PRADHAN KARMA

 

According to the Charak Samhita, the body normally uses three routes to eliminate waste products and toxins: the mouth, anus, and pores of the skin. The three doshas act as the vehicle which carries ama either upward, downward, or out through the periphery. Through dosha gati, the doshas move these impurities from the deep structures to the G-I tract and from the G-I tract to the body's three main outlets. There are five PradhanKarmas : Vamana, Virechana, Basti, RaktaMokshan and Nasya.

Panchkarmas related to Direction of Elimination of Ama

	Type of karma Impact on Dosha Direction Vaman Karma Nasya Karma Kapha Dosha Zone Upward Movement Virechan Karma Pitta Dosha Zone Downward Movement Basti Karma (Anuvasan and Nirooha) Vata Dosha Zone Downward Movement Raktamokshana Karma Blood Vessels Peripheral Movement

• PASCHAT KARMA

The set of procedures that follow the main eliminative treatments of Panchkarma and assist this rebuilding process are called, collectively, PaschatKarma. They assure the re-establishment of healthy metabolic function and immunity. If these post-procedures are neglected, digestion does not normalize. Weak digestion generates new ama and the tissues continue to receive toxic material instead of nutritive, strenghtening substances. The body then finds it difficult to re-establish its natural immune function and is more likely to fall ill again.

While the digestive fires are re-kindling, it is important to respect the somewhat vulnerable state of the physiology. Energy resources are not at their full capacity, and as result, we cannot do as much as we will be able to do once the dhatus are rebuilt and up to the speed. It is therefore crucial for the success of Panchkarma that the patient follow a regulated diet and lifestyle immediately after treatment.

There are two procedures of Paschat Karma : Samsarjana Karma and Rasayan Chikitsa

SAMSARJANA KARMA (Graduated Diet)

 Samsarjana Karma constitutes the primary post-treatment procedure for digestion. This term iterally means a "Graded administration of Diet". It consists of a specially prepared diet designed to re-establish full digestive capacity and prevent the formation of new ama.

Digestion is the first aspect of physiology that needs to be reconstructed. The Panchkarma treatments dramatically effect the digestive process because the G-I tract provides the primary route for the elimination of the toxins. The digestive fire is weakened by the process of ama being drawn back into the digestive tract and expelled from the body.

The diet given to the patient immediately after Panchkarma consists of nutritive and easily digested preparations of rice and split yellow mung dal (lentill). The diet is structured in stages, going from more liquid preparations to increasingly solid ones. These stages of digestibility are called manda, peya, vilepi, odana, yusha and kichari.

MANDA : RICE WATER

Manda, meaning "liquid", is the first meal after vamana or virechana. It is normally taken when the appetite returns, which for most people is about four hours after completing these procedures. Manda is mainly just the water in which basmati
rice was boiled. It should be eaten lukewarm with a little ghee and a pinch of black salt.

PEYA : RICE SOUP

The patient takes the next meal called, peya, two to three hours later. Peya means "soup" and is traditionally made with eight parts water to one part rice. The rice is cooked until it is very soft, so that it has the consistencyy of a thin, light porridge.

VILEPI : THICK RICE SOUP

Vilepi, or "thick soup", describes the third and fourth meals after vamana or virechana. Vilepi consists of a slightly thicker porridge of soft, cooked rice grains and is made with a ratio of four parts water to one part grain. A little black salt water and dried sugarcane juice can be added for taste. In order to add some strength to the digestive fire, one can lightly saute a little fresh ginger, turmeric, cumin, coriander or fennel in a small amount of ghee and add them to the porridge.

ODANA : COOKED RICE

Odana, which means "cooked rice" and has the consistency of normal, soft, cooked rice, is given as the fifth meal.

YUSHA : MUNG LENTIL SOUP

Dal is added to the sixth meal, which the patient eats on the second day after Virecahan and Vamana. Yusha or "soup mixture", is rice with some yellow mung dal added.

