The Ayurvedic path for detoxification and Healing
It is an interesting fact to realize, a few elements of Panchakarma were prevalent during the Vedic period itself though the word Panchakarma appears only in Ayurvedic literature. Panchakarma as a comprehensive system of therapy took shape in Charakasamhita (Ayurvedic Classical Text 900-600 BCE ) period.
As a living tradition, Panchakarma is widely practiced in Kerala.
Till recently, in Western Bio-medicine there was practice of medicated enemas for conditions like arthritis, asthma described in the form of high rectal or low rectal enema. Even recent pharmacological books had explanations on how these get absorbed into the body through lymphatic or systemic circulation and their effects.
If these methods are widely described in various traditions, one wonders what is exceptional about Panchakarma. Panchakarma has a systematic approach that includes pre-Panchakarma techniques, a sequential approach of five methods and post Panchakarma procedures. There are clear description about indications/ contra indications of Panchakarma in patients.
Adaptive variations has to be followed in panchakarma, based on the strength of the patient, seasons etc. In the context of vasti (herbal enema), it is mentioned “Etat chikitsardham iti pratishtha….“ which means that vasti is considered “half of treatment” in Ayurveda.
In Ayurveda, body is made of 7 different levels of tissues called dhatu, based on the functional aspect. These dhatu are nourished through food materials that get transformed by action of bio-digestive fire (Agni). The nutritive elements are then carried to different dhatu through Srotas (body channels). At each tissue level, there is an Agni that reintegrates nutritive elements to transform to the respective dhatu.
As a by-product of this process, Mala (waste materials) are formed which are eventually eliminated. Because of different intrinsic or extrinsic reasons there can be errors in the process of digestion, absorption and transportation. This may create unnatural molecules which is a burden for the homeostasis of the body (Ama). Ama blocks the different Chanels in the body, which are nourishing and maintaining healthy functions of the Doshas and dhatu. Origin of disease are because of these.
During Panchakarma, these are expelled through natural orifices. As it is a mechanism to eliminate the waste materials from the body, Pancharkarma is not only used as curative treatment but also as preventive and promotive.
Astanga Samgraha, one of the classical texts, says that Panchakarma has to be applied to remove the waste materials accumulated in the body in different seasons for preventing diseases caused by seasonal changes. It is mentioned that waste materials accumulated in the body during winter would be eliminated in spring, those accumulated in summer should be eliminated in rainy season and that accumulated in rainy season should be cleared in autumn.
Ama refers to the material that is a drop out of body’s metabolic process i.e. the undigested materials which interfere with the health of the biological system. Panchakarma activates body’s natural processes and eliminates Mala (waste) from the body. An interesting fact about Panchakarma is, it uses body’s natural routes of elimination. We do induce/ improvise the route by administrating using suitable fat/ oil preparations which protects the system.
A BRIEF INTRODUCTION TO PANCHAKARMA
The objective of Ayurveda is “Svasthasya svasthya rakshanam athurasya vikaraprasamanam“
which means to protect the health of the healthy and to relieve the suffering of the sufferer. To achieve this objective, Ayurveda advises different methods of treatment. One of the classifications is as follows.
Treatment
Here are two types of treatment (upakrama) mentioned in Ayurveda – These are also known as
Santharpana or Brimhana (nourinshing) and
Apatharpana or Langhana (depleting ) respectively.
Langhana or Apatharpana (depleting) is divided into further two categories.
They are Sodhana (elimination) and Samana (pacifying).
Sodhana is the elimination of waste materials accumulated in the body through a series of treatment processes and samana is pacifying of the condition. Sodhana is done when there is excessive accumulation of waste materials where as, Samana is done when there is less waste materials. In today’s Ayurvedic treatment most of the practices like internal use of herbal medicines or therapies and steam baths fall into the category of samana.
1) Vamana (emesis)
2) Virechana (purgation)
3) Vasti (enema)
4) Nasya (nasal medication)
5) Rakta Moksha (blood letting)
WHAT IS PANCHAKARMA?
Panchakarma literally means five actions or techniques. They are vamana (induced vomiting/emesis) virechana (purgation), kashaya vasti and sneha vasti (two kinds of medicated enemas with decoction and unctuous material), nasya (nasal medication) and raktamoksha (blood letting).
According to Charaka samhita, one of the earliest writings on Ayurveda, if a disease is treated with sodhana, it does not recur. Thus Panchakarma becomes an important part of Ayurvedic treatment modality.
Panchakarma is commonly used in treating broad categories of conditions – arthritic, rheumatic, neurological, neuromuscular, musculoskeletal disorders, other degenerative conditions, mental disorders, insomnia, depression, menstrual irregularities, infertility, obesity, asthma and other respiratory conditions, irritable bowel syndrome, gastro-intestinal conditions, other chronic conditions, etc. Thus Panchakarma has preventive, curative and promotive functions.
