Panchakarma in modern lifestyle

This article is based on a lecture delivered by Prof. Dr. Anup Thakar, Director I.T.R.A Jamnagar, Gujarat, India. in Prof. M. S. Baghel Memorial Lecture Series on January 09, 2022.

Contributors

Section/Chapter/topic	Concepts and Contemporary Practices -Nidana Chikitsa / Panchakarma / Panchakarma in modern lifestyle
Author	Thakar A. B. 1
Reviewer	Basisht G.2
Editors	Deole Y.S.3, Aneesh E.G.2
Affiliations	1 Director, I.T.R.A Jamnagar, Gujarat, India 2Charak Samhita Research, Training and Development Centre, I.T.& R.A., Jamnagar, Gujarat, India 3 Executive Editor and Professor in Kayachikitsa, G.J.Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails	carakasamhita@gmail.com
Date of first publication:	February 01, 2022
DOI	10.47468/CSNE.2022.e01.s09.085

Modern lifestyle & diseases

It is estimated that approximately 70-80% of present-day population indulges in harmful lifestyle factors like alcohol, smoking, unhealthy diet, physical inactivity etc. Among these factors, the most hazardous factor is mental stress with a higher impact on health as compared to others. These result in the development of chronic and non-communicable diseases like heart diseases, stroke, diabetes, obesity, metabolic syndrome, chronic obstructive pulmonary disease, malignancy etc. According to United Nations, by 2030, the proportion of total global deaths due to chronic diseases is expected to increase by 70 percent and the global burden of disease to 56 percent. If these diseases can be managed just by modifying lifestyle and following Panchakarma, it will create a huge impact on the society. Proper life style, good diet and Panchakarma can change the scenario leading to healthy world with minimum global burden of diseases.

Health and health determinants

Holistic approach encompasses all elements required for healthy living. Holistic approach doesn’t essentially mean following herbal and traditional systems of medicine. The ‘individual’ undergoing the therapy is more important and most suitable ‘therapy’ to a person’s health should be provided. The integrative approach should be adopted and implemented with such individualistic focus. The health promotion, specific protection by restoration and rehabilitation through panchakarma and healthy lifestyle is need of the hour.

Blueprint for preservation of health

Following the seasonal and daily regimes as mentioned in Ayurveda is the blueprint of health preservation.

Daily regimes (dinacharya): This includes waking up early in the morning; passing urge of urination and defecation; brushing teeth; application of collyrium in the eye; 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 (abhyanga); physical exercise (vyayama); massage with powdered drugs; bath, and indulge in professional activities by observing good social conduct.

Seasonal regimes (ritucharya): This includes specific treatments as per season, viz. therapeutic emesis (vamana) in spring (vasanta); therapeutic purgation (virechana) during autumn (sharad) and therapeutic enema (basti) during monsoon season (varsha). Suitable diet and lifestyle changes are advised according to changes in seasonal conditions.

During the ongoing COVID-19 crisis, nasal instillation of oil (nasya) and oil pulling (gandusha) showed a greater role in protection of health. When the nasal pathway is smeared with oil, there forms an oil coating in nasal mucosa which traps the foreign body including bacteria and viruses and thus prevents its entry into vital structures. Oil pulling therapy also works in the same way. Oil application in nostrils can be done for fifteen times in a day. [A. Hr. Sutra Sthana 20/28-29]

Chewing betel leaves (tambula) especially after food intake shows many health benefits. Betel leaf also has anti-cancerous effect. One who follows the daily and seasonal regimens properly will have a lesser chance of getting disease.

Pathogenesis of lifestyle disorders & utility of panchakarma – Ayurvedic view

If a person continuously indulges in high calorie food, irregular or improper diet, lack of physical activity, disturbed sleep and stress, it results in accumulation of dosha. This also alters the status of related body tissues like blood (rakta), body fluids (rasa), fat (meda dhatu) etc. High calorie food has a natural affinity towards fat tissue (meda dhatu). So continuous intake of high calorie food alters the status of fat tissue (meda dhatu).

