An Introduction to Panchakarma
Presenter : Dr. Praerna Bhargav Chair Person : Dr. Kishore R K Research Associate Research Officer (Ayurveda) DST – SATYAM Project RARIMD, CCRAS, Bengaluru
OVERVIEW
Panchakarma in Ayurvedic Classics Pathogenesis of disease Ayurvedic Principles of Treatment Fundamental Principle behind Panchakarma What is Panchakarma? Objectives of Panchakarma Steps in Panchakarma Purvakarma Pradhankarma Paschatkarma Major Precautions in Panchakarma Importance of Panchakarma Benefits of Panchakarma Research findings
Panchakarma in Ayurvedic Classics
Charaka Samhita Sushruta Samhita Ashtanga Hrudaya Ashtanga Sangraha
Pathogenesis of disease
Every disease is related to an imbalance of the doshas.
Other coherent factors are:
The disturbance of the biological fires (agnis) The formation and accumulation of undigested nutrients(ama), Obstruction of the body channels (srotorodha) Disturbed assimilation in the tissues (vitiated doshas). Ayurvedic Principles of treatment
Nidana Parivarjana – Preventing the cause Samprapti Vighatan - Shodhana - Bio-purification by Panchakarma Shamana - Bio-balancing care by Aushadhi - Medicine Aahara – Dietary regime Vihara – Life style modification (Ashtanga Sangrah Sutra Sthana 16-20)
Fundamental Principle Behind Panchkarma
Concept of Jatharagani and Ama Body as Yajnya Kunda Cow’s Ghee as the Carrier: Bio- permeable Importance of Cleansing the srotas (Subtle channels) – Koshta –shakhagat srotas Removing impurities from tissues without surgery
What is Panchakarma?
Panchakarma Pancha means five and karma means actions or treatments So Panchakarma is a special therapeutic procedure in Ayurveda, involving five types of evacuating treatment which leads to detoxification of the body and strengthening of the immune system, thus, restoring balance and well-being with resultant rejuvenation. Objectives of Panchakarma
Three major objectives: Swasthya Rakshana - Health maintenance Roga nivarana – Elimination of the disease Prepare for rejuvenation (Charak Sutra Sthana 7-47,48) Swasthya Rakshana - Health Maintenance
Recommended even for healthy individuals, as part of regular seasonal regimens as doshas naturally accumulate owing to seasonal changes and can cause disease if not removed timely. (Charak Sutra Sthana 7-46) Dosha aggravation rhythm cycle
VATA ↑ VATA
KAPHA ↓ PITTA↑ Varsha Sharad PITTA Hemant KAPHA VATA ↓ Shishira Vasant Grishma KAPHA ↑ PITTA ↓
Roga Nivarana – Elimination of the disease
When the doshas are vitiated beyond a certain level, they give rise to various endo-toxins (Ama), which have a tendency to be accumulated in the minute channels (Srotas). When such condition is beyond the level of pacification and do not respond well to medications then they need to be eliminated from the body through Shodhana therapy.
