Origin or source of Panchakarma Chikitsa

Panchakarma is very much important part of Chikitsa Padhati, and as enlighten as it is a separate Chikitsa then need to know where it was begins or originate. Whole treatment of Ayurved is mainly divided into two type of Upakrama. The word upakrama means the procedures which are used for chikitsa purpose. Different types of upakrama are mentioned as basic principles of Panchakarma by many Acharyay. Acharya Vagbhatta has mentioned the Dwividhopkrama. There are two types of upakrama one is Santarpana and another is Apatarpana, also called Brihana and Langhana respectively. These two Upakrama includes the Shadvidhopkrama of Acharya Caharak.

APATARPANA:- Langhana, Swedana, Rookshana, Shodhana, Pachana, Deepana, Kshudha & Kshara

SANTARPANA:- Brihana, Snehana, Stambhana,  Shamana, Trishna, Vyayama, Aatap, Marut, Agni, Pralepa etc.

1. Langhana:- Whatever drug, food or activity is capable to produce laghuta in the body is called Langhana. According to Acharya charaka Langhana includes ten Upakrama viz- Vamana, Virechana, Nasya, Niruha, Pipasa, Maruta, Aatapa, Pachana, Upawasa and Vyayama. Conditions (Awastha Vishesha) for Laghana (a) Balwana Roga- Shodhana, eg. in Sthoola Pramehi with Bahudosha Awastha Samshodhana is indicated. (b) Madhyabala Roga- Pachana, eg in Navajwara, Chhardi, Visuchika Pachana is indicated. (c) Alpabala Roga- Upawasa and Pipasa Nigrahana is indicated. 

2. Brinhana:- The drug diet or activity which nourishes and increases the bulk of the body is called Brinhana. The person who are suffering from muscle wasting, emaciation, old age, weakness, exertion from long toures, habitual indulgence in sexual act and wine needs this therapy. We can see some examples like- (a)Brihana Nasya(Snehana)- given in the treatment of Swarbheda in Rajyakshma and Ksheer Bala Taila Nasya in Ardita is examples of Brihana Nasya. (a)Brihana Snehapana in Krusha patients. (c)Pinda Sweda eg. Ksheer or Manasarasa Siddha Pinda can be used in Shosh Pradhan Vyadhi like Pakshaghata. (d)Samvahana Karma, Anuvasana Basti and Yapana Basti are some of the Brihana procedures. 

3. Snehana:- The drug, diet or an activity which causes unctuousness, fluidity, softness and moistness in the body is called Snehana. This therapy can be used as- (a)Shodhana Purvakarma (b)Pradhanakarma like Awapida Sneha and brihana Sneha Matra. (c)Abhyanga, Mardana, Samvahana, Anuvasana Basti, Matra Basti, Snehana Nasya, Shirobasti, Shirodhara etc. are included in this. 

4. Rukshana:- The drug or an activity which causes dryness, roughness and non sliminess is called Rookshana. Some examples can be coated as- (a)Lekhana Basti in Santapanottha Vyadhi is Aptarpana and Rooksha in nature. (b)Likewise Udwartana, Valukapottali Swedana, Choorna Pinda Swedana, Dhmpana Nasya and Vairechanika Dhoomapana in it. (c)Eg. Rooksha Sweda is indicated in Amavata, Udwartana is indicated in Sthoola patients etc. 

5. Swedana:- The drug or activities which cures stiffness, heaviness and coldness of body is called Swedana. They are mainly indicated in Kapha-Vata Pradhana Vyadhi. This is used as- (a)Purvakarma of Panchakarma (b)Pradhana karma in some Vyadhi Awastha (c)It is of two types, Rooksha Sweda of Valika Pottali is used in Amavata (d)Snigdha Pinda Sweda is used in Pakshwadha, Patrapinda in Kasa when there is Kapha and Aama dominance, Choorna Pind can be used in when there is Vataja Shotha and Shoola in nerves. 

6. Stambhana:- The therapy that surely prevents mobility and flow of bodily substances is known as Stambhana. The drugs which are rooksha, sheeta, kashaya rasatmaka, laghuvipaki and vatakara in nature are Stambhana. This is Shamana in nature. (a)PicchaBasti of Shalmali in Pravahika (b)Shamana Nasya of Sheetajala in Urdhwag Raktapitta is Stambhana in nature. 

So, we can see that, Panchakarma procedures are tool for doing Shadavdhopkrama treatments which includes every type of karma like Shodhana, Snehana, Brihana, Rookshana, Stambhana, Langhana, Lekhana, Chikitsa depending on the need of individual. It is person specific treatment and can be designed differently for the desired action like Swasthavritta, Vajikarana, Rasayana, Chakshushya, Indriya Prasadana, Doshahara, Vyadhihara, and so many other conditions. 