If the person undergoes seasonal purification procedures like therapeutic emesis etc., the therapy breaks the chain of pathogenesis of disease. This cleanses the body by expelling out increased dosha and brings back normalcy of tissues.

Panchakarma is a unique treatment modality of Ayurveda with five major therapeutic procedures for internal purification of body with allied procedures. Purification procedures of panchakarma allow the biological system to return to homeostasis and rejuvenate rapidly.

Panchakarma

‘Panchakarma’ comprises of five therapeutic procedures as follows:

1. Therapeutic emesis (vamana): to eliminate aggravated kapha dosha through mouth.
2. Therapeutic purgation (virechana): to eliminate aggravated pitta dosha through anal route.
3. Therapeutic enema (basti): to eliminate aggravated vata dosha by administering herbal decoction or oil/medicated ghee through anal route.
4. Therapeutic nasal administration (nasya): to eliminate doshas above clavicle region (urdhwajatru) by administering medication through nose.
5. Therapeutic bloodletting (raktamokshana): to eliminate aggravated blood (rakta) based morbidities.

The other allied panchakarma therapies are oil massage (abhyanga), sweat inducing therapies or fomentation (swedana), liquid dripping therapy over forehead (shirodhara), powder massage therapy (udwartana), oil pulling therapy (gandoosha) etc.

Global prospects of panchakarma in public health

Panchakarma procedures are highly effective natural bio cleansing procedures. It can lead to a paradigm shift of health care from curative to preventive and promotive therapies.

Benefits of bio cleansing (shodhana)

• Increases metabolic fire (agni): Proper bio cleansing (shodhana) followed by proper diet plan (samsarjana) improves the digestive and metabolic processes (agni) or correct the metabolism. When metabolism is intact, the natural immunity will be at its optimum.
• Improves intelligence and strengthens sense organs
• Attain stability of body tissues: Biocleansing clears the accumulated dosha and thus prevents further aggravation of disease.
• Increases longevity: By acquiring the above said benefits the life expectancy will also increase. Purification therapies followed by rejuvenating therapy contribute antioxidant action and free radical scavenging activity. This minimizes free radical induced damage which is a key cause of aging.

Role of Panchakarma

• Preventive: Prevents non communicable diseases/life style diseases through seasonal bio cleansing.
• Curative: Curative approach in major non communicable diseases and communicable diseases.
• Restorative: Restoration of health is achieved through rejuvenating (rasayana) therapy. The benefits of rasayana therapy can be achieved only after proper bio cleansing through Panchakarma.

Therapeutic emesis (Vamana)

Vamana is done in spring season approximately in the month of March and April for the elimination of vitiated kapha dosha. It helps in managing conditions like bronchial asthma, allergic bronchitis, rhinitis, sinusitis, migrane, hyperacidity, indigestion, anorexia, obesity, overweight, dyslipidemia, diabetes mellitus, acne vulgaris, psoriasis, eczema, urticaria etc.

In a study, it is reported that vamana increases glucocorticoid, ACTH and catecholamine. Vamana increases heart rate and results in vasodilatation. It prevents auto immune and inflammatory conditions. Anti-streptolysin (ASLO) titer is reported to be reduced by vamana. This suggests vamana is a definite answer for auto-immune disorders.

In another study, four samples of vamana at different time intervals were collected to find the impact of lipid peroxidation. Lipid peroxidation refers to the oxidative degradation of lipids. It is the process in which free radicals steal electrons from the lipids in cell membrane, resulting in cell damage. This process proceeds by free radical chain reaction mechanism. Lipid peroxidation is the causative factor for atherosclerosis and it aggravates the initial tissue injury caused by ischemic or traumatic brain damage. Catalase is a protective enzyme which prevents the accumulation of toxic levels of hydrogen peroxide formed as a by-product of metabolic process.

In this study, it is found that catalase activity increases as vamana goes on. In the first sample it was 36.12 and in the fourth sample it was 50.53. At the same time, the lipid peroxidase reaction decreases from 7.82 in first sample to 2.25 in fourth sample.

