A PRACTICAL HANDBOOK OF PANCHAKARMA PROCEDURES
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A PRACTICAL HANDBOOKOFPANCHAKARMA PROCEDURESCENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHADepartment of AYUSH, Ministry of Health and Family Welfare,Government of IndiaJ.L.N.B.C.E.H. Anusandhan Bhawan, 61-65 Institutional AreaOpposite D-Block, Janakpuri, New Delhi- 110058www.ccras.nic.in
A PRACTICAL HANDBOOKOFPANCHAKARMA PROCEDURESCHIEF EDITORProf. G. S. LavekarDirector GeneralCentral Council for Research in Ayurveda and Siddha, New DelhiCONTRIBUTORSDr. T.V. MenonEx. Assistant Director (Ayurveda) InchargeDr.(Mrs.) BhartiAssistant Director (Ayurveda)Central Research Institute (Ayurveda), New DelhiCENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHADepartment of AYUSH, Ministry of Health and Family Welfare,Government of IndiaJ.L.N.B.C.E.H. Anusandhan Bhawan, 61-65 Institutional AreaOpposite D-Block, Janakpuri, New Delhi- 110058www.ccras.nic.in2
A PRACTICAL HANDBOOKOFPANCHAKARMA PROCEDURESEDITORSDr. M.M.PadhiDeputy Director (Technical) CCRAS, New DelhiDr. Sharda OtaReseach Officer (Ayurveda) CCRAS, New DelhiDr. M.M. SharmaReseach Officer (Ayurveda) CCRAS, New DelhiDr. B. VenkateshwarluReseach Officer (Ayurveda) CCRAS, New DelhiREVIEWED BYDr. Bhima BhatHOD, Ayurveda Department, Holy Family Hospital, New DelhiVd. R.S. SharmaAsso. Professor & Head, Department of Panchakarma, N.I.A., JaipurDr. Nandini K. KumarConsultant, Division of Basic Medical Sciences, ICMR, New DelhiDr. S.C.MahapatraProfessor, Department of Physiology, AIIMS3
PublisherCENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHADepartment of AYUSH, Ministry of Health and Family Welfare,Government of IndiaJ.L.N.B.C.E.H. Anusandhan Bhawan, 61-65 Institutional AreaOpposite D-Block, Janakpuri, New Delhi- 110058E-mail: ccras dir1@nic.in www.ccras.nic.inISBN :978-81-907420-9-2C - CENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHA2009Reprint 20104
PREFACEPractical handbook of Panchakarma Procedures is a brief knowledge several ofPanchakarma procedures followed in different parts of the country. It alsoincludes some of the common therapeutic procedures popular in Kerala.Panchakarma therapy is an integral part of Ayurvedic treatment. All the learnedscholars of Ayurveda since beginning of the present era have highly appreciatedthe importance and therapeutic efficacy of Panchakarma therapy. The descriptionof Panchakarma is found to be popular in Ayurvedic classics viz Charak Samhita,Sushrut Samhita, Ashtang Hridayam, Ashtang Sangraha, Sharangdhara andVangsena etc. Classical Panchakarma includes Vamana, Virechana, AnuvasanBasti, Niruh Basti, Nasya and Raktamokshana, which require more attention andcare from the physician. The procedures are also time taking. Due to these factssome of the physicians developed easier techniques with better therapeutic effects.These procedures are popular in India but now they are becoming popular all overworld.This book deals with the commonly practiced, popular Panchakarma proceduresminutely in simplified form for the benefit of students and Ayurvedicpractitioners. It has been tried to give the material requirements, names and dosesof commonly used medicines with administration time, indications andcontraindications with necessary photographs. The assessment of minimumrequired man power in various procedures has also been done. This book isrecommends space and staff requirements for a model Panchakarma unit. Textualreferences are also given wherever possible.I appreciate Dr. M.M. Sharma, Dr. B.S Sharma, Mr. Upendra Singh and Mr.Narender Singh from publication section for their tireless efforts in bringing outthis publication.I hope that this handbook will serve as a ready reckon document for students,practitioners, academicians, research scholars and certainly help to establish agood Panchakarma center for better health care services.Place: New DelhiProf. G.S. LavekarDirector GeneralCCRAS5
