Introduction

Panchakarma is an important part of treatment in Ayurved. The word ‘Panchakarma’ is made from two words. ‘Pancha’ means five and ‘Karma’ means processes. It means five processes are described in Ayurved which are useful in detoxification or taking out unwanted/vitiated materials/allergens out from body by the nearest path. Panchakarma is useful for healthy persons to cleanse the body on regular basis with different karmas. These karmas are to be done by a healthy person according to seasonal changes to obtain maximum benefits. Panchakarma is helpful in many diseases and can be done according to the need of the disease treatment. People have a misconception that Panchakarma means various types of massages and few other processes. It is completely wrong. Here we have elaborated the processes of Panchakarma for better understanding.

Panchakarma has gained very importance in Ayurvedic treatments but at the same time it is clearly mentioned in ancient texts that,

1. It should be done only if required.

2. According to the need type of Panchakarma is to be selected.

3. It is to be done under strict supervision of a specialist.

4. It is a time and effort consuming procedure hence will be always costly hence to be done in avoidable conditions only.

5. Processes if not done correctly may give few hazards hence should be done only if required.

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Concept of season in Ayurved

According to Ayurved nature shows different seasons. These seasons do show impact on human body and mind, which can be good or bad. The bad impact can produce unwanted things in excess quantity which should be taken out by appropriate way. Here Panchakarma plays an important role in healthy person’s life as well as in diseased persons too.

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There are six seasons described in Ayurved. Entire year is divided in these seasons. Each season is generally categorized in two month periods. The division is as follows:

Season’s name                  Period (months in Indian language / months in Indian language)

1. Shishir (winter end)                        Magh – Falgun / December – January

2. Vasant (summer start)                    Chaitra – Vaishakha / Feb – March

3. Grishma (Summer)                         Jyeshtha – Ashadha / April – May

4. Varsha (Rains)                                 Shravan – Bhadrapad / June – July

5. Sharad (summer)                            Ashwin – Kartik / August – September

6. Hemant (winter start)                     Margashirsh – Paush / October – November

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This is a broad division of time and can show a difference of about 15 days (either before or after this period). In between every season, the cusp period shows mixed symptoms of both seasons. This period is considered to be last 15 days of ending season & starting 15 days of the new season. It is called ‘Ritu-sandhi’. This period is considered to be bad for health since a lot of changes happen with the climate in a short period of time. If body resistance is low, various diseases or symptoms can get established easily. e.g. season change gives allergic cough and cold to large number of population. Seasons varies in various combinations at various places depending on solar displacement at that point on earth. E.g. Mumbai shows mainly 4 seasons and they are Vasant, Grishma, Varsha and Hemant.

According to seasons, specific karmas are done to nullify the unwanted changes happening in body. Season wise karmas are as follows:

Karma                                     Season

Vaman                                      Vasant

Virechan                                   Grishma & Sharad

Basti                                         Varsha, Hemant and Shishir

Nasya                                       All seasons (various types of Nasya are done)

Rakta-mokshana                     Sharad

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Panchakarma Procedure

Any karma is done in a particular way which consists of 3 steps.

1. Purva Karma (pre-process management)

2. Pradhan karma (actual process)

3. Pashchat karma (Post-process management)

 

Purva karma (pre-process management): Before doing any Panchakarma process, two processes are done as pre-management. They are Snehan (lubrication or oleation) and Swedan (fomentation). Snehan is of two types and both the types are to be done very seriously. They are Abhyantar (Internal) snehan and Bahya (External) Snehan.

Snehan:

1. Internally oils or ghee is used to drink. The quantity is decided according to the need and then warm oil or ghee is consumed every day (generally the quantity starts from 40ml). Every day the quantity should be doubled of the previous day. (So if the quantity of first day is 40ml then on second day it will be 80ml. On third day it will be 160ml and so on.) Warm ghee or oil is to be consumed in the morning. Drinking hot water (sip by sip - entire day) is always helpful to digest the consumed ghee or oil. Later from afternoon, full meal is to be consumed according to the hunger. Some food items are to be avoided for the better results.This schedule is to be maintained for 3/5/7 days depending on the need.

2. Externally various medicated oils or ghee are used for Sarvanga Abhyangam (full Body Massage). This helps in nourishing the body externally. (It is very much important to understand the concept of Oliation of Ayurved. Ayurved strongly states that if the body oliation is up to the mark then and pathology cannot sustain in that place. It is same like making pickles. After the pickle is ready it is necessary to add adequate quantity of oil over it for the preservation purpose. Same like this doing oliatiion helps body to be immune. The processes of Snehan and Swedan described are very much specific and need other things to be manage strictly. They are daily routine, food specifications (do’s and don’ts), adequate exercise, proper sleep etc. they all are of same importance to maintain the health.)

