Module on “Significance of AMA in the Practice of Panchakarma” Talk By- Dr. Rajkala P. Patil

Significance of Ama in the Practice of Panchakarma

Dr. Rajkala P. Patil
Head & Associate Professor,
Department of Panchakarma,
Faculty of Ayurveda, IMS, BHU, Varanasi

Introduction: 

Ama, a concept deeply rooted in Ayurveda, plays a pivotal role in the philosophy and practice of Panchakarma—a renowned and comprehensive system of natural healing. The term “Ama” refers to toxins or undigested substances within the body that result from incomplete digestion and metabolism. These toxic remnants are considered a significant precursor to a wide array of diseases and imbalances, making their proper understanding and management a crucial aspect of Ayurvedic health care. In the context of Panchakarma, a set of five therapeutic procedures designed to purify and rejuvenate the body, the presence and management of Ama holds immense significance. These therapies aim to eliminate Ama and restore the body to a state of equilibrium and vitality. This introduction will delve into the profound importance of recognizing and addressing Ama in the practice of Panchakarma, highlighting the foundational role it plays in the pursuit of holistic well-being and health restoration according to Ayurvedic principles.

RATIONALITY OF AVASTHA IN PANCHAKARMA

In Ayurveda, “Dipana” and “Pachana” are two distinct therapeutic processes that support digestion and metabolism:

1. Dipana: Dipana refers to the process of kindling or stimulating the digestive fire (Agni) in the body. Agni is considered a vital factor in Ayurveda as it governs the digestion and assimilation of food, ensuring that nutrients are properly absorbed and waste products are efficiently eliminated. When Agni is weak or impaired, it can lead to incomplete digestion and the formation of Ama (undigested or toxic substances). Dipana therapies typically involve the use of herbs and formulations with pungent, digestive, and heating properties. These substances help to ignite or enhance the digestive fire, promoting efficient digestion. For example, common Dipana herbs include ginger, black pepper, cumin, and long pepper. These herbs are often used in cooking or taken as supplements to improve digestion.
2. Pachana: Pachana, on the other hand, is the process of digesting or metabolizing Ama, which are undigested or toxic substances that can accumulate in the body due to weak Agni or improper digestion. Pachana therapies aim to break down and eliminate these toxic remnants from the body. Pachana typically involves the use of specific herbs and formulations that have deep cleansing properties, helping to digest and remove Ama. Common Pachana medicines may include Chitrakadi Vati, Amapachana Vati etc. 

Assessment of Dipana-Pachana

विमलेन्द्रियता सर्गो मलानां लाघवं रुचिः|
क्षुत्तृट्सहोदयः शुद्धहृदयोद्गारकण्ठता||१७||
व्याधिमार्दवमुत्साहस्तन्द्रानाशश्च लङ्घिते| A.H.Su.13/17-18

The duration of Dipana and Pachana therapies in Panchakarma can indeed vary based on several factors, including:

1. Disease Type: The nature and severity of the disease or condition being treated can influence the duration of Dipana and Pachana. Chronic or complex health issues may require a longer duration of treatment.
2. Prakriti: The individual’s Prakriti, or their inherent constitution, plays a significant role in determining the duration. Individuals with different Prakriti may respond differently to treatment. For example, a person with a predominantly Kapha Prakriti may require longer Pachana therapy to manage Ama related to Kapha imbalances.
3. Kala (Time): The timing of the treatment can also affect its duration. Some conditions may be more responsive to Dipana and Pachana during specific seasons or times of the day, which could impact the duration.
4. Desha (Location): The geographic location and environmental factors can influence treatment duration. Climate, pollution, and other local factors may affect how the body responds to therapy.
5. Agni (Digestive Fire): The strength of an individual’s Agni is crucial. If someone has a weak Agni, they may require a longer duration of Dipana and Pachana to strengthen digestion and eliminate Ama effectively.
6. Dosha Imbalance: The specific dosha or doshas that are imbalanced can also impact the duration of treatment. For instance, addressing a severe Pitta imbalance may require longer Pachana therapy.
7. Bala (Strength): The overall strength and vitality of the patient can determine how well they respond to treatment and, subsequently, the duration required.
8. Vaya (Age): The age of the patient can influence treatment duration. Children and the elderly may have different needs and responses to Dipana and Pachana.

Due to these varying factors, the duration of Dipana and Pachana therapies should be individualized and personalized to each patient’s specific needs and conditions. 

