Daily regimen for the preservation of health (dinacharya)

Ayurveda emphasizes on the preservation of health and prevention of diseases as its primary objective. Daily regimen (dinacharya), seasonal regimen (ritucharya), dietetic rules (ahara vidhi), and code of conduct (sadvritta) are prescribed for healthy and long life.

The classically prescribed daily routine or regimen is followed with due consideration of one's body constitution (deha prakriti), strength (bala), age (vaya), season (ritu), and any existing disease condition (vyadhi).[ SAT-J.9] This article deals with the critical review of these daily regimens and their importance in the contemporary views.

The sequence of activities

The sequence of daily activities is as follows:

• Waking up early morning

• passing urge of urination and defecation(shaucha vidhi)

• brushing teeth (dantapavana)

• application of collyrium in the eye (anjana)

• nasal instillation of oil (nasya)

• oil pulling in the mouth (gandusha)

• inhalation of herbal smoke (dhumapana)

• chewing of oral fresheners with betel leaf (tambula)

• oil application and body massage the (abhyanga)

• exercise (vyayama)

• massage with powdered drugs (udwartana)

• bath (snana)

• professional activities by observing good social conduct can be started after this morning routine. [A. Hr. Sutra Sthana 2]

These procedures are aimed specifically at preserving health of sense organs. It makes the person more productive and improves the quality of life.

Wake up in early morning

The first step of setting a daily routine is fixing a proper time to wake up in the morning. It helps to maintain the natural circadian rhythm.The recommended time to wake up is about 45 minutes to 1 hour before sunrise, known as "brahma muhurta". It is the best time to start the daily activities and has many positive benefits on physical and mental health [ A. S. Sutra Sthana 3/2].

In a study assessing the relationship between physical activity and daily lifestyle habits it was observed that early waking time has significant positive correlations with children's physical activity level. Studies have shown that late wake-up time was associated with an unfavorable activity and weight status profile. Another study regarding self-reported health status, using evening and morning lateness scales (E and M) of the sleep-wake pattern indicates that healthier respondents prefer earlier wake-up times.

Gut hygiene(shaucha vidhi)

On waking up, the first activity should be micturition and defecation because this process cleans the metabolic wastes (mala) accumulated in body during night. The urge to defecate in the morning is indicator of good digestive health and gut motility. The time, frequency, and duration of defecation are assessed clinically for examination of quality of digestion (agni) and gut pattern (koshtha).Frequent and long-time suppression of urge of defecation and urination can cause serious disorders.[Cha.Sa.Sutra Sthana 7/3-6]

A survey study regarding bowel habits indicates that the most common bowel habit of once daily was a minority practice in both sexes in the modern era. A regular 24-hour cycle was apparent in only 40% of men and 33% of women. But the most common time in which defecation occurs is the early morning itself.

Oral hygiene

Oral cavity is an important body orifice for the entry of food and water. Oral hygiene is important in gustatory sensation, initial digestion stages, and proper food passage to the stomach. It is also crucial in its social aspect in the context of verbal communication.

Various measures have been recommended for promoting oral hygiene, which includes,

a)brushing teeth(danta pavana)

b)cleaning tongue (jihwa nirlekhana)

c)mouth and face wash (mukha prakshalana)

d)oil pulling in the mouth (gandusha/kavala)

e)chewing of betel leaf (tambula) and mouth fresheners

Brushing teeth(dantapavana)

Chewing of herbal stems, 9 inches long and girth equal to little finger, is recommended for cleansing effect on teeth. [A.Hr.Sutra Sthana 2/2-3] It is comparable with the brushing of teeth with specially designed toothbrushes in the modern era. Teeth shall be cleaned after waking up in the morning, taking food, and before sleep. [A.Hr.Sutra Shana 2/2], [Cha. Sa. Sutra Sthana 5/71]

These herbal sticks should be either astringent (kashaya), acrid (katu), bitter (tikta) or sweet (madhura) in taste. [Su. Sa. Chikitsa Sthana 24/6] The sticks are first crushed at one end, then chewed slowly without injuring the gums. [Cha. Sa. Sutra Sthana 5/71-72]

