Panchakarma literally means "five therapies". These five therapeutic means of eliminating toxins from the body are Vaman (emesis), Virechan (purgation), Nasya(nasal insufflation), Basti (enema) and Raktamoskshana (blood-letting by using leech and different instruments). This fivefold therapy is aimed at Shodhana i.e., the eradication of the basic cause of disease and later to achieve Shamana which means the mitigation of the disease and its symptoms.
Panchakarma is essentially applicable to all cases covering a wide range of preventive, curative and promotive conditions. Panchakarma is advocated in a healthy person to combat seasonal imbalance of tridosha. Ayurveda describes that the disorders treated with this mode of therapy do not recur while those treated with other palliative methods might re-appear. These measures are preceded by oleation therapy (snehana) and sudation therapy (svedana) and are followed by special diet recommendations (samsarjana karma).
Emesis has been claimed as the best treatment for diseases of Kapha, purgation for diseases of pitta and enema for diseases of vata. Classically panchakarma therapy is prescribed and practiced through following schedule viz., (1) Preparatory measures orpurva karma, (2) The principal measures or pradhana karma (3) Post therapy measures of paschat karma.
Purvakarma (preparatory measures)
Before the administration of panchakarma therapy, the patient is prepared suitably with the administration of fat (oils and clarified butter) i.e. snehana or oleation therapy and sweating measures i.e. Swedana or sudation therapy as preparatory measures.Panchakarma therapy should not be undertaken without purva karma otherwise it fails to eliminate the dosha situated in the tissues. The administration of fat therapy renders the body soft and disintegrates the accumulated dosha and sweating therapy melts thedosha stagnated in the subtle channels of circulation. At this stage administration of panchakarma measures eliminates the dosha out of the body easily and effectively through respective pathways.
ii Snehana-Administrationof preparations containing fat to a patient for a limited period to get the desired clinical effect is called Snehana (Oleation). Fat influences abnormalvata, renders the body soft and clears the accumulated wastes which have obstructed the body channels. Further the regular use of fats has been considered beneficial for the proper digestion, cleansing of the bowel, the promotion of body strength and integrity of senses and the prevention of aging in the aged besides several other beneficial effects of oleation. Fat preparations can be administered through different kinds of foods, as enema, massage etc. according to the feasibility. The fats may be used singly or may be mixed with other drugs. Fat may be administered before, during or after food according to the disease.
iii Swedana-Making a person to sweat, with or without heat, is called Swedana(Sudation). Generally the sudation therapy should be undertaken after the oleation therapy. It is considered that the sweating therapy melts the waste products of metabolism, stagnated in the subtle channels of circulation which have been disintegrated by the fat therapy51. Two types of measures are employed for sweating, (1) using external heat (Sagni sweda) and (2) Without direct application of heat (Niragni sweda) by using practices like indulgence in strenuous physical labour, staying in a closed room, covering oneself with thick clothes, hunger, administration of different kinds of alcoholic beverages, by covering the body with leather, wrestling and walking in the sun and other measures which may generate heat and sweating52. Care should be taken while performing swedana of certain parts of the body such as groin, eyes, testes and precardial region.
iv Pradhana Karma (Main procedures)
After preparing the patient with snehana (oleation) and swedana (sudation) the patient is subjected to the main measures of panchakarma - Vaman (emesis), Virechan(purgation), Nasya (nasal insufflation), Basti (enema) and Raktamoskshana (blood-letting by using leech and different instruments).
v Vamana (Emesis therapy)-Vamana is the procedure of eliminating waste products of the body through the upper passage by vomiting. Emesis is the therapy of choice in diseases of kapha dosha. It is specially indicated in the fever of recent origin, cough, cold, bronchial asthma, elephantiasis, diabetes, bleeding through lower channels, nausea, diarrhoea, loss of appetite, poisoning, stomatitis, anemia, mental diseases, epilepsy, erysipelas, lymphadenopathy etc. Emesis therapy is contraindicated in the patients if they are child, very old, debilitated and hungry and also in trauma of lungs, sprue, bleeding or upper channels, anuria, enlargement of spleen, abdominal tumours and abdominal diseases etc. A subjective feeling of cleanliness of the heart, chest, head etc., lightness in the body, timely passing of urine stool etc. are the features of well administered emesis therapy.
vi Virechana (Purgation therapy)-Virechana or purgation therapy is a systemic therapy for the diseases of pitta dosha. Purgation therapy is indicated in diseases of skin, fever, diabetes, bleeding of upper channels like mouth, nose etc., diseases of gastrointestinal tract, piles, abdominal tumour, enlargement of spleen, anuria, helmenthiasis, erysipelas, gout, vaginal diseases, fistula-in-ano, tumour, glandular swelling, anemia, jaundice, loss of appetite etc. It is contraindicated in children and old patients and also in diseases like bleeding of lower channels, pregnancy, fever of recent origin, indigestion, lymphadenitis, weakness, debility, diarrhea etc. Feeling of cleanliness in the channels and sense organs, lightness in the body and increase of appetite etc. are the symptoms of well administered Virechana karma.
vii Basti (Enema)-Medication administered by the enema to get desired therapeutic effects is known as basti (enema) therapy. According to the Ayurveda vata is the main morbid factor in the causation of disease pertaining to tissue and organs in the body andbasti (enemata) therapy is the best treatment of excessive excited vata, therefore, bastikarma is considered half the treatment of all the diseases described in Ayurveda. This therapy is also very useful as a health promoting measure. It is beneficial for old as well as for the young and there are no notable hazards in this therapy. It cures all kinds of diseases due to its varied pharmacodynamics and various kinds of drugs used in its preparations. Enemata therapy is of two types viz. Oily enema (Anuvasana basti) and Decoction enema (Niruha basti).
viii Nasya (Nasal insufflation)-Nasya is a process by which drug is administered through the nostrils. It is useful in all the diseases manifesting above the neck (urdhwajatru gata) because it eliminates toxins through the nostril. On the basis of its therapeutic action and the way of administration it is classified in to many types likevirechana nasya (cleansing nasya) , brumhana nasya (nutritive) shamana nasya(pecifying) , navana nasya (decoction nasya) marsha nasya (ghee or oil), pratimarshya(daily oil nasya) etc.
ix Raktamoskshana (Blood-letting)-Rakta Mokshana or blood letting is one of thepanchakarma developed by Susrutha as a specialized technique. Here a small amount of venous blood is extracted by using either sharp instrument or specialised equipment or leech. It is helpful in relieving diseases of pitta origin, blood born and chronic skin diseases.
Paschata Karma (Post Panchkarma Procedure Management):
The procedures like internal intake of sneha in high dosage followed by the purificatory therapy is definitely going to create some sort of impairment in function of digestive power temporarily. So, immediately the subject is not allowed to come back to his normal diet patter. In order to bring back the agni (digestive fire) to normal state some specific diet patterns are followed after the main procedure. This is known as Sansarjan krama; in which initially easily digestible liquid dominant diet is given with gradual introduction of salt, pepper, mustard, oil etc.
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