In Ayurveda treatment consists of four basic forms, namely - medicine or drug therapy, pancha (five) karma (actions/ systems), dietary regime and regulation of lifestyle. And works in two fundamental ways - cure and prevention.
The preventive aspect of treatment is further subdivided into swastha varta (personal hygiene) - consisting of dinacharya (daily routine), ritucharya (seasonal corrections) and sadachara (appropriate behaviour) - rasayana & vajikarana (rejuvenation & virlification) and yoga. The curative aspect consists of three parts antati parimaijana (internal medicine) - consisting of samsodhana (internal purification through panchkarma) and samsamana (curative action) - external medicine as massage, use of pastes & powders and finally surgical treatment.
The deep cleansing process, unique to Ayurveda, that enables the body to release excess doshas and toxins from its cells and expel them is called Panchakarma, which basically denotes detoxification or elimination of toxins from the body. Although the human body is considered as a great, intelligent, natural healing system capable of rejuvenating itself, the formation of toxins reduces that natural capacity. It is then that Panchakarma plays a crucial role in that correction
Ayurveda says that to restore health we must understand the exact quality, nature and structure of disease, disorder, or imbalance. The body has its own intelligence to create balance. and we are helping in that process. There are four main classifications of management of disease in Ayurveda: shodan, or cleansing; shaman or palliation; rasayana, or rejuvenation; and satvajaya, or mental hygiene.
The purpose of shodan, is to remove excess doshas and ama from the body. Shodan includes purvakarma (initial procedures) pradhanakarma (the main procedures) and pashchatkarma (post-operative procedures). Purvakarma procedures move the aggravated doshas and ama from sites deeper in the body to locations in preparation for elimination. Panchakarma (five actions), which belongs to pradhanakarma, then removes these doshas and ama. It includes vaman (vomiting), virechan (purgation), basti (medicinal enema), rakta-moksha (blood cleansing) and nasya (nasal insufflation, administration).
Vaman is vomiting therapy for removing excess kapha impurities out of the body. Virechan is for removing pitta by giving purgation therapy. Basti is to remove excess vata from the body by enema therapy. Nasya is administration of certain herbal powders, medicated oils and medicated concoctions, and ghee into the nose for purification of prana, mind and consciousness. Rakta-moksha includes blood letting by application of leaches or removing blood or donating blood to the blood bank, and using certain cleansing and blood thinning herbs.
Ayurveda says toxins are produced when the aggravated dosha, vata-pitta-kapha, effects the biological fire, agni, which in turn effects digestion, metabolism and assimilation. So undigested, un- absorbed, unassimilated food products remain in the body as a morbid substance. Ama, then, is a toxic, morbid, raw, undigested, unabsorbed, unassimilated, non-homogeneous, sticky substance in the body that adheres to the tissues, clogs the channels and creates toxicity in the body. It enters the blood and creates toxemia, which is a root cause of disease. The root cause of ama is the aggravated dosha attacking agni (fire) and producing low digestion and metabolism. So Ayurveda says that one should remove these aggravated doshas by panchakarma.
According to Ayurveda shaman, is the balancing and pacification of bodily doshas (as opposed to elimination). Shaman consists of Deepana, Pachana, Kshudha, Trishna Vyayama, Marutha .Atapasevana and pranayama.
The first method in shaman is dipan, kindling the fire. Kindling the bodily fire is absolutely necessary in kapha and vata disorders, where the person has low gastric fire. Pachan, burning the toxins is done with certain herbs in certain proportions, because kindling the gastric fire is necessary to improve the digestive capacity. Ksud-nigraha is fasting, or eating a mono-diet. In acute fever, acute indigestion, acute dysentery and diarrhea, Ayurveda suggests fasting. A person may only eat cooked apple with ghee or basmati rice with mung dal and ghee, or just yogurt and rice, and in small quantity. But in acute fever, acute diarrhea and dysentery it is better not to eat anything for a couple of days, so that the bodily fire will kindle and burn the internal toxins. For this, observing a fast is very important.
