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Lord Atreya the foremost among the sages described the successful administration of [[Panchakarma]] for the well being of the people in the form of answer to the twelve queries. [60-61½]

Lord Atreya the foremost among the sages described the successful administration of [[Panchakarma]] for the well being of the people in the form of answer to the twelve queries. [60-61½]

=== Tattva Vimarsha ===

=== ''Tattva Vimarsha'' ===

• Siddhisthana implies the concept of reproducibility in therapeutic administration as sidhhi is achieved not by chance, but by the characteristics of repeatability.

• Siddhisthana implies the concept of reproducibility in therapeutic administration as sidhhi is achieved not by chance, but by the characteristics of repeatability.

• Basti is best treatment for vata disorders. Niruha (evacuative enema with decoction) is generally given for purification purpose in case of diseases with obstructive vata pathology. Anuvasana (unctuous enema) is generally given for nourishment purpose in case of diseases with degenerative vata pathology.  

• Basti is best treatment for vata disorders. Niruha (evacuative enema with decoction) is generally given for purification purpose in case of diseases with obstructive vata pathology. Anuvasana (unctuous enema) is generally given for nourishment purpose in case of diseases with degenerative vata pathology.  

• Samsarjana karma ( post-purification therapeutic measures) in terms of specific diet and lifestyle are important to attain maximum effect of administered purification.  

• Samsarjana karma ( post-purification therapeutic measures) in terms of specific diet and lifestyle are important to attain maximum effect of administered purification.  

Vidhi Vimarsha:

 

Acharya Charaka has described formulations useful for panchakarma procedures, methods of their preparation, their applications and successful management of any complications if arise. Thus the name Siddhisthana implies to the knowledge that gives excellence in panchakarma therapies. It also ensures the concept of reproducibility in therapeutic administration as Sidhhi is achieved not by chance, but by the characteristics of repeatability.  

=== ''Vidhi Vimarsha'' ===

Queries asked by Agnivesha: [verse 3-6]

 

Acharya Charaka has described formulations useful for panchakarma procedures, methods of their preparation, their applications and successful management of any complications if arise. Thus the name Siddhisthana implies to the knowledge that gives excellence in panchakarma therapies. It also ensures the concept of reproducibility in therapeutic administration as Sidhhi is achieved not by chance, but by the characteristics of repeatability.

==== Queries asked by Agnivesha (verse 3-6) ====

 

The word kalpana refers to the Application of panchakarma which is considered as main treatment among Ayurvedic therapeutics. Thus the whole Siddhisthana is devoted by the acharya to elaborate these measures.  The queries asked by Agnivesha can be considered as an abstract of Siddhisthana because the whole section deals with the topics related to these questions.

The word kalpana refers to the Application of panchakarma which is considered as main treatment among Ayurvedic therapeutics. Thus the whole Siddhisthana is devoted by the acharya to elaborate these measures.  The queries asked by Agnivesha can be considered as an abstract of Siddhisthana because the whole section deals with the topics related to these questions.

Duration of oleation therapy [ verse 7]

 

==== Duration of oleation therapy (verse 7) ====

 

Duration for oleation therapy depends upon the sensitivity of GIT of an  individual also termed as koshtha.

Duration for oleation therapy depends upon the sensitivity of GIT of an  individual also termed as koshtha.

Those with mridu (mild) koshtha become easily oleated as vata is less compared to other dosha thus oleation is not hampered or attenuated at any point, giving early results. In addition pitta is said to be responsible for mridu koshtha which itself has snigdha property which assists the oleation.

Those with mridu (mild) koshtha become easily oleated as vata is less compared to other dosha thus oleation is not hampered or attenuated at any point, giving early results. In addition pitta is said to be responsible for mridu koshtha which itself has snigdha property which assists the oleation.

On contrary krura koshtha individuals have vata dominance in the digestive system that hampers the oleation to some extent by virtue of dry nature of vata hence it takes maximum i.e. seven days duration to complete oleation. Also as per the dhatu-parinaman (way how dhatu are produced) concept, minimum seven days duration is must for taking any nutritional property to the deepest i.e. shukra dhatu. Madhyama koshtha individuals may get oleated in 5 days which is midpoint of limits. This is because madhyama koshtha individuals have dominance of kapha or sama dosha status. Kapha also has snigdha property but has stagnant and slow nature due to which sneha may take some extra time as compared to that of mridu koshtha. Thus seven days seems to be the maximum possible limit for oleation therapy after which it is said that sneha becomes habituated that indicates the fact that body’s capacity to digest fats increases, as more and more fats are consumed. This hypothesis is supported by the fact that, high-fat feeding is associated with increased production of bile acid required for fat metabolism.  Consequently, a high-fat diet elevates the fecal concentration of bile acids that is responsible for increased intestinal permeability.  Snehapana (internal oleation) is intended for creating asathmyata (non-acceptability). It is neither absorbed or assimilated upto 7 days in shodhananga (purification purpose). If exceeds 7 days, body will assimilate the sneha which is not intended in shodhananga sneghapana. However, if patient is not oleated in 7 days then it can be continued a little more or after break of few days whole procedure can be repeated.

