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Different Techniques involved in Panchakarma
Mainly three stages are there ;
1. Poorvakarma (Preparatory techniques)
2. Pradhanakarma (Major techniques)
3. Paschatkarma (Post – Panchakarma regimen)
Poorvakarma / Preparatory Techniques
This consists of snehana (oleation) and svedana (sudation)
a. Snehana :
- Snehana involves making the body oily or unctuous by giving materials that are oily in nature in high quantity either internally or externally sarpi (ghee), majja (bone marrow), vasa (adipose / fast tissue), taila (oil) are four unctuous materials. The method of administering high doses of unctuous material internally is known as snehapana. Dose is decided according to the severity of the condition, its stage age, digestive capacity of the patient etc., Maximum oleation is given for seven days. Medicine is selected according to the dosha predominant of the disease.Snehapana is effective in conditions like Amlapitta (Acid gastric), tamaka svasa (bronchial asthma), antarvridhi (hernia), kushtam and visarpam (skin diseases), vataraktha (arthritic conditions) and vatam (rheumatic conditions).
b. Svedana (Sudation)
After oleation, the waste materials blocked in the body channels become unctuous and the channels become lubricated. Through svedana these waste materials are brought to main body channel (mahakoshta) before it is expelled through the main techniques of Panchakarma. Four different methods of applying sudation according to Ashtanga Hridaya are taapa(fomentation by applying heat), Upanaha (warm poultice of different medicinal materials) Usna (steam) and drava (pouring warm liquid). Sudation can be mild, moderate and maximum according to the disease, patient, habitat and season.
Sudation is effective in breathing disorders, hoarseness of voice, diseases of vata, kapha, metabolic dysfunction ( ama) stiffness, feeling of heaviness, aches, sprains, dysuria, tumours etc.,
Apart from being preparatory techniques for Panchakarma these two methods (snehana and Sveda) are after used as part of samana.
2. Pradhana Karma / Major techniques
It consists of five techniques mentioned earlier and is meant to purify a particular dosha (vata, pitta, kapha) in the body.
Vamana - Kapha (Upper part of body)
Virechana - Pitta (middle part of body)
Vasti - Vata (below naval)
Nasya - Kapha (upper part of the body)
Rakthamoksha - Raktha (blood)
a. Vamana / Emesis
After poorvakarma (Sneha, Sveda) if the patient has had a good digestion and pleasant sleep, the patient is made to consume specific types of gruel, milk, fish, curds etc., Next morning the patient is given medicine made of emetic drugs and after a muhurtha (around 48 minutes) the patient starts getting bouts of vomiting. Generally four, six and eight spells are considered good in minimum, medium and maximum types of emesis. After vamana, certain inhalation is given with medicated smoke.
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 (visarpa, kushta) anaemic conditions, migraine, kapha type of heart diseases, tumours of the neck, poisoning, infertility and minor conditions like pimples etc.,
b. Virechana / purgation
Purgation is mainly done pitta type of conditions. It also takes care of the kapha, which is located in the place of pitta. In Panchakarma procedure virechana is done after vamana. Virechana medication is given in the morning. The materials, dosage etc., are decided based on condition, strength, digestive capacity and bowel habits of the patient, dosha involvement and season.
According to classical texts ten, twenty and thirty evacuations are considered the best for mridu (mild), madhyama (medium) and uthama (maximum) types of purgation respectively.
Virechana is effective in skin diseases, tumours of the abdomen, Anorexia, constipation, spleen disorders, enlargement of abdomen due to fluid collection, abscesses, blood disorders, bleeding through orifices of upper part of the body etc.,
Clarity of intellect, strength of senses, stability of body tissues, increased digestive capacity, delayed aging are the effects of purification therapy if done properly.
c. Vasti (Medicated enema)
Medicated enema is very effective in vata type of disorders. It is also applied in other dosa disorders as well. Vasti is considered as equivalent to half of the treatments in Ayurveda, there are two types of vasti :-
i. Asthapana / Kashayavasti - done with decoction
ii. Anuvasana / Sneha Vasti - done with unctuous materials like oil, ghee etc.,
There is a third type of vasti known as Uthara Vasti to treat genito - urinary conditions.
Vasti is administered with a specially prepared yanthra called vasthi yanthra. Kashaya vasti is done before food and snehavasti after food. There are three types of vasti courses. They are yoga vasti, kalavasti and karma vasti. Yoga vasti includes eight vastis – 4 of kashaya and 4 of sneha in alternate order. Similarly kala consists of 15 vatis and Karma of 30.
