Panchkarma 

                                  (Detoxification , Cleansing Procedures, शोधन चिकित्सा)               

                                                             (

                                 (Cluttering the body, Cleansing therapy. Body is cleaned and uncluttered inside.)

Panchkarma 
The seven tissues (dhatus) which constitutes the body decay all the time (therefore body is also called {शरीर }, and receive replenishment through food. Upon digestion food releases two products, both of which are regarded as Prasada dhatu  nutrients (Prasada dhatu) which contribute to the building and repair of seven tissues; Waste products or Maladhatu such as sweat, urine,feces etc.
Panchakarma : Tridosha is treated. 

The proper nutrition  of the body and the elimination of the waste materials keep the body fit. If the waste material is not eliminated on time , it accumulates in the body resulting ultimately in a diseased condition.Therefore, detoxifying  the body assumes great importance.

Introduction

How nature cures

The principle of nature cure is that all diseases of the body are caused by the presence of unwanted toxic substances in the body (toxemia) and simultaneously because of the absence of useful substances in the body (deficiency). Hence the logical treatment of such a condition is to remove the poisonous substances from the body and to supple all the vital substances to it.

Water facilitates the detoxification process. Once the poison have left the body, the appetite for food return, and one starts , accepting food which goes to replenish his body

 and restore his health strength and vigour.

Hence in order to cure disease, one has to remove the toxins and replace the vital substances. This understanding helps us  to assist nature in performing the task effectively and restoring health.

Nature cure is a gentle sure and effective way to heal in most cases but there are occasions when, along with natural means, one require the help of  medications. Medications in such circumstances are necessary only in small doses and for a shorter duration.This means available to us  in nature cure are diverse and all pervading.They are available every where and they are almost free of cost.. Hence nature cure  can be used by anyone at any time.

he means are sunshine, water, air, earth, fire and a host of combinations there off.:

Sunshine

Sunshine provides warmth to the body and triggers the release of its hormones. It is vital for maintenance of good health In nature cure sunbathing has been given a lot of importance in restoring health. The best time for sunbathing is the early part of morning or the later part of evening when the sun's ray are warm but not as harsh as the mid-day sun.

Water

• Water is the best cleansing agents and hence is the most important tool in healing from any sickness. Bathing in water, cold and warm sponges.
• Drinking enough water.
•  Enemas are  a very useful adjunct in internal cleansing. However some precautions are necessary An enema should never be given by an inexperienced person. It may not be given when intestinal obstruction is suspected or if there is a suspicion of an intestinal infection.Enema should not be given in high fever such as seen in typhoid fever. It should never be given with hot water The temperature should be same as room temperature. Forceful introduction of enema tube could cause very serious damage.
• Whirlpool baths, jacuzzis and hipbaths are some of the other uses of water  in nature cure.

Air

Air is of paramount importance in healing. Breathing exercises and physical exercise are good way to optimize our air intake. The ability to breath correctly helps in providing the body with adequate oxygen that is so necessary to heal from disease. Yogic breathing exercises helps to train children to breath correctly and also provide impetus for enhanced lung function. Yoga is an extremely versatile science that could augment the physical, mental and spiritual growth of a child. However these exercises should be done under supervision.

Earth

Earth is used directly in the form of mudpack and indirectly by cultivating it for all our various fruits, vegetables,  nuts, grains sprouts, beans and other foods. 

Fire

Fire is used to create warmth and also helps to cook our food to make  it easier to digest.  All these elements are used alone are in varying combinations to provide the basis for optimum healing.

Evacuation (Cleansing) Procedures / Kriya

Principles of evaluative procedures Panchkarma 

EMESIS (Vaman)

PURGATION (Virechana)

NASAL EVACUATION (Nasya)

It is not difficult to eliminate by emesis and purgation what ever  has collected in the alimentary canal.

