PANCHKARMA

 AYURVEDA USES TWO MAIN MODALITIES IN THE TREATMENT OF DISEASE, EACH WITH ITS OWN DISTINCT PURPOSE, namely Shamana and Shodhana therapies.

SHAMANA CHIKITSA
(Procedures for Alleviating the Symptoms)

Shamana, which means "to suppress", reduces or eliminates symptoms. Shamana treatments make the patient feel better by suppressing the effects of the body's accumulated ama. When we take aspirin to alleviate headache or muscular pain, we are employing a shamana or palliative type of treatment.

SHODHAN CHIKITSA
(Procedures for Eradicating Disease)

The second means that Ayurveda uses to treat illness is called Shodhana, which literally means "to go away". In this form of treatment, the basis of the disease process is eradicated. Shodhana therapy rids the body of ama and mala and restores balance to the doshas. It is considered superior to Shamana because it not only removes the symptoms of disease but also eliminates their cause.

Panchkarma is one of the unique therapeutic procedure in Ayurveda advocated for the radical elimination of disease causing factors and to maintain the equilibrium of doshas. The five fold measures comprehended by this therapy for internal purification of body system are Vamana (Therapeutic Emesis), Virechana (Therapeutic Purgation), Basti (Therapeutic Enema), RaktaMokshan (Therapeutic withdrawal of Blood), Nasya (Therapeutic cleansing of Sinuses).
 
It Prevents ageing process and improves memory and functions of sense organs. Panchkarma therapy is very effective in the management of auto-immune disorders, chronic ailments like rheumatoid arthritis, bronchial asthma, G.I.T. disorders and mental diseases.
                                         

Panchkarma Procedure

The whole procedure of Panchkarma is divided into 3 steps : Purva Karma, Pradhan Karma and Paschat Karma

• PURVA KARMA

The set of procedures which Ayurveda prescribes to facilitate the removal of ama and toxins from the tissues is collectively called Purvakarma. Purva means "before" and Karma means "actions". These treatments help to loosen ama and move it out of the deep structures into the G-I tract, where Panchkarma's main therapies can then eliminate it. There are two purvakarmas : Snehana and Swedana

SNEHANA (Therapeutic Oleation)

Snehana, the first step of Purvakarma, saturates the body with herbal and medicated oils. The saturation takes two forms: bahya snehana or external oleation, where medicated oils are vigorously massaged into the body; and abhyantar snehana or internal oleation, where medicated oils are ingested. Snehana uses four types of oleaginous substances: vegetable oils (taila), clarified butter (ghee), animal fats (vasa) and fat from bone marrow (majja). 

• OLEAGINOUS SUBSTANCES


SEASAME OIL (til) is the primary vegetable oil used for external application. It is sweet, bitter and astringent in taste, warming in action and easily penetrates and nourishes the skin. It soothes and reduces the effects of excess vata without aggaravting kapha and promotes stability and strength. Seasame and all other herbal oils used in snehana are prepared with herbal decoctions to enhance their effectiveness for individual patients.

HERBALIZED GHEE (tikta ghrita) , the main substance used for internal oleation, is made by processing butter to remove all its milk solids, proteins and water and then cooking it with numerous prescribed herbs. By itself, ghee has remarkable properties as a nutritive and medicinal substance. Its effect on the body is quite different from that of butter, and research has demonstrated that it does not tend to elevate cholesterol levels. In proper amounts, Ghee increases the strength of the digestive agnis, while decreasing the heat and inflammation due to excess pita. It reduces excess acidity both in the digestive tract and in the tissues, pacifies vata and softens and lubricates the tissues and joints.

VASA (Animal Fat) and MAJJA (Bone Marrow) are also used in the internal oleation. However, these oils are heavy and difficult to digest, and they can produce excess kapha and ama if a patient's digestive agni is weak. Their use is indicated only for specific disorders such as leukemia and several other types of cancer, as well as certain degenerative disease conditions like myopathy. 
 

• TYPES OF SNEHAN


INTERNAL OLEATION (Abhyantar Snehana), consists of taking prescribed amounts of warm, herbal ghee, called tikta ghrita, first thing in the morning and in late afternoon on an empty stomach. The Ayurvedic physician gradually increases the prescribed dosage, depending on the strength of the patient's digestive agni. The patient does not eat until the ghee is digested, which is signaled by the return of appetite.

In preparation for the main eliminative procedures, the patient receives both internal and external oleation each day. These treatments continue for seven days, the time required for the oleaginous substances to reach and saturate all seven dhatus. After the seventh day, oleation becomes counterproductive, as there is nowhere else for the oil to go. If continued, it starts to collapse in the dhatus as saturated fat and depletes the dhatu agnis.

