Ayurveda Panchakarma Treatment

The Ayurvedic methodology of healing involves a radical understanding of the normalcy of each individual and hence utilizing various natural resources in regaining the balance in the wake of a constrained state of one’s constitution. In terms of the magnitude of the imbalance, the management could also vary. A minuscule imbalance would call for a pacifying treatment strategy (Shamana chikitsa) wherein internal medications, as well as dietary or lifestyle modifications, could strike a chord in achieving the balance. It can be tricky when it comes to complicated and longstanding abnormalities in one’s constitution where the physician, after proper identification of the involvement of the factors, need to go for a forceful cleansing of the body. Such a cleansing or purification (Shodhana chikitsa) shall be done only according to certain prescribed methodology and also under critical observation and care. This ensures eradication of the basic cause of imbalance right from its roots. Classically, five therapies are listed under this category. They are collectively known as ‘Panchakarma’.

Panchakarma therapies are:

1. Vamana (medically induced vomiting)
2. Virechana (medically induced purgation)
3. Nasya (nasal medication)
4. Vasti (medicinal enema)
5. Rakthamoksha (controlled bloodletting)

Panchakarma is essentially applicable to all forms of imbalance covering a wide range of preventive, curative and rejuvenating aspects. Panchakarma is advocated in a healthy person to combat seasonal imbalance of bodily humor. Ayurveda describes that the disorders treated with this mode of therapy do not recur while those treated with other palliative methods might re-appear. These measures are preceded by oleation therapy (snehana) and sudation therapy (svedana) and are followed by special diet recommendations (samsarjana karma).

Vamana therapy applies ideally for diseases of Kapha, Virechana therapy for diseases of Pitta and Vasti therapy for diseases of Vata. Classically Panchakarma therapy is prescribed and practiced through following schedule viz;

1. Purvakarma (preparatory therapies)
2. Pradhana karma (major therapy)
3. Paschat karma (post-therapeutic management)

Purvakarma (preparatory therapies)

Before the administration of panchakarma therapy, the patient has to be prepared suitably with the administration of fat (unctuous substances) i.e. snehana or oleation therapy followed by induced sweating measures i.e. Swedana or sudation therapy as preparatory measures. Panchakarma therapy should not be undertaken without such preparatory therapies otherwise it fails to eliminate the dosha situated in the tissues. The administration of Snehana renders the body soft and disintegrates the accumulated dosha and sweating therapy melts and mobilizes the doshas stagnated in the subtle channels of circulation. At this stage, administration of ‘Panchakarma’ measures eliminates the dosha out of the body easily and effectively through respective pathways.

Purvakarma includes two methods, 1) Snehana and 2) Swedana

Snehana

External or internal administration of unctuous preparations to a patient for a limited period to get the desired clinical effect is called Snehana (Oleation). Sneha influences abnormal vata, renders the body soft and clears the accumulated wastes which have obstructed the body channels. Further, the regular use of fats has been considered beneficial for the proper digestion, cleansing of the bowel, the promotion of body strength and integrity of senses and the prevention of aging in the aged besides several other beneficial effects of oleation. There are different techniques in the administration of such unctuous substances externally as well as internally. Popular therapies like oil massage, bolus treatments, oil pouring, enema, etc exemplifies external Snehana measures whereas oily preparations given internally in the form of food or as prescribed medicines helps in providing adequate unctuousness from the inside. The fats may be used singly or may be mixed with other drugs. Fat may be administered before, during or after food according to the disease.

Swedana

Making a person to sweat, with or without heat, is called Swedana (Sudation). Ideally, sudation therapy should be undertaken after the oleation therapy. It is considered that the sweating therapy melts and mobilizes the waste products of metabolism, stagnated in the subtle channels of circulation which have been disintegrated by the Snehana therapy.

Two types of measures are employed for sweating-

1. using direct sources of heat (Sagni sweda) and
2. without direct application of heat (Niragni sweda) by using practices like - indulgence in strenuous physical labour, staying in closed rooms, covering oneself with thick clothes, hunger, administration of different kinds of alcoholic beverages, by covering the body with leather, wrestling and walking in the Sun and other measures which may generate heat and sweating.

Care should be taken while performing swedana on certain parts of the body such as groin, eyes, testes and pericardial region.