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INTRODUCTION:Ayurveda, an ancient Indian System of Medicine, has been in vogue from timesimmemorial to impart natural healing for various ailments. The system was nurtured by ancientscholars on the basis of sound underlying philosophy, oriental methodology and practicesprevalent in that era. This system is believed to be quite safe and free from side effects as it ismore close to nature.Ayurvedic treatment comprises of two major parts viz. Samshodhana Chikitsa (Biocleansing therapy) and Samshaman Chikitsa (Pacifying therapy). Samshaman Chikitsa consistsof conservative treatment like Langhana, Pachana, drug administration etc. SamshodhanaChikitsa envisages Panchakarma treatment which is basically a Bio-cleansing regimen intendedto eliminate the toxic elements from the body and thereby enhances the immunity of the body.Samshodhana Chikitsa is considered superior to Samshamana Chikitsa as the chances forrecurrence of the disease so treated are remote1.sPancakarma increases the acceptability of body to various therapeutic regimens likeRasayana (Rejuvenation) and Vajikarana (Aphrodisiac). Thus, Panchakarma therapy isbelieved to impart radical elimination of disease causing factors and maintain the equilibrium ofDoshas. Five fold measures2 comprehended as Pancakarma are:1. Vamana (Therapeutic Emesis)2. Virechana (Therapeutic Purgation)3. Anuvasana (Medicated Oil Enema)4. Asthapana (Medicated Decoction Enema)5. Nasya (Nasal administration of Medicaments)Description of these five procedures is available in Charaka Samhita Kalpa Sthana,Shusruta Samhita Chikitsa Sthana and Ashtanga Hridya Sutra Sthana. Vagabhatta in AshtangaHridya has enumerated five types of samshodhanas3 i.e.1. Niruha2. Vamana3. Virechana4. Nasaya5. Rakatmokshana1nks"kk% dnkfpr dqI;fUr ftrkya?kuikpuS%Aftrk% la’kks/kuS;sZRrq u rss"kka iqu#n Hko% AA¼pñ lwñ 16@20½2oeua jspua uL;a fu#g’pkuqoklue A,rkfu iapdekZf.k dfFkrkfu equh’ojS% AA¼'kkñ mñ 8@70½3;nhj;s}fgnksZ”kku iap/kk ‘kks/kuap rr Afu:gks oeua dk;f’kjksjsdks·lzfolzqfr%AA¼vñ g ñ lwñ 14@5½7
Prior to these five Pradhan Karmas (main procedures), Purva Karma (preparatorymeasures) given to the patient are: Pachana (Ama Pachana & Deepana medicines like Shunthi Kwatha may be given) Snehana (Oleation) and Swedana (Sudation).After the main procedures, Pashchat Karma (Samsarjana Krama), a special diet and liferegimen (period of convalescence) is advocated as post operative measures. Panchakarmatherapy plays a definite role in the management of diseases especially of neuromuscular,rheumatological and gastrointestinal origin. In addition to this Panchakarma procedures areutilized for the purpose of preservation, maintenance and conservation of health and thepromotion of longevity.Based on Ayurvedic principles and own experiences, the Ayurvedic scholars inSouth India have modified certain techniques/ procedures according to Dosha, Prakriti (bodyconstitution), Kala (season), drug availability etc. and found them quite effective. Later on,these procedures got popularized as Keraliya specialities of Panchakarma which areextensively practiced in India and abroad as main procedures. Shashtika shali pinda sweda,pizhichil, Shirovasti, shirodhara, shirolepana are some of these practices. These procedures arespecialized varieties of Snehana and Swedana which have more nutritive/ nourishing effect thanbio-cleansing or depleting effect.With the spread of Buddhism to the southern parts of India, Ayurvedic treatment gotpopularized as it was practiced in the monasteries. After the decline of the Buddhism, many ofthese monasteries were converted to temples and the practice of Ayurvedic