Panchakarma ( Purification PENTAD) in Ayurveda - Practised in Sri LankaIntroduction Concepts of Ayurveda, in every aspect resemble that of indigenous or the traditional methods of treatment in Sri Lanka. The main difference of these two systems depends on the practical approach in introducing the treatment methods with timely and traditionally proved drugs used in the medication by Sri Lankan Physicians. This is automatically proved, understood and convinced when any interested party does go through the written texts of the ancient scholars in Sri Lanka. “Sarartha Sangrahava” was written by the king named “Sri Buddhadasa” who was a reputed physician too. “Singhala Yoga Rathnakaraya” is another proof to add more weight to above statement and there are some more examples available. Main concept of the body formation is the suitably fitted conjunction of three humours Va, Pit, Sem. In other words Vata, Pitta, Kapha are responsible for forming the (animal) human body. These three are arranging in the body in certain way at the time of birth. Maintenance of the body must be performed in a way that these three humours of the person are not affected. Attention to maintain the body depends on various aspects with due care and observation on food, climate, behaviour and environment. If any disturbance or mal practices influenced upon these factors there is a possibility of derangement of existing situation of above doshas Vata, Pitta, Kapha ( Va, Pit, Sem). There are three types of mental characters Satva, Rajas, Thamas. These factors also should be considered in the maintenance of the health in addition to Va, Pit, Sem. Due to many reasons Doshas can be congested and later vitiated. Sometimes sudden vitiation of doshas also may take place. But if the congestion of doshas can be eliminated from the body at the same stage itself there is a possibility to achieve good health not leading to ill health. At this stage Panchakarma will do marvelous help. Ayurveda defines that “Sanchayepahrita Dosha Na Theshan Punarudbhavan”.
If Doshas are removed at the stage of “Samchaya” congestion stage there is no existing of disease condition.

To overcome this situation, the indigenous treatment methodology of Sri Lanka recommends five methods of cleaning the body, by eliminating unwanted congestive Doshas. These five methods are known as Panchakarma ( Purification Pentad).
In a real disease condition there can be “Ama” stage; acute serious situations, ill health phenomena in the body where no evacuation therapy can be performed. Specially in Ama stages, introducing removal techniques for unwanted congestion of Vata, Pita, Katha will cause wrong effects on the body leading to some serious illness.

But in certain disease conditions whose there is no Ama (Row stage) if the person is fit enough to undergo such treatment and congestion of doshas are well noted by an eminent well experienced physician, then the purification therapy can be introduced.

Though there are five methods available, in the text of career it’s not essential or compulsory need to do the five kinds of evacuations. Individual to individual the necessity of purification may change. Some persons may be treated with one particular method or two or three or all. It varies from person to person, considering the state of the congestive condition of doshas.

Panchakarma Varieties

Ancestral sages specially recommended Vasti varieties (Enema per rectum) for Vata type disease condition, Vireka( Purgation varieties) for pitta type and Vamana (Introducing vomiting) for kapha (sema) type conditions. Though it’s easy to explain these therapy methods in a nutshell, the efficient and experienced traditional doctor may decide the fitness or suitability how these methods of treatment to be administered.

• for Vata dosha – Vasti treatment
• for pitta dosha – Vireka treatment
• for Kapha dosha – Vamana treatment

are mainly recommended by the ancestral sages, with due consideration on doshas (Humours). Later on blood letting treatment Raktamokshana (Le Ereema) has been made essential to remove unwanted toxic blood from the body. Nasne (purification) through the Nasal tract too came as an essential and well efficacious method of cleaning(phlegm) mucus in naso- pharyngeal- laryngeal tract.

  • Usage of Panchakarma

    1. Layavireka (Vomiting, Vamana)
    2. Mainly for the “Sema” collection of the chest. Nasna (Nasal douche, Nasya)
    3. Mainly for the “Sema” collection in the Nasal tract sinuses. Badavireka (Purgation, Vireka)
    4. Mainly for the pitta condition in the bowels and the body. Vasti (Guda vasti)
    5. Enema per rectum, mainly for the lower abdomen area and Vata type diseases Le Ereema( Raktha Mokshana)
    6. Blood letting – mainly for the chronic blood toxins and toxic conditions under the skin. These purification pentad are classified according to various necessities and applicability. Varieties of sub divisions of these may be inserted here for your further understanding

  • Importance of Panchakarma

    Panchakarma (Five Evacuation Therapy) is used to
    1. Protect disease conditions
    2. Prevent disease conditions
    3. Cure disease conditions
    Generally for the prevention and promotion of disease conditions, undergoing these treatments at least once a year is highly recommended, Vireka, Vasti, Nasya are mostly preferred.

