Panchakarma

Panchakarma: Procedures in Panchakarma

As the name suggest, panchkarma means panch karma i.e. five methods or five operation in ayurvedic medicinal system. These are:

• Vaman karma (emetic)
• Virechan karma (purgative)
• Anuvasan vasti (soothing enema)
• Nirooh vasti (cleansing enema)
• Nasya karma (nasal purge)

Ayurveda believes that any substance entering in our body has an effect on our body. Thus to clensify the wrong effects in the body by that external substance, panchkarma methods were devised. Panchkarma procedures purify, pacify and remove the cause on any disease. For curing any disease one must purify the effective body system by eliminating the aberrant material from the body. Secondly one must soothe the already effected part. And thirdly one must remove the hetu (cause) of the disease. Panchkarma procedures are so designed that they satisfy the above mentioned three requirements of a physician in eradicating a disease. Shad upkarmas (six methods of treatment).Ayurveda has mentioned six upkarmas i.e. six methods of treatment under which all the treatments are performed. These are

• Brimhana karma (promoting growth)
• Lahghan karma (effecting reduction)
• Snehan karma (lubrication)
• Rookshan (drying)
• Swedan (sweating)
• Stambhana (promoting contraction)

According to Charak, the great ancient physician, says the best physician is that who has mastery over in performing methods of Brimhana karma (promoting growth), Lahghan karma (effecting reduction), Snehan karma (lubrication), Rookshan (drying), Swedan (sweating), Stambhana (promoting contraction). All methods of medical treatment in ayurvedic system of medicine may be classified under one or the other of the following categories mentioned below

• Brimhana karma (promoting growth) – promoting growth or encouraging plumpiness in body.
• Lahghan karma (effecting reduction) – effecting leanness, it is opposite of brimhana karma
• Snehan karma (lubrication) – lubrication or increasing fat or watery content in the body Rookshan (drying) – promoting dryness, the opposite of the above i.e. removal of the fat or moisture
• Swedan (sweating) – promoting sweat or diaphoresis, etc, i.e., encourages the dilatation (vikaaranaam) of all channels and opening in the body
• Stambhana (promoting contraction) – promoting contraction (sankochanam) or the vessels of supply such as arterioles, blood, lymph vessels etc, i.e. the opposite of swedanam.

In a general view all the above method mentions methods can be classified into the first two methods i.e. brimhana and lahghan. As ultimate all the six promotes growth or auses reduction in body. Langahan karma, swedan karma and rookshan karma all comes into one category. And brimhana, Snehan and stambhana come in one category. On account to the multifarious complex combinations of the three doshas, the medical treatment also may become complicated. However combined, number does not exceed six, just as the number of doshas however combined cannot be transcended their three fold character.

These methods of treatment should be performed in a very delicate and balanced manner, so that any excess or deficiency of the six methods or their combinations may be avoided.

The patient is the best judge to know weather the method of treatment is performed correctly or not. The progress in the relief of the sufferings of the patient confirms the utility of the treatment. The patient feels happier if the equilibrium prevails and he feels unhappy the moment equilibrium is disturbed. For instance, if a particular portion of the body is dirty and non oily and if a little lubricant is applied to this, the opposite treatment of drying is given, the patient is sure to feel more discomfort. As in other system of medicine ayurveda also gives treatment generally consist of supplying the opposite of supplementing the lost element in the body by the effect of the diseased condition. It may be mentioned here that all the above methods oftreatment and operations included in the six categories of the treatment called the shad upkarmas, includes the panchkarma, which constitute mainly, the Langahan part of the six methods. All these process of treatments are included in antaparimarjana (internal cleaning) and bahirparimarjana (external cleaning)

Introduction of panchkarma

As mentioned earlier, term panchkarma literally means five procedures. These are efined in two ways:-Charak includes the following five operations or procedures in panchkarma

Nasya karma: it is popularly known as shiroveraechan. Nasya is the administration of medicine either in theliquid or in the powder forms into the nostrils. Its main function is to purify the nasal passage and relieves the congestion in the cranial region. In fact, the administration of nasya karma is considered as a purgative to the head as the term shiroveraechan literally implies.

Vaman karma: according to ayurveda, definitions say that it is the procedure in which aggravated doshas ofthe body are expelled out of the body by oral canal. Vaman or administration of emetics is one of the procedures by which Shodhana (cleansing) of the body is being done. The aim and the objective of performing Vaman karma are different from and more comprehensive than those of administration emetics. It is widely used in eradicating disorders caused by kapha dosha.

Virechan karma: it’s the procedure by which aggravated or imbalanced doshas are expelled out of the body through anal region. Virechan means purgative. This is chiefly in disorders caused due to pitta dosha. It helps in cleansing the body from doshas thus helping in providing stability and homeostasis in the body. Nirooh vasti karma: nirooh vasti is commonly known as astthapan vasti. It includes the administration of certain decoctions of specific herbs as enemata for the chief purpose of cleaning the intestine. It is widely used in intestinal colic due to irregular eristalsis (udaavartham) and in constipation (vibhandh).

Anuvasan vasti karma: this is also called Snehan vasti. It helps in brimhana trengthening) of the body hence provides power to the body organs. This is administration of enemata, which is prepared whole solely in oils there fore helps in toning up of organs. Besides cleansing purpose it also helps in relieving disorders caused by vata dosha.

Karma in normal terminology means special operations or procedure. The word karma means special act whose main purpose is to expel out the vitiated doshas thus helping in cleaning the body. As understood by name panch karma is five in numbers in which four are Shodhana karma i.e. helps in cleaning the body. These are Vaman, virechan, nasya, and nirooh vasti. There main purpose is to purify body or eliminating the aggravated doshas (vata, pitta and kapha) out of the body or subduing them, there fore they are classified into Langahan karma. The one left is anuvasan vasti which is considers as growth promoter and toner thus helps in lubricating and toning muscles and organs often body. Therefore it is characterized into samana karma, a soothing treatment: although its main purpose is also to eliminate or check a premier dosha i.e. vata hence included in brimhana chikitsa (treatment). Rakta mokshana as a panchkarma

Maharishi Charak has mentioned the above mentioned five karmas but Maharishi Sushurut has considered rakta mokshana karma in panchkarma therapy and has included anuvasan vasti and nirooh vasti under vasti karma. Rakta mokshana commonly signifies to venesection or blood letting, to treat disorders caused by aggravated doshas. Maharishi Vagabhatta has accepted and supported this view as mentioned in ashtang hridayam. One thing is worth mentioning here that Maharishi sushurut has considered four doshas instead of three i.e. vata, pitta, kapha and rakta.

Stambhana karma: Stambhana karma is the method of treatment by which contraction of the part of the body of the constriction of the arteries or other vessels in that part of the body or in the whole body takes place. This is the opposite of swedan karma, whose purpose is to dilate the pores and to lubricate (Snehan), to liquidate (vishyand), to soften (maardava), or to moisten (kleda) the part. Swedanam encourages perspiration. It checks sthambhan (contraction or solidification), heaviness (gauravam) and cold (sheet). The purpose of stambhana on the other hand is to check movement (sthambhayati yat gatimantham, chalam) by contracting or congealing the opening of the channels. Things used for causing stambhana. The things used for casing contraction are generally promoting slowness in movement, sheet (cold), mand (slow), soft (mridu), slakshan (glaszy), rookksh (non oily), sooksham (subtle or quickly permeating), dravya (liquid), sthir (steady) and laghu (light). Soft and cold potters earth, ice, styptic, haemostatic, constipation, anti diuretics (like opium), and anti diaphoretics (like atropine), vaso constrictors (like adrenaline) may all be included under stambhana substances.Substances which are sweet, bitter and astringent are stmabhak in action.

Person fit for stambhana karma - Those people who have aggravated pitta and presently the same picture as of pitta dominance like buring eyes, having persistent diarrhoea and vomiting. People who are affected by poison, people who sweat excessively or people suffering from similar kind of diseases are considered fit for stambhana karma.

Symptoms for proper stambhana treatment Following are the symptoms by which pplication of stambhana karma is recognized: -

• The relief by the patient of all the distressing symptoms which he has been previously suffering
• The acquisitation of strength which is easily felt by the patient who had a proper stambhana treatment
• Symptoms of excessive stambhana treatment Following are the symptoms presented when a person is over treated by stambhana karma. black or grey discoloration of the treated part due to excessive venous congestion, necrosis or gangrene
• Stupefaction, loss of sensation or heaviness of the part treated. hurried respiration or excitement tendency of lock jaw
• A feeling of heaviness in heart region.

Constipation.

Method of administrating panchkarma procedures Panchkarma procedures are considered to as operations, which are to be performed in a sequence designed by ancient rishis and physicians. A pattern as followed by modern surgeons has been taken from ayurvedic medicinal system. It includes three steps. These are:

• Purva karma or the pre-operative procedure
• Pradhan karma or the main procedure
• Paschat karma or the post-operative care

It is very essential that panchkarma procedures are to be followed in proper sequence and an expert guidance is extremely essential as even little bit of carelessness and ignorance in performing the procedures can lead to extreme effects on body. One should also be ery cautions in following the pre-operative and post-operative procedures for very good results.