treatment throughthese temples still continues in Kerala. One such example is Tiruviza of Allappy Distt. ofcoastal area where Vamana procedures are done daily. Panchakarma procedures were notconfined to the higher societies only. Rather lower classes of the society also contributed to thepromotion, progress and development of these specialized techniques. Due to this fact,modified techniques of Panchakarma treatment developed in Kerala, unlike North India. Withthe modernization and globalization of Ayurveda, more and more people are showing interest inthese treatment procedures due to their effectiveness in addition to the conventionalPanchakarma practices. Physicians from other parts of the country and the western world wishto acquire this knowledge.This Practical Handbook of Panchakarma Procedures is written with a view to impartsimple and basic knowledge of these procedures to the learners. It has also been tried to put thetextual references wherever possible and to give the photographs of different procedures.However, before administration of Panchakarma procedures, one must carefully select,assess and prepare the patient explaining all the procedures to be followed. The doses of drugs,vegas and frequency of procedures may vary according to condition of the patient and/ orseverity of the disease. While under going procedures, it is duty of the physician to assess thepatient’s strength, constitution, age, season, disease stage and other relevant factors4.4nw";a ns‘ka cya dkyeuya izd fra o;% AlÙoa lkRE;a rFkk··gkjeoLFkk'p i FkfXo/kk% AAlw{elw{ek% leh{;S”kka nks”kkS”k/kfu:i.ksA8
The Samshodhana Chikitsa (Bio-cleansing therapy) of Ayurveda, which includesPanchakarma treatment, basically intends to eliminate the toxic elements from the body and therebyenhances the immunity of the body. The toxic products of body metabolism can be broadly dividedinto water soluble, fat soluble and volatile substances. The volatile substances like carbon-di-oxidecan easily be removed from the body through lungs. While there are number of mechanismsavailable to get rid of the water soluble toxic materials through kidney, sweat and other bodysecretions, removal of fat soluble toxic materials is very difficult and only liver can play a smallrole. Hence it is likely that, there would be accumulation of fat soluble toxic products in the body.Liberal use of oil and ghee in various Panchakarma procedures makes it possible to eliminate thesetoxic products. In modern day medicine, we understand that molecules moves from higherconcentration to lower concentration when separated by a diffusible membrane. The skin and themucous membrane provide an excellent opportunity for this maneuver. While skin of an averageadult only provides a surface area of less than 2 square meters, the gastrointestinal tract is manymeters long with a highly permeable mucous membrane. The mucous membrane of gut has manyfolds and projections in the form of villi and microvilli, which help to increase the total exchangearea, equivalent to a tennis court. Various Panchakarma procedures like. Vamana (TherapeuticEmesis), Virechana (Therapeutic Purgation) and Anuvasana (Medicated Oil Enema) use oilliberally, there by removing toxic fat soluble waste materials. Prior to the five Pradhan Karmas(main procedures), Purva Karma (preparatory measures) i.e. Bahya Snehana (External oleation) andSarvanga Swedana (Whole Body Sudation) are given to the patient. These procedures further helpsin removing toxic materials from the body. Swedana procedure using hot steam increases the localskin blood flow there by enhancing the exchange process. It is known that the fat soluble toxicsubstances are stored in the body fat. Fat in human body is largely located below the skin and insideabdomen around the mesentery of the gut. During various