Kati Basti: Ayurvedic Oil Pooling Treatment for Lower Back Pain

Kati Basti is an Ayurvedic healing treatment in which medicated oils are poured and pooled for a fixed duration of time in a compartment or a cabin constructed over the low back area using a ring of dough made from the wet flour of black gram (urad dhal) that covers the Lumbo-sacral and Sacro-iliac joints.

Lower back pain is a disorder involving the muscles and bones of the back. It affects about 40% of people at some point in their lives and is a common disease that has haunted human beings for centuries. Nurses, teachers, sportspeople, people who do physical, manual and heavy work, and even those who work in offices, would have experienced a sore lower back of various intensities at some point in their lives.

The food we consume today, together with our lifestyle and activities, our lowered immunity, frequency and mode of travel, metabolic diseases including obesity and so on, the stress, rush and push in life have all contributed to and indicted in increasing the graphical picture and global incidence of lower back pain. It is among the top listed diseases for which patients visit clinics to seek medical attention.

Ayurveda has the status of offering the best remedies for lower back pain and related painful conditions. Among the various remedies available for low back pain, Kati Basti is the most popular. People who have experienced  Kati Basti treatments would definitely tell you how they felt at the end of the course of their treatment. It is not surprising when those undergoing Kati Basti report that they had almost forgotten that they had pain in their back, such is the patient’s benefit from this treatment.

What is Kati Basti?

The term has 2 words:
Kati  means low back
Basti (Vasti) means to hold and refers to a compartment, vessel or container which holds.

Kati Basti is a treatment in which medicated oils are poured and pooled for a fixed duration of time in a compartment or a cabin constructed over the low back area using a ring of dough made from the wet flour of black gram (urad dhal) that covers the Lumbo-sacral and Sacro-iliac joints.

In simple words, Kati Basti is Ayurveda’s pain-relieving, oil-pooling treatment conducted for lower back pain.

Basti or Vasti is a term used to describe the urinary bladder in Ayurveda. The urinary bladder is a bag that holds urine for a certain amount of time until it is voided. Similarly in Kati Basti a compartment is constructed over the low back area by using flour of black gram and the pain-relieving medicated (herbal) oils are pooled in this compartment for a fixed duration of time. Hence the procedure is called Kati Basti.

In which conditions is Kati Basti beneficial?

Kati Basti is highly beneficial in the following conditions:

Lower back pain (lumbago)

This is a common disorder of the lower back involving the muscles and bones of the back.

Lumbar spondylosis

This is a type of degenerative osteoarthritis of the joints of the bones forming the lower back.

Sciatica

Sciatica is pain affecting the back, hip, thigh and outer side of the leg, caused by compression of a spinal nerve root in the lower back, often owing to degeneration of an intervertebral disc. Thus Sciatica is nerve pain from irritation of the Sciatic nerve. The pain along with tingling, numbness, and weakness start in the lower back and travel downwards through the back of your thigh and outer side of the leg on the affected side.

Sacroiliac joint pain or dysfunction

This is a disease of the sacroiliac joint which causes lower back and/or leg pain. The pain is typically felt when the dimples or pits (hollow) on either side of your lower back are pressed or compressed manually. The pain experienced can spread down the leg and a little upward too.

Coccydynia

This is a medical term given to a pain in the coccyx or tail bone pain, usually brought on by sitting too abruptly.

Intervertebral disc prolapse (IVDP) or Lumbar disk disorders or Spinal disc herniation

This is a frequent source of low back pain. In between every 2 vertebrae (bones making up your backbone) there is an intervertebral disc, a soft cartilaginous cushion that allows free movement of the spine (your backbone). When these discs bulge, protrude, extrude or are sequestered, they press on a nerve root thus leading to pain and other symptoms in the leg.

Spondylolisthesis

This is a condition in which there is a forward displacement of a vertebra, especially the 5^thLumbar Vertebra, where there is general stiffening of the back, lower back pain and tightening of hamstring muscles (muscles making the back of your thigh), a leaning-forward pose (kyphotic), a waddle while walking (duck type walking) and a shooting pain along the course of sciatic nerve (involving pain in the back of thigh and leg).

