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Panchakarmiya Siddhi (view source)

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<big>'''Abstract </big>'''

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[[Charaka Samhita]] [[Siddhi Sthana]] is designed to discuss the proper methods of application of [[Panchakarma]] as well as complications of the same due to improper use and their successful management. In the previous chapter ([[Kalpana Siddhi]]), various aspects of administration of [[Panchakarma]] were discussed. ''Pravritti'' (indications) and ''nivritti'' (contraindications) of [[Panchakarma]] are essential to discuss without which successful administration cannot be assured. In the beginning of the chapter, persons unsuitable for both ''shodhana'' and ''shamana chikitsa'' are mentioned. At the end of the chapter, it is stated that in spite of having all the instructions, a wise physician should use his own wisdom and reasoning in arriving at the correct judgment as in many cases contraindications turn into indications and vice versa according to the stage of disease and need of the patient.

'''Keywords''': Asthapana-basti, Anuvasana-basti, Panchakarma, Siddhi, Shirovirechana, Vamana, Virechana, indications, contra-indications, therapeutic enema, therapeutic purgation, therapeutic emesis, therapeutic intra-nasal administration.

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{{Infobox

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== Introduction ==

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''Dhatusamya'' i.e. equilibrium of body tissues needs to be maintained for disease free state. It is achieved by the prevention and promotion of health as well as cure of diseases. The cure of diseases is done by two means i.e. ''shodhana chikitsa'' (bio-purification therapy) and ''shamana-chikitsa'' (alleviation therapy). ''Shodhana-karma'' or ''chikitsa'' is generally considered as a synonym of [[Panchakarma]] and is accepted as the best therapy for cure of diseases without recurrence. If we go into the depth, we find that there are minor differences between ''shodhana-chikitsa'' and [[Panchakarma]]. ''Shodhana-chikitsa'' is of two types on the basis of external and internal purification where as [[Panchakarma]] is only related to internal purification of the body. Another important aspect is that there may be a long list of ''shodhana-karmas'' but [[Panchakarma]] are only five biopurificatory procedures. ''Vamana'' (therapeutic emesis), ''virechana'' (therapeutic purgation), ''asthapana-basti'' (therapeutic enema having more quantity of decoction), ''anuvasana-basti'' (therapeutic enema with medicated oil, ghee etc. fatty substances) and ''shirovirechana'' (head-evacuation) are considered under the heading of [[Panchakarma]]. These five procedures, eliminate the ''doshas'' in more quantity and are more potent in purification of the body. These procedures are intended to bring vitiated dosha from periphery (shakha) to gut (koshtha) and then expel them outside from nearest external orifice thoroughly. Some scholars include ''raktamokshana'' (blood-letting) among [[Panchakarma]]. However this opinion is not acceptable as it removes dosha directly from shakha without any prior effect on vitiated dosha in gut. Hence Raktamokshana cannot be considered under [[panchakarma]].

[[Panchakarma]] are supposed to produce ''Kaya-kalpa'' i.e. dramatic changes in the body provided properly administered considering ''desha'' (habitat), ''kala'' (season), ''dosha'' i.e. ''vata, pitta'' and ''kapha, dushya'' (those which get vitiated), ''koshtha'' (nature of bowel), ''agni'' (digestive power), ''bala'' (body strength) and ''prakriti'' (constitution of the body). Before administration of [[Panchakarma]], indications and contra-indications are essential to be considered to achieve the desired effects. [[Panchakarmiya Siddhi]] is written to discuss the suitable and unsuitable persons or patients for each of the procedure of [[Panchakarma]] which is very much crucial in getting the success. Instructions laid down in this chapter are as per general rule which are followed in most of the cases but exceptions are also found in the text considering the particular stage of disease.

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== Sanskrit text, Transliteration and English Translation ==

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yeShAM ca kArayettAni tat sarvaM sampravakShyate||3||<br />

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O! Agnivesha, we will now describe about the patients for whom [[Panchakarma]] therapies are contra-indicated with proper reasoning and the patients for whom [[Panchakarma]] are indicated. [3]

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=== Persons who are generally ''anupakramya'' (unsuitable for treatment) ===

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avasthAM pravibhajyaiShAM varjyaM kAryaM ca vakShyate||7||

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The wise physician should not treat the following types of patients:

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Henceforth, we will discuss the indications and contra-indications of each of the procedure of [[Panchakarma]] therapies considering the different situations. [4-7]

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=== Contra-indications of ''vamana karma'' ===

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sarveShvapi tu khalveteShu viShagaraviruddhAjIrNAbhyavahArAmakRuteShvapratiShiddhaM shIghratarakAritvAdeShAmiti ||9||

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If a person suffering from ''kshata'' (chest injury) is given ''vamana'' (emetic therapy), then it further aggravates the injury (to the lungs) and causes excessive haemoptysis.

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''Vamana'' given to the persons suffering from headache, pain in the ears and eyes etc. leads to aggravation of pain. Therefore, ''vamana'' is contra-indicated for all these types of patients. However, in all these cases ''vamana'' is not contra-indicated in the conditions of poisons, artificial poisons, incompatible food, intake of food during indigestion and ''ama'' (ailment caused by the product of improper digestion and metabolism) because these conditions are of emergent nature.

[9]

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=== Indications of ''vamana karma'' ===

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| All ''Kapha-dosha'' disorders mentioned in the [[Maharoga Adhyaya]] of [[Charaka Samhita]] [[Sutra Sthana]]

|}

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In these above mentioned conditions, action of ''vamana karma'' in causing cure of diseases caused by aggravation of ''kapha'' being similar to water laden paddy field getting spoiled due to clogging of water which can be corrected by the letting out the water out of the field like ''vamana'' does with ''kapha''. [10]

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=== Contra-indications of ''virechana karma'' ===

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tatra subhagasya sukumArokto doShaH syAt, kShatagudasya kShate gude prANoparodhakarIM rujAM janayet,muktanAlamatipravRuttyA hanyAt, adhobhAgaraktapittinaM tadvat, vila~gghitadurbalendriyAlpAgninirUDhAauShadhavegaM na saheran, kAmAdivyagramanaso na pravartate kRucchreNa vA pravartamAnamayogadoShAnkuryAt, ajIrNina AmadoShaH syAt, navajvariNo~avipakvAn doShAn na nirhared vAtameva ca kopayet, madAtyayitasyamadyakShINe dehe vĀyuH prANoparodhaM kuryAt, AdhmAtasyAdhamato vA purIShakoShThe nicito vĀyurvisarpansahasA~a~anAhaM tIvrataraM maraNaM vA janayet, shalyArditAbhihatayoH kShate vĀyurAshrito jIvitaM hiMsyAt,atisnigdhasyAtiyogabhayaM bhavet, rUkShasya vĀyura~ggapragrahaM kuryAt, dAruNakoShThasya virecanoddhatAdoShA hRucchUlaparvabhedAnAhA~ggamardacchardimUrcchAklamA~jjanayitvA prANAn hanyuH, kShatAdInAMgarbhiNyantAnAM chardanokto doShaH syAt; tasmAdete na virecyAH||12||

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If ''virechana'' is given to a person who is ''subhaga'' (having tender health or soft perineum), then he or she will suffer from the same disorder as described for ''vamana'' administered to ''sukumara'' (having tender health).

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''Virechana'' given in those suffering from disease beginning with ''kshata'' (chest wound) and ending with pregnancy, the defects said under ''vamana'' may arise.

Therefore, above mentioned persons should not be treated with ''virechana karma''. [12]

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=== Indications of ''virechana karma'' ===

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| ''Paittika'' type disorders mentioned in [[Maharoga Adhyaya]] of [[Charaka Samhita]] [[Sutra Sthana]]

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For the above-mentioned diseases, ''virechana karma'' is the foremost therapy. As the extinguisher of fire normalizes a house on fire, similarly ''virechana karma'' cures the diseases by eliminating aggravated ''pitta''. [13]

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=== Contra-indications of ''asthapana basti'' ===

