PANCHKARMA THERAPY

Panchkarma means 5 therapeutic procedures:-

1. VAMANA- therapeutic emesis

2. VIRECHANA- therapeutic purgation
3. BASTI- therapeutic enema
4. NASYA- therapeutic errhine
5. RAKTAMOKSHANA- therapeutic blood letting

NEED FOR PANCHKARMA

• According to Ayurveda, due to the effect of atmosphere, weather, improper diet and
lifestyle habits etc, the toxins in the body accumulate. These toxins, in Ayurvedic term is
called as ‘Ama’.
• Toxins can be of two types –
1.The toxins that enter into the body due to improper food / lifestyle – such as exposure
to microorganisms through food, air etc.
2.The toxins that our body generates due to seasonal variations, improper diet etc –
such as high fat consumption leading to excessive cholesterol, old age causing wear and
tear in joints causing arthritis etc.
• To re-word the term toxins, Ayurveda uses the word Tridosha. – They are Vata, Pitta and
Kapha.
• When they are normal, they support the body and maintain health. But when they go
abnormal, they cause disease.
• Medicines cannot remove toxins from body and moreover sometimes they don’t reach
the site of disease. In such conditions, panchkarma proves very beneficial because: It
removes all waste materials and free radicals from the body without taxing body organs
and thus helps in curing the disease.
• To bring the Doshas into normal levels, we use massage, oral medicines etc. It is helpful
in minor Dosha imbalances. But if they have been vitiated to a large extent (bahudosha
avastha), better to get rid of them. This is done by Panchakarma treatment.

INDICATIONS FOR PANCHKARMA

• When doshas are aggrevated (bahu dosha awastha)
• Various conditions like indigestion, loss of taste of food, obesity, anaemia, heaviness,
lethargy, boils & pustules, itching, stiffness, weakness, insomnia, excess sleep, etc.
CONTRAINDICATIONS FOR PANCHKARMA
• When there is ama in bahu dosha awsatha
• When physician is not following rules and regulatios written in text and he has not done
all procedure himself and is undue courageous
• When patient is not rich enough to pay for expenses
• When there are not enough good attendants
• When patient has not enough strength and is suffering from incurable diseases and
symptoms of complications are present (arishta).

CONTRAINDICATIONS DURING PANCHKARMA

• Ashtamahadoshkar Bhava e.g. speaking loudly, travelling by vehicles, too much walking,
continuous sitting, taking diet before previous meals get digested, unwholesome diet,
sleeping in daytime and coitus as it may cause further dosha prakopa.
• Vayu sewana, shitala jalapana, shitala jalasnana, ati atapa sewana, apathya ahara
sewana, taking bath immediately after procedure, heavy exercises, exposure to cold,
etc.

BENEFITS OF PANCHKARMA
• Cleansing of alimentary canal
• Digestive fire increases
• Diseases are alleviated
• Health is restored and maintained
• All sense organ function properly
• Mind and intellect work properly
• Colour of skin improves
• Strength increases
• Person becomes capable of getting good progeny
• Aging process delayed
• Person enjoys disease free healthy life
• In healthy persons, to avoid seasonal disorders and give long standing immunity
MOOLA SIDDHANTA OF PANCHKARMA
DVIVIDHA UPKRAMA

1. Langhan Upkrama
2. Brimhana Upkrama

LANGHANA BRIMHANA
Vamana Sneha nasya
Virechana Sneha basti
Niruha basti Brimhana nasya
Shodhan nasya Brimhana basti

❖ What Langhana does :

1. Eliminates accumulated mala.
2. Cleanses body channels.
3. Regulates normal movement of vata.

❖ What Brimhana does :

1. Replenishes dhatu and strotas.
2. Reduces extra space.
3. Avoids accumulation of vata..
4. Reduces snigdhta, mriduta, guruta, etc.
5. Regulates normal movement of vata.

SHADVIDHA UPKRAMA

1. LANGHAN - deepan, pachan vyayam, kshudha, vaman, virechan, niruha basti, lekhan basti,
kshara basti, vaitran basti, raktamokshan etc.

