Lecture Note: “An Introduction to Panchkarma & Shodhana Chikitsa”

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  “An Introduction to
Panchkarma & Shodhana Chikitsa”  


       Dr Abhinav       
Assistant Professor, Dept of Panchakarma,
Faculty of Ayurveda, IMS, BHU

    based on the lecture available at    
“An Introduction to Panchkarma & Shodhana Chikitsa”

This is a modern era of globalization. It is an era marked by science and technology, advanced computers, and simultaneously, challenges such as pollution, deforestation, extreme stress, tension, and health issues. Health has always been a major concern since the Stone Age, and the individuals of this era are no exception. In this period, a disconnection from spirituality and nature has led to an alteration in our lifestyle and the environment we inhabit. Although our brains are well-developed but our bodies remain undernourished or in better words malnourished. Consequently, people tend to fall sick early, leading to a decline in life expectancy and overall quality of life. People may do live longer but, faces challenging health issues like respiratory disorders, depression, obesity, cardiac diseases, diabetes, renal disorders, tension, stress, and anxiety.

  How health problems really start?  

At a molecular level, these health problems originate from an imbalance in the body’s metabolic system. This imbalance reduces an individual’s state of health and vitality, preparing the base for the development of diseases. The major causes of this metabolic imbalance include a lack of self-observation, a sedentary lifestyle, an improper and irregular diet, the absence of relaxation techniques and meditation practices, tension, and stress. These factors play a crucial role in disrupting the body’s metabolic system.

When there is impairment in the body’s metabolic system, the formation of Ama occurs. Ama is an outcome of improper digestion and metabolism and can be formed at the gastrointestinal level or present in systemic circulation. Ama possesses the property of Guru, Guruta, meaning heaviness. It inherently causes obstruction in the channels and the vitiation of Doshas. This creates a problem statement, leading to the accumulation of morbid materials in the body and the vitiation of Doshas. If an individual continues to engage in the causative factors, these doshas become vitiated beyond a particular level which again give rise to production of more morbid materials, which tend to accumulate in the microchannels. This sets off a vicious cycle of producing toxic clogs in the body, leading to the blockage of channels and the manifestation of various disorders.

  Srotas:  

The concept of srotas are integral to Ayurveda, where it is believed that no corporeal entity can arise or decay without their involvement. The human body, according to Ayurveda, is an aggregate of these Srotas, which are numerous in number. These Srotas serve the crucial purpose of transporting various substances within the body, including Doshas, transformed Dhatus, and nutrients. Essentially, Srotas represent the biological transport system or the membrane system of the body, operating continuously and rhythmically from the cellular level to the larger organ system level.

This intricate system of Srotas plays a pivotal role in both health and illness. Morphologically, Srotas can be classified into two types of channels: macro and micro channels. Macro channels encompass the gastrointestinal (GI) tract and respiratory tract, while micro channels include structures like capillaries and nephrons.

At the minutest level, the cell serves as the structural and functional unit of life, and micro channels are the smallest components of the Srotas. Consequently, Srotas play a critical role in the manifestation of diseases. Ayurvedic texts emphasize that if these channels are deranged or experience any disharmony, it leads to the onset of disease. On the contrary, when these channels function normally, they contribute to the maintenance of overall health. Understanding and maintaining the balance and harmony of Srotas are thus fundamental in Ayurveda for achieving and preserving well-being.

When an individual engages in improper diet and erratic behaviour, which is contrary to the Doshas and in opposition to the Dhatus, it can lead to abnormalities in the channels. This abnormality tends to cause obliteration or thickening of these channels, ultimately disrupting the function of the channels or the biological transport system in the body. This disruption can manifest in the form of loss of function, structural distortion, or a combination of both.

When there is a loss of function or structural distortion, it results in the manifestation of Srotodusti. Srotodusti exhibits characteristics such as Ati pravitti (excessive flow), Sang (stasis), Siranam granthi (nodules or cysts), Vimargamanam (deviation). The occurrence of Srotodusti is crucial for the manifestation of any disease. The nature of the disease depends on the extent and site of the Srotas involved, as well as the extent and nature of the Doshas involved in the disturbance.

Ultimately, this disturbance in the channels and the subsequent Srotodusti contribute to the production of diseases. It’s a very well-versed being written in Ayurveda regarding the manifestation of disease

कुपितानां हि दोषाणां शरीरे परिधावताम् |
यत्र सङ्गः खवैगुण्याद्व्याधिस्तत्रोपजायते ||
(Su,Sha 21/10)

It clearly explains that the provoked doshas travel all over the body, but they are not able to cause the disease until they reside in the channels where either functional or structural distortion is present. When they reside there, they initiate Dosha-Dushya Samurchana (pathogenesis) leading to the manifestation of the disease.  It reveals an importance of Srotas in disease manifestation.

