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− | ''Panchakarma'' literally means five therapeutic procedures.
| + | The word panchakarma is composed of two words, ‘pancha’ and ‘karma’. Pancha means five and karma means ‘action’. In this context karma represents therapeutic procedure or treatment given by a physician. Thus, Panchakarma means the five kinds of therapeutic procedures or treatments. This includes therapeutic emesis ([[vamana]]), therapeutic purgation ([[virechana]]), therapeutic enema with decoction (niruha), therapeutic enema with unctuous substances (anuvasana) and trans-nasal drug administration ([[nasya]]). These procedures are intended to maintain equilibrium in body by expelling the excessively aggravated [[dosha]] outside through nearest external route. [Chakrapani on [[Sutra Sthana]] 2/15] [Su.Sa.Chi.33/3]. These are indicated as seasonal regimen for preservation of health and prevention of diseases. [Cha.Sa.[[Sutra Sthana]] 7/45-50] |
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− | ==Panchakarma==
| + | {{Infobox |
− | The five therapeutic procedures are generally indicated for expelling out the excessively aggravated ''dosha'' and maintain equilibrium of ''dosha'' in body. [[Panchakarma]] is the most essential part of [[Ayurveda]] treatments. It can be practiced as preventive, preservative, promotive, curative and rehabilitative therapy as per the need of the patient.<ref name=Bhatted2011>Bhatted S, Shukla V D, Thakar A, Bhatt N N. A study on Vasantika Vamana (therapeutic emesis in spring season) - A preventive measure for diseases of Kapha origin. AYU [serial online] 2011 [cited 2019 Feb 20];32:181-6. Available from: http://www.ayujournal.org/text.asp?2011/32/2/181/92562</ref>
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− | ==Five therapeutic procedures== | + | |title = Contributors |
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− | ===''Vamana'' ( therapeutic emesis):=== | + | |label1 = Section/Chapter/topic |
− | It is beneficial in vitiation of Kapha dosha disorders. For preservation of health, it is followed in Vasanta ritu (spring season) during March-April in India.<ref name=Bhatted2011/>
| + | |data1 = [[Chikitsa]] / [[Pachakarma]] |
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− | ===''Virechana'' (therapeutic purgation):=== | + | |label2 = Authors |
− | It is beneficial in vitiation of Pitta dosha disorders. For preservation of health, it is followed in Sharada ritu (autumn season) during October in India.
| + | |data2 = Aneesh E.G., Deole Y.S. |
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− | ===''Basti'' (therapeutic enema)=== | + | |label3 = Reviewed by |
− | It includes two types viz. ''Niruha'' (enema with medicinal decoction) and ''Anuvasana'' (enema with unctuous substance mainly oil).It is beneficial in vitiation of Vata dosha disorders. For preservation of health, it is followed in Varsha ritu (rainy season) during July-August in India.
| + | |data3 = Basisht G. |
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− | ===''Nasya'' (nasal errhines/ drug delivery through nose)=== | + | |label4 = Affiliations |
− | It is indicated in the disorders of body parts above the supra-clavicular region like head, ear, nose and throat.
| + | |data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar |
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− | ===''Raktamokshana'' (blood letting modalities)=== | + | |label5 = Correspondence email: |
− | This procedure is indicated in vitiation of blood specifically in the diseases like Kushtha(skin diseases), Vatarakta etc.
| + | |data5 = carakasamhita@gmail.com |
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− | ==Related Chapters== | + | |label6 = Date of first publication: |
− | The description of ''Panchakarma'' procedures is elaborated in sections of [[Siddhi Sthana]] and [[Sutra Sthana]] chapters. The medicines used in these procedures are described in [[Kalpa Sthana]].