Pongamia pinnata (karanja), Nerium indicum (karavira), Calotropis gigantean Linn (arka), Aganosma dichotoma (malati), Terminalia arjuna Roxb (arjuna), Terminalia tomentosa (asana), Ficus benghalensis (vata), Acacia catechu (khadira), Vateria indica Linn.(sarja), Acacia farnesiana Wild(arimeda), Achyranthes aspera(apamarga) are the medicinal plants mentioned for making chewing herbal brushes.[Cha. Sa. Sutra Sthana 5/73], [A. S. Sutra Sthana 3/5]

With reference to the individual's constitution and dominant dosha, the suitable herbal stick is selected based on its dominant taste (rasa).

Body constitution (prakruti)	Taste(rasa)	Plants
Vata predominant	Sweet(madhura), Astringent(kashaya)	Glycyrrhiza glabra(madhuka),Acacia catechu (khadira)
PittaPredominant	Bitter(tikta)	Azadirachta indica(nimba)
Kapha Predominant	Pungent(katu)	Pongamia pinnata(Karanja), Calotropis gigantean Linn (arka)

The toothbrush made with plastic handle and nylon bristles is used to clean teeth since the early 20th century. Medium and soft bristles are preferred for protection of dentin and gums. Toothpaste is a paste or gel dentifrice used with a toothbrush to clean and maintain the aesthetics and health of teeth.

A review of advantage and disadvantages of contemporary toothbrushes and herbal chewing sticks was done. Phyto-chemical examinations revealed that the herbal sticks contain natural ingredients, which are beneficial for oral health. Chewing sticks contains volatile oils, tannic acid, sulfur and sterols which attribute to anti-septic, astringent and bactericidal properties that reduce plaque formation, provides anti-carious effects, eliminates bad odor, improves the sense of taste, and cures many systemic diseases. Chewing sticks showed parallel or even greater mechanical and chemical cleansing of oral tissues than a toothbrush.

Tooth powder

For cleansing the teeth, a combination of Saussurea lappa(kushta), Terminalia chebula(haritaki), Emblica officinalis (amalaki), Terminalia bellerica(bibhitaki), Zingiber officinale(shunthi), Piper nigrum Linn(maricha),Piper longum Linn(pippali),Cinnamomum zeylanicum(twak),Elettaria cardammum(ela) and Cinnamomum tamala(patra) in powder form mixed with honey is recommended. [A.S.Sutra Sthana 3/5]

Now a days, various herbal tooth powders and pastes are available in market. Neem extract is widely used in studies of antiplaque activities of Ayurvedic tooth powders and commercial herbal toothpastes.

The research on herbal toothpastes or tooth powders or appropriating herbal stick as per body constitution may reveal new insights into prevention of dental disorders.

Cleaning the tongue (jivha nirlekhana)

Apart from brushing the teeth, cleaning the tongue using a scraper is also recommended. The tongue-scraper should be curved without a sharp edge. Classics, metallic tongue scrapers made up of gold, silver, copper, tin or brass are recommended. [Cha.Sa.Sutra Sthana 5/76]

Recent research has shown that the tongue scraping and tongue brushing play an important role in controlling bacterial load and plaque level. In a study comparing three types, two commercially available tongue scrapers (a manual toothbrush that has a tongue scraper on the back of its head, metallic and plastic tongue cleaners), the most effective reduction of the bacterial count was observed with plastic tongue cleaners.

Mouth fresheners

It is recommended to keep Myristica fragrans Hoult (jati), Hibiscuss abelmoschus Linn (katuka), Areca catechu Linn (puga), Syzygium aromaticum (lavanga), Piper cubeba Linn. (kankola), Betel-leaves (tambula), Cinnamomum camphora Nees (karpura), and small cardamom (sukshma ela) in the mouth for securing cleanliness, taste and fragrance.[Cha.Sa.Sutra Sthana 5/77]. This practice is followed often after meals.