Spina bifida (occulta)

This is a birth defect where there is an incomplete closing of the backbone and membranes around the spinal cord. It presents with leg weakness and paralysis, club foot, hip dislocation, bladder and bowel control problems and so on.

Benefits of Kati Basti 

• Relieves pain in the low back and lower limbs
• Relieves stiffness in the low back and lower limb
• Relieves swelling and inflammation in the low back, in the bones and soft tissues of the low back
• Brings lightness and a sense of health in the lower portion of the body
• Improves movements at the back and lower limbs and enable us to move and work freely
• Strengthens the low back (bones, muscles and soft tissues therein)
• Soothes the nerves supplying the low back and legs (lower limbs)
• Enhances blood supply to the low back area

Read related
Healthy Back by Shanti Gowans

How is Kati Basti done?

Kati basti is done in the following method:

PURVAKARMA, Pre-treatment procedures

This includes:

Preparation of the patient:

• The patient is thoroughly examined.
• Their Prakriti (basic constitution) and Vikriti (details of morbidity) are documented in detail.
• The disease is also examined.
• The treatment line-up, materials, and medicines that need to be used are enlisted.
• The patient is given a sadhyo-virechana (instant purgation) for detoxification. This will also evacuate the bowel and reduce the pressure over the back and thus enhance the effect of the Kati Basti treatment.

Preparation for the treatment:
Materials needed for the treatment are collected beforehand. They are:

For Kati Basti (oil pooling)

• Taila (medicated oil), Ghee (medicated ghee) or both, suitable to the disease and patient are collected and stored beforehand. The same medicines are used for conducting Abhyanga (massage) after the completion of Kati Basti procedure
• Flour of black gram (urid dhal)
• Water
• Stove, bowls, vessels, spoons, etc
• Sterile cloth

For Churna Pinda Sweda

Herbal powders such as Rasnadi Churna, Kottamchukkadi Churna, Jatamayadi Churna, Ellumnishadi Churna, Grihadhoomadi Churna, Kolakulattadi Churna, etc are collected for Churna Pinda Sweda (Powder bolus fomentation).

Churna pinda sweda

Kati Basti or oil pooling is a sthanika sneha (local oleation) procedure. It provides extra-ordinary relief if done on a dry surface of the back. Dryness is created by conducting a rukshana procedure, namely Churna pinda sweda.

Churna pinda sweda is administered for a couple of days before starting Kati basti as a part of pre-treatment procedures. The aim is to cause rukshana (drying therapy) before conducting Kati basti.

Method for Churna pinda sweda

The appropriate herbal powders are chosen according to the nature of the disease, symptoms and dosha involvement.

– Rasnadi churna is used when pain predominates,

– Jatamayadi churna is used when inflammation predominates etc.

The powder is heated on a pan and tied in a sterile cloth so as to form a bolus.

A couple of such boluses are kept ready.

After giving a massage to the lower back with herbal oils, hot fomentation is given with the powder boluses. This brings about Rukshana (dryness).

– The powder should be used in a dry form if symptoms of ama (metabolic wastes created by low metabolism and indigestion which have a sticky nature and has a tendency to produce pain and stiffness) and morbid kapha-like pain, stiffness, swelling, etc are found in the low back.

– If the pain is of a dry nature, with the involvement of morbid Vayu, the powder may be heated by frying it in oil and used for pinda sweda.

Churna pinda sweda is done for 30-45 minutes daily for 2-3 days prior to Kati Basti.

Udwarthana

Udwarthana refers to massage conducted using powders fried in medicated oils.

The massage should be done in reverse direction (from down upwards). This is preferred when symptoms of excess ama (partially digewsted endotoxins) and or kapha or meda (fat) is found associated with lower back pain.

Materials needed for Udwarthan

Powders such as Kolakulattadi Churnam etc, oils (same oils used for abhyanga can be used), etc

• Fresh leaves of pain killing and vata alleviating drugs such as Eranda(Ricinus communis, castor plant), Nigundi (Vitex negundo), Arka, Chincha (tamarind), etc. for conducting Patra panda sweda (leaf bolus fomentation) as a part of post-treatment procedure.
• Lemon, coconut gratings, Rasnadi Churna, Haridra (Turmeric powder), Methika (fenugreek), Saindhava Lavana (rock salt), Eranda Taila (castor oil) etc for patra pinda sweda
• In some cases, Kati Basti can be clubbed with Matra Basti(oil / ghee enemas given in a fixed dose, everyday). If this is planned, the medicated oil / ghee and enema syringe should be kept ready.

