EFFECT LSP. Result: There was a significant reduction in



Sunil Sapkota1,
Sashikiran H C 2 Rabin Lal Shrestha3

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1 BNYS graduate SDM
College of Naturopathy and Yogic Sciences, Ujire 574240, Karnataka India

2 Assistant professor SDM College of Naturopathy and Yogic
Sciences, Ujire 574240, Karnataka India

3 Post Graduate  SDM  College
of Naturopathy and Yogic Sciences, Ujire 574240, Karnataka India

for correspondence: Dr.Sunil Sapkota, SDM College of Naturopathy and Yogic
Sciences Ujire 574240, Karnataka India, [email protected]



Introduction: Laghu Sankhaprakshalana
(LSP) is a type of yogic cleansing technique (Shatkarma) which is being practiced since ancient time. In this
technique, set of Asanas that aids
the intestinal motility are practiced along with intake of lukewarm saline
water. It is an easy and effective technique to clean the
gastrointestinal canal. This study aims to
study the effect of LSP on bowel health.

Aim:  To evaluate the effect of Laghu Sankhaprakshalana practice on bowel health in healthy
individuals and safety of it.

Materials and Methods:
Sixty healthy individuals (Male 30 & Female 30) of mean age 20.70±2.89
were randomly recruited for study group (n=30)
and control group (n=30). The study group was made to practice
LSP once per week, for four weeks. The control group received no intervention.
Constipation score was recorded by using Cleveland Clinic Constipation Score before
and after completion of four sessions of LSP.