In Ayurveda, there are three methods of treatment. They are 1. Against cause, 2. Against disease, 3. Both the above). Panchakarma includes all the three types of treatments.
TECHNIQUES IN PANCHAKARMA
1. Preparatory techniques
2. Major techniques
3. Post Panchakarma regimen
Preparatory Pancharkarma Techniques
Preparatory Techniques
After doing a detailed examination of the patient through the different diagnostic methods, a physician decides whether patient should undergo a samana (pacifying) therapy of sodhana (purificatory) therapy. It has to be noted, a positive digestive fire, a good digestion has to be achieved before doing a panchakarma. It may need time to take the patient at this level using proper herbal medication and diet. Before starting Panchakarma one has to undergo two types of preparatory treatments. This consists of snehana (Oleation) and svedana (sudation). Oleation helps in making the blocks (created by the metabolic waste materials in the body channels) slimy and non-cohesive. After making them unctuous, svedana (fomentation) is done to bring all these waste materials into the Koshta i.e. the open spaces in the body and expelled through Panchakarma.
Panchakarma-Main Techniques
A. Vamana (emesis)
Emesis is usually given for kapha type of disorders. After sneha, sveda, if the patient has a good digestion and a pleasant sleep, the patient is made to consume specific types of gruel, milk, fish, curds etc. Next morning the patient is given a paste of emetic drugs followed by intake of an emetic decoction. It is mentioned that it should be done on an auspicious day after chanting certain mantras. After around 48 minutes, the person starts getting bouts of vomiting. If the bouts are insufficient, consuming lukewarm emetic decoction should induce it. The spells of vomiting and the quantity differ according to the dose of medicine consumed. Generally four, six, eight spells are considered good in minimum, medium and maximum types of emesis.
After vamana, certain inhalation is given with medicated smoke. Complete rest is taken on that day, and in the evening the patient is given thin gruel.
What the restrictions in the diet and routine, management of complications, effects of good vomiting, what drugs to be used in each stage are few other topics detailed in the classical texts.
Vamana is good for all kapha disorders. It helps in improving sleep and reducing excessive sleep; it is useful in treating mental disorders, asthma, epilepsy, skin diseases, anaemic conditions, migraine, kapha type of heart conditions, tumors of the neck, poisoning, infertility and minor conditions like pimples etc.
B. Virechana (purgation)
Purgation is mainly done for pitta type of conditions. It also takes care of the kapha, which is located in the place of pitta. In the Panchakarma procedure, virechana is done after vamana. In this case again snehana and sveda have to be done. Virechana medication is given in the morning. The materials, dosage etc are decided based on the condition, strength, digestive capacity and bowel habits of the patient, dosa involvement and season.
Small quantity of warm water can be consumed till one gets complete evacuation. It could also prevent dehydration. Optimal measure has to be taken to avoid complications such as dehydration.
*Clarity of intellect, strengthens the senses, stability of body tissues , increased digestive capacity, regulated aging are the effects of purification therapy (if done properly)
C. Vasti (medicated enema)
Medicated enema is highly effective in vata type of disorders. It is also applied in other dosa disorders as well. Vasti is considered as half of the treatment in Ayurveda. There are two types of medicated enema. They are done with decoction (kashaya) and unctuous materials (sneha) like oil, ghee etc. Generally kashayavasti is done before food and sneha vasti after food.
Usually kashaya vasti is done after virechana. Initially a few sneha vastis are done to make the large intestine unctuous. Diet and routine restrictions have to be followed.
Uthara vasti is another major technique, which is applied through penis, vagina, or urinary tract. This is effective in reproductive problems, urinary disorders including calculi, uterine, disorders like bleeding, endometriosis, fibroid, vaginal disorders, infertility and delicate pregnancy (with chances of miscarriage)
i) Anuvasana vasti (unctuous enema)
Anuvasana is either given independently or along with kashaya vasti. Thus this has both rejuvenative or nourishing and purificatory effect on the body. As the quantity is relatively less this is given with syringe. Normal motion along with oil would occur after few minutes. Anuvasana makes the naval region unctuous; it facilitates downward movement of vayu, strengthens the body, and nourishes body tissues. Matra vasti is given in smaller dose. For this purpose generally other purificatory techniques are not done.
ii) Kashaya vasti (decoction enema)
Specially prepared decoctions are used for this purpose. The quantity given is one litre or more. Specially prepared instrument is used for administration of vasti. The main purpose of kashaya vasti is purification. It is also given as nourishing or for preventive purposes. The dosage, formulation etc are decided based on the purposes for which it is given.
D. Nasya (nasal medication)
Nasya is applied in kapha disorders. This is very effective in disorders above shoulders. It is applied in unconsciousness, headache, hemiplegia, other neurological disorders etc. Pratimarsa is done in a small dose as a daily routine for healthy people, elderly and children. Nasya can be done either by oil/ghee, juice, decoction, paste or powder. Nasya is given in the morning for kapha disorders, during the noon for pitta disorders and in the evening for vata disorders.