PRADHANA KARMA, Treatment proper

Positioning the patient

Kati Basti is ideally done

– in the morning when the Kapha symptoms predominate in the low back (stiffness),

– in the noon when pitta symptoms predominate (inflammation, burning sensation, etc) and

– in the evening if Vata symptoms predominate (pain).

However, it is generally done early in the morning when the convenience of the patient is taken into consideration.

The patient is asked to come or attend the treatment on an empty stomach because while doing Kati Basti, the patient has to sleep in a prone position (on their stomach).

The patient is positioned and made to lie on her/his belly on a comfortable massage table or similar.

Preparing the wet flour for the treatment

Finely pounded black gram flour is taken in a sterile bowl or vessel.

Water is added to it (preferably warm water) and kneaded well so as to prepare a bolus.

Preparation and construction of Kati Basti ring (compartment)

From this bolus, a ring is made.

– The ring should be having a diameter that will accommodate and enclose the lumbar vertebrae (lower backbones), the sacroiliac joints and coccyx (tailbone) within it. This means that when the ring of dough is placed on the back, these parts of the back are enclosed within the ring.

– The height of the ring should be at least 4-5 inches.

– The junction of the ring and skin is sealed with wet flour.

– A small amount of oil is now poured in the ring (compartment) of flour and checked for leakage.

Kati Basti should be started after confirming that there is no leakage at the base of the walls of the ring.

Method of oil pooling

– The chosen medicated oil is heated passively.

– The required quantity of oil, sufficient enough to fill the space within the ring of dough, is place in a small bowl.

– The bowl is kept in the vessel filled with hot water. When the oil gets warm, the bowl is removed.

– Oil is poured into the compartment (space within the constructed ring of wet flour).

Recycling the oil

Care should be taken to maintain the temperature of the oil in the Kati Basti pool.

– The temperature should be kept uniform throughout the procedure (until the procedure is completed).

– For this to happen, the oil from the pool is removed at regular intervals (leaving some oil in it i.e. oil should not be completely removed) and replaced by warm oil (on the other side, simultaneously oil is passively heated).

Oils / ghee used for Kati Basti / Abhyanga

• Ksheerabala tailam
• Mahamasha tailam
• Mahanarayana tailam
• Balashwagandhadi Tailam
• Ashwagandhabalalakshadi Tailam
• Pinda tailam
• Tiktaka ghritam
• Guggulutiktaka ghritam
• Tila taila (sesame oil) etc

PASCHAT KARMA, Post-treatment procedures

Removal of oil and flour ring

At the end of fixed duration meant for completing a schedule (30-45 minutes roughly), the oil is slowly removed from the pool and stored in a container or bottle.

Whilst it is ideal to use new oil every day, practically it becomes unaffordable from the patient’s and practitioner’s perspective. On the next day, the same oil will be reused after adding some more oil to replace the quantity consumed for treatment procedures on the previous day.

The entire oil needs to be replaced on the fourth day of the treatment.

The dough container (kati basti ring) is also removed thoroughly.

Abhyanga

– A light massage is given using the same oil for 10-15 minutes.

– Care should be taken not to apply too much pressure while massaging.

– The lower limbs and feet can also be massaged (optional).

Patra Pinda Sweda, Leaf bolus fomentation

The fresh leaves of the Vata alleviating / pain-relieving herbs are collected and sliced.

Examples include leaves of:

– Eranda (Ricinus communis – castor plant)

– Nigundi (Vitex nigundo)

– Arka (Calotropis gigantean)

– Chincha (tamarind)

– Shigru (Moringa oleifera – Drum stick leaves)

– Dhattura (Datura stramonium)

– Agnimantha (Clerodendrum phlomidis),

The sliced leaves are fried in oil (appropriate for Kati Basti).