Result: There
was a significant reduction in constipation score, p<0.0001 after the four sessions of LSP practice. Conclusion: The present study showed that Laghu Sankhaprakshalana has a tendency to improve the bowel health. The regular practice of LSP is safe and effective in a healthy individual. Key Words: - Bowel health, Constipation Score, Laghu Sankhaprakshyalan.   INTRODUCTION Bowel health is associated with the healthy functioning of other systems like cardiovascular system, nervous system etc. The function of the gastrointestinal (GI) tract has been thought to have little impact on cardiovascular health. However, recently emerging evidence suggests that GI function may play a greater role in cardiovascular health 1.  Digestive diseases, like inflammatory bowel disease and gallstone disease, have been associated with an increased risk of cardiovascular disease (CVD) 2-4 as well as various cardio-metabolic risk factors such as obesity, dyslipidemia, and insulin resistance 5. In addition, disorders of GI system are closely related to abundance, type, and metabolism of gut microbiota 6-8 with known impact on risk of CVD, diabetes and other diseases 9-11. Change in bowel movement frequency represents one of the major characteristics of functional bowel disorders 12. One studies show that abnormal bowel movement frequency occurring in irritable bowel syndrome and functional constipation has been related to a variety of cardiovascular risk factors including elevated circulating levels of cholesterol and triglycerides, hypertension, diabetes 13-18. Another study shows that constipation is associated with low substantia nigra neuron density independent of the presence of Lewis Body 19. Evidence suggests that bowel health has an impact on cardiovascular health and it is associated with various cardio-metabolic risk factors.   Sankhaprakhs?lana is a yogic practice (kriya) recommended for cleansing the gastrointestinal tract 20. Laghu Sankhapraksh?lana (LSP) is a simple form of Sankhaprakhs?lana kriya which is completed in a shorter time and offers lesser physical strain. The Sanskrit word laghoo means 'short', sankha means 'shell' and prakshalana means 'to wash'. The word shankha is intended to represent and describe the intestine, with its cavernous and coiled shape. Therefore, the combined term Sankhaprakshalana means to completely wash or clean the intestines.  LSP is a more comprehensive technique which can be done very quickly & with little preparation. Furthermore, the two practices have a slightly different purpose: Sankhaprakshalan cleans the whole gastrointestinal tract, whereas LSP encourages normal functioning of the intestine. Lukewarm saline water creates a high osmotic pressure much higher than pure water, preventing absorption. It also acts as a lubricant & loosens up the stool to flush the system. Normally, bulk and movement of stool that acts as a trigger which, in turn, stimulates the nerves which activate peristalsis. The lukewarm saline water softens the hardened stool to move, which prompts the nerve to carry out their normal functions of the gastrointestinal tract 21. LSP clears the bowel by the activation of local peristaltic reflex during the various set of physical postures and strengthens whole body 20, 22. It is an easy and effective technique to clean the gastrointestinal canal, thereby eliminating all the waste material and auto-intoxicants present in the intestine for a long time period. Moreover, it is very economical procedures which can be performed by the peoples at his/her own residence. Clinical experience is evident of LSP being very effective for increasing body mass index, spinal flexibility and to reduce pain, disability, anxiety, and neurosis 23, 24. So far there is no study to look at the effect of yogic cleansing techniques (LSP) on bowel health. Hence the present study was planned with the objective to assess the impact of LSP on bowel health, the safety of its practice and to correlate its use in clinical practice.   MATERIALS AND METHODS Subjects: Sixty Students, male (n=30) and female (n=30), aged between 18-24 years (20.70±2.89) were recruited from the college in Dakshina Kannada for the study. The Inclusion criteria; age group 18-30 years, no orthopedic limitations, healthy, not having any medical condition and willingness to participate voluntarily. The exclusion criteria; subjects having any medical condition, those exposed to any infection during the study period, weak and debilitating individuals, individuals having a systemic illness, smoking and taking recreational alcohol. A written informed consent was taken from the subjects after explaining them the detail procedure. The ethical clearance was taken from the ethical committee of the college. Study design: Sixty students were randomly assigned to two groups, study group (n=30, male=15, and female=15), and control group (n=30, male=15 and female=15) by using the online random number generating tool at the website-www.random.org.   The study group included healthy individuals of average age 20.70±2.89 years and average BMI 26.93±3.24 kg/mt². The control groups included healthy individuals of average age 20.70±2.39 years and average BMI 27.26±2.46 kg/mt². All the participants of both the group successfully completed the study. Study group underwent LSP once a week for four weeks. The control group did not receive any intervention.   Figure 1: Trial profile Exclusion ( n=15) Fever (n=6) Voluntary withdraw (n=9)   Identification and screening of subjects (n=75) Recruitment to study group (n=60)     Post-assessment Intervention once/week for 4 weeks            Randomization Study group (n= 30) Male (n=15), Female (n=15)   Control group (n= 30) Male (n=15), Female (n=15)   Pre-assessment Pre-assessment   No intervention for 4 weeks Post-assessment       Data analysis (n=60)                  .                     Intervention: The study group underwent the following procedure for LSP, early morning on an empty stomach. The subject was made to drink two glasses of lukewarm saline water as quickly as possible. They were instructed five Asanas ten times each in the following sequence: (1) Tadasana (Palm Tree Pose), (2) Tiryaka Tadasana (Swaying Palm Tree pose), (3) Kati Chakrasana (Waist Rotating Pose), (4) Tiryaka Bhujangasana (Twisting Cobra Pose) and (5) Udarakarshanasana (Abdominal stretch pose). This completes the first round of practice. After the completion of the first round once again subjects were asked to drink two more glasses of saline lukewarm water and again repeat the five asanas ten times each. Subjects completed the process by the maximum six to eight glass water. The subject was permitted to go to the toilet when the pressure built up. There was no rest during the asana and between the rounds. Total rest was provided to the subjects after the completion of procedure by making them lie down in Shavasana for 5 minutes 25. After completing Shankha-Prakshalana subject ate khicheri (cooked rice and lentil) with ghee. There was no any intervention for the control group participants and they were instructed to carry out their normal routine activities.  Assessments: The entire subjects in the group were assessed before the intervention as to take pre-data and post-data were taken after 24 hours of last intervention. Constipation score was measured by using Cleveland Clinic Constipation Score. Statistical analysis: The statistical analysis of within the group was performed using paired samples t-test and between the group, analysis was performed using independent sample t-test with the use of Statistical Package "R" version 3.2.3. P value < .05 was considered as significant.   RESULTS AND DISCUSSION Result The recruited 60 participants were randomized into two group, study group (n=30) and control group (n=30). Baseline and post-intervention assessment of each group were taken before and after the intervention. To compare baseline and post-intervention assessment between the group independent samples t-test was performed and to compare within the group paired samples t-test was performed. There were no significant differences in demographic variables of the subjects of both the groups participated in this study (Table 1).   Table 1. Demographic variables of study group(n=30) and control subjects(n=30) Variables Study Group Control Groups Age (years) 20.70±2.89 20.70±2.39 Height (cm) 165.10±10.56 164.60±10.26 Weight (Kg) 73.52±11.72 74.10±11.44         *All values are in mean± standard deviation Statistical analysis was done to compare baseline and post-intervention assessments of between the groups (independent sample t-test) and within the group (dependent t-test). There was no significant difference between case and control group at baseline assessment (Table 2). The result of our study showed that there is a statistically significant difference between the case and control group of post-intervention assessment with respect to constipation score (Table 3). The analysis within the group done by using the dependent t-test showed the significant decrease in constipation score, p<0.0001 (Table 4).           Table 2. Baseline assessment of study group (30) and control group (30) by independent t-test. Variables Group Pre assessment t-value p-value   Constipation score Case group 8.73±0.69 -1.27 0.2092 Control group 8.5±0.73           Table 3. Post-assessment of study group (n=30) and control group (n=30) by dependent t-test. Variables Group Post assessment t-value p-value   Constipation score Case group 3.63±0.49 28.639 0.0001* Control group 8.6±0.81             Table 4. Baseline assessment and post-assessment of the study group (n=30) and control group (n=30) by dependent t-test. Variables Group Baseline assessment Post assessment t-value p-value   Constipation score Case group 8.73±0.69 3.63+-0.49 58.116 0.0001* Control group 8.5±0.73 8.6+-0.81 -1.3605 0.1841 Note: - all values are in mean ± Standard deviation.  *p<0.05         Discussion The present study assessed the effect of yogic colon cleansing technique (LSP) on bowel health in the healthy individual. In this study, we examined the changes in constipation score (CS) after the practice of LSP. Our finding suggests there is a decrease in CS (p<0.0001) in the study group but no changes in the control group. There is no adverse effect of LSP documented which suggests that it is safe to practice once in a week for four weeks by healthy individuals. Frequency of bowel movements; difficult or painful evacuation; completeness of evacuation; abdominal pain; time per attempt; type of assistance including laxatives; digitations or enemas; number of unsuccessful attempts at evacuation in a 24-hour period and duration of constipation are the variables of constipation scoring system 26.  These variables are the measures of bowel health. The decrease in constipation score indicates that improves in bowel health. The digestive tract requires being rotated in order to be washed thoroughly. In LSP this is achieved by performing a set of Asanas which increase intestinal motility temporarily. Tadasana (Palm Tree Pose), opens the pyloric sphincter of the stomach through the expansion of esophagus, stomach and, a duodenum. Then saline water enters into the small intestine (Gherand Samhita, Chapter1, and Versus 17). Tiryaka Tadasana (Swaying Palm Tree pose), repeatedly contracts in one side and relaxes in another side of the intestines (Gherand Samhita, Chapter1, and Versus 17).  Katichakrasana (Waist Rotating Pose), twists the whole smooth muscles of stomach and intestine, which pushes the foodstuffs downwards along with the water (Gherand Samhita, Chapter1, Versus 17). Tiryaka Bhujangasana (Abdominal Stretch Pose) opens the ileocecal sphincter. At that moment from the small intestine, water enters into the large intestine (Gherand Samhita, Chapter1,Versus 17). Udarakarshan (Abdominal stretch Pose), stretches the digestive organs, nerves, and muscles. Therefore repeated contraction and relaxation occurs in the whole digestive tract (Gherand Samhita, Chapter1,Versus 17). Finally, complete bowel evacuation occurs and gastrointestinal tract will be free from fecal matter 22. This cleansing of the gastrointestinal tract improves the digestive process and bowel health. The strength of the study are; effective randomization and no any adverse effects during the study. Limitations of the study are; a smaller sample size, no blinding, and only subjective variables. Future studies may be designed to look at the long-term effect of LSP on bowel health.  CONCLUSIONS The present study showed Laghu Shankhaprakshalana has a tendency to improve the bowel health. So this yogic practice can be suggested in cleansing modalities of Naturopathic and Yogic treatments on a regular basis. The regular practice of LSP is safe and effective in a healthy individual.  Large-scale randomized trials are warranted to confirm the results. ACKNOWLEDGEMENT We would like to extend our sincere gratitude to Dr. Prashanth Shetty, Principal SDM College of Naturopathy and Yogic Sciences, Ujire Karnataka for his inspiration and constant support. We thank all the students (Undergraduate& Postgraduate) and staff of SDM CNYS Ujire Karnataka for their cooperation in conducting the program and our special thanks to Dr. Skanda Dangi for guidance throughout the research work.