Duration of Dipana-Pachana may vary According to disease

• Sthaulya – 3 weeks
• Vatashonita-2 to 3 weeks
• Sandhigatavata -7 to10 days
• Sharad rutu- 4 to 8 days
• Kushtha/Shopha/Prameha –more Rukshana 
• Pancreatitis- carefully
• ILD-Long duration
• Duration always approximately-till Samyak Langhana Lakshana – Nirama 

Medicines for Dipana-Pachana:

• Agntundi Vati 
• Chitrakadi vati
• Trikatu Choorna
• Hingwasthak Choorna
• Shaddharanam Choorna
• Vaishwanar Choorna
• Shivakshar Pachana Choorna
• Musta Choorna
• Guduchi+Haritaki+Shunthi
• Kwatha according to Dosha
• Vata Vikara- Rasnadi, Nagaradi
• Pitta- Patoladi, Mahatiktak, Manjisthadi, Nimbadi
• Kapha Vikara– Triphala, Mahamanjishtadi Kwatha

What if Pachana not done properly: may lead to complications. 

Let’s discuss where Panchakarma advised in Amavastha

Jwara:

कफप्रधानानुत्क्लिष्टान् दोषानामाशयस्थितान्||१४६||
बुद्ध्वा ज्वरकरान् काले वम्यानां वमनैर्हरेत्|१४७|

Complications of Vamana in taruna jwara

अनुपस्थितदोषाणां वमनं तरुणेज्वरे||१४७||
हृद्रोगं श्वासमानाहं मोहं [१] च जनयेद्भृशम्|
सर्वदेहानुगाः सामा धातुस्था असुनिर्हराः [२] ||१४८||
दोषाः फलानामामानां [३] स्वरसा इव सात्ययाः|१४९|

WHAT IS PROCEDURE FOR AMAVASTHA

Panchakarma for ama- External Amapachana

Procedures –

• Kashaya Dhara
• Ruksha Sweda: Valuka Sweda, Lavana Sweda
• Dhanyamla Dhara

According to Dosha predominance

Lepa: without Sneha

• Jadamayadi Lepa
• Dashanga Lepa
• Kottamachukadi Lepa
• Udvartana:
• Kottamachukadi Churna
• Triphala Churna
• Java/Bajara/jawar

Local Dhara & Pichu:

• Saindhavadi Taila 
• Brihat Saindhavadi Taila
• Murivenna

Ruksha basti: Vaitarana Basti

Amlika (Tamrind) -50gm

Guda (Jaggery) -100gm 

Gomutra 120ml

Saindhava -10 gm

Eranda sneha -25ml 

Can be administered after food also. 

Takradhara – shirodhara

Diseases avastha and panchakarma

Vatashonita 

• Amavastha
  • TiktaDhara
  • Vaitarana Basti
  • Lavana Sweda
  • PPS without oil/ Brihat Saindhavadi oil
  • CPS with Kolkuthyadi Churna
• Niramavastha: 
• Dugdha Dhara
• Guduchyadi Ksheerabasti
• Virechana
• Yapana

Kushtha:
    Amavastha:

• Wet eczema – Avachoornan
• Kashaya Dhara
• Ruksha Virechana

Niramavastha:

• Snehapana
• Local application of Sneha/ cream
• Takradhara
• Yapana Basti (No Anuvasana)

Jwara

 

Amavastha:

• Kashayapana
• Ruksha Sweda
• Vamana

Niramavastha:

• Virechana
• Snehapana
• Basti
• Anuvasana Basti

Sandhigatavata

 

• Amavastha:

• Dhara
• Pizhichil with Kwatha
• Lepa

Niramavastha:

• Dhara with oil
• Anuvasana
• Yoga Basti
• Mridu Virechana

Pakshaghata

Haemorrhagic – Pitta + Vata

Infarctive – Kapha + Vata

 Amavastha:

• Pizhichil with Dhanyamla, Kwatha
• Udvartana
• Koshthashuddhi

Niramavastha:

• Virechana
• Basti
• Pizhichil with Taila
• Shirodhara with Taila, Milk.
• Talapodichil

Chronic Renal Failure (CRF)

• No Sneha
• Ruksha Virechana
• Shodhana Basti
• Yapana Basti

Pakshaghata-Coma case

Amavastha:

• Shunthi, Vacha, Jala Nasya
• Pradhamana Nasya- Trikatu
• Shadabindu Taila Nasya

Niramavastha:

• Anutaila
• Panchendriya Taila

Discussion about Dipana and Pachana, as well as the factors influencing their duration, is as follows:

