GLIMPSES ON PANCHAKARMA THERAPY IN AYURVEDA.
Ayurveda, the “science of life” which finds its roots in the four Vedas is a time tested system of Indian Medicine which helps in promoting positive health, in preventing diseases and helps in achieving long life to fulfill the four ultimate goals viz., Dharma, Artha, Kama and Moksha.
Ayurveda also called Ashtanga Veda consists of eight branches viz.
Kaya Chikitsa – General Medicine
Bala Chikitsa - Paediatrics
Graha Chikitsa – Psychiatry
Urdhvanga Chikitsa – Opthalmology and Oto rhino laryngology
Shalya Chikitsa – General surgery
Dhamshtra Chikitsa – Toxicology
Jara Chikitsa – Geriatrics &
Vrisha Chikitsa – Aphrodisiacs.
Ayurveda which accepts the philosophies of SANKYA and YOGA believes that the human body is made up of 25 basic factors viz.,
1. Athman (Purusha/Self)
2. Avyaktha (Primordial matter)
3. Mahat (Supreme intelligence)
4. Ahankara ( Ego)
5. Manas (Mind)
6-10 Pancha Tanmathras (Five basic elements viz., Earth, Water,
Fire, Air and Space in atomic state.)
11-15 Pancha Maha Boothas (Five basic elements in Gross state)
16-20 Pancha Gnanendriyas (Five sense organs viz., Eyes, Ears, Nose,
Tongue and Skin)
21-25 Pancha Karmendriyas (Five motor organs viz., Mouth, Hands, Legs,
Gender organs & Anus)
The above mentioned Pancha Maha Boothas predominantly exist in the human body in the form of Tridoshas viz., Vata (Air and Space), Pitta (Agni), and Kapha (Earth and Water). These Tridoshas (the Content) are contained in the Shareeram (the Container) which is made up of Sapta Dathus viz., Rasam, Raktam, Mamsa, Medas, Asthi, Majja, and Shukra. Tridoshas and Sapta Dathus are nourished by the 13 Agnis (Digestive fires viz., Jataragni, 5 boothagnis and 7 Dathwagnis) located respectively in the stomach, 5 boothas and 7 Dathus and which digests the Ahara made up of again the 5 Maha boothas and the resultant Malas (waste products) are 3 in nos. viz., Pureesha, Muthra and Sweda (faeces, urine, and sweat respectively).
Ayurveda defines Health as “the total equilibrium of 3 Doshas, 7 Dathus, 3 Malas, and 13 Agnis, and the total well being of Athman (Soul), Manas (Mind) and Indriyas (Sensory and Motor organs) in the Shareeram”. Hence, any disturbance in the quality or quantity of the above factors will lead to ill health. Disease is just the inequilibrium of Tridoshas, Dathus, Malas etc.,
Diseases are mainly caused by 3 factors viz.,
1. Asatmyaendriyartha samyoga – Incompatible contact between the 5 sense
organs and their respective objects.
2. Prajnaparadha - Misuse of Prajna, (the Intellect) &
3. Parinama - Transformation (because of time).
The Principal causative factor of all diseases is Asatmyaendriyartha samyoga, which is nothing but the excessive, less or wrongful contact between the 5 sense organs and their respective objects. For eg., i) excessive contact between the tongue and its object viz., the Madurarasa (sweet) will lead to Sthoulyam (Obesity), ii) Consuming in less quantity vital Vitamins and minerals leads to deficiency disorders (less contact between the tongue and its objects), iii) wrongful contact/misuse of contact between the nose and its object viz., poisonous gas will lead to unwanted disorder.
The other main causative factor of all diseases is Prajnaparadha the misuse of Prajna. Prajna, the intellect consists of 3 main functional faculties viz., i) Dhi (the capacity of the intellect to preserve knowledge, its faculty of rational thinking and its ability to take decision) ii) Dhruti. (the courage required to act or behave according to the decision taken by Dhi and iii) Smruti (Memory or the capacity of intellect to recollect promptly the decisions taken by Dhi and its ability to act without interruption according to Dhruti. When these faculties of Prajna are influenced by Satva quality it is called Samabuddhi i.e. healthy intellect and when the same are influenced by Rajas & Thamo gunas, they lead to harmful actions and misdeeds which are called Prajnaparadha. This Prajnaparadha leads to several non beneficial consequences like neglecting natural urges / body reflexes, not following Dinacharya (Daily regimens), Ritucharya (Seasonal regimens) etc., which leads to physical and psychological disorders.
The third causative factor viz., Parinama, (transformation) also causes various diseases due to the “time” factor. for eg. Geriatric disorders.
Pathogenesis in Ayurveda:
To understand Pathogenesis in Ayurveda, one has to know all the variations which the Dosas and Dathus undergo during the day and night. Dosas and Dathus undergo 3 physiological changes viz. Chaya, Prakopa and Prashamana during the day and night depending upon the various causative factors.
The Tridoshas undergo the stages of accumulation, aggravation and pacification as a routine physiological activity which is also called diurinal variations. These 3 stages usually occur in the locations of the doshas itself. Because of various causative factor as mentioned earlier when the doshas does not undergo Prashamana stage after Chaya and Prakopa it results in pathological condition. i.e. they undergo pathological stages to create various disorders/diseases. It is the Tridoshas which cause various diseases by undergoing 6 stages of transformation called Shadkriyakalas (Pathogenesis). The six stages are viz., Chaya, Prakopa, Prasara, Sthanasamraya, Vyakthi and Bheda.
i) Chaya - Due to various causative factors as mentioned earlier, Doshas get accumulated in its own Sthana i.e. Koshta (hollow organs)
ii) Prakopa - Due to precipitative factors the accumulated doshas get aggravated and that also takes place in their own sthana.
iii) Prasara – When the same precipitative factors persists, the aggravated doshas expand, increase, and then overflow the limits of their respective places and moves to the neighbouring sthanas viz. Shakas.
iv) Sthanasamsraya - Thus overflowing doshas get embedded in the neighbouring sthanas because of the continuous indulgence in the causative factors by an individual, and produces certain mild signs and symptoms which is otherwise early demonstrable disease/ Purvarupa/premonitory symptoms of a disease.
v) Vyakthi – Even after observing the premonitory symptoms, if one does not stop from indulging in causative factors and have those Aharas and indulge in those activities which are similar to the qualities of disease causing dosha then actual disease occur with full blown signs and symptoms.
vi) Bheda - When the disease is full grown depending upon the dosha and dhathu involvement the signs and symptoms simply varies and leads to varieties of the same disease.
Thus, during the normal physiological activities doshas do not move from koshtas to shakas but during pathological condition, the doshas move from the koshtas to the shakas and treatment of such condition is nothing but bringing back the doshas which are embedded in the neighbouring/foreign area/shakas to their normal sthanas/koshtas.
Chikitsa in Ayurveda in general is of two types viz., Shamana (Palliative therapy) and Shodhana (Purificatory therapy). In the Shamana therapy, simply the aggravated doshas are brought back to their original sthanam (koshtam) from the neighbouring areas (shakas) through 7 different types of therapies viz.,
1. Undergoing fasting 2. Withholding thirst 3. Exercise 4. Athapasevanam (Exposure to sun) 5. Marutha sevanam (Exposure to wind / fresh air) 6. Taking Oushatham which increases the 13 Agnis including Jataragini 7. Taking Oushatham which destroys Ama (toxins). When one undergoes palliative therapy there is a chance of recurrence of the same disease because the accumulated and aggravated excessive dosha is not removed from the body but only pacified in its own sthanam.
But, during the Shodhana therapy, the aggravated excessive doshas which are embedded in the shakas are further aggravated, liquefied and kindled to move back to their own sthanas or to the Mahakoshtam (Gastro intestinal tract). These excessive doshas which are brought to the Mahakoshtam by means of poorvakarma (Preparatory therapy) are brought out through the nearest available srothas viz. mouth, anus etc. Since excessive doshas are brought out of the Shariram, chance of recurrences of the disease are either remote or NIL.
Though the palliative therapies can be administered independently, the Shodhana karma should be done only after administering proper Shamana therapy. Shodhana karma i.e. purificatory therapy consists of 5 different purificatory procedures according to Acharya Caraka viz. 1.Vamana, 2.Virechana 3. Anuvasana Vasti, 4. Niruha/Kashaya Vasti and 5. Nasyam. Acharya Sushruta, being a surgeon, enumerates the panchakarmas as Vamana, Virechana, Vasti, Nasyam and Rakta Mokshan (Blood letting).