Trut-nigraha, observing thirst (not drinking water) is very important when water disorders take place, kapha disorders. The next important shaman is vyayam, exercise, yoga stretching. Exercise is defined here as stretching of the muscles in a particular direction with a goal so that you can reach the goal with effort and in that effort you are creating physical stress. Physical stress kindles the fire, like hiking in the mountains, walking, jogging and jumping.
Ayurveda says exercise has such a quality that it improves circulation, accelerates the heart rate, enhances the combustion of calories and also stimulates metabolism, regulates body temperature and maintains body weight. Exercise makes your senses alert and attentive and your mind becomes very sharp and develops keen perception. These qualities of exercise are very important, but again, exercise varies from person to person.
Atap-seva, lying in the sun, is another ancient shaman. The sun is the source of heat and light. The sun is the source of higher consciousness. Pitta predominant people can lie in the sun and apply certain oils (sun blockers) so that they will reduce their exposure. The pitta person should not lie in the sun more than half an hour. The vata person can lie in the sun for about an hour. The kapha person can lie in the sun for more than an hour. If the proper care is taken, lying in the sun and meditating upon the solar plexus, is a wonderful shaman for kapha and vata. It improves circulation, the absorption of vitamin D, and strengthens the bones.
Lastly, there is breathing. Respiration is partly conscious and partly unconscious. One should do proper breathing through both nostrils by doing alternate nostril pranayama. There are different types of pranayama, the breathing exercise, and there is a totally different science of breath one can study from an experienced teacher. But if you sit quietly, inhale deeply through one nostril, hold the breath into the lower abdomen, and slowly exhale through the opposite nostril, repeating alternately, this kind of pranayama helps to bring balance to prana, apana and udana (subtypes of prana). Out of that balance, one can attain the highest state of tranquility.
Shaman as a whole does bring balance between the body, mind and consciousness and balance to the three bodily humors, vata-pitta-kapha. It cleanses the physical body, subtle body and causal body. According to Ayurveda, every soul is immortal, every soul is sacred, and to understand the individual, to understand oneself, is the foundation of life. Without this self knowing, life has no meaning. So by understanding the basic principals of life, by understanding one's own constitution as explained in the Ayurvedic literature, and by understanding the exact nature and structure of doshic aggravation, one can follow the proper guidelines of shodan, cleansing, and shaman, palliation and pacification.
INTRODUCTION
‘Panchakarma’, as the name indicates is a method of treatment, which includes five (Paanch) basic procedures (Karma). Through these different procedures are put under the umbrella term ‘Panchakarma” different medicines are used for the different procedures depending upon the constitution of the patient. The physician determines the kind of procedure and the types of medicines to be used after examining the patient. It is not necessary that a patient should undergo all the five procedures of treatment used in Panchakarma. Panchakarma should not be administered to those below seven years and those above 80 years. If it is done properly healing of the disease treated, along with clear intelligence, alertness of the senses, stability of the body, efficacy of digestion and absorption, prolongation of youth are all achieved
Panchakarma consists of medicated emesis ( vamana) to remove excess kapha, therapeutic purgation ( viracana) to clear excess pitta, medicated enema ( vasti) to eject excess vata, nasal drops or snuffs ( nasya) for diseases of the head & neck and bloodletting ( raktamokshana) in case of blood disorders. Five purification procedures for removing accumulated toxins and other waste material in the body. As the humors and tissues are related closely to each other, this discharge procedure affects the tissues indirectly by the strong elimination of related humor. For example, the pronounced elimination of kapha by herb induced emesis causes an effect on the nutrient tissue fluid pool, containing water and electrolytes, plasma, muscle, fat. Or the large release of pitta by selective purgation similarly causes an indirect effect on the total colouring material in the body or blood. Vasti is somewhat different, as it is meant to nullify excess vata and contains warm oleation substances. During its long contact with the membrane of the large intestine, it separates layers of faecal matter and thus enhances better absorption, which is responsible for the ultimate nourishment of all tissues. Nasya in turn cleans the sinus and thereby improves the function of sense organs.