Pradhana Karma (Main procedures)

After preparing the patient with snehana (oleation) and swedana (sudation) the patient is subjected to the main measures of panchakarma - Vamana (induced vomiting), Virechana (induced purgation), Nasya (nasal medication), Vasti (enema) and Raktamoksha (blood-letting by using leech or other instruments).

Vamana (Induced vomiting therapy)

Vamana is the procedure of eliminating waste products of the body through the upper passage by vomiting. Emesis is the therapy of choice in diseases of kapha dosha. It is specially indicated in conditions like fever of recent origin, cough, cold, bronchial asthma, elephantiasis, diabetes, bleeding through lower channels, nausea, diarrhoea, loss of appetite, poisoning, stomatitis, anemia, mental diseases, epilepsy, erysipelas, lymphadenopathy etc. Emesis therapy is contraindicated in the patients if they are very young(children), very old, debilitated and hungry and also in trauma of lungs, sprue, bleeding or upper channels, anuria, enlargement of spleen, abdominal tumours and abdominal diseases etc. A subjective feeling of cleanliness of the heart, chest, head etc., lightness in the body, timely passing of urine stool etc. are the features of well administered emesis therapy.

Virechana (Induced purgation therapy)

Virechana or purgation therapy is a systemic therapy for the diseases of pitta dosha. Purgation therapy is indicated in diseases of skin, fever, diabetes, bleeding of upper channels like mouth, nose etc., diseases of gastrointestinal tract, piles, abdominal tumour, enlargement of spleen, anuria, helminthiasis, erysipelas, gout, vaginal diseases, fistula-in-ano, tumour, glandular swelling, anemia, jaundice, loss of appetite etc. It is contraindicated in children and old patients and also in diseases like bleeding of lower channels, pregnancy, fever of recent origin, indigestion, lymphadenitis, weakness, debility, diarrhea etc. Feeling of cleanliness in the channels and sense organs, lightness in the body and increase of appetite etc. are the symptoms of well administered Virechana karma.

Vasti (Enema)

Medication administered through anus in the form of medicated enema to get desired therapeutic effects is known as Vasti (enema) therapy. According to the Ayurveda vata is the main morbid factor in the causation of disease pertaining to tissue and organs in the body and Vasti (enema) therapy is the best treatment of excessively excited vata, therefore, vasti karma is considered half the treatment for all the diseases described in Ayurveda. This therapy is also very useful as a health-promoting measure. It is beneficial for old as well as for the young. It cures all kinds of diseases due to its varied pharmacodynamics and various kinds of drugs used in its preparations. Enema therapy is of two types; viz. Oily enema (Anuvasana vasti) and Decoction enema (Niruha vasti). Vasti is generally contraindicated in all types of diarrheas, dysenteries, rectal bleeding, diabetes, severe anaemia, breathlessness associated with any pulmonary pathologies, etc.

Nasya (Nasal medication)

Nasya is a process by which drug is administered through the nostrils. Nose is considered as the gateway to the head and hence nasal route is ideal in treating all diseases of the head. In fact it is useful in all the diseases manifesting above the neck (urdhwajatru gata roga) because it eliminates toxins through the nostril. On the basis of its therapeutic action and the way of administration it is classified into many types.

Raktamosksha (Blood-letting)

Rakta Mokshana or bloodletting is one of the therapies developed by Susrutha as a specialized technique. Here, a small amount of venous blood is extracted by using either specially designed sharp instruments or specialised equipment or leech. It is helpful in relieving diseases of pitta origin, blood born and chronic skin diseases. This therapy is contraindicated in cases of anemia, edema, extreme weakness, diabetes and in children and elderly persons. It is also not advised in pregnant ladies as well as lactating mothers.

Paschata Karma (Post-therapeutic management):

The procedures like internal intake of sneha in high dosage followed by the purificatory therapy are definitely going to create some sort of impairment in the function of digestive power temporarily. The body of the subject will be in a tired state after such cleansing measures. So, immediately the subject is not allowed to come back to his normal diet pattern. In order to bring back the agni (digestive fire) to the normal state, some specific diet patterns are followed after the main procedure. This is known as Samsarjana krama; in which initially easily digestible liquid dominant diet is given with gradual introduction of salt, pepper, mustard, oil etc. Along with the dietary restrictions, a certain amount of physical and mental rest also form an integral part of Post-therapeutic management in Panchakarma.