Panchkarma
The technique and methods of pancha-karma treatment are deeply rooted in the ancient texts of Ayurveda, like Charak and Sushrut Samhita. They have been recorded in these texts around 1500 B.C., nearly 5000 yrs ago. Panch-karma properly speaking, is not a singular noun denoting a particular thing or a standard treatment sequence. Rather it describes five therapeutic procedures used to eradicate the increased excessive dosha’s (Vata, Pitta,Kapha) from the body which in turn restore the health. Ideally the procedures should be undergone by healthy person also during the normal seasons with no extreme heat -cold or heavy raining.
Purpose of Panchkarma
1. To eradicate excessive doshas before they are able to corrupt the physiology. That in turn maintains health.
2. Helping excellent body elements which delays old age and achieve active longevity.
3. Panch-karma helps to maintain the equilibrium of bodily doshas to keep the working of body in healthy and robust state. Helping to get rid of various diseases. In short, Panch-karma therapy does the work of ‘servicing’ of the body which is constantly working.
‘Panch-karma’ is a well-defined classical therapeutic treatment. The term Panch-karma has now coined a commercial value. Some treatments well famous with society like – shiro-dhara, massage etc. are not at all can be termed as Panch-karma. Such treatments have gained popularity due to some promotions with commercial purpose. The treatments like oil massage, shiro-dhara, fomenting with cooked rice etc. are few traditional treatments meant to treat few of the ailments. But surely, they do not serve purpose of Panch-karma.
While undergoing Panch-karma, one must follow some strict regimen of diet and daily routine. Panch-karma takes out lot of doshas out of the body. They are like “physiological surgery”. One must follow the pre and post operative regimens for the Panch-karma procedures. Furthermore Panch-karma should be done only after thorough examination by a trained Ayurveda Vaidya.
Panch-karma can be planned in a healthy as well as a diseased person only after evaluation of his/her body and disease status. This surely proves as a health productive investment for a healthy person and saviour for a diseased one.
Let’s see the details of individual procedures of ‘Panch-karma’ one by one.
We pray at lotus feet of Lord Dhanwantari and our Guru, to help us establish and convey the true -pure concept of Panch-karma treatments to society and stop the further wrong propagation of mere traditional thoughts.
Preparatory Procedures
1. To eradicate excessive doshas before they are able to corrupt the physiology. That in turn maintains health.
2. Helping excellent body elements which delays old age and achieve active longevity.
3. Panch-karma helps to maintain the equilibrium of bodily doshas to keep the working of body in healthy and robust state. Helping to get rid of various diseases. In short, Panch-karma therapy does the work of ‘servicing’ of the body which is constantly working.
‘Panch-karma’ is a well-defined classical therapeutic treatment. The term Panch-karma has now coined a commercial value. Some treatments well famous with society like – shiro-dhara, massage etc. are not at all can be termed as Panch-karma. Such treatments have gained popularity due to some promotions with commercial purpose. The treatments like oil massage, shiro-dhara, fomenting with cooked rice etc. are few traditional treatments meant to treat few of the ailments. But surely, they do not serve purpose of Panch-karma.
While undergoing Panch-karma, one must follow some strict regimen of diet and daily routine. Panch-karma takes out lot of doshas out of the body. They are like “physiological surgery”. One must follow the pre and post operative regimens for the Panch-karma procedures. Furthermore Panch-karma should be done only after thorough examination by a trained Ayurveda Vaidya.
Panch-karma can be planned in a healthy as well as a diseased person only after evaluation of his/her body and disease status. This surely proves as a health productive investment for a healthy person and saviour for a diseased one.
Let’s see the details of individual procedures of ‘Panch-karma’ one by one.
We pray at lotus feet of Lord Dhanwantari and our Guru, to help us establish and convey the true -pure concept of Panch-karma treatments to society and stop the further wrong propagation of mere traditional thoughts.
