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.

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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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