| + | |data6 = June 25, 2020 |
| + | }} |
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− | *[[Kalpana Siddhi]], [[Panchakarmiya Siddhi]], [[Bastisutriyam Siddhi]], [[Snehavyapat Siddhi]], [[Netrabastivyapat Siddhi]], [[Vamana Virechana Vyapat Siddhi]], [[Bastivyapat Siddhi]], [[Prasrita Yogiyam Siddhi]], [[Trimarmiya Siddhi]], [[Basti Siddhi]], [[Phalamatra Siddhi]], [[Uttar Basti Siddhi]]
| + | ==Synonyms== |
− | *[[Snehadhyaya]], [[Swedadhyaya]], [[Upakalpaniya Adhyaya]], [[Chikitsaprabhritiya Adhyaya]]
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− | ==Researches on Panchakarma== | + | *Shodhana: It literally means purification. It is the procedure by which excessively aggravated [[dosha]] are expelled out from the body [AH.Su.14/5] |
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| + | *Virechana: It literally means specifically dragging outside. At some places, this term is applied to denote evacuation of [[dosha]] through upward (mouth) and downward (anus) directions. [Cha.Sa.[[Kalpa Sthana 1/4]. Mostly this term is used to denote therapeutic purgation only. |
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| + | ==Five procedures== |
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| + | #Therapeutic emesis ([[Vamana]]) |
| + | #Therapeutic purgation ([[Virechana]]) |
| + | #Trans nasal drug administration([[Nasya]]) |
| + | #Therapeutic enema with decoction (Niruha[[basti]]) |
| + | #Therapeutic enema with unctuous substances (Anuvasana[[basti]]) |
| + | #Bloodletting ([[Raktamoksha]]) |
| + | |
| + | ==Inclusion of bloodletting ([[raktamoksha]]) in panchakarma== |
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| + | There are differences in opinions about inclusion of bloodletting ([[raktamokshana]]) in five purification procedures. The total number remains five only as they combine two types of enema (unctuous and non-unctuous) in single procedure[A.H.Su.14/5]. However, this inclusion is not supported by Charak as it does not fulfill the inclusion criteria with fundamental principles of purification. The reasons are as below: |
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| + | #Panchakarma are intended to expel out [[dosha]] only. Blood ([[rakta]]) is a body component under category of [[dhatu]], not [[dosha]]. |
| + | #The principles of purification state to take aggravated [[dosha]] from periphery (shakha) to gut (koshtha) by preparatory procedures. Then the [[dosha]] is removed through nearest external opening of body. In case of bloodletting, the [[dosha]] in periphery are removed through artificial opening created by using some instrument. |
| + | #Panchakarma procedures are intended towards generalized purification of whole body with additional benefits on mind and senses. However, [[raktamokshan]] mostly shows limited local benefits on purification of [[rakta] [[dhatu]]. |
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| + | ==Principles of Panchakarma== |
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| + | The following principles are applied in panchakarma procedures: |
| + | #The procedure is intended to correct imbalance in body physiology. It shall remove excessively aggravated [[dosha]] and bring them to normal state. |
| + | #The procedure is performed only in a state of excess aggravation (bahu[[dosha]]) and natural tendency to get removed (utklesha) through nearest natural orifice. |
| + | #If the [[dosha]] are in dormant state (leena[[dosha]]), then procedure is performed after bringing them to gut (koshtha) from periphery (shakha). The following factors lead to movement of [[dosha]] from periphery to gut. [Cha.Sa.[[Sutra Sthana]] 28/33] |
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| + | *Aggravation of [[dosha]] (vriddhi) |
| + | *Liquefaction of [[dosha]] (vishyandana) |
| + | *Suppuration of [[dosha]] (paka) |
| + | *Clearing the body channels (srotoshodhana) |
| + | *Pacification of [[vata]] (vayunigraha) |
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| + | ==General protocol for conducting panchakarma== |
| + | |
| + | For safe and effective administration, each procedure is conducted in the following three steps: |
| + | #Preparation of patient (Purvakarma) |
| + | #Main procedure (Pradhanakarma) |
| + | #Post therapy regimen (Pashchatkarma) |
