Article by Dr Raghuram Y.S. MD (Ay)
Among all the remedies available for acute or chronic knee pain, Janu Vasti (Janu Basti) is the most popular Ayurvedic therapies. It gives a magical relief from the pain and stiffness associated with knee pain. In many cases Jaanu Vasti provides a long standing relief. Ayurveda offers the best time tested remedies for knee pain related to osteoarthritis and other related painful conditions.
Modern day man is a representative and essence of evolution of this world. This evolution has been a long journey wherein the primitive man has made a long walk from using stone to variety of gadgets of highest sophistication. For this the man required to move from place to place in the quest of basic essentials of life. This would not have been possible without effective usage of legs. We can tell that legs of the modern man have been the wheels of evolution.
There are many bony joints which make up the anatomy of the leg. Knee joint is the most important joint in the human body. The easy movements of knee joints make our locomotion easy. We walk on our feet. Our foot is made up of many small bones. It is difficult for the foot to carry our body weight and still function smoothly. Knee joint acts as a filter and filters most of our body weight before it is transferred to the feet. This means to tell that the knee joints are under constant stress as they participate in all our activities throughout the day.
Knee joint pain is one of the common health issues we encounter in the modern day clinics. There are many conditions which produce knee pain and stiffness. Knee pain, immaterial of its periodicity disturbs our day to day activities and makes us crippled. Knee pain is often associated with stiffness, swelling, burning sensation, click sounds and limitation of movements. Degeneration, inflammation and injury are the most common causes of knee pain.
Osteoarthritis is a common disorder affecting the knee joints. This is a degenerative disease of the joint and many people find it difficult to manage their day to day activities when they suffer from this condition.
When Janu Vasti is combined with effective treatments like Abhyanga (massage with herbal oils), Patra Pinda Sweda (leaf bolus fomentation) and Vasti (medicated enemas) etc and disease modifying drugs and compounds, it provides a very good relief in many painful knee conditions like Osteoarthritis etc.
Now let me introduce this wonderful treatment to you.
What is Janu Vasti (Jaanu Basti)?
The word has 2 terms –
Janu – means Knee joint
Basti – means to hold (compartment which holds)
Thus Janu Vasti means a treatment in which medicated oil is poured and pooled for a fixed duration of time in a compartment or a cabin constructed around the knee joint / joints using wet flour of black gram.
In simple words, Janu Vasti is a pain relieving oil-pooling treatment conducted for knee joint pain caused due to many causes
Vasti or Basti is a term used to describe the urinary bladder in Ayurveda. Urinary bladder is a bag which holds urine for a certain a period of time till it is voided.
Similarly in Janu Vasti a compartment (cabin or compound like structure) is constructed around the knee joint (front or back, depending on where the site of degeneration or inflammation or injury is present) by using flour of black gram and the pain relieving medicated (herbal) oils are pooled and left in place (retained) in this compartment for a fixed duration of time. Therefore the procedure is called Janu Vasti.
In which conditions is Janu Vasti beneficial?
Jaanu Vasti is highly beneficial in the below said conditions –
Most common causes (reasons) for knee pain –
Osteoarthritis of knee joint – It is the most common form of arthritis in the knee joint. It is a degenerative wear and tear type of arthritis. It occurs most often in people around 50 years of age and older. It may occur in younger people also. In this disease, the cartilage in the knee joint gradually wears away. This leads to pain, stiffness, swelling and disturbance of movements along with click sounds when the joint is mobilized.
Iliotibial band syndrome – The ilio-tibial band is a band of rough tissue that runs from your hip down to the outer part of your knee. If it is irritated by overuse or other problems, it becomes inflamed and cause pain on the outer side of the knee.
Osgood-Schlatter Disease – This disease causes a painful bump below the knee, where a tendon from the knee-cap connects to the shin. It is usually caused by overuse and irritation at the tendon insertion known as the tibial tubercle. The pain may come and go over time. It is common in teenage boys and girls (ages 13 and 14)
Patello-femoral pain syndrome (Chondromalacia patellae) – This often results from issues associated with muscle imbalance, tightness and alignment of the legs, rather than an injury. Pain is present between the patella and the underlying thighbone (femur). It is common in athletes, young adults especially those who have a slight misalignment of kneecap. In older adults develop this condition due to arthritis of kneecap.
