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

Charaka Samhita Sushruta Samhita Ashtanga Hrudaya Ashtanga Sangraha

Panchakarma in Ayurvedic Classics

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

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.

What is Panchakarma?

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)

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)

Swasthya Rakshana - Health Maintenance

Dosha aggravation rhythm cycle

Varsha

Sharad

Hemant

Shishira

Vasant

Grishma

VATA PITTA↑

PITTA

VATA ↓

PITTA ↓ KAPHA ↑

KAPHA

VATA ↑

KAPHA ↓

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 karma

Pradhan Karma

Paschata karma

Vamana

Virechana

Nasya

Basti

Raktamokshana

Snehana

Swedana

Samsarajana Karma – Diet

Regimen Deepana

Pachana Rasayanadi Karma –

Rejuvenation therapy

Shamana Karma –

Pacification

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

Purva Karma – Preparatory procedure

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)

Significance of Purva Karma

Indications

• Vata disorders - paraplegia, hemiplegia, facial paralysis, arthritis, sciatica, backache, joint disorders, constipation, colicky pains, spasmodic pains,

• Oedema, • Dysuria, • Heaviness of the body

• Respiratory disorders - Chronic coryza. Asthma, Cough, Hiccup

• Headache

• Pharyngitis

Contraindications

• Alcohol abuse

• Pregnancy

• Menstruation, • Malnourished persons

• Gastrointestinal disorders

• Obesity

• Comatose pt • Tuberculosis

• Diabetes

• Very old people, • Pitta prakriti /pitta disorders

Snehana - Svedana

Properties of Samyak Snehana- vatanulaeMy< dIÝaei¶vRcR> iõGxms<htm!, madRv< iõGxta ca¼e iõGxanamupjayte.

(Charak Sutra Sthana 13-48) Evacuation of flatus, increase of digestive fire, unctuous and soft stool, supple and soft body, oily skin Properties of Samyak Svedana-

zItzUlVyuprme StMÉgaErvin¢he,

s<jate madRve Svede SvednadivritmRta. (Charak Sutra Sthana 14-13)

Relief from coldness, stiffness, heaviness and pain, induces sweating and softness of the body.

Properties of appropriate Snehana - Svedana

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

Nasya For Kapha dosha

in head

Raktamokshana For Rakta and

Pitta dosha

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

Vamana - Therapeutic emesis

Indications

• Respiratory disorders - Asthma, Cough, Bronchitis, repeated colds

Pharyngitis

• Kapha disorders

• Dyspnoea

• Nausea

• Anorexia

• Sinusitis

• Skin diseases

• Obesity

• Diabetes

• Psychological disorders

Contraindications

• Young children

• Pregnancy

• Elderly

• Malnourished persons

• Debilitated

• Stomach ulcers

• Severe lung/heart disease

• Abdominal tumors

• Intestinal obstruction

• Splenic disorders

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:

Properties of appropriate Vamana

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

* 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.

Virechana – Therapeutic purgation

Indications

• Chronic skin disorders

• Diabetes

• Ano-rectal disorders - Fistula, Haemorrhoids

• GI disorders – Ascites, liver disorders, indigestion, constipation

• Anaemia

• Migraine

• Jaundice

• Oedema

• Gout

Contraindications

• Anal fissures

• Ano rectal bleeding

• Anorexia

• Malnourished persons

• Debilitated

• Elderly

• Pregnancy

• Children

• Fever

• Alcoholic

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

Properties of appropriate Virechana

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

• Pain disorders

• Cardiac disorders

• Vata disorders

• Amenorrhea

• Infertility

• Obstruction of faeces, urine, flatus

• Haemorrhoids

• Schizophrenia

Contraindications

• Indigestion

• GI disorders - Obstruction or perforation in the intestines, ascites, peritonitis, dysentry, diarrhoea, vomiting