A. Purvakarmas or the pre-operative procedures Purva karma means procedures of the karmas which are to be performed before starting with the main procedure. It can be included in the prior preparation of the main procedures which includes preparing patient mentally and physically for the main procedure. It includes three procedures. These are.
• Pachan karma
• Snehan karma
• Swedan karma

B. Pradhan karma or the main procedure It includes the main treatment to be given to the patient. It is most essential step in curing the patients from the disease. It includes all the panchkarma procedures. These are:
• Vaman karma
• Virechan karma
• Vasti karma
• Shiroveraechan karma
• Rakta mokshana

C. Paschat karma or the post-operative care Post operative care is one in which certain precautions are to be taken to get the full benefit of the main procedure. It also includes management and maintenance after recovery period by lifestyle management and diet management or by giving some herbal supplements. These includes following procedures.
• sansarjan karma
• rasayan adi prayogam
• shaman chikitsa


Vaman Karma

It is expulsion of aggravated doshas from the mouth region or the oral canal is called Vaman karma. It should not be compared with vomiting. Vomiting is the forceful expulsion of content of stomach. Where as Vaman karma is performed after sequence of procedures under the supervision of panchkarma expert and is done according to the patients requirements from treating him from the disease.

Definition. - Vaman or administration of emetics is one of the series of panchkarma procedures. This is a Shodhana karma (cleansing procedure) or purifying operation with regards to kapha dosha. The aim and administration of Vaman karma are different from and more comprehensive than those of administration of emetics in modern sciencesDifference between administration of emetics and Vaman karma

• Benefits of Vaman karma
• Properties of herbs that are used in Vaman karma
• Unfit for Vaman karma
• Uses of Vaman in dieses mentioned by various rishis.
• Avamya roga (contra indication of Vaman karma)
• Necessity of performing purva karma before performing Vaman Procedure
• Selection of emetic
• Herbs used for Vaman karma.
• Herbs mentioned by various rishis for Vaman purpose
• Various kalpnaye (various recipes) for preparation of vamaka dravya.
• Purva karmas of Vaman karma
• Administration of the vamaka dravya
• How does an emetic work


Panchakarma: Difference between administration of emetics and Vaman Karma

Vaman karma is not done merely with the object of relieving stomach with its contents, especially poisonous contents and to clear out passage of children as stated above. Vaman karma in ayurvedic system of medicine is performed when there is presentation of kapha doshas, which has symptoms such as heaviness in body etc. The doshas predominantly affects amashya (compared to stomach), then the Vaman karma is advised after performing the purva karma i.e., Snehan and swedan in a proper procedure mentioned according to ayurvedic text. These injunctions will be set below and if carried out, no untoward symptoms such as depression and gastrointestinal irritation should result. More over, in ayurveda, the herbs used such as madanphala, pipilli, nimb, and kutaja seed, etc. are of vegetable origin and are not minerals such as tartar emetic etc, are therefore not poisonous and depressant and therefore are not involved in degrading and deteriorating bodies’ mechanism. Their selection again depends upon the condition of doshas presented by the patient.


Benefits of Vaman Karma

• Vaman karma is effective in Shodhana of amashya i.e. cleaning stomach
• Vaman karma is highly recommended on countering the kapha dosha which is in aggravated state
• Vaman karma is very effective and acts as a life saver in situations like ajirn (indigestion), vish peet (consumption of poisonous substance), visuchika (cholera) and virudh aahar (food poisoning).
• Vaman not only cleanses the doshas present in stomach but also helps in purification of the whole body as the purvakarmas i.e. Snehan and swedan helps in bringing kleda (aggravated kapha) to the amashya (stomach) which is been removed from the body by practicing Vaman karma


Herbs used for Vaman karma.

The herbs mentioned below are used in performing Vaman karma in general use.
• Madan phala
• Yastimadhu
• bitter gourd
• neem
• kaakanaasa
• indravaruni
• bitter cucumber
• kutaja
• morrvamool
• devadaali
• vidanga
• jalavetasa
• chitraka
• mooshikaparnee
• kosavatee
• karanja
• pipilli
• saindhav lavan
• vacha
• ela
• mustard
• kritavedhana
• kaanchanaara
• ashwagandha
• bandhujeeva
• satapushpa


Unfit for Vaman Karma

Vaman is not permissible in patients who are sufferingfrom aneurism, hernia, prolepses of uterus or rectum, peritonitis or tendency of hemorrhages, because of straining induced by vomiting, which should make us a cautious in giving it to those who have disease ofvessels or high tension in them, for the straining may lead to hemorrhage

Uses of Vaman in diseases mentioned by various rishis.

Serial no. Disease Maharishi charak Maharishi
sushurut Maharishi Vagabhatta

1 Peenus (sinusitis and influenza) + + +
2 Kushth (skin disease) + - +
3 Nav jwar (acute fever) + + +
4 Rajyakshma (tuberculosis) + + +
5 Kaas (cough) + + +
6 Shwas (asthma) + + +
7 Malgrah (constipation) + - -
8 Shlipada (elephantiasis) + + +
9 Galgand (goiter) + + +
10 Prahmeh (urine related diseases) + - +
11 Mandagni (loss of appetite) + + +
12 Virudh aahar (food poisoning) + + +
13 Ajirn (indigestion) + - +
14 Visuchika (cholera) + - +
15 Alsak () + + +
16 Vish peet () + + +
17 Dasht, digdhviddh + - +
18 Adhog rakt pitta (bleeding per rectum) + - +
19 Mutraprasek () + + +
20 Arsh (hemorrhoids) + - -
21 Hallaas + + +
22 Aruchi (tastelessness) + + +
23 Avipaak + - +
24 Apchi + - +
25 Granthi - - +
26 Apasmar (epilepsy) + + +
27 Unnmad (hysteria) + + +
28 Atisaar (diarrhoea) + + +
29 Shauf (oedema) + - -
30 Pandu (anemia) + - -
31 Mukh paak (stomastis) + + -
32 Stanay dushti () + + +
33 Arburd (tumor) - - +
34 Vidarika (skin disease) - + +
35 Medo roga (obesity) - + +
36 Hridya roga (heart disease) - + -
37 Chitt vibrham (depression) - + -
38 Visarp (ery) - + +
39 Vidradhi (abscess) - + -
40 Pootinash - + -
41 Kanth paak (pharyngitis) - + -
42 Karn srav(otoria) - + -
43 Adhijivika (uvilitis) - + -
44 Gal shundika (adenoids) - + -
45 kapha roga + + +


Avamya roga

Serial no.
Disease Maharishi charak Maharishi
sushurut Maharishi Vagabhatta

1 Shat shirn (weakened due disease) + + +
2 Atisthool (obese) + - +
3 Atikrish (weak + + +
4 Baal (child) + + +
5 Vridh (old) + + +
6 Durbal (weak) + + +
7 Shrant + + +
8 Pipasit (thirsty) + + +
9 Shudhit (hungry) + + +
10 Karmhatt + - -
11 Nhar hatt + - -
12 Adharv hatt + - -
13 Upvasit (fasting) + - -
14 Maityhun prast + - -
15 Adhyan prast + - -
16 Vyayam prast + - -
17 Chinta prast (tensed) + - -
18 Ksham + - -
19 Garbhini (pregnant) + + +
20 Sukumar (new born) + - -
21 Sanvritam koshth + + -
22 Krimi koshth - + +
23 Dushchardan + + +
24 Udharv rakt pitta (epistasis) + + +
25 Prasakt chardi + + +
26 Asthapitt + + +
27 Udhrava vata + + +
28 Anuvasit+ + + +
29 Hridya roga (heart disease) + - +
30 Udavaata + +

Selection of emetic

There have been some principles laid down for selection of vamaka dravya (emetic). It is judged according to the prakruti (nature and body constitution of the individual) and the status of all the three doshas of the body. When a person has the predominance of kapha dosha then the herb which is to be selected must be of katu rasa and dominant. It should also be tikshan in guna and ushan in virya (hot potency).When the patient is of pitta dominance then madhur rasa dominant herbs should be preferred in treating the pitta dosha. Sheet virya (cold potent) herb is to be administered in the cases of pitta dominance that will help in subduing the pitta aggravation in the body, especially in amashya (stomach).If there is vata predominance with the association of aggravated kapha then the herbs that are madhur (sweet), amal (sour) and lavan (salty). Herbs which are ushan in virya i.e. hot in potency are to be used to counter the vata dosha.

According to sharanghdhar samhita in kapha dominant disease pipilli (piper longum), madan phala and saindhav lavan are to administered by hot waterIf pitta dosha is of dominance then the cool decoction of patol patra, vasa and neem are to be taken. In vata dominance diseases associated with kapha dosha present in urah pradesh (chest region) or amashya (stomach), madan phala is to be given with cows’ milk. In indigestion, saindhav lavan is to be taken with hot water to produce Vaman.