Together with the leaves,

– grated coconut

– sliced lemon

– Rasnadi Churna

– Haridra (Turmeric powder)

– Methika (fenugreek)

– Saindhava Lavana (rock salt)

– Eranda Taila (castor oil)

are also added and fried.

 

The sliced leaves are tied in a bolus to form a Patra Pinda (Leaf bolus).

A couple of boluses are prepared

The leaf bolus is dipped in warm oil, any oil drooping from the bolus is mopped over the edge of the pan, and the temperature of the bolus is tested and used for giving fomentation.

The bolus is rubbed on the affected part gently (as good as massaging with bolus).

Circular motions with gentle pressure are given over the joints and rubbed vertically from above downwards while giving fomentation over muscles (in the direction of muscles).

Once the bolus loses its temperature, it should be replaced with the other bolus which has been kept dipped in the oil in the heated pan. The fire beneath the pan should be constant (mild flame) until the treatment is completed.

The boluses are thus changed one after the other until the procedure is completed.

After the completion of treatment, the residual oil, etc are cleansed with the help of a tissue paper or Vata alleviating leaves or with sterile cloth/cotton dipped in warm water.

Shashtika Shali Pinda Sweda

Fomentation with Shashtika Rice (rice grown in 60 days duration) processed with medicinal decoctions packed in boluses shall be preferred as a combined therapy for Kati Basti when there are signs of severe Vata vitiation and degeneration of tissues and when nourishment seems to be in demand as far as the low back is concerned.

Snana, Bath

The patient is allowed to rest for about 1 hour and later advised to take a hot water bath. The patient should be using green gram powder to rub their body. Alternatively, Siddhartha Snana churna (bathing powder) or any herbal powder can also be used.

If the patient is being treated as an outpatient, the patient is advised to take a bath at home after an hour or a couple of hours.

Matra Basti 
Basti (Vasti), medicated enema’s are the best to control morbid Vayu and hence the painful conditions caused by it, including low back pain.

Matra Basti is a subtype of the Basti procedure wherein a small quantity of enema using medicated oil or ghee or a combination of both is given daily. Usually, 50-75 ml is given after food.

Medicines used for Matra Basti

Guggulutiktakam Ghritam, Mahanarayana Tailam, Sahacharadi Tailam, Dhanwantaram tailam / mezhupakam  etc
Matra Basti is given on all days of Kati Basti

Nitya Virechana

Daily metered dose of purgation with purgative decoctions or oils such as Gandharvahastadi Kashayam, Gandharvahastadi Eranda tailam, Nimbamritadi Eranda Tailam etc can be administered if a small amount of detoxification is essential on a daily basis or if morbid Vata and Pitta need to be tackled (optional and strictly based on the decision of the doctor). This can be thought of when Virechana is needed during treatment. Nitya Virechana can also be a part of follow up treatment. Nitya Virechana should never be administered when Matra Basti is planned in the protocol of treatment. In such cases, Matra Basti can be given during the schedule of Kati Basti and Nitya Virechana, if needed can be brought in the follow up seeing the morbidity of Vata and Pitta.

Nitya Virechana and Matra Basti

These also cleanse the bowel and bladder, thus minimising the pressure of bowel and bladder on low back.

Discharge

The patient is discharged on a daily basis as an out-patient, or after the course has been completed if they are an in-patient, after giving proper lifestyle and diet advice along with suitable oral medicines.

The patient is also advised to undergo the treatment twice or thrice in a year as a part of maintenance and to avoid recurrence.

Chronic diseases should be attended by prompt intake of treatment. Obesity is one of the main concerns and risk factors for lower back pain and arthritis. Correction of constipation and menstrual disorders in women also should be focussed upon. Regular, beneficial exercises should be added with a planned diet to reduce weight.

Some physicians like to tend the process after finishing Kati Basti without touching or extending it to Abhyanga, Patra pinda sweda and Basti. However, in our experience, there is no problem combining therapies with the aim of providing better relief. Whenever we have combined Kati Basti with Patra Pinda Sweda or Matra Basti, the results have been outstanding. But again the nature of the disease, the predominance of the Dosha, and affordability to the patient should be considered. There are no fixed rules for carrying on the treatments, the only rule is that things should not be overdone or underdone and the relief of the patient is the most important motive. Ayurveda has given us the liberty to experiment.