2. RUKSHAN - vayu sevan, udvartana, valuka sweda, churna pinda sweda, pradhman nasya

3. SWEDAN - 13 types of agni sweda, 10 types of niragni sweda

4. BRIMHANA - bahya snehan, shali shashtik pinda sweda, annalepa, anuvasan basti, matra
basti, yapan basti, brimhana nasya, snehan nasya etc.

5. SNEHAN- snehapana, bahya sneha, anuvasan basti, matra basti, ksheera basti, yapan basti,
snehan nasya etc.

6. STAMBHAN - avpida nasya, piccha basti etc.

Note:

• It is clear that various forms of poorva, pradhan and paschat karma are essentially fine
parts of Shadvidha upkrama.
• And langhan, rukshan and swedan can be included in langhan upkrama and brimhana,
snehan and stambhan can be included in brimhana upkrama of dvividha upkrama.

CLASSICAL PANCHKARMA THERAPY

POORVA KARMA PRADHANA KARMA PASCHATA KARMA
1.Vamana
1.Pachana 2. Virechana 1.Samsarjana krama
2. Snehana 3. Basti 2.Rasayanadi karma
3. Swedana 4. Nasya 3.Shaman prayoga
5.Raktamokshana

NEED OF POORVA KARMA

Diet, lifestyle and various other causative factors (apathya aahara vihara)

Lead to Dosha sanchaya, prakopa and prasar to shakha (peripheries)

Sthanasamshraya in weak organs, tissues and channels

Toxins produced which obstructs channels (strotoavrodha)

Dosha can not go back to koshtha and stick in shakha

Disease produced

By poorvakarma procedure these vitiated doshas are brought back to koshtha from where they
can be easily eliminated by pradhana karma.

1. PACHANA (DIGESTIVE THERAPY)

• Administration of herbs or medicines to digest and liquify the toxins.
• These drugs are ushna, katu, and tikta.
• This therapy must be done 1 week before snehana to digest toxins (ama pachana).
• Commonly used herbs are: Piper nigrum, Zingiber officinale, Piper longum, Cuminum
cyminum.
• Commonly used medicine are: Aampachak vati, Shankh vati, chitrakadi vati etc. in the
dose of 500mg TDS, hingwashtak churna, shivakshara pachak churna etc. in the dose of
3g BD.
MODE OF ACTION OF PACHANA:

• They increase internal heat, stimulate metabolism, enkindle digestive enzymes, increase
peristalsis, improve circulation.
• It stimulates vagus nerve which secretws gastric juice.
• It stimulates duodenum which secretes digestive enzymes and hormones.
• It simulates pancreas to secrete pancreatic juice.

2.SNEHANA (OLEATION)

• Process of doing oleation of the body with the help of sneha.

• Creates uncutousness, softness and moistness of the body.
• Is of 2 types: 1.Bahya (external) e.g. abhyanga, shirodhara, parisheka, gandoosh etc.
2.Abhyantara (internal) e.g. snehapana, basti, nasya etc.

MODE OF ACTION OF SNEHANA:

Abhyantara sneha:

• Sneha acts as a solvent and increases the moisture content of the body (utkleshana). It
loosens and dissolves/liquefies the doshas which are adherent to minute channels
resulting in removal of strotorodha (samprapti vighatan) so they can move to koshtha.
• Also it sticks to walls of strotas so that doshas don’t stick back. It forms protective layer
for healthy tissues.
• It pacifies aggrevated vata dosha and reduces its obstruction.

Bahya snehan:

• It increases flow of circulation to local area, strengthens the fascia, restores mobility of
soft tissues, relieves pain by releasing muscle tension, drains extra fluid into lymph
vessels thus reducing oedema (chronic).
• Warm oil applied to skin causes capillary dilatation. Fat enters through dilated capillaries
and is easily absorbed into the system.
• Sneha undergoes pachan by bhrajak pitta and by its virya is absorbed through romakupa
and dhamni and is thus circulated in the body.