Rasayana & Vajikarana – Rejuvenation/Revitalization Therapy
Panchakarma procedures prepares the body to respond well to Rasayana (Rejuvenation) and Vajeekarana (revitalization) therapies which helps to strengthen various body tissues and delays degenerative processes. (Charak Sutra Sthana 7-48,49) Steps of Panchakarma
Purva Pradhan Paschata karma Karma karma
Vamana Samsarajana Deepana Karma – Diet Regimen Virechana Pachana Rasayanadi Karma – Nasya Rejuvenation Snehana therapy Basti Shamana Swedana Karma – Raktamokshana Pacification Purva Karma – Preparatory procedure
These are the preparatory procedures that help the body discard the toxins present in tissues and GI tract. It includes following procedures: Deepana & Pachana - Digestive Therapy Snehana - External & Internal Oleation Therapy Swedana - Sudation / Fomentation Therapy Significance of Purva Karma
These preparatory procedures help by :
Ignition & promotion of digestive fire
Loosening of deep rooted toxins & softening of the body parts (Ca.Si. 1;7)
Liquefaction and mobilization of aggravated doshas from shakha (periphery) to koshtha (GI tract) (Ca.Si. 1;7)
Snehana - Svedana
Indications Contraindications • Vata disorders - paraplegia, • Alcohol abuse hemiplegia, facial paralysis, • Pregnancy arthritis, sciatica, backache, joint • Menstruation, disorders, constipation, colicky • Malnourished persons pains, spasmodic pains, • Gastrointestinal disorders • Oedema, • Obesity • Dysuria, • Comatose pt • Heaviness of the body • Tuberculosis • Respiratory disorders - Chronic
coryza. Asthma, Cough, Hiccup • Diabetes
• Headache • Very old people,
• Pharyngitis • Pitta prakriti /pitta disorders
Properties of appropriate Snehana - Svedana
Properties of Samyak Snehana- vatanulaeMy < dIÝaei¶vRcR> iõGxms Properties of Samyak Svedana- zItzUlVyuprme StMÉgaErvin¢he, s Pradhana Karma – Main Procedure Vamana - Induced vomiting Virechana - Induced purgation Basti - Medicated enema Aasthaapan basti - herbal decoction enema Anuvasana basti - herbal oil enema Nasya - Nasal medication Raktamokshana – Blood letting Effects of Panchakarma on dosha Procedure Dosha Vaman For Kapha dosha Virechan For Pitta dosha Basti For Vata dosha For Kapha dosha Nasya in head For Rakta and Raktamokshana Pitta dosha Vamana - Therapeutic emesis Procedure –2-3 litres of either milk/ sugar water/ licorice tea/ buttermilk to drink followed by emetic dose usually comprising of Randia dumetorum seed (Madanphala) with calamus (Vacha) and pinch of rock salt mixed with honey. Wait period of 45 mins Vegas start Removes excessive Kapha and accumulated toxins from upper GI tract and the respiratory system Vamana - Therapeutic emesis Indications Contraindications • Respiratory disorders - Asthma, • Young children Cough, Bronchitis, repeated colds • Pregnancy Pharyngitis • Elderly • Kapha disorders • Malnourished persons • Dyspnoea • Debilitated • Nausea • Stomach ulcers • Anorexia • Severe lung/heart disease • Sinusitis • Abdominal tumors • Skin diseases • Intestinal obstruction • Obesity • Splenic disorders • Diabetes • Psychological disorders Properties of appropriate Vamana kale àv&iÄrnitmhtI Vywa ywa³m< dae;hr[< Svy < cavSwanimit yaegl][ain ÉviNt. (Charak Sutra Sthana 15-13) Timely disposition of vegas, not causing much discomfort, evacuation of doshas in proper sequence and termination of the vegas on its own after proper detoxification ipÄaNtimò < vmn < (Charak Siddhi Sthana 1-14) Sign of perfect emesis with expulsion of pitta According to the disposition of number of vegas, purification can be of three types: Type of Shuddhi Number of vegas Quantity of waste Heena 4 768 gm Madhya 6 1152 gm Pradhana 8 1536 gm Virechana – Therapeutic purgation Procedure – After purvakarma the person is made to ingest any of the herbal purgatives such as eranda taila/ triphala/ katuki/ Abhaya/ senna to eliminate solid/liquid wastes (feces, urine) from the body After 30 – 45 mins vegas start Removes excessive pitta and toxins accumulated in liver and gall bladder from lower GI tract Purifies blood