Practical Guide on Panchakarma

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About the Book In the recent past the entire world is looking for Alternative therapies and that too Ayurveda for the management of their health problems. Accordingly a lot of treatment centers based on Panchakarma are mushrooming every nook and corner of the cities and towns all over the country and practicing without following the guidelines laid down by Acharyas of Ayurveda. Acharya Charaka has clearly stated that though these therapies are administered in a skillful manner; do at times fail to cure the diseases due to insufficient or excessive dosage or wrong time of administration. That means suitable therapy administered in appropriate manner certainly gives beneficial results. Before going to commence, one should have a clear-cut idea about the dosage and time required to perform all the Panchakarma therapeutic procedures in a systematic way. Keeping this in view an attempt has been made to set up standard guidelines for practicing Panchakarma in this book entitled 'Practical Guide on Panchakarma' in a comprehensive manner for the benefit of students and practitioners of Ayurveda.

Dr. R. Vidyanath was born on 4' Feb. 1961 at Guntur, Andhra Pradesh. Joined as Medical Officer in the Dept. of AYUSH during the year 1986 and served in different capacities as Lecturer, Assistant Professor, Professor and In-charge Principal. Currently working as Professor Et HOD, P.G. Dept. of Ayurveda Samhita, Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabad. He has obtained PG from Gujarat Ayurveda University, Jamnagar and Ph.D. from Dr. N.T.R. University of Health Sciences, Vijayawada. He is the recipient of State Best Teacher Awardee 2013, Global Role Model Teacher Awardee 2015 and Vaidya Shree Award 2018. He was published 47 Scientific Papers and attended nearly 85 National and International conferences in the capacity of Paper presenter, Guest Speaker, Organizing Secretary, Adjudicator and Chairperson.

History reveals that around five thousands of years ago, one will find mention of the principles of Panchakarma therapeutic procedures. Going through the literature on history of Ayurvedic medicine, it is observed that physicians of Greek, Egypt, Mesopotamia, Persia and South America, due to different reasons, were using various methods of Panchakarma therapies.

It is fascinating to note that a few elements of Panchakarma were prevalent during the Vedic period itself though the word Panchakarma appears only in the literature of Ayurveda. There are references related to Virechana and Vamana Dravyas in the Vedic and post- Vedic literature. Dhanvantari, the lord of Ayurveda holds a Jalouka (leech) in one hand symbolizing para-surgical procedure, denotes that different forms of bloodletting procedures were prevalent even during ancient period. Similarly one can see references to Nasya (nasal medication) in Pumsavana in Vedic literature. For example, to conceive by an infertile woman, Nasya is done with root juice of white flowered Brihati (Solanum indicum Linn.) collected on Pushya Nakshatra.

Origin of Massage Therapy in Different Cultures

Since ages people have tried out different methods of healing the body by direct manipulation of the muscles, connective tissues and even deep organ tissues. Almost every ancient culture had some name for this technique of rubbing the body for therapeutic purposes. Paintings of people being massaged have been found on ancient Egyptian tombs. According to the Bible, around 493 BC, even the ancient Hebrews used to practice this therapy regularly to improve physical appearance and stay healthy. Greek and Roman physicians were also known to have used it as a principal technique for relieving pain. It is said that the Roman Emperor, Julius Caesar, was also given a massage daily for the treatment of neuralgia. In the 5th century BC, the famous Greek philosopher, Hippocrates, also known as the Father of Western Medicine mentioned about the importance of a physician having experience in rubbing the body for healing purposes. Even in the East, the "Yellow Emperor", considered to be the Father of Traditional Chinese Medicine, had recommended massage of the skin and deep tissues for treating paralysis, chills and fever in his medical philosophy.

Ayurveda, the traditional Indian system of medicine, which is practiced widely in India, also emphasizes on the importance of rubbing the body with special oils and spices to relieve stress and pain as well as in the treatment of certain diseases. Physiotherapy is actually based on these methods developed by Ling. World War I also saw the use of massage therapy for treating patients with nerve injury or shell shock.