Various Recipes for Preparation of Vamaka Dravya

churan (powder)
kalk
kashaya (decoction)
sneh
varti
avleh
kshir
dahi (curd)
dadhisaar
ghrit (ghee)
takr
mastu
yvagu
krishra
yuush (soup)
utkarika
shaskuli
apuup
shadav
kambalik
faint
modak (ladoo like sweet)
manth
navneet
matrayen
madira (alcohol)
suramand
aasut
palal
mansras
dhreyeyog
ikshuras (juice of sugarcane)
salil


Administration of the Vamaka Dravya

If the patient is a delicate one or weak or very much afraid of the emetic or a boy or an old man, he should be give yavagu (conjee) or milk or butter milk or curds to the fullest and then the emetic dose is to be given to vomit it out along with the dosha. After taking the dose of the emetic, the patient has to rest for a muhurat. To have his body fomented with heated hands all the while. If sweat appears, it should be known that dosha is being melting and liquefying, if horripilation occurs, it should be known that the dosha has begun to move from its location, if the distension of the abdomen appears, it should be known that the dosha has come to kukshi (koshtha). When nausea (hrillaasa) and the watering of the mouth (aasyasravanam) occur, it should be known that the dosha is coming out. The patient should sit on a cushioned chair about eighteen inches in height, so as to enable him to stoop forward and vomit easily and to rest in the interval. He should be held by the attendants. These parts should be also massaged by them. If the patient does not feel sufficiently nauseous, he should tickle his face with finger or with his fingers or with the stem of errand nalaa (stem of castor plant), or with the stalk of the water lily flower, so that he may easily vomit out the contents.The patient is thus induced to vomit when he gets the nauseous sensation; he should not be made to vomit when he gets the nauseous sensation, he should not be made to vomit sufficient nausea. In this way, he may vomit four to six times or eight times according to his strength. Four vomits are considered to be due to an inferior action of medicine. Six vomits are considered to be due to medium action of the medicine and eight vomits are due to drastic action of the medicine. There are four ways of knowing that the dose of the emetics has produced its results in a satisfactory manner. The four ways of such knowledge are named by the commentators.laingikee: the patient should experience a feeling of relief as he vomits out the dosha, and he feels lightness of heart region, sides, heads, senses and upper koshta and a feeling of relief their in . This sort of feeling demotes the laingikee way of knowing that the emetic has acted in the desirable manner.

Maanikee: the total volume of the vomited matter is measured and one prastha (2 seers= about 48 fluid ozs.) of the matter is considered as madhayama (medium) suddhi (purification) and four prastha are considered as uttam (best) suddhi (purification). This consideration of suddhi is according to manna or measurement and hence it is called maanikee

Vaigikee: the number of vegaas or urges to vomit is another consideration. It is noted already that four vegaas or urges or vomits are considered as madhayama suddhi and eight vegaas are considered uttam suddhi (pradhaana suddhi). As the consideration of suddhi rests on the number of vegaas of the patient, it is called vaigikee.

Aantikee: the patient who has taken an emetic should first vomit the medicine and gradually kapha in the succeeding vomits and pitta in the last vomit. Thus pitta is the last to be vomited and hence it is said “pittaanam isstam vamanam” i.e. pitta should be the last to be vomited. The appearance of pitta (bile) in the concluding vomit is desired and this kind of suddhi is called aantikee (pertaining to conclusion). Or Vayu is also, however, said to be the last or concluding dosha.

But the discharge of the Vayu is only inferred by the empty urges (to vomit) in the end and it is not attended with any matter. If there is matter, however little, it should be pitta. Hence pitta is practically the last dosha to appear concretely. This consideration of suddhi
is called aantikee. The commentators (Chakarpani and Dalhan etc) say that there may be fallacies in concluding that the doshas have been expelled by any one or two of these consideration and hence all these points should be considered in deciding weather the patient had a thorough suddhi or not.

Panchakarma: Herbs Used in Vaman Karma

Ushan (heat): due to this ushan gunn (hot property) vamaka dravya (emetic herbs) makes doshas vishyand i.e. it melts the doshas and then makes it to reach amashya (stomach) and mahastrota (gastro intestinal tract)thus doshas enters in kushth, which are easier to eliminate from the body.

Tikshan (sharpness): it is an agneye (fire) in dominance thus helps in melting the doshas which get stick to the body parts due to this property it easily penetrate

Suksham (fineness): due to Aakash mahabhoot, vyavyahi and tejas gunna it gets the property of penetrating power which helps it to penetrating into the small strotas (channels)

Vyavyahi: it is property in which the herb enters body and digested in the whole body. It has dominance of Aakash and Vayu mahabhoot.

Vikashi; herb that gets spreads in whole body and then decreases oja ands creates shathiliye in dhatus and sandhis. It has been predominantly Vayu mahabhoot rich.

Udhrapravati: in literal meaning it means the tendency to move upwards. These vamaka herbs help in upward movements the doshas thus helping in emesis.

Procedure

In the morning, the panchkarma is to be performed; proper dose of the vamaka dravya (emetic) is to be administered to the patient. The decoction of madanphala is advocated as the best. Honey, decoction of Yastimadhu, saindhav lavan (rock salt) and some quantity of phaanita (syrup of jaggery) are added to the medicine prepared. Not only madan phala but the herbs mentioned in the kalp sthana (chapter based on the vamaka dravya and virechak dravya) i.e. jeemutak, ishwaaku, dhaamaargrava, vatsaka, kritavedhana, etc are advocated in charak samhita. According to Maharishi Charak there are 355 recipes of vamaka dravya preparation. According to him these herbs can be administered in the form of powders, confections, lehyams (jam form), inhalations, etc. however he consider madan phalka the best out of all the emetics mentioned. The various recipes mentioned in kalp sthana of Charak samhita are composed according to different constitutions, temperatures, diseases, tastes, habits etc.

Purva karmas of Vaman karma

Following points have to be kept in mind before the Vaman karma is to be administered
Atmanirikshan (self analysis) First of all the physician performing panchkarma procedure has to have that confident that, he is capable in performing the procedure efficiently and with ease. He should be having expertise in handling all the complications or situations that might arise during the procedure.

Atur pariksha (patients condition)

It is very important to examine the patient thoroughly and then the procedure should be preceded. Check the strength of the patient, his physical fitness, environmental conditions, his condition of doshas. His diet, things that would be suitable to him while
performing the procedure and most importantly his age.

Vaman samagri (things required in performing Vaman karma)

It is necessary to have the proper availability of substances needed in performing the Vaman karma like a well shielded room in which patient do not gets exposed to the out side environment. Room should be cozy and should able to capacitate small family. It should be well supplied with water. it should have a proper kitchen, washroom and bathroom. The utensils which are to be used or are used in performing Vaman karma are to be well equipped in that place.

Paricharak (assistance)

A trained assistant must be present who will help in performing the procedure and also to nurse the patient. He should help patient in performing his day to day activity like bathing etc. He should be expert in helping the physician in carrying out the procedure and should follow instruction given by the doctor carefully. And most importantly should be very enthusiastic in performing his duties. He should also have feeling of kindness towards the patients.

Aushadh (herb that is vamaka in nature)

The herb which has been decided after the proper examination of the patient should be in adequate amount and its availability should always be there. In case of any emergency antidotes should be available. Certain drugs and herbs should be available to counter any kind of situations and complications

Rogi ka utklesh (preparing patient for the operation)

After performing the Snehan and swedan of the body patient should be advice a diet which is rich in food of kapha origin especially a night before the procedure has top be performed. For example milk, curd, till and meat of fish and animals who live in water etc. It helps in increasing the kapha content in the body therefore which is essential for expulsion of kapha dosha the next day when the procedure has to be performed the next day.

Snehan swedan (lubrication and sweating)

According to the category of the disease patient should be lubricated with the oils internally and externally. When the symptom of proper swedan appears then the swedan should be stopped. After the appearance of these symptoms swedan should be performed. Swedan should be of stream which is helpful in whole body sweating.

Vamankalika achar (phsycological therapy)

Patient should be given proper sympathy and should be taken in confidence, that the physian is expert in performing the Vaman procedure and has all the qualification and confidence in treating the patient and curing him off, of his ailments. Patient should also be informed about the steps involved in the procedure and all the steps to be followed while performing the procedure. Patient should be given full guaranteed that he will not face any trouble and he would definitely will get well from the suffering he is suffering from. Accompanied of the patient should also be given assurance that the procedure is for benefit of the patient and it would help him getting free from his troubles. They should also be informed that procedure is safe and has very little chances of that the procedure has complications.

Necessity of performing Purva Karma before performing Vaman

Purva karma is very essential before performing the Vaman karma. Other wise many complications can arise. Snehan (lubrication) and swedan (sweating) are very important procedures are very critical before the Vaman karma is initiated. Snehan (lubrication) checks the Vayu, softens the tissues (deham) and separates the debris (mala) from the healthy tissue. Sweating, if it is conducted after proper lubrication, liquefies the debris which is entangled in the tiny channels. In order to enhance the effect of Snehan and swedan, kapha or moisture should be increased by the previous administration of milk or other kapha increasing foods.

In a chronic disease, such as prameha (urine disorder), kushth (skin disease), apasmaara (epilepsy), etc which is caused principally by kapha dosha or by any other dosha located in amashya (stomach) along with kapha, the preliminary process of Snehan karma and swedan karma has to be sufficiently executed before Vaman karma is administered, carefully regulating the diet and other habits all the while. Such processes were described by charaka and sushurut in the following manner. The patient is to undergo snehakarma along with proper diet. Usually three to six days relapse in such a course. Swedan karma suited to constitution and the dosha vitiation of the patient in the next administered. If the patient is in the habit of taking snigdh foods, he may have swedan karma administers on the next day following Snehan karma. He has to take abhishyandi or kapha producing food such as anoop maasam or milk or black gram etc, on the night of the next day. This act of eating such food increases kapha and this increased kapha makes the old stationary kapha somewhat mobile. If the static dosha is thus made mobile; it may easily be removed by administration of proper emetic.

How does an Emetic Work

According Maharishi Charak the emetic substance which is empowered with be ushan, tikshan, suksham, vyavyahi and vikashi qualities, reaches the hridya by its own penetrating power (swa veeryena) and from there, it gets into the dhamanees (channels) and entering the big and minute strotas (sthoola anu srotrebhyah) throughout the body (kevelam sareeragatam), liquefies the doshas lodge there, by its agneye (biochemical) quantities and breaks (vicchindati) the dosha by its tikshan qualities. The dosha thus liberated, enters the circulation broken and when the patient’s body had been sufficiently lubricated by the previous Snehan, the dosha cannot stick up anywhere, just as honey cannot stick up in a vessel, which is anointed with oil and therefore the dosha naturally comes to the koshth. From the alimentary canal the dosha is finally vomited out by the action of udan Vayu. The emetic which starts its action in the alimentary canal enters the circulation and brings the dosha along with it, into the alimentary canal for elimination from there.

Excessive use of the emetics

If the dose of the emetic is excessive, there would be atiyoga, i.e. excessive action of the emetic which is not desirable. Such a dose produces excessive evacuation of pitta, unconsciousness and pain in the heart region and throat. Moreover thirst, coma, , vitiation of Vayu, sleepiness, excessive weakness also may be caused. Streaks of blood, foam etc, and may be seen in the vomited matter. There may be tympanitis, hemorrhages etc as a result of an excessive dose of an emetic herb.

Ayoga- insufficient dose of emetics

There, in the Ayoga or improper evacuation of the dosha the emetic , the symptoms caused by such an improper dose are dribbling of saliva, sensation as if there is no purification in the heart region and itching, skin eruption (kotha and sphotaka) and heaviness of the body.

Dhumapanam after emetics

The patients who has had a desirable evacuation (samyoga) of the dosha by the emetic (Vaman karma) should have a Dhumapanam (medicated smoking). There are three kinds of medicated smokes, Snehan, virechan, and samana. The proper one should be selected. If there is still some little dosha, a little virechan or samana Dhumapanam should be given: if there is excessive evacuation and consequently a little increase of vata is suspected, a Snehan Dhumapanam is given.

Diet to administered after Vaman karma

The patient should not take food immediately; he should at least fast until afternoon. When according to his jatharagni, he should be allowed to take a light meal with kulutha yoosha or mugadha yoosha or aadhaka yoosha or jaangalamaamsarasa, having taken a refreshing hot water bath.

Maharishi charak says that the patient should fast for that day or may take a thin manda and yavagu of old red saali rice on that day in the evening if he is so allowed by the physician after judging his digestive capacity. He should repeat the same at the time of the two meals on the next day also; on the third day, he should take the vilepi or thick kanjee of the same rice preferably without salt or with very little salt (if it is so desired by the (patient). The same is too repeated on the third day evening and fourth day forenoon (only two meals are to allowed). On the evening of the fourth day, he may take same old rice well boiled with the mudga yoosha. The same is to be repeated on the fifth day both forenoon and evening. On the sixth day, in the morning, he may take the same food with jaangalamaamsarasa added to it (according top satmyam of the body) the same food is to be repeated in the evening and on the seventh day both in the morning and evening. On the eight day onwards, the patient may gradually indulge in his usual food but with good care. The principal to be noted here is that the consideration of jatharagni (digestive fire)is most important. The Shodhana karma (Vaman) makes the jatharagni weak by its nature and any food hastily given after such Shodhana Kama only weakens the jatharagni further which means further vitiation of the tridoshas eventfully. Hence, if his jatharagni is alright the patient may be allowed to take light meals: otherwise manda, peya etc should be given prior to the administration of the usual food for some days till his jatharagni becomes proper. In this connection, Maharishi Charak has mentioned that just as the fire in the outside world is kindled by the bits of dry straw, hay, dry cow dung cakes, small dry twigs, etc. and gradually develops into a large fire, when it will be able to consume powerful by graded and planned diet, hence it should be kindled by peya etc, and made firm before normal indulgence in ordinary foods. It is very important to mention here that during the whole course of treatment of Vaman karma, a person should follow all the rules and regulation of brahmacharya (non indulgence in sexual affair) as mentioned by Maharishi sushurut.

Things to be avoided

In chronic diseases where systematic Vaman karma is done after sneak and swedan, the patient, in addition to the regulation of diet mentioned already, should rest in the room free from draughts and should not indulge in overwork, fasting, excessive walking, walking in night, sexual intercourse, sleep, heavy and in compatible food etc.

Vaman in rasayan treatment

Person who desires to take rasayan treatment (though they do not suffer from any disease) should first undergo panchkarma, Vaman being the first karma in the sequence of five methods of treatment. Patient should carefully and patiently undergo all the procedures for the duration each and every process requites.


Panchakarma: Introduction to Virechan Karma

Virechan Karma (Administration of Purgative)

Virechan means administration of purgative for the purpose of eradicating dosha from the body. It is mainly done to eradicate the aggravated pitta dosha in the body. It is the karma that’s should be performed only after doing Snehan and swedan. Virechan karma is to be performed on the sunny day, wind should not be blowing and day should be auspicious. Various forms of herbal preparations like churn (powders), swaras (juices) are to be administered to perform virechan karma. The kind of herb and the method of its preparation are to be considered according to the disease and the condition of dosha. As an example trivith is very beneficial in the diseases which have pitta and kapha dominance. If there is Vayu, herb containing or mixture with the herbs which have snigdh, ushan qualities and lavan rasa are to be used as medicated castor oil etc.

Definition - Virechan or administration of purgatives is one of the series of panchkarma procedures. This is a Shodhana karma (cleansing procedure) or purifying operation with regards to pitta dosha. The aim and administration of virechan karma are different from and more comprehensive than those of administration of purgatives in modern sciences.

Benefits of virechan
• Properties of herbs that are used in virechan karma
• Virechan is indicated in following diseases.
• Action of virechan dravya (purgative) dravya (substance)
• Importance of performing purva karma before performing Vaman
• Mode of administration
• Different types of bowels (koshth)
• Purva karmas of Virechan karma
• Pradhan karma (main procedure)
• Complication of improper virechan karma


Panchakarma: Types of Bowels, Mild Bowel, Severe Bowel, Medium Bowel

• There are three of koshth or the bowel
• Mridu koshth (mild bowel)
• Karoor koshth (severe bowel)

Madhya koshth (medium bowel)

If a person has a Mridu koshth he ahs to administered by mild laxative like warm milk, which has the potency to evacuate bowel. Karoor koshth or the habitual constipated bowel is administered by using drastic purgatives. This type of koshth is to handles by first administrating it with the Snehan (lubrication) at least for six days and then the swedan karma (sweating) is to done. Madhayama or the medium koshth can be administered by any purgative of normal potency. Karoor koshth is the result of vata. Mridu koshth is the result of pitta and madhayama koshth is due to homeostasis of the all the doshas. After the purgative has been administered person should not obstruct the urge of evacuation of the bowel.

Panchakarma: Purva Karmas of Virechan Karma

In this process, we prepare our selves to perform the major process i.e. the virechan karma. Following are the points which are to be taken care of before the procedure has to start.
(a) Samagri or the collection
Before performing virechan one must do Snehan, swedan and Vaman karma. It is very important to perform these karmas before the virechan karma otherwise complications may arise.

(b) Rogi pariksha or the investigation of the patient
It should be first adjudged that does patient require virechan karma. If he requires this karma then he should be care fully investigated and his health should be judged on the criteria of desh (place), kaal (time and season), bal (strength), sharir (body), prakruti (nature). Depending on all these conditions it should be decided, that to what degree of and what type of virechan is to be given.

