Introduction to the science of healing and rejuvenation!!

Panchakarma therapy consists of five cleansing aspects:

• Emesis (VAMANA)
• Purgation (VIRECHANA),
• Medicated enemas (BASTI)
• Medicated nasal oils (NASYA)
• Toxic bloodletting (RAKTAMOKSHAN)

Vamana - Vamana Chikitsa, or Emesis Therapy, involves controlled, medically-induced vomiting. It is

aimed to eliminate excess Kapha Dosha in the body which can otherwise trigger a series of ailments
like acne, asthma, arthritis, chronic cold and diabetes.
It is mentioned in Ayurvedic texts that a person after Samyak Vamana (proper Vamana)
experiences lightness of the body, Hrit (precordium), Kantha (throat/voice), and Shirah (head) and
weakness.

VIRECHANA -Also known as the purgation process, the Virechana treatment focuses on the torso
region of our body. Virechana helps our body eliminate toxic doshas with laxative oils and drugs.
Virechana is used to treat diseases arising out of pitta doshas, like diabetes, chronic skin disease,
migraine, and colitis.

Benefits of Virechana therapy:

• Balances pitta dosha.

• Flushes out of toxins and excess mucus from the small intestine, this helping in improving
digestion.
• Clears congestion from the liver thus improves metabolism.
• Enables fat digestion, thus helping in weight loss.
• Relieves many gastrointestinal disorders

BASTI -Basti is one of the five procedures of panchakarma in Ayurveda. Classically, it is advocated in
the diseases of vata. It is mainly of two types viz. asthapana and anuvasana.
Kati Basti is a lower back pain treatment in Ayurveda. It is a soothing and gentle solution for when the
pain in your lower back is too tender to benefit from massage.

NASYA -When we administrated ghee through the nostrils, it may prevent inhalation of those unwanted
particle which enters through nasal passage with polluted air. Nasya also increases our immune power
and prevent other diseases also like hair fall, premature graying of hairs, chronic headache, coryza,
eye diseases.
Nasya is one of the most effective form of treatment to clear the ear, nose, throat, and head regions
from toxins.

RAKTAMOKSHAN- Raktamokshana is an effective blood purification therapy, in which carefully

controlled removal of small quantities of blood is conducted to neutralise accumulated Pitta toxins of
many blood-borne diseases.
Raktamokshana is effective in conditions like allergies, tonsillitis, sciatica, gout, acne, migraine,
eczema, psoriasis, Lyme disease, filariasis, glaucoma, liver & spleen disorders, osteoarthritis,
rheumatoid arthritis, frozen shoulder, rheumatic disease, diabetic wounds, non-healing ulcers, varicose
veins, ...

Virechana: Therapeutic Purging –

Virechana means therapeutic purgation. It is a part of Panchakarma cleansing therapies.
Virechana targets expulsion of morbid pitta or pitta predominant doshas from the body. But it is said
that the purgation therapy should be given until the kapha is eliminated in the feces. The Sanskrit word
Virechana denotes induced purgation to eliminate toxins from the body. It is a premium 7-day detox and
rