A Comprehensive Review of Ksheera Basti in the Management of Gridhrasi (Sciatica): Pharmacology, Mechanisms, and Clinical Evidence

Background: Sciatica, characterized by radiating leg pain, stiffness, and limited straight-leg raise, is considered a Vata-dominant disorder (Gridhrasi) in Ayurveda. Classical texts recommend rectal therapies such as Kṣīra Basti (milk enema) to restore physiological balance and support neuromuscular function. Methods: This narrative review integrates Ayurvedic concepts with contemporary evidence on rectal drug delivery and pharmacological effects of bitter and garlic-based formulations. Sources include experimental studies, mechanistic research, pilot clinical trials, and classical literature focusing on inflammation, neuroimmune pathways, and functional outcomes. Results: Milk-based enemas function as amphiphilic carriers, enhancing solubility, mucosal retention, and lymphatic absorption of bioactive compounds. Studies report reductions in inflammatory markers such as IL-6, TNF-α, and CRP. Pilot findings indicate improvements in pain, mobility, and straight-leg raise, though variability in formulation, dose, and administration affects reproducibility. Discussion & Conclusion: The therapy shows potential for local and systemic effects, including immune modulation and reduction of neuroinflammation, complementing conventional care. Kṣīra Basti demonstrates promise as an adjunct in sciatica management. Standardized randomized controlled trials are required to validate efficacy and optimize protocols. Keywords: Sciatica, milk enema, neuroinflammation, cytokines, rectal therapy