Loose bodies in the knee joint – Sometimes a knee injury can break loose cartilage. These pieces can get stuck in the joint, causing it to freeze and producing pain and swelling.
Runner’s knee – It refers to a number of overuse injuries involving pain around the kneecap (patella), such as Patello-femoral pain syndrome.
ACL (Anterior cruciate ligament) injury – An ACL injury is the tearing of the anterior cruciate ligament – one of the 4 ligaments that connect your shinbone to your thigh bone. An ACL injury is common in people playing basketball, soccer or other sports that require sudden changes in direction.
Torn Meniscus – The meniscus is formed of tough rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if the knee is suddenly twisted while bearing weight on it.
Knee Bursitis – Bursa is a small sac of fluid that is located below the skin overlying your joints. The bursa overlying the knee cap (patella) gets irritated due to overuse, fall or repeated bending and kneeling. This will lead to pain and swelling. This is called prepatellar bursitis. It is also called as Housemaid’s knee or Preacher’s knee since they are often caused by repetitive kneeling.
Patellar tendonitis – This results from inflammation of the tendons surrounding your knee. Tendons are tough bands of tissue that connect muscles to your bones. Overuse can make the tendons inflamed and sore. The most common type of patellar tendonitis is called jumpers knee. Runners, skiers, cyclists and those involved in jumping sports and activities are prone to develop inflammation in the patellar tendon which connects the quadriceps muscle on the front of the thigh to the shinbone.
Old (chronic) knee injury which was not properly treated
How is Janu Vasti done?
Jaanu vasti is done in the below said method –
Purvakarma (Pre-treatment procedures):
This includes –
Preparation of the patient:
The patient is thoroughly examined. The Prakriti (basic constitution) and Vikriti (details of morbidity) are documented in detail. The disease is also examined. The treatment line-up, materials and medicines which need to be used are enlisted.
Preparation for the treatment:
Materials needed for the treatment are collected beforehand. They are:
For Jaanu Vasti (oil pooling) – Taila (medicated oil), Ghee (medicated ghee) or both suitable to the disease and diseased are collected and stored beforehand. The same medicines are used for conducting Abhyanga (massage) after the completion of Jaanu Vasti procedure
Flour of black gram
Stove, bowls, vessels, spoons etc
Herbal powders like – 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 is administered for a couple of days before starting Janu Vasti as a part of pre-treatment procedures. This aims at causing Rukshana (drying therapy) before conducting Janu Vasti. Janu vasti is a sthanika sneha procedure (local oleation). Janu Vasti or oil pooling is said to provide extra-ordinary relief if done on a dry surface, dryness being created after conducting Rukshana procedure. This is especially preferred when symptoms of ama (endotoxins, metabolites or intermediate products of digestion which tend to block the channels and transport systems of the body owing to sticky nature) and Kapha like swelling, stiffness, mild to moderate pain etc. It can be skipped when Vata (severe pain, degeneration) prevails. Even in this the wet form (dipped in oil) of churna pinda sweda can be preferred. It can be avoided when there is high pitta symptoms like burning sensation, rise in heat, redness etc.
Method of Churna pinda sweda – The above mentioned herbal powders are chosen according to the nature of the disease, symptoms and dosha involvement. Ex. 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 affected knee joint / joints 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 knee joint. 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 Vasti.
Patra pinda sweda: Fresh leaves of pain killing and vata alleviating drugs like Eranda (Ricinus communis – castor plant), Nigundi (Vitex negundo), Arka, Chincha (tamarind), etc. for conducting Patra pinda 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, Janu Vasti can be clubbed with Matra Vasti (oil / ghee enemas given in a fixed dose, everyday). If this is planned, the medicated oil / ghee and enema syringe should be kept ready
In severe cases of knee pains Kashaya (Asthapana) Vasti – decoction enemas are also given. For this enema cans, sterile cotton, Kashaya churna’s (Coarse powder of powdered drugs to prepare decoction), rock salt, honey, oil / ghee, paste of medicinal drugs, milk etc are kept ready. The same materials shall be kept ready beforehand for Ksheera Vasti (enemas with milk processed with pain relieving drugs) also. Ksheera Vasti is a variant of Kashaya Vasti and is generally preferred when inflammatory conditions of the knee joint prevail (high pitta and high rakta conditions). When Kashaya Vasti is planned as a part of treatment protocol, Anuvasana Vasti (enema with large doses of medicated oils and ghee) should be mandatorily given on alternate days. For this enema syringes, medicated oil and or ghee are kept ready beforehand.
