Panchakarma has become a familiar term for most of us today. It’s a critical component of Ayurvedic treatment. The statement ‘Ayurveda is not a treatment but a way of life’ is perhaps ubiquitous today. It essentially means that Ayurveda aims to maintain normality of health in people in addition to curing diseases.

The concept of Ayurveda is based on the Tridosha theory. According to this concept, the physical, physiological and psychological aspects of individuals are attributed to their tridoshas, or the three humors – Vata, Pitta and Kapha. A balance of tridoshas leads to normalcy in health, and a loss of it gradually results in manifestation of diseases. Many factors like diet, habits, exercise, emotional factors, seasonal variations and age may be responsible for this vitiation. To put in a nutshell, treatment in Ayurveda is about bringing the tridoshas back to normalcy.

When thinking of doshas and their balance, a question may arise as to how we bring all diseases under a single roof of dosha vitiation. How can we include conditions like infections that result from external causes? Well, Ayurveda classifies diseases into Nija (caused due to factors within the body) and Aganthu (caused due to external factors).  In case of Nija, vitiation of dosha occurs prior to the disease, whereas in Aganthu, the causative factor precedes vitiation of doshas.  Thus deviation from normalcy of doshas occurs in both cases.

Hence treatment in Ayurveda consists of several steps, which include identification of causes of the disease and their prevention (nidana parivarjana), expulsion of the vitiated dosha from the body (sodhana chikitsa), alleviation of the doshas that are vitiated (samana chikitsa) and finally rejuvenation of the body to its original state (rasayana chikitsa). Among this, samana chikitsa and sodhana chikitsa are major treatments. Samana chikitsa is relatively simple and can be done on an outpatient basis. Dosha balance can be restored by the gentle procedures of samana if the perturbation is mild. Sodhana chikitsa/ panchakarma is a more complex procedure, and it expels the vitiated doshas from the body. In more simple terms, Panchakarma flushes out the toxins and uproots the disease completely, and is done especially when the perturbation of doshas is severe.

Concept of personalised medicine in Ayurveda

The normalcy of doshas in an individual is considered as prakriti of that particular individual. Prakriti can be somewhat regarded as the Ayurvedic way of determining the genetic constitution of an individual in terms of three doshas.

Genomic studies of recent times have proved that people with similar prakriti have identical genetic make-up. Though the prakriti is grouped broadly into seven, depending upon the predominance of one or two or three doshas (one type), innumerable permutations and combinations are possible between them. It is similar to each human having a unique genetic combination, where two persons can be genetically similar but not exactly alike.

Disease is considered as a deviation from prakriti. Since the normalcy of doshas is unique for each individual, their deviation from normalcy is also unique and consequently so is the required treatment for the individual. This is essentially why we call Ayurveda a personalised medicine.

Panchakarma

The term Panchakarma means five processes. The five karmas include Nasya (instillation of nasal medication), Vamana (emesis/ vomiting), Virechana (purgation), Snehavasthi (oil enema) and Kashyayavasthi (decoction enema). Raktamoksha (bloodletting) is also an important process in the surgical point view of Ayurveda, even though it is not included under Panchakarma.

A Panchakarma treatment can be divided into three phases:-

n  Purva karma/ preceding phase /preparatory phase. This phase includes Snehapana (oil/ghee intake) and Sweda karma (sudation therapies).

n  Pradhana Karma/main phase of Panchakarma treatment – includes the five processes mentioned above.

n  Paschaat Karma/ succeeding phase/Follow up – mainly includes dietary patterns

Purva karma/preparatory phase

Snehapana (oil/ghee intake)

Snehapana can be prepared in two ways. One method is to have oil/ghee daily in small doses (Vicharana snehapana) along with normal food. The second method is to have oil/ghee in increasing dose on empty stomach for 3-7 days (Accha Snehapana). The second method can be done only when the person is completely under doctor’s direct supervision since there are increased chances of complications. The type of Snehapana, the dosage, type of oil/ ghee/animal fat and the number of days, all depend upon the patient’s strength and disease condition and should be determined by the doctor.

Snehapana is arguably the most difficult form of treatment for the patient as well as the doctor, especially when performed in high doses. The oil or ghee consumed as part of this procedure spreads all over the body, and in the last days of Snehapana, one can smell the ghee in the hair, skin and bed of the patient and also feel the oil in their skin and hair follicles.

Svedana Karmas (sudation therapies)

Svedana Karmas are done in conjunction with external oil application. It’s normally done after internal administration and along with external application of oil. It includes almost all types of massages. These processes are often done under the label of Panchakarma whereas in reality it’s only a preparatory therapy of Panchakarma.  Svedana Karma can be done in various techniques like oil application and steaming; application of bolus made of medicated powders, leaves, rice etc. The required technique is selected based on the condition of the patient. This phase of treatment is usually pleasurable for the patient, but many restrictions are required for a successful therapy. Generally, it’s done for seven days. The procedure can be continued till the certain symptoms of saturation or optimum application (samyak lakshanas) appear in the patient. More than one Svedhana karma can be done in a patient.

The oil intake/snehapana and sudation therapies/Sweda Karmas can also be done as Samana Chikitsa. In such cases, it’s not associated with Panchakarmas. However, for doing Panchkarmas, oil intake and sudation therapies are mandatory. The five purification procedures on their own can’t remove vitiated doshas present in the vast network of body channels. Hence the purvakarmas help to loosen and mobilize the doshas from the body channels, clear the openings of the channels into the alimentary canal and deliver them into its lumen.

Five Pradhan karmas/ Main processes

Vamana/ Emesis

 The Vamana process is done to eliminate the vitiated kapha dosha from the body. Specific emetic drugs are selected as per the condition of the patient and repeated emesis is induced for the complete elimination of doshas.

Virechana/Purgation

Virechana is done to eliminate the vitiated Pitta dosha from the body. The purgative drug and its dose are determined by the condition of the patient.

Vasthi/ Enema

Vasthi is of two types – Kashaya Vasthi (non-lubricant) and Sneha vasthi (lubricant enema). It is done to eliminate the vitiated Vata dosha. Decoction enema/ Kashaya Vasthi plays a major role in elimination of doshas, but it can be done only in combination with oil enema. Otherwise it may give rise to complications. The number of days and medication for Vasthi is determined by the condition of the patient. Vasthi alone is regarded as half treatment in many conditions.

Nasya (nasal instillation of medicine)

Nasya includes the instillation of nasal medication and is done for the elimination of doshas, mainly in diseases affecting head and neck region. The Purvakarmas like snehapana and generalised swedana is not mandatory for nasya. But application of oil and fermentation is done in the head and neck region. The purvakarmas like Snehapana and generalised swedana is not mandatory for nasya. But application of oil and fermentation is done in the head and neck region just before the procedure.

Rakta Moksha

Rakta Moksha is also an important process of Sodhana, but is not included under the title of Panchakarma. This process includes the removal of impure blood from different sites of the body through scarification using metallic instruments and application of leeches. The site depends upon the disease condition. This treatment is seen to be effective in cases where other treatment procedures fail to yield results.

Panchakarma -- Follow up treatments

During this phase, the body will be in a very fragile condition.  The digestive capacity will be weak and to protect and enhance the same, certain dietary patterns and restrictions (pathya kala) are advised for this period. In practice, it’s normal to take upto three months before receiving the benefits of Panchakarma even though changes start to occur just after the treatment. This period doesn’t require hospitalisation.

(Authors Dr Divya P and Dr Ramesh G are Consultants of Agasthya Parva Ayurveda)