The Panchakarma treatment as told in Sastras is useful not only in therapeutic aspect but also in preventive medicine. Persons who want to have Rasayana and Vajikarna therapy must also undergo these purificatory therapies so as to clean the body and then have Rasayana and Vajikarna to have total effect. Panchakarma comprises of 3 stages viz., Purvakarma, Pradhanakarma, and Pashchathkarma.
1. Purvakarma (Preparatory procedures) – They are
a) Digestive therapy – Pachana karma (Ama-Pachana)
b) Oleation therapy – Snehana karma
c) Fomentation therapy – Swedhena karma
Before any purificatory procedure, purvakarmas must be carried out properly. Due to dietary, behavioural and various other factors the doshas get accumulated, aggravated, overflows from its site, moves to neighbouring areas, gets embedded there and because of Ama, obstruction takes place in the Srothas and return of the vitiated doshas become impossible. By performing purvakarma and Deepanapachana, the Ama is removed and thereby the obstruction of srothas is removed. Later, by making the individual to undergo Snehana therapy the doshas get loosened up (increased sliminess/pichilathuvam) in the shakas. By means of fomentation, the doshas gets liquefied and they move back from the shakas to the koshtas through the opened up srothases.
2. Pradhanakarma (Main therapies)
They are 5 in number and are performed only after purvakarma.
a. Vamanam (Emesis) : Inducing vomiting by administering various drugs. By this generally, Excessive aggravated Kapha dosha gets eliminated through the nearest outlet from its sthanam.
b. Virechanam (Purgation): Inducing purgation by administering various drugs, and by this procedure excessive aggravated Pitta dosha gets eliminated through the nearest outlet from its sthanam.
c. Vasti (Enema): By administering both oil and kashaya medications, in suitable order, through the anus, the excessive aggravated vata dosham is eliminated from its pradhana sthanam.
d. Nasiyam (Errhines) : By administering various medications through the nostrils, excessive aggravated doshas located above the clavicle bone (i.e. head) are eliminated.
e. Rakta Mokshana (Blood letting) (as per Acharya Sushruta) : Using leech, by venesection etc., unwanted impure blood is let out from the body.
3. Pashchat Karma: (Post operative therapy) :
Because of various pradhana karmas, the individual becomes very weak, the Jataragini and other 12 agnis also become weak, hence the post operative therapy includes administration of various food preparations in stages so as to enhance the power of Jataragni and other agnis and thereby the general health of the individual who has undergone panchakarma also improves.
SNEHANAM: OLEATION THERAPY
The procedure which produces softness and smoothness in the body is known as Snehana. The fatty substances used in this therapy are for the purpose of producing lubrication, anointing or oleating effect on the internal and external organs. This treatment has qualities like restfulness, strength, invigoration and cognition. This is mainly done with oil and ghee, the other two substances viz. Vasa and majja are rarely used these days.
Indications for Snehana:
Preliminary therapy before Panchakarma
1. To strengthen & improve the delicacy of the skin.
2. For intelligence, also to improve grasping power and memory.
3. Vata diseases or Vata pitta disorders.
4. After heavy work, or long journey
5. For all weak, exhausted, anemic persons and
6. As a rasayana therapy
Contra Indications for Snehanam
1. Obesity and Kapha predominance
2. Immediately after Panchakarma
3. Those suffering from diarrhoea and dysentery
4. When Jataragni is very weak
5. When the abdominal organs like liver spleen etc are enlarged.
Snehanam is of two types: a. Internal and b. External
Internal: It means oral use of oily substances.
The internal oleation has been further divided into 3 types depending upon the mixture of oleating substances. When two substances are mixed it is called as yamaka. When three are mixed it is known as Trivruta and when 4 or more are mixed together, it is called as Maha Sneham. Similarly if only one oleating substance is given, it is known as Achcha and when it is mixed with some other ingredients and given it is called as Vicharana. This vicharana according to Caraka and Sushruta are again divided into 24 types.
Ghee: Among the various oleating drugs, ghee is the best. It is usually used in those who have Pitta constitution and those who suffer from pitta or pitta vata disorders.
Oil, vasa (fat in the muscle), and majja (bone marrow) should be used in persons having vata constitution. Now-a-days vasa and majja are not used in practice.
Oil, generally Thila tailam (Sesame oil) should be given in the following conditions viz., 1. Kapha predominance 2. Predominance of fat 3. Vata diseases like Ekanga vata, Sarvanga vata etc., 4. Vata constitution 5. To reduce body weight 6. To increase muscle strength.
Application of oil and other fatty substances on the skin.
- Abhyanga – Oil massage of the body in the direction of hair growth.
- Udvartana – Massage of herbal powders in opposite direction of hair growth.
- Lepa – Application of an herbal paste which dries on the skin and is then removed.
- Mardana –Unmardana – Pressure massage. The application of warm oil to the body followed by a kneading type of massage.
- Pizhichal (Sarvangdhara) – Continuous pouring of warm medicated oil over the entire body for an extended period of time (one to two hours).
- Gandusha (Gargle) - Mouth should be filled with oil and then it should be retained for a period of time.
- Shirodhara – Pouring of warm oil on forehead region from a vessel hanging overhead.
- Shirovasti – Keeping oil on head with the help of special leather cap
- Tarpana – Keeping oil over the eyeballs, ears, vagina etc. by keeping cotton swab dipped in oil on these regions.
- Sneha avagahana – Taking a bath in a tub full of warm oil.
All these methods are practical and can be learned from expert Panchakarma Physician. Out of these ten types 1, 2, and 4 are types of abhyanga. The main purpose of massaging the body with oil is, to encourage the detachment of toxins (including vitiated doshas) from the deeper tissues and the subsequent movement of these toxins back to their origins in the gastrointestinal tract where they can be efficiently eliminated with the help of main purification procedures. Massage has an obvious added benefit in this regard namely the stimulation of the circulatory systems of the blood and lymph tissues.
Benefits of Abhyanga:
1. To delay old age 2. To release fatigue 3. For all vata diseases 4. To relieve pain in the body 5.To increase the capacity of eyes 6. Promotes all tissues and increases body strength 7.Adds years to life and life to years 8. Brings normal sleep 9. Strengthens and vitalizes skin 10. Protects skin from infection 11. Increases immunity 12. Beneficial to skin colour and complexion.
SWEDANA – FOMENTATION OR SUDATION
Fomentation which is given by different types of heat, brings sweat on the skin through the hair follicles as it opens the pours of the skin, also liquefies the aggravated doshas embedded in the sakhas. Fomentation also dilates all the srothases (channels) in the body. It is an extremely important preparatory procedure which is indicated in preparation for panchakarma except in diseases where there is an extreme aggravation of pitta dosha. Fomentation is considered to be a powerful method of treatment in most of the vata and Kapha disorders. It is instrumental in helping to liquefy the sticky and adherent doshas which are lodged in the sakhas (peripheral tissues). Properly timed fomentation will soften and melt these toxins sufficiently for the body to efficiently expel them with the assistance of pradhana karma which then directly follow.
Indications for fomentation:
1. Vata constitution and disorders 2. Exposure to cold and Kapha disorders 3. Hiccough 4. Asthma 5. Heaviness of the body and obesity 6. Pain in neck, lumber-sacral region, back, hip, legs, head, hands etc. 7. pharyngitis & laryngitis 8. Facial paralysis 9. Hemiplegia 10. Paraplegia 11. Myopathies 12. Tympanitis 13. Constipation 14. Stiffness in neck, hip and back 15. lock jaw 16. Sciatica 17. Joint diseases 18. Urinary disorders 19. After delivery 20. Muscle atrophy and contracture of joints.
Contra indications for fomentation:
1. Habituated Alcoholic 2. Pregnancy 3. Pitta predominant diseases like fever, inflammations 4. Bleeding tendencies and jaundice 5. Skin diseases with external ulcers & Oozing 6. Severe diarrhoea 7. Tired due to excessive physical work 8. Toxic conditions 9. Unconscious patient 10. Obesity 11. Severe anemic patient 12. Leprosy 13. During menstruation 14. Diseases of eye and scrotum.