    Laya Vireka (Vamanaya, Therapeutic Vomiting)
    This treatment is mainly introduced in case of phlegm congestion in the chest causing repeating attacks of bronchitis, Bronchial asthma, long standing eczema or skin diseases such as psoriasis to remove the toxic conditions of the breast milk, during lactation period, Lymphatic oedematous stages, chronic indigestion and oedema. In case of diabetes, bronchitis, chronic cold are also amongst the suitable disease conditions where this chest cleaning method can be applied.

    Bada Vireka ( Vireka , Colon Cleaning, Purgation)
    Amongst five evacuation therapeutics this is the method which is used in most cases. This method is mainly applied in cases of gulma ( chronic abdominal colic ), piles (hemorrhoids), skin blisters, psoriasis, constipation, skin inflammation, eczema, Acne ( pimples in the face) , biliary vomiting, discolouration of the skin of the body or specially in the face, nausea, jaundice, spleen enlargement, liver enlargement, chronic attacks of fever, ascites, chronic blepharitis, chronic sore eyes, burning eyes, swelling and water collection of the feet and hands, obesity, weight increase, low colon and high colon diseases, flatulence, disease of vaginal, urethral seminal sites, rectal disorders and etc.

    Guda Vasti (Basti, Enema)
    This therapy is applied in the vitiated Vata conditions such as constipation, back pains, leg pains, sciatica, joint pains, chronic fever, distension of the abdomen, sexual disorders, gout, Rheumatism, kidney stones, heart pain, chest pain, chronic headaches, migraine, sub fertility and etc….

    Nasne ( Nasya, Nasal douche, Nasal cleaning)
    It is well true that life sustaining air travels through this organ. Certain diseases attached to this tract can be overcome by using nasya therapy. This method of nasal cleaning is well benefited in cases of sinusitis, adenoids, cervical lymph adenitis , tonsil enlargement , eye conditions, epilepsy, sore eyes, headaches, site worms, drowsiness, even nausea, hoarseness of the voice, stiffness of the neck and neck muscles, cervical spondylosis, Parkinson’s diseases, face swelling, discolouration, dizziness, heaviness of the head, loss of memory, Nasal polypus and recurrent inflammation of the nasal tract, paralysis, paresis and facial paralysis (Bell’s palsy) and etc…

    Le ereema ( Rakta mokshana, Blood Letting)
    Removing blood from skin and veins is performed specially in the cases of blood born diseases, blood toxins, gout, herpes, eczema, psoriasis, chronic itching, urticaria ( allergic skin), leuco-derma circulatory conditions, skin oedematous conditions, chronic inflammatory wounds and abscesses, sinuses, acne and etc.

  • Contra Indications

    Generally evacuation treatment is not recommended for babies, infants, old personalities, pregnant, weak persons and during convalescence. Colon cleaning purgation is not suitable for those who are suffering from diarrhoea but enema therapy may be fruitful in case of chronic sprue like diarrhoea. In the case of bleeding is occurring either due to systemic or particular relevant tract disorders no exerting treatment like cleaning should be applied. Then the method called “Samana” pacifying (Calminative) treatment may be introduced. This is other method of treatment where cleaning is not suitable.

  • How cleaning methods act upon

    When cleaning is introduced it helps in many angles to get rid of the imbalance congestive conditions of the persons.

    It removes unwanted particles from the body.
    It gives strength to the site where it is applied specially by manipulation, stimulating the vital points in the area and by the efficacy of the drug used.
    It stimulates the vital points of the body reflectively and thereby produces harmony of the imbalance of body tissues or doshas.
    It cures the particular disease and eases the patient.
    It brings mental and body relax to the person who underwent cleaning treatment.
    Remove stress and improve energy.