On contrary krura koshtha individuals have vata dominance in the digestive system that hampers the oleation to some extent by virtue of dry nature of vata hence it takes maximum i.e. seven days duration to complete oleation. Also as per the dhatu-parinaman (way how dhatu are produced) concept, minimum seven days duration is must for taking any nutritional property to the deepest i.e. shukra dhatu. Madhyama koshtha individuals may get oleated in 5 days which is midpoint of limits. This is because madhyama koshtha individuals have dominance of kapha or sama dosha status. Kapha also has snigdha property but has stagnant and slow nature due to which sneha may take some extra time as compared to that of mridu koshtha. Thus seven days seems to be the maximum possible limit for oleation therapy after which it is said that sneha becomes habituated that indicates the fact that body’s capacity to digest fats increases, as more and more fats are consumed. This hypothesis is supported by the fact that, high-fat feeding is associated with increased production of bile acid required for fat metabolism.  Consequently, a high-fat diet elevates the fecal concentration of bile acids that is responsible for increased intestinal permeability.  Snehapana (internal oleation) is intended for creating asathmyata (non-acceptability). It is neither absorbed or assimilated upto 7 days in shodhananga (purification purpose). If exceeds 7 days, body will assimilate the sneha which is not intended in shodhananga sneghapana. However, if patient is not oleated in 7 days then it can be continued a little more or after break of few days whole procedure can be repeated.

Effect of oleation and fomentation therapy: [verse 7-8]

 

==== Effect of oleation and fomentation therapy (verse 7-8) ====

 

Vitiated dosha as explained by acharya can be considered to be the morbid matter adhering at cellular levels thus obstructing normal functioning of the micro-functional units of the body. Sneha consumption causes oleation of all body parts including cell membrane and other microcellular components. Cell membrane is basically made up of phospholipid bilayer.  Thus due to oleation sneha goes inside easily clearing the channels and dissolving impurities into it. These impurities along with fats are removed out of cell and other organic systems of the body by fomentation that increases the body temperature, opens up all channels and facilitate the transfer of dosha towards bowel.

Vitiated dosha as explained by acharya can be considered to be the morbid matter adhering at cellular levels thus obstructing normal functioning of the micro-functional units of the body. Sneha consumption causes oleation of all body parts including cell membrane and other microcellular components. Cell membrane is basically made up of phospholipid bilayer.  Thus due to oleation sneha goes inside easily clearing the channels and dissolving impurities into it. These impurities along with fats are removed out of cell and other organic systems of the body by fomentation that increases the body temperature, opens up all channels and facilitate the transfer of dosha towards bowel.

Diet before shodhana and reasons for vamana and virechana working in opposite ways: [verse 8-10]

Diet before shodhana and reasons for vamana and virechana working in opposite ways: [verse 8-10]

In vamana ‘kapha utklesha’(excited) is expected which is evident by excess salivation, nausea etc.  these factors plays an important role in  induction of vomiting. The vagal and enteric nervous system inputs transmit information regarding the state of the gastrointestinal system. Irritation of the GI mucosa by any drug or distension activates the 5-HT3 receptors of these inputs.  Thus if kapha is not aggravated then the key mechanism of distension of stomach, excess salivary secretions and nausea fails to initiate vomiting thus drug passes to the intestine and causes purgation. On contrary if kapha is highly aggravated then drug for purgation may lead to vomiting due to above said mechanism. This is the probable reason for specific diet before cleansing processes.

In vamana ‘kapha utklesha’(excited) is expected which is evident by excess salivation, nausea etc.  these factors plays an important role in  induction of vomiting. The vagal and enteric nervous system inputs transmit information regarding the state of the gastrointestinal system. Irritation of the GI mucosa by any drug or distension activates the 5-HT3 receptors of these inputs.  Thus if kapha is not aggravated then the key mechanism of distension of stomach, excess salivary secretions and nausea fails to initiate vomiting thus drug passes to the intestine and causes purgation. On contrary if kapha is highly aggravated then drug for purgation may lead to vomiting due to above said mechanism. This is the probable reason for specific diet before cleansing processes.