3. SWEDANA (SUDATION/FOMENTATION)

• Process which initiates sweating.

• It eliminates stiffness, coldness, and heaviness from the body.
• Is of 2 types:- 1.Sagni e.g. pinda sweda, vashpa sweda, upnaha etc.

2.Niragni e.g. vyayama, ushna sadan, guru pravrana, etc.

MODE OF ACTION OF SWEDANA:

• Swedana drugs penetrate strotas and activate sweat glands to produce sweat. After
dilatation of strotas (strotomukh vispharan), they liquify doshas so they can move to
koshtha and can be expelled out with miminum resistance or excreted through
micropores of skin in form of sweda.
• It pacifies aggrevated vata dosha thus reducing its obstruction.
• It also improves agni (digestive fire). By heating of tissues, body temperature rises,
which increases sympathetic activity. This in turn releases hormones which activate
meatabolic rate. This increases demand of oxygen and food and output of waste
products (strotoshodhan) which acta as samprapti vighatan.
• Thus swedan acts by vasodilatation, sweating and increasing metabolism.

Note :- Snehan and Swedan are done as poorvakarma before pradhan procedures. Also they
are done as pradhan karma in various vatavyadhis. Sometimes swedan is done as paschata
karma also.

PRADHANA KARMA
1. VAMANA KARMA
• Expulsion of vitiated dosha through mouth. Here the drug is administered through
mouth only.
• The person is made to vomit by giving many medicines. The vomiting continues for a
short while.
• Vamana treatment is given after preparation procedures called Purvakarma. After the
end of the procedure, a diet plan is advised to follow for 3– 7 days time.
Vamana treatment is usually given in Kapha imbalance diseases.

2.VIRECHANA KARMA

• Eliminated of vitiated doshas through rectum. Here the drug is administered through
mouth and expelled through anus.
• The person is made to have loose motions for a short while, by administering medicines.
• Virechana treatment is given after preparation procedure called Poorva Karma. After
the end of the procedure, a diet plan is advised to follow for 3 – 7 days time.
• Virechana treatment is usually given Pitta imbalance diseases.

3.BASTI KARMA

• Administration of medicated oils or decoction into the rectum. Here the vitiated doshas
are expelled through rectum only.
 • Basti treatment is adopted in wide range of diseases, predominantly of Vata imbalance.
• According to the type of drug used it is of 2 types:-
1. Niruha :- when decoctions are used
2. Anuvasan:- when oils are used.

4.NASYA KARMA

• Administration of medicated oils, juices, powders, etc. through nostrils.

• It can be done for the purpose of shodhana, shaman, and snehana.

5.RAKTAMOKSHANA

• Expulsion of vitiated blood from the body through the nearest vein involved.
• It is mainly done in pitta or rakta dushti.
• It is of 2 types:-
1. Shastrakrita- prachhana, siravedha
2. Ashastrakrita- jalauka, shringa, alabu, ghati

PASCHATA KARMA
1. SAMSARJANA KRAMA
• Restoration of digestive power by giving specific diet gradually taking from light to
heavy.
• Usually done after shodhana therapy (Vamana, Virechana).

DAY PRAVARA SHUDDHI MADHYAMA AVARA SHUDDHI

SHUDDHI
1 M
E Peya Peya Peya
2 M Peya Peya Vilepi
E Peya Vilepi Yusha
3 M Vilepi Vilepi Mamsarasa
E Vilepi Akrita yusha Normal diet
4 M Vilepi Krita yusha
E Akrita yusha Akrita mamsarasa
5 M Krita yusha Krita mamsarasa
E Krita yusha Normal diet
6 M Akrita mamsarasa
E Krita mamsarasa
7 M Krita mamsarasa
E Normal diet
RASADI KRAMA:

• For the restoration of digestive power after vamana and virechana peyadi karma is
indicated.
• In case of basti, rasadi karma is indicated due to degree of difference in impairment of
digestive power.
• In rasadi karma, firstly singdha, madhur and amla rasa is given to subside vata in
pakwashya.
• Then, amla, lavana rasais given to increase digestive power.
• Then madhur and tikta rasa is given to pacify pitta.
• Then kshaya and katu rasa is given to pacify kapha.