  • How to process therapeutic approaches

    First select suitability to undergo such line of treatments. Decide one particular treatment or two or three or all giving attention to the imbalance situation. Plan the line of treatment and consider the time factor. Time factor involves on,
    a). Preparatory Treatment
    This consist of internal and external oleation plus sudation (body sweating : These are explained in Ayurveda as Poorvakarma under the topic of Snigdha and Sweda. ( 3-7 days)).
    b). Post Panchakarma ( Samsarjana, yoga, meditation treatment)
    Mainly on regime of food system (Samsarjana) to be followed and rest. (1-7 days) Internal & External Oleation
    Mainly ghee (Butter milk oil) or sesame oil or even bone marrow oil is used according to body treatment of the patient, ghee is mostly used. Oil is given to drink in escalating doses between 3 to 7 days. Limitation of consumption is diagnosed when the symptoms of mild loss of hunger, mild nausea, and mild loose motion with oily character are present. Then internal oleation is stopped. Meanwhile external oleation and body sweating treatment is started to perform. At least body sweating treatment is being continued for 3 days or one day as applicable.
    Thereafter one of the main Panchakarma is to be introduced. Sudation area of the body differs according to particularity of the pentad. If nasal cleaning is to be performed, there is no necessity of administering sweat (body heating) therapy for whole body. It is applied only for above shoulder level, which is quiet sufficient for the need.
    (c). Main objective treatment either purgation (colon cleaning), enema (Vasti) or other. (See Below)
    ( Laya Vireka) Arrangement for main administration is to be undergone on following criteria, after proper ( Poorvakarma) preparation treatment.

    It must be a good bearable climate day.

    Time should be a good auspicious period of the day. Auspicious time factor is well attended by Sri Lankan physicians. Astrologically it must be a very good time which brings good result on faith. Good times are already mentioned in yearly published Almanac in Sri Lanka.

    Place (room) is to be well ventilated.( Pravatha Gruha)

    Must have sufficient number of qualified or well trained helping guides.(therapeutics, nurses, attendants)

    Doctor should well verse in advance that all required drugs available for the main treatment and first aid facilities with medicine if necessary arises, in addition to above mentioned requirements.

    Must examine the person again just above the main treatment is going to be introduced. Should give preference to Pulse ( Nadi), heart, blood pressure, blood sugar, digestion ( bowels opening), hunger feeling and patient’s mentality.

    If emesis ( Vomiting Therapy) is to be done he must be well pre prepared with “Kapa Uthkleda” food such as fish, yoghurt, gingerly seeds, jaggery, curd etc… given on previous night.

    Same day early in the morning he is given only rice soup water or milk to drink and no solid food.

    He is asked to sit looking at planetary good side of the time of the day. His mental energy is encouraged with good blessings either religious wise or by general pacifying talks.

    Patient is made dressed well as directed in the guidelines.

    Then medicine is given to drink and must support without creating embarrassment to him.

    Within short period of time (5- 15 minutes), when he develops urge to vomit, it is the duty of therapist or the physicians to support him.

    Note : Please note approach of technique to individual Panchakarma is differed from one another.

  • Nasya ( Nasal douche)

    This has various varieties of sub divisions. Treatment pattern therefore differs according to the topic. The necessary variety ( sub division) is decided by eminent physician. Faith, confidence and experience are the salient factors involved in the decision when suitable sub variety is to be selected.

  • La Ereema ( Rakta Mokshana, Blood Letting)