  Solution:  

There occurs an impairment; after the impairment, toxic clogs accumulate in the channels, block them, vitiate the Doshas, and the body becomes diseased. Numerous challenging health problems arise. To address this, a proven fundamental solution is provided by the oldest life science called ‘Shodhan Chikitsa’, mainly comprising Panchakarma therapy. Panchakarma, meaning five actions or five elements, has specific biopurificative efficacy to clean, purify, and sanitize the Srotas for optimal functioning.

  Shodhan Chikitsa:  

Panchakarma comprises five therapies: Vaman, Virechan, Anuvasana vasti, Niruha vasti, and Nasya. Among these, Anuvasana vasti doesn’t primarily perform Shodhan; it aids in cleansing the colon but is more palliative and nutritive in nature. Acharya Vaghbhat and many other Acharyas have given the concept of Panchavidha Sodhan, which includes ‘Niruha Vamanam Kayasirorekaha Asravishruti’. Specifically discussing Shodhan, we refer to Vaman, Virechan Karma, Vasti, Nasya, and Rakta Moksha. These five therapeutic procedures comprise and create Shodhan Chikitsa.

  • Vaman Karma is a process in which Doshas are expelled from the body through the oral route, predominantly expelling Kapha Dosha from the gastrointestinal tract.
  • Virechan Karma involves the expulsion of vitiated doshas from the anal route, predominantly expelling vitiated Pitta dosha from the Grahni or Duodenum or biliary apparatus.
  • Vasti Chikitsa includes two kinds of vastis: Niruha Vasti (decoction-based) and Anuvasana Vasti (oil-based). In terms of Shodhan, decoction-based Niruha Vasti is preferred. It is a process in which the decoction is introduced either in the anal, urethral, or vaginal route to pacify or expel toxins. It helps in the removal of vitiated Vata dosha accumulated in the Pakvashaya.
  • Nasya Karma represents the process in which drugs are given through the nostrils. The nose is considered the doorway to the brain and consciousness. Drugs given via the nostrils reach different parts of the head, expelling vitiated morbid matters from the head to the nearest possible route of elimination via the nose. It plays a crucial role in removing doshas accumulated in areas above the neck region.
  • The last one is Raktamokshana, involving bloodletting. It helps in removing impurities from the blood, and it is written that undergoing Raktamokshana prevents disorders like Twak roga, Granthi, Shonitaja roga from happening again.

Overall, Panchakarma utilizes a set of five therapeutic procedures designed to restore the integrity of the channel system in the body in both health and disease conditions. It promotes the elimination of toxic substances from the body through the nearest possible route of elimination. It profoundly affects the detoxification mechanism and metabolism of the human physiology, serving both the purposes of Ayurveda: ‘Swasthasya swasthya rakshnam’ that is, maintenance of health of healthy individual and ‘Aturasya vikara prashamanam”  means to cure disease.

  Vyadhi Samprapti  

How does Panchkarma actually break the pathology? Because, from what I understand, the best definition of Chikitsa is ‘Samprapati vigatana meva chikitsa’. So, to understand the Samprapati vighatana via Panchkarma, we have to first understand the Vyadhi samprapati. It starts with the indulgence in causative factors, then it causes the impairment in Agni. When there is impairment of Agni, it starts accumulating the Doshas into the Koshtha. If the patient continues to indulge in the causative factors, then these accumulated Doshas get provoked. These provocative Doshas circulate all through the body and then stick to the areas where there is either functional or structural distortion. There, they start the Dosha Dushya samurchana, and Vyadhi utpatti occurs.

  Role of Panchakarma in breaking   the Samprapati:  

 Shakhagat Dosha clearly means those which are circulating all through the body. So, via the Purvakarma, Snehan, Svedan, we actually ripen these Doshas, provoke them, liquefy them, modify them in a way that it is able to mobilize /dislodged from the site of their morbidity to the site of their evacuation. In that way, the Doshas, ready to be detached from the Shakhas, and Doshotklesh will occur. After that, we do the Pradhana karma, that is, the Panchkarma therapy is being applied. What we get is that after applying this Vaman, Virechan or any other Shodhan procedure, these Doshas come into the Koshtha, and from the Koshtha, they are being removed from the body via the nearest possible route of elimination.

In the present era, Panchakarma can be re-categorized into two groups. While no such actual division exists in any classical text of Ayurveda but it is popular in society. So, I am mentioning here one is classical Panchkarma, the other is Keraliya Panchkarma.

Classical Panchakarma: It is the actual form of Panchkarma mentioned in all classical texts. It is the genuine form of bio purification, including five Karma: Vaman, Virechan, Anvasanvasti, Nirhuvasti, and Nasya. It performs transmembrane or transvisceral purification.

Keraliya Panchakarma: It is based on certain traditional practices in Kerala. It is generally designed to have a rehabilitative physiotherapeutic effect on the body. It mainly comprises Kaya Seka, Dhara Karma, Sirolepa, Annalepa, and Pindasveda. Keralya Panchkarma is mainly based on external oleation and fomentation techniques. It doesn’t cause the actual form of bio-purification, but it does have transdermal body purification.

So, overall, the combined effect is the cleansing of the channels, resulting in the optimization of natural body function.

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