Panca Karma Therapy: (Ancient Classical Concepts, Traditional Practices, Recent Advances and Guidelines of Standard Practice)

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The revised and enlarged 2nd edition of the book Pancakarma Therapy produced by well known author Prof. R.H. Singh who has the long experience of teaching, Research and practice of Ayurvedic Medicine, is being presented for the first time in the form of a complete and update work on the subject. The book deals in details the Classical Concepts of Pancakarma Therapy in Ayurveda besides a detailed account of the traditional Keraliya Practices of Pancakarma. The book contains separate Chaptors on Biopurificatory measures of allied disciplines such as Yogic Satkriya and Nature Cure therapies. The book also deals in a separate Chaptor with essentials of conventional modern physical medicine and rehabilitation.

The present edition of the book is highly enriched with additional Chaptors on Pancakarma Sarira i.e. applied anatomy and physiology relevant to Pancakarma Therapy. For the first time a critical write up has been added in this book in a Chaptor on Pancakarma Therapy for women, children and elderly.

This book has attained a significant scientific standard because of additional extended Chaptors on Recent Advances in Pancakarma Therapy reviewing the recent researches in the relevant field and a write up on guidelines set by the author for standardization and Clinical research on Pancakarma. An added attraction to this edition is the extended glossary of technical words of Ayurveda and the update bibliography and word index besides the Sanskrit text reproduced on each page as foot notes.

Thus, this is the best and the most complete book so for produced on Pancakarma Therapy written in English with update information and scientific temper.

‘Pancakarma’ (five measures) play a vital role in Ayurvedic therapeutics and as such they occupy an important place in Ayurvedic Medicine. It is not known why the number five was preferred but it is definite that these measures were in vogue in the times of the Caraka-samhita (CS). CS begins with the first quadruple on bhesaja (drugs) which is mostly and primarily devoted to the drugs used in Pancakarma. These five measures are vamana (emesis), virecana (purgation), niruha (non-unctuous enema), anuvasana (unctuous enema) and nasya or sirovirecana (head evacuation). Some take niruha and anuvasana under basti and complete the number (five) by adding raktamoksana (blood-letting).

Why only these five are designated as ‘karma’ when there a number of other remedial measures? This point has been discussed by Cakrapanidatta (CD) at length. He says that here ‘karma’ denotes extensive management and pronounced potency for elimination of impurities. Sneha, sveda and collyrium etc. are not covered by this definition and as such are not included in it. Moreover, now the term has been restricted to the five evacuative measures (CS. SU. 2.15).

Cikitsa is broadly classified into two: ‘sodhana’ (evacuatory or eliminatory) and samana (pacificatory). Here also sodhana occupies the first place. The question can be raised why so much importance to sodhana Cikitsa of which Panca Karmas are the important means? The importance of Pancakarma in Ayurveda is testified by the fact that it is essentially applicable to all cases, covering a wide range of preventive, curative and promotive conditions. It is commonly said that as dyeing is not properly effected if the cloth is not properly washed and cleaned the samana therapy does not work well if sodhana Cikitsa is not done priorly and thus the ground is not prepared well. Even in Rasayana and vajikarana evacuation of dosas is a pre-condition for their effective application (CS. CI. 1.4.36-37; l.50-S1). In rtucarya (seasonal regimen), elimination of accumulated dosas is prescribed before they are aggravated enough to produce disorders. CS says that accumulation of dosas should be eliminated in the months of caitra, sravana and margasirsa (in cases of kapha, vata and pitta respectively) (CS. SU. 7.46; also Sa. 2.45). CD has given a long discussion on this elucidating many important points. He has shown that the list of seasons having pravrt replacing sisira is designed particularly for eliminative treatment and not because of the geographical variations as Kasyapa says. This point has been again discussed in detail in vimanasthana (8.125-127). There it is said that in hemanta, grisma and varsa cold, heat and rains are pronounce respectively while in between are the three moderate seasons- vasanta, pravrt and sarad. It is in the moderate seasons that the eliminative measures are applied in order to avoid complications due to extreme environmental factors.

The other important point to be noted here is that the dosas are eliminated not in the beginning of the aggravating seasons but at the later part. The reason is that the dosas are extracted only when they are fully aggravated and liquified otherwise their elimination is difficult. The underlying point is that the malas have natural tendency to get out (bahirmukha) and the measures are only to help, restore the natural process rather than forcefully driving them out. That is why in vamana etc. utklesana (excitation) is a very important prior procedure for success of the therapy. It should always be borne in mind that Ayurveda being a way of nature-cure relies and emphasises on the natural instincts and tendencies which should neither be suppressed nor forced out. In context of the above verse, Bhattara Haricandra has a different view and takes karttika instead of margasirsa and so does Vagbhata. But even then the central concept is not in any way disturbed.

Sodhana is concerned with malas while samana deals with dosas. Pancakarma is meant for elimination of malas and as such to understand the role of Pancakarma it is necessary to know the nature and functions of malas. The human body is composed of three biological units- dosas, dhatus and malas (SS, SU. 15.3) which maintain the body if they are in the state of equilibrium. In this way, they are all dhatus as in normal condition they sustain the body. When food is ingested it undergoes digestion and by the action of jatharagni the product is bifurcated into prasada (essence) and kitta or mala (excrete) both being dhatu (CS. SU. 28.4) because of their sustaining character. The word ‘mala’ is formed by the verb-root ‘Mala-dharane’ which indicates its sustaining character. In normal state it provides strength. Strength of man depends on sukra while life depends on mala, thus say Vrnda and Cakrapanidatta (in the ch. on Rajayaksma). But this function is attributed to it in minimal quantum and what is excess of it should be evacuated properly and regularly. The word-‘kitta, which is formed by the verb root ‘kit gatau’denotes its excretable character otherwise it threatens to cause disorders. If it is not excreted properly it accumulates in channels, brocks them and cause disorders. The various types of srotas must be clear so as to produce and carry the biological entities. Haritaki performs this function excellently and, that is why it is known as ‘pathya’ and the best among pathyas (drugs useful for srotas). When the residue is to be excreted it is kitta or mala and when it is prone to cause disorder it is dosa. Thus mala is also dhatu and dosa as well in different states. Dosa and dhatu too have other two states.

