The Pancakarma Treatment of Ayurveda Including Keraliya Pancakarma

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Pancakarma Therapy primarily aims at clearing the body of its accumulated impurities, toxins or stagnant Malas and nourishing the body Dhatus. Panca Karma therapy is not only a prerequisite for all the therapeutic procedures and medications but has also a full therapy role as a promotive, preventive, curative and rehabilitative procedure. The purpose of this endeavour is to introduce this important therapy to students, scholars, researchers and foreigners in very simple language. The classical facts about the Panca Karma Therapy available in various Ayurvedic treatise have been compiled, rearranged and reoriented to make it more practicable. The book reviews the ancient classical concepts, traditional practices and recent advances made in this important field.

A number of photographs and illustrations are given at appropriate places through out the book to make it more beneficial for the readers. Personal experiences of the author are also inserted at relavent places to enrich the subject matter.

It is expected that the students, scholars, physicians, scientists and common people who are interested in the subject will find this book useful.

The author of the Book “The Panca Karma Treatment of Ayurveda (Including Keraliya Panca Karma)” Prof Ajay kumar Sharma is Professor and Head of PG. Department of Kayacikitsa including Panca Karma at National Institute of Ayurveda, Jaipur. He completed graduation from A. & U. Tibbia College, New Delhi and M.D. (Ay.) & Ph. D. under the supervision of Prof. R.H. Singh, B.H.U., Varanasi. He has had an outstanding brilliant academic carrier. He is the topper of successful candidates in his graduation exams. He got many awards & prizes for his outstanding carrier during his student life.

Prof. Sharma is attached with Ayurvedic teachings and research activities for more than 22 years. He is a very successful, popular and senior most clinician and Panca Karma Specialist of NIA, Jaipur. Prof. Sharma has produced 25 M.D. (Ay.) Scholars so far and five Ph.D. Scholars are pursuing their doctorate level studies under his dynamic supervision. He has published more than 70 Research Articles in various Journals of National and International reputation. Prof. Sharma has attended several important National and International Conferences and Seminars and has presented many scientific papers. His other two books viz. “Ayurvedic Cardiology” and “Ayurvedic Gastro enterology” are under the process of publications.

Ayurvedic Medicine has attracted renewed interest of medical profession at large all over the world because of its holistic approach, safe medications and a range of unique therapeutic modalities. One of such modalities is Panca Karma Therapy for which there is no parallel in the occident.

Ayurveda is one of the most ancient medical and health wisdoms of the world, its antiquity going back to the sacred Vedas. It is a codified written tradition with unbroken practice of thousands of years in India and is flourishing even today as an official system of medicine with rich acceptability by the masses. Currently there are about 5 Lakhs of registered practitioners, 3000 hospitals with 60,000 hospital beds and 10,000 licensed Ayurvedic Pharmacies actively engaged in this sector besides thousands of Ayurvedic dispensaries in the rural areas. Nearly 200 Graduate Colleges and over 50 Postgraduate Institutions and dozens of regional research centres are engaged in Ayurvedic Education and Research in this country. The education and research in Ayurveda are being controlled by autonomous councils like CCIM and CCRAS established by Acts of Indian Parliament. This huge infrastructure, although not very well organised at the moment, presents the testimony of the fact that Ayurveda is a living system of Medicine. On the other hand there has been amazing resurgence of interest about Ayurveda throughout the world and gradually Ayurveda is becoming a global scientific discipline. The globalisation of Ayurveda, its medications and other treatment modalities, concepts and principles axe facing multidimensional challenges including the challenge of new Patent Regime and regulations of WTO.

On the other hand WHO and other like minded corners have been urging for due scientific evidence for safety and efficacy of the system and its medications which warrants more and more R and D activities particularly in the therapeutic sector. Panca Karma has not remained untouched.