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tatrAjIrNyatisnigdhapItasnehAnAM dUShyodaraM mUrcchAshvayathurvA syAt, utkliShTadoShamandAgnyorarocakastIvraH, yAnaklAntasyakShobhavyApanno bastirAshu dehaM shoShayet, atidurbalakShuttRuShNAshramArtAnAM pUrvoktodoShaH syAt, atikRushasya kArshyaMpunarjanayet, bhuktabhaktapItodakayorutklishyordhvamadho vA vĀyurbastimutkShipya kShipraM ghorAn vikArA~jjanayet, vamitaviriktayosturUkShaM sharIraM nirUhaH kShataM kShAra iva dahet, kRutanastaHkarmaNo vibhraMshaM bhRushasaMruddhasrotasaH kuryAt,kruddhabhItayorbastirUrdhvamupaplavet, mattamUrcchitayo rbhRushaM vicalitAyAM sa~jj~jAyAM cittopaghAtAd vyApat syAt,prasaktacchardirniShThIvikAshvAsakAsahikkArtAnAmUrdhvIbhUto vĀyurUrdhvaM bastiM nayet, baddhacchidrodakodarAdhmAnArtAnAMbhRushataramAdhyApya bastiH prANAn hiMsyAt, alasakavisUcikAmaprajAtAmAtisAriNAmAmakRuto doShaH syAt, madhumehakuShThinorvyAdheHpunarvRuddhiH; tasmAdete nAsthApyAH||15||

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Application of ''Asthapana-basti'' (non-unctuous enema) in the persons suffering from indigestion, over-uncted and just taken unctuous substances causes ''dushyodara'' (''udara-roga'' caused by aggravation of all the three ''dosha''), fainting or edema. In the cases having excited ''dosha'' and suppression of digestion power, it causes severe type of anorexia. In a person exhausted due to riding, the ''asthapana''-''basti'' disturbed by agitation dry up the body quickly leading to emaciation. In the persons who are excessively weak and suffering from excessive hunger, thirst and tiredness, ''basti'' causes the same harms as discussed for exhausted due to riding. In excessively emaciated person if ''asthapana-basti'' is applied, it increases the emaciation. In those who have just taken food and water, ''asthapana basti'' causes provocation of ''vata'' which divert the enema upwards or downwards leading to manifestation of severe diseases soon. In that undergone emesis or purgation, the ''niruha'' or ''asthapana-basti'' burns the body as alkali does the wound. In a person who has undergone the snuffing, it causes the untoward effects related to sense organs and further obstruction of the channels of circulation. In the person having anger and fear, the ''basti'' may go upwards and produce agitation. In the condition of narcosis and fainting, the ''basti'' causes further agitation and there may be complications due to mental injury. If ''asthapana basti'' is applied in the conditions of constant vomiting, excessive spitting, dyspnea, cough and hiccup, ''vata'' moving upwards can cause upward movement of ''basti''. In the persons suffering from intestinal obstruction, intestinal perforation and ascites associated with tympanitis, ''asthapana basti'' further increase the distension and may lead to the death of the patient. In the persons suffering from ''alasaka, visuchika,'' premature delivery and ''amatisara'', it causes the disorders due to ''ama'' (product of improper digestion). In diabetes mellitus and ''kushtha'' (obstinate skin diseases including leprosy), application of ''asthapana basti'' further increases these diseases. Therefore, ''asthapana basti'' should not be given to the above mentioned persons.[15]

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=== Indications of ''asthapana basti'' ===

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| Vatika disorders specially discussed in [[Maharoga Adhyaya]] of [[Charaka Samhita]] [[Sutra Sthana]]

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In the above mentioned diseases, ''asthapana basti'' is the foremost therapy. As a tree gets destroyed by cutting its roots, similarly the above mentioned diseases are eradicated by administration of ''asthapana basti''. [16]

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=== Contra-indications of ''anuvasana basti'' ===

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ya evAnAsthApyAsta evAnanuvAsyAH syuH;visheShatastvabhuktabhaktanavajvarapANDurogakAmalApramehArshaHpratishyAyArocakamandAgnidurbalaplIhakaphodarorustambhavarcobheda-viShagarapItapittakaphAbhiShyandagurukoShThashlIpadagalagaNDApacikrimikoShThinaH ||17|

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Those persons who are unfit for ''asthapana basti'', are considered unfit for ''anuvasana basti''. Conditions in which ''anuvasana basti'' is specifically contra-indicated, are listed in the table given below:

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{| class="wikitable" style="text-align: center;