Fomentation should not be given in the eyes, heart, or the testicles. During fomentation of the entire body, these areas should be protected with cool moist cloths, wet lotus leaves or cool water. During the fomentation therapy, the physician must always keep constant watch on the patient and one attendant should also remain in the vicinity to help the patient if needed.
Signs of excessive fomentation:
· Burning sensation
· Circular rashes on the skin
· Excessive thirst
· weak voice
· Pain in the joints
If these signs of Pitta aggravation are observed, the fomentation must be immediately stopped. The best treatment is stambhana or astringent therapy. Patient should be then removed to cool, well ventilated place and be given cool drinks containing sugar and praval or oxide of coral. To ease the symptoms of burning on the skin, sandalwood paste should be applied.
Signs of improper fomentation:
· Coldness, stiffness and heaviness remain in the body
If these signs are observed then the heat should be increased and the fomentation should be again properly started.
Clinical signs of optimum fomentation:
· visible and adequate perspiration
· disappearance of coldness
· alleviation of pain
· reduction in stiffness
· reduction in heaviness
· increased softness of the body
Types of fomentation:
Fomentation is of two main types viz., Agni Sweda and Anagni sweda. In Agni Sweda heat is directly applied and in Anagni sweda heat is indirectly applied. According to Caraka Anagni sweda are of 10 types which includes 1.exercises like boxing, 2.walking, 3. lifting heavy weights, 4. exposure to hot sunlight, 5. staying in a closed room with no ventilation, 6. covering oneself with heavy blankets,7. hunger, 8. administration of different kinds of alcoholic beverages, 9.emotions like fear or pain, 10. anger.
Again fomentation has been divided into external fomentation and internal. For internal, various herbs having pungent taste and hot potency are used. e.g. ricinus comunis, moringa pterrigosperma, curcuma longa, calotropis procerra, comiphora mukul, agaru and Dasamulam.
Fomentation has also been divided again into two types depending upon, whether it has been given to the whole body or the part of it.
Similarly, depending on the quality of the substances used in fomentation, it has been divided into oleating or dry fomentation types. If the fomentation is done with poultice or steam it is good to alleviate Vata, while the dry type of fomentation is good for Kapha and Pitta disorders.
Four Main types of Swedanam (Fomentation)
Type of Swedana
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Usually solid material like sand, stone, brick, rice etc. are used
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Semi-solid or semi-liquid material like poultice is used
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A type of steam therapy whereby water is sprinkled on hot materials i.e. stone, ashes or kept in pressure pan to produce steam.
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Bathing in decoctions of herbs to promote fomentation
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Usually following swedanas are very useful and commonly used in practice.
Type of swedana
Particulars of the type
Steam/vapour fomentation of nirgudi leaves, dasamoola, nimba, eranda leaves etc.,
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Steam/vapour of above leaves for local use by pine method.
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Shashtika shali pinda sweda
Rice bolus of particular type of rice which matures in 60 days, is used with special decoction of roots of bala to cook it. Hot bolus are moved on the body in the fashion of abhyanga with special techniques.
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Oil pouring on the body
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Valuka pottali sweda
It is a dry fomentation by sand
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It is a tub bath in warm decoction, siddha jala (Medicated water) or in oil.
1. Tapa Sweda
In this procedure substances like sand, bricks or cotton cloths are heated and are directly applied to the body of the patient to produce sweat. This fomentation can be dry as well as wet type. For dry fomentation, in ancient time, various substances like sand, bricks and cloths were heated and used for this purpose. Now a days one can use infra red lamps, electric hot pads etc.,
For wet fomentation, use of water bottles of various sizes is good.
2. Upanaha sweda – Fomentation by poultice
This has been described under sankara sweda. Sushruta has described a special poultice – Salvana – with salt. In this poultice various substances like salt, oil, flour of wheat, herbs, meat and some sour substances should be cooked together and while they are hot they should be kept in suitable cloth bundle and then firmly applied to the particular part of the body.
3. Ushma Swedana – Steam fomentation
Whole body fomentation
In this procedure, a person is made to perspire by the application of medicated steam in a closed wooden chamber. This is whole body sudation procedure, however the head of the patient must be kept outside the chamber.
This chamber is specially prepared in which patient can sit or lie down. After proper oleation by abhyanga, the patient is asked to sit or lie in this chamber with minimum clothes. The head of the patient must remain outside the chamber. Chamber is then closed and simple or medicated steam is allowed to pass inside. The temperature should be adjusted to 1020 F. The person should be asked to stay inside till the proper perspiration is achieved (Perspiration on forehead is the limit of fomentation)
Then he is asked to come out and his body is wrapped properly. When the body temperature returns to normal, he is allowed to take warm water bath and then take rest.
Local fomentation by Naadi sweda
For steam fomentation of joint or some other local part of the body, one should use very simple instrument of naadi sweda. This can be prepared by any person at home. Attach rubber tubing which can be fitted to the top of the pressure cooker. Keep water and some suitable herbs like vitex negundo or dashmoola inside and keep the pressure cooker on the gas stove for heating. When the steam starts coming out of the tube direct the steam to the proper organ which you want to give fomentation.
In this procedure, warm liquid, medicated oil or milk is poured on the body (kayaseka) or on the head (Siraseka). This is an extremely important therapy for all Vata disorders.
To decide the particular type of sudation procedure, one must take into account the constitution of the patient, the disease and the bodily organs most affected, the season, the age of the patient, and the place where the treatment is being given (i.e. one has to take into consideration the TEN main factors before deciding the strength and the type of any treatment viz. Dhushyam (doshas and dhatus), Desham (Dwelling place of the patient), Balam (Strength of the patient), Kalam (Rutu/Season during which treatment is given), Analam (Strength of the Jataragni), Prakurti (Constitution), Vayah (Age of the patient), Satwam (Mind of the patient), Satmeeyam (Compatibility of the patient) and Aaharam (Nature of the food the patient consumes).
Post fomentation regimen:
Having completed a course of fomentation, patient should be advised to take rest, avoid cold, take warm baths and get adequate fresh air.
Food should be primarily easy to digest, and non obstructive.
Care must be taken to consume only moderate amounts of both food & liquids.
If purgation has to be done afterwards it should be done two days after fomentation is completed.
Nasya, Vasti or bloodletting can be done immediately after fomentation.
VAMANA – EMESIS
In this procedure, excess and vitiated doshas are removed from the upper part of the body by way of vomiting. It is normally the first main purificatory therapy which follows preparatory procedures. Vomiting is induced with herbal emetic substances for the purpose of eliminating vitiated Kapha and Pitta.
Indications of Medicated Emesis:
It is the supreme method of eradicating aggravated Kapha dosha and to some extent for removal of Pitta. Hence, it is useful for patients having disorders of Kapha and Pitta predominance like asthma, bronchitis, sinusitis, cervical lymph adenitis, indigestion, skin diseases, obesity, stomatitis, laryngitis & Pharyngitis, mental disorders, epilepsy, excessive salivation, loss of taste of the food.
Similarly, medicated emesis is useful in diseases of fatty tissue and muscular tissue also e.g. haemorrhoids, tumors of fat and muscle etc.
It is also useful in diseases like visarpa – erysipelas, eczema and diabetes.
Contra indications of medicated emesis:
Patients who are very weak and old and those who have lost their body strength due to chronic long standing diseases, small children, pregnant women should not be given medicated emesis.
Similarly in diseases where there is bleeding through upper respiratory passage, oesophageal varices, heart disease, spleenomegaly and ascites it is contra indicated.
Method of Administration of Medicated emesis
After completing the preliminary procedures of oleation and fomentation the patient must be given food preparation containing Tila, or other oils to aggravate Kapha or he should be given rice with yoghurt. The patient thus suitably prepared is asked to drink 500 cc. or 4 to 8 cups of warm milk, sugarcane juice or buttermilk. This should be given till the stomach is full. Herb induced emesis should NOT be given in empty stomach. Many herbs having emetic action are mentioned by Charaka and Vagbhata. The best combinations are as follows:
1. Madana Phala (Randia dumetorium) – 3 Parts.
Vacha (Acorus calamus) – 2 Parts
Yashtimadhu (Glycerrhiza glabra) - 1 Part with honey or water.
2. Randia dumetorium – 3 Parts + Liquourice – 2 Parts + Rock salt – 1 Part
mixed with honey or water.