There are different types of vasti based on the dose, materials used or action. They are dvadasaprasorithika, madhuthaila, rajayapana, yapana, lekhana vasti, brimhana vasti, pichavasti, ksheera vasti, siddha vasti etc.,
(i) Anuvasana Vasti
It is either given independently or alongwith kashaya vasti. It has both rejuvenative or nourishing and purificatory effect on the body. As the quantity is less this is given with syringe. A particular quantity of oil or ghee is administered through anal orifice. Anuvasana makes the naval region unctuous, it facilitates downward movement of vayu, strengthens the body and nourishes body tissues.
Anuvasana is suitable in patients who have strong digestive power, suffering from vata disorders and excessive dryness.
(ii) Kashayavasti
Usually Kashayavasti is done after virechana. Initially a few snehavastis are done to make pakuvasaya unctuous. Kashaya vasti is done in the morning after doing oil application and sudation. The patient has to lie on the left side of the body. According to dosa, disease strength of the patient and age, kashayavasti is prepared. Honey, salt, oil paste and decoction are added and churned for sometime for making a good mixture. Then it is mildly warmed. It takes 10-15 minutes to pass bowels after vasti. Diet and routine restrictions have to be followed.
Kashayavasthi is mainly intended for 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.
Kashayavasti is suitable for persons with abdominal tumours, gout, spleenic disorders pain in abdomen, amenorrhea, urinary calculi, obstruction of semen, flatus and farces and vata diseases.
Uthara Vasti
It 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).
d. Nasya (Nasal Medication)
Nasya is applied mainly in Kapha disorders and is very effective in disorders above shoulders. There are 2 types of nasya depending on dose, Marsa and pratimarsa. Marsa Nasya is major type and is again divided into uttama, madhyama and adhama types. 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.
There are 3 types of nasya based on action. They are ;
(i) Sodhana / Virechana
(eliminative) is done for headache, heaviness of head, eye disease, disease of throat, ocdema, tumours of the neck, worm infestation, tumours in the body, leprosy, epilepsy and rhinitus (ii) Samana type (pacifying) is done for vata type of headache migraine, loss of voice, dryness of mouth and nose, speech problems etc., samana is done for discoloration on the face, diseases of hair and eyes.e. Raktamoksha (Blood letting)
Blood becomes impure due to activities and food that aggravate pitta and Kapha. For removing the impure blood, there are four different methods used –
(i) Siravedha ( Cutting the blood vessel). It is done for sciatica, arthritis, mental disorders, head ache,
tumours of neck etc.
(ii) Prachana (Blood letting by pricking)
It is done mainly in skin disorders.
(iii) Jalooka (application of medicinal leech)
It is used in persons who are weak, young, old and those who cannot tolerate other methods of blood letting. As leeches have cooling nature they are used in pitta type of disorders. They are commonly used in abdominal swelling, piles, inflammatory abscess, skin disease, arthritic condition, eye disease, poisonous bites, erysipelas etc.
(iv) Sringa , Alabu, Ghatika (Application of horn etc)
This is method of extraction of blood by cupping. Materials like horn (sringa) fruit of a plant (alabes – cucumis- largenarius) or a special type of pot (ghatika) are used. It is done in areas where there is lack of sensations of touch.
Paschat Karma ( Post Panchakarma Regimens)
Post pachakarma regimen is very important for getting the maximum benefits. After participation, giving suitable materials like rasayanas nourishes the body. This is essential to build up the exhausted body tissues and establishment of normal metabolic and immune functions. One of the important factors of paschaat karma is diet others being sleep and sex. These are also told as thristhamba ( tripod of health- diet, sleep and sex).a. Aahaara or Peyadi Karma ( Dietary Prescriptions)
Peyadikarma 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), akritha yusa (rice gruel prepared with pulses like green gram), kritha yusa (rice along with green gram soup and spicy foods and condiments), akritha rasa ( meat soup with rice) kritha rasa (rice with meat) and so on.
(a) Vihaara (Life style preparations)
A regulated life style also plays an important role in getting 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.
The other techniques that are subsidiary to panchakarma mentioned in classic texts are dhumapana (medicated smoking) gandusa (holding medicated material in the mouth), kavala (gargling), pratisarana (applying paste of drugs to mouth), mukhalepa ( application on face) murdha taila (applying oil on the head), karna poorana (applying medicines in ears), ascyotana (eye drops), anjana (collyrium), tarpana and patapaka ( pooling of medicinal preparations in the eyes)
Abhyanga
Is herbal oil massage which aids in removing impurities, stimulates both arterial and lymphatic circulation, harmonies, detoxifies, strengthens and revitalizes entire body and relaxes mind and body promoting over all healing. It also stimulates immune system.
Udvarthana
Is a message using a course herbal paste or powder to enliven and energize the body. It promotes better digestion, healthier skin, firmer muscle tone, increased circulations and a breakdown of cellulite. It is strongly recommended in obesity.