1. Oleation  Massage : Abhyanga Full body massage before morning bath keep your skin supple.
2. Sudation therapy (Swedana)
3. Vomiting (Vaman) Mild emesis
4. Purgation : Virechana Therapeutic purgation. Eat Triphala at night to keep colon healthy.
5. Enema (Basti) as treatment for Vayu Dosha. 1 Treatment of choice - Oil Enema (Anuvasan Basti) Enema Lubricants and non lubricant enema it is most important because they enter the colon and strike at the root of Vata which causes wide ranging effects of Vata to wither away.
   This is reminiscent of the destruction of the roots which invariably lead to the atrophy of the whole tree including trunk, branches, leaves, flowers and fruits.
6. Nasya

 Introduction

 Panchakarma: Cleansing therapy.  To eliminate toxins to balance dosas and  keep the body  healthy. As dosas accumulate during seasons at specific intervals. This help to clear the body's channels by the various internal cleansing processes. 

Prior to causing pertubation dosas tend to accululate Caya  in their respective locations. The main seat of dosas is the alimentary canal  ( Koshta ). When vata, pitta and Kapha have their preferred locationsin the upper, middle and lower  part of alimentary cannal.

To a lesser extend dosas also collect in tissues Dhatus, which because of specific fires Dhatvagni  are constantly active and give rise to waste products  (Maladhatu) which turns into disease (dosas) on exceeding limits.

When dosas accumulate they are susceptable to pertubation by numerous factors such as 

1. Dietary
2. Indiscretion
3. Suppression of natural urges and
4. Emotional upheavals

The perturbed dosas from the alimentary cannal enters the body compartments through the openings of countless channels which criss-cross through the body. Pitta and kapha being immobile. Their movement in all directions is activated by perturbed  vata. 

Dosas balance can be restored by the gentle procedures of samana is the purification is mild. When the perturbation is severe and the elimination of dosas essential, Panchkarma alone is effective.

                     "Panchkarma procedures aim to settle the perturbation of dosas and restore their equilibrium."

The best panchkarma therapy for menopause is a  gentle body massage

Shirodhara : Continous  floe of medicated oil, decoction and butter milk on the head., which sooths and calms the brain.

The preparatory steps to loosen and mobilize the dosas from the body channels. It clears the opening of the channels into the alimentary canal and deliver them into its lumen. The preparatory step should be taken only when the dosas are seriously perturbed. Otherwise attempt to mobilize them prematurely say at the stage of accumulation may be as futile as preparing a juice from a raw fruit.

Remove perturbed dosas which had been mobilized by 

1. Lubricant Therapy  (Vicarana)
2. Fomentation  (Swedana) Sudation
3. Remove 

Application of lubricants and steam for unclogging a network of pipes. Th loosen dosas from the body channels return to alimentary canal through openings which also would have been unblocked by the preparation measures.

The elimination of dosas from the head had to be done separately through the nasal route. The return of dosas is aided by their natural tendency to resume habitual locations.

Disease : Disorder of body are the manifestation of perturbation in the equilibrium of body constituents including dosas.  Pertubation involves increase or decrease of dhatus, which are restored to the normal range by administering substances with qualities oppose to those of the relevant dhatus and dosas. This would be hardly possible  in the absence of the homology between the body and administered substance in the times  of their composition.

Concept of evolution:

Collective and undifferentiated entity (avyakta) as a predecessor of bhutas. Evolution of matter sequentially from avyakta. to 5 elements bhutas namely i,e, air,fire,water,earth and sky.

Para is superior

Apara is inferior

Yukti Choice of a appropriate medicine for the disease.

Similar and Dissimilar : This is of supreme importance for food and medicines. With similar quality substance would cause growth or increase of body tissues ,where as those with dis similar qualities would produce decrease or decline in body tissues.

Fomentation /Sweda/ Sweating

"Even a twig, dry and stiff, becomes soft and supple on the judicious application of oil and heat."