KICHARI : RICA AND DAL MIXTURE

The patient gets kichari for a number of meals. Kichari contains a mixture of basmati rice and spilt yellow mung dal coked together with a pinch of black salt and the sauteed spices. The nourishing food forms the basis of the traditionial purification, recuperation and rejuvenation diets in Panchkarma therapy.

• TIPS FOR HEALTHY BODY AND SOUL:

1) Only eat when you have appetite.

2) Do not eat to full capacity. Always leave a little room in your stomach at the end of each meal.

3) Avoid drinking cold liquids with your meals.

4) Eat your main meal at noon time when the environmental agni is strongest, and eat a lighter meal at night.

5) Eat in a calm atmosphere and sit down when you eat.

6) When possible, avoid snacks between meals and avoid eating just before going to bed.

7) Once every week or two, fast or eat lightly to give your digestion a much needed rest.

8) Avoid foods that are deep-fried or are too heavy.

RASAYANA CHIKITSA (Rejuvenation Therapy)
 

 Rasayan Karma does not technically belong to Panchkarma therapy, but forms its own system withnin Ayurvedic System. However, the rasayan therapy increases the effectiveness of Panchkarma's rejuvenating processes. Rasayana actually means "that which increases the essence of each dhatu, starting with rasa".

 When people hear about the rejuvenating properties of rasayanas, it is common for them to want to take them immediately, without going through the necessary procedures to make the body receptive to their influence. This will not work for three reasons :

(i) The rasayana are very refined and concentrated herbal and mineral formulas that take strong digestive capacity to metabolize.

(ii) Imbalanced doshic functioning impedes delivery of these substances to the dhatus.

(iii) The ama and mala stored in the dhatus block their ability to asimilate these special compounds.

As a result of these three factors, Rasayana doesn't achieve its desired effect. Digestion must be strenghened, the doshas must be balanced and impurities must be eliminated from the dhatus through Panchkarma therapy in order for the rasayanas to work.

Many herbs and herbal formulas are commonly given after Panchkarma to produce specific effects.

• Ashwagandha pacifies and balances vata.

• Brahmi and Manjistha pacify pitta.

• Ginger, black pepper and Pippali improve the digestive capacity of all the dhatus agnis and pacifies kapha.

• Amalki increases sattva, thereby improving the calrity, stillness and positivity of the mind. It also pacifies both pitta and vata.

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BASTI (Therapeutic Enema)

Basti one of the most powerful of all the main five procedures of Panchkarma. Charaka, as well as many other Ayurvedic scholars have unanimously praised the features of Basti. Basti like Virechana use pitta and vata dosha's downward movment to remove related toxins and waste materials from the system. Basti cleanses the vata area, whose focal point is the large intestine.

Basti is the introduction of medicated liquids into the colon through the rectum. While it directly effects the colon, its is not a localized or symptomatic treatment. Basti treatments balance and nurture vata dosha. When vata functions normally, it helps bring toxins and waste matter out of the dhatus and eliminates them.

It treats localized symptoms of constipation by promoting evacuation. It clears faeces that have collected in the rectum and sigmoid colon- the last eight to ten inches of the colon.

• THERAPEUTIC BENEFITS OF BASTI THERAPY:

Basti therapy is the most effective treatment for disorders arising from abdominal vata. This includes chronic constipation, low back pain, sciatica, rheumatism, gout, arthritis, hemiplegia, poliomyelitis, Alzheimer's disease, Parkinson's Disease, multiple sclerosis and dystrophy and atrophy of nerves and muscles. It benefits epilepsy, mental retardation, and sensory dysfunction.

• TYPES OF BASTI THERAPY:

Basti fulfils many needs, so the type of basti used during Panchkarma varies according to the intended purpose of the treatment. One type of basti eliminates the ama that has gathered in the colon from throughout the body. Another normalizes Vata function.