Post therapeutic measures (samsarjana krama): [verse 11-12]

 

==== Post therapeutic measures (samsarjana krama) (verse 11-12) ====

 

Duration of post therapeutic measures varies with type/quality of cleansing. This is directly related to the extent of changes brought by cleansing the digestive system and duration required to regain its normal functioning. Mucosal layer in the digestive tract plays important functions like barrier to protect from acids,  maintaining optimal immune function, proper digestion & assimilation of food & nutrients etc.  also the bacterial flora residing in intestine is also responsible for some functions like fermentation of undigested carbohydrates and the subsequent absorption of short-chain fatty acids, plays a role in synthesizing vitamin B and vitamin K as well as metabolising bile acids, sterols and xenobiotics.  Vomiting and purgation leads to cleansing of entire tract that causes removal of unhealthy bacterial flora and also inflammation and damage to the mucosal barrier. Thus till regeneration of new flora and proper mucosal barrier, the diet needs to be light and gradually increasing in thickness. Fats and some spices are given at later phases as they require proper mucosal functioning for absorption. Moreover this regimen facilitates the gradual induction of carbohydrate, vegetable protein, fat and meat protein as digestion  improves gradually.

Duration of post therapeutic measures varies with type/quality of cleansing. This is directly related to the extent of changes brought by cleansing the digestive system and duration required to regain its normal functioning. Mucosal layer in the digestive tract plays important functions like barrier to protect from acids,  maintaining optimal immune function, proper digestion & assimilation of food & nutrients etc.  also the bacterial flora residing in intestine is also responsible for some functions like fermentation of undigested carbohydrates and the subsequent absorption of short-chain fatty acids, plays a role in synthesizing vitamin B and vitamin K as well as metabolising bile acids, sterols and xenobiotics.  Vomiting and purgation leads to cleansing of entire tract that causes removal of unhealthy bacterial flora and also inflammation and damage to the mucosal barrier. Thus till regeneration of new flora and proper mucosal barrier, the diet needs to be light and gradually increasing in thickness. Fats and some spices are given at later phases as they require proper mucosal functioning for absorption. Moreover this regimen facilitates the gradual induction of carbohydrate, vegetable protein, fat and meat protein as digestion  improves gradually.

Characteristics of Three types of emesis and purgation: [verse 13-15]

 

==== Characteristics of Three types of emesis and purgation (verse 13-15) ====

 

Yellowish-greenish vomiting along with bitter taste in mouth indicates that the pyloric valve is open and bile is flowing into the stomach from the duodenum.  This is considered as end point of emesis and called pittanta vamana. In case of virechana, mucosal layer gets removed partially at the end point that can be considered as kaphanta virechana. Continuing cleansing beyond these endpoints may cause deleterious effects on the health.

Yellowish-greenish vomiting along with bitter taste in mouth indicates that the pyloric valve is open and bile is flowing into the stomach from the duodenum.  This is considered as end point of emesis and called pittanta vamana. In case of virechana, mucosal layer gets removed partially at the end point that can be considered as kaphanta virechana. Continuing cleansing beyond these endpoints may cause deleterious effects on the health.

Symptomatic evaluation of cleansing processes: [verse 15-20]

Symptomatic evaluation of cleansing processes: [verse 15-20]

Properly administered cleansing processes causes lightness in the body, feeling of happiness, clarity of heart region and sense organs etc. Both vamana and virechana clear digestive tract that is filled of morbid matter and bulky food, fluid etc. hence causes feeling of lightness. Sense organs respond to the stimuli either internal or external thus any adherence of morbid matter in these organs is responsible for ill functioning. Especially in vamana cleansing of nasal cavity, oral cavity is directly evident whereas skin is affected during oleation and fomentation. Removal of dosha causes blood purification which is responsible for health and proper functioning of skin.

Properly administered cleansing processes causes lightness in the body, feeling of happiness, clarity of heart region and sense organs etc. Both vamana and virechana clear digestive tract that is filled of morbid matter and bulky food, fluid etc. hence causes feeling of lightness. Sense organs respond to the stimuli either internal or external thus any adherence of morbid matter in these organs is responsible for ill functioning. Especially in vamana cleansing of nasal cavity, oral cavity is directly evident whereas skin is affected during oleation and fomentation. Removal of dosha causes blood purification which is responsible for health and proper functioning of skin.