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tatrAbhuktabhaktasyAnAvRutamArgatvAdUrdhvamativartate snehaH, navajvarapANDurogakAmalApramehiNAM doShAnutklishyodara~jjanayet,arshasasyArshAMsyabhiShyandyAdhmAnaM kuryAt, arocakArtasyAnnagRuddhiM punarhanyAt, mandAgnidurbalayormandataramagniM kuryAt,pratishyAyaplIhAdimatAM bhRushamutkliShTadoShANAM bhUya eva doShaM vardhayet; tasmAdete nAnuvAsyAH||18||

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If ''anuvasana basti'' is administered to the person who is empty stomach, it goes upwards due to the absence of any obstruction in the passage. In the acute fever, anaemia, jaundice and ''prameha'', ''anuvasana basti'' causes excitement of ''dosha'' which further leads to ''Udara roga'' (obstinate abdominal disease including ascites). In the person suffering from piles, use of ''anuvasana basti'' may create obstruction in the piles leading to ''adhmana'' (abdominal distension). In the person suffering from anorexia, application of ''anuvasana basti'' further diminishes the desire for food. In case of suppression of power of digestion and weakness, the application of ''anuvasana basti'' makes the digestive power poorer. If ''anuvasana basti'' is administered to the persons suffering from coryza, splenic disorders and such other diseases, it causes the further excitement of ''dosha'' which are already aggravated. Therefore, the above mentioned persons are unfit for the administration of ''anuvasana basti''. [18]

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=== Indications of ''anuvasana basti'' ===

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ya evAsthApyAsta evAnuvAsyAH; visheShatastu rUkShatIkShNAgnayaH kevalavAtarogArtAshca; eteShu hyAnuvāsanaM pradhAnatamamityuktaMmUle drumaprasekavat||19||

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The persons who are fit for ''asthapana basti'' are considered fit for ''anuvasana basti'' also. The conditions where specifically it is indicated, are listed in the table given below:

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{| class="wikitable" style="text-align: center;

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tatrAjIrNibhuktabhaktayordoSha UrdhvavahAni srotAMsyAvRutya kAsashvAsacchardipratishyAyA~jjanayet, pItasnehamadyatoyapAtukAmAnAM kRute capibatAM mukhanAsAsrAvAkShyupadehatimirashirorogA~jjanayet, snAtashirasaH kRute ca snAnAcchirasaH pratishyAyaM, kShudhArtasya vAtaprakopaM,tRuShNArtasya punastRuShNAbhivRuddhiM mukhashoShaM ca, shramArtamattamUrcchitAnAmĀsthāpanaoktaM doShaM janayet,shastradaNDahatayostIvratarAM rujaM janayet, vyavAyavyAyAmapAnaklAntAnAM shiraHskandhanetroraHpIDanaM, navajvarashokAbhitaptayorUShmAnetranADIranusRutya timiraM jvaravRuddhiM ca kuryAt, viriktasya vĀyurindriyopaghAtaM kuryAt, anuvAsitasya kaphaHshirogurutvakaNDUkrimidoShA~jjanayet, garbhiNyA garbhaM stambhayet sa kANaH kuNiH pakShahataH pIThasarpI vA jAyate, navapratishyAyArtasyasrotAMsi vyApAdayet, anRutau durdine ca shItadoShAn pUtinasyaM shirorogaM ca janayet; tasmAdete na ŚirovirecanarhAH||21||

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''Shirovirechana'' applied in the case of indigestion and full stomach causes the occlusion of the channels moving upwards by vitiated ''dosha'' which further leads to manifestation of cough, dyspnea, vomiting and coryza. In those who have taken fatty substances or desirous of taking wine or water or take after head-evacuation, ''shirovirechana'' gives rise to discharge from mouth and nose, dirt and stickiness in eyes, cataract and head diseases. If the person who has taken head- bath or takes head-bath after the therapy, then it causes the coryza. Application of ''shirovirechana'' in a person afflicted with hunger causes aggravation of ''vata dosha''. If it is administered to the person afflicted with thirst then it further increases the thirst and causes the dryness of mouth. ''Shirovirechana'' applied in the cases of fatigue, intoxication and fainting produces the same adverse effects as mentioned under the ''asthapana basti''. If this therapy is administered in the persons injured with weapons or stick, it increases the pain. In those exhausted by sexual intercourse, physical exercise and intake of alcohol, it causes pain in head, shoulder, eyes and chest. ''Shirovirechana'' applied to those suffering from acute fever and grief causes the heat to spread into the channels of eye, produces the cataract and increases the fever. If this therapy is given to the person who has undergone purgation therapy, then it aggravates ''vata dosha'' which may further leads to the damage of the sense organs. ''Shirovirechana'' given to the person who has undergone ''anuvasana basti'', causes aggravation of ''kapha dosha'' which produces heaviness of head, itching and parasitic infestation. In the case of pregnant woman, this therapy inhibits the growth of the fetus and she gives birth to an offspring who may be blind by one eye, with deformity of upper limbs, hemiplegic and with deformity of lower limbs. ''Shirovirechana'' given to the person suffering from acute coryza causes the morbidity of the channels of circulation. If this therapy is given in unsuitable season and on a cloudy day then it causes the diseases due to cold, putrefied rhinitis and head-diseases. Therefore, these persons are not fit for head-evacuation therapy. [21]