Applied Aspect:- According to Gunas of drug respect to Rasas is very important aspect in application of Chikitsa like Shadvidhopakrama because these are the Gunas that attend the state of Virya. We are doing Chikitsa (Shadvidhopakramas) like Brihana, Langhana, Swedana, Stambhana, Rukshana and Snehana. So, Guna we may form six groups each containing three Rasas in order of predominance 1) Madhur, Kashay & Lavana. 2) Tikta, Katu & Amla. 3) Lavana, Amla & Katu. 4) Kashaya, Madhura & Tikta. 5) Kashaya, Katu & Tikta. 6) Madhura, Amla & Lavana act in the Shadvidhopakrama as Guru, Laghu, Ushna, Sheeta, Ruksha and Snigdha respectively.

Trividha Karma

Trividham karma-poorva karma pradhankarma paschyatkarmeti || Su.Su. 5/1 

Acharya Dhallana which was the Commentator of Acharya Sushruta has been given explanation above said verse as Snehana, Svedana, Vamana, Asthapana, Anuvasana, Dhupa, Nasya, Kawalagraha, Gandusha, and Deepana, Pachana, Samshamanadi kriya. This is the Chikitsarthvachaka meaning of word Karma. 

Therefore, we will not administer independent karma, and has pre-operative, and post-operative measure should be consider. So, extended Panchakarma procedures i.e. Trividha Karma are as follows- 

(I)Poorvakarma- are three in numbers 1) Pachana, 2) Snehana and 3) Svedana. 

1) Pachana- it is given for Ama. Those medicines are Ama Pachana mentioned in Samhita can be used for Pachana. 

2) Snehana- it is divided into two types Bahya and Abhyanatara. Abhyanatara Snehana is of two categories Vicharana and Acchapeya. Again Sthavara, Jangama are its types. Also, it of so many types according to actions. Vicharana Sneha is Odana, Mansarasa, Yushadi etc. types. 

3) Svedana- firstly it is of two types Anagni and Niragni. Anagni Svedana is subdivided into Vyayama, Ushnasadana, Gurupravarana, Kshudha, Bahupana, Bhaya, Krodha, Upanaha, Aahava (Mushthi Yuddha) and Aatapa. Sagani Svedana is subdivided into Tapa, Upanaha, Ushma and Drava. 

(II)Pradhana Karma- are five in numbers Vamana, Virechana, Basti, Nasya, and Raktamokshana. 

1) Vamana- Procedure of expelling out Doshas through mouth is as called Vamana. According action it is of three types Pravara, Madhya and Avara. 

2) Virechana- Procedure of expelling out Doshas through anus is called as Virechana. Those medicines purifies Mana is known as Virechaka or Rechaka. According to action Virechana is four types Anulomana, Stransana, Bhedana and Rechana. 

3) Basti- The bladder of animals is known as Basti. By the use of bladder medicinal decoction, medicated oils, etc medicines administered through anus into the pakvashaya (large intestine) is called as Basti. According to route viz- through anus into pakvashaya, through vagina and cervix into garbhashaya and through urethra into mootrashaya are three types of Basti. According to type of medicine it is two types Niruha and Anuvasana. Niruha Basti is various types of actions Shodhana, Lekhana, Utkleshana, Bruhana, Shamana, Rasayana, Vajikarana, etc. In Niruha Basti main content is Kwatha or Kashaya so called as Kashaya Basti. Synonym of Niruha is Asthapana. For Basti used Ghrita, Taila etc Sneha. This type of Basti are Sneha, Anuvasana and Matra according quantity of Sneha. Basti given by Uttar marga is called as Uttar Basti. Uttar marga means Uttarvarti to Guda i.e. Medhra or Yoni. Uttar Basti is of two types Niruha and Anuvasana. 

4) Nasya- Drugs administered through nose is called Nasya. Main three types of Nasya are Virechana or Rechana, Bruhana or Tarpana and Shamana. According method of procedure Nasya is five types Navana, Pradhamana, Marsha, Pratimarsha Dhooma and Avapeedana. 

5) Raktamokshana- letting of blood from the body is called as Raktamokshana. Synonym is Raktavisruti. Raktamokshana is of six types Shriga, Jalookavacharana, Alabu, Pracchana, Siramokshana or Siravyadha and Ghatiyantra. 

(III)Paschat Karma- after main procedures body will be in strenuous state, for bringing to normal state those procedure are performed is known as paschat karma. These are three in numbers Sansarjana krama, Rasayanadi krama and Shamana chikitsa. 