Mouth wash and gargling

Mouth wash with water in healthy individual and medicated decoction of Ficus bengalensis(nyagrodha), Ficus racemosa (udumbara), Ficus religiosa (ashwatha), Ficus lecor (plaksha), and Thespesia populnea (parisha), decoction of Symplocos racemosa (lodhra) or Embilica officinalis(amalaki) are also recommended as mouth wash in specific oral conditions.[Su.Sa.Chikitsa Sthana 24/15]

Oil pulling in mouth

There are mainly two techniques for filling of liquids in oral cavity.

a)Holding liquid in mouth (gandusha): Maximum quantity of liquid is held in mouth, so that movement of liquid is not possible and it is retained for a few minutes.

b)Gargling (kavala graha): A suitable amount of liquid is retained in mouth for gargling.

Oil pulling using sesame oil is recommended as a daily routine. It imparts strength to the jaws, clarity to the voice, excellent gustatory sensation and gives protection from dryness of throat, lips, dental caries etc. It has a good role in preventing and curing both local and systemic illnesses.[Cha. Sa. Sutra Sthana 5/7-79]

In a study, the oil pulling therapy showed reduction in the plaque index, modified gingival scores, and total colony count of aerobic microorganisms in the plaque of adolescents with plaque-induced gingivitis. Oil pulling is observed to bring improvement in oral hygiene when practiced correctly and regularly. The tongue influences and interacts with the body systems. Its dysfunction leads to different local and systemic pathologies.

The sense organs like eye, ear, nose and skin are also protected by various measures in daily routine.

Eye care

• Eye wash (netra prakshalana)

Washing eyes with decoction of Symplocos racemosa (lodhra), or Emblica officinalis (amalaki) or with cold water helps in maintaining the constant clear vision. [Su.Sa.Chikitsa Sthana 24/15]

• Application of collyrium (anjana)

The vision perception is predominantly done by teja mahabhuta constituent. Hence the eyes are always susceptible to disorders of kapha dosha. Daily application of collyrium is recommended for promoting clear vision. Application of solid extract of Berberis aristata (rasanjana) is advised in an interval of 5- 8 days during night time for lacrimation and cleansing purpose. Strong collyrium should not be applied to the eyes during daytime. The collyrium meant for cleansing purpose shall be done only at night.[Cha.Sa.Sutra Sthana 5/15-17]

This procedure has preventive and curative effect in eye disorders. The combination of extract of Berberis aristata (rasanjana) and honey was found to be very effective in relieving all clinical features like mucopurulent discharge, foreign body sensation, redness, burning sensation, conjunctival congestion, and papillary hypertrophy in patients of mucopurulent conjunctivitis (netra abhishyanda).

• Relation of feet and eyes :

Oil application to soles and feet (padabhyanga), washing (padaprakshalana) and covering the foot with suitable footwear (padatradharana) are recommended in eye care. [Su.Sa.Chikitsa Sthana 24/69-71]

As per the foot reflexology, eye points are located on the undersides of second and third toes. The pressure effect on these points during oil massage can promote the health of eye and relieve the signs and symptoms of eye disorders.

Nasal application (nasya)

Nasal cavity is directly connected with with the sensorineural structures of brain. The medicated oil applied through nasal cavity reaches to "Shringataka marma" (cavernous sinus), which is the seat of all the centres of vision, hearing, smell, and taste. The most important oil preparation recommended for nasal instillation is "anu taila." [ Cha. Sa. Sutra Sthana 5/56-63].

Recently , the Ministry of AYUSH, Government of India, included oil pulling therapy and nasal application therapies in self care and immunity boosting preventive protocol for management of SARS-Covid-19 pandemic.