Massage Therapy - The Present Scenario : With the latest developments and breakthroughs in medical technology, there is growing inclination among modern day physiotherapists to make use of electrical instruments for stimulating the tissues. Nonetheless, an awareness of the benefits of massage among people is also increasing. Today massage finds extensive use in intensive care units and also in the treatment for the elderly. It is also used in the treatment of diseases such as cancer, AIDS, strokes and in health and fitness centers and pain relief clinics.

Historical Background of Sweda Karma

Sweda was administered independently as one of the methods of treatment from the very ancient periods of Vedas. The most natural source of heat, for Swedana is the Sun. Importance of sunrays in the treatment of Hridroga, Kamala and skin diseases is described in Rigveda and Adharvana Veda. Sunbath is also recommended in the modern world also for the preservation of health and prevention of diseases. For thousands of years, cultures around the world have indulged in the soothing heat of the steam bath and initially made popular by the ancient Greeks and Romans. The origins of the steam bath come from the Roman bath, which began during the height of the Roman Empire. But do not forget that the Mayans, Alaskan Eskimos, Russians, Turks and Chinese of ancient times all enjoyed the benefits of steam. These cultures used steam to rejuvenate tired muscles, provide a sense of spiritual identity and provide a place for socializing.

Historical Aspects of Vamana & Virechana

In Rigveda and Yajurveda no direct references are available regarding Vamana. In Adharvana Veda it is mentioned that conduction of Vamana by means of Madanaphala in the treatment of poisoning. Further in case of snake bite poisoning Dhamargava and Katutumbi are advised for conducting Vamana. Description of Vamana is also available in Kousika Sutra of Adharvana Veda. In Vinayapitaka it is mentioned that Jivaka used to perform Vamana Karma to his patients wherever necessary. In Garuda Purana also Vamanakarma is recommended for the management of Kushta. Dhamargava, Madanaphala and Indrayava have been mentioned as Vamaka Dravyas .

In Agnipurana it is mentioned that Vamana is the important therapeutic procedure for the management of Adhogata Raktapitta. Madanaphala is stated as the best emetic drug and Kashaya and Kalka Yogas of Madanaphala are also available in Agni purana.

Not only in Ayurveda but also in other different medical cultures as well, one could see treatment such as Panchakarma used for purification purposes. For instance, catharsis in the Greek medicine is a method ofpurgation or purification.

Techniques like emesis or purgation that support or activate body's natural processes. One can see techniques like induced vomiting being used by animals as well. Cats or dogs when sick eat grass and induce vomiting. Even in the local community specific oral traditions of India, one can find some of these treatments widely prevalent.

Historical Aspects of Vasti

In Kousika Sutra of Adharvana Veda, Vasti is indicated as a substitute for minor operation. In Agnipurana, Vasti is quoted as principal treatment for the diseases manifested by the predominance of Vata. It is also indicated in fatigue state of horses, in the form of Taila Vasti. According to season different Sneha are indicated for Vasti.

In the world history of the enemas it is observed that the birds waders "ibis, crane, storks, flamingos and others" are injected with the long beak the water in the anal orifice to provoke the intestinal evacuation. Colonic lavage was first recorded in Egypt in 1500 BC in the document Ebers Papyrus which outlined Medical treatments of the time. Even Greeks have written about the Egyptians cleanliness with use of enemas.

Facts have shown that in ancient times, enema was very much in the routine for some serious problems too. The Egyptians believed that all diseases were caused by superfluities of the food, which now most people believe to be true. Enemas were known in the ancient African region, Greece, Babylonia, India, and China. It is also known that American Indians developed it by using a syringe made of an animal bladder and a hollow leg bone. Pre-Columbian South Americans also used latex in the first rubber enema bags and tubes. Enemas can also be seen in some famous literature by some great authors of all time like Aristophanes to Shakespeare, Gulliver Travels to Peyton Place. In fact, there is hardly a region where enema was not used.

