Pancakarma, as the name specifies, includes five types of actions or processes which eliminate vitiated dosas and malas from the body. Pancakarma is an important part of Ayurvedic treatment because several times disease aggravation recurs, in spite of using different types of medicines. The methods of purification and detoxification for the prevention as well as eradication of disease, by the elimination of aggravated dosas and malas from the body, is Pancakarma treatment. The processes before the initiation of Pancakarma treatment are pre-monitoring procedures, carried out with the help of palliation and purification therapies, which especially includes oleation and fomentation. These five basic processes are as follows:
- Vamana (Emetic therapy)
- Virecana (Purgative therapy)
- Nasya (Inhalation therapy or Errhine)
- Anuvasana basti (A type of enema)
- Niruha basti (Another type of enema)
Acharya Susruta and other scholars described rakta moksana (blood-letting therapy) in place of nasya (errhine) as a part of pancakarma. Before administering all such treatments, it is necessary to find out whether the patient is capable, physically and mentally, to bear such treatments. Otherwise it may get harm instead of them benefitting a patient. The preparations before pancakarma treatment, after examining the mental condition of the patient, are ‘pre-monitoring procedures,’ and some precautions and compatible diet must be followed along with and after the treatment which are ‘post-treatment measures.’ Special types of medicines and procedures are selected according to the patient and diseases. These pancakarma procedures are described here in brief.
- For elimination of Kapha – Emesis is the best.
- For elimination of Pitta – Purgation is the best.
- For elimination of Vata – Enema or basti (both anuvasana and asthapana basti) is the best.
- For tenderness in the body – Fomentation is the best.
1) Vamana: Emetic therapy
The treatment where emetic drugs are used to induce vomiting for detoxification of the abdomen is emetic therapy or therapeutic vomiting. This treatment can be followed throughout the year except in severe winter and extreme summer. Emetic medicines are used to expel toxic substances or wastes from the body.
Emesis is beneficial for all those suffering from Kapha and Pitta disorders. Therapeutic vomiting is also useful when there is congestion in the lungs causing cough, bronchial asthma, fever due to Kapha, tonsillitis, cold, inflammation of the nose, sinus and suppuration in the nose, palate and lips, and otorrhea (suppuration from the ears). It is also indicated in nausea, loss of appetite, indigestion, sprue syndrome, diarrhea, fat accumulation or diseases due to obesity, anemia, poisoning, intrinsic hemorrhage from lower channels of the body, dermatitis and other skin diseases (itching, erysipelas, etc.), boils, glandular swelling, edema, urinary disorders, excessive sleeping, drowsiness, hydrocele, epilepsy and insanity.
Therapeutic vomiting is useful for those who are suffering from the above-mentioned diseases, who have strong vision, who have no problem while vomiting and have patience.
Therapeutic vomiting is contraindicated in childhood, old age, debility, emaciation, hunger, heart patients, those having cavities in the lungs, bleeding from the upper body channels, during menstruation, during pregnancy, while in grief, in obesity or in any sort of disorders, intoxicated people, those having fear of vomiting, those who face difficulty in vomiting, those with eye diseases (cataract, blindness, pain in the eyes and so on), and those with a dry body constitution, jaundice, worm infestation and Vata disorders.
Even in contra-indications if a person suffers from Kapha aggravation, indigestion or poisoning, emetic therapy can be administered in a mild form using a decoction of liquorice root. But in childhood, debility and in fragile and fearful persons this therapy is not feasible.
- Pre-emesis measures
Before emesis, measures should be taken to aggravate Kapha in the patient’s body. For this 1-3 days prior to emesis, a person is provided with medicated oils to drink 2-3 times a day until the feces become oily and he feels nauseated. A day before initiation of the treatment, oleation (oil massage) followed by fomentation on the chest and back are administered to liquefy Kapha. To vitiate Kapha, a Kapha facilitating diet such as thin gruel, Basmati rice, milk, buttermilk, and yogurt should be eaten with adequate salt in it. Emesis should be conducted in the morning (the time when Kapha is active).
- Emetic substances
Rock salt and honey are importantly used. Besides emetic nut, licorice root, margosa, bitter sponge gourd, bitter bottle gourd, long pepper, bitter oleander, and cardamom are the main emetic substances. In Kapha provocation pungent, penetrating and hot potency substances; and in Pitta provocation sweet and cool potency substances are used as emetics. In case of Vata and Kapha aggravation sweet, salty, sour and hot potency substances are useful. All these medicines are used as decoctions, boiled and reduced to half the amount (in the ratio 170g in 3 liters of water).
During emesis a person should sit at ease on his legs with folded knees or on a chair of knee-height and drink the decoction in high, moderate or low doses of 7, 4.5 or 1.5 liter(s) respectively. After the intake, the person will feel nauseated. At this time the person should use his middle and index finger or use a tender and smooth castor twig to rub the tongue up to the throat to induce vomiting, continuing the process until it causes elimination of Pitta and Kapha followed by medicine taken, and finally Pitta is expelled in vomiting. If a person feels detoxified with lightness in the heart, throat, head and in the whole body, then emesis is successfully performed. The degree of success is determined by the number of vomits. Eight, six and four vomits are maximum, moderate or minimum respectively.
- Post-emesis measures
When hungry, give vegetable soup, boiled rice and green gram to eat. For at least one day avoid cold drinks and cool substances, physical exercise, coitus, anger, ghee or oil massage. Be careful of getting indigestion.
- Result of the therapy
The symptoms observed after every treatment help to analyze the degree of success, whether it is successfully perfomed, less than required or more than required. The aim of the treatment is to pacify the disease. If the disease gets pacified, the body feels light, fresh and energetic, and the dosas get expelled from the body. If all the medicine taken is vomited and this results in the carmination of Vata, it can be considered that the procedure has been satisfactorily performed.
- Minimal effect
If more vitiation of dosas is seen as compared to before and there is heaviness in the body, lethargy, oiliness, smoothness, nausea and itching then the dosas have not been eliminated properly. The effect of the therapy is then below normal.
On the contrary, excessive dryness in the body, syncope, pain, excessive weakness, anorexia, stiffness, excessive thirst and excessive elimination of dosas indicates the over-effect of the procedure.