1) Sansarjana krama- after Vamanadi procedures clears Agnimandya, but purpose to improve Agnis power, stability and digest heavy food not advise normal food to the patient. Here we advise for Agnibala vardhan Peya, Vilepi, Akruta Yusha, Kruta Yusha, Akruta Mansarasa, Kruta Manasa Rasa, and then normal food. By following slowly slowly this sequence of food is known as Sansarjana krama. 

2) Rasayanadi krama- if Vamanadi procedures are done in the patient as detoxification/ cleansing/purification of the body before starting of Rasayana (Rejuvenation) and Vajikarana (Aphordiastic) treatments, then in paschata karma you advise patient to take these medicines. 

3) Shamana Aoushadhi Prayoga- suppose as per disease condition we have done one of the pradhana karma then we have advise to the patient that take Shamana treatment of that disease in paschata karma.

Meaning of term ‘Panchakarma’

The term ‘Panchakarma’ is comprising of two words namely ‘Pancha’ and ‘Karma’. ‘Pancha’ means five and ‘Karma’ means procedure. 

Vamanam Rechanam Nasyam Niruhaschyaanuvasanam| 

Atani panch karmani kathitani muneeshwarehe || Sha.U.A8/70 

Vamana (Emesis), Virechana (Purgation), Nasya (Errihne), Niruha (Medicine Decoction Enema) and Anuvasana (Medicine Oil Enema) are the Panchakarmas stated by Muneeshwar. 

Question is, Why only five karmas (procedures)? Why not more or less? Answer is that, such figure has been fixed or finalized according to Siddhanta (concept) of science as like 3 Doshas, 7 Dhatus, 3 Malas, 3 Agnis, 5 Mahabhootas, 5 Panchakas 6 Rasas, 500 Virechana Kalpas, 8 Angas of Ayurveda, 6 Anga of Sharir. 

Eha vamanadishu karma lakshanam bhietikartvyata yogi dosha nirharan shktijyayastwam| Ch.Su.2/15 

Panchakarma procedures have Doshanirharana pradhanta is the main property. In Vamana 1, 1 ½ , & 2 Prasta matra (1 Prastha= 54 Tola means 540 ml/gm) of Kapha Dosha, Virechana 2, 3 & 4 Prastha matra of Pitta and in Niruha and Anuvasana Vata Dosha in Prabhoota matra will be expelled out from the body. 

Another question is that, Which are these five procedures? Panchakarma names as per Acharya Charaka given in Apamarga Tanduliya Adhyaya, Panchakarmiya Siddhi Adhyaya, Kalpana Siddhi Adhyaya are to be- Vamana, Virechana, Niruha (Asthapana), Anuvasana and Shiro-Virechana (Nasya), these are accepted by Acharya Sharangdhara and Acharya Bhavprakash. 

Acharya Sushruta told Trividha karma i.e. Poorva karma, Pradhana karma and Pachyata karma and Commentator of Sushruta Acharya Dhallana given three impressions on these Trividha karma and his third impression is- 

Trividham karma-poorva karma pradhankarma paschyatkarmeti || Su.Su. 5/1 

Anye samshodhya pachana snehana svedanani poorva karma virechana bastinasya shira mokashanani pradhanam karma, peyadyaanna sansarjanam paschyatakarma | 

Dhallana commentary on above said verse. Acharya Vagbhatta not mentioned names of the Panchakarmas but his commentator Acharya Arunadatta told Panchakarma names as ‘Nuriho vamanam kaya shirovirekaastravistrutihi’ which are same panchadha shodhanam stated by Acharya Vagbhatta. 

The word ‘Karma’ means Chikitsa. Chikitsa is that which will produce Dhatu samya and way of remedies that not again forms Dhatu vayshamya. Sushruta has called Kriya for word Karma. Kriya is divided into two types Chedyadi Kriya and Snehadi Kriya. Acharya Dhallana which was Commentator of Acharya Sushruta has been given clarification of Snehadi word as Snehana, Svedana, Vamana, Asthapana, Anuvasana, Dhupa, Nasya, Kawalagraha, Gandusha, and Deepana, Pachana, Samshamanadi kriya. This is the Chikitsarthvachaka meaning of word Karma.

Different Kalas (Time) of Nasya

1) Doshabhedat- i) Vata Roga- Aparanha, Ratro. ii) Kapha Rog- Pratah. iii) Pitta Roga- Madhyan. 2) Rutubhedat- i) Sheet- Dinmadhye. ii) Greeshma- Sayan. iii) Varsha- Vidyamane, Aatape 3)Vayobhedat- Age less than seven years. Age above eighty years. 4) Prashastat- Pratimarsh- Aajanmmaran Shastah. Benefits- Like Basti therapy and it gives Marsh Nasya effects.