Dhara
The word “Dhara” means continuous pouring of a liquid substance. Generally medicated oils, decoctions or dhanyamla ( fermented preparations from different grains), thakra dhara (medicated butter milk), ksheera dhara (milk) and sthanya dhara (Breast milk) are used for this purpose. This can be done either on a part of body or to the whole body known as ekanga dhara and sarvanga dhara respectively.
In sarvangadhara, medicated and luke warm oil is poured all over the body for about 45-60 minutes.
In Sirodhara, medicated oil or milk or buttermilk is poured continuously in a steady stream on the forehead from an earthen vessel. This treatment is meant to alleviate fatigue, improve memory, restore equilibrium and is also effective in cases involving insomnia, migraine, ear nose disease, spondylitis and paraplegia. It is an amazingly relaxing therapy which gently relaxes stress and tension from the mind and body.
Sirovasthi
In Sirovasti, a cap like structure usually of leather is attached to forehead and medicated oil is kept pooled over the scalp area for about 45-60 minutes. Its indications and effects are similar to that of sirodhara.
Kativasthi
Kativasthi is the localised pooling of medicated luke warm oil over the lower back area. It helps to alleviate stress, pain or swelling in the lower back. It also reduces muscle spasms, increases lower spine rigidity and strengthens the bone tissues of the lower back.
Urovasthi
Medicated luke warm oil is placed over the chest region by making an herbal paste boundary. It is beneficial in heart disorders, respiratory disorder’s etc.
Rasayana Chikilsa ( Rejuvenation Therapy)
This treatment includes internal rejuvinative medicines and also external treatment procedures like massage. This is to rejuvenate mind, body and soul, to tone up skin, to strengthen all systems so as to achieve ideal health and longevity. This increases ojas (vitality) and improves mental clarity, thereby increasing body resistance.
Traditional Kerala Ayurveda Therapies
(A) Uzhichil (Oil Application)
This is Abhyanga ie: oil application and massage, a method of bahya snehana or external oleation. This is good for regulating age exhaustions, nourishment of the body, longevity of life, sound sleep, healthy skin and also in vata vitiated disorders.
In Kerala, people who have good knowledge about vital points in the body (marmas) and anatomy do massage in a specialized way. These techniques have not developed sole by as a part of the Ayurvedic tradition. Techniques like uzhichil are part of Kalari (martial art) and Kathakali (a dance form of Kerala). These massages are either done with hands or legs (Chavitti Uzhichil)
(B) Njavarakizhi
Is also known as Shashtikapinda Sveda. This is one of the methods of fomentation of the body parts.
A special kind of rice called navara is cooked along with decoctions (usually made of sida retna) and milk. This porridge is tied in a cloth and made in to Kizhi/ Pottali / (Bag or Poultice) and bag after dipping into a mixture of warm milk and decoctions, is massaged on the body.
Navarakizhi is effective in vata vitiated disorders where there is a depletion of kapha. It is done especially for depletion or wasting of muscle tissue. It is also indicated for different types of neurological disorders, disused atrophy, degenerative conditions of the joints, burning in the body, body weakness sciatica and convalescence in different diseases.
(C ) Ilakizhi
Like in navarakizhi, here application is done by leaves. If the application is by powder then it is called podikizhi. These two are done in vata vitiated disorders with an association of Kapha. Different leaves are fried along with coconut gratings, lemon and salt and made into kizhi or poultice. Before applying kizhi, oil application is done on the body. These are very effective in pain due to swelling, spondylosis, sciatic pains, arthritis complaints, stiffness and inflammatory conditions of joints.
(D) Pizhichil
This yet another method of sneha and sveda, which is very popularly used in Kerala, also known as Kayareka. Oil is applied to head and body and gently massage. Following, therapists squeeze warm oil from a cloth on the whole body of the patient continuously from either side. Patient is made to sit and lie down to different positions during the procedure, which lasts for around one hour. After this warm bath is taken. Generally it is done for 7,14, or 21 days.
This is commonly used in all vata types of disorders including hemiplegia paraplegia, pain, stiffness and arthritic condition.
(E) Thalam
Is a unique treatment in which paste made of medicines is applied in the center of head for prescribed time. Formulations like rasnadi choorna, kachooradi choorna are mixed with specific oils in different conditions and applied as thalam. It is also done with Emblica officinalis, Sandal wood and other bitta reducing drugs. This is beneficial in Insomnia, Headaches, Mental disorders etc.
(F) Pichu
In this a thin pad or cotton dipped in oil is put on the head for a period of time. This can be done in mental disorders, insomnia etc. Pichu can also be applied to other parts of body in case of pain etc.
(G) Palpuka / Ksheeradhoomam
In this milk is boiled with medicines like sida vetura and the body is exposed to the vapour coming out of milk. This is generally used for vata conditions affecting the upper part of the body, especially in facial paralysis etc.
(H) Thalapothichil / Sirolepa