If the patient is Kapha Prakriti or with Kapha Rogam 1 part of Piper longum should be added to the above recipe. If it is Pitta Prakriti or with Pitta Rogam 1 part of Neem or Vasa should be added. If the individual is Vata Prakriti or with Vata Rogam the above recipe should be taken with cow’s milk.
Charaka has stated that patient should be observed for a muhoorta (48 minutes) after the administration of vamana-dravyas. According to him, the onset of perspiration is indicative of the liquification of doshas (malas), lomaharsa or horripilation signifies that the dosha (mala) has been dislodged from the places where it has been embedded, the distension of the stomach is being caused by the dosha which has reached this place. Hrillasa or nausea and asyasravana or salivation are indicative of its upward movement for being expelled.
The patient is then instructed to vomit without straining himself unduly and must be discouraged from inhibiting the urge. In the case of sluggish response, the patient’s tongue should be tickled to encourage the emptying of the stomach. His head should be supported while he is actually vomiting.
Minute observation of patient to judge whether the purification done has shown optimum signs or it is in excess or inadequate should be made.
The physician should watch the pulse and respiration of the patient from time to time. Pulse should always remain below 150 per minute.
Measure the quantity of intake and output. Total output should be always more than the total intake.
Examine the vomited matter in each bout for Kapha, pitta or blood
To know whether proper signs of purification has developed or not, the physician is asked to conduct 4 types of examinations. 1. He should observe the substances coming out in vomitus. 2. He should measure the substance that is vomited out. 3. He should measure the number of vomits and 4. He should also observe the symptoms of optimum purification.
From these signs, one can decide whether the purification done is optimum, medium or minimum.
Symptoms of proper emesis
Usually the vomited matter comes in the following serial first the food, followed by mucous-Kapha, then yellowish or greenish secretions of Pitta and lastly Vata will come out.
The amount vomited is evaluated to know whether the purification done is maximum, medium or minimum. These are judged from the number of vomiting and the total quantity of vomit expelled during the therapy.
Number of vomiting Quantity expelled
4 minimum 325 c.c.
6 moderate 650 c.c.
8 maximum 1,300 c.c.
However the symptoms of proper elimination are more important than the quantity expelled or the number of vomiting. The symptoms of proper elimination are a feeling of lightness in the body, increased digestive power, decrease in the symptoms of the disease for which the emesis was prescribed, and the automatic stopping of vomiting after the expulsion of the doshas.
Symptoms of inadequate emesis
The process does not start or even if it starts in between two bouts there is large gap. Only the material given to start the process comes out. This means that the expected vitiated doshas do not come out. Also symptoms like rashes on the skin, heaviness in the abdomen and heart and lethargy develop.
In such condition, try to induce emesis with mechanical aids. The patient is instructed to stimulate the gag reflex by gently tickling the base of the tongue (or back of the throat) with one or two fingers, or give warm decoction of licorice again. If there is no response and the patient becomes restless, put Ryle’s tube into the stomach to take out the ingested material. When the whole material comes out, give Tab. Shankha vati and Tab. Sutashekhar 2 tablets with honey.
Symptoms of excessive emesis:
After proper purification, the vomiting should stop automatically, instead if it continues and sometimes if there is blood in the vomiting, it is excessive emesis and is associated with excessive thirst, giddiness, weakness and burning in the stomach and chest region. Due to dehydration he may faint and there are symptoms of Pitta aggravation.
First apply little oil on the body and give cold water bath to the patient. Also give sip by sip fruit juice of apple or grapes in small quantity, but repeatedly. It is also beneficial to give puffed rice water along with rock candy. If there is too much irritation of stomach, give mixture of shatavari, rock candy, oxide of praval with cool water. Use Pitta alleviating minerals and herbs like sandalwood, vetivera or give Suvarna sutshekhara 125 mg. with honey three times a day, or mauktik kamadugha three to four times a day.
After 6 to 8 hours of vomiting, give salt water for last bout of vomiting. In the end, ask the patient to do gargling of salt water followed by ordinary warm water gargling, and then ask him to take complete bed rest.
Post Emesis Regimen
1. Medicated smoking
To remove the mucous in the region of pharynx, ask the patient to smoke medicated cigarette which contains mixture of various herbs like agaru, jyotishmati etc. (This special cigarette does not contain any tobacco). Do not give any food or drinks for next two hours. After that, herbal tea can be given. In the evening the patient should not take any food but should be given hot liquids like soup or herbal tea.
2. Behaviours to be avoided
Overeating, loud speech, excessive sitting or walking, anger, anxiety, excessive use of vehicle, sex, excessive heat or cold, wind, inhibition of natural urges etc.,
3. Dietary regimen (Samsarjana Krama)
Day Time Diet
Day 1 Morning --
Day 1 Evening Peya
Day 2 Morning Vilepy
Day 2 Evening Akrita Yusha
Day 3 Morning Akrita or Krita Yusha
Day 3 Evening
Peya: Cook 1/3rd cup of basmati rice in 4 cups of water for 25 minutes. Strain. The liquid which remains is Peya.
Vilepy: Cook 1/3rd cup of basmati rice in 2 or 3 cups of water for 25 minutes or until rice is soft. The rice plus the water is Vilepy.
Yusha: Cook 1/3rd pre-soaked (2 hours) split moong dal in 2 cups of water until the dal is soft; Eat this semi-solid soup, this is Yusha.
Krita Yusha: Yusha added with salt, black pepper, asafoetida, pippali and other spices.
Akrita Yusha: is without spices
Beginning with the normal diet on 3rd day evening, patients should gradually begin to take foods which are appropriate for their constitution and/or season.
The most important rule to follow is to simply not overeat. Also it is wise not to combine too many different foods at any cost during 1st week. Complications of Herb induced emesis are excessive purification or negligible purification.
Complications of medicated emesis
Various complications can occur due to improper assessment by the physician or if the patient has not followed the instructions given by the physician or the emetic substances are not potent.
These include abdominal distension, blood in the vomiting, dehydration, heaviness in the heart, heaviness in the limbs or the whole body.
Drug induced Purgation (Virechana Karma)
Drug induced purgation is the second Principal detoxification procedure. The aim of the treatment is to stimulate vitiated doshas from the stomach, small intestine, liver and gall bladder, and bring them to the gastro intestinal tract for their eventual expulsion from the body via the rectum. Various herbs like ricinus communis, triphala – three myrobalan fruits, cassia fistula, trivrit-operculina turpethum, can be used for this purpose.
Drug induced purgation is a specific modality for the elimination of Pitta Dosha. It is indicated for the treatment of conditions involving excess Pitta, for individuals of Pitta constitution or in conditions involving Pitta mixed with Kapha, and for excess Kapha dosha which happens to be lodged in the Pitta areas of the body. Drug induced purgation is also treatment for diseases of rakta dhatu or blood.
Benefits of drug induced purgation
This process not only eradicates the diseases of Pitta and blood but it helps to rejuvenate all the tissues and organs in abdomen, it improves skin complexion, gives longevity and increases immunity also.
Indications of Drug induced purgation
Purgation is indicated in various skin diseases, chronic fevers, enlargement of liver and spleen, jaundice, erysipelas, glandular swelling due to vitiated blood, and various diseases of toxic blood due to Pitta, like stomatitis, glossitis and hyperacidity and other Pitta predominant diseases.
Contra indicatations of Drug induced purgation
It is contra indicated in children, very old and weak patients, persons who have developed fissure in anus or have disorders like bleeding peptic ulcer of the small or large intestine, fissure in anal canal, prolapse of the rectum, diarrhoea and dysentery, haemoptysis – blood in sputum due to tuberculosis or any other cause, pregnant women, immediately after delivery, and person suffering from acute heart disease, all conditions involving toxins -ama- in the body e.g. toxic fever etc.
Drug induced purgation is a simple therapy to execute, involving only the administration of an appropriate purgative substance. The single most important factor is that a proper course of preliminary procedures must be completed, prior to the procedure for the full and utmost effect of Drug induced purgation.
Drug induced purgation is usually followed after drug induced emesis. But this can be done without drug induced emesis, because it acts on Kapha dosha too along with Pitta dosha. For pitta, mild type of drug induced emesis is recommended.