BASTI CLASSIFIED BY SITE OF ADMINISTRATION :

The first major classification scheme refers to the administration site and the primary organs receiving the treatment. It recognises four areas.

A) Pakwashaya gata Basti :	Medicated liquids sent through the anus and rectum into the colon.
B) Utara Basti :	Medicated liquids sent through the vagina and cervix to cleanse and nourish the uterus.
C) Mutrashaya gata Basti :	Medicated liquids introduced into the penis and urethhra to treat the male genital and urinary organs.
D) Vranagata Basti :	Cleansing and medicated liquids used to irrigate and heal abscesses or wounds.

Four types of external Basti are classified according to their site of administration.

1) NETRA BASTI OR NETRA TARPANA

In this, medicated ghee is applied to the eyes. The ghee is contained by a dam constructed around the eye sockets, made of the dough from the black gram flour. Netra basti is highly nourishing for the eyes, removes eye strain and improves the vision.

2) KATTI BASTI

It means "retained on the lower back". It applies medicated oils in a container of black gram dough built around the lumbosacral araea. This form of external basti particularly benefits muscle spasm and rigidity of the lower spine and strengthens the bone tissue in that area.

3) URO BASTI

It means "retained on the chest and heart area". It uses medicated oils in a container - also constructed of black gram dough - around the heart. It reduces pain in the sternum area and strengthens the heart.

4) SHIRO BASTI

It is administered on the head through the use of a specialized leather container resembling a hat. This type of basti improves the functioning of prana vayu and revitalizes sensory functions. It also improves kaphagenic secretions in the pre-nasal sinus zone which reduces vascular congestion in the brain.

BASTI CLASSIFIED BY SITE OF FUNCTION :

While Charaka developed and presented basti therapy in great detail, his knowledge provides general guidelines which allow experienced and well-trained Ayurvedic physicians to adapt treatments to their patient's needs. Following types of basti are decsribed according to their site of function.

1) SHODHANA BASTI

It cleanses and detoxifies. It is divided into two strong treatments which penetrate to the deeper dhatus, and mild treatments, which work on the more superficial level of the dhatus. Nirooha offers the prime example of this form of therapy.

2) UTKLESHANA BASTI

.....meaning "promoting secretions in the colon". It promotes the liquefication of ama and mala in the colon. It helps the colon expel them. Similar to western enema, this basti increases colonic peristalsis, producing rapid elimination of the faeces.

3) SHAMANA BASTI

It is palliative. It restores doshic performance, reduces symptoms and allows the patient to feel better. In cases of rectal bleeding or dysentry, the immediate objective is to stop the bleeding. For example, picha basti, which uses astringent herbs, shrinks the capillaries or shrotas and stops the bleeding or peristalsis, ending the symptoms.

4) LEKHANA BASTI

It is stronger in its effects and generally much larger in volume. Its strong and penetrating. It is particularly useful for kapha and meda dhatu disorders, where excess fatty substances have accumulated that need to be eliminated as in case of obesity and arteriosclerosis.

5) BRUHAN BASTI

It nourishes. Highly nutritious sustances are used to balance and strenghten the dhatus and their metabolism, and increase the body's resistance to infectious diseases. It's very effective in regenerating the dhatus and are specifically used to tone the muscles and reduce atrophy and emaciation.

6) SNEHANA BASTI

It is similar to anuvasan because it is prepared only from oleated substances, but is larger. Because of its size, it has a greater lubricating effect on both the colon and the body in general. It has a strong pacifying influence on vata and is particularly useful in cracking of joints and for those who have very dry skin or who are emaciated.

7) RASAYANA BASTI

It rejuvenates and can be prepared to rebuild and strengthen either specific dhatus or the whole body.

8) VAJIKARNA BASTI

It treats infertility, it increases virility and fertility and gives vigour and vitality to the body.