Pradhana Karma (Treatment proper):
Janu Basti Procedure:
Positioning of the patient:
Janu Vasti is done in the morning when the Kapha symptoms predominate in the knee (stiffness), in the noon when pitta symptoms predominate (inflammation, burning sensation etc) and in the evening if Vata symptoms predominate (pain). However the treatment shall be avoided in high pitta, kapha and ama conditions and in acute manifestations of diseases like Amavata (Rheumatoid Arthritis). Generally it is done early in the morning if convenience of the patient has to be seen.
The patient is asked to come or attend the treatment on empty stomach because while doing Janu Basti, the patient has to sleep in prone position (on stomach). Of course many times Janu Basti is also performed on the front of the knee joint when the patient has to sleep in supine position (on the back). Even in this condition it is preferable for the patient to take the treatment on empty stomach.
The patient is positioned and made to lie on his belly on a comfortable couch. The construction of Janu Basti compartment and the pooling of oil shall be carried out on the knee joint of the patient.
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 Jaanu Basti ring / compartment:
From this bolus a ring is made. The ring should be having a diameter so as to accommodate and enclose the knee joint within it. That means to tell that when the ring of wet flour is placed on the knee joint, the whole joint is enclosed within the ring. The height of the ring should be at least 5-6 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. Janu Vasti should be started after confirming that there is no leakage at the base of the walls of the ring. The compartment can be constructed either in front or back of the knee.
Method of oil pooling:
The chosen medicated oil is heated passively. Required quantity of oil (sufficient enough to fill the space within the ring of wet flour) is taken 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 Janu 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 Janu Basti / Abhyanga:
Tila taila (sesame oil) etc
Paschat Karma (Post-treatment procedures):
Removal of oil and flour cabinet:
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. On the next day, the same oil shall be reused after adding some more oil to replace the quantity consumed for treatment procedures on the previous day. The oil shall be replaced on the 4th day of the treatment. Actually it is good to take new oil every day but practically it becomes unaffordable from the patients perspective. The flour cabinet (janu-vasti ring) is also removed thoroughly.
A light massage is given using the same oil for 10-15 minutes. Care should be taken not to apply more pressure while massaging. The lower limbs, including thighs, legs and feet also shall be covered in the massage (optional).
Patra Pinda Sweda – Leaf bolus fomentation
The fresh leaves of the Vata alleviating / pain relieving herbs are collected and sliced. Ex. 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), etc are taken and sliced. The sliced leaves are fried in oil (oil taken for Kati Vasti). Along 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 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 is given over the joints and rubbed vertically from above downwards when doing it on thighs and legs and muscles (in the direction of muscles).
Once the bolus loses its temperature, it should be replaced with 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 Janu 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 knee joint is concerned. It rejuvenates, nourishes and strengthens the bones, muscles and soft tissues of knee joint.
Snana – Bath
The person is allowed to rest for about 1 hour and later advised to take a hot water bath. He should be using green gram powder to rub his body. Siddhartha Snana churna (bathing powder) or any herbal powder can also be used alternatively. If the patient is being treated as outpatient, the patient is advised to take a bath at home after an hour or couple of hours.
Matra Basti –
Vasti (Basti) – medicated Enema’s are the best to control morbid Vayu and hence the painful conditions caused by it, including knee pain. It works wonder when there is degeneration in knee joints as in lumbar spondylosis and is also handy in osteopenia and osteoporosis.
Matra Vasti is a subtype of Vasti 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 Vasti – Guggulutiktakam Ghritam, Mahanarayana Tailam, Sahacharadi Tailam, Dhanwantaram tailam / mezhupakam etc
Matra Vasti is given on all days of Jaanu Vasti
Nitya Virechana – Daily metered dose of purgation with purgative decoctions or oils like 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. Nitya Virechana should never be administered when Matra Vasti is planned in the protocol of treatment. In such cases, where more than one procedure seems to be useful, they shall be used at different time periods. Ex. Nitya Virechana can be given during the schedule of Janu Vasti and Matra Vasti if needed can be brought in the follow up seeing the morbidity of Vata and Pitta.