External – Abhyanga with mild massage should be done
Internal – Ghee or oil is selected according to the predominance of dosha. It is either pure cow’s ghee, sesame oil or medicated ghee or oil. Herbs used for medication are nimba, dadima, guduchi, arjun, rasna etc. Internal oleation is given in moderate dose for three to seven days. The dose is adjusted in such a way that patient is not hungry for twelve hours after consuming ghee or oil in the morning. During this procedure, patient must drink hot water throughout the day during the period. In addition the food during this period should be primarily warm, liquid and somewhat oily.
Whole body fomentation should be done either in sauna or the specific chamber used for this purpose. It is administered each day following external oleation. Two days gap is necessary between completion of internal oleation and drug induced purgation. During these two days, fomentation is given as before. The patient should be given light diet and he should drink hot water.
Emesis is not given in empty stomach, but purgation is given in empty stomach preferably in the morning.
The medicine of choice in this therapy is a decoction of draksha (vitis vinifera), aragwadha (cassia fistula), haritaki (terminalia chebula), 12 gms each and katuka (picrorhiza kurroa), 6 gms. First make a decoction of these herbs in water and then take two ounces of castor oil. This is an ideal medicine for purgation. This dosage is for promoting medium type of drug induced purgation.
Useful herbs for purgation:
Charaka in Kalpasthana chapter 12 has described more than 245 different preparations for medicated purgation. He has described 110 preparations of trivrut, 11 of aragvadha, 16 of tilvaka, 20 of sudha, 39 of saptala shankhani and 48 of danti.
Sl.No. Name of Medicine Mild Moderate Maximum
dose dose dose
1. Castor Oil 10-20 ml 20-40 ml 40-60 ml.
2. Powder of trivrut, haritaki 1-3 gms. 3-6 gms. 6-10 gms.
3. Decoction of draksha,
haritaki, or triphala 10-20 ml. 20-40 ml. 40-60 ml.
4. Psyllium husk 3 g. 3 – 6 gm 6 – 10 g.
5. Ecchbhedi or
which contain Jepal or
croton ½ - 1 gm. 1 – 2 gm. 2 – 4 g.
Selection of appropriate herbs for purgation
There are many medicines which can be used for this method of purification, but selection depends upon,
· the softness or hardness of the patient’s bowel movements
· the constitution of the patient.
In general, patients with Vata constitution will have harder bowel movements and those of Pitta and Kapha constitution will have softer bowel movements.
Thus following chart is useful to select herb according to constitution—
Constitution Recommended Purgative
Vata Trivrit (Operculina turpenthum) + Ginger powder +
Salt Aragwadha (fistula) Arka (Calotropis procera), Eranda (Rocinus comunis) Snuhi (Euphorbia nerifolia) Isabgol (Plantago ovata)
Pitta Draksha (Vitus vinifera) Katuki (Picrorhiza kurroa) Puga (areca catechu)
Kapha Trivrit (Operculina turpenthum) Danti (Baliospermum montanum) Snuhi (Euforbia neriifolia) Haritaki (Terminalia chebula)
Method of administration
· As mentioned before, this medicine is always given in empty stomach.
· Mild laxatives like Haritaki, Triphala, can be given at night during bed time with hot water. They all produce one or two motions in morning in mild dose.
· All drastic purgatives can be given in morning from 3 to 4 hours after sunrise. The patient is asked to drink the medicine prepared for purgation. Soon purgation starts due to its secretion-promoting action.
· Nothing by mouth should be given after Herb induced purgation until satisfactory result.
- Patient should be instructed to watch his stool for number, colour, frequency and consistency.
- Watch for symptoms of excessive and negligible purification.
- If patient is weak, arrange for bed pan.
- Watch for complications and treat them accordingly.
Symptoms of optimum purgation
Feeling of cleanliness in the channels and sense organs, lightness in the body, and increase in the appetite (after some time) are the indications of proper elimination by Purgation. During the procedure, the patient first passes liquid faecal matter and urine, then mucus, and then yellowish coloured pitta (bile).
Symptoms of inadequate purgation
Inadequate bowel movements, frequent motions but little in quantity and with obstruction, motion with pain, heaviness in the body, or there is vomiting instead of purgation or constipation and difficulty in micturation, stupor, loss of appetite, cardiac discomfort, itching around the anus.
Give the patient relaxing oil massage, using oil and rock salt. Then give fomentation by tube over the abdomen and repeat same or different purgative medicines, or administer a cleansing decoction enema with dashamoola or other suitable medicated enema. Afterwards, ask the patient to take soup of meat juice and then repeat medicine for purgation. In addition, the patient should be given adequate amount of hot water to drink.
Symptoms of excessive purgation
Number of bowel movements are more than our expectation, excessive quantity of faecal matter, frequent watery discharge. Due to loss of water and Kapha from the body there is weakness, tremors in hands and legs, fainting, cutting pain in the anus and mental/ emotional instability.
First give fruit juices, lemon juice, butter milk to the patient to avoid dehydration. Then ask the patient to take complete bed rest. To control the diarrhoea, give Tab. Shankha vati 250 mg with or Kutaj
Post Herb induced purgation regimen
After treatment the patient should rest. The samsarjan karma (dietary regimen) is the same as post – emesis. This consists of starting with a light diet like vegetable soup and then slowly increasing the diet to a heavier quality.
Patient should avoid overeating, loud talking, excessive sitting or walking, anger and sorrow, anxiety, excessive use of vehicles, sex, sleeplessness, excessive heat or cold, wind, inhibition of natural urges etc.,
MEDICATED ENEMAS – VASTI
In this procedure medicated oils and decoctions are introduced into the large intestine through rectum with the help of an enema pot or special bag made for this purpose. The word “Vasti” means the urinary bladder. In the ancient days for introduction of liquid substances into the rectum the urinary bladders of cow, buffalo, sheep were used. A metal or wooden nozzle would be attached to it for smooth function.
Today, the best instrument for this purpose is the adult size enema pot, which holds approximately 450 ml. of liquid.
Medicated enema is universally regarded as the most important Panchakarma procedure. Because it removes the excess Vata dosha from the entire body. In modern terms for enema, the world colon therapy is used. But these modern procedures are nothing more than bowel cleansing or nutritive therapies. The scope of Ayurvedic Vasti treatment is far more significant and hence cannot be compared with contemporary enema.
Types of medicated enema
It is mainly of two types.
- Niruha or Asthapan Vasti:- this is also called as decoction or cleansing enema. The word ‘Niruha’ means “that whose benefit is great.
- Anuvasana or Sneha Vasti:- This contains only oil. The word ‘Anuvasana’ means “ that which remains inside (vas) the body for a long time (anu) without causing harm.” This can also be given daily (anudina) without any side effects hence it is called as – anuvasana.
The niruha is given usually for purification and the anuvasana is used for nourishing and for reducing Vata.
In decoction enema, salt, honey, oils, pastes, and decoctions of herbs are used. According to the variation of substances used, this Vasti is further classified into yapana, brimhana, etc.,
In Anuvasana Vasti only sesame oil or medicated sesame oil is used.
Depending on the properties of the herbal medicine which is used, Vasti has a number of different functions.
1. It can be used for radical purification or for gentle alleviation therapy.
2. It can be used for increasing semen or for nourishing weak individuals – with anabolic herbs – brimhana
3. It can have a reducing effect (langhana) or scrapping effect (lekhana) for obese patients;
4. Or can also be used for protecting the vision (chakshushya).
5. It can prevent age related diseases (jarahara) and to promote strength and longevity.
Classification of medicated enemas.
1. According to the site
- A wound cavity
2. According to the substance used
- Cleansing or decoction (Niruha)
- Oleating (Anuvasana)
3. According to therapeutic action
· Shodhana – for purification
· Lekhana – for reducing excess tissue
· Snehana – for oleation
· Brimhana – for increasing deficient tissues in the body
· Shamana – for palliation
· Doshahara – to remove particular doshas
4. According to the course of treatment
- Karma – Total course of thirty enemas are given. In this course first one Anuvasana Vasti is given, then alternately twelve Niruha and twelve Anuvasana are given, and finally five Anuvasana are given.
- Kala – Total course of sixteen enemas. First one is Anuvasana then alternately six Nuruha and six Anuvasana are given, and finally three Anuvasana.
- Yoga – Total course of eight enemas. First one Anuvasana, then alternately three Anuvasana and three Niruha, and finally one Anuvasana is given.
Herbs used for decoction or cleansing enema
Charaka has explained 6 groups of these herbs according to the predominant taste.
- Those having predominant sweet taste – There are 86 herbs in this group including Shatavari, Yashtimadhu, draksha etc.