Swedan:

Full body fomentation (Steam bath) is done with various medicated decoction according to the need. Generally decoction of Dashamool (famous combination of 10 hearbs, used on very much regular basis in ayurved). Full body fomentation is to be done after Snehan.

Fomentation without Snehan increases dryness in the body hence it is to be done after Snehan only.

The cumulative action of both (Snehan and Swedan) is to liquefy the toxins and bring them to digestive tract. It is easy to excrete them through Digestive tract with the help of Panchakarma.

After this Purva karma, the body is fully saturated by oils or ghee. It helps the body to sustain at best while performing the Panchakarma. It also reduces the bad after-effects of Panchakarma like extreme dryness etc.

Commonly it is believed that consumption of oil or ghee results in increase in body fat, cholesterol and triglyceride levels. But drinking oil or ghee as Purva karma for panchakarma (without mistaking in following the rules) does not result in so.

Pradhan karma (actual process of Panchakarma):

This can be any of the basic five karmas of panchakarmas from following five

1. Vaman (Induced emission)

2. Virechan (Induced Purgation)

3. Basti (Enema)

4. Nasya (Nasal Drops)

5. Rakta-mokshan (Blood letting)

About processes of Panchakarma

1.  Vaman karma (Induced vomiting or stomach wash):

This process shows impact on upper 1/3rd part of digestive system. (Grossly from mouth till stomach)

According to Ayurved formation of Kapha dosh happens at first level of digestion process i.e. (Madhur avasthapak). Vaman shows impact on 1st 1/3rd part of digestive system. Hence the ‘Vaman’ process is useful in diseases related to Kapha dosh. e.g. recurrent cough and cold can be treated by ‘Vaman’. This helps in removing unwanted, excessive and vitiated kapha dosh from the body, from the nearest root to its production house, that is Amashaya (according to Ayurvedic terminolies it is area grossly from stomach to duodenum). ‘Snehan’ (The pre-process management) helps in liquefying the kapha dosh and helps it to travel to digestive system from where it is spread out to places all over the body.

In ‘Vasant’ (spring) season, climate changes from cold to hot. In previous season of Shishir (end part of winter) the climate stays cold and dry which solidifies the increased kapha dosh in body. The heat of Vasant season liquefies this solid Kapha dosh. Hence this is the best season for ‘Vaman’.

Procedure: early morning the medicated decoction is to be consumed as much as possible. Minimum quantity expected is 2 liters. And maximum quantity expected is 5 liters. After 15 to 20 minutes of drinking this decoction Vomiting is induced by chewing some bitter medicines or simply by touching the base of tongue inside the mouth. By this maximum liquid consumed again comes out in few episodes of vomit. Maximum episodes and quantity coming out through vomit is called successful procedure. Minimum quantity coming out through vomits is called less successful procedure. In these less successful cases again the vomit is induced. Presence of yellow coloured secretions at the end of episodes of vomiting is an indicator of successful procedure.

Routinely Decoction of licorice is used for consumption. Licorice avoids gastric irritation and helps to protect the mucosal layers of digestive tract.

Vaman makes a huge impact on stomach and makes it weak for a period of time. Hence ‘Sansarjan krama’ is important after ‘Vaman’, which helps it to regain its strength to normal. It is described in Post-process management

2. Virechan (Induced purgation) –

According to Ayurved, Pitta dosh formation first involves the liver function. It is released in Digestive system for second level of digestion i.e. ‘Amla Avasthapak’. (Ayurved covers parts of digestive system from deodinum to small intestine in 2nd level of digestion). Once the food is passed ahead of stomach, its movement is controlled by a peristaltic movement of the gut. This peristaltic movement is normally downwards. Hence it is easy to take out the unwanted or excess or vitiated pitta by the end part of the Digestive system by triggering off this peristaltic movement. Hence induced purgation helps in diseases related to Pitta dosh.

(e.g. In Jaundice the best treatment available in the world is of Ayurved and that involves ‘Virechan’. Virechan is made by giving herbs inducing loose motions by increasing the bowel movement and breaking the stool into liquid bulk. Along with other medicines as per the need of patient the Virechan given helps in excellent manner.)