Snehana Therapy
In snehana, the unctuous materials such as oil, ghee are used to lubricate & nourish the body inside & out, loosen morbid, unwanted materials and to give the body tissues greater resilience & elasticity. These Are Two –
1) Internal snehana
2) External snehana
Internal Sneha-paana – (Drinking of ghee/oil)
There are three forms of internal oleation therapies, depending upon its dosage. Here we will discuss only the type of internal sneh-paana, used as a tool to facilitate dosha expulsion from the body through means of Panch-karma. This is termed as ‘shodhan snehpaana’.
Shodhana Sneha-Paan –
This Method is used specially to prepare the body for shodhana i.e., the Panchakarma procedures. This method lubricates all of the gross & subtle bodily channels so that the doshas can be dislodged, expelled out from the body. It also imparts the great resilience & elasticity to the tissues so that they can easily endure any strain involved in Shodhana (elimination) process. The chosen ghee/oil is taken on an empty stomach in the early morning close to sunrise. At this time, it is expected that, the digestive tract should have processed all the food material from the previous day. After taking ghee or oil one should not eat anything until the consumed sneha is digested and a person feels good appetite. The dose of sneha is decided, as per the digestion capacity of person and nature of disease. Each day increasing amount of ghee such as 30ml, 60ml, 90ml and so on is given which varies from person to person. Normally for 3 to 7 days this procedure is repeated until body becomes thoroughly lubricated. This is evidenced and examined by a Vaidya to decide completion of sneh-paana. To facilitate to digest the increasing amount of sneha, without landing into unwanted complications, this dose decision by trained physician is very crucial one. During the sneh-paana, it is important to take warm food & warm water for all purposes like drinking, cleaning, washing, bathing etc. As cool water, constricts channels & create complications. One must follow the detailed instruction given by clinical authorities for better performance of therapy and avoidance of any complications.
External Snehana
Oil-Ghee etc. applied to the body from outside. Applying external lubrication is called ‘Abhyang’. Abhyang is the most prevalent form of external oleation. Oil etc. is absorbed into the body through the skin pores. Abhyang is regularly advised in healthy persons. Any oil, ghee, fat etc. Or the proportionate mixture of them can be used for Abhyanga. But the oil is used as a cheaper and best suitable cure for Vata dosha. There are thousands of different Ayurvedic medicated oils & snehas for wide range of constitution, changing climatic conditions & disorders. Plain sesame oil is of hot nature, can be practiced in cold climate and constitution. Similarly, coconut oil, naturally cold in nature, can be used for warmer climate. Daily abhyang is recommend for all healthy persons. Special emphasis is given to massage of head and feet. It is also advisable to have few drops of warm oil in ears as well. After abhyang, swedana or sudation is done or warm water bath can be taken. Do not use soap or any excessively cleansing chemicals. Use of herbal scrub bath powder (ubtan) is recommended.
Benefits of Abhyanga -
1. Reduces fatigue, stress.
2. Diseases of Vata are pacified.
3. Sound and deep sleep.
4. The skin becomes soft and strong and the color brightens.
5. This helps to acquire strength to endure hardship and trauma.
6. Improves eyesight.
7. Aging process is controlled and prolongs working life.
Swedana – Sudation therapy
Sudation Therapy describes a wide range of methods that use heat to induce perspiration. The phenomenon of sweating is a natural process that occurs with exercise as well as in warm climates and seasons. This phenomenon is harnessed by swedan therapy to relive specific areas of stiffness, cold and obstruction. This method dilates all of the gross & subtle bodily channels so that the doshas can be dislodged, expelled out from the body. Swedan can be accomplished easily even at home by number of techniques such as Hot Baths, Sitz Baths, Heating Pads, Home Saunas, etc….
But swedana is not an act of regular practice like Abhyanga.
Swedan combined with snehan treatment, helps to dislodge and loosen doshas from body elements and facilitates their movement to the GI tract for elimination. This makes swedana very important preparatory procedure for panch-karma therapies. Swedan can also be used as independent treatment in many diseases of kapha and vata dosha.