- Those having predominat sour taste – These include different forms of wines and yogurt etc., prepared from herbs like amalaki etc.,
- Different types of salts – herbs do not contain salts but in this group there are varieties of salts.
- Those having predominant pungent taste – This group includes 35 herbs like garlic, trikatu etc.,
- Those having predominant bitter taste – This group includes 45 herbs like guduchi, katuka etc.,
- Those having predominantly astringent taste – This group includes 63 herbs like ashoka, triphala etc.
However the commonest herbs are – ten roots, sida cordifolia, tinospora cordifoiia, tribulus terrestris, terminalia chebula; withania somnifera, aegle marmelos, gmelina arborea, emblica officinalis, mucuna prureins and bacopa monniera.
Contra-indications of Cleansing medicated enema
It is contra-indicated in conditions of indigestion, obstruction or perforation in the intestines, for very old or debilitated patients, for toxins (Ama) in the gastro-intestinal tract, diarrhoea and vomiting. It is also contra-indicated in patients who have received too much oleation, have severe loss of appetite (Agnimandya), and are tired due to long travel, hunger and thirst, immediate after meals or purgation, in status asthamaticus, ascitis and piles.
Indications for Cleansing medicated enema
Excluding all above diseases, decoction or cleansing enema can be given for any disorder. This is indicated in diseases of Vata especially when it is vitiated due to the obstruction in the channels. e.g. conditions like pain in the abdomen, chest, pelvic region, eyes, ears or legs, headache, cardiac pain, hemiplegia, facial paralysis, constipation, obstruction in urination, worms, stiffness in the body, fistula, joint diseases, stiffness in back and hip, problems of lactation, tremors, loss of strength in the body and gout.
Indications for Anuvasana medicated enema
A person, who is suitable for Niruha Vasti is usually suitable for Anuvasana Vasti. It is also indicated in patients having dryness of the body. Very strong gastric fire, all diseases of Vata, due to tissue loss (wasting and debilitating diseases). It is given for the purpose of oleation and nutrition also.
Contra-indications of Anuvasana medicated enema
It is contra-indicated in acute fever, Anemia, jaundice, diabetes, ascitis and Kapha in gastro-intestinal tract.
Preparation of Decoction medicated enema
To prepare the mixture for decoction enema, one must follow a sequence of mixing various ingredients. First add honey and rock salt and mix properly. Then add sesame oil or ghee, again mixing properly. Then add to it a fine paste (kalka) of herbs, and finally add to it the medicated decoction. The whole mixture, when thoroughly mixed, should be heated to body temperature over water vapour. Then pour these contents into an enema bag.
The exact amount of the ingredients is as follows—
- Select all herbs useful for cleansing enema total 1200 gm. Mix powder of 8 fruits of randia dumetorum (madana phala), add 16 times water and prepare decoction of 1 litre.
- Add oil or ghee according to the purpose of alleviation of particular dosha, for the enema used for Vata – ¼ th amount of decoction or 30 gm. For Pitta - 1/6th or 20 gm. For Kapha – 1/8th or 15 gm.
- Then add 1/8th or 15 gm. of fine paste of herbs or kalka.
- Then add 5 gm. each of jaggery and saindhava and 20 gm of honey.
Then mix the contents in particular sequence described above. Usually Decoction enema contains 400 ml of decoction, 50 to 60 ml of oil, ghee, honey and 3 g. rock salt and 3 to 6 g. of herbal paste (kalka). Dose can be increased if necessary. The standard volume of this enema is 450 ml.
Method of administration
- Preliminary procedure
Physician must carry out proper examination of the patient to know what is the state of aggravated dosha, agni, satmya, age, strength, season and then decide what herbs one must select for the procedure.
If doshas are aggravated one should use decoction enema, if doshas are in the state of very low and the body strength is reduced one should use nourishing or brimhana type, if they are amalgamated in blood use varnya type of enema to purify the blood, if doshas are in muscle, use scrapping or lekhana enema, if they are lodged in bones use enema containing meat soup, milk and herbs having bitter taste.
- Main procedure
This procedure should be carried out four to six hours after food has been taken and preferably early in the morning or in the evening. Before introducing Vasti, there is no necessity to give internal oleation. Only oil should be applied to the region of abdomen and back and then fomentation should be done.
The patient should then lie on a bed with the head low and in the left lateral position. He should be asked to extend his left leg, with the right leg taken near the abdomen by folding it.
He should keep his left hand below the head. Then a small amount of oil should be applied to the rectum as well as to the nozzle of the Vasti instrument. After this, the nozzle should be inserted slowly into the rectum and the balloon should be squeezed. It is very important not to introduce any air into the rectum with the Vasti. When all the contents of the Vasti have entered into the large intestine, the nozzle should be slowly withdrawn. The medicated contents should be retained in the intestine for maximum 48 to 50 minutes and then allowed to come out again along with the faecal matter and excess pitta and Kapha. The patient should be asked to use the bed pan.
· Instruct the patient to evacuate when there is urge of passing out the stools. He should not strain or pass motion forcibly or retain forcibly.
· Every Niruha Vasti is followed by Anuvasana Vasti on alternate day.
· In chronic cases, Vasti can be given for 8 days, 16 days, or even for 30 days.
After administering all the contents of Niruha Vasti, the patient feels the urge to pass out the contents within 48 to 50 minutes. Sometimes the patient will need to eliminate immediately after the Vasti is given. In this case the Vasti must be re-administered. If the patient has retained the Vasti for 15 minutes, there is no need to re-administer the same.
Symptoms of optimum purification
Evacuation of stools, urine and flatus, increase in the digestive fire and then patient feels hungry and he also relishes the food he consumes. Symptoms of the disease for which the enema is given are alleviated.
Symptoms of inadequate purification
The contents which have been introduced do not come out and hence there is distension of abdomen and pain not only in abdomen but in head, in the region of heart also and patient may develop dyspnoea or difficulty in breathing.
If the patient has not eliminated the material introduced and has developed certain symptoms like distension of abdomen or pain in the abdomen, within 48 to 50 minutes, the following steps should be taken.
1. Administer another 450 ml. of fluid consisting of a hot herbal decoction.
2. Give slight fomentation to the lower abdominal region (with the help of fomentation through tube or with hot water bottle)
3. Ask the patient to drink plenty of hot water.
4. Administer purgative herbs if the above three measures are not effective within 50 minutes.
Paschimottanasana (Seated forward bend) is useful in this state.
Introduce suppository (phalavarti) in the rectum and give warm water to drink with tab. shankha vati 250 mg. 2 to 4 times a day.
Symptoms of excessive purification
Same as that of excessive purgation e.g. repeated loose stools leading to dehydration, severe weakness, fainting, hiccough, Treatment should be the same like the one given for excessive purgation.
After treatment the patient should be given rest. Then he is given warm water and when hungry, should be given a diet consisting of grains, milk and other nourishing substances.
Post decoction enema procedure
Once the symptoms of optimum purification are observed, ask the patient to take a warm bath and followed by bed rest. Then he should take light diet of moong kichari. He should then follow certain rules of do’s for certain period which is known as ‘Parihara kala’. During this period he should not travel, make loud speech or wander in hot sun.
Method of administration of Anuvasana vasti
1. Preliminary procedure
Physician should carry out proper examination of the patient and then decide whether he needs only oil enema or medicated oil enema. Charaka has advised different types of medicated oil enema in different diseases.
2. Main Procedure
The main procedure and post Vasti treatment is the same as that of decoction or cleansing enema. The only difference is that, here the quantity being small, from 60 to 100 c.c. a rubber catheter and a plastic syringe can be used. Now ready-made oil Vasti are also available which are disposable and easy to use.
The contents of the Vasti, being small in quantity, do not cause any harm to the patient even when retained in the intestine for more than 24 hours. While giving oil enema to adult patient, medicated or plain sesame oil is mixed with fine powder of anise and rock salt before it is administered.
Now ready made oil enemas are also available. They can also be used.
Some useful medicated enemas
- Eranda taila and Lavana jala Vasti:- Rock salt 3 to 4 g. in + 50 to 60 ml. of castor oil mixed with one pint of warm water to relieve constipation.
- Madhu tailika Vasti:- Eranda moola kwatha (Ricinus Communis) 300 to 400 ml, Honey - 50 ml, Rock salt - 3 g, Anise powder 6 g. for pain due to Vata and constipation.
