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

Background: Sciatica, clinically characterized by radiating leg pain, stiffness, and limited straight-leg raise, is considered a Vata-dominant disorder in Ayurveda (Gridhrasi [sciatica]). Traditional texts recommend rectal herbal therapies, such as milk-based enemas (Kṣīra Basti [milk enema]), to modulate physiological imbalance and support musculoskeletal and neural function. Methods: This narrative review integrates classical Ayurvedic rationale with contemporary research on rectal drug delivery systems and pharmacological properties of bitter and garlic-based herbal formulations. Sources included experimental studies, mechanistic research, pilot clinical trials, and classical literature, with focus on systemic inflammation, neuroimmune pathways, and functional outcomes. Results: Milk-based rectal formulations act as amphiphilic vehicles, enhancing solubility, mucosal retention, and lymphatic absorption of bioactive compounds. Oral studies of herbal constituents suggest reductions in pro-inflammatory cytokines (IL-6, TNF-α, CRP), supporting potential neuroinflammatory modulation in sciatica. Pilot studies indicate improvements in pain, functional mobility, and straight-leg raise, although variability in formulation, dose, retention, and sterility limits reproducibility. Controlled comparative studies of bitter versus garlic milk enemas are lacking. Discussion: Integrating traditional therapy with modern pharmacological principles provides a plausible mechanism for both local and systemic effects, including immune modulation and attenuation of inflammatory pathways. Rectal delivery may offer targeted absorption while complementing standard care. Conclusion: Milk-based rectal therapy (Kṣīra Basti [milk enema]) shows promise as an adjunct in sciatica management. Standardized randomized controlled trials with objective outcomes are essential to validate efficacy and optimize clinical protocols.