2.RASAYANADI KARMA

• Administration of rasayan and vajikaran drugs after shodhana.

• Before rasayan and vajikaran, if panchkarm ais done then body and channels are
cleansed thoroughly due to which efficacy of rasayan and vajikaran drugs increases.

3.SHAMANA PRAYOGA

• After the process of detoxification, to treat the particular disease with left over dosha if
any, administration of oral medicine is required.
• It also helps in preventing the reoccurrence and increasing the immunity and strength.
CHRONOLOGICAL ORDER AND TIME PERIOD FOR PANCHKARMA

S.NO. NAME OF PRAVARA MADHYAMA AVARA SHUDDHI

TREATMENT SHUDDHI SHUDDHI
1 Snehapana 7days 5days 3days
2 Abhaynga and 1day 1day 1day
Swedan
3 Vamana 9th day 7th day 5th day
Samsarjana 7days 5days 3days
krama
Rest 1day 3days 5days
Snehapana 9th to 11th day 9th to 11th day 9th to 11th day
Abhyanga & 12th to 14th day 12th to 14th day 12th to 14th day
swedana
4 Virechana 24th day 22nd day 20th day
Samsarjana 7days 5days 3days
krama
Rest 1day 3days 5days
5 Basti Karma basti (30 Kaala basti (16 Yoga basti ( 8
days) 33rd-62nd days) 31st to 46th days) 29th -36th
day day day
Basti parihar 60 days (63rd- 32 days (47th- 16 days (37th -
kaala 122nd day) 78th day) 52nd day)
6 Nasya 7 days (123rd- 5days (79th-83rd 3 days(53rd-55th
129th day) day) day)
7 Raktamokshana
Snehapana 7days (130th- 5 days (84th -88th 3 days (56th -58th
136th day) day) day)
Abhyanga 1day (137th day) 1 day (89th day) 1 day (59th day)
swedan
Raktamokshana 138th day 90th day 60th day

Note:-

• Always after vamana, virechana should be conducted on 15th day.

• Always after virechana, basti should be conducted on 9th day starting from anuvasana
basti.
EFFECTIVE PANCHKARMA IN VATAVYADHI
• Vata is mainly located in lower portion of body, in pelvis where colon and urinary
apparatus is located. Though vata is predominantly seated in colon, waist, pelvis, ears,
bones and skin, its predominant seat is colon (pakwashya).
• When Basti (medicated enema) is administered in pakwashya (main seat of vata dosha)
vitiated vata is expelled out of the body. Vata comes to balance and diseases caused by
it get cured as it it corrected at its site of origin.
• All functions come back to rhythm, there is rejuvenation of tissues and organs are
rehabilitated, body gains strength and endurance and immunity is established. Thus,
vasti is quoted to be half treatment of all treatments available in world.
Some vata disorders which can be effectively treated by administering enema are:-

• Obstruction of feces, urine, fart and semen

• Destruction and deterioration of strength, muscles, semen
• Bloating, flatulence, Colic
• Pain in butts, knee, calf, thigh, hands, feet, vagina, arm, fingers and toes, breast, tooth,
nails, small joints of fingers etc
• Hemiplegia, Tremors, facial paralysis, joint pains and arthritis, etc

TREATMENT: in classics, snehan, swedan, basti and snehan nasya has been described as
samanya chiktsa for vata vyadhis, out of which basti is the main line of treatment because it
treats root cause of vatavyadhis.