Fomentation is a part of settling an imbalance of doshas of moderate severity and an essential prelude to evacuative measures. Even a twig, dry and stiff, becomes soft and supple on the judicious application of oil and heat. How much more than, would be the response of the body? Indeed fomentation preceded by the application of oil, both in proper measure, corrects disorders of vata and kapha and ensures the smooth passage of body fluids. It is done with moderate heat- neither too much nor too little- in a chosen location with appropriate medications. The kind of disease  and the season also weigh on the choice of procedure. As a general rule, vigorous fomentation is suitable for sturdy persons and for disease caused by cold weather.; moderate and mild procedure should be adopted for  person on the  basis of their strength. Fomentation is beneficial when vata or kapha are disturbed singly or in combination but the procedure adopted for each condition would be oily and dry.

When vata and kapha gets lodged in the stomach and large bowel; fomentation should be done  by dry measures for the former and oily one for later. Dry fomentation for vata and wet fomentation for kapha.

Choice of candidate

Fomentation is beneficial for heterogenous conditions affecting any  part of the body. Those include cough and cold. shortness of breath, non-relaxation, pain in ear, neck and head, congested throat, paralysis of one limb, one side or the entire body, constipation, urinary obstruction and dysuria, stiffness in thighs, knees, legs and feet.

Fomentation is not advisable in persons who regularly take medications. of plant extract and alcohol., in pregnant women, or those suffering from  bleeding disorders, diarrhea, diabetes, burns, jaundice, emanciation, and defective vision.

Techniques Of Fomentation

Fomentation should be carried out in a room or chamber in the cellar which has been heated with charcoal fire and  rid of smoke. The subject should be massaged  prior to fomentation and his eyes, cardiac region, testicles, and groin  should be protected with  clean cloth, pieces of dough or lotus flowers.. Fomentation should be stopped when the subject feels relief from pain, stiffness and cold and experiences relaxation and sweating. If overdone, fomentation may produce complications such as fainting, severe thirst, burning sensation or weakness, which should be countered by appropriate measures after discontinuing the procedure.

Fomentation can be applied in several different forms:

Bolus Fomentation (Sankara)/ Podikizhi

A bolus can be made up of rice cooked in milk, wheat, sesamum, blackgram. The material may or may not be covered by cloth during application.

Bed Fomentation (Prastara)

A cloth piece of silk or wool or a layer of leaves of errand and arka are laid on the bed  made of grain husk or rice cooked in milk. After proper massage, the subject lies down or sleeps on bed when Prastara  sweda is applied.

Tube Fomentation (Nadi)

                                                         

Decoction of leaves of Giloy, Eranda are boiled in a pot which let out vapors through a pipe. The pi[e should be bent in two or three places and tapered with the circumference at the subject's end by approximately 1/8th of that  at the pot end.. Vapors coursing through the convoluted channel is tolerated well and does not produce burn. Vapors are taken through pipe

Shower Fomentation (Parisheka)

The patent afflicted by vata disorder is massaged with oily substances,, covered with a cloth and exposed  to a shower of  the warm extracts of vata alleviating roots from pots and pipe like containers with  multiple holes

Tub Fomentation (Avagahana)

                                                     

A chamber or a tub is filled with vata-relieving substances such as tolerably hot milk, oil, ghee or hot water wherein  the subject takes bath.

Chamber Fomentation (Jentaka)

Jentaka is a specially constructed room for administering fomentation. The center of the room a chimney is placed. The wood of medicinal plant Khadira /or asvakarna is burnt inside the chimney until the room becomes hot and is rid of smoke. At this point the subject who has  been massaged with vata alleviating preparations and covered with cloth should enter the chamber and lie down on a platform on either side of chimney alternatively. He should rest on a platform even when sweating or feeling faint, since a premature attempt to get up  would be risky. The subject should feel light as if the body channels are  free from blocks and there is no constipation, stiffness, and pain as he gets up, reaches for the door and leaves the room. After three quarters of an hour, a bath in warm water and meals are in order.