(c) Preparation of the Rogi
If the patient has also to be administered with Vaman karma prior to the virechan karma, then after performing Vaman karma, Snehan and swedan is to be performed again.

After performing Vaman karma sansarjan karma is to be performed in sequence and on the ninth, tenth, eleventh day and twelth day snehpaan (internal lubrication of body) is to be done.

After performing this one should take rest and then the procedure of virechan is to be performed.

The person who has to be given virechan must be given fatty stuff like ghee butter etc mixed with meat; rice etc prior 2 to 3 days before virechan karma and then he should be given purgatives.

Virechan should be performed empty stomach only.

Person who is to treated should be given psychological encouragement that he will be fine after the procedure is over.

(d) Preparing medicine

A person who is week, lean and sensitive should be given Mridu virechak (mild purgative)

If a person has the Mridu koshth (mild bowel) he can be given sugarcane juice, milk, ghee, triphala and warm water for performing virechan karma.

If a person has Karoor koshth, he has vata dominance in his grehni (first part of intestine).

It should be determined earlier the condition of koshth (bowel) of the person.


Panchakarma: Introduction to Pradhan Karma (Main Procedure)

After careful examination patient should be administered with the purgatives when he is empty stomach. According to Maharishi Sharanghdhar following are the doses that are to be administered in the following doses. Type of purgative Maximum dose Medium dose Least dose
Kashaya (decoction)2 pal (100 ml)1 pal (50 ml)½ pal (12 ml)
kalk50 gram25gram12 gram
Churan (powder)50 gram25 gram12 gram
Modak (laddu like sweet)50 gram25 gram12 gram

Some of the doses of commonly used purgatives Serial number purgative Doses in Karoor koshth 2waDoses in madhayama koshth Doses in Mridu koshth
1Ichabhedi rasa500 mg250 mg125 mg
2erand tail120 gram60 gram30 gram
3Isabgol15 gram8 gram4gram
4Trivritt churan15 gram8 gram4 gram
5Panchaskar churan15 gram8 gram4 gram
6Amaltas kwath120 ml60ml30 ml

After the purgative has been given he should be kept under careful observation.

It should be check that patient due do bad taste of the purgative should not vomit out the medicine. To prevent all this he should be kept in well fragmented place with calm ness all around.

He should also gargle his mouth with the warm water. Wash his face with cold water to make him feel fresh.

He should be kept in a place which is undisturbed by people.

He should be made to drink warm water in small small amount.

He should evacuate on bed in bed pan in lying down condition.

In the process of virechan first of all mal (faeces), then pitta (bile juices) and at last kapha (mucous) comes out. After it patient feels weakness and lightness in the body. If the medicines has digested and there is no out flow of faeces then the patient is given food that day and virechan karma is administered next day. If still virechan is in effected then after ten days again Snehan and swedan are done and with the strong purgatives.

Amount of evacuation in virechan karma. One should not count the first 2 to 3 Vegas (times) of the faeces and then it should be counted that how many times the patient has evacuated. The degrees up to which the virechan is done is classified into three categories i.e. pravar (most), Madhya (medium) and avar (least).

Serial number Degree of shuddhi Vegas (time) Maan (quantity) Dosha which comes out the last 1Pravar304 prasthKapha2Madhya203 prasthKapha 3Avar102 prasthkapha. It is advised that after every evacuation the bed pan should be changed so as the analysis of the last passed stool could be done.

Panchakarma: Importance of performing Purva Karma before performing Vaman

Importance of performing purva karma before performing Vaman Purva karma is very essential before performing the virechan karma. Other wise many complications can arise.

Snehan (lubrication) and swedan (sweating) are very important procedures are very critical before the virechan karma is initiated.

Snehan (lubrication) checks the Vayu, softens the tissues (deham) and separates the debris (mala) from the healthy tissue.

Sweating, if it is conducted after proper lubrication, liquefies the debris which is entangled in the tiny channels. In order to enhance the effect of Snehan and swedan, pitta or heat should be increased by the previous administration of In a chronic disease, such as prameha (urine disorder), kushth (skin disease), apasmaara (epilepsy), etc which is caused principally by kapha dosha and pitta or by any other dosha located in amashya (stomach) along with kapha, the preliminary process of Snehan karma and swedan karma has to be sufficiently executed before Virechan karma is administered, carefully regulating the diet and other habits all the while. Such processes were described by charaka and sushurut in the following manner

The patient is to undergo Snehan karma along with proper diet. Usually three to six days relapse in such a course. Swedan karma suited to constitution and the dosha vitiation of the patient in the next administered. If the patient is in the habit of taking hot potency foods, he may have swedan karma administers on the next day following Snehan karma. He has to take pitta producing food on the night of the next day. This act of eating such food increases pitta and this increased pitta makes the old stationary pitta somewhat mobile. If the static dosha is thus made mobile; it may easily be removed by administration of proper emetic.


Panchakarma: Mode of Administration of Panchakarma

If there is presence of kapha in the amashya (stomach) then one should. First go for Vaman karma and then after again going Snehan and swedan karma he should go for virechan of removing predominance of pitta. Most important of all the things is to properly handle the diet. If there is any kapha, the vairechanika dravya or the purgative is to be administered properly only serves to bring the kapha to the grehni (first part of the
intestine) and creating imbalance in jatharagni (digestive fire).hence it must be noted that virechan should not be given without overcoming kapha by following the suitable diet regimen and doing lahghan karma. It is advised that the person should take laghu aahar (light food), ushanodak (warm water) and juice liker that of orange Etc. on seeing in the next morning weather the previous meals had been digested. If yes then one should perform virechan karma.


Panchakarma: Diseases where Virechan is Indicated and Contraindicated

Virechan is indicated in following diseases.
Serial no. Disease charak sushurut Vagabhatta
1 Jwar + + +
2 Kushth + + +
3 Prameha + + +
4 Udharvagata rakta pitta + + +
5 Bhagandar + + +
6 Arsh + + +
7 Pliha dosha + + +
8 Gulm + + +
9 Arburd + + -
10 Galgand + + +
11 Granthi + + +
12 Visuchika + + -
13 Alsak + + -
14 Mutra ghaat + + +
15 Krimi koshth + + +
16 Visarpa + + +
17 Pandu + + -
18 Shirr shool + + +
19 Parshav shool + - -
20 Netra dah + + -
21 Hridya roga + + -
22 Aruchi + + -
23 Netra sraav + - -
24 Halimak + - +
25 Shwas + - +
26 Kaas + - +
27 Kamala + - +
28 Apchi + - +
29 Apasmaara + + -
30 Unnmad + - -
31 Vatarakt + + +
32 Yoni dosha + + +
33 Rakta dosha + - +
34 Timir + + +
35 Chardi + + +
36 Visphot + + +
37 Vibhandh - + -
38 Vidradhi - + +
39 Shavthu + + +
40 Dagdh - + -
41 Akshi paak - + -
42 Abhishayad - + -
43 Guda dah - + -
44 medh dah-+- - + -
45 Nasika dah - + -
46 Anah - + +
47 Shlipada - - +
48 Stabnnya dosha - - +

Virechan contraindicated in following diseases.

Serial no. Disease charak sushurut Vagabhatta
1 Shat guda + - +
2 Adhog rakta pitta + + +
3 Durbal + - -
4 AlpglanI + + +
5 Ajirn + + +
6 Nav jwar + - +
7 Ati snigdh + + +
8 Ati ruksh + + +
9 Ati sthool + + +
10 Ati krish + + +
11 Balak + + +
12 Vridh + + +
13 Shrant + + -
14 Pipasit + + -
15 Upvasit + + -
16 Methun Prasakt + - -
17 Garbhini + + +
18 Rajyakshma - - +
19 Atisaar - - +
20 Shudhit - - +
21 Hridya Rogi - - +
22 Bhyabhiitgt - - +
23 Subhag (child) + - -

Panchakarma: Benefits of Virechan

Virechan karma is the wonderful remedy in disorders caused by pitta dosha
• It helps in reducing jwar (fever).
• Helps in normalizing blood pressure
• Helps in relieving constipation
• It helps in normalizing the menstrual problems
• It is very helpful in gouty arthritis (vatarakt)
• It is help ful in conditions like jalodar (ascitis)
• It remove oedema from the body
• It makes our genital organs strong.
• By performing virechan karma our sense organs also gains strength
• It provides overall strength to the body.


Panchakarma: Properties of Herbs Used in Virechan Karma


Properties of herbs that are used in Virechan Karma

Ushan (hot): due to this ushan gunn (hot property) virechak dravya (purgative herbs) makes doshas vishyand i.e. it melts the doshas and then makes it to reach amashya (stomach) and mahastrota (gastro intestinal tract) thus doshas enters in koshth (body trunk), which are easier to eliminate from the body.

Tikshan (sharpness) ): it is an agneye (fire) in dominance thus helps in melting the doshas which get stick to the body parts due to this property it easily penetrate Vyavyahi: it is property in which the herb enters body and digested in the whole body. It has dominance of Aakash and Vayu mahabhoot. Vikashi: it helps in separating the doshas which are stuck to the dhatus (tissues) so as to make the movement in the body trunk so as to get it removed by the action of purgatives. Suksham (fineness): due to Aakash mahabhoot, vyavyahi and tejas gunna it gets the property of penetrating power which helps it to penetrating into the small strotas (channels)

Adhomargharan: due to this property the downward movement is obtained and the dosha re carried in the downward direction and hence acts as purgative.


Panchakarma: Action of Virechan Dravya

Action of Virechan Dravya (purgative) Dravya (substance)
Action of virechan dravya (purgative) dravya (substance)

It generally acts in four ways.Some or the purgative herbs stimulates the mucous membrane of our gastrointestinal tract which makes it to secrete more secretions. E.g. indravaruni.
Some of the herbs increase the peristaltic movements in the gastro intestinal tract especially in the intestines. It also increases the bile secretions which are involved in producing the purgation.] Some herbs get absorbed in the blood and perform there function. E.g. sanai leaves.


Panchakarma: Complication of Improper Virechan Karma

Complication of improper virechan karma. If the procedure of virechan is not properly carried out then following complications occur.

Heaviness in body
Piercing pain in chest region
Burning sensation
Itching over the body
Retention of stools
Vertigo
Unconsciousness
anal prolepses
pain in the body

Diet
If the patient has no appetite or hunger for food, do not force him to take any thing and let him fast instead of giving him peya. If the patient feels weak and thirsty then he may be given with the warm kanji.

Paschat karma
After completion of Virechan karma one should administer Sansarjan karma: It is the sequence of easily digestible food.

Tarpan Aushadh: these are the medicines that provide strength to the patient weekend after the vairechanika procedure

Sayam Niyam: it means disciplined life.

Anuvasan Vasthi

Anuvasan vasti is also known as Snehan vasti. It consists of oil ghee or vasa (animal fats) and medications. Anuvasan vasti is to be given after proper purva karma i.e. Snehan and swedan. Anuvasan vasti can be administered even as a purva roopa but it is generally given after as the sequence is maintained. After virechan karma is performed generally a gap of seven days is maintained so as to reignite the jatharagni or the digestive fire anuvasan vasti is administered. Even after performing anuvasan and nirooh vasti anuvasan vasti is being given Anuvasan vasti is indicated in people who have voracious appetite (ati Agni), in person who are very ruksh or in those afflicted by pure vata i.e. unmixed with pitta or kapha.

Both anuvasan and nirooh vasti are to be administered in various diseases mentioned below. They are both mentioned by Maharishi charak and Maharishi sushurut Sarvang roga Eking rogaKukshi roga

Vata sangMutra sangMala sang
Shukra sangBal kshayMans kshay
Dosha kshayShukra kshayAdhyamaan
angsuptiKrimi koshthAtisaar
Hridya rogaBhagandarShool
jwarShirh shoolUnnmad
Hridya shoolParshav shoolPrisht shool
Kati shoolaakshepAng gaurav
RajyakshmaJanu shooljangha rhool
Uru shoolGulm shoolYoni shool
Anguli shoolStan shoolDant shool
Nakha shoolShoshStambh
PericardiaTimirPratishyay
AdhimandArditPakshghat
AshmariUpdanshVatarakt
ArshStanya kshyaManya grah
Hanu grahSharkra shoolmutrakritch

Certain disease in which anuvasan should not be administered are

Nav jwarPanduKamala
PramehaArshPratishyay
ArochakMandagniDurbalta
PlihodarKaphodarUrustambh
Vish pitShlipadaGalgand
ApchiKrimi koshthKushth
Sthaulyapeenus

Anuvasan vasti is generally given by the method as follows
The maximum dosage is six pals (300ml) and minimum is four pals (200 ml) {1 pal = 50 ml}. The ghee or the oil used for the purpose may be mixed with the saindhav lavan (rock salt) and sataahwa powder each to be powdered and mixed in 6,4 and 2 masha (64 masha =1 pal) respectively for the above doses. Ghee or medicated oil with the following herbs may also be administered. These are.
• Dashmoola
• Roots of errand (castor tree)
• Punarnava
• Yav (barley)
• Khulthi dal (horse gram)
• Badara fruit
• Guduchi
• Madan phala
• Palash
• Saindhav lavan (rock salt)
The medicated oils or the pure oil mixed with the rock salt is to be rectally, injected lowly and it is to be retained in the intestines by the patient for sometimes. The patient may sleep after this procedure. Do not let him expel out the medicine which has been inserted. To an estimate, medicine should be retained in for nine hours. If it gets absorbed in the intestines and there is no urge, let another day pass. On the day of administration of anuvasan vasti let the patient take abhayang (massage). After giving him the rectal injection, then patient’s legs are to be massaged for some times. The potion in of the bed which bears the legs of the patient should be raise for some time and the position of the bed is again brought to normal. This is to be done for three times. This process is adapted
so as to make sure that all the medicines is absorbed and lubricate the intestines. If after 4 hours, it does not come out of the feces then nirooh vasti is to be given. On the other hand if the oil comes out with the faeces with out producing any symptoms like heaviness in abdomen, loss of apatite, heavy sensation in body etc, it should be considered that the anuvasan vasti has got to its place to produce desired result. Patient after this allowed taking his meals which are light and easily digestible. If heaviness, dullness occurs then he should not eat any thing at night. Instead he should be given decoction of sunthi (dried ginger) and dhania (coriander) the next morning. Anuvasan vasti is to be repeated on the third day after the previous vasti. But if the person is healthy and is habitual of taking these vasti then he can be administered with the anuvasan vasti everyday. In such a condition the dose should be lessened. If the sneh vasti is taken daily it is called matra vasti. 3 to 4 anuvasan vasti are enough to make a parsons body lubricated. He should also be given nirooh vasti so as to along with anuvasan vasti so as to counter the vata and its allied doshas. If the anuvasan vasti soon comes out then another vasti is to be given soon.

Uttar vasti

It is a part of vasti karma in which vasti is administered in the vaginal cavity or in the urethra. The nozzle of the kale urethra is to be about 12 anguli. Now a day’s rubber catheter is being used. The nozzle of the vasti is of flexible material and the bag attached to it should be compressible. The nozzle is to be sterilized and the smeared with the ghee. The person who has to be administered with the Uttar vasti should previously be given with the nirooh and anuvasan vasti alternately. Now the person is to be seated on a stool or should lay on his back the nozzle of the tube should then be inserted. Only about seven anguli of the tube is to be passed inside the urethra and then the tube is gent ally withdrawn. The fluid may be allowed to remain for a while but retention for too longer time is not advisable. Small pills made out of araghwadh leaves with Nirgundi juice, rock salt and cow’s urine is made of the size that of mustard seed and then it is introduced in the urethra in order to avoid the sneh coming out that has been introduced. The sneh that has to be given to the person has to be about 30 grams in a youth of age 25 years and 50 grams above the age of 25 years. Maharishi sushurut has advised that the u suppository Uttar vasti is to be carried out in the morning time and up to four Uttar vasti can be administered in a day, in this manner Uttar vasti can be given consecutively for three days.

In case of any allergic reaction, a decoction prepared from Yastimadhu and honey and sugar and be used as Uttar vasti. Uttar vasti is being advised in disease like mutrakritch (Dysurea), ashmari (Calculi), spermatorrhoea, pain in the bladder or in the groin region, disease of the bladder etc. For women the Uttar vasti may be given in vagina or urethra in a thin tube of about 2 anguli. It should be introduced in the urethra. In virgins it should be only of one finger length. It should be injected when the women are in supine position with her knees raised. The Uttar vasti is to be administered in the ritu kaalam (12 days commencement of the menstruation) only. Uttar vasti is recommended in disease like of cervix, uterus, and vagina etc. as well as the diseases of the bladder.


Panchakarma: Introduction to Nirooh Vasti

It is also known as astthapan vasti. As the anuvasan vasti imparts snigdh vasti, nirooh imparts Shodhana vasti i.e. it performs the function of clearance and purification. Hence it should always be kept in mind that before the administration of anuvasan vasti one should never ever administer nirooh vasti. It is given along with the anuvasan vasti to counter the vata disorder.