Virechan is advisable to healthy person in seasons like Grishma (summer) and Sharad (October heat). In these two seasons the heat is greatly increased in the body. The body in normal course takes out the bulk of the heat along with stools. So it is better to enhance the purgation process to take out maximum amount of heat through its normal route. Virechan makes huge impact on large intestine and makes it weak for a period of time. Hence ‘Sansarjan krama’ is important after virechan, which helps bowel to regain its strength to normal. It is described in Post-process management.

3. Basti:

They are of three types – 1) Anuvasanam (oil enema), 2) Asthapanam/Niruha (enemas with various decoctions) 3) Uttar-basti (enemas given in genital organs in males as well as females)

‘Basti’ term means Bladder. In ancient time the goat bladder was used to hold the liquid of enemas. Hence the process is named as ‘Basti’. Usually the area which comes under influence of Basti is large intestine. According to Ayurved this is base production house of Vata dosh. This comes in third part of digestion process i.e. ‘Katu Avasthapak’. Here at this point in digestion Vata dosh is nourished. Hence to treat diseases of Vata Dosh, Basti is the best karma.

Depending on conditions the material used for enemas is selected such as oils, ghee, buttermilk, non-vegetarian soups, milk, herbal decoctions or fresh goat blood and many more.

Vata dosh’s important property is dryness (which if increased dries up the bowel and reduces the peristaltic movement which in turn results in constipation). To reduce it ‘Snehan’ (lubrication or overhauling or oliation) of large intestine is the best remedy which softens the intestine and improves its peristaltic movement. The ‘Snehan’ property of oil is the best in all. Hence it is used in basti as the main material.

For a healthy person The Varsha (rainy) season is the most suitable period to undergo Basti treatment.

Three types of Basti:

(1) Anuvasanam – it consists of medicated oil enema. Generally 40ml to 80ml of warm oil is pushed into the intestine. If the intestine holds the given oil for minimum 6 to 12 hours the result is moderate. In some cases the oil holds on for 3 to 6 hours only or it may get hold for more than 24 hours. The more it remains, greater is the result. This can be done for minimum three continuous days to obtain the best result.

(2) Asthapanam/Niruha – In this, generally, decoctions of herbs are used. It is an intestinal wash with the help of herbal decoction. Generally 1½ liters to 2 liters of decoction is pushed into the intestine. Immediate in 2-5 minutes the person gets the urge to pass the stools. The decoction comes out with the material inside and intestine is washed. The decoction used is warm. It helps to a great extent in reducing dryness along with softening of the intestines. It is good to use herbal decoctions than using soap water or plain water. The herbs used, act locally on the intestinal walls in this process and helps against the diseases.

This is done on, next day after Oil enema. It is not advised to give direct Asthapanam. Both these can be done alternately for 7/14/21 days depending on the medical condition. In the normal course, 7 to 10 days cycle is enough for a healthy person.

(3) Uttar-basti – enema given in male or female genital organ is called ‘Uttar-basti’. This is generally given with medicated oils or ghee. This is very helpful in Gynecological problems in females, infertility in both sexes, etc. This should be done by an experienced Vaidya only.

4. Nasyam (Nasal drops of oils, medicines, powders etc.)

Nose is the nearest path to reach brain or any organ in head. Broadly nasya is generally of two types – Shodhan and Shaman. If the unwanted material is to be taken out, then shodhan nasya is advocated, and if the severity is not high then the unwanted material can be dealt with, without taking them out. They can be nullified in the body itself, with the help of shaman nasya. Usually it is done with medicated oils, medicated ghee. In some cases it is done with herbal powders, herbal juices, milk etc.

There are many types of Nasya. The safest one for everybody on a daily basis is called “Pratimarsha Nasyam”. It is done as follows:

Apply a drop of medicated oil/pure cow’s ghee in each nostril and rub it till it gets absorbed on inner layer of nostril. Then breathe in deep through that nostril and breathe out through the mouth. Apply 3-3 drops to each nostril. Every time after application of a drop, breathe deep in for 5 times. This helps in nourishment of each organ of upper 1/3rd part of the body (lungs, neck, shoulder, skull, brain, eyes, nose, ears etc.) this can be done by any person of any age on a daily basis. Especially in old age when the nourishment is hampered, this helps to regain the functionality of these organs.

5. Rakta-mokshanam –

Removal of unwanted/vitiated blood at various locations on body (i.e. from veins or arteries of upper and lower limbs, skin, and temporal region on head) is called Rakta-mokshan. It is done by various methods depending on type of vitiated Dosh. i.e. Shrunga (Hollow stag-horn – not used now days) for kapha dosh, Alabu (dried hollow pumpkin) is used for Vata dosh and Jalauka (leeches) are used for Pitta dosh. These processes come under external treatment. In this, generally 20ml to 30ml blood is removed. But in some cases when the required amount of blood to be taken out is around 100-150ml then the blood is directly taken out from the veins. (The process is same like blood donation) This blood is discarded after its removal. The properties of the collected blood are noted before discarding it.