Panchakarma procedures, exposure ofskin and gut mucous membrane (which are very close to the fat stores) to a large quantity of oilseems to be a logical and ideal procedure. Repetition of these procedures over several days willlargely remove the toxic wastes by concentration gradient. The Ayurvedic medicines added to the oilmight give additional benefits.One of the important features of these procedures is the safety and easiness by which these can beadministered without any major side effects. Although the practitioners of modern system ofmedicine do realize the individual variations in patient population suffering from the same disease,most of them fail to appreciate these variations in practice. In Ayurvedic practice of Panchakarma,Dosha (fault or disease), Prakriti (body constitution), Kala (season), drug availability etc. arealways of prime concern.SNEHANA (OLEATION)Snehana stands for lubrication of body systems by the administration of fatty substancesinternally and externally. Snehapana (internal administration of sneha) is an importantpreparatory procedure for Panchakarma. Four types of Snehana dravyas are mentioned in the;ks orZrs fpfdRlk;ka u l L[kyfr tkrqfpr AA¼v0 â0 lw0 12@67&68½9
classics viz. Ghrita (Ghee), Taila (Oil), Vasa (Fat) and Majja (bone marrow). Out of theseGhrita is considered as the best5.Snehana (Oleation) includes: Abhyantara Snehana (Internal Oleation)Bahya snehana (External Oleation)Abhyantara snehana is again classified into Achhapana and Vicharana.Achhapana is the oral intake of medicated or non medicated Sneha (Ghee/ oil) without mixingwith food or other medicinal preparations and used for the purpose of softening and lubricatingof body tissues prior to the Shodhana therapy.Materials required: Medicated ghee or oil according to the requirement. Measuring glass Hot water for drinking (boiled with Shunthi Dhanyaka).Medicines commonly used: Indukanta GhritaMaha tiktaka GhritaSukumara GhritaDhanwantara TailaKsheera Bala Taila etc.Man Power: Ayurvedic PhysicianAttendant/ Nurse:1:1Procedure for Snehapana:Agnibala may be assessed in the patient prior to Snehapana, so as to assess the dose ofSneha dravya (Hina, Madhyama, Uttama, Hrisyasi matra). For the patient with unknowndoshas, agni etc. one may start with Hrisyasi matra6 (which digests within two yamas).5lfiZLrSya olk eTtk loZLusgksÙkek erk%A,”kq pSoksÙkealfiZ% laLdkjL;kuqorZukr AA¼pñlwñ 13@13½10
The patient who is intended to under go Snehapana is to take the Sneha in the earlymorning (within 15 minutes of sunrise) in the prescribed dose based on his Agnibala (digestivecapacity), nature of disease, condition of body etc. The usual dosage is between 50 to 75ml forGhrita and 30 to 50 ml for Taila on the first day. The dose for the next day should be fixed afterassessing the time taken for digestion. Hot water boiled with a piece of Shunthi (dry ginger) Dhanyaka (dry coriander seeds) is given in small doses to enhance the digestion (Deepan,Pachana).Snehapana may be continued till Samyak Snigdha Lakshanas7 (symptoms of desired effect) areobserved and usually it is obtained within 3 to 7 days8.Usual practice of increasing order of Snehapana dosage:First daySecond dayThird dayFourth dayUp to 7th day:::::50ml100ml150ml200ml350mlIndications9: 6Swedya, Samshodhya (Persons undergoing sudation and biocleansing procedures)Ruksha Sharira (Roughness in the body)Nithyamadya (Alcoholic)Krisha (Debility)Timira (Premature cataract)}kH;ka prqfHkZj”VkfHk;kZeSthZ;ZfUr ;k% Øekr AAâLoe/;ksÙkek ek kLrkLrkH;’p âlh;lhe AdYi;s}h{; nks”kknhu çkxso rq âlh;lheAA¼vñg ñlwñ 16@17&18½7okrkuqyksE;a nhIrks·fXuoZpZ% fLuX/kelagre AeknZoa fLuX/krk pkaxs fLuX/kkukeqitk;rsAA¼pñlañlwñ13@58½8LusguL; çd”kkSZ rq lIrjk f jk dkSA¼pñlañlwñ13@51½11