In persistent vata disorder nirooh is to be administered only after 3 to 4 anuvasan vasti. Following are the diseases that are to be administered with the nirooh vasti. As entioned by both Maharishi charak and Maharishi sushurut.
• Sarvang rogaEking rogaKukshi roga
• Vata sangMutra sangMala sang
• Shukra sangBal kshayMans kshay
• Dosha kshayShukra kshayAdhyamaan
• angsuptiKrimi koshthAtisaar
• Hridya rogaBhagandarShool
• jwarShirh shoolUnnmad
• Hridya shoolParshav shoolPrisht shool
• Kati shoolaakshepAng gaurav
• RajyakshmaJanu shooljangha rhool
• Uru shoolGulm shoolYoni shool
• Anguli shoolStan shoolDant shool
• Nakha shoolShoshStambh
• PericardiaTimirPratishyay
• AdhimandArditPakshghat
• AshmariUpdanshVatarakt
• ArshStanya kshyaManya grah
• Hanu grahSharkra shoolmutrakritch

It has to be kept in mind the nirooh vasti should never to be given after meals; it should only be administered before meals. In the beginning the rock salt is mixed after grinding the salt with honey. (150 grams of honey mixed with 40 grams of rock salt). To this availed mixture Snehan (oil, ghee and animal fats) are being added and then it is homogenously mixed. Now the kalk of the herbs that are to be administered are being added in the form of decoction. The mixture is put in a vapor bath and used when it is comfortably warm. If the patient fells that he is having natural urge then he should be allowed to evacuate his bowel. If the nirooh vasti does not come out even after 48 hours of the administration then a tikshan (stronger) vasti is being given like that of go mutra (cows urine) so as to expel it out of the body. A phala varti (suppository) may also be helpful in such a condition.

In the discharge after the vasti karma the fecal matter should appear first, then the pitta or the bile as we say in modern sciences and then the kapha i.e. the mucus. If the person feels relieved, light and strength then it is considered as the vasti has been doing right function in the body for which it has been administered. On an average 3 to 4 nirooh vasti are necessary to a person to get a relief. After it the person should be administered with the vasti he should be given hot water bath and then he should be given light meals Nirooh vasti is still classified into three categories These are:

• Utklesh vasti
• Dosha hara vasti
• Saman vasti

Nasya Karma

It is also known as shiroveraechan. A very important part of the panch karma therapy. Nasya karma is a procedure mentioned in ayurvedic texts regarding the diseases related to head, eyes, nose etc. i.e. in urdhv jatru gata roga. Nasya karma means administration medicine through the nostrils. Nostril is considered as the pathway to the brain.

Importance of nasya karma

The importance of administration of treatment through nostril has been practiced in India since ages. Nasal douching with the clean and pure water early morning is considered good for improving eyesight, prevents premature graying of hairs and hair fall. Purpose of performing nasya karma is to through out the vitiated dosha in the head region. Nasya karma is particularly advised in disease of head such as inflammation of nasal sinuses, diseases of eyes such as pains, inflammation, reddishness and weakness, diseases of ears and diseases of the upper throat. It has been regularly being prescribed in insanity.

Diseases in which nasya karma is used
• Shirh stambhManya stambh
• HanugrahPeenus
• Dant stanbh shoolGal shalook
• Netra rogaTimir
• Vartam rogaUpjhivika
• Ardh vibehdakGriva roga
• Skandh rogaAns shool
• Mukh rogaKarn shool
• Nasa shoolAkshi shool
• Shirh shoolArdit
• AptantrakGalgand
• Dant shoolDant harsh
• ArburdSwar bheda

Following are the diseases in which nasya karma is not to be given
• AjirnPitt sneh
• Shudha yuktShrammit
• MoorchaShastra dand hatt
• VyayamkalantNav jwar
• Shok santaptGarbhini
• BaalVridh
• VegavrodhitSwasgrast
• Rakta sravitSutika
• Kaas grasitGar peerit
• krudh

The main function of the nose is to warm the air when it passes through the labyrinth of the intricate passage into the nose and also to filter the air of certain impurities contained in the atmosphere. If the air comes in contact with the epithelium of the lungs, without undergoing the process of drying and filtration, it is sure that it may cause an injury. To make the nose capable for inhaling nasya is also advised.

Timings of performing nasya karma

Usually nasya karma is to be performed in early morning for kapha related disorders. In pitta related disorders nasya is to be performed in the noon or mid day time. Evening is the time for treating vata related disorders.

Nasya is also advised in night time for certain disease s like excessive salivating, talking in sleep, grinding of teeth, greaning in sleep, difficulty in opening the eye lids, offensive breathe, karna naada (tinnitus aurium), hemiplegia, disease of head, swas roga (asthma), cough and excessive sleepiness.

It is to be kept in mind that before performing nasya karma, Snehan and swedan is to be done to the head region. Usually paanitaap sweda (application of heat with the heated palms) is to be done all over the head Procedure of nasya karma Before stating the main procedure one should always apply the oil on the head and then it is massaged and then it is warmed with the palms. The patient is then laid down on a hard bench on his back and is bent bit backwards. Now the tumbler containing the medicine is put into hot water so as to warm the medicine. Now close one nostril and the medicine is put into other nostril and vice versa. The excess medicine that reaches his mouth is to be spitted out. A good massage to his feet, shoulders and head is to done. After the first administration of nasya, the head, cheeks, neck etc are again done with swedan. After this procedure is over the patient is advised Dhumapanam (medicated smoking). Patient should be kept in a clean environment where he is to be protected fro direct exposure to air, dirt and dust. Emotional stress should also be avoided. If the nasya is performed in a proper way the patient feels lightness on his head and has good sleep with out any discomfort.

Important points to be noted for nasya karma

Nasya karma may be at the most consecutively performed for seven days.
• Nasya karma can be performed in both morning and evening in diseases like hiccups, tonsillitis etc.
• After the completion of nasya karma one should take nutritious diet.
• After completion of virechan nasya (avapeed or pradhamana) some oil drops are to be put into the nostril.
• After the nasya is complete, the patient should lie down on the bed for at least half an hour.

Paschat karma of nasya karma
Following are the things that are to be performed after nasya karma.

• Dhumapanam
• Kaval and Gandusha
• Life style
• Dhumapanam

Dhumapanam is the inhalation of medicated smoke. It is employed in certain diseases i.e. kapha and vata disorders pertaining to head and neck. The patient is made to smoke through pipe, or through inhalation of dhum (fumes) or by specially prepared cigars. It is also of three types

• Snigdh
• Madyam
• Tikshan.

Procedure
The dhum is to be taken when the person is sitting erect with his mind attentive on the act. Usually dhum is sucked is taken through one nostril and the process is repeated in vice versa. If the dosha is situated in the head region or in the nose and if it moved from its seat (utklishta). In such a case person should smoke through nose. In contrast, if the dosha is firmly attached in the head or nose and is not moving, then he may take the smoke through the mouth. If the dosha is situated in the throat then, he should first take the smoke through the nostril and next through the mouth. In all the cases, this inhalation of smoke should be left off through the mouth and never through the nose. The smoke is to be drawn in and then left off and this process is repeated three times on an occasion.

Herbs used for Dhumapanam
Shallaki, laksha, prithveeka, lotus, lily, nyagrodha bark, udumbara, aswatha, plaksha, lodhar, sugar, muklethi, suwarnatwak, padmakam, manjishtha and all the fragrants substavces excepts kushta and tagra. These are saman dravya (herbs), if after these still some doshas are left then administration of tikshan dhum is done.

Disease in which Dhumapanam is indicated
Disease or symptoms like cough, asthma, peenus, loss of voice, offensive breath, anemia, premature graying of hairs, ottorrhoea, discharge from eyes, excessive salivation, itching and pain in the eyes, ears and mouth, stiffness in these parts, sleepiness and sluggishness and hiccough. These symptoms or disease are prevented in a person who uses proper humapanam. Dhum may be applied to the ulcers and at that procedure it is called vranadhupnah (fumigation of the wound.)

Kaval and Gandusha
Gandusha means holding a mouthful of tailam or any decoction for a while after filling the mouth wit it. Kaval means filling the mouth partially and gargling with it.

Gandusha is of for types
Snigdh Gandusha : it is done with oils. These are medicated with sweet, sour and saltish substances. It is useful in pitta disorders. Saman Gandusha : it is done by decoction prepared with the bitter, astringent and sweet substance. It is useful in kapha disorders.Shodhana Gandusha: it is done with the decoction etc. prepared with astringent and sweet substance. It is useful in vata disorder. Ropana Gandusha: it is done with the decoction which is prepared with astringent and bitter substances. It is useful in ulceration of mouth.

Dravya (herbs) used in Gandusha For performing Gandusha oils, ghee, milk, water mixed with honey, liquors, meat juice, cow’s urine, and dhaanyaamlam etc, mixed or unmixed with other herbs may be used. These herbs have rasa or the taste, as indicated the disease we are treating. Sweet gingerly oil or meat juice may be employed for Gandusha daily by all the people, even they are not suffering from any disease also.

In mukh paak (stomatitis) or the ulceration of the mouth or in inflammation of any part of the mouth accompanied with burning sensation or in injuries caused in the mouth, Gandusha with honey, ghee and milk are very effective. If there is kapha in mouth, Gandusha with ksharodaka is very useful.