9) MATRA BASTI

It can be given any time of the day, and is particularly useful to pacify vata aggravation resulting from travel, exercise or stress.

BASTI CLASSIFIED BY SITE OF FREQUENCY AND DURATION :

Charaka describes three additional classifications which are based on specific treatment regimens : karma basti, kala basti and yoga basti.

1) KARMA BASTI

Karma Basti comprises a month long treatment and is given to people who have vata dominant constitutions and vata related disorders. It begins with anuvasan basti and alternates with nirooha basti for twenty-five consecutive days. The thirty day program ends with five days of anuvasan basti.

2) KALA BASTI

Kala Basti lasts for fifteen days and is used mainly for patients with pitta - dominant constitutions and vata disorders. It starts with an anuvasan basti and alternates with nirooha basti for ten or twelve days and concludes with three or five days of anuvasana basti.

3) YOGA BASTI

Its given for eight days, suits kaphic patients with vata diseases. It first gives anuvasan basti, and alternates three times with nirooha. It concludes with two days of anuvasan.

• TYPES OF BASTIS USED IN PANCHKARMA :

Due to the importance of the colon's eliminative and rejuvenating functions, Panchkarma largely employs pakwashaya gata bastis given during this therapy. They are called nirooha and anuwasan basti.

NIROOHA BASTI, which means, "that which gets eliminated", cleanses toxins from the dhatus and removes naturally accumulated malas form the colon. Charaka Samhita has indicated that this Shodhana type of basti is capable of cleansing the entire body. These basti primarily, but not exclusively, use water - based decoctions of purifying herbs. The quantity of liquid administered is approximately 400 ml (1-3/4 cups), though the dosage may vary from individual to individual.

The quantity is always less than in enemas, since the basti's efficacy and specific action is not based on the volume of the liquids, but on the effects of the herbs. In nirooha, or purifying bastis, the liquid is retained in the colon for approximately forty-eight minutes. During this time, some of the ingredients get absorbed and their purifying influence moves throughout the body. The rest gets expelled along along with fecal matter and toxins.

Nirooha Bastis are given in a series of treatments over a period of several days. These bastis, along with the preparatory procedures, allow the cleansing process to reach deeper and deeper into the tissues with each passing day.

The first day of this basti treatment cleanses the colon of ama and mala. The second day of nirooha balances and nourishes vata, producing increased mental calm and clarity. Beacuse the vata zone has now been cleared, the third day pulls out ama and toxins from the pitta zone. This balances and nourishes the pitta function.

On the fourth and fifth days of administration, toxins get pulled out of the kapha area. Kapha resides in two major sites, other than the stomach: mamsa (muscles) and meda (adipose tissue), and this cleansing automatically purifies and strengthens both of them. On the sixth and seventh days, the basti's benefits reach the deeper tissues. This sequential cleansing process stimulates the natural absorptive and eliminative functions of the colon to remove ama and malas from all the tissues of the body.

ANUWASAN BASTI, the second major of the pakwashya gata basti, has as its purpose to nourish the body. It does so through the application of herbalized oils. Oil naturally lubricates and nourishes the dhatus, an effect which is opposite to the drying and wasting influence of excessive vata. Therefore, this class of basti is particularly successsful in the treatment of vata disorders.

Anuwasan Basti are usually administered after a cleansing course of nirooha basti to ensure that vata dosha is operting properly. They not only restore health to the colon, but also lubricate and nourish all the dhatus.

Anuwasan basti refers to "that which is to remain in the body for a while". For this type of basti, it is optimum if it can be retained in the body for a longer period of time in order to have its intended effect. Three to six hours is the ideal retention time. If it is administered, it is best if it can be held overnight.

Bastis are always applied slowly, but Anuwasan should be introduced extremely slowly, ideally a drop at a time. This is particularly important for individuals with irritable bowel syndrome. Slow administration reduces the possiblity that a hyperactive colon will go into a refelxive response and reject the basti, and insures that the bastis's nourishing ingredients will soothe and restore normal function to the colon.