Smoke inhalation (dhoomapana)

Inhalation of medicated smoke is advised to pacify the aggravation of vata and kapha.Eight specific times of administration of medicated smoke are prescribed for daily use. It shall be done after taking bath, after scraping the tongue, after sneezing, after brushing the teeth, after nasal instillation of medicine, after the use of collyrium and after waking from sleep.[Cha.Sa. Sutra Sthana 5/34-35]

This procedure is helpful in preventing and treating diseases of of the head, nose and eye. [Cha.Sa.Sutra Sthana5/46-49] Nowadays, this procedure is used only after therapeutic emesis (vamana). It is rarely practiced as a part of daily routine.

Care of ears

Daily application of oil in ears is recommended for preservation of health of auditory organs. [A. Hr. Sutra Sthana 2/10].Filling of ear with oil is a therapeutic procedure known as "karnapoorana.This can be practiced as a daily regimen also for promoting the power of hearing. [A.Hr.Sutra Sthana 22/32] Nowadays, this procedure is practiced only for therapeutic puposes and not as daily practice.

Skin care

Oil application and massaging (abhyanga)

Daily application of oil on body and massaging is recommended for promoting the skin health. It energizes the body, promotes youthful appearance, and good physique. It is good for nourishment of body and improves quality of sleep. [A. Hr. Sutra Sthana 2/8] Two more types of massages are included in the daily regimen as per the body constitution, predominant dosha and endurance of the individual. In a study conducted in infants, the daily massaging with sesame oil showed significant results in growth parameters, blood flow and sleep pattern in comparison with other herbal and mineral oils.

Gentle massage (samvahana)

The gentle and soft massage which is comfortable for the body is termed as "samvahana".[Su. Sa. Chikitsa Sthana 24/83] It is indicated in vata dominant conditions, in individual with thin physique and low endurance.

Powder Massage (Udvartana)

Massaging and rubbing the body using a herbal powder is termed as podwer massage (udvartana). It is generally done in a direction opposite to that of body hair. It is indicated in kapha dominant conditions and obese individuals. It helps to reduce fat, provides firmness to body parts and cleanses the skin. [A. Hr. Sutra Sthana 2/16] Udvartana effectively mobilizes the stored fat by liquefying it, making it easily available for disposal from the system. The therapeutic efficacy of this procedure has been proven in conditions like obesity , dyslipidaemia.

Exercise (vyayama)

Well co-ordinated and balanced movements are included in execrcise (vyayama). Regular exercise renders body light and efficient in activities, improves digestive power and wanes obesity. Healthy individuals, who are habituated to fat rich diet should routinely practice exercise especially during winter and spring seasons. In other seasons, it can be performed moderately. [A. Hr. Sutra Sthana 2/11-13] Research shows that exercise is as beneficial as a medicine for health. As for any other drug, amount of exercise is equally important based on personified requirements and conditions. The optimum limit of exercise is upto half strength of the person. Exercise is not recommended in diseases due to vitiation of vata and pitta, tender children, and aged persons. Excessive exercise beyond ones capacity, can cause excessive thirst (trushna), emaciation(kshaya), dyspnoea(pratamaka), bleeding disorders(raktapitta), fatigue, cough, fever, and vomiting. [A. Hr. Sutra Sthana 2/14]. Moderate and regular exercise can prevent many life style disorders. Studies have shown the evidences for the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. After exercise it is recommended to massage the entire body comfortably. [A. Hr. Sutra Sthana 2/13]

Bath (snana)