Therapeutic purgation (virechana)

Virechana is indicated in autumn (sharad) season (mid September to mid November approximately). It eliminates excessive vitiated dosha in general and pitta dosha in particular from the body through the anal route. Purgation simply represents cleansing of intestine, but virechana is cleansing of the whole body.

Studies show that virechana can lower hepatic glucose production and helps to prevent elevated blood sugar level.

The concept of microbiome is also considered here. The whole environment of intestine changes after virechana. This changes the microbiome flora too. Diet restrictions (samsarjana) after virechana, in which the person is subjected to a controlled exposure to carbohydrate diet primarily followed by protein and fat, provides a new microbiome environment in the gut.

Therapeutic enema (basti)

The procedure in which medicines are administered through rectal route is termed as ‘basti’. Based on the ingredients it is of two types. Basti with decoction (niruhabasti) and with medicated oils/ghee (anuvasanabasti).

Niruha basti: It facilitates peristaltic action and enhances the absorption of nutrients from the caecum and ascending colon. Mustadi yapanabasti (a type of niruha basti) is seen to reduce the TB specific IgG and IgM significantly. This clearly denotes the immune modulation effect of basti therapy.

Anuvasana basti: It influences the immune function of the body by production of T helper cells, leucocytes, cytokines and modulation of lymph mechanism.

Entric nervous system of GIT has connection with CNS. ENS works in synergy with CNS. Stimulation of ENS by chemo or mechanic receptors in turn stimulates the concerned CNS. This might be a reason behind efficacy of basti in neurological conditions like paralysis. The role of gut microbiome should also be considered here. Through basti, there might be alteration of gut microbiome which secretes enzyme that might stimulate the CNS.

Genomic study on the effect of virechana and basti

Image 1: Volcano plot - Basti

Image 2: Volcano plot - Virechana

A study was conducted at I.P.G.T.R.A., Jamnagar in collaboration with Institute of genomic and integrated biology (IGIB) under CSIR, New Delhi. Total 60 patients were selected randomly for basti and virechana. Ten patients from each group were selected for gene expression analysis. Serum samples were taken before and after the respective treatments. Collected samples were sent to Ayurgenomics lab, IGIB-CSIR, New Delhi.

Procedure: Procedure carried out as per instructions in Illumine kit manual. RNA samples placed on a bead chip array placed on an iscan reader. The iscan reader uses a laser to excite the fluor of the single base extension product on the beads of the bead chip sections. Light emission from these fluors recorded in high resolution images of the bead chip sections. Data from these images were analyzed to determine SNP genotypes using Illumina’s genome studio gene expression module. The volcano plot shows that some genes (red dots) are differently expressed after basti [image 1] and virechana [image 2]. Around 120 genes were down regulated and around 125 genes were up regulated. By virechana also around 26 genes were down regulated and 61 genes were up regulated.

Upregulated pathways after virechana:

• NF kappa B signaling pathway: Compensates the damage caused by reactive oxygen species and inflammation resulting after ischemic attack.
• NOD like receptor signaling pathway: Prevention of added infections by helping in formation of another defense line.
• Cytosol DNA sensing pathway enrichment: Triggers robust immune responses including inflammasome activation.
• Antigen processing and presentation: Promotion of immune responses.
• Hematopoietic stem cell lineage: Neuroprotection and reduction in post ischemic inflammation.

Downregulated pathways after virechana:

• Jak stat signaling pathway: Restoration of the calcium ions and tight junctions.
• Reinstating the brain homeostasis by blood brain barrier patch up.
• Map kinase signaling pathway: Prevention of further development of pathological changes in the brain tissue and prevent further damage due to stroke.
• Cellular senescence: Maintenance of integrity of blood brain barrier.
• Glycosphingolipid biosynthesis-ganglio series: Ameliorates atherosclerosis, causes a profound reduction of plasma cholesterol.

Upregulated pathways after basti:

• Antigen processing and presentation: Upliftment of the immune system for the prevention of any infection immediately after stroke.
• Natural killer cell mediated cytotoxicity: Potent boost to immune system, preventing further infection or inflammation in the brain tissue.
• Retrograde endocannabinoid signaling: Neuroprotection of the brain tissue after the turmoil created by infarction or hemorrhage; reduction in overall stress and pain (due to anti-stress effects of cannabinoid receptors).