Stone Bed Fomentation (Asmaghana)

A stone slab is heated by fire from  wood which relieves vata disorders. After heating the charcoal is removed and hot water poured over the surface. Thereafter it is covered with a sheet of silk or wool and the patient having been massaged and covered, lies on it for fomentation.

Trench Fomentation (Karsu)

Given limited space, a furrow should be dug below the cot and filled with burn, but not smoking. charcoal. The patient lies comfortably on the cot and undergoes fomentation.

Room Fomentation (Kuti)

A medium size circular room without windows is constructed with thick walls and lined with kushta etc. A cot is kept at the center of the room and covered with sheets of leather, silk or wool. All round, ovens filled with lighted charcoals are placed. The patient lies comfortably on  cot after having been massaged.

Earth Fomentation (Bhu)

This is similar to stone fomentation., but the place where the fomentation is to be considered is larger and windless and the surface smoother.

Jug Fomentation (Kumbhika)

A jar filled with extract of vata relieving plants is placed so  that up to a  third and half  of its hieght is inside the earth. A cot or seat is placed over it  and covered with a sheet. At this stage, heated pieces of stone are put into the jar. The patient who have been massaged with vata relieving oils sit or lies on the seat or cot and undergoes fomentation.

Wall Fomentation (Kupa)

When it is hot, the well massaged patient lies on the covered cot which has been placed over the pit.

Dung Fomentation (Holaka)

The procedure of kupa sweda is followed except that the dung is burnt on the earth, not in a pit. The cot is placed only when the earth becomes hot and smoke less.

Thirteen techniques mentioned so far involves the use of fire. But there are also techniques which do not use fire and yet produce effects similar to those of fermentation. They are Physical exercise and fighting a warm habitation, heavy cloths, and bandaging,, hunger, copious drinks, of hot fluids, fear, anger, and the hot sun. Fomentation  may also be to a part or whole of the body and with or without prior massage with oily substances.

After fomentation, the subject should take aggregable meals and refrain from physical exertion for a day.

5 Processes

5 Evacuative (Cleansing) Procedures / Kriya

Principles of evaluative procedures Panchkarma 

In all the evacuative therapy, given properly gets rid of impurities, relieves illness, enhances strength and complexion and prolongs life.

EMESIS (Vaman)

Best for kapha

Emesis  is another evacuative procedure ; it should always be proceeded by lubrication and fomentation. Sufficient time should have passed for the previous meal to have been digested. He should be seated comfortably and than the drug should be administered. The dose should be adjusted for each patient to eliminate the accumulated doshas. The patients head should be supported and belly pressed at the navel (towards the spine)Meanwhile the physician should instruct the patient to keep his mouth open , bend the neck and upper part of the body slightly..

If that is unproductive the throat should be tickled with two fingers. The physician should inspect the vomitus consisting of drug alone or indication of inadequate treatment. Vomiting without discomfort and spontaneous arrest of bouts are sign of effective therapy. The evacuative response to the treatment may be classified as  mild, medium and excellent. Over dose of emetic preparation is suggested by the appearance of froth, blood and shiny material in the  vomitus. its manifestation include earache, Bodyache, stiffness, salivation, palpitation, vomiting of blood, displacement of viscera ,and exhaustion. After recovery from vomiting, the patient should wash face, hands and feet and recieve the assurance. If strength permits, medicated smoke can be offered to the patient before he takes bath.

Post emesis care

During recovery the patient should lie down on a quiet room free from wind and refrain from loud talk, sitting, standing and walking for long stretches of time. He should avoid travel, emotional excesses, night watch, sleep during the day,, heavy and irregular diet, and suppression of natural urges.. The whole day should be spent quietly in this manner when the patient rest physically and mentally.