Duration of the course 
The number of days of treatment varies from 7-14 days depending upon the nature and intensity of the disease.

Treatment (only Kati Basti) is done for a period of 30-45 minutes per session (Please note, the duration of treatment will extend beyond this if it is combined with other treatments mentioned above).

Medications for Lower back pain (Kati Shula), Lower back stiffness (Katigraha), Sciatica and other forms of back pain:

Kashaya’s, herbal decoctions

• Rasnasaptakam Kashayam
• Rasnapanchakam Kashayam
• Dhanwantaram Kashayam
• Sahacharadi Kashayam
• Sahacharabaladi Kashayam
• Amrutottaram Kashayam
• Guggulutiktakam Kashayam
• Kokilaksham Kashayam
• Guluchyadi Kashayam
• Gandharvahastadi Kashayam

Ghritam and Tailam, medicated ghee and oils

• Guggulutiktakam Ghritam
• Varanadi Ghritam
• Rasnadi Ghritam
• Dhanwantaram Ghritam
• Tiktakam Ghritam
• Ksheerabala Tailam
• Sahacharadi Tailam
• Ksheerabala tailam 101
• Dhanwantaram tailam 101

Asava / Arishtam

• Abhayarishtam
• Ashwagandharishtam
• Balarishtam
• Dhanwantararishtam
• Devadarvarishtam etc

Vati and Gulika, Tablets:

• Trayodashanga Guggulu
• Rasnadi Guggulu
• Navaka Guggulu
• Kaishora Guggulu
• Yogaraja Guggulu
• Panchatikta Ghrita Guggulu
• Mahavata vidhwamsini ras
• Vatagajankush ras

External applications
The same herbal oils mentioned in Abhyanga etc. can be used for external application.

SUMMARY

Kati Basti is the best treatment which Ayurveda provides to heal your back pain. All you need to do is to meet an experienced Ayurvedic doctor and put forth your problems. The doctor will help you to get your sore back into its rhythm.

The beauty of Kati Basti is that it can even be administered on healthy individuals and health fanatics, thus also forming an important part of prophylactic back care,  with a ‘prevention is better than cure’ philosophy.

If you have occasional back pain, understand that this is a platform for a more serious one. If your job and posture are bad enough to predispose for recurrent episodes of backache, you need to take preventive ‘Kati Basti’ sessions. In this, your doctor may advise you to take Kati Basti and Patra Pinda Sweda once or twice a month, say on alternate Saturday’s or Sunday’s. This is really good news for all back pain sufferers.

Probable mode of action

Almost all pains are caused due to :

• Aggravation of Vayu (mainly degenerative types of pain). This further leads to depletion and degeneration of tissues
• Avarana of Vayu (enveloping of the smooth functioning of Vayu by one or the other element of the body including Pitta, Kapha, Dhatus (tissues)
• Ama. Sticky toxins produced as a result of low digestion (gut and cellular) which hamper the smooth functioning of Doshas and Dhatus and block the excretion of body wastes by blocking them.
• High Pitta can cause an inflammatory type of pain in the low back and also in lower limbs
• High Pitta can cause stiffness and loss of movements in the low back.
• Udwarthanaand or Churna Pinda Sweda done before Kati Basti would dry up ama and kapha, liquidity of pitta (sama pitta) and relieve stiffness and loss of movements. Kati Basti nourishes the joints of the low back, pacifies the dosha causing pain or discomfort (by using ideal oils), soothes the nerves, relieves degeneration, stiffness, and inflammation and cures pain. Patra Pinda Sweda further rejuvenates the back by controlling Vayu. Shashtika shali pinda sweda strengthens and nourishes the low back and limbs. Virechana detoxifies the system and relieves inflammation and Basti drives the morbid Vayu out of the system and fortifies the cure. Basti and Virechana also help in removing the avarana of Vayu and also in preventing the recurrence of low back pain. Bastiand Virechana also normalise the functions of Apana vayu, thus correcting all the functional aspects of the lower body under its governance.

It is not mandatory to combine all the treatments at a time but it is left to the wisdom of the Ayurvedic doctor attending your low back and the diagnosis he or she has done after examining you.