In Ayurveda 13 methods of sudation are explained. The actual use of external heat is done in these methods, which includes Pindasweda, Pottalisweda, Bashpasweda, Nadisweda, etc. Most common method is use of steam box which is filled with steam of simple or medicated boiling water. Dry swedan treatment can also be given in specific condition, without application of sneha or abhyanga. Sweating is more frequently and intensely used in the cold season.
The duration of sweating is relative to the patient until he sweats well. It usually takes 10 to 15 minutes to get a good sweat.
Benefits of sweating -
1) The body becomes light, and vata dosha is pacified.
2) Appetite increases.
3) The skin is soft and supple.
4) Improves energy levels, reduces fat depositions and body heaviness, lethargy,
5) Improves joint movements and reduces obstruction in bodily passages.t
6) Bloating can be relived easily by easy passage of gas.
Excessive swedan causes – extreme weakness, vertigo and red rashes on skin. One should not take regular swedan of any kind without physicians’ advice.
Vamana – Emetic Therapy
Vamana literally means ‘Vomiting’. The Process by which vomiting is induced in the body to take out excessive doshas. People many times drink salt water & stimulate base of throat and vomit. But the ayurvedic vamana procedure is different. Vamana therapy of Ayurveda is the method of utilizing specific medicinal substances to expel vitiated doshas which have been brought to treat from throughout the body via the upward channel of mouth.
Vaman therapy purifies the body and is especially useful for treating disorders arising from Kapha and Pitta doshas. The diseases such as Rhinitis, Asthama, Skin Disorders, Chronic Cough, Fevers, Indigestion, Nodular Swelling and various allergies etc can be well treated by vaman treatment.
Due to the intensive nature of this Purifying Procedure, it is essential that body is properly prepared via Oleation (Snehan) And Sudation Therapies (Swedan). Usually, 3 -7 days of Internal snehana is done in conjunction with external snehana and swedana as per the patient’s strength, constitution, age, disorders and with consideration for the season and environment.
On the day, prior to vamana, a special diet like curd rice, khichadi made with Udad dal (black gram) is given to increase and fluidity of the doshas which have been brought to tract, thereby ensuring their easy expulsion.
On the day of vamana, in the morning patient is given snehana & swedana and then begin consuming vamana decoction in quiet larger quantity. In complete vaman procedure, normally 5-8 liters of liquid is consumed and vomited. For drinking sugarcane juice, herbal decoctions, medicated water and sometimes milk can be used. After drinking few glasses of liquid, the medicinal induction of vomiting commences.
Proper expulsion in vamana draw out the vitiated Kapha initially followed by pitta dosha effortlessly & with minimal discomfort. The medicinal decoction is given continuously until all of the doshas have been expelled and the proper symptoms of the treatment starts to appear such as lightness in Chest, Abdomen & Body feeling of relief, clarity of the senses & gentle fatigue.
Patient’s cooperation is essential in this treatment.
Out of all Panch-karma, Vamana is the one which is most capable of giving rapid & radical results as well as the most dependent on the compliance of the patient undergoing the treatment. The consumption of needed quantity of liquids is very crucial factor for success with vaman therapy. All the procedure of drinking and vomiting do not last for more than 70-90 minutes.
After observing needed symptoms and strength of patient, vaman procedure is stopped.
After vamana, Dhumpana i.e.medicinal smoke of different herbs is gently inhaled to remove any residual kapha dosha. Then the gandusha (Gargles) i.e., Herbal mouthwash is administered and then the patient is encouraged to rest but not to sleep till night. Then for 4-5 days patient is given a regimented diet to kindle the Agni called “Samsarjana Krama”.
Emetic Therapy is effective in curing a number of disorders arising from the Doshas and useful in the prevention of many others. It is traditionally performed as a preventative health measure once a year during the Spring to prevent weight gain, allergies, tendency, towards fever, cough / cold and other deficiencies of immunity.