Ayurveda makes an unique approach to cure. The Ayurvedic Cure is a two fold strategy comprising of (I) Sansodhana or Biopurification by Pancha Karma and related measures and (2) Sanamana or Palliation of imbalances by appropriately planned diet, drug and life style interventions. The Ayurvedic classics describe the full range of therapeutics through Sadupakramas consisting of Langhana — Brmhana, Rusana — Snehana, Swedana — Stambhana. This classic scheme incorporates both Sansodhana and Sansamana and the popular Panca Karma Therapy is an offshoot of the same.

Ayurveda conceives that the living body is made up of innumerable channels i.e. Srotamsi. Caraka, the foremost authority on Ayurveda proclaims the all pervasiveness of the channels and the significance of the need of their competence — “Srotomayam Hi Sariram”. It is obvious that due to wear and tear and exposure to morbid factors the body channels loose their competence and the channels get blocked. Such a macro or micro blockade of channels leads to interruption of flow of nutrients, energies and impulses and also the bioavailability of medicaments. Such a morbid state leads in turn to pre-disease state and makes the body prone to a wide range of diseases. One of the most commonly associated bio-factor which plays a crucial role in generic morbidity is hypo functioning of Agni with production of a range of byproducts of Mandagni categorically termed as Ama. Such Ama materials play a significant role in blockade of the channels. This is why the Acaryas proclaim — “Rogah Sarvepi Mandegna”. All such morbid situations warrant Sansodhana or Biopurification as the main stay of treatment, both preventive or curative.

The Srotas system as depicted in Ayurveda simulate and correspond to the membrane system of the body including the cell membranes, mucosa lining the hollow organs, viscera and body cavities as well as the endothelium and the like membranous structures lining the tubular structures of the body like blood vessels, capillaries, lymphatics, nephrons, seminiferous tubules etc. It is known that this membrane system and the entire membrane biology is responsible for the biotransport system of living body. And as such any lack of competence and blockade of the membrane system may lead to a range of morbid changes precipitating a disease. Thus the logical care for prevention of o diseases and cure lies in cleansing and biopurification of the Membrane System. The same is the theme of Sansodhana in Ayurveda.

The Ayurvedic Classics described a radical method of biopurification through five major procedures namely Vamana (Emesis), Virecana (Purgation), Basti (Enemata), Sirovirecana (Errhines) and Raktamoksana (Blood letting). These major radical purificatory procedures are performed after adequate Purva Karma or preparation of the patient by Dipana, Pacana, Snehana and Swedana Procedures which are designed to restore the Agni (Biofire) system of the body and to push the toxins and excretables from akha (cells, tissues and circulation) towards the Kostha i.e. hollow organs from where the excretables could be easily expelled out with the help of major Five Karmas. Sansodhana should not be done without due preparation because it may not succeed to purify the body Similarly after Sansodhana procedure it is an Important pre- requisite to subject the patient to a careful Pacata Karma i.e. post therapy regimen also known as Sansarjana Karma which comprises of a specialised dietary regimen. If such a regimen is not followed, the patient may land into digestive upset after Panca Karma.

Besides the above Classical Panca Karma Therapy described in authentic Classical texts of Ayurveda, one may come across a simplified traditional form of Panca Karma prev3lent in South India specially in Kerala. This so called Keraliya Panca Karma is essentially a therapeutically developed form of Purva Karma of Classical Panca Karma itself where Snehana, Swedana and massage are the main tools. Such a Panca Karma is more Sansamana than Sansodhana. However, because of non-invasive nature the Keraliya Panca Karma became popular and is flourishing well.

Thus Panca Karma Therapy is one of the most living disciplines of Ayurveda and is based on unique approach of biopurication and biorehabilitation. It is becoming more and more popular in present times. There is a need of setting standards and guidelines for good practices of Panca Karma so that it can be practiced all over the world through uniform standard methods in uniform indications. The Centre for Panca Karma therapy of the Faculty of Ayurveda at Banaras Hindu University, Varansai located in North India has done pioneering work in standardizing various already published a Monograph, a book and a series of research papers in Scientific journals communicating the professional experiences of this leading Centre.