EFFECTIVE PANCHKARMA IN PITTAVYADHI

• Therapeutic purgation is best treatment to expel vitiated pitta out of body. Pitta is
mainly
• located in middle portion of body, wherein digestive apparatus is situated.
• Though pitta is predominantly seated in navel, stomach, intestine, sweat, lymph, blood,
plasma, skin and eyes, its predominant seat is navel (amashya).
• When purgation is administered vitiated pitta is expelled out of the body through anal
route. Pitta comes to balance and diseases caused by pitta get cured as its treated at its
site of origin.
Some pitta disorders which can be effectively treated by administering purgation are:-
• Skin disorders caused by vitiated pitta
• Spleen disorders
• Anaemia and liver disorders caused by aggravated pitta
• Jaundice
• Gout
TREATMENT: In classics, sheeta guna yukta sneha, virechana, sheetala parisheka has been
described as samanya chiktsa for pitta vyadhis, out of which virechana is the main line of
treatment because it treats root cause of pittavyadhis.

EFFECTIVE PANCHKARMA IN KAPHAVYADHI

• Vamana (Therapeutic emesis) is best treatment for expelling vitiated kapha out of body.
• Kapha is mainly located in upper portions of body. Though it is predominantly seated in
throat, head, trachea, inter-phalangeal joints, stomach, lymph, fat tissue, nose and
tongue, predominant seat of kapha is chest (urah pradesh).
• When emesis is administered vitiated kapha is expelled through vomiting. Kapha comes
to balance and diseases caused by kapha get cured as its treated at its site of origin.
Some kapha disorders which can be effectively treated by administering emesis are:-

• Common cold which is chronic

• Acute fever with kapha predominance
• Cough, Asthma and breathlessness
• Diabetes, Obesity
• Excessive salivation, Indigestion

TREATMENT: In classics, rooksha swedana, vamana, shodhana nasya has been described as
samanya chiktsa for kapha vyadhis, out of which vamana is the main line of treatment because
it treats root cause of kaphavyadhis.

EFFECTIVE PANCHKARMA IN URDHWAJATRUGATA VIKARA

• Nasya or medicines administered through nasal route is best treatment to expel doshas
• accumulated in head and neck.
• Nose is said to be gateway for head. Medicines instilled in nose in form of medicinal
juices, powder, decoction, processed milk and oil and fumes would expel doshas
accumulated in head and neck by pulling them from their place of accumulation and
origin. By doing so, nasal medicines cure diseases related to head, neck and sense
organs.
• This treatment also ignites mind and senses and helps in proper perception and induces
proper sleep.
Some disorders caused by dosha accumulation / vitiation in head which can be effectively
treated by administering errhines
• Stiffness of head and neck
• Stuffed nose and cold
 • Dimness of vision
• Headaches
• Diseases of shoulder and neck, like cervical spondylosis and frozen shoulder
• Diseases of mouth and tongue
• Pain in scapular region arm, ear, nose, eye, head
• Facial paralysis
• Tooth pain and looseness
• Voice disorders, stammer etc

TREATMENT: In classics, various types of nasya have been described as samanya chiktsa for
urdhwajatru gata vikara because nose is the gateway of head.

EFFECTIVE PANCHKARMA IN RAKTA PRADOSHAJ VIKARA

• Raktamokshana or blood letting is best treatment for expelling vitiated blood out of the
body. When vitiated blood is expelled out pitta comes to balance and also rakta is
purified so the disease get cured.
• When a disease is not cured by either snehana or rukshana chikitsa and either ushna or
sheeta chikitsa then it can be corrected by raktamokshana.

Some rakta pradoshaja vikara which can be treated by raktamokshana are:-

• Skin diseses like kushta and visarpa

• Kshudra roga like yuvana pidika, vyanga, indralupta, padadri, vranashotha, etc
• Vidradhi
• Udar roga like pleehodara and yakritodara
• Prameha pidikas

TREATMENT: In classics, virechana, upvasa and raktamokshana has been described as samanya
chiktsa for raktaja vikara.

CONCLUSION

• Diagnosis of a disease should be done precisely.

• Panchkarma application should be done after analyzing ekadasha pareekshya bhava.
• Classics have given standard guidelines for the treatment of diseases which should be
applied logically.
• Sometimes we have to think out of the box and plan the panchkarma accordingly.