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| + | ===Preparation of patient(Purvakarma)=== |
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| + | This includes the therapies prior to a panchakarma procedure. These are mainly intended for bringing [[dosha]] in gut. The general therapies are as below: |
| + | *[[Deepana]]: This is initiation and stimulation of process of digestion and metabolism |
| + | *[[Pachana]]: This is enhancing process of digestion specially the undigested and poorly metabolized substances ([[ama]]) |
| + | *[[Snehana]]: This is oleation therapy or lubrication in the form of internal administration and external application of unctuous substances |
| + | *[[Swedana]]: This is sudation or fomentation |
| + | These procedures are done to detach [[dosha]] from their sites of vitiation, expedite their movement and bring them to gut to get expelled out. |
| + | Through these procedures, the [[dosha]]s are liquefied and moved towards gut. This helps in removing obstruction in the body channels and pacifying [[vata]][[dosha]] for its normal movements. |
| + | The medicines and time span for these preparatory procedures varies according to type of procedure and biological condition of patient or individual undergoing treatment. |
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| + | ===Main procedure(Pradhanakarma)=== |
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| + | The main procedure is performed based upon the disease conditions, site of [[dosha]] vitiation and nearest route to expel it. If a healthy person is following these procedures for preservation of health, then the general sequence includes therapeutic emesis, followed by purgation, unctuous enema, enema with decoction, trans-nasal drug administration. For management of disease, one or more procedures are performed till [[dosha]] equilibrium is achieved. Specific parameters based on end-results of [[dosha]] state (antiki), number of episodes (vegiki) and clinical features observed (laingiki) are observed during each procedure to assess efficacy of therapy. |
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| + | ===Post therapy regimen(Pashchatkarma)=== |
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| + | Specific regimen (samsarjana krama) is indicated after completion of the main procedure. The strength is weakened due to expulsion of [[dosha]] outside. Therefore, in order to regain the strength of body and correct digestion, certain guidelines in diet and lifestyle must be followed. |
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| + | ==Indications== |
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| + | Mainly two factors are considered before implementing panchakarma. |
| + | *State of [[dosha]] |
| + | *Suitability and strength of person/patient. This includes co-morbidities too. |
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| + | ===State of [[dosha]]=== |
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| + | *[[Dosha]] should be in excessive aggravated state [Cha.Sa.[[Sutra Sthana 16/13-16]] |
| + | *Excessive vitiation of either [[kapha]], [[pitta]],[[rakta]] and wastes (mala). |
| + | *Affliction and obstruction of [[Vata]][[dosha]]. [Cha.Sa.[[Sutra Sthana]] 22/19] |
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| + | The state of excess aggravation of dosha is observed by following clinical features: |
| + | Indigestion, anorexia, corpulence, anemia, heaviness, exhaustion, eruption of pimples and wheals (bumps or itchy sores), pruritis, sluggishness, indolence, weakness, foul smell of the body, lassitude, precipitation (utklesha) of [[kapha]] and [[pitta]], sleeplessness or excessive drowsiness, impotency, impediment to intelligence, inauspicious dreams, and loss of strength and complexion inspite of taking nourishing diet and correct therapy. [Cha.Sa.[[Sutra Sthana]] 16/13-15] |
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| + | ===Person=== |
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| + | The person should have good strength in order to withstand the purificatory procedures [Cha.Sa[[Sutra Sthana 22/19]. |
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| + | ==Contraindications== |
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| + | *If the [[dosha]] are not in aggravated state or are in dormant state |