    This will be done by using a few devices, but animal variety called leeches is mainly used. Stainless or silver or gold devices such as needles, blades are used practically nowadays. This is for alleviating blood toxic affected situation of the body and has very good result. Venesection and removing blood is also comes under this topic as it is done for a therapeutic approach. There are number of varieties of leeches, but such animals living in the pure water and clean and well marked according to traditional medicinal criteria are used to remove blood. Genuine leeches must be collected and made them available keeping in a saffron diluted water at least four to twenty four hours. Site of the patient where blood letting to be applied, must be well cleaned without oil with mild hot water. Just prior to keeping leeches on the skin, of course cleaning with soap is not recommended, because leaches may not sting the place to suck blood. Then keep leaches 1 to 6 in the area where bad blood to be removed. After the blood sucking by them they will fall down spontaneously.
    Note : After this, must squeeze the leeches to make them vomit out blood, sucked by them. Otherwise this insect may trend to die. Same insects may be used for the same person after one or two days of this, making them starving again as usual, but not to be used them for any other persons.
    In this text, process or procedures are being discussed to have an idea on each and every variety of Panchakarma. However it’s left to the hand of experience physicians to arrive at decisions whom should be selected for the therapy, what type of doshas prevailing on him and what kind of therapies to be applied, what are the medicines to be used according to body constitutes and stamina of the patient etc…

  • Preliminary arrangement for Panchakarma

    As early in this article mentioned it’s necessary to explain about “Thel Galveema ( Snigbha , Oleation) either internally or externally for general understanding of the readers. Instant oleation is mainly done in Sri Lanka prior to the main therapy in the art of practice. Where as internal Oleation itself is done within 1 to 7 days according to Ayurveda External oleation also performed as external application ( Abhyanga) , Lepa (paste application) Udvarthana ( mainly powder application) Mardana ( muscle stimulation by kneading) Parisheka – shower oil to the body and etc…

  • Sudation ( Daha Galveema)

    Soon after oleaton or along with it, sudation is also taken place in an instant treatment. Otherwise, sudation is performed along with oleation or after the oleation. Sudation is also performed as a separate pattern of treatment where Panchakarma is not concerned. This is someway and many ways can be attributed to sauna system.
    This sudation may be done in a strong manner, medium manner or gentle manner, according to individuals body treatments and necessities.
    It may be done using only heat. using heaty drugs : using vapours : using water either showering or immersing in it.
    Sudation is not usually performed specially in a strong manner for those who are more adopted to alcohol or suffering from severe diabetes, poisoning, hunger, anger, sorrow, haemorrhage, emaciation, pregnancy and etc…

  • Enema (Vasti)

    Oily Vasti( Anuvasana) which is retaining in the body at least 24 hours and contains only a few millimeters of medicinal oil.

  • Concoction Vasti (Nirooha, Asthapana)

    Which is to be retained in the rectal bowels about at least for 45 minutes has divided into various sub categories and those are applicable according to disease conditions of the victims. Vasti is introduced for 30,15 or 8 days ( sometimes 3 or 4 days).
    Even some kind of vasti is instilled into the vagina and named as Uttara Vasti (Yoni Vasti).
    Little dose of oily enema named as Matraa Vasti can be introduced daily specially for very sensitive personalities.
    Note : Shiro Dhara and Shiro Abhyanga or Shiro Vasti is not come under this Vasti treatment though the word Vasti is used for Shiro Vasti. Those are separate therapeutic methods to ease the person from stress, headaches, migraine, paralysis etc..
    Sometimes this is also performed as a requirement in Poorvakarma (Preparatory Treatment) in Panchakarma)
    Nasya ( Nasal cleaning) is also divided into sub categories and used for individual stages and state of the disease or healthy conditions.
    Some are nutritious, some are really expel the unwanted phlegm (mucus) of the nasal tract. For sedation and stimulations of the organs, also some particular Nasyas are done. Medicines used for nasya differ from strong to smoothness.
    Nasya is also done in very minute dose or little high dose. Course of this treatment takes place at least 3 times within 7 days.
    Note : The above explanations are catered here for general understanding for readers. Any kind of treatment should be provided by an experienced and qualified Ayurveda doctor. Panchakarma therapy, therefore perform as a health promoting energy balancing treatment of the body, and as a line of curative treatment for certain diseases. Course period for preventive (energy increasing) treatment consist of 2 weeks’ course to 3 months’ course. Only one or two items of panchakarma alongwith Shirodhara, face anointing (massage), body anointing (massage) and foot massage may be performed according to the shorter period of the customer’s wishes. Pressing vital points (acupressure) either as separate entity or within the Abhyanga (massage) techniques spontaneously resulted. However decisions on every aspect of the treatment depends on advise of a senior Ayurvedic consultant, and he may decide and advice on this after consultation.