Virechana – Therapeutic purgation Indications Contraindications • Chronic skin disorders • Anal fissures • Diabetes • Ano rectal bleeding • Ano-rectal disorders - Fistula, • Anorexia Haemorrhoids • Malnourished persons • GI disorders – Ascites, liver • Debilitated disorders, indigestion, • Elderly constipation • Pregnancy • Anaemia • Children • Migraine • Fever • Jaundice • Alcoholic • Oedema • Gout * Quantity, counts, color and consistency of waste emitted should be observed. Also blood pressure, pulse, respiration should be tracked for both Vamana and Virechana Therapies. Properties of appropriate Virechana daEbRLy < la"v < GlainVyaRxInam[uta éic>, ùÖ[Rzuix> ]uÄ&:[a kale vegàvtRnm!. buÏIiNÔymn> zuixmaRétSynulaemta, sMyiGvir´il¼ain kaya¶eínuvtRnm!. (Charak Sutra Sthana 16- 5,6) Weakness, lightness and tiredness of body, subsidence of disease, finding taste in food, purification of the heart and improved complexion, feeling of hunger and thirst, timely disposition of vegas, clarity of thoughts, intellect, senses, channelization of vata and improved bio fire. k)aNt< c ivrek> (Charak Siddhi Sthana 1-14) Sign of perfect purgation with expulsion of kapha Type of Shuddhi Number of vegas Quantity of waste Heena 10 1536 gm Madhya 20 2304 gm Pradhana 30 3072 gm Basti – Medicated enema “Basti” means sac or pouch Various medicated enemas are used for inducing into the large intestine through rectum (basti) using an enema bag (basti) Cleanses or lubricate the system and alleviate dryness caused by an excess of Vata It is also considered as the mother of all Panchakarma treatments as it cleanses the accumulated toxins from all the 3 doshas : Vata, Pitta and Kapha, through the colon. Types of Basti Based on liquid used for enema, basti is of 2 types – Niruha / Asthapana basti (Herbal decoction based - Cleansing ) Anuvasana / Sneha / Matra / Taila (oil based - Oleation) Based on site of administration, basti can be of several types – Guda basti Uttara basti Shiro basti Hrut basti Kati basti Nabhi basti Jaanu basti Aasthaapana Basti Procedure – Enema comprises of honey, salt, oil, and herbal decoction and is administered on an empty stomach in the morning. Quantity - 500 cc (age, disease, condition) Position - left-lateral lying down Wait period - medicated contents are retained in the intestines for a maximum of 45 minutes and then allowed to come out along with fecal matter and excess Pitta and Kapha Person can use bed pan or rest near to the bathroom Aasthaapan Basti Indications Contraindications • Pain disorders • Indigestion • Cardiac disorders • GI disorders - Obstruction or • Vata disorders perforation in the intestines, • Amenorrhea ascites, peritonitis, dysentry, diarrhoea, vomiting • Infertility • Malnourished persons • Obstruction of faeces, urine, flatus • Debilitated • Haemorrhoids • Elderly • Schizophrenia • Diabetes • Tuberculosis • Skin disoders Anuvaasana Basti Procedure – Herbal or plain sesame oil is administered after a meal, preferably during night Quantity – 100 cc Position – Left lateral lying down Wait Period – As the quantity is small can be retained for even more than 24 hours Generally the oil is absorbed slowly through the intestines. Anuvaasana Basti Indications Contraindications • Vata disorders • Severe hemorrhoids • Sexual debility • Excessive Kapha in GI • Low body weight • Low digestive fire • Asthma • GI disorders – ascites, jaundice, • Colitis intestinal worms, diarrhoea • Cervical Spondylosis • Anaemia • IBS • Diabetes • Constipation • Tuberculosis • Thyroid disoders • Skin disorders • Coma Nasya - Nasal medication Procedure – Massage of Forehead, face, neck is done with herbal oils followed by fomentation. Then head is tilted back and liquid/powder is put into the nostrils. Removal of secretions → massage → mild fomentation → Gargling → Inhalation of medicated smoke Types of Nasya According to action Shodhana (Purification) to eliminate doshas Shamana (Palliation) to reduce dosha provocation Brimhana (Tonifying) to strengthen Vata According to substance used