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=== Indications of ''shirovirechana'' ===

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rditApatantrakApatAnakagalagaNDadantashUlaharShacAlAkShirAjyarbudasvarabhedavAggrahagadgadakrathanAdaya UrdhvajatrugatAshcavAtAdivikArAHparipakvAshca; eteShu ŚirovirecanaM pradhAnatamamityuktaM, taddhyuttamA~ggamanupravishyamu~jjAdIShikAmivAsaktAM kevalaM vikArakaraM doShamapakarShati||22||

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The persons other than above mentioned are fit for ''shirovirechana'' (head-evacuation therapy). It is especially useful in the conditions mentioned in the table given below:

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{| class="wikitable" style="text-align: center;

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|Diseases of the part above clavicle caused by aggravation of ''vatadi dosha'' and which are free from ''ama dosha''

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In these conditions, head-evacuation is the foremost therapy as it entering into the head eliminates the entire pathogenic impurities like fibrous coating of ''munja'' (a type of grass) from the ''pith'' (''ishika''). [22]

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=== Consideration of appropriate time for ''shirovirechana'' in emergency conditions ===

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prAvRuTsharadvasantetareShvAtyayikeShu rogeShu nAvanaM kuryAt kRutrimaguNopadhAnAt; grIShmepUrvAhNe, shIte madhyAhne, varShAsvadurdine ceti||23||

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In the case of emergency, ''shirovirechana'' (head-evacuation therapy) should be given in the season other than ''pravriṭ'' (early rain), ''Sharad'' (autumn) and ''Vasanta'' (spring) by arranging environment artificially. In summer, it should be applied in the morning, in winter during noon time and in rainy season when sky is free from clouds. [23]

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=== Summary ===

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vinA tarkeNa yA siddhiryadRucchAsiddhireva sA||28||

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Now the summing up verses:-

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The wise physician should not blindly follow the general instructions laid down in this chapter in the form of conclusions but he should decide rationally using his own discretion because condition may arise due to the nature of place, time and strength of the patient in which the prescribed therapy may be ineffective and the prohibited therapy may be applicable such as emesis is prescribed in certain stage of vomiting, heart-disease and ''gulma'' (abdominal lump) though it is generally contra-indicated. Similarly ''basti'' is advised in the treatment of ''kushtha roga'' though it is generally contra-indicated depending upon the particular stage of the disease. Hence, in spite of general instructions available in the text, a physician should rationally think all the aspects using his intellect. The success achieved without proper reasoning is nothing but the success by chance. [24-28]

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ityAgniveśaakRute tantre carakapratisaMskRute~prApte dRuDhabalasaMpUrite siddhisthAne pa~jcakarmIyasiddhirnAma dvitIyo~dhyAyaH. ||2||

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Thus, ends the second chapter on successful management of [[Panchakarma]] in the treatise composed by Agnivesha, redacted by Charaka and because of its non-availability, supplemented by Dridhabala. [2]

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General indications and contraindications of all [[panchakarma]] are included in this chapter. Further it is needed to elaborate efficacy of these procedures in the specific stages of the disease.

For e.g. Asthapana Basti is contraindicated in fatigue due to excess travelling (Yanaklanta). However in other reference Yuktaratha Basti is indicated in certain conditions with similarity of pathogenesis. Though basti is contraindicated in skin diseases (Kushtha), a formulation for basti is prescribed in management of Kushtha. This is specific to the conditions associated with specific dosha. A study is required to elaborate and explain the reasons.

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== References ==

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