It is prepared in a wide variety of ways, depending on the specific nutritive requirement. They can benefit neuromuscular disorders, in which dhatu is impaired, including muscles, bone, bone marrow, and nerve tissue.

• PREPARING FOR BASTI THERAPY :

As with all Panchkarma procedures, proper preparation is crucial for successful basti treatment. First Snehana and Swedana must loosen out ama and open the body's channels so that it can be moved out. This greatly aids the effectiveness of both the cleansing and nourishing bastis. They are always administered immediately after oelation and sudation (heating).

Basti ingerdients are freshly prepared, A typical Anuwasan Basti consists of approximately 60 ml of herbalized sesame oil. Nirooha Basti contain primarily herbal decoctions of water with a small amount of oil. A typical nirooha basti contains 400 ml (1-3/4 cups) of a water decoction of dashmoola, a standard preparation consisting of a mixture of ten different herbal roots, 30 ml of seasame oil, a little honey and a pinch of black salt. The black salt is added to increase secretions in the colon.

• BASTI ADMINISTRATION :

To facilitate the movement of the basti fluids from the rectum up through the descending colon, patient always lies on the left side when receving basti. The patient extends his left leg, while bending his right knee and drawing it up towards the chest. This makes the anal opening more accessible to the nurse or physician administering the basti. The patient's head should be supported on a pillow and he should be warm and relaxed.

The basti temperature must be near or at body temperature to increase the body's receptivity to treatment. The decoction is drawn up into a rectal syringe and introduced into the rectum through a thin rubber cartridge. Both the anal opening and the catheter are lubricated to allow easier access. With the permission of the patient, the doctor or nurse introduces the catheter, slowly and gently, about six inches into the rectum while the patient inhales deeply. After the basti, the patient lies on his back and rests for ten to twenty minutes.

Because of its small volume, Anuwasan Basti can be easily retained for a long period of time. However, with nirooha basti, the pateint is more likely to feel the urge to defeacate within forty-five minutes to an hour and in some cases, sooner. In Nirooha, the ama which the doshas drew into the colon is eliminated along with much of the basti fluid and faecal matter.

The time of Basti administration is noted along with the time of each subsequent bowel movement. It is often not possible for the physician to do this, so the patient is instructed to observe and note the frequency, color, consistency, odor and other signs which can show the physician whether ama is present and what type of ama is being eliminated.

• TREATMENT REGIMEN :

The Ayurvedic physician always closely monitors the patient's response to basti treatments. He then makes adjustments in the type of basti, its oil and water content, the specicfic herbal decoctions used and the number of bastis which alternate nirooha with anuwasan.

Based on the information presented in the Charaka Samhita, several regimens which alternate herbal water decoctions with oil bastis are employed. The specific regimen depends on the constitution of the patient and the condition of the colon. A nirooha decoction is often applied for two consecutive days and then followed by an oil based anuwasan basti on the third. If there is greater need for cleansing, nirooha bastis can be given for three days, followed by oil on the fourth.

In most cases, this type of treatment schedule, followed for eight to ten days, cleanses ama and mala from the dhatus and assists the rebuilding of dhatu structures. This regimen restores normal balance to the doshas and the dhatus.

It is essential to always end treatment with anuwasan basti. This guarantees that vata is operating properly and that the colon is left lubricated and nourished. When properly administered, basti treatment does not interfere with normal intestinal flora and strenghtens the function of the mucous membranes lining the colon.

Bastis have proven remarkably successful in treating situations that have not responded to any other form of therapy. Their power and efficay as a treatment modality have gone largely unrecognized by modern medicine. When the vital functions of vata dosha are not understood, it is easy to overlook the tremendous absorptive power of the colon. As a consequence, modern medicine has failed to take advantage of the colon as an important route for the administration of medicines and nutrients.

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