Avapeeda - uses herbal extracts, juices Naavana - instilling milk, oils etc., Dhuma - inhaling smoke of various herbs Pradhamana – herbal powders According to dose Pratimarsha - 2 drops in each nostril Marsha - 8 - 32 drops in each nostril Nasya - Nasal medication Indications Contraindications • Vata pitta disorders of head, ears, • Severe digestive disorders eyes, nose, mouth region • Fever • Dryness of throat • Pregnancy • Dental problems • Children below 5 years • Tonsillitis • After bath • Hair related problems • After physical exertion • Facial paralysis • After virechana • Allergies • After anuvasana basti • Breathing problems • Alcoholics Raktamokshana Best treatment for purification of vitiated blood. Can be accomplished by – Siravedha (Blood letting) –blood is drawn from a vein. Jaloukavcharan (Leech Therapy) –blood is drawn using leeches Cures skin diseases, headaches, acute pain at localised sites, psoriasis, gout, Leprosy, Leucoderma, Depigmentation, Haemorrhoids, Pruritis, Spleen disorders, Mouth ulcers etc. Paschaat Karma – Post procedure Sansarjana Krama Shamana Karma Sansarjana Karma – Dietary regimen Peya - a liquid diet of bland, warm, thin gruel with salt Vilepi – Thick gruel - porridge Akrita yusha - a semisolid kichari (rice lentil dish) Krita yusha - a semisolid kichari (rice lentil dish) with Ghee and spices Anna with Mansarasa - bland meat/vegetable soups with cooked rice Number of days 1st Anna kaal 2nd Anna kaal Day of Shodhana Only liquid Peya 1st day Peya Peya 2nd day Vilepi Vilepi 3rd day Vilepi Akrita yusha 4th day Akrita yusha Akrita yusha 5th day Krita yusha Krita yusha 6th day Krita yusha Anna with Mansarasa 7th day Anna with Mansarasa Anna with Mansarasa Shamana Chikitsa (Curing of diseases) Shamana is usually done after Shodhana therapy and in less vitiation. By internal and external use of medicines – to achieve equilibrium at Dosha, Dhatu, Mala and Agni and to boost Immunity (Ojas) Major Precautions To avoid - Extremes of Climate Excess or Nil physical activity Bad Habits Suppression of Natural urges Excess of Emotions Wrong Eating habits To follow – Sipping hot water throughout the day Early to bed and early to wake Gentle yoga Pranayama Meditation Chanting, singing Gentle movements Importance of Panchakarma dae;a kdaicÄ! k…PyiNt ijta l'œ"npacnE, ijta s<;aexnEyeR tu n te;a < punéÑv>. (Charak Sutra Sthana 16-20) Dosha alleviation done by use of carminatives and digestives can sometime get aggravated but extraction of aggravated doshas through purification therapy can never get aggravated. Benefits of Panchakarma Restores metabolic power. Eliminates toxins Balance of tridoshas. Enhances mental clarity, awareness Helps implement healthy diet and lifestyle Reduces stress Slows ageing process Increases the skin’s glow, luster and immunity. Boosts body immunity and energy level. Improves strength, energy and vitality. Removes insomnia and mental problems Research evidence Title of study & Authors n Intervention Result Conclusion Journal, Year A standard controlled B.A Pooja 90 Group A – All 3 groups VIrechana Karma is clinical study and Virechana showed effective in reducing on Virechana Santosh Group B – statistically triglyceride level, Karma and Lekhana Kumar Lekhana Basti significant whereas Lekhana Basti in the management Bhatted Group C - improvement in Basti is effective in of dyslipidemia Atorvastatin the lipid profile reducing the (Medoroga) after treatment cholesterol level in Ayu; 2016 and in follow up. particular. Combination of Sharma VM 60 AY group – Migraine Traditional Ayurveda Ayurveda and Yoga etal therapeutic symptoms along with Yoga therapy reduces pain purgation including pain therapy reduces intensity and improves followed by intensity and symptoms, intensity quality of life in patients yoga therapy Headache related of pain and improves with migraine headache CT group – Quality of Life Quality of life in Complemen Ther Clin symptomatic improved Migraine pract; 2018 treatment significantly in AY with no significant change in CT