Documentation of Clinical Experiences of Siddha Therapeutic Procedure Peechu (Douche Application) Among Siddha Practitioners in Southern Districts of Tamil Nadu: A Descriptive Qualitative Study

Abstract

Peechu (Douche application) is one of the 32 classical external therapeutic procedures in Siddha medicine, involving administration of medicated liquids- including Kashayam (decoctions), Thailam (medicated oils), milk, and mineral solutions- through the anal, vaginal, or urethral route via a Peechu karuvi (enema syringe or enema can). Despite its documented role in managing Vaatha-predominant disorders, no comprehensive multi-practitioner documentation of its clinical practice exists. Objective: To document the clinical experiences, methodologies, drug preferences, prognostic indicators, mechanisms of action, and barriers in clinical practice of Peechu among registered Siddha practitioners in the southern districts of Tamil Nadu. Methods: A descriptive qualitative study was conducted from May to September 2024. Six registered Siddha practitioners with more than five years of clinical experience in Peechu were selected using purposive sampling. Semi-structured questionnaire-based interviews were conducted after obtaining informed consent and Institutional Ethics Committee (IEC) approval. Data were categorized and analysed thematically. Results: All six practitioners reported positive clinical outcomes primarily for Vaatha-related musculoskeletal, ano-rectal, and chronic skin diseases. The therapy was administered predominantly via the anal route in the left-lateral or standing posture using glycerin syringes or enema cans. Three schools of mechanistic thought emerged: (1) enhanced bioavailability and gut symbiosis; (2) modulation of colonic microflora and endogenous Vitamin B12 synthesis; and (3) local cleansing action in Ano-rectal diseases. A Standard Operating Procedure (SOP) was developed from consolidated practitioner experiences. Treatment costs ranged from Rs. 300 to Rs. 1000 per session. Conclusion: Peechu is a cost-effective, efficacious therapeutic procedure within Siddha medicine with multi-dimensional benefits. This study provides the first multi-practitioner documentation of its clinical application, laying the foundation for standardized protocols and future evidence-based validation.