Panchakarma Preliminary Steps

Panchakarma

DIGESTION THERAPY (PACHANA)

The Digestive Therapy (Pachana), digests and liquefies toxins in various tissues and channels of the body. This is accomplished by increasing the digestive fire of the body by means of ingesting specific herbs. The herbs are generally pungent and bitter in taste and hot in potency. They increase the internal heat of the body, stimulate the metabolism, activate the digestive enzymes, increase the peristalsis and improve the circulation. Many of these herbs have anti-parasitic or antibacterial properties and some even enhance the immune system.

The herbs used for this therapy are generally in the form of powders, pastes or decoctions.

OILELATION  THERAPY (ABHYANGAM)
It Involves saturation of the body with herbal & medicated oil via external & internal oelation to make it soft and disintegrate the doshas. Takes between three to seven days to take effect. It is employed in order to liquefy the vitiated Doshas and to bring and collect these in the main body channels such as digestive tract and respiratory tract.

The medium used is of 4 types - vegetable oils (for external oelation), animal fat & fats from bones (for internal oelation) and clarified butter (for internal oelation). The natural material available for oleation is oils and Ghrita (clarified butter).

Caution should be exercised in ensuring that oil used matches need of the patient.

Indications

• All persons who require any of the five cleansing procedures must be given oleation therapy. 
• Persons suffering from vitiation of Vata Dosha, which increases the dryness in the body.
• Persons suffering from arthritic conditions, or nervous disorders.
• Persons who undergo regular physical strain.
• Persons prone to psychological symptoms such as emotional stress and anxiety.

Physicial Indications

Persons who suffer from coryza, asthma, cough, hiccoughs, earache, headache, pharyngitis, paraplegia, hemiplegia, arthritis, facial paralysis, sciatica, backache, joint disorders, edema, constipation, urinary obstruction, and spasmodic pains, etc. are given hot fomentation.

Contraindications

Persons whose Kapha Dosha and Medo Dhatu (body fats) are augmented and corrupted; pregnant women; persons suffering from ascites, indigestion, anorexia, and nausea and persons who are taking the treatment of Basti Karma and Nasya Karma should not be given oleation therapy.

Procedure

When employed as a reparatory procedure before starting with any of the five cleansing methods, a certain amount of pure Ghrita or sesame oil should be given every night for seven nights two hours after dinner, either with some food or in pure form, according to status of individual's health or status of disease. Persons with weak bowels are administered with oleation therapy for three days.

Special precautions

Very mild diaphoresis should be employed to the delicate parts like testes, eyes or heart, for a very short time. Also, blood pressure, pulse and respiration chart is maintained. Precautionary measures should be taken to overcome any dehydration caused by excessive perspiration.

Signs and symptoms of a properly oleated person

• It works as appetizer. 
• Internal smoothness and external oily complexion. 
• Smooth passage of stools and gases. 

Complications of improper diaphoresis

When Oleation therapy is either incomplete or in excess; various complications occur. These are fever, heaviness in body, edema, diarrhoea and dysentery, and excessive thirst, etc.

Instant Oleation

In some diseases when cleansing procedures are required to be employed at the earliest, the process of instant oleation is described. In this, all the four important Snehan Dravyas, i.e. Ghrita, Taila (oil), Vasa (animal fats) and Majja (marrow) are taken in equal quantities and are cooked with one part of rice. This preparation is called Pancha Prasutiki Peya. It is given for instant oleation. Also, use of salt along with oleation material is advised, as salt is absorbed by the minutest part of the body and in the process carries along with it the oleation material, which is distributed throughout the body.

External oleation (Abhyanga)

It is nothing but oil massage or local application of medicated Ghrita. It is given either as a treatment for various diseases, or as a preparatory procedure before starting five cleansing procedures.

Shirodhara

The most commonly employed pre-procedure, it means `the dripping of oil like a thread (dhara) on the head (shiro). This treatment drips warm oil in a steady stream on the forehead, particularly on the brow and in the region between the eyes. It is often added to the panchakarma regimen because it pacifies vata and calms the central system. It cleans both the mind and the senses which allows the body's natural healing mechanisms to release stress from the nervous systems. This in turn, improves mental clarity and comprehension. Usually given for twenty minutes, three to four times during a seven day treatment period, it uses oils made with special herbs (Mahanarayan Oil, Mahamash Oil etc.) that calm and nourish the nervous system. The technician administers the oil in a thin stream which flows from a copper vessel hung approximately 6-8 inches above the patient's forehead.