• Malnourished persons

• Debilitated

• Elderly

• 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

• Vata disorders

• Sexual debility

• Low body weight • Asthma

• Colitis

• Cervical Spondylosis

• IBS

• Constipation

Contraindications

• Severe hemorrhoids

• Excessive Kapha in GI • Low digestive fire

• GI disorders – ascites, jaundice, intestinal worms, diarrhoea

• Anaemia

• Diabetes

• 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

Indications

• Vata pitta disorders of head, ears, eyes, nose, mouth region

• Dryness of throat • Dental problems

• Tonsillitis

• Hair related problems

• Facial paralysis

• Allergies

• Breathing problems

Contraindications

• Severe digestive disorders

• Fever

• Pregnancy

• Children below 5 years

• After bath

• After physical exertion

• After virechana

• After anuvasana basti • Alcoholics

Nasya - Nasal medication

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

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

Sansarjana Karma – Dietary regimen

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)

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

Major Precautions

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 & Journal, Year

Authors n Intervention Result Conclusion

A standard controlled clinical study on Virechana Karma and Lekhana Basti in the management of dyslipidemia (Medoroga) Ayu; 2016

B.A Pooja and Santosh Kumar Bhatted

90 Group A – Virechana Group B – Lekhana Basti Group C - Atorvastatin

All 3 groups showed statistically significant improvement in the lipid profile after treatment and in follow up.

VIrechana Karma is effective in reducing triglyceride level, whereas Lekhana Basti is effective in reducing the cholesterol level in particular.

Combination of Ayurveda and Yoga therapy reduces pain intensity and improves quality of life in patients with migraine headache Complemen Ther Clin pract; 2018

Sharma VM etal

60 AY group – therapeutic purgation followed by yoga therapy CT group – symptomatic treatment

Migraine symptoms including pain intensity and Headache related Quality of Life improved significantly in AY with no significant change in CT

Traditional Ayurveda along with Yoga therapy reduces symptoms, intensity of pain and improves Quality of life in Migraine

Title of study & Journal, Year

Authors n Intervention Result Conclusion

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

S. Dubey etal

80 Group A – Vamana Group B – Unmada Gajankusha Rasa Group C – Both 1 and 2 Group D - Fluoxetine

All 4 groups showed statistically significant change in mean score of HDRS but Group C was better than Group B and Group A was better than Group D

Vamana therapy is very effective and Unmada Gajankusha Rasa is mild to moderately effective in major depressive disorder. Both together have moderate to mild antidepressant effect

A randomized controlled clinical trial to assess the efficacy of Nasya in reducing the signs and symptoms of cervical spondylosis Ayu; 2012

C Radhika etal

36 Nasya group & CT group – Both groups given7 days rookshana, 7 days svedana along with kashaya, 7 days nasya

Most of the parameters improved significantly in both the groups but improvement was more in the nasya group

Conventional management along with Nasya was more efficacious than conventional management alone in reducing the signs and symptoms of cervical spondylosis.

Research evidence

Title of study & Journal, Year

Author n Intervention Result Conclusion

Identification of Altered Metabolomic Profiles Following a Panchakarma-based Ayurvedic Intervention in Healthy Subjects: The Self-Directed Biological Transformation Initiative (SBTI) Sci Rep; 2016

C. T. Peterson etal

119 Perfect Health Experimental Group (PH): Panchakarma-based Ayurvedic intervention Relaxation/Vacation Control Group

Significant reductions in PH group in 12 phosphatidylcholines and changes in an additional 57 metabolites (amino acids, biogenic amines, acylcarnitines, glycerophospholipids and sphingolipids were observed as compared to CG

Panchakarma promoted statistically significant changes in plasma levels of phosphatidylcholines, sphingomyelins and others in just 6 days

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

D Hegde etal

30 Group A – Integrated Yoga therapy Group B – Integrated Yoga therapy + Shirodhara

Both groups significantly improved clinically. Group B showed significantly better scores in Stroop word task than group A. Also sleep quality improved in YA group

Adding of Shirodhara technique to YT was feasible and may be useful in improving executive memory and sleep quality in adults with ADs.

Research evidence

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.

References

Thank You. .