| + | *If [[dosha]] are deep-seated inside the body channels ([[srotas]]) or tissues ([[dhatu]]) |
| + | *If the strength of the person is less |
| + | *If the seasonal condition is not favorable (unless in emergency) |
| + | *If the patient suffers from diseases of thigh (urustambha) |
| + | *If the patient is not willing to undergo treatment |
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| + | ==Importance of Panchakarma== |
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| + | *Panchakarma are indicated for purification of body, mind and senses. It helps to maintain equilibrium of body components. It is an important part in seasonal regimen for preservation of health. It eradicates diseases from their roots. Therefore, prevention of disease occurrence and recurrence is possible through panchakarma. These are preferred over pacification therapies ([[shamana]]) where recurrence is possible [Cha.Sa.[[Sutra Sthana]] 16/20]. |
| + | *Purification results in improvement in functioning of agni (factors responsible for digestion and metabolism), clarity of sense organs, mind, intellect, strength and virility. [Cha.Sa.[[Sutra Sthana]] 16/17-19]. |
| + | *Panchakarma are pre-requisite for rejuvenation ([[rasayana]) therapy. In order to get the complete benefit of rejuvenation, purification is essential [Su.Sa.Chi.27/3]. |
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| + | ===Importance in preservation of health and prevention of disease=== |
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| + | The [[dosha]] have a natural tendency to get aggravated in specific seasons due to environmental conditions. If the aggravated [[dosha]] are removed properly by following seasonal regimen, then diseases can be prevented and equilibrium of health can be maintained [Cha.Sa.[[Sutra Sthana]] 07/46]. For example, [[vata]] [[dosha]] is aggravated in early rainy season. If it is managed through administration of therapeutic enema ([[basti]]) in that season, then diseases due to [[vata]] [[dosha]] can be prevented. It is the best treatment to normalize [[vata]] [Cha.Sa.[[Siddhi Sthana]] 1/40]. |
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| + | ===Suitable seasons for purification therapy in healthy individuals=== |
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| + | Following panchakarma procedures are indicated in seasonal regimen to preserve health [Cha.Sa.[[Sutra Sthana]]]7/46] [Cha.Sa.[[Siddhi Sthana]] 6/5-6]. |
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| + | {| class="wikitable" |
| + | |- |
| + | ! Season !! Month in Indian subcontinent !! Naturally aggravated [[dosha]] !! Prescribed therapy for purification |
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| + | | | Early rains (Pravrit) ||Mid June to Mid August||[[Vata]]||Therapeutic enema ([[basti]]) |
| + | |- |
| + | | |Autumn (Sharad)||Mid October to Mid December||[[Pitta]]||Therapeutic purgation ([[virechana]]) |
| + | |- |
| + | | |Spring (Vasant)||Mid February to Mid April||[[Kapha]]||Therapeutic emesis ([[vamana]]) |
| + | |- |
| + | |} |
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| + | Trans-nasal administration in low dose (pratimarsha [[nasya]]) is advised as a part of daily regimen to preserve health. It has preventive and protective effect against the diseases of head and neck region [Su.Sa.Chi.40/52]. The time of trans-nasal administration varies according to season. |
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| + | ===Importance in management of disease=== |
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| + | Panchakarma are indicated in management of all diseases in which the [[dosha]] are excessively aggravated and need to be removed from body [Cha.Sa.[[Vimana Sthana]] 3/44]. |
| + | Panchakarma are administered in acute exacerbated conditions of diseases like skin diseases (kushtha) [Cha.Sa.[[Chikitsa Sthana]] 7], erysipelas(visarpa)[Cha.Sa.[[Chikitsa Sthana]] 21], diseases of three vital organs -heart, brain and kidney (tri [[marma]])[Cha.Sa.[[Chikitsa Sthana]] 26]. |
| + | These therapies are effective in management of chronic diseases by removing toxins like [[ama]]. Panchakarma therapies like unctuous enema (anuvasana) are utilized for restoration of health. Panchakarma is helpful in the prevention of diseases, preservation and promotion of health. |
