Safety and usefulness of Laghu shankha prakshalana in patients with essential hypertension: A self controlled clinical study

BACKGROUND: Yoga and Ayurveda texts emphasize the role of cleansing the bowel as an important component of management of hypertension (HTN). Observations during our clinical experience and pilot studies on Laghu shankha prakshalana kriya (LSP), a yogic bowel cleansing technique, appeared to be safe and complimentary. OBJECTIVE: To test the safety and effectiveness of LSP in patients with essential hypertension. MATERIALS AND METHODS: This self control study recruited 32 patients with mild to moderate essential HTN admitted for a week long residential integrated yoga therapy program at the integrative health home in Bengaluru. Patients had a daily routine of 6 hours of integrated approach of yoga therapy (IAYT) module for HTN that included physical postures, relaxation sessions, pranayama and meditations. LSP, an additional practice, that involved drinking of luke-warm water (with or without a herbal combination, triphala) followed by a set of specific yoga postures that activates defecation reflex, was administered on 2(nd) (LSP without triphala) and 5(th) day (LSP with triphala). Assessments (sitting blood pressure and pulse rate) were done just before and after both the sessions of LSP. Secondary outcome measures such as body mass index (BMI), symptom scores, medication scores, fatigue, state and trait anxiety, general health and quality of life were assessed on 1(st) and 6(th) day of IAYT intervention. RESULTS: There was significant (P < 0.001, paired t test) reduction in blood pressure (systolic and diastolic) and pulse rate immediately after both the sessions (LSP with and without triphala). There were no adverse effects reported during or after LSP. There was no significant difference between the two techniques (P < 0.505, independent samples t test), although the percentage change appeared to be higher after triphala LSP session. The number of visits to clear the bowel during the procedure was significantly (P < 0.001, independent samples t test) higher after LSP with triphala than LSP without triphalā. After weeklong IAYT, there were significant reductions in blood pressure (P < 0.001), BMI (P < 0.004), medication score (P < 0.001), symptoms score (P < 0.001), fatigue (P < 0.001), state and trait anxiety (STAI, P < 0.001), scores of general ill health (GHQ, P < 0.001), and increase in comfort level (P < 0.001) and quality of sleep (P < 0.001). CONCLUSION: LSP (a part of IAYT) is a safe and useful procedure for patients with essential hypertension. LSP with triphala is more useful.