Discharge – The patient is discharged on daily basis (out-patient) or after the course has been completed (in-patient) after giving proper lifestyle and diet advices along with suitable medicines (oral). 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 if any should be attended by prompt intake of medication. Regular exercises should be added with a planned diet to reduce weight. Yoga and meditation too comes hand in hand in relieving the pain and other complaints related to knee joint pathology.
From my clinical experience – Dr Raghuram
Some physicians like to finish the process after finishing Janu Basti without touching or extending it to Abhyanga, Patra pinda sweda etc treatments which can be effectively combined. But with my clinical experience, combining therapies will definitely provide better and long-standing relief. Whenever I have combined Janu Vasti with Patra Pinda Sweda or Matra Vasti, the results have been outstanding. But again the nature of the disease and the predominance of the Dosha and affordability of 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 a liberty to experiment (Yukti).
Duration of the course –
The number of days of treatment varies from 7-14 days depending on the nature and intensity of the disease
Treatment (only Janu Basti) is done for a period of 30-45 minutes per session (Treatment duration will extend beyond this if it is combined with other treatments mentioned above)
Medications for Knee pain and stiffness –
Kashaya’s (Herbal decoctions):
Rasnaerandadi Kashayam (Cheriya Rasnadi Kashayam)
Gandharvahastadi Kashayam etc
Ghritam and Tailam (medicated ghee and oils):
Ksheerabala tailam 101
Dhanwantaram tailam 101
Vati and Gulika (Tablets):
Panchatikta Ghrita Guggulu
Mahavata vidhwamsini ras
Maharajaprasarini Tailam / Tailam caps
Ksheerabala Tailam 101 caps
Dhanwantaram Tailam 101 caps etc
The same herbal oils mentioned in Abhyanga etc. can be used for external application.
Relieves pain in the knee joints and legs
Relieves stiffness in the knee joint
Relieves swelling and inflammation in the knee joint
Brings lightness and a sense of health in the knee and legs
Improves movements of the knee joints and enable us to move and work freely
Strengthens the knee joints and the related structures
Soothes the nerves supplying the knee joint and the surrounding structures
Enhances blood supply to the knee joint and soft tissues around
Mode of action
Probable mode of action of Janu Vasti
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 smooth functioning of Vayu by one or the other element of the body including Pitta, Kapha, Dhatus – tissues, etc)
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 inflammatory type of pain in the knee joints
High Kapha can cause stiffness and loss of movements in the knee joints
Udwarthana and or Churna Pinda Sweda done before Janu Vasti would dry up ama and kapha, liquidity of pitta (sama pitta) and relieve stiffness and loss of movements. Janu Basti nourishes the knee joints, 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 knee by controlling Vayu. Shashtika shali pinda sweda strengthens and nourishes the knee and lower limbs. Virechana detoxifies the system and relieves inflammation and Vasti drives the morbid Vayu out of the system and fortifies the cure. Vasti and Virechana also help in removing the avarana of Vayu and also in preventing the recurrence of knee pain. Vasti and Virechana together helps in preventing degeneration and inflammation, nourishes and rejuvenates the bones and soft tissues around the knee, enhances immunity and prevents recurrence.
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 sore knee joints and the diagnosis he or she has done after examining you.
To sum up,
Janu Basti is the best treatment which Ayurveda provides to heal your acute and chronic knee pains. 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 knee into its rhythm.
The beauty of Janu Vasti is that it can even be administered on healthy individuals and health freaks. Thus Janu Basti forms an important part of prophylactic knee care, a part of ‘prevention is better than cure’ mantra.
If you have occasional knee joint pain, you are having a platform for a more serious one. If your job and posture are bad enough to predispose for recurrent episodes of knee pain and stiffness, you need to take preventive ‘Janu Vasti’ sessions. In this your doctor may advise you to take Janu Vasti and Patra Pinda Sweda once (one day) a month or twice a month, say on alternate Saturday’s or Sunday’s.
Isn’t it good news to all of you?
So whenever you have a knee pain, think of Janu Vasti
Click to Consult Dr Raghuram Y.S. MD (Ayu)