana (sudation) is recommended.

If Tikta Ksheera Basti is not given correctly or in rare cases it does not act as expected, it may lead to serious complications. These include rectal bleeding, retention of urine (Mutraghata), rectal prolapse (Gudabhramsa), fissure in ano (Parikartika), syncope (Murcha), diarrhea (Pravahika), stiffness in the chest, and persistent hiccups (Hikka).

Proper pre-assessment, technique, and post-care help prevent these complications and ensure optimal therapeutic benefits. Proper post-Basti guidelines including diet and lifestyle must be followed for maximum benefits.

Tikta Ksheera Basti Contraindications

Tikta Ksheera Basti, though highly beneficial, is not suitable for everyone, some major contraindications include:

Pregnancy – Basti therapy is not recommended during pregnancy as it may cause complications.
Children and the Elderly – Due to their delicate constitution and reduced strength, Basti may not be well tolerated.
Recent Travel – Individuals who have recently traveled long distances may have imbalanced Vata, making Basti therapy unsuitable.
Severe Weakness or Exhaustion (Ati Kruchha)– People who are excessively weak or fatigued and cannot tolerate Basti Karma.
Anemia (Pandu Roga) – In conditions of severe anemia, Basti may further deplete essential nutrients.
Severe Dehydration – Basti therapy may exacerbate dehydration and lead to further energy depletion.
Intestinal Perforation (Chidrodara) – A serious condition where the integrity of the intestines is compromised, making enema administration dangerous.
Intestinal Obstruction (Baddhagudodara)– Basti should not be given in cases of obstruction, as it may worsen the condition.
Ascites (Jalodara) – May cause Excess fluid accumulation in the peritoneal cavity, which can lead to complications. Virechana is considered useful for this condition.
Uncontrolled Diabetes and Skin disorders (Kushtha Roga).

Proper patient assessment before Tikta Ksheera Basti is essential to ensure safety and effectiveness. If any contraindications are present, alternative therapies should be considered to avoid complications.

Conclusion

Basti Karma is one of the most successful therapies among Panchakarma that serves as the best treatment for Vata Disorders. Where Tikta Ksheera Basti and Pancha Tikta Ksheera Basti are powerful Basti therapy that effectively manages a range of Vata disorders especially those affecting Asthi Dhatu (bone tissue) and Sandhi (joints). With a strong foundation in Ayurveda, increasing validation from modern research, it stands as a promising therapy for conditions such as Athi-Ashrita Vyadhi (bone and joint disorders), including osteoporosis, osteoarthritis, rheumatoid arthritis, and even certain neurological ailments like sciatica and spondylosis.

References

1
Agnivesh Charaka Samhita, (Siddhisthana 1/39).
2
Agnivesh Charak Samhita (Sutrasthana 28/27).
3
Survase, M. R. (n.d.-a). A CLINICAL STUDY OF TIKTA KSHEERAVASTHI (KALAVASTHI) IN OSTEOPOROSIS W. R. T. ASTHIGATAVATA. https://www.wjpmr.com/home/article_abstract/1464.
4
Kapadiya, V. B. S. V. a. R. a. V. M. (n.d.). A SINGLE CASE STUDY ON THE ROLE OF TIKTA KSHEER BASTI IN THE MANAGEMENT OF AVASCULAR NECROSIS OF HEAD OF FEMUR. https://www.wjpmr.com/home/article_abstract/5006.
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Satyajit Behera, & Kajaria Divya. (2022). Ayurveda Management of Avascular Necrosis of Femoral Head – A Case Study. Journal of Ayurveda and Integrated Medical Sciences, 7(1), 434 – 439. Retrieved from https://jaims.in/jaims/article/view/1644.
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Singh SK, Rajoria K, Sharma S. An Ayurveda approach in the management of avascular necrosis of bilateral hip joint-A case report. J Ayurveda Integr Med. 2023 Sep-Oct;14(5):100792. doi: 10.1016/j.jaim.2023.100792. Epub 2023 Sep 21. PMID: 37741160; PMCID: PMC10520428.
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Singh, S., Pawar, A., Suryavamshi, P., & Sharma, K. (2023). Efficacy of Tikta Ksheera Basti in management of Katigatvata- A Case Study. Journal of Ayurveda and Holistic Medicine (JAHM), 11(9). https://doi.org/10.70066/jahm.v11i9.1004.
8
Kaalia, Neelam; Bhatted, Santosh Kumar; Acharya, S. H.. Effect of Panchatikta Ksheera basti with Kati basti in Katishoola w. s. r lumbar disc degeneration – A clinical study. Indian Journal of Health Sciences and Biomedical Research (KLEU) 14(1):p 108-112, Jan–Apr 2021. | DOI: 10.4103/kleuhsj.kleuhsj_264_20.
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Dr. Mridula Pathak, & Dr. Ashish Mhatre. (2020). Clinical efficacy of Panchatikta Kshira Basti in the management of Gridhrasi. Journal of Ayurveda and Integrated Medical Sciences, 5(01), 45-51. https://doi.org/10.21760/jaims.v5i01.814.
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Arpitha G.H and Gajanana Hegde (2024); A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF DASHAMOOLA NIRUHA BASTI WITH BHADRADARVADI GANA KASHAYA BASTI IN GRIDHRASI VIS-A-VIS SCIATICA Int. J. of Adv. Res. (Jan). 149-155] (ISSN 2320-5407).