 

Pashchat karma (Post-process management):

Pashchat Karma is done on two levels.

1. Oliation and fomentation: The Snehan (oliation – external and internal) and Swedan (fomentation) described in Pre-process management is to be followed again after any panchakarm is done. This should be done at least for 3, 5 or 7 days. This helps to reduce the dryness and other complications of Panchakarma and gives nourishment to body to avoid fatigue.

2. Diet management: After any panchakarma process the digestive power becomes sensitive and weak, and hence one should not rush for a full meal immediately. There is a method described in Ayurved, called as “Sansarjan krama” by which one can get his digestive power back at full strength.

 

Following is broadly the ‘Sansarjan krama’ which one can follow after any of the Panchakarmas.

Day      Time                            Food and Working pattern

1          Early morning             nothing but only rest (do not sleep, it increases the Kapha)

            Afternoon                   soups [vegetarian or non vegetarian clear (chicken/mutton) soups] and rest

   Evening                      warm water with rest

            Night                          soups [vegetarian or non vegetarian clear (chicken/mutton) soups] and rest

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2          Early morning             soups [vegetarian or non vegetarian clear (chicken/mutton) soup] and rest

            Afternoon                     semi-solid soup (vegetarian) with or without seasoning and rest

   Evening                         soups [vegetarian or non vegetarian clear (chicken/mutton)soups] and rest

            Night                            semi-solid soup (vegetarian) with or without seasoning and rest

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3          Early morning               semi-solid soup (vegetarian /non- vegetarian) with or without seasoning and rest

            Afternoon                     Thick soups (vegetarian /non- vegetarian /Kheers) and rest

   Evening                          Semi-solid soup (vegetarian /non- vegetarian) with or without seasoning and rest

            Night                            solid food 1/4th part and 3/4th part thick liquids and rest

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4          Early morning               Thick soups (vegetarian /non- vegetarian /Kheers) and rest

            Afternoon                     Solid food half part and half part thick liquids and rest

   Evening                         Semi-solid soup (vegetarian /non- vegetarian) with or without seasoning and rest

            Night                            solid food half part and half part thick liquids and rest

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5          Early morning               Thick soups (vegetarian /non- vegetarian /Kheers) and rest

            Afternoon                     Solid food 3/4th part and 1/4th part thick liquids and rest

   Evening                         Thick soups (vegetarian /non- vegetarian /Kheers) and rest

            Night                             Solid food 3/4th part and 1/4th part thick liquids and rest

6          Early morning               Thick soups (vegetarian /non- vegetarian /Kheers) and rest

            Afternoon                     Full meal and rest

   Evening                        Thick soups (vegetarian /non- vegetarian /Kheers) and rest

            Night                            Full meal and rest

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This pattern can be altered, depending on hunger of the person and is strictly to be done under observation of an experienced Vaidya (Ayurvedic doctor). Starvation or Dehydration should not happen while doing ‘SANSARJAN KRAMA’ and if such complications occur at any point of time it is important that, they should be managed immediately.

This ‘Sansarjan krama’ should be designed depending on the severity of the main karma. If a lesser result is obtained then it should be done for 3 days only. If moderate result is obtained then is should be done for 5 days and if excellent results are obtained then it should be done for 6-7 days. Expert consultation is a must to do any kind of Panchakarma and its pre and post management should also be done under supervision.

 

The food items to be used in ‘Sansarjan Krama’ are as follows:

• Cereals and legumes: Jowar (great millet flour), Mung flour (Green gram flour), Rice flour, barley

• Fruit-vegetables: Bottle gourd, snake gourd, ribbed gourd, round gourd (Tinda and Tindli), tender lady’s finger, Ash gourd, drumstick pods

• Leafy-vegetables: Spinach, Amaranthus, Salad leaves

• Tubers: Carrots, turmeric, onions, raddish, water chestnut

• Milk & milk products: cow’s milk, goat milk, buttermilk, ghee, shrikhand (Indian sweets variety made from curd by removing water and adding sugar to it.)

• Oils: sweet groundnut oil, sesame oil, olive oil

• Spices: curry leaves, turmeric, cumin seed powder, coriander seed powder and leaves, omum seed powder, asafoetida, rock salt, mint, black pepper, ginger