Certain classical signs indicate oleation's completion. When oil has saturated all seven dhatus, the body is well-lubricated, internally and externally. The skin displays a soft and shiny appearance and smells slightly unctuous.

EXTERNAL OLEATION (Bahya Snehana), employs a specific form of massage to apply the herbalized oil to the skin. There is great significance to the strokes used in bahaya snehana, for they match the movements of vata's five different directional functions.

Description of vata's five directional functions :

Prana Vayu, the vata function which moves from the head, mouth and nostrils to the navel, takes prana, or life-force, in the form of air, food and water from the environment into the body. It also controls sensory functioning.

Udana Vayu, flows in the opposite direction, moving from the navel to the mouth, nostrils and head. Udana Vayu eliminates carbon dioxide and various forms of mala, like mucus and saliva, from the kapha zone, and also creates the sounds used in speech.

Samana Vayu, circulates in a clock-wise direction around the navel area. It helps strengthen the digestive agni in the same way that air or wind strokes a fire.

Vyana Vayu, moves from the heart to the periphery and from the periphery back to the heart in a circadian rhythm.

Apana Vayu, travels from the navel to the anus and urethra. Its main function is to eliminate urine, faeces and menstrual discharge. Its also responsible for childbirth.

Both the massage technique and the herbs allow the oil to penetrate deep into the tissues to loosen the grip of the ama.The ama that has formed on the walls of the dhatus shrotas is also loosened, opening up these channels so that ama can be more easily removed from the tissues. Snehana's actual meaning implies kindness, tenderness and love, and true to its meaning, it is a thoroughly soothing and enjoyable experience.
 

• IMPORTANCE OF SNEHANA


1) It Induces the Dhatus to give up their accumulated toxins.

2) It enhances the secretions through which the doshas transport ama and malas to the gastrointestinal tract for elimination.

3) It lubricates and protects the dhatus from damage while ama is being removed.

4) It pacifies and nourishes vata through its unctuous qualities.

5) It removes the obstructions in the shrotas or channels. 

 

SVEDANA (Therapeutic Heat)

The second major aspect of the preparatory procedures of PurvaKarma is called swedana, the theraputic application of heat to the body. Though swedana literally means "sweat", the main purpose of swedana is not to poduce sweat, but to dilate the body's shrotas or channels so that oleation's objective - removing anna from the dhatus - can be easily achieved.
 

Sweat results naturally when the channels widen. In addition, the application of heat also counteracts the coldness of both vata and kapha, reduces the body's stiffnes and heaviness, and counters the slow, heavy and sticky attributes of ama.

As the influence of agni bhuta increases, it begins to soften or melt ama's density. Ama gets liquified and shrinks in volume, making it easier to be carried from the tissues. The heating action of swedana also mobilizes the doshas, which are responsible for transporting these toxic waste materials from the deep tissues to the gastrointestinal tract.

• TYPES OF SWEDANA


NADI SWEDA (Penetrating Heat), Nadi, which means "tube", uses steam from an herbal water decoction. Nowadays, this method is facilitated by the use of a pressure cooker and a nylon reinforced plastic hose which eases the steam's application to the body's surface. Nadi is a more penetrating type of wet heat than bashpa, because the steam actively drives the heat and oil deep into the tissues through the pores of the skin.

Although this type of steam treatment is given to the whole body, it focuses on the thick and complex structures of the joints to improve their mobility. Nadi swedana usually lasts for five to seven minutes. Outside the panchkarma process, it can be used with snehana for reducing pain, muscle pain, muscle spasm and rigidity in localized areas. This treatment can be very helpful in the palliative management of backache, inflammation of the spine, hip and knee, and for generalized muscle pain.


BASHPA SWEDA (Steam Heat), the second type of agni swedana, generally folows immediately after nadi swedana is administered. Bashpa literally means "steam" and unlike the more directed form of heat used in nadi swedana, bashpa applies steam evenly to the entire body.

Bashpa sweda uses a sweat box, in which the patient either sits or lies down on his back. Every part of the body is exposed to the heat except the head, as it cannot tolerate high range of temperatures. In fact, a technician continuously places cool compresses on the forehead during the treatment to maintain the head's normal temperature. To avoid dehydration, the patient is given a glass of water before administering bashpa sweda.

These small, one-person steam baths are normally constructed of wood with a thermostat that allows their temperature to be easily controlled. Herbal steam is released into the box according to the needs of the patient. The duration of the treatment is seven to ten minutes, or until sweat begins to bead on the face and forehead.
 




• CONTRA - INDICATIONS :


Though Bashpa sweda is an important preparatory procedure, it is not appropriate for people with heart disease or hypertension, since the heat may cause a rise in heart rate and blood pressure. Individuals with blood disorders, such as anaemia or leukaemia, also cannot tolerate the temperatures used to induce a full body sweat during this treatement.