The same evening or the next morning he should take a bath in Luke worm water and take his first meal which should be a warm, well cooked gruel of red rice. The second and third meals should remain the same. 4th, 5th and 6th should contain thicker preparation of red rice  with a little salt and lubricant substance. 7th,8th and 9th meal should progress to  well cooked red rice, thin green gram soup flavoured with little salt and lubricant substance which should be followed by a drink of warm water. 10th, 11th and 12th meal with cooked rice and vegetables, meat soup seasoned with salt and should be followed by a drink of warm water. By this time digestion and assimilation which had been disturbed would have recovered and the patient would have no difficulty in resuming his normal diet after seven nights.

The patient should be observed for :  Sweating indicates liquefaction of the accumulated  dosha, and appearance of goose flesh points to its mobilization and movement. 

PURGATION (Virechana)

Best for pitta

Purgation is another evacuative procedure ; it should always be proceeded by lubrication and fomentation. The preliminary conditions such as  digestion of previous meals, comfortable position, cheerfulness, oblation. The patient should than be given the chosen purgative in the appropriate dose and medium. The choice of drug is chosen by patients disorder and strength. The post purgation management is done except smoking to be avoided.

When the patient regains strength and color and feels well and cheerful he should take a bath including the hair, anoint the body. He would than be free to enjoy the company of his friends and relatives.

NASAL EVACUATION (Nasya)

It is not difficult to eliminate by emesis and purgation what ever  has collected in the alimentary canal.

ENEMA (Basti)

1. Non Lubricant (Kashaya Basti)  {Best of all}
2. Lubricant Enema  (Sneha Basti ) 

"Panchkarma mobilizes dosas from the constituents of the body and eliminating them through oral, nasal and anal passages."

Its an active intervention in the treatment of disease.

Sweating out
*.     By exercising 
*       Steam bath
*.       Consuming Cyenne pepper ( red chilly or Lal mirch) can help flush out toxins too. By eating hot Rasam, a hot spicy soup  when cold .



Basti (Enema) (Cleansing procedures) Therapeutic cleansing of the large intestine by medicated enema, basti is used to flush out the loosened doshas through the intestinal tract.

 Detoxification and cleansing therapies : ,Shodhana therapy like Vamana or Virechana.

1. Oleation  Massage : Abhyanga Full body massage before morning bath keep your skin supple.
2. Sudation therapy (Swedana)
3. Vomiting (Vaman) Mild emesis
4. Purgation : Virechana Therapeutic purgation. Eat Triphala at night to keep colon healthy.
5. Enema (Basti) as treatment for Vayu Dosha. 1 Treatment of choice - Oil Enema (Anuvasan Basti) Enema Lubricants and non lubricant enema it is most important because they enter the colon and strike at the root of Vata which causes wide ranging effects of Vata to wither away.
   This is reminiscent of the destruction of the roots which invariably lead to the atrophy of the whole tree including trunk, branches, leaves, flowers and fruits.

Enema  or  Basti : Basti Chikitsa is the prime treatment modality of Ayurveda. It is also considered as Ardha Chikitsa (half treatment). is described as an internal route of drug administration and is considered as one of the methods of Snehana. Hence, whenever patient is not ready for having medicated fats orally, anal route can be considered as an alternative. Patients showed urdhvaga utklesha with symptoms such as nausea, feeling of stickiness in throat, heaviness in head. This shows that effect of Basti is not restricted to ano-rectal region locally. Basti reaches up to duodenum.

patients showed adhoga utklesha with symptoms like feeling heavy in the lower abdomen, sticky motions, and decreased appetite.

Oil Enema Anuvasan Basti : 

Unctuous enema or Anuvasana Basti is the treatment of choice in Vatavyadhi. Ksheerabala Taila is one of the most popular oil preparations in Ayurveda and recognized as a very effective remedy for neurological disorders such as facial paralysis, sciatica, hemiplegia, paraplegia, poliomyelitis and other such conditions. 