Life style
One should avoid cold water, curd; heavy food stuff and fatty food items. One should bathe with warm water. One should reside in cozy and warm environment. Atmosphere should clean without any dirt, dust and any kind of pollution. Any kind of emotional stress should be avoided. Traveling shold also be avoided.

Types of nasya karma

• Virechan
• Brimhana
• Samana

Brimhana
It is a kind of nasya which make our body organs strong. It is also called nutrient nasya. It is useful in relieving from pain which is predominantly caused by vata vitiation. Certain disease like Surya avartha (a kind of head ache), swar bhang (loss of voice), parching of nose and throat, loss of speech, opening of the eyelids with difficulty and apabhaahuka (paralysis of arm), brimhana nasya may also be performed with the meat juice of jaangula animal or birds, flesh, blood of the animals etc, extract or exudations of certain herbs.
It is still of two types: These are:

Marsa – it means large dose of Snehan. Thirty two drops constitute the maximum dose and sixteen drops is the minimum dose. These doses may not be administered at one go but may be given in two or three times. It is useful in disease caused by vata vitiation.

Pratimarsa – this type of nasya is given in the healthy person. In this only one drop per nostril is being administered. It is basically maintaing the normal health of the individual. The dose should be dropped any number of time in a day without any restrictions. This nasya is advised in any time of the day and even in the night. This nasya is generally recommended in people having hemoptysis, in emaciated people, in children, in old men and in people who desires comforts. It is not advisable in dusht peenus (severe cold), after use of alcohol, when ears are filled with pusetc.


Samana

In this types of nays karma, a patient is administered by providing him the medication by milk and water. Samana nasya are performed in people who are of soft physical built like children, women and old aged people. Timings of performing nasya karma. Usually nasya karma is to be performed in early morning for kapha related disorders. In pitta related disorders nasya is to be performed in the noon or mid day time. Evening is the time for treating vata related disorders.

Nasya is also advised in night time for certain disease s like excessive salivating, talking in sleep, grinding of teeth, greaning in sleep, difficulty in opening the eye lids, offensive breathe, karna naada (tinnitus aurium), hemiplegia, disease of head, swas roga (asthma), cough and excessive sleepiness. It is to be kept in mind that before performing nasya karma, Snehan and swedan is to be done to the head region. Usually paanitaap sweda (application of heat with the heated palms) is to be done all over the head Procedure of nasya karma Before stating the main procedure one should always apply the oil on the head and then it is massaged and then it is warmed with the palms. The patient is then laid down on a hard bench on his back and is bent bit backwards. Now the tumbler containing the medicine is put into hot water so as to warm the medicine. Now close one nostril and the medicine is put into other nostril and vice versa. The excess medicine that reaches his mouth is to be spitted out. A good massage to his feet, shoulders and head is to done. After the first administration of nasya, the head, cheeks, neck etc are again done with swedan. After this procedure is over the patient is advised Dhumapanam (medicated smoking). Patient should be kept in a clean environment where he is to be protected fro direct exposure to air, dirt and dust. Emotional stress should also be avoided. If the nasya is performed in a proper way the patient feels lightness on his head and has good sleep with out any discomfort.

Important points to be noted for nasya karma Nasya karma may be at the most consecutively performedfor seven days. Nasya karma can be performed in both morning and evening in diseases like hiccups, tonsillitis etc. After the completion of nasya karma one should take nutritious diet. After completion of virechan nasya (avapeed or pradhamana) some oil drops are to be put into the nostril. After the nasya is complete, the patient should liedown on the bed for at least half an hour.

• Paschat karma of nasya karma
• Following are the things that are to be performed after nasya karma.
• Dhumapanam
• Kaval and Gandusha
• Life style
• Dhumapanam

Dhumapanam is the inhalation of medicated smoke. It is employed in certain diseases i.e. kapha and vata disorders pertaining to head and neck. The patient is made to smoke through pipe, or through inhalation of dhum (fumes) or by specially prepared cigars. It is also of three types

• Snigdh
• Madyam
• Tikshan.

Procedure

The dhum is to be taken when the person is sitting erect with his mind attentive on the act. Usually dhum is sucked is taken through one nostril and the process is repeated in vice versa. If the dosha is situated in the head region or in the nose and if it moved from its seat (utklishta). In such a case person should smoke through nose. In contrast, if the dosha is firmly attached in the head or nose and is not moving, then he may take the smoke through the mouth. If the dosha is situated in the throat then, he should first take the smoke through the nostril and next through the mouth. In all the cases, this inhalation of smoke should be left off through the mouth and never through the nose. The smoke is to be drawn in and then left off and this process is repeated three times on an occasion. Herbs used for Dhumapanam Shallaki, laksha, prithveeka, lotus, lily, nyagrodha bark, udumbara, aswatha, plaksha, lodhar, sugar, muklethi, suwarnatwak, padmakam, manjishtha and all the fragrants substavces excepts kushta and tagra. These are saman dravya (herbs), if after these still some doshas are left then administration of tikshan dhum is done.

Disease in which Dhumapanam is indicated Disease or symptoms like cough, asthma, peenus, loss of voice, offensive breath, anemia, premature graying of hairs, ottorrhoea, discharge from eyes, excessive salivation, itching and pain in the eyes, ears and mouth, stiffness in these parts, sleepiness and sluggishness and hiccough. These symptoms or disease are prevented in a person who uses proper Dhumapanam. Dhum may be applied to the ulcers and at that procedure it is called vranadhupnah (fumigation of the wound.) Kaval and Gandusha Gandusha means holding a mouthful of tailam or any decoction for a while after filling the mouth wit it. Kaval means filling the mouth partially and gargling
with it. Gandusha is of for types

• Snigdh Gandusha : it is done with oils. These are medicated with sweet, sour and saltish substances. It is useful in pitta disorders.
• Saman Gandusha : it is done by decoction prepared with the bitter, astringent and sweet substance. It is useful in kapha disorders.
• Shodhana Gandusha: it is done with the decoction etc. prepared with astringent and sweet substance. It is useful in vata disorder.
• Ropana Gandusha: it is done with the decoction which is prepared with astringent and bitter substances. It is useful in ulceration of mouth.

Dravya (herbs) used in Gandusha For performing Gandusha oils, ghee, milk, water mixed
with honey, liquors, meat juice, cow’s urine, and dhaanyaamlam etc, mixed or unmixed with other herbs may be used. These herbs have rasa or the taste, as indicated the disease we are treating. Sweet gingerly oil or meat juice may be employed for Gandusha daily by all the people, even they are not suffering from any disease also. In mukh paak (stomatitis) or the ulceration of the mouth or in inflammation of any part of the mouth accompanied with burning sensation or in injuries caused in the mouth, Gandusha with honey, ghee and milk are very effective. If there is kapha in mouth, Gandusha with ksharodaka is very useful.

Life style

One should avoid cold water, curd; heavy food stuff and fatty food items. One should bathe with warm water. One should reside in cozy and warm environment. Atmosphere
should clean without any dirt, dust and any kind of pollution. Any kind of emotional stress should be avoided. Traveling shold also be avoided.

Virechan nasya

Virechan nasya or seerssha virechan is useful in shirh shool (head ache), abhishyandi (conjunctivitis), kanth roga (disease of throat), mukh shoof (swelling of the face), Krimi (worms), granthi (enlargement of the glands), kushth (leprosy), apasmaara (epilepsy), peenus (nasal disease in which smell sensation is lost). Following are the herbs used in giving virechan nasya. Garlic juice mixed with mustard oil or medicated sprits with also a addition of marich (black pepper).

Apamarg seeds, pipilli (piper longum), marich (black pepper), vidang, siguru seeds, mustard oils, tamburu (tobacco), ajeern (indigestion), ajagandha, peelu, ela (cardamoms), herenuka, prithweeka, tulsi (holy basil),kutheraa, phanijjaka, saindhav lavan (rock salt), souvarchal lavan, haridra (turmeric), daru haridra, jyotish mati, and sunthi. These herbs are used in performing nasya of vairechanika type. Virechan is thus of two types

• Avapeed
• Pradhamana

Avapeed nasya

Usually fresh juice or juice extracted after throbbing the herb with a little water, if the herbs are dry, oils and sprits medicated with the above termed as avapeed nasya. It is a form of virechan nasya in which the fresh juices or the extracted rasa from there kalk are being used. On an average about four, six or eight drops of the herbs are recommended. This type of nasya is very helpful in kanth roga (disease of throat), jwar (fever), Nidra Nash (insomnia), manas roga (mental disorder), Krimi (worms) etc.

Pradhamana nasya

If the dry drugs are powdered and blown in the nostril, it is called as pradhamana nasya. The pradhamana is more irritating as it is more tikshan (stronger). This kind of nays is administered when the dosha are very intense as it has the capability to absorb doshas. The herbs that are usually used are saindhav lavan (rock salt), marich (black pepper), pipilli, sunthi, garlic, guggulu etc. All these herbs are mixed in equal quantity and is powdered well along with the gall stone of a fish and kept dry. The powder is then used to perform nasya karma