Daily bath is advised for preservation of overall health. It not only removes toxins from skin, but also relaxes and rejuvenates mind. It is the foremost measure to reduce fatigue. [Cha.Sa.Sutra Sthana 25/40] The temperature of water for bath shall be suitable according to the climatic conditions in respective seasons. Generally, hot water bath is recommended for promoting the strength of lower body parts. Cold water is suitable for head bath. Using hot water shower over head may adversely affect eyes and other sense organs. Extremely cold water for bathing during winter season can cause aggravation of vata and kapha.Similarly use of very hot water during summer season causes aggravation of pitta and rakta." [Su. Sa. Chikitsa Sthana 24/61] Some studies have shown that people who had a habit of bathing in hot water have good subjective health status, sufficient sleep and rest, low levels of stress, and high subjective happiness. It imparts the psychological benefits of bathing too. Among the two types of bath, routine immersion bathing appeared more beneficial to mental and physical health than routine shower bathing without immersion. A randomized controlled trial compared the effects of immersion bathing and shower bathing. Visual analogue scale scores were significantly better for fatigue, stress, pain, and smile, self-reported heath and skin condition in case of immersion bathing. The study reported that immersion bathing, but not shower bathing, exerted hyper thermic action that induced increase in blood flow and metabolic waste elimination, which may afford physical refreshment. Japanese researcher evaluated the effects of hot water and bathroom temperatures on human thermoregulatory function and thermal perception during half-body bathing in the winter season. It was concluded that high bathroom temperature is better than half-body bathing at a low water temperature. Now a days, a variety of commercial products like bathing soaps and shampoos are available. Normal healthy skin has a pH range of 5.4-5.9 and a normal bacterial flora. A study was carried out to evaluate the pH of different brands of bathing soaps and shampoos available in the market. It showed that majority of the soaps have a pH range of 9-10. Use of soap with high pH can cause an increase in dehydrative effect, irritability and alteration in bacterial flora. A soap with low pH might be useful to preserve skin health. Therefore, in daily regimen, it is recommended to consider pH of bath soap, bathroom tempearature and water temperature as per the body constitution to have maximum health benefits of bath.

Hair care

Daily application of oil on head (shiro abhyanga) promotes the growth of healthy and long hairs. It prevents the disorders of scalp and hairs.[Su. Sa. Chikitsa Sthana 24/25] Various kinds of hair oils are available for promoting hair growth and also for specific conditions like dandruff, hair fall etc. Research studies are carried out to evaluate the effect of different oils like mineral oil, sunflower oil and coconut oil. These oils are used as the bases in majority of the commercial hair oils. The observation in research shows that coconut oil reduced the protein loss remarkably when used as a pre-wash and post-wash grooming product, in comparison with other oils. In modern era, shampoos, conditioners, hair straightening products, hair dyes and henna are used for hair care. But the chemical contents in these products can cause various kinds of side effects including allergy, contact dermatitis etc. Judicious use of these products as per the suitability of person is recommended to prevent diseases. Daily combing of hair (kesha prasadana) and covering of hair with some kind of cloth (ushneesha) is advised to keep the hair healthy and clean. [Su. Sa. Chikitsa Sthana 24/29, 75]

The sequence of massage, exercise and bath is adjusted suitably as per the need of the individual.

Importance of diet

The food shall be taken only when the person is hungry and after complete digestion of previous meals. It should be taken at a frequency of twice a day. Frequent eating is not recommended. [Su. Sa. Uttara Tantra 34/ 75] Specific dietetic rules and eating habits (ahara vidhi) are described for preservation of health. [Cha. Sa. Vimana Sthana 1/21-25]

Social and occupational health

Ideal code of conduct in social life and professional life (sadvritta) is recommended for preventing exogenous disorders. [ Cha. Sa. Sutra Sthana 8/25] The impact of psychological, behavioural and cognitive factors on health is an area of great scope for research.

Sleep

Sleep (nidra) is recommended in proper quantity and at proper time. The quantity of sleep for an individual depends upon his basic physiological needs and other conditions such as age, body constitution, occupation etc. Appropriate sleep leads to happiness, nourishment, strength, fertility, knowledge and longevity. [Cha.Sa.Sutra Sthana 21/30] Summary: Daily regimen includes various procedures to be followed for preservation of health of various body parts. The time of waking up, taking meals, professional activities, and sleep shall be regular to maintain equilibrium inside body. All the procedures and observation of code of conduct is beneficial for preservation of mental health and spiritual health, too. The procedures impart cosmetic, anti-ageing and longevity benefits. Appropriate observation of daily regimen can prevent variety of lifestyle disorders and reduce global burden of disease significantly. References