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| + | ==Cautions in administration of panchakarma== |
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| + | The only contra-indication for panchakarma is urustambha (diseases of thigh) [Cha.Sa.[[Chikitsa Sthana]] 27/20-22]. In this condition, only drying therapies ([[rukshana]]) are indicated. |
| + | Improper administration of panchakarma procedures can lead to diseases like skin disorders [Cha.Sa.[[Chikitsa Sthana]] 7/6], diseases of digestion (grahani) [Cha.Sa.[[Chikitsa Sthana]] 15/43], disease due to [[vata]] vitiation [Cha.Sa.[[Chikitsa Sthana]] 28/15]. Excessive or inadequate administration of panchakarma also leads to complications [Cha.Sa.[[Siddhi Sthana]]. Therefore, the panchakarma shall be administered cautiously after considering all suitable factors. Otherwise it may fail to give expected results and cause complications [Cha.Sa.[[Siddhi Sthana]] 1/59]. |
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| + | ==Contemporary approach== |
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| + | Panchakarma are popularly known as detoxification therapies, cleansing therapies, purification therapies or elimination therapies in healthcare society today. Various modifications of these procedures are in vogue. |
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| + | Some scholars classify panchakarma in two categories. 1. Classical and 2. Traditional |
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| + | 1. Classical panchakarma therapies are followed as described in classics. |
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| + | 2. Traditional panchakarma therapies are modified and sophisticated external oleation and sudation therapies based on classics. These are widely publicized as Keraliya panchakarma. Some practitioners consider pouring medicated liquid on head (shiraseka), whole body (kaya seka), application of processed rice in bolus (shashtikashalipindasweda), as paste on body (anna lepa), application of herbal paste on head (shirolepa) as keraliya panchakarma. These therapies gained global recognition due to their efficacy and practices in resorts and spas. |
| + | However, the fundamental principles of panchakarma therapies shall always be followed to achieve maximum benefit. |
| + | |
| + | ==Current researches== |
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| + | Many research studies show efficacy of panchakarma therapies in management of diseases. |
| + | *Research has shown that it reduces risk factors for heart disease and decreases blood levels of fat-soluble toxins such as polychlorinated biphenyls and agrochemicals by about 50%. |
| + | *External and internal purification therapy is found to be effective in reducing the symptoms of blistering skin disease (visphotakushtha) within a short duration with a longlasting effect. |
| + | *Panchakarma followed by internal medications showed amelioration of motor, sensory and sphincter deficits in case of GuillainBarre syndrome. |
| + | *Panchakarma along with internal medications showed improvement in growth and development and also reduces spasticity in spastic cerebral palsy. |
| + | *The quality of life of patients can be improved through panchakarma procedures especially in case of skin disorders. |
| + | *In neurodegenerative conditions like supranuclear palsy Ayurvedic treatment modalities including panchakarma is found effective in causing symptomatic improvements. |
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| + | ==List of theses done== |
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| + | There are total 99 research works done on various procedures of panchakarma in last 17 years since 2001 to 2018. |
| + | The following table shows number of research works done on each procedure: |
| + | {| class="wikitable" |
| + | |- |
| + | ! Serial NO. !! Name of procedure !! Number of research works |
| + | |- |
| + | | | 1 ||[[Snehana]]||11 |
| + | |- |
| + | | |2||[[Swedana]]||3 |
| + | |- |
| + | | |3||[[Vamana]]||17 |
| + | |- |
| + | | |4||[[Virechana]]||39 |
| + | |- |
| + | | |5||[[Basti]]||35 |
| + | |- |
| + | | |6||[[Nasya]]||11 |
| + | |- |
| + | | |5||[[Raktamoksha]]||5 |
| + | |- |
| + | |} |
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| + | Following list shows theses works done on the general aspects of panchakarma. |