Vatarogas (Neuromuscular disorders)Kasa (Cough)Shwasa (Dyspnoea)Hikka (Hiccough)Swarbheda (Hoarseness of voice), etc.Contraindications10: Sthoola (Obese)Kaphaja Vikaras (Kapha disorders)Atisara (Diarrhoea)Raktapitta (Bleeding disorders) etc.Regimen during Snehapana: RestAvoid day sleepTake Rice gruel after feeling hungry (when consumed Sneha is digested).Complications and management: ion etc.In such conditions, Snehapana should be discontinued and fasting, Deepana(Stomachic), Pachana (Digestive) drugs may be given based on the patient/ disease condition.Scientific observation11:9 Los la’kks/;e L hO;k;keklDrfpUrdk%A o )ckykcyÑ’kk :{kk% {kh.kklzjsrl%AAokrkrZL;Unfrfejnk#.kçfrcksf/ku% Lusák%A¼vñâñlwñ16@5&6½10&u yjksxxjksnjS%A ewPNkZPN ZZ#fp’ys”er ”.kke S’p ihfMrk%A¼vñâñlwñ16@6&7½11 nhIrkUrjfXu% ifj’kq)dks”B% çR;xz/kkrqcyo.kZ;qDr%An sfUnz;ks eUntj% ‘krk;q% Lusgksilsoh iq:”kks HkosÙkqAA12
Oleation pacifies Vata; lubricates and softens the Doshas. It improves digestion, regularizesbowels, improves the strength and complexion and prevents premature ageing.N. B. After completing Snehana (oleation), Swedana (sudation) is to be carried out (1-3 days)based on the patient/ disease condition.¼lqñlañfpñ] 31@56½13
SWEDANASwedana is a process to induce sweating (sudation) artificially in a patient/volunteerwho has already undergone Snehana. Swedana is of four types12 –(i)Tapa Sweda(ii)Ushma Sweda(iii) Upnaha Sweda(iv)Drava SwedaSnehana and Swedana constitute Poorvakarmas. The patient is given Snehapana for 3-7days depending upon the appearance of fat in stool which is considered as the end point ofSnehana. Snehana is followed by Swedana and Swedana in turn is followed by VamanaprocedureTypes of Swedana (on the basis of induction of heat):1. Thermal (Sagni Sweda)-132. Non Thermal (Niragni Sweda)-10Types of Swedana (on the basis of application of heat):1. Local (Ekanga Sweda)2. General (Sarvanga Sweda)Types of Swedana (on the basis of nature of heat):1. Moist heat (Snigdha Sweda)2. Dry heat (Rooksha Sweda)Types of Swedana (on the basis of intensity of heat):1. High Sweat (Maha Sweda)2. Medium Sweat (Madhyama Sweda)3. Low Sweat (Durbala Sweda)General features of Swedana Dravyas:The medicines which produce Sweda are generallyUshna, Tikshna, Sara, Snigdha, Sukshama, Rooksha, Sthira, Drava, Guru.12 LosnLrkiksiukgks”enzo HksnkPprqfoZ/k%¼vñg ñlwñ] 17@1½14
Indications of Swedana:According to Charaka, Swedana relieves: Stiffness (Stambha) Heaviness (Gourava) Cold (Sheeta)Stambha Gourava Sheetaghnam Swedanam SwedakarkamStambhanam Stambhayati yat gatimantam chalam dhruvam(Carak Sutra-22/11).Indications of Swedana: 13 Following SnehanaStiffness of the bodyPainColdHeavinessDrynessVatadosha/ Obstruction to Mala, Mutra and ShukraPrior to Panchakarma Procedures, as a Poorvakarma.Swedana is given to even infants by using warm hands14.Contra indications of Swedana: Dagdha (burnt) Vishapeeta (Poisoned) Madapeeta (Alcoholic) Trishita (Thirsty/dehydrated) Nidranasha(Insomnia) Chhardi (vomiting) Rakta pitta (Bleeding disorders) Hridya Rogas (Cardiac Diseases)13 izfr’;k;s p dkls p fgDdkÜokls”oyk?kosA ------------- lokZaxs”kq fodkjs”kq Losnua fgreqP;rsAA¼pñ lwñ 14@20&24½14 tUeçHk fr ckykuka Losne”Vfo/kafgre AA¼dkñlwñ] 23@25½15
VASHPA SWEDA (STEAM BATH)This is a kind of sudation by which medicated steam is applied to the patient’s body fora certain period of time to get perspiration. It removes stiffness, heaviness and coldness fromthe body15.For this purpose Bashpa Sweda Yantra (A steam-bath chamber) is required. Medicinalherbs /decoction is kept boiling in the Bashpa Sweda Yantra from where the ste
Practical handbook of Panchakarma Procedures is a brief knowledge several of Panchakarma procedures followed in different parts of the country. It also includes some of the common therapeutic procedures popular in Kerala. Panc
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