1. Understand Ama: Ama, or toxic and undigested substances in the body, is a crucial concept in Ayurveda. Recognizing and addressing Ama is essential for maintaining good health. Ama can be a precursor to various diseases and imbalances, making its management a central aspect of Ayurvedic healthcare.
2. Specify Avastha of Disease: The stage or avastha of a disease is an important consideration in Ayurveda. Different stages of a disease may require varying approaches to treatment. Identifying whether the disease is in the acute or chronic phase, for example, helps in determining the appropriate therapeutic interventions.
3. Doshavastha in Particular Disease: Understanding the specific dosha or doshas responsible for a particular disease is crucial. Different diseases can be attributed to imbalances in Vata, Pitta, or Kapha doshas, and treatment approaches must be tailored accordingly.
4. Most Important is Clinical Assessment of Niramavastha: Among all the factors that influence the duration and approach to treatment, the clinical assessment of the patient’s current state (Niramavastha) is of utmost importance. This assessment takes into account the individual’s constitution (Prakriti), the nature and severity of the disease, the strength of their Agni (digestive fire), their age, and other relevant factors.

In summary, when considering Dipana and Pachana therapies, and indeed any Ayurvedic treatment, it is crucial to assess the patient’s current clinical condition comprehensively. This assessment should consider the individual’s constitution, the stage of the disease, the dosha imbalances, and various other factors that impact the choice of treatment and its duration. By understanding the specific needs and imbalances of the patient, Ayurvedic practitioners can provide more effective and tailored treatments to promote health and well-being.

10 multiple-choice questions (MCQs) related to the significance of Ama in the practice of Panchakarma:

1. What is the term “Ama” in Ayurveda referring to?
a. Balanced energy
b. Toxins or undigested substances
c. A spiritual practice
d. A type of meditation

Answer: b. Toxins or undigested substances

2. In Ayurveda, which process kindles or stimulates the digestive fire (Agni) to promote efficient digestion?
a. Pachana
b. Dipana
c. Sweda
d. Basti

Answer: b. Dipana

3. Which of the following herbs is commonly used in Dipana therapies to enhance digestion?
a. Guduchi
b. Triphala
c. Cumin
d. Musta

Answer: c. Cumin

4. What is the process of digesting or metabolizing Ama called in Ayurveda?
a. Pachana
b. Sweda
c. Dipana
d. Basti

Answer: a. Pachana

5. What plays a significant role in determining the duration of Dipana and Pachana therapies in Panchakarma?
a. Disease Type
b. Age of the patient
c. Season of the year
d. All of the above

Answer: d. All of the above

6. What can happen if Pachana is not done properly in Ayurvedic therapy?
a. Improved digestion
b. Enhanced energy levels
c. Complications and imbalances
d. Better sleep quality

Answer: c. Complications and imbalances

7. In which condition is Panchakarma advised in Amavastha (Ama-dominant stage)?
a. Hypertension
b. Jwara (fever)
c. Diabetes
d. Insomnia

Answer: b. Jwara (fever)

8. Which Ayurvedic procedure is not recommended for Ama in the Amavata (Ama-dominant stage)?
a. Ruksha Sweda
b. Dhanyamla Dhara
c. Lavana Sweda
d. Kheera dhara

Answer: b. Kheera Dhara

9. What external Amapachana procedure involves the application of medicated pastes without oil?
a. Lepa
b. Pizhichil
c. Basti
d. Snehapana

Answer: a. Lepa

10. Which Panchakarma therapy is recommended for Amavastha in the context of Vatashonita (gout)?
a. Dhanyamla Dhara
b. Yapana Basti
c. Virechana
d. Pizhichil with taila

Answer: a. Dhanyamla Dhara

References: 

1. Agnivesha; Charaka Samhita; redacted by Charaka and Dridabala with Ayurveda Dipika Commentary by Chakrapanidutta; English translation edition 1997; by Ram Karan Sharma and Vaidya Bhagwan Dash; Chaukhambha Sanskrit Series Office, Varanasi, Uttar Pradesh. Pp 738 pg 699-700
2. Vagbhatacharya; Ashtanga Hridaya with commentaries Sarvangasundara of Arunadutta and Ayurveda Rasayana of Hemadri, ed. by Pandit Bhishak Acharya, Hari Shastri Paradkar Akola; 8th edition, 2000; Chaukhambha Orientalia, Varanasi, Uttar Pradesh. Pp 956 pg 769
3. Sushruta, Sushruta Samhita with commentary of Sri Dalhanacharya edited by Aryan Ram Acharya “Kavyatirtha”, published by Chaukhamba Orientalia, Varanasi, Reprint 2009
4. Dravyaguna Vijnana by Dr. J. L. N Shastri, Vol. 2, 3rd Edition, Chaukhamba Orientalia, Varanasi, 2008