Physical and mental diseases occur due to the vitation of somatic doshas vata, pitta and kapha and due to mental doshas Rajas and Tamas. Volitional transgression, effect of time and senses are the three primary causes responsible for vitation of biological and mental doshas. Food, drinks & environmental factors with similar properties to the doshas vitiates them and cause disease. Panchakarma's purificatory therapies balance out the three doshas, acting both as a curative and a preventive measure.
The Three Stages
Poorva (pre) Karma - These important preparatory procedures have two parts
Oelation ( snehana) Therapy
Fomentation ( swedana) Therapy
Pradhan (main) Karma - Consists of the five essential purificatory therapies, namely.
Paschat (post) Karma - Crucial follow-up therapies that include diet, medication & lifestyle.
Snehana -Oelation Therapy
Involves saturation of the body with herbal & medicated oil via external & internal oelation to make it soft and disintegrate the doshas. Takes between three to seven days to take effect.
The medium used is of 4 types - vegetable oils (for external oelation), animal fat & fats from bones (for internal oelation) and clarified butter (for internal oelation).
Caution should be exercised in ensuring that oil used matches need of the patient.
The most commonly employed pre-procedure, it means `the dripping of oil like a thread (dhara) on the head (shiro). This treatment drips warm oil in a steady stream on the forehead, particularly on the brow and in the region between the eyes. It is often added to the panchakarma regimen because it pacifies vata and calms the central system. It cleans both the mind and the senses which allows the body's natural healing mechanisms to release stress from the nervous systems. This in turn, improves mental clarity and comprehension. Usually given for twenty minutes, three to four times during a seven day treatment period, it uses oils made with special herbs (Mahanarayan Oil, Mahamash Oil etc.) that calm and nourish the nervous system. The technician administers the oil in a thin stream which flows from a copper vessel hung approximately 6-8 inches above the patient's forehead.
Swedana -Fomentation Therapy
Fomentation, or sweating, necessarily follows oleation. Induced by heat from different sources it brings sweat on the skin through hair follicles by opening the pores of the skin. Due to fomentation the agni is increased and the fatty tissue gets mobilised. While throwing out waste as ama (toxins) through the skin it also helps liquify aggravated doshas, dilating all body channels for the cleansing.
It is divided into two main types, Agni Sweda wherein heat is applied directly as steam and Anagni Sweda where no external heat source is necessary e.g exercises, fighting, walking, lifting heavy loads, exposure to sunlight, stay in centrally heated rooms, putting heavy blankets over the body etc.
Charaka has described about thirteen types of fomentation of which some are in practice now.
Upanaha Sweda - fomentation by poultice
Ushma Sweda - steam fomentation
Nadi Sweda - local steam fomentation (steam/vapour of medicated decoction of leaves)
Avagah Sweda - tub bath in warm decoction of medicated water.
Pizichili - pouring of oil on the body.
After this therapy patients are advised to go for rest, avoid cold, take warm baths and get adequate fresh air. Nasal therapy, enema or bloodletting can be undertaken immediately after fomentation. Purgation should be done only after two days of fomentation. However, care should be taken to ensure that no part of the treatment is missed out on as that would not only reduce efficacy but may even prove detrimental.
Once the body has been correctly and suitably prepared, under supervision of a qualified doctor only should the administering of Panchakarma happen. It is best to depend on a reputed Ayurvedic nursing home and experienced Ayurvedic doctors.
Vamana -Emesis Therapy
This is really effective for nasal disorders, tuberculosis, bronchitis, asthma, diabetes, poor digestion, anorexia, dyspepsia, inflammation of lymph glands, epilepsy, insanity, edema, obesity, heart diseases and pangeutis.