- Ksheera Vasti:- 200 ml. of Milk, 50 ml of honey, 50 ml. of Ghee and 50 ml. of Oil thoroughly mixed and given by drip method, is useful in abdominal pain, ulcers and pitta diseases.
- Tikta Vasti:- It is a combination of medicated ghee with bitter herbs + ksheera Vasti (50 ml), which is very useful in osteo arthiritis, lumbar, sacral pain, back pain, sciatica and other pain.
- Rajyapan Vasti:- Mustadi decoction (Cyperus rotundus), meat soup, milk, ghee and honey are used in this Vasti, which is useful for myopathic problems, weakness, epilepsy, tuberculosis, anaemia etc.
- Piccha Vasti:- Decoction of bark of Udumbara or decoction of mocharasa Kwatha, oil and ghee used in diarrhoea, dysentery, rectal bleeding, colitis and ulcerative colitis.
- Matra Vasti:- Most commonly used in which, 25 to 40 ml. of Sesame oil is given.
Post anuvasana procedure
Once the optimum symptoms are developed e.g. the contents return back within 12 hours and do not cause any untoward effects, the patient should be asked to take rest and he can be given light meals.
Benefits of Vasti:
1. Vata dosha is brought under proper control, all other aggravated doshas and waste products are removed and hence all the tissues are properly developed.
2. Person remains healthy and does not fall prey to any diseases.
3. Strength, agni and intelligence are increased
4. The complexion of the skin and voice becomes good.
Nasya Karma - Nasal Medication
Nasya is the procedure in which medications are administered through the nostrils in order to purify the head and neck region.
The medicines which are used for this procedure include oil, pastes, powders, plant juices, decoctions, infusions, and even smoke.
“Nasa hi shiraso dwarum” means the nose is the doorway to the head. Being gateway to the head, is considered to be effective in diseases of head including five sense organs (Indriyas). In this procedure vitiated doshas above the region of clavicle – In the head and neck – are eliminated through the nose. Hence this therapy is specifically advised for head and neck diseases.
Types of Nasal Medication
There are three ways of differentiating the various forms of nasal medication.
1. According to action
· Shodhana (Purification) or Virechana – for the elimination of aggravated doshas
· Shamana (Palliation) – for subsiding the aggravated doshas
· Brimhana (Nourishing) – for subsidence of Vata
2. According to the substance used
· Avapeeda – Fresh herbs are squeezed and the juice is put into the nose
· Navana – Instilling liquids into the nose like milk and oils
· Dhooma – Inhaling the smoke of various dry herbs
· Virechana dhumapana – Employing medicinal powders into the nose with a special apparatus.
3.According to the dose
· Pratimarsha – a dose of only 2 drops in each nostril
· Marsha – 8 to 32 drops in each nostril.
Here are some of the other types of nasya which have been described over the centuries in the ancient texts:
Tarpana - nourishing
Karshana - depleting
Sneha nasya - oil nasya
Dhooma - using medicinal smoke or vapours
Virechana - blowing the herbal powder into the nose by tube
Prayogika - frequent
Stambhana - for stopping the bleeding from nose – astringent herbs
Raktastambhana – Haemostatic
Indications for Nasal medication
Headache, migraine, stiffness in head, neck, shoulders, lock jaw, dental pain, ear pain, nasal pain, eye pain, sinusitis, facial paralysis, epilepsy, sleeplessness, loss of speech, stammering, diseases of shoulder, hysteria. In short this can be given for any disease of eye, nose, ear or throat .
Contraindications for Nasal medication
Pregnancy, menstruation, exhaustion due to any of the physical exercises, sex, hard labour, extreme thirst, extreme hunger, immediately following purgation or Vasti and during fasting, bleeding disorders, patients who are below 8 years of age and above 80 years, shortness of breath, suffering from acute anger or grief.
In short, nasya should not be administered directly following a meal, a bath, an alcoholic drink, sex, or exercise.
Common herbs and other substances used for Nasal medication:-
Apamarga seeds- Achyranthus aspera, Pippali – Piper longum, Marich – Black pepper, Shunthi – Zinziber officinale, Vidanga – Embelia ribes, Tulsi – Ocimum sanctum, Haridra – Curcuma longa, Brahmi – Centella asiatica, Madana Phala – Randia dumatorum, Devdara – Cedrus deodara, Til oil – Sesame oil, Ghee, Milk, Honey, Medicated oils – Anu taila, Vacha taila, Panchaguna taila, Padmakadi taila.
Some commonly used preparations for Nasal medications:
Anu tailum, Shadbindu taila, Padmakadi taila, Jatyadi taila, Cow-ghee, Shatavari ghrita, Brahmi ghrita, Shunthi guda, Trikatu, Katphala churna, Nirgundi oil and vapour of Nirgundi leaves, smoke of Kantakari.
Method of administration
Nasal medication usually follows Vamana, Virechana and/or Vasti. There is a one day rest period between the completion of these procedures and nasya.
· The patient is first asked to empty the bladder and/or the bowels.
· Then a light meal can be taken, if the patient is hungry
· The teeth must be then cleaned.
Then follow the next steps.
1. First apply suitable oil on head, face, forehead, shoulder and nasal region for 10 minutes.
2. Then carry out hot water fomentation by rubber bag, or cloths for another 10 minutes leaving the eyes.
1. Allow patient to lie down on straight bed, keeping pillow below his neck to bring nose in front and face in little lower position. Or patient can sit in a special chair like dental chair and neck can be rested on cushion to keep face in lower level and nose up.
2. Anu taila, shadbindu taila, or juice or any liquid medicine should be warmed and taken into the special container or dropper. Close left nostril by thumb, and put 4 to 8 drops in right nostril and ask the patient to inhale the same. Repeat the same in left nostril by closing right nostril. Advice the patient to inhale it by inspiration.
1. Powder nasya – a pinch (125 mgm) can be administered by inspiration inhalation.
2. Pradhamana nasya – It is specific type in which powder is filled in metal or wooden tube or paper tube and enter one end of it into the nostril of the patient. Then blow the powder in the nostril. Other devices such as rubber balloon with tubing can also be used for this purpose.
3. Vapour nasya – Leaves of medicine or decoction is kept on boiling.
Patient is advised to cover with towel his head and face and inhale the
vapour as per his tolerance.
Signs of optimum purification of Nasya
Lightness in head and body, good sleep, proper functioning of sense organs and mind, elimination of vitiated doshas from nasal sinuses and nose, relieves signs and symptoms of disease for which it is given.
Signs of inadequate Nasya
Signs of vata aggravation like dryness in the nose with itching occurs. In this condition administer again the proper nasya medicine in the nostrils.
Signs of excessive purification due to Nasya
Due to shodhana or prdhamana nasya there may be excessive secretions not only from nose but also from eyes with severe burning. Some times there might be bleeding from the nose. In such case always instill few drops of ghee in the nostrils.
Post Nasya procedure
Give mild fomentation on forehead, face, throat and neck., wash face and neck, ask the patient to gargle with hot water. Once the optimum symptoms of purification are found, allow the patient to take complete rest. After purification type of nasya, always instill some ghee drops in the nostrils.
Benefits of Nasya
1. Regular use can prevent disease of ear, nose, throat and that of head
2. It is also very effective for treating diseases like falling of hairs, baldness and use of nasya can improve the quality of hairs.
3. Nasya controls all doshas in the region of head as well as all the centres of sense organs and motor organs situated in the head, hence it is also useful in the treatment of various disorders like headache, migraine facial paralysis, hemiplegia, aphasis etc.
Signs of optimum purification of Nasya
Lightness in head and body, good sleep, proper functioning of sense organs and mind, elimination of vitiated doshas from nasal sinuses and nostrils, relieves signs and symptoms of disease for which it is given.
Rakta Mokshana - Blood Letting
Blood letting / Raktamokshana is an invasive procedure, hence it should only be administered by a licensed physician.
Sushruta, being the father of Surgery has given much importance to the blood. He considered blood to be a fourth dosha in the body. Pure blood has life giving value, while impure blood can create or spread disease. Hence impure blood should be removed from the body.
Pitta dosha has an affinity with the blood. Hence when it is vitiated and cannot be treated by the usual medicines, bloodletting can be helpful. Hence it is the therapy for the diseases due to both vitiated blood and pitta. The purpose of blood letting is to remove toxic blood with vitiated doshas like Pitta from the body. Therefore it is the main form of therapy for both blood related and pitta related diseases.