Shirovasti

Shirovasti is administered on the head through the use of a specialized leather container resembling a hat. This type of vasti improves the sensory functions. It also promotes kaphagenic secretions in the para-nasal sinus zone which reduce vascular congestion in the brain. Shirovasti is extremely useful in vascular headaches, schizophrenia, obsessive-compulsive.

FOMENTATION ( SWEDANAM)
Fomentation, or sweating, necessarily follows oleation. Induced by heat from different sources it brings sweat on the skin through hair follicles by opening the pores of the skin. Due to fomentation the agni is increased and the fatty tissue gets mobilised. While throwing out waste as ama (toxins) through the skin it also helps liquify aggravated doshas, dilating all body channels for the cleansing.

Charaka has described about thirteen types of fomentation of which some are in practice now
Upanaha Sweda - fomentation by poultice
Ushma Sweda - steam fomentation
Nadi Sweda - local steam fomentation (steam/vapour of medicated decoction of leaves)
Avagah Sweda - tub bath in warm decoction of medicated water
Pizichili - pouring of oil on the body

After this therapy patients are advised to go for rest, avoid cold, take warm baths and get adequate fresh air. Nasal therapy, enema or bloodletting can be undertaken immediately after fomentation. Purgation should be done only after two days of fomentation. However, care should be taken to ensure that no part of the treatment is missed out on as that would not only reduce efficacy but may even prove detrimental.

Once the body has been correctly and suitably prepared, under supervision of a qualified doctor only should the administering of Panchakarma happen. It is best to depend on a reputed Ayurvedic nursing home and experienced Ayurvedic doctors.

Swedan Karma (fomentation therapy) is one of the three preparatory procedures, which is employed before starting any of the five cleansing procedures. Swedan Karma or diaphoresis is advocated only after employing proper oleation. A person undergoing this therapy is given heat either by using a decoction of medicinal herbs or by applying indirect heat to the body, in the form of warm clothing or keeping the patient in a warm cabin or partially open box. Properly employed fomentation softens and melts the body toxins so as to efficiently expel these with the assistance of the main purification procedures.

Types of Diaphoresis

Diaphoresis is divided into following main types

• It is divided into two main types, Agni Sweda wherein heat is applied directly as steam and Anagni Sweda where no external heat source is necessary e.g exercises, fighting, walking, lifting heavy loads, exposure to sunlight, stay in centrally heated rooms, putting heavy blankets over the body etc.

• Smooth (Singdha) and dry (Ruksha)
• Mild (Mrudu), moderate (Madhyam) and Strong (Tikshna)
• Local (Ekanga) and whole body (Sarvanga)

Indications

Persons who suffer from coryza, asthma, cough, hiccoughs, earache, headache, pharyngitis, paraplegia, hemiplegia, arthritis, facial paralysis, sciatica, backache, joint disorders, edema, constipation, urinary obstruction, and spasmodic pains, etc. are given hot fomentation.

Contraindications

Alcoholics, pregnant woman, malnourished persons, diabetics, persons suffering from liver diseases, persons having cataract, and very young and very old patients should not be given diaphoresis.

Procedure

As per the severity and site of the disease, the type of diaphoresis is advocated. External oleation therapy or massage is mandatory before a patient is given diaphoresis. Diaphoresis is given by various methods. Local diaphoresis is given by applying a poultice (paste) of medicinal herbs or by kettle steam diaphoresis. In chronic diseases, whole body diaphoresis is given either by giving steam bath of medicated decoctions, or by making the patient lie down on a specially designed table.

Special precautions

Very mild diaphoresis should be employed to the delicate parts like testes, eyes or heart, for a very short time. Also, blood pressure, pulse and respiration chart is maintained. Precautionary measures should be taken to overcome any dehydration caused by excessive perspiration.

Signs and symptoms of patient having proper diaphoresis

• Patient feels cool due to excessive perspiration.
• Pain is subsided.
• Joints and body stiffness is reduced, making all the body movements more flexible.

Complications of improper diaphoresis

• Coma, giddiness and weakness.
• Excessive thirst and dehydration.
• Burning sensation of the body.

Functions of Diaphoresis

Body flexibility is increased after oleation and diaphoresis treatment, and helps in eliminating the toxins completely. Swedan benefits the patient by relieving him of stiffness and pain.

Post Fomentation Regimen

Immediately after completing fomentation therapy, it is advisable to rest, avoid exposure to the cold, bathe in warm water, and rest in adequate fresh air. Liquids and easily digestible food should be consumed in moderate amount. If induced emesis has been recommended, it should be done the following morning. If purgation is required, it should be done two days after the fomentation is completed. Nasal cleansing, a medicated colon therapy or bloodletting can be done immediately after fomentation.

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