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| + | #Chaturvedi GN (1959): A study of panchakarma therapy vis-à-vis its physio-pathological basis.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #Vasant Sohanlal (1960): Panchakarma shastram.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #Parashar BN (1965): Sodhanamdoshanirghatanam.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #Selote SB (1962): Elimination therapy.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #Ramu MG (1966): Diseases of raktavahasrotasa and shodhana therapy.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #Arunachalam S (1969): Sanshodhanasanshamanachikitsa in agnimandya.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #Pilapitiya U (1969): Sanshodhana and sanshamanachikitsa in amlapitta.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #Vidya Shekar MS (1971): Shodhanaupakrama for tridosha.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #Misha SK (1988): A clinical study on the role of shodhana in the management of vicharchika.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #Moradia Ghanshyam (1990): A comparative study on the role of shodhana and shaman therapies of gridhrasi (sciatica).Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #ManoranjanSahu (2002): A critical study on aetiopathogenesis of Gridhrasi and its management with RasnaGuggulu along with Shodhana therapy.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
| + | #Nakum Sudha K (2003): Comparative study of the roleofShamana (Rasayana) andShodhana therapy inVicharchika.Department of Kayachikitsa, I.P.G.T. & R.A. Jamnagar |
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| + | ==More information== |
| + | |
| + | [[ApamargaTanduliyaAdhyaya]] [[Snehadhyaya]] [[Swedadhyaya]] [[Upakalpaniya Adhyaya]] [[Chikitsaprabhritiya Adhyaya]] [[Kalpana Siddhi]] [[Panchakarmiya Siddhi]] [[Bastisutriyam Siddhi]] [[Snehavyapat Siddhi]] [[Netrabastivyapat Siddhi]] [[Vamana Virechana Vyapat Siddhi]] [[Bastivyapat Siddhi]] [[Prasrita Yogiyam Siddhi]] [[Trimarmiya Siddhi]] [[Basti Siddhi]] [[Phalamatra Siddhi]] [[Uttar Basti Siddhi]] |
| + | |
| + | ===Related Articles=== |
| + | |
| + | [[Vamana]] [[Virechana]] [[Basti]] [[Nasya]] [[Raktamoksha]] [[Snehana]] [[Swedana]] |
| + | |
| + | ===List of references=== |
| + | |
| + | The list of references for Panchakarma in Charak Samhita can be seen here |
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− | *Bharti Gupta, Physiological and biochemical changes with Vamana procedure, AYU, 2012, 33,3:348-355
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− | *Santoshkumar Bhatted, VD Shukla, Anup Thakar, NN Bhatt, A study on Vasantika Vamana (therapeutic emesis in spring season) - A preventive measure for diseases of Kapha origin, 2011, 32( 2): 181-186
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− | *Ranjip Kumar Dass, Nilesh N Bhatt, Anup B Thakar, Vagish Dutt Shukla, A comparative clinical study on standardization of Vamana Vidhi by classical and traditional methods, 2012, 33 (4) : 517-522
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− | *Somsri Wiwanitkit, Viroj Wiwanitkit, Vamana procedure, AYU, 2011, 32(3): 434
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− | *Adil Rais, Santoshkumar Bhatted, Clinical study to evaluate the effect of Virechanakarma on serum electrolytes, AYU, 2013,34(4):379-382
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− | *Anand RM, Gurjar GK, Virechana Karma in Indian literature, Bulletin of Indian Institute of History of Medicine, 1976;6(1):37-41.
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− | *Yashwant M Juneja, Anup B Thakar, Clinical evaluation of Basti administered by Basti Putak (Pressure method), Enema pot method (Gravity fed method), and syringe method in Kshinashukra (Oligozoospermia), 2011 , 32 (2) : 234-240
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− | *SS Savrikar, CE Lagad, Study of preparation and standardization of Maadhutailika Basti' with special reference to emulsion stability, 2010, 31(1) : 1-6
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− | *Pharmacodynamics of Nasya Karma K.Y., Srikanth, V. Krishna murthy, M. Srinivasulu, International Journal of Research in [[Ayurveda]] & Pharmacy, 2011; 2(1):24-26.
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| ==References== | | ==References== |