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Panchakarma is a synonym for samsodhana. Panchakarma actually is a group of treatments, five in number, all of which are not commonly practised in all diseases. The panchakarma are vamana, virechana, snehavasti, kashayavasti and nasya. Vamana is emesis, virechana is purging, vasti is enema, which of two kinds done with medicated oils and medicated decoctions and are called snehavasti and kashayavasti respectively. Nasya is instillation of medicines through nose. Susrutha, the father of surgery, gives stress to rakthamoksha (blood-letting) as one of the panchakarma, taking the two kinds of vasti as a single karma.

There are certain steps to be followed before doing panchakarma called poorvakarmas. They are snehana (oleation) and swedana (sudation). Snehana has to be done by two ways, application of snehadravyas internally and externally. Swedana is classified into four types to promote sweat. The purpose of poorvakarma is to liquefy and guide the provoked doshas to the mainstream to facilitate the sodhana karma.

Vamana (Emesis):- The first in panchasodhana karma, this process requires good attention and skilled assistance. It induces expulsion of the stomach contents through the mouth. Kapha or kapha dominant diseases are selected for this procedure. Diseases like severe skin diseases (psoriasis, urticaria) bronchial asthma, mental disorders and so on. This process is not suggested for pregnant women, the aged, those suffering from cardiac problems and those who are not very strong. On the previous day, the patient, who has undergone sneha sweda is given kapha increasing foods. The next morning, after ablutions and a hot water bath, the patient should be asked to sit in a relaxed manner in an armchair. Milk is commonly used for this purpose. For those with milk intolerance, sugarcane juice can be used. The patient has to drink as much as milk as he can. Then a paste of madana phala (10 gms) along with yashtimadhu powder (5 gms), vacha (5 gms), rock salt (5 gms) and honey (5 ml) mixed with milk should be given. Within a short time, the patient will feel nauseous and starts vomiting. All impure accumulated kapha will come out. Normally eight bouts are seen. The attenders should hold the patient's forehead and massage his back and wipe away the sweat. Vomiting is stopped when the pitta or yellow colouration is seen, which is considered the correct symptom. If the bouts are less, vomiting should be by irritating the uvula by touching with the figers or a quill. Then allow the patient to wash his face and fingers with hot water. Then dhoomapana - inhalation of medicated fumes - is done. The smoke should be inhaled through one nostil and exhaled through the mouth and the other nostril. This should be done thrice.

After this, certain steps have to be necessarily followed called paschat-karma. These are mainly food restrictions, called samsarjana kriya. Just after vamana, if the patient is hungry, thin gruel is given. After ascertaining the digestive power, thick gruel, porridge, porridge with meat soup are given. The entire treatment takes 15 days.

Virechana (Purgation):- Pitta and pitta dominant diseases are cured by this process. By this the vitiated doshas are made to pass through the anus. Poorvakarma as noted in vamana are advocated here. Though several drugs are mentioned for virechana, trivrit is considered the best. Trivrit combinations, like avipathy churna, trivrileha are used. To give the medicine it should be ascertained whether the last meal has been digested. Medicine should be given after the kaphakala (about 9 a.m.) - 15 to 25 gms of Avipathy churna mixed with hot water. No food is given till virechana is over. In proper virechana, the patient passes urine, stool, pitta, medicine, kapha and vata in order. About 20 purges may be seen. This also depends on the patient's health.

A mild form of virechana is an unavoidable factor in ayurvedic therapy. It is commonly used to treat various kinds of ailments in which poorvakarma is not necessary. So virechana is also used for prevention. The paschat karma followed is similar to that of vamana except that dhoomapana is not administered.

Vasti (Enema):- This is a process of injecting fluid through the anal, urinary or vaginal canal. Vasti or the urinary bladder of animals is used and hence this term. Today, a bag of polyethene or leather is used. Vasti is for combating vata and vata dominant diseases. As vasti is important among the panchakarma, many consider vasti as half the entire range of treatment and some as the complete range. The equipment for vasti karma consists of a nozzle and a bag.

Snehavasti is Vasti with unctuous oils. This is not advised in patients suffering from diabetes, anaemia, diarrohea, obesity, filaria. After poorvakarma, the patient is advised to take a hot water bath and permitted to eat a light meal not more than three quarters of usual quantity, a suitable drink may follow. He should lie down in a cot on his left side (left lateral position) (i.e.: the left is stretched and right one is folded). The suitable oil is poured in the vasti bag which is connected with the nozzle. The nozzle end and anus are soothened with oil and enema is applied. Gentle pressure should be applied on the bag so that the fluid passes without interruption. The patient should now lie on his back. Certain methods are adopted to retain the oil inside the body such as raising the leg. The effectiveness of the vasti is indicated if the oil stays inside for the intended period and comes out with all faeces and air. The quantity of oils is one quarter of kashaya vasti (10 ozs) mixed thoroughly with powdered rock salt, satahva (5 gm each), and warmed suitably before giving.

Kashaya vasti:- Diseases like hemiplegia, IVDP, and disease due to vata are treated as well. Acute diarrhoea, chest lesions, piles, hiccups, are contraindicated. For kashaya vasti, honey, rock salt, sneham, paste of medicines are required and is mixed one by one in the above order. Total quantity is nearly 40 ozs. An emulsion is made by churning all and warming in a water bath. This should be taken on an empty stomach at about 10 a.m. Application is the same as snehavasti. When the bowels are clear the patient is allowed to take a hot water bath. This should be done after two or three snehavastis. Sneham, paste of medicines, kashayam noted above are selected as per disease and stage.

Nasya:- Instillation through the nose is called nasya. It is the best and important procedure for the treatment of sirorogas i.e, sodhana of urdhvanga. Our body is compared to a tree, its root is the head and extremities are the branches. Head is also called uttamanga, as it is the seat of manas and panchendriyas, which gives a unique status of superiority. After suitably warmed oil is applied to the shoulder and neck of the patient, the patient should lie supine and tip his head back. Lightly warmed oil is dropped into each nostril. The patient should inhale deeply. The usual dose is 8 drops but this varies according to the disease and its nature. The timings are morning in kapha diseases, noon in pitta diseases and evening in vata diseases. After the nasya, the shoulder, face, palm and sole of limbs should be massaged briskly for few minutes. The percolated kapha will be spat. Dhoomapana and gargling with hotwater should be done afterwards. Nasya should not be done continuously for more than seven days.

Panchakarma should not be administered to those below seven years and those above 80 years. If it is done properly, healing of the disease treated, along with clear intelligence, alertness of the senses, stability of the body, efficacy of digestion and absorption, prolongation of youth are all achieved.