Susruta defines the general principle of treatment as follows-dosas decreased should be promoted, aggravated ones be pacified, those much advanced should be eliminated and those in normalcy should be preserved as such (SS. Ci. 33.3) Here distinction has been made between ‘kupita’ (aggravated) and vrddha (advanced) which have to be treated with pacification and elimination respectively. While explaining this Dalhana says that vrddhi (increase) of Dosas is of two types-caya (accumulation) and prakopa (aggravation) characterized by compactness (Samhati) and vilayana (liquification) respectively. It is in the latter state that elimination is prescribed. In fact, the aggravated dosas, after exerting for sometime, become powerless and reduced to the state of mala which must be eliminated. Here the word ‘vrddha’ signifies this.

I am happy to present this monograph on Pancakarma Therapy to the prospective readers, which has been written entirely from a new angle. It reviews the ancient classical concepts, traditional practices and recent advances made in this important field with due evaluation and rational assessment. I wrote the first draft of this monograph few years back but it remained incomplete till I visited Czechoslovakia under a Scientific Exchange Programme. During this tour I had to face number of querries about the approach and utility of Panca Karma Therapy and such other unique practices of Ayurveda. This inspired me to complete this monograph and to publish it at the earliest.

The Panca Karma therapy is not only an important component of Ayurvedic treatment but it also forms the fundamental basis of Ayurvedic Therapy. The classical Ayurvediya Panca Karma is the comprehensive method of internal purification of the body by emesis, purgation, enemata, snuffing and blood letting. It is postulated that the vitiated Dosas and Malas of the body need to be eliminated radically before a palliative therapy is given. The palliative therapy in the form of drugs and diets may not be effective unless the body channels are cleansed and morbid Dosas and Malas are eliminated. This is an unique approach and is very fundamental of Ayurveda.

Unfortunately such an important component of Ayurvedic Therapeutics gradually declined and almost ceased to be in practice specially in North India till recent past. A simplified form of Panca Karma specially of the type of Vahih Parimarjana continued in traditional form in South India specially in Kerala and is flourishing even now. But type of Panca Karma which is practised in Kerala is very much different from classical Ayurvedic Panca Karma Therepy. The Keraliya Panca Karma is more or less the Purva Karma Therapy, practised as physiotherapeutic procedure. However, these practices are very popular and are also very effective. Thanks to the practitioners and scholars of Kerala who have kept the tradition alive in some form. As a matter of fact it is the Kerala tradition which is now inspiring the Ayurvedic world in general to revive the classical Panca Karma Therapy.

During post independence era now attempts have been made to revive the practice of Panca Karma at institutional level. But the review of the developments made so far, shows that the progress is not very encouraging. Very few centres have created clinical units for practice of Panca Karma and only sporadic research activities have been initiated. Whatever studies have been reported in the literature lack scientific methodology. However, there has been increasing awareness about the task ahead.

There is an urgent need of standardising the classical Panca Karma procedures in consideration of the need of today. The dosage schedule, exact procedures, medicaments, effects and side effects are to be standardised so that an uniform schedule of practice may be developed to be practised at all centres. There is also a need to launch therapeutic trials on Panca Karma procedures individually or in total sequence to demonstrate their utility and possible complications. There have been some studies on this line, although preliminary in nature. They have been reviewed and evaluated in this monograph. Our own studies conducted at Banaras Hindu University on Purva Karmas and Pradhana Karma have been reproduced in this monograph in abridged form to serve as provisional models for further studies.

After the establishment of the new department of I.S.M. in the Ministry of Health Government of India more and more attention is being drawn to the study and practice of Panca Karma. Department of ISM has recently advised all major hospitals of the Country to open Panca Karma centres. The Department of I.S.M. and Central Council for Research in Ayurveda and Siddha have been keen to develop guide lines for standardization and clinical research in Panca Karma and the author of this book was entrusted with the responsibility of preparing a comprehensive draft guideline which has been now submitted and is being considered by W.H.O. for publication as a global document for this purpose. It is pertinent to note that the new edition of Oxford English dictionary has recently included ‘Panca Karma’ as a word in its text. All this reveal the growing interest in the subject.

It is hoped that this book will interest the students, researchers, scholars and practitioners interested in classical and traditional practice of Ayurveda with scientific temper. In preparation of this monograph initially I received good help from my co-workers Doctors U. k. Jha, R. S. Singh and P. Muralikrishna. I was greatly inspired to work in this field by my senior colleague Late Professor G. N. Chaturvedi to whome I am grateful. I am specially thankful to my own teacher late Professor K. N. Udupa the former Director lnstitute of Medical Sciences, Banaras Hindu University for inspirations.

My fine colleagues Dr. Praveen Kumar Madikonda and Dr. M. Srividya have extended substantial help to me in revising the 2nd Edition of this book which I acknowledge with great pleasure.

I am extremely thankful to Prof. P. V. Sharma the noted Ayurvedic scholar for having agreed to write the foreword to this work which is an added attraction to this monograph because of original statements made by Prof. Sharma in the foreword.