Down regulated pathways after basti:

• Regulation of Actin cytoskeleton: Detrimental effect on production of reactive oxygen species, thus protection from degenerative changes.
• Osteoclast differentiation: Reducing the level of osteoprotegerin (atherosclerosis and cardio vascular diseases).
• Hematopoietic cell lineage: Checking high inflammatory responses after stroke by lymphocyte and monocyte production.
• Jak-Stat signaling pathway: Activation of Jak Stat pathway leads to decreased cerebral recovery.
• Th1 and Th2 cell differentiation: Control of inflammation post stroke incidence.
• Apoptosis: Preventive application of basti in stroke management through regulation of apoptosis and preventing cell death.

These show that epigenetic results are also achieved through panchakarma. Through panchakarma gene correction is possible. Gene damage as a result of modern lifestyle can be corrected to some extent through panchakarma.

Effects of other panchakarma procedures

Oil massage (abhyanga): Total 10 healthy men and 10 healthy women underwent 1 hour oil massage and was studied for effects on subjective stress experience. Significant reduction in subjective stress experience was observed. It decreases cortisol levels and anxiety. It increases the blood and lymphatic flow. Other associated symptoms like pain, sleeplessness and fatigue were reduced.

Foot massage (pada abhyanga): This is also mentioned under daily routine that has to be followed. It is the quickest, simplest, most pleasurable and inexpensive way to make someone healthier and happier. In a study conducted to observe the effect of foot massage on eye strain, it is observed that regular practice of foot massage is very beneficial for reducing eye strain. Marked improvement was observed in Visual analogue scale to measure severity of symptoms and Likert scale for measuring frequency of symptoms.

Head massage with oil (shiroabhyanga): A study in which head massage (shiroabhyanga) done with medicated oil (mahabhringrajtaila) is effective in reducing generalized body ache (angamarda), indigestion (apakti), vertigo (bhrama), yawning (jrimbha) and heaviness of head (shirogaurava). It is also reported that duration of sleep was improved by 6-7 hours.

In a study among 34 female office workers, scalp massage was applied twice a week for 10 weeks. Positive effects were observed on stress hormone, blood pressure and heart rate. Therefore, scalp massage can be used for stress control with no spatial or time limit.

In another study among 30 anxiety neurosis patients, head massage with brahmi taila reports that mean gradation of anxiety reduced by 53.2 per cent which was highly significant.

Pouring of medicated oil over forehead (shirodhara): Total 16 volunteers were subjected to this procedure. Mood and stress levels, electrocardiogram (ECG), electroencephalogram (EEG) and selected biochemical markers of stress were assessed. Significant improvement in mood scores and level of stress were observed. Significant decrease in respiratory rate, heart rate and reduction in diastolic blood pressure were noted. The relaxed alert state after shirodhara was co-related with an increase in alfa rhythm in EEG. It leads to a state of alert calmness similar to the relaxation response observed in meditation.

Nasal instillation of oil in less quantity (pratimarsha nasya): In a study, it is reported that performing pratimarsha nasya as daily routine may be useful in controlling the progression as well as treatment of generalized anxiety disorder (GAD) if implemented in early stage. The study was conducted on 54 GAD patients. Nasya was performed daily for 3 months.

Powder massage (udwartana): Powder massage is very effective in improving the texture and to open up the channels of skin. In a clinical study 10 obese persons were subjected to this therapy. Massage was done with Kola kulatthadi churna for 7 days. Significant reduction in body weight (mean weight reduced from 84.7 to 81.8) was reported.

Conclusion

Panchakarma, as a therapy, has proved to be effective in treating many pathological conditions. Performing panchakarma as a daily routine will help in prevention of diseases and preservation of health. Primordial primary prevention, curation and promotive aspects should be given emphasis through panchakarma. It should focus on comprehensive and inclusive health care of the community. An evidence based approach in Ayurveda through panchakarma will lead to global revolution in public health care.

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