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*Curative: Curative approach in major non communicable diseases and communicable diseases.
 
*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]].
 
*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]].
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====Therapeutic emesis ([[Vamana]])====
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[[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<ref>Patil SG, Thakar AB. Efficacy of Vamana Karma with Ikshvaku Ksheera Yoga in the management of Tamaka Shvasa (bronchial asthma). Ayu. 2017 Jan-Jun;38(1-2):10-14. doi: 10.4103/ayu.AYU_95_13. PMID: 29861586; PMCID: PMC5954254.</ref>, allergic bronchitis, rhinitis, sinusitis, migrane, hyperacidity, indigestion, anorexia, obesity, overweight, dyslipidemia, diabetes mellitus, acne vulgaris, psoriasis, eczema, urticaria etc.
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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.<ref>Rohini RN, Niranjan R. A clinical study to evaluate the efficacy of Vamana karma with Kalingadi yoga in amavata w.s.r to Rheumatoid arthritis. Int J. Ayur Pharma Chem. 2019 Vol.11 Issue 2. e ISSN 2350-0204]</ref>
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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.
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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.
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====Therapeutic purgation ([[virechana]])====
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[[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.
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Studies show that [[virechana]] can lower hepatic glucose production and helps to prevent elevated blood sugar level.<ref>Chaturvedi A, Rao PN, Kumar MA, Ravishankar B, Rao N, Ravi M. Effect and Mechanism of Virechana Karma (Therapeutic Purgation) Over Fructose-Induced Metabolic Syndrome: An Experimental Study. J Evid Based Complementary Altern Med. 2016 Jul;21(3):194-201. doi: 10.1177/2156587215596283. Epub 2015 Jul 22. PMID: 26207023.</ref>
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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.
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====Therapeutic enema ([[basti]])====
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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).
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'''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.<ref>Pulak Kanti Kar et al: Effect Of Mustadi Yapana Basti On Vyadhikshamatwa With Special Reference To T.B Specific Immunoglobulin Estimation In Rajayakshma. International Ayurvedic Medical Journal. 2019. [cited  18th January, 2022] Available from: http://www.iamj.in/posts/2019/images/upload/1772_1780_1.pdf</ref>
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'''Anuvasana basti:''' It influences the immune function of the body by production of T helper cells, leucocytes, cytokines and modulation of lymph mechanism.
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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.<ref>Shukla, Gyanendra D., Pandey, Shweta, &Thakar, Anup.B. (2012). Pharmacodynamic understanding of Basti: A contemporary approach. International Journal of Pharmaceutical & Biological Archives, 3(4), 893-896.</ref>
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'''Genomic study on the effect of virechana and basti'''
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[[File: Basti_volcano_plot.JPG|500px|'''Image 1: Volcano plot - Basti'''|thumb]]
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[[File: Virechana_volcano_plot.JPG|500px|'''Image 2: Volcano plot - Virechana'''|thumb]]
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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.
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'''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.<ref>Adil R. A comparative study to evaluate the efficacy of Virechana karma and Kaala Basti along with Shamana Drug in the management of Pakshaghata involving Clinical and Ayurgenomics approach. [PhD Thesis]. Dept. of Pancahkarma. IPGTRA Jamnagar.</ref>
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Upregulated pathways after [[virechana]]:
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*NF kappa B signaling pathway: Compensates the damage caused by reactive oxygen species and inflammation resulting after ischemic attack.
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*NOD like receptor signaling pathway: Prevention of added infections by helping in formation of another defense line.
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*Cytosol DNA sensing pathway enrichment: Triggers robust immune responses including inflammasome activation.
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*Antigen processing and presentation: Promotion of immune responses.
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*Hematopoietic stem cell lineage: Neuroprotection and reduction in post ischemic inflammation.
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Downregulated pathways after [[virechana]]:
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*Jak stat signaling pathway: Restoration of the calcium ions and tight junctions.
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*Reinstating the brain homeostasis by blood brain barrier patch up.
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*Map kinase signaling pathway: Prevention of further development of pathological changes in the brain tissue and prevent further damage due to stroke.
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*Cellular senescence: Maintenance of integrity of blood brain barrier.
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*Glycosphingolipid biosynthesis-ganglio series: Ameliorates atherosclerosis, causes a profound reduction of plasma cholesterol.
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Upregulated pathways after [[basti]]:
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*Antigen processing and presentation: Upliftment of the immune system for the prevention of any infection immediately after stroke.
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*Natural killer cell mediated cytotoxicity: Potent boost to immune system, preventing further infection or inflammation in the brain tissue.
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*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).
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Down regulated pathways after [[basti]]:
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*Regulation of Actin cytoskeleton: Detrimental effect on production of reactive oxygen species, thus protection from degenerative changes.
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*Osteoclast differentiation: Reducing the level of osteoprotegerin (atherosclerosis and cardio vascular diseases).
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*Hematopoietic cell lineage: Checking high inflammatory responses after stroke by lymphocyte and monocyte production.
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*Jak-Stat signaling pathway: Activation of Jak Stat pathway leads to decreased cerebral recovery.
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*Th1 and Th2 cell differentiation: Control of inflammation post stroke incidence.
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*Apoptosis: Preventive application of [[basti]] in stroke management through regulation of apoptosis and preventing cell death.
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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]].
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