In pre-revolutionary France adapted enemas were used on a daily basis after dinner and were also considered good for skin complexion. This practice was considered as a good remedy for many diseases. Ladies took three or four a day to keep a fresh complexion, and dandies took as many for a white skin. Even Louis XIV had used enema about 2000 times in his whole lifetime and stayed healthy for his entire life.

Hippocrates recorded using enemas for fevers in the 4th and 5th centuries BC and Galen recognized and used enemas in the 2nd century AD. Hippocrates Thel7th Century was the Golden Age of the enema. The crude instruments of the past -tubes of bone or wood attached to animal bladders or silk bags-were replaced by a formidable piston & cylinder device.

Till recently, in Western Bio-medicine there was practice of medicated enemas for conditions like arthritis, asthma described in the form of high rectal or low rectal enema. Even recent pharmacological books had explanations on how these get absorbed into the body through lymphatic or systemic circulation and their effects.

Historical Aspects of Raktamokshana

The practice of Raktamokshana can be traced back from Vedic period and the references related to bloodletting by means of leech application are available in the Kousika sutra of Adharvana Veda.

Bloodletting is the withdrawal of often small quantities of blood from a patient to cure or prevent illness and disease. It was the most common medical practice performed by physicians from antiquity until the late 19th century. It is conceivable that historically, in the absence of other treatments for hypertension, bloodletting could sometimes have had a beneficial effect in temporarily reducing B.P. by reducing blood volume. Bloodletting is one of the oldest medical techniques, having been practiced among ancient peoples including the Mesopotamians, the Egyptians, and the Greeks. In Greece, bloodletting was in use in the fifth century B.C. during the lifetime of Hippocrates, who mentions this practice but generally relied on dietary techniques.

Islamic medical authors too advised bloodletting, particularly for fevers. The practice was probably passed to them by the Greeks. Bloodletting was used to "treat" a wide range of diseases, becoming a standard treatment for almost every ailment, and was practiced prophylactic ally as well as therapeutically. One British medical text recommended bloodletting for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, insanity, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis, and for some one hundred other diseases.

By the above facts, it shows that the Panchakarma therapeutic procedures were much more popular throughout the globe up to 17th - 18th century AD. The people have forgotten the importance of this complementary treatment due to the dominancy of western medicine.

Though sufficient options are available to treat a patient successfully, many a number of Ayurvedic practitioners were unable to practice Panchakarma due to lack of practical orientation and phobia of establishing hospitals. Keeping this in view the present work has been taken up to provide certain standard guidelines to practice Sastric as well as Keraliya Panchakarma procedures easily by every Ayurvedic physician.

I am confident that this practice will become more popular in the days to come to cater the health needs of the suffering mankind in a comprehensive manner.

On this happiest occasion I would like to express my gratitude to all my teachers especially to Dr. K. Nishteswar and my parents Dr. R. Satyanarayanachargulu and Smt. R. Rajyalakshmi. I would like to convey my appreciation to my life partner Smt. Padma Vani, my only son Satyateja, daughter-in-law Geetha Meghana and to my lovely grand daughter Advaita for their constant encouragment and support in completion ofthis work.

My special thanks are due to my B.A.M.S. Colleagues Dr. Ch. Ramakrishna, Dr. K.V. Ramana Raju, Dr. C.N. Murthy, Dr. D.A.P. Reddy, Dr. S. Venkateswara Rao, Dr. S. Sarveswara Rao, Dr. P. Manohar, Dr. B. Rama Rao, Dr. P. Gayatri Devi, Dr. N. Sri Lakshmi and Dr. V.K.D. Varaprasadini for their lovely friendship for building up my career at various levels. For which I would like to dedicate this work to all my friends. At the end I would like to acknowledge my heartfelt thanks to Mr. Surendra Kumar Gupta & Mr. Arpit Gupta, Chaukhambha Prakashan, Varanasi for accepting to take up this work and published upto my satisfaction in a record time.