To realize the benefits of Emetic Therapy the rules and regulations of its proper administration must be strictly adhered to.
Virechana – Purgation Therapy
Excessive doshas of the body are removed through loose motions in virechna therapy.
Virechana, the Puragation Therapy of Ayurveda, has the more profound objective of discharging not only waste products but also the Doshas themselves, thereby eradicating the elements responsible for disease pathogenesis from their root. This form of virechana is especially helpful in the treatment of disorders arising from Pitta Dosha such as Jaundice, Skin Disorders, Piles and Hemorrhoids, Digestive Disorders, Asthma, Chronic Fevers, Genital Disorders, Blood Disorders and Chronic Toxicity. Generally, virechna is contraindicated during Pregnancy, Childhood and in cases of heart disease.
To properly execute this virechana, the body is prepared for 5-7 days utilizing the same techniques employed in vamana (Emetic Therapy), namely: Snehana & Swedana with due regard and differential consideration for the Patients strength, constitution, age, disease, the environment, season, etc.… Again as in the preparation for vamana when the body has been thoroughly lubricated within and without, the doshas become dislodged from the bodily tissues and collect in the digestive tract for elimination, but in this case via the downward route.
When the above stage has been realized in the body and the doshas are ready for expulsion there will be a gap of 1-2 days from sneh-paan and on the following morning the appropriate medicine to induce virechana is given. However, virechana should not be administered in cloudy weather or on days that are very hot or very cold. On the appropriate day the patient should have a light breakfast of Mung Daal soon after Sunrise. After sufficient time has been given for the initial stages of digestion (approximately 2 to 2 ½ hours) and the cold of the morning has been relieved by the warmth of the day, the patient again receives abhyanga and swedana and immediately thereafter consumes the appropriate virechana medicine which has been selected by their Physician with due consideration of the nature of their alimentary canal, digestive capacity, age, strength, constitution, etc.…
Mostly virechana begin to take effect within 2-3 hours, stimulating 5-20 rounds of elimination. The fecal matter, then Pitta & Kapha dosha are expelled out.
After taking the virechana medicine , the patient should abstain from eating and sleeping until the eliminations have finished and they receive further instruction from their physician. Also, they should avoid going outside and all direct exposure to breezes. During this period, it is important that the patient drink only warm water and use only warm water externally as well to wash hands, etc.… After every elimination the patient should take few sips of warm water and take note of their stool so they can convey the needed information.
After proper virechana, patient feels lightness in abdominal region & all over body, feels enthusiasm, great clarity in their senses, little fatigue. Also, as in vamana Karma, when patient feels hungry, the patient must observe a specific regimen of diet for 3-5 days to restore proper strength of digestion.(Agni.)
Virechana therapy if not administered properly, many nuisances are likely to occur. Therefore, should be taken only under the guidance of an experienced physician.
Nasya Therapy
Ayurveda utilizes virtually all of the bodily orifices to administer herbal preparations and treatments, i.e. the colon, mouth, ears, eyes and nose. For all disorders above the clavicles and especially for disease of the head, the nasal passage is the most important route for the administration of herbal preparations. In Ayurveda it is said nasal passage is the gateway to the head and brain. Thus by administering appropriate herbal preparations via the nasal passage the Doshas and morbid materials collected throughout the head, neck and face are dislodged, scratched out and expelled through the nostrils. This treatment is known as Nasya.
The overall action of Nasya can vary greatly as per the medicinal substances that are used. Generally substances such as milk or ghee will be soothing and pacifying for the doshas, while substance such as medicated smoke, herbal powders and strong herbal decoctions will be more purifying.
The ideal seasonal times to perform Nasya are just before rainy seasons, during early Autumn and immediately before spring. However as per necessity, Nasya can be administered at almost any time by creating an opportune environment in which it is neither too dry nor too moist.