Types of therapeutic blood-letting
1. With sharp instruments:
Prachana – taking quick sharp incisions. A tourniquet or tight bandage is placed on the proximal portion of arm or a leg of the patient. Distal to the tourniquet, a sharp scalpel is used to make superficial, parallel, vertical incisions. Care is taken NOT to incise over local marma points, veins, arteries, joints or nerves.
2. Siravyadha – Venesection. This is performed directly puncturing a vein with a needle, scalp vein needle preferably 18 or 19 no. or other sharp objects. The amount of blood removed should not exceed one pint (350 ml) Therefore, when this procedure is warranted patients can be instructed to donate a pint of blood at local blood bank.
3. With blunt instruments.
· Shringa - Horn of cow to withdraw superficial blood after scraping, taking the advantage of its hollowness.
· Alabu - A fruit of cucurbita lagnaria or vulgaris is dried and internal part is taken off, the hollow part is used for evacuation of blood by sucking method.
· Jalauka (Leeches) - The most renowned method of blood letting and the mildest of all types, is jalauka. It is still used today for children, women, the elderly, wealthy, princely, and other delicate patients. It is a safe, painless, and effective form of treatment.
How to apply leeches – (Jalauka)
- Of the many varieties of leeches existing, six non-poisonous are in clinical use. They are kept in glass jar with water or in earthen pot for ready use.
- When leeches are used, the particular part of the body where leeches are to be applied should be thoroughly washed with water (disinfectant drugs should not be applied to the skin), cleaned and dried.
- Leeches are first put in the water containing turmeric for purification. Then they should be kept in ordinary water. They are covered with damp gauze piece.
- If they are not catching, then a scratch should be made or a drop of milk should be put on the skin where a leech is to be applied.
- No. of leeches to be applied, depend upon the skin surface affected. One leech for one square cm. is to be applied. Usually 3 to 6 and maximum 35 leeches are applied. One leech usually sucks 8 to 10 c.c. of blood.
- After sucking sufficient blood, the leech automatically separates from the skin. Otherwise one can apply little salt water drop on their mouth, so that they leave the skin. Put them to salt or turmeric water to vomit blood and then keep them in the clean water.
- The small wound made by the leech should be dressed with medicated oil such as jatyadi or padmakadi taila and then firmly bandaged.
- These leeches can be used again to same patient after 15 days.
Indications of Blood-letting
Chronic Skin Diseases, Eye diseases, Headache, Chronic anger, Excessive sweating, Eczema, Spleenomegaly, Tumors, Skin pigmentations. Mental confusion, Psoriasis, Hepatomegaly, Bodyache, Pruritis, Vitiligo, Acne, Gingivitis, Jaundice, Tremors, Acid reflux, Urticaria. Anxiety, Gout, Alcoholism, Metrorrhagia, Boils, Stomatitis, Snake bite, Foul body odour, Erysipelas, Haemorrhoids, Anorexia, Allergies, and Pittaja rogas.
Contra Indications of Blood-letting
Pregnancy, Angina, Impotency, Fasting.General anasarca, Chest injury, Severe cachexia, Dehydration, Anaemia, Fear of the procedure,Acute asthma, and immediately after vamana, virechana, and Vasti.
Post Blood-letting regimen
· Avoid excess cold or heat, and refrain from sex for one week
· Avoid aggravation and anger, and avoid day time sleep.
Additional Panchakarma Procedures
There are many supplementary panchakarma procedures which are practiced in different indications. They are useful to deal with either the whole body or some parts of the body. They are useful in health and in disease. The style, herbs and duration changes according to the necessity.
This is one of the important external oleation method. It consist of medicated oil retention over the head. This is done with the help of specially designed elongated leather cap.
Indications for Shirovasti
Shirovasti is indicated in Facial palsy, Insomnia, Dry nose, Dryness of the eye, Migraine, Headache, Memory loss, Mental stress and strain. Even though it is useful in all dosha types, it is more useful in vata vitiation, and vata diseases.
In addition to the usefulness in above conditions, Shiro Vasti has an added benefit of rejuvenating the whole body, relieving the exhaustion and restoring the luster of the skin. It also relieves mental stress, balances the doshas, and increases ojas of body and mind.
- Specially prepared ShiroVasti leather Cap (It should be well tanned, soft and without any openings),
- Warm sesame oil in a stainless bowl,
- Black gram flour,
- Glass of water,
- Cotton towels or Paper napkins
Preparation before Shirovasti
To start with, shave the scalp properly. If not possible, then keep the hair as less as possible. Give gentle massage to the scalp and forehead. Then give little fomentation to the head, neck and shoulders. This preparation is done in the morning. Main shirovasti can be given after this basic preparation in the afternoon.
Main procedure of Shirovasti
To start with keep the leather cap over the head up to the ear lobules. Fill the gaps within the head and outside the cap by filling it with Black gram dough. Apply this dough from outside too, at the border between fore head and cap. Plastic mud can also be used to fill in the gaps instead of Black gram dough. Ask the patient to sit straight in an comfortable chair. Put warm sesame oil gradually into the leather cap to fill it more than half. It should be filled till the scalp is covered with oil. It is retained 50, 40, and 30 Minutes in Vata, Pitta and Kapha dominance respectively.
Cleaning up after Shirovasti
After signs of proper shirovasti are observed, such as relief from pain, secretions from nose and mouth, ask the patient to move forward so as to enable the physician to collect back the oil poured in the cap.
Clean the scalp, neck and forehead with a cotton towel or paper napkins. Make it dry. Ask the patient to have a warm water bath after taking some rest.
Precautions after Shirovasti
Advice the patient to avoid exposure to excessive cold, heat or dampness, air and to cover the head while moving out. This precaution is necessary throughout the week of the treatment and even one week after the Shirovasti.
Usually this procedure is done for seven consecutive days.
Pouring of sneha on forehead region from a vessel (dhara patra) hanging overhead. It allows the farthermost corners of your mind and body to release and relax as a fine stream of warm sesame oil is poured over the centre of the forehead.
Equipment for Shirodhara
a. Massage Table
b.Blanket and Pillow
c.Traditional Shirodhara Pot or separatory funnel with ring and stand
e.Warm Sesame Oil
The person lies on his back on the massage table under a blanket to keep him warm. Some people are comfortable with a pillow under their knees.
Step by step Shirodhara Procedure
1. Give the basic facial massage. Cover your palms with a light amount of warm oil. Apply warm oil to the face in deliberate strokes, starting from the mid-line of the chin and using both of your entire hands, moving toward the temples.
2. Call the person little up over the table. Put a rolled towel under his neck. It will give more comfortable tilt to the head.
3. Keep the warm oil ready in Shirodhra pot or Separatory funnel and position it on a table, or stand so that the tip of the Dharapatra or funnel will allow the oil to drip on the middle of the forehead. Check to make sure that oil is not too warm for the client.
4. Release the valve on the funnel so that a continuous fine stream of oil flows on the centre of the forehead. There are energy centres on the top of the head. Warm oil flowing through these areas on the head, calms and balances the energies in the body that cause pain and stress.
5. Stay throughout, during all the procedures checking that oil is flowing in the right place. Refill the pot if necessary.
6. When the funnel or the pot is empty, wipe off the excess oil from the patient’s forehead and hair and tell him to move slowly when he is ready.
7. After this procedure, it is better that he stays in fairly calm surroundings and avoid stressful encounters.
SOME MORE OIL RETENTION PROCEDURES
Ayurved has described some nutritive, palliative type of Vasties, such as Kati, Hridaya, Udar, Netra, Shiro etc, which are externally placed in localized areas, such as low back, heart, abdomen, and eyes. We have already explained the Netra and Shirovasti. Let us know about Kati Vasti.
It means retaining oil over the lower back with the help of container prepared of either black gram or wheat dough. This form of external Vasti particularly benefits muscle spasm and rigidity of the lower spine and strengthens the bone tissue in that area.
Oils medicated with Vitex nigundo, devdaru, castor roots can be used for Kati Vasti Four figures of Kati Vasti .
When oil is retained over the area of heart and chest it is called as Hridaya Vasti. The procedure is same as that of Kati Vasti. Only the site is different.
It reduces the pain in the sternum area and strengthens the heart.