 The ingredients of this preparation are Ksheera (Cow's milk), Bala (Sida cordifolia) and Tila Taila (Sesame oil). Ksheerabala Taila is used for the purpose of Anuvasana Basti. S. cordifolia has been reported to possess analgesic, anti-inflammatory as well as hepato-protective activity. Administration of sodium chloride improves fat absorption. Oil enema is administered after having the food

An alternative for Snehapana before Vamana and Virechana: 

Anuvasana Basti with Ksheerabala Taila in Sandhigata Vata (Osteoarthritis) 

Anuvasana Basti of medicated sesame oil with rock salt 

Exclusion criteria

Patients who were suffering from anal diseases (haemorrhoids, fissure, fistula, etc.) 

Standard operative procedure for Anuvasana Basti

 In Panchakarma Center after having a breakfast (around 9.30 am). Warm sesame oil is applied on the abdomen and lumber region and fomentation  done locally. Left lateral position was given to the patient with left leg extended and right leg flexed at knee joint. Especially designed enema pouch with prescribed quantity of processed sesame oil and rock salt was kept in warm water for 15 min to make the contents warm.

Lubricated catheter was inserted inside the anus parallel to the vertebral column. Oil was pushed inside slowly and steadily. Patient is asked to lie on the bed with his legs in an elevated position for 10 min. Patients were advised to drink lukewarm water throughout the day and immediate after administration of oil enema. Feeling of hunger for every patient was observed and accordingly they were advised to have light diet, preferably soup of green gram whenever they felt hungry. Daily assessment was done for symptoms of proper Snehana. The dose of sesame oil was 120 ml with 500 mg rock salt on the 1st day. Sesame oil was increased by 25 ml and rock salt by 100 mg/day.

Processed sesame oil along with rock salt was selected for oil enema. Sesame oil is Snigdha (unctuous) and guru (heavy). Hence it can be used as a sneha, a substance that oleates body. Rock salt helps sesame oil to enter into subtle channels. Even though, Basti is a rectal route of drug administration; it is considered as an internal route of drug administration

Effect

Oiliness of skin was increased  patients after administrating oil enema in escalating dose for 5-7 days. Oil enema administered into the rectum performs significant results up to head to toe in the human body. Potency (Veerya ) of  enema (Basti) spreads all over the body even though it is administered in rectum.  On the 4th day Enema Basti reaches up to plasma level (Rasa dhatu) and on 5th day upto muscle level (Mamsa dhatu). It indicates that oil (sneha) can reach up to skin within 5 days as the skin is suborgan (upadhatu) of muscle (Mamsa) and  site of manifestation (vyadhithana)   of  plasma (Rasa)

Snehpana

Oral administration of medicated fats (oil or ghee) is termed as Snehapana.  It is an essential step before Vamana (therapeutic emesis) and Virechana (therapeutic purgation).

Patients have a major problem in terms of quantity, taste, smell and oiliness of medicated fat. 

Snehapana is given on an empty stomach and the digestion takes place according to the jatharagni,

In the process of Snehapana, after a certain period, stool becomes oily due to saturation of sneha in body.

Jala Neti

Jal Neti

                                               


Nasal cleaning : 
Jala neti is beneficial for upper respiratory health. It would well become a part of one’s daily morning routine. 
The Sanskrit word, Jala, means “water”. The original meaning of neti is “to guide”. It has also come to mean “nasal cleansing”. Therefore, Jala neti means guiding water through the nasal passages to cleanse them.Jala neti is a traditional Ayurvedic and Yogic practice that clears the nose and sinus passages through nasal irrigation. Sea salt is dissolved into warm, pure water in a Neti pot, a tool specifically designed for this purpose. The head is tilted forward and to the side and the solution is poured into one nostril and allowed to pour out the other, thereby clearing the nasal passages and sinuses of excess mucous, toxins and debris along the way. Neti allows for fuller, freer breathing, which increases the amount of prana, or vital life energy, that we absorb. 

Kunjal