The present book entitled “The Panca Karma Treatment of Ayurveda (Including Karaliya Panca Karma)” is another step in this direction which describes various aspects of Panca Karma in details. The author of this book Prof. Ajay Kumar Sharma is a senior faculty member and chief of the service at National Institute of Ayurveda, Jaipur. Prof. Sharma worked with me team at Banaras Hindu University nearly two decades ago and in all trueness he represents the BHU School at NIA, Jaipur. I appreciated his efforts in bringing out this useful text and wish all success for this publication.

Ayurveda is the science of life. It is not merely a system of medicines but it also imparts the knowledge to masses about the art of living a healthy life without suffering from various ailments. Specialised therapies of Ayurveda while curing such diseases strengthen the immunity system in the body and thus help in the prevention of diseases and preservation as well as promotion of positive health. Diseases as prevalent today manifest themselves in such a complex manner that it becomes difficult to treat them by merely administering palliative treatment or Samana therapy. Acarya Caraka has specifically mentioned that the diseases/Doshas controlled by Sanamana Therapy have the possibilities of reprovocation while there is no such probability in the eventuality of the control of diseases / Doshas treated by Sansodhana Therapy (Panca Karma Therapy), (Caraka Sutra 16/ 20). Pancakarma therapy primarily aims at cleansing the body of its accumulated impurities, toxins or stagnant Malas and nourishing the body tissues (Dhatus). Once this is achieved, it becomes very easy to rejuvenate all body Dhatus and prevent the process of premature ageing. Thus life span of an individual is prolonged and he leads a disease free old age. Highlighting the effects of Sansodhana Therapy, Acarya Caraka has mentioned that in a person, who has undergone the purificatory regimen, the digestive power increases, his disorders disappear and his health returns to normal, senses, mind, understanding and complexion become clear & the individual acquires strength, vigour and virility. His ageing is retarded and he lives a long disease free life. (Caraka Sutra 16/17-19).

This is unfortunate that such an important component of Ayurvedic Therapeutics is not in its full swing as on today. As a mailer of fact gradually there was decline of practice of Panca Karma Therapy due to various factors. Several myths are prevalent among masses about Panca Karma Therapy like, Panca Karma is an expensive and time consuming therapy with possibilities of complications. But this is not true. If a we trained and skilled person administers various procedures of Panca Karma Therapy, there are very remote chances of complications. If at all there are any, they can be easily managed. There is no need to undergo all the Panca Karmas (procedures) at stretch, specific Karmas (procedures) can be adopted for treating specific diseases.

The great advances that have been made in the ‘field of Panca Karma therapy in recent years, especially in Southern India have revolutionised the management of certain dreadful diseases with Panca Karma procedures. A simplified form of Panca Karma (in the form of Purva Karma of Classical Ayurvediya Panca Karma viz. Snehana and Swedana i.e. Bahira Parimarjana) continued in traditional form in South India, especially in Kerala which is flourishing even now. But the type of Panca Karma which is practised in Kerala is very different from classical Ayurvedika Panca Karma Therapy. Following five therapist are enlisted as Keraliya Panca Karmas, although they use many other practices also—

I. Dhara Karma
2. Pinda Sweda
3. Kaya Seka
4. Annalepa
5. Sirolepa
On the other hand Classical Ayurvediya Panca Karma comprises of following five components—

I. Vamana Karma (Emesis)
2. Virecana Karma (Purgation)
3. Anuvasana Vasti (Oil based Enemata)
4. Asthapana Vasti (Decoction based Enemata)
5. Nasya Karma (Errhines)

It appears that the overwhelming success of Keraliya Panca Karma has motivated Ayurvedic people for reviving back Classical Panca Karma Therapy on a strong footing. Classical Panca Karma is gaining more popularity at the global level. There is increased awareness throughout the world about the potential of Panca Karma therapy in treating disorders like Arthritis, Spondilitis, Allergic disorders, Skin diseases, Mental disorders and many Neurological disorders, it is expected- that Panca Karma Therapy should be revived back on scientific parameters. Attempts have been made by various agencies including Central Govt. of India to revive the practice of Panca Karma at Institutional level on scientific basis. But inspite of all these efforts, the progress in this direction is not satisfactory. Much has to be done speedily. Various Clinical Units have been established for practicing Panca Karma on scientific parameters but only sporadic research activities have been initiated. Whatever studies have been reported uptil now, majority of them lack scientific methodology, they show considerable variations in the procedures, precision, quality and standards.