In the process of administering Nasya first the head, face and neck massaged thoroughly with appropriate oily substances. Then these same parts are given Swedana though localized steam. The medicinal substance is brought to a lukewarm temperature and with the Patient lying down, the head is tiled back, the tip of the nose is raised and the substance is delivered into the nasal passage drop by drop. The head is gently massaged to encourage the herbal preparation’s dispersion and absorption while the patient relaxes, avoiding speech, anger, laughing, sneezing and shaking. To calm and ground the nervous system, the hands and feet are also gently massaged at this time.
When the action of the herbal preparations reach a climax, the Patient sits up and the Doshas, especially Kapha, begin to leave the head through the nasal passages along with the herbal preparations that were used. It is very important that the Patient makes an effort not to swallow but rather to spit out any and all discharge enters the oropharynx it should be spat out rather than swallowed as it is mixed with doshas which should not be allowed to re-enter circulation.
The above method of administering Nasya is useful in the treatment of headaches, neck stiffness and disorders of the cervical vertebrae, hoarseness of voice, vision and ocular disorders, tonsillitis, rhinitis, facial paralysis, disorders of the mouth and especially TMJ and lockjaw. However, given the intensive nature of this treatment, it is contraindicated after eating, after drinking, during indigestion, when experiencing fatigue, after coitus, after exercise, during fever, rhinitis, pregnancy, post-partum, in cases of poisoning and after having undergone Vamana, Virechana or Basti Therapy.
As a far less intensive and restrictive practice, Ayurveda encourages the regular application of gentle Nasya, Pratimarsha nasya, in which just two drops of oil or ghee are inserted into each nostril. This form of Nasya can be done during any season and any age, with a number of opportunities throughout the day such as after rising, brushing the teeth, gargling or instilling eye drops, before going out , after exercise or coitus, after walking, urination, defecation and after meals. As a regular practise, this gentle Nasya gives strength and robustness to the face, neck, head, chest and shoulders, supports cognitive and sensory function and tonifies the brain and sense organs.
Nasya offers great and unique remedial potential in the modern environment of stress, tension, competition and perpetual sensory and cognitive strain by imbuing the brain and sense organs with greater strength, resilience and adaptive capacity.
Basti – Medicated Enema Therapy
Long before the advent of intravenous fluids, the Physician of Ayurveda administered numerous herbal preparations directly into the anal canal to reach the deep tissues of the body and to manage different acute disorders. This form of treatment is known as Basti in Ayurveda. Though commonly referred to simply as ‘Enema Therapy’, Basti Therapy greatly exceeds the understanding and application of enemas as they are employed in the West. Basti Therapy utilize a wide range of medicinal substances to treat very specific disorders.
Basti literally means ‘bladder
This treatment is called Basti in Ayurveda because in ancient times prior to the invention of catheters and syringes, Physicians used the clean and fashioned Urinary bladders of animals to administer herbal preparations in this way. Now of course Physician use equipment such as enema bags or pots with catheters or syringes.
The concept of Basti Therapy most commonly implies the administration of herbal preparations through the vagina and urethra. These latter applications are called ‘Uttar Basti’
Basti Therapy is mostly used for disorders of Vata Dosha. Through Basti Therapy, herbal preparations are absorbed through the large intestine and thereby spread throughout the body into the deepest tissues, pulling Doshas back into the large intestine. The large intestine is the main seat of Vata in the body. Nevertheless, Basti Therapy is often used in the treatment of disorders arising from Pitta and Kapha Doshas as well just by switching the herbal preparations which are used. For Kapha Dosha, Bastis are given Kapha (scraping and) reducing substances such as Ghee and Milk.
In the Classical Text of Ayurveda, it is said that ‘Basti Therapy is half of the treatment in all disease.’ On one side of treatment are all of the herbal preparations and treatments of Ayurveda on the other side is Basti Therapy alone, illustrating the unparalleled importance and utility of Basti Therapy within Ayurveda.
Basti Therapy is divided into two categories:1) Niruha Basti (Decoction Enemas)
2) Anuvasana Basti (Oil Enemas).