Nasya Types, Medicines, Dose and Indication

1) Navan i) Snehan (Uncting)- Medicines-Taila- Anu, Malkangani, Karpasasthi. Ghrita- Triphala. Dose- 8 Drops/ Nostril or 2 to 8 Drops/ Nostril Indications- Vataj shirorog, dantapatan, keshpatan, tivrakarnashool, karnkshved, avabahuk, akalajvalee, akalajpalit, nasarog, mukharog. ii) Shodhan (Evacuating)- Medicines- Taila- Shadbindu, Apamarg, Vacha, Vidang, Bharangyadi Dose- 4 to 8 Drops/ Nostril Indications- Shirogaurav, Shirashool, Peenas, Apasmar 2) Avapeed i) Stambhan (Retentive)- Medicines- Doorva Swaras, Ikshuras, Milk, Madhu Dose- 4 to 8 Drops/Nostril Indication- Raktapitta (urdhwag), ii) Shodhan (Evacuating)- Medicines-Tulsi Swaras, Vidang,Shigru, Dose- 4 to 8 Drops/Nostril Indication- Peenas, Jeerna Pratishyay, Murcha, Moh, Sanyas, Nasa Awarodh. 3) Dhamapan ( Pradhaman ) (Cleans the body channels)- Medicines- Powders of Vacha, Shunthi. Dose- Three Mucchutti ( Approx 300 mg )/ Nostril Indication- Apasmar, Shirorog, Jeerna Pratishyay, Ardit, 4) Dhoom i) Prayogik (Pacificatory)- Medicines- Fumes of Jatamansi, Kumkum, Guggulu, Chandanpatra Dose- 3 Times/ Nostril Indication- Shirorog, Nasarog, Akshirog. Dosh Shamanarth, Swasthvrutta ii) Vairechanik (Evacuation)- Medicines-Agarupatra, Shvetaparajita, Hartal,Manshil. Dose- 3 times/ nostril Indication-Kaphapradhan Vyadhi iii) Snaihik (Uncting)- Medicines- Vasa, Ghrut, Wax Dose-3 times/ nostril Indication-Vatapradhan Vyadhi 5) Pratimarsh – According to doses it is divided into two types viz Pratimarsh and Marsh i) Pratimarsh (Pacification)- Medicines- Snehan Taila- Bala, Anu, Panchindriyvardhan Indication- Manyastambha/shool, Vataj Jeernapratishyay, Karna Badhirya. Dose- 2 Bindu Virechan Taila- Vacha, Shunti Indication-Shirogaurav, Kaphaja Jeerna Pratishyay. Dose- 2 Bindu ii) Marsh (Evacuation)- Medicines and Indications- as mentioned in Pratimarsh Nasya. Dose- 10, 8, 6 Drops as a Uttam, Madhyam, Hina Matras (Doses) respectively

Shiro-Virechana Nasya Samyakadi Laxana & management

1)Shiro-Virechana Nasya Samyak, Ayog & Atiyog Laxana- I)Samyakyog Laxana- 1 Sharir- Shir Laghuta 2 Sukh-swapna prabodhan 3 Vyadhi upashay 4 Indriy-Mana prasannata 5 Srotas shuddhi, II)Ayog Laxana- 1 Akshistabdhata 2 Nasa-shosh 3 Asya-shosh 4 Murdhshunyata, III)Atiyog Laxana- 1 Kandu 2 Guruta 3 Prasek 4 Aruchi 5 Pinas 6 Indriyvibhram 7 Trushna 8 Mastulung Aagamo, 2)Management of Shiro-Virechana Nasya Ayog and Atiyog Laxana- I) In laxanas of Ayog- If Nasya procedure was not done properly, Medicine used in which low potency was present, Attendant was unskilled, done by new Vaidya etc. due to these causes Ayog laxanas will be produced. In the Ayog Laxanas diseases are produced those are mainly Vatadominated. Management- Repeat the Nasya procedure up to Samyak yog. II) In laxanas of Atiyog- i) If Snehan nasya is given in the maximum quantity, then Kapha srav,shiroguruta, Indriya vibhram etc. laxanas will be produced. Management- Treat the patient with Ruksh medicines. ii) If Shodhan nasya is given in the maximum quantity, then Mastulung aagaman, vata prakop, Indriya vibhram, Shir shunyata etc. laxanas will be produced. Management- Treat the patient with Kaphaghna and Vataghn medicines.

69) Describe phases of clinical study

Synopsis-

1) Introduction

2) Phases

3) Conclusion