Although Panca Karma Therapy of Ayurveda has enormous therapeutic potential, but it is still looking towards various agencies for it’s over all development in the form of standardizing all the classical Panca Karma procedures. The standard procedures to be adopted for different Panca Karma procedure, the medicaments to be used with the standard dosage, specific indications and contraindication and other relevant factors are to be standarized so that an uniform schedule of practice may be developed to be practised at call centres for obtaining uniform results. Data based and evidence based studies are needed to elevate the status of classical Ayurvedic Panca Karma Therapy through out the world. This is most challenging task for all of us. We are also conducting therapeutic trials on Panca Karma procedures at Nationa Institute of Ayurveda. Jaipur for treating various diseases. Our studies conducted so far on Purva Karmas and Pradhana Karmas of Panca Karma Therapy have been reproduced in the present book.

A few years back, I happened to visit Kerala for attending a National workshop on Panca Karam Therapy. I visited many Pancha Karma centres there. I was pleasantly surprised to witness the popularity of this specialised therapy of Ayurveda there. I got the inspirations from Kerala to develop and upgrade the Panca Karma Unit of P.C Deptt. of Kayachikitsa, National Institute of Ayurveda, Jaipur. Luckily I got the chance to work in the capacity of Professor and Head of the P.G...Deptt. of Kayachikitsa including Panca Karma, N.I.A. Jaipur. I took the initiative and I was ably supported by my departmental colleagues, M.D. (Ay.) & Ph. D. scholars and the staff of Panca Karma Unit. I received every possible cooperation and encouragement from our worthy Director Prof. B.L. Gaur As a result, as on today we have a well reputed and well established Panca Karma Centre of National repute at National Institute of Ayurveda, Jaipur.

My post graduate students have been inspiring me to bring out a book on Panca Karma Therapy in English, covering all literary review along with latest developments in the concerned subject. I am happy to present this book on Panca Karma Treatment of Ayurveda to the prospective readers. It is hoped that this book will interest the Students, Scholars, Researchers and Practitioners interested in classical and traditional practices of Ayurveda with scientific temper. In this book I endeavour to present the first hand knowledge about the Panca Karma Therapy. The purpose of this endeavour is to introduce this important therapy to students, scholars, researchers, foreigners and to make it accessible to the English knowing world. The classical facts about the Panca Karma Therapy available in various Ayurvedic Treaties have been compiled, rearranged and reoriented to make it more practicable. The book reviews the ancient classical concepts, traditional practices and recent advances made in this important field.

The book contains twelve Chapters. First two chapters deal with general introduction to Ayurveda, Kayachikitsa and Panca Karma Therapy. Third and fourth chapters are devoted to Purva Kamas and their discussion i.e. Snehana and Swedana Karma respectively. Chapter No. five to nine present the discussion of Pradhana Karmas i.e. Vamana, Virecana, Vasti, Nasya and Rakta Moksana in separate chapters on each Karma. Tenth chapter deals with classical concepts of Keraliya Panca Karma. Details of some important instruments used in Panca Karma Therapy have been given in chapter eleven. Chapter no. twelve contains a comprehensive list of disease wise indications and contraindication5 of Panca Karma Therapy. The Book also contains a Glossary of terms. Important terms used in this book have been explained and their meanings are given in very simple words to make it more convenient for readers to understand the subject matter clearly. A Bibliography of references is included in the end, in order to facilitate the work of scholars who are interested in Panca Karma Therapy.

A number of photographs and illustrations are given at appropriate places through out the book to make it more beneficial (hr the readers. Opinions and suggestions to improve the book are welcome.