Basti chikitsa: The prime therapeutic modality of panchakarma with special reference to sandhigatavata management

Ayurveda recognizes Basti Chikitsa as a principal therapeutic modality of Panchakarma, particularly in disorders dominated by Vata Dosha. Sandhigatavata is a Vata-dominant disorder characterized by Sandhi Shoola, Sandhi Shotha, Stambha, restricted joint movement and Atopa. These manifestations show clinical similarity to degenerative joint disorders, particularly osteoarthritis, although Sandhigatavata and osteoarthritis represent different conceptual frameworks and should not be considered identical. The present review aims to examine the classical concept of Basti Chikitsa and evaluate its therapeutic relevance in Sandhigatavata. Classical Ayurvedic texts, including Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya, Ashtanga Sangraha and relevant later compendia, were reviewed for descriptions of Basti, Vata Dosha, Sandhigatavata, its etiopathogenesis, clinical features and management principles. Contemporary literature on osteoarthritis, pain, stiffness, functional disability and proposed mechanisms of Basti was also considered. Basti includes Niruha or Ashtapana, Anuvasana and Matra Basti, selected according to therapeutic objectives and patient characteristics. In Sandhigatavata, its rationale may be understood through Vata Shamana, Vatanulomana, Snehana, Srotoshodhana, Brimhana and Balya. Selection should be individualized according to Prakriti, Vikriti, Dosha predominance, Rogi Bala, Rogabala, Agni, Koshta, disease stage, Ama and Dhatu involvement. Basti thus provides a relevant therapeutic framework for Vata-dominant joint disorders. However, standardized formulation-specific clinical studies using validated outcomes are required to establish its efficacy, safety, optimal protocols and possible mechanisms of action.