Research evidence Title of study & Authors n Intervention Result Conclusion Journal, Year A Comparative clinical S. Dubey 80 Group A – All 4 groups Vamana therapy is trial on the role etal Vamana showed very effective of Panchakarma therapy Group B – statistically and Unmada and Unmada Gajankusha Unmada significant change Gajankusha Rasa is Rasa in the cases of Gajankusha in mean score of mild to moderately major depressive Rasa HDRS but Group C effective in major disorder vis-à-vis Group C – Both was better than depressive kaphaja Unmada 1 and 2 Group B and disorder. Both Ayu; 2010 Group D - Group A was together have Fluoxetine better than Group moderate to mild D antidepressant effect A randomized controlled C Radhika 36 Nasya group & Most of the Conventional clinical trial to assess the etal CT group – parameters management along efficacy of Nasya in Both groups improved with Nasya was more reducing the signs and given7 days significantly in efficacious than symptoms of cervical rookshana, 7 both the groups conventional spondylosis days svedana but improvement management alone in Ayu; 2012 along with was more in the reducing the signs kashaya, 7 nasya group and symptoms of days nasya cervical spondylosis. Research evidence Title of study & Author n Intervention Result Conclusion Journal, Year Identification of Altered C. T. 119 Perfect Health Significant reductions Panchakarma prom Metabolomic Profiles Peterson Experimental in PH group in 12 oted statistically Following etal Group (PH): phosphatidylcholines significant changes a Panchakarma-based Panchakarma and changes in an in plasma levels of Ayurvedic Intervention -based additional 57 phosphatidylcholine in Healthy Subjects: The Ayurvedic metabolites (amino s, sphingomyelins Self-Directed Biological intervention acids, biogenic and others in just 6 Transformation Initiative Relaxation/Va amines, acylcarnitines, days (SBTI) cation Control glycerophospholipids Sci Rep; 2016 Group and sphingolipids were observed as compared to CG Feasibility and Pilot D Hegde 30 Group A – Both groups Adding of Efficacy Testing of etal Integrated significantly improved Shirodhara Integrated Yoga and Yoga therapy clinically. Group B technique to YT was Shirodhara (Ayurvedic Group B – showed significantly feasible and may be oil-dripping) Intervention Integrated better scores in useful in improving on Clinical Symptoms, Yoga therapy Stroop word task executive memory Cognitive Functions and + Shirodhara than group A. Also and sleep quality in Sleep Quality of Adults sleep quality adults with ADs. with Anxiety Disorder improved in YA group IJOY; 2019 References . Charaka Samhita: Sutra Sthaana, Siddhi Sthaana . Sushruta Samhita: Sutra Sthaana, Uttara tantra . Ashtanga Sangrah: Sutra Sthaana . Ashtanga Hrudaya: Sutra Sthaana . B.A Pooja and Santosh Kumar Bhatted. A standard controlled clinical study on Virechana Karma and Lekhana Basti in the management of dyslipidemia (Medoroga). Ayu; 2016; 37(1): 32–37 . Sharma VM etal.Combination of Ayurveda and Yoga therapy reduces pain intensity and improves quality of life in patients with migraine headache. Complemen Ther Clin pract; 2018. . Sarvesh Dubey, J. S. Tripathi, etal. A Comparative clinical trial on the role of Panchakarma therapy and Unmada Gajankusha Rasa in the cases of major depressive disorder vis-à-vis kaphaja Unmada. Ayu; 2010;31(2): 205–209. . C Radhika, G. Vinod Kumar, etal. A randomized controlled clinical trial to assess the efficacy of Nasya in reducing the signs and symptoms of cervical spondylosis. Ayu; 2012; 33(1): 73–77. . C. T. Peterson etal. Identification of Altered Metabolomic Profiles Following a Panchakarma-based Ayurvedic Intervention in Healthy Subjects: The Self-Directed Biological Transformation Initiative (SBTI) Sci Rep; 2016; 6: 32609. • D Hegde etal. Feasibility and Pilot Efficacy Testing of Integrated Yoga and Shirodhara (Ayurvedic oil-dripping) Intervention on Clinical Symptoms, Cognitive Functions and Sleep Quality of Adults with Anxiety Disorder. IJOY; 2019. Thank You. .