Jalooka is used for persons who are weak, young, old and those who cannot tolerate other methods of bloodletting. As leeches have cooling nature these are used in pitta type of disorders. They are commonly used in abdominal swellings, piles, inflammatory abscess, skin diseases, arthritic conditions, eye diseases, poisonous bites, erysipelas etc. There are 12 species of leeches used in Ayurveda and are classified into poisonous and non-poisonous types. Six out of twelve are poisonous and the others are non-poisonous. If poisonous leeches are used for blood letting then complications like itching, inflammation, fever and unconsciousness happen.
The poisonous leeches grow in dead matter, urine, faecal matter of poisonous fishes, frogs, insects, in putrid water etc. The non-poisonous ones originate from the dead matter of lotus, lily, white lily, fragrant white lotus, moss, etc. The non-poisonous leeches are best if collected from yavana (Greece/north west India/Junagad), pandya (Tirunelveli, Madurai districts of Tamilnadu), sahya (northern parts of Western Ghats and poutana (Paithan on the north bank of Godavari) regions. These have good strength and are fast acting.
A few interesting facts about leeches:
Length of the body ranges upto 20cm and has 34 segments. The digestive system contains a pouch in which food can be stored for several months. They have two suckers. One on the anterior and the other on the posterior end. The saliva of the leech contains a substance that anaesthetizes the wound area, dilates the blood vessels to increase blood flow and prevent the blood from clotting. The anticoagulam Hirudin is used for medicinal purpose.
Srunga, alabu, and ghatika
This is a method of extraction of blood through cupping. Materials like horn (srnga), fruit of a plant (alabu Cucumis lagenarius), or a special type of pot (ghatika) are used. An incision is made on the part where bloodletting is to be done and over that cupping is done by creating a vacuum by burning some material inside the instrument.
Yogya (suitable)
Those who are below 16 years old or above seventy, have had bleeding, those who have not undergone sneha and sveda, excessive sveda affected persons, patients suffering from vata condition, women who are pregnant or just delivered, those who have indigestion or diarrhoea, bleeding disorders, breathing disorders, ascitis, vomiting, anasarca or immediately after vamana etc.
Some scholars do not include raktamoska in Panchakarma. A reason mentioned is that Panchakarma is a technique that helps the body to eliminate the materials through its natural orifices in the form of faecal matters, sweat, breath, phlegm, urine etc. Whereas there is no natural way in which blood can come out of the body, bloodletting is not included in this. Apart from this, there are socio – cultural factors that have also influenced this. Bloodletting or other surgical interventions were considered a taboo and unclean during some period in the history when the concept of ahimsa was prevalent. Another reason was that the rakta was not included a dosa. Even then raktamoksha was appreciated by many classical authors describing it as one of the best techniques for rakta vikara (blood disorders).
Paschatkarma (Post Panchakarma Regimen)
Post Panchakarma regimen is very important for getting the maximum benefits. After purification, giving suitable materials like rasayanas nourishes the body. This is essential to build up the exhausted body tissues and establish normal metabolic and immune functions. If this process is not done properly, the new ama (metabolic wastes) is generated which affects the immune function of the body. One of the important factors of the Paschatkarma is diet others being sleep and sex. These are also told as thristhambha (tripod of health)
a. Aahaara or Peyadi Krama (dietary prescriptions)
In Panchakarma, peyadikrama has a major role to play. Peyadikrama is a method to increase the strength of the digestive fire by giving lighter diet to start with and gradually bringing the patient to his or her normal diet. The preparations are peya (red rice gruel), vilepi (gruel with more quantity of rice), akrithayusa (rice gruel prepared with pulses like green gram), kritchayusa, (rice along with green gram soup and spicy foods & condiments), akritha rasa (meat soup with rice), kritha rasa (rice with meat) and so on. It is mentioned in Astangahrdaya that:
“Yathanuragni trinagomayadyai sandhukshyamano bhavati kramena mahan sthirash sarva pachasthathaiva suddhasya peyadibhirantharagni“
Like an ember that slowly lights and forms into flames when grass or cow is put, the digestive fire in the body increase, becomes stable and powerful by doing peyadikrama.
b. Vihaara (life style prescriptions)
A regulated life style also plays an important role in getting the maximum benefits of Panchakarma. It has to be followed for equal number of days for which Panchakarma was done. For a period of time one has to observe strict regimen (kathina pathya ) and later slowly taper into normal lifestyle.
Apart from pre, main and post techniques, in the classical texts few other techniques that are subsidiary to Panchakarma are also mentioned. They are dhumapana (herbal fumes to inhale), gandusa (holding medicated materials in the mouth), kavala (gargling), pratisarana (applying a coat of the drug paste to mouth), mukhalepa (application on face), murdha taila (applying oil on the head), karna poorana (applying medicine in ears), ascyotana (eye drops), anjana (collyrium), tarpana & putapaka (eye medications)