In Niruha Basti (Decoction Enemas) first a strong Herbal Decoction is prepared and to this honey, salts, herbal powders and different oils or animal fats are employed, sometimes mixed with a small amount of Black salt or herbs.
Anuvasana Basti Primarily contain oil or ghee. Niruha Basti excrete out the Vatadosha and old-saturated wastes from the body whereas Anuvasana Basti pacifies Vatadosha in the body itself.
Prior to administering Basti Therapy, the body is prepared by External Oleation in the form Snehana & Swedana, giving the tissues strength and resilience and widening the internal channels to encourage the Doshas to enter the GI tract. Often is only necessary to apply External snehan and Swedan to the back, abdomen and things to prepare for Basti. This of course will depend upon the individual and disorders.
After the Abhyanga and Swedana, the Patient lays prone with the left leg extended and the right knee bent. A small amount of oil is applied directly to the anus and then a well lubricated catheter is inserted in the direction of the vertebral column to administer the basti material. The fluids are inserted gradually with gentle, uniform pressure and thereafter the Patient rolls over to relax, lying supine with their hips elevated atop a pillow until the urge to release comes.
Niruha Basti are given immediately after abhyanga & swedana on empty stomach. For oil Enemas, after Snehana and Swedana the Patient should have a light meal and then receive the Basti. Niruha Bastis are usually expelled along with the Doshas quickly due to the potency of the herbal preparations used. Niruha Basti cannot be retained for more than 45 minutes and are seldom held for even 10 minutes. The Patient can eat immediately afterwards and must drink only hot water. In the case of Anuvasana Basti, the Patient should not eat after receiving the Enema until they have expelled it and start to have strong hunger. Anuvasana Basti are often administered in the evening and held overnight or during the day and held for 3 to 4 hours. In the management of different disorders, it is very common for Niruha and Anuvasan Basti to be given together in a sequence of alternating days, sometimes for an extended period of time up to a month.
Travelling, excess talking, day naps, Exercise. Sex etc. should be avoided during Basti therapy. Food should be light to digest and freshly cooked.
Niruha Basti are used in the treatment and management of abdominal disorders, distension, gout, splenic disorders, recurrent fever, runny nose, cough, male and gynaecological disorders and infertility, obstructed faeces or urine, scrotal enlargement, urinary stones, amenorrhea and in disorders of the nervous system such as tremors, paralysis, paraplegia, complications of sensory function, etc.
Anuvasan Basti (Oil Enemas) are used to rebuild strength and stamina in lieu of wasting and debilitation resulting from excessive dryness, fatigue, excessive activity, excessive sex, anxiety, excessive thinking, fractures and injuries and in general convalescence. Also for easy and comfortable labour, pregnant woman is advised to take Basti in the 9th month of Pregnancy.
Uttar Basti
As mentioned earlier, Uttar Bastis are Therapeutic Enemas administered via the vaginal or urethral passages. Uttar Bastis use special medicated oils and snehas as per the specific disorders to relive dysfunction of the urinary system like dysuria, burning, delayed or obstructed micturition, stones, seminal disorders such as poor motility, oligospermia, general reproductive disorders, vaginal disorders and menstrual difficulties. It is especially indicated in infertility and female reproductive disorders.
For women, as these treatments clear the internal passages and thereby promote the efficacy and potency of Uttar Basti. After completing these cleansing measures, the vaginal passage is further treated by douching with specific herbal decoctions, a practice called Yoni Dhavana in Ayurveda. Thereafter, Uttar Basti is administered by inserting a catheter through the cervical passage, ideally immediately after the cessation of menstruation. This Uttar Basti itself is then followed by the insertion of tampons which tampons are called as Picchus in Ayurveda. All of these procedure must be performed with great care and strict hygienic practices by a qualified Physician. When properly executed, Uttar Basti is exceptional in improving the quality and function of the uterus and in treating female reproductive disorders such as ovarian cyst.
Rakta Mokshana : Therapeutic Bleeding