Since kapha resides in the upper part of the body, its elimination by the nearest route is an acceptable and desirable, given that if any dosha is eliminated from its chief site the chances of recurrence are very low. Honey and rock salt are the common vehicles to administer the puking.
Proper therapy brings about a feeling of cleanliness of the chest and stomach, lightness of the body and ensures timely passing of urine and stool. But care must be taken to avoid over-administration as it could result in unconsciousness, blood vomiting, sudden drop of blood pressure and chest pain. While any under-administration would result in not achieving the desired effect.
Virechana -Purgation Therapy
Aims to eliminate those doshas that cannot be removed by emesis or through other channels as kidneys, lungs and sweat glands. It is highly effective in cases of fever, skin diseases, bleeding from the mouth & nose, piles, worms, gout, vaginal diseases, anal problems, fistulas, anemia, glandular swellings and loss of appetite.
A systematic therapy for the elimination of pitta and pitta- kappha performed through the anus using mediums as laxatives, mild purgatives and strong purgatives, it must be practiced only after Poorva Karma. However, it is not suitable for children, the old, the infirm and pregnant woman. And strictly avoided under conditions of bleeding of the lower channels, weaknesses or diarrhoea.
Basti -Enema Therapy
Considered the best treatment for a deranged vata, it purifies and rejuvenates the colon that then nourishes the entire body and helps to gain control of the disease process before it goes into a migratory phase. Classified into Oily Enema, Decoction Enema, and Enema therapies, it is administered through the anal passage or vagina.
Because vata is the force behind retention or elimination of all items, its imbalance is the root cause of diseases related to tissues and organs of the body. This therapy thus proves effective for nearly all types of ailments discussed in Ayurveda. Helping rejuvenate the body and providing strength and long life.
Vasti is essentially of two types : Nirooha that cleanses toxins from the dhatus and removes naturally accumulated malas (body waste) from the colon, and Anuwasana that which is meant to be retained in the body for a longer period of time in order to have its intended effect.
But it cannot be applied in case of particular skin diseases, obese patients, problems of the gastro-intestinal tracts, loss of appetite, enlargement of liver & spleen, thirst, dyspnea, edema and in states of grief and shock.
Nasya - Nasal Administration
Making use of medicated oils taken through the nostrils, it is used to assist emesis therapy in dislodging toxins and excess kapha from the throat, nose, sinus & other organs. It is effective for diseases in the head, ears, nose, throat, teeth and improving connections between the senses & respective organs. Although it is not suitable for patients suffering from indigestion, thirst, hunger, grief or pregnancy. And in excess it may lead to an excessive discharge from the nose and eyes, heaviness of the body, abnormal functioning of the sense organs.
Raktha mokshana -Bloodletting
Toxins absorbed into the bloodstream through the gastro-intestinal tract get circulated throughout the body, manifesting under the skin or in the joint-spaces making rooms for disease. Their elimination and purification of the blood then becomes necessary. Thus his therapy is very good in case of all imbalance of blood and pitta disorders as stubborn skin diseases, tumours, gout, excessive drowsiness, alopecia, hallucinations and enlarged liver & spleen.
A sharp scalpel is usually used to make superficial, parallel or vertical incisions with extreme care after a soothing and antiseptic paste has been applied to the location. The amount of blood let out should not be more than 350ml. At such times a needle should be used to puncture a vein. It is however not to be used for people suffering from general swelling of limbs, debility, severe anemia, piles, fever, thirst, alcoholism.
The real objective of Panchakarma is to eliminate the cause of disease, since in itself the absence of symptoms does not always indicate a complete cure. Symptoms can often be quickly eliminated. But cure usually takes more time. Since it is based on the individual constitution, it is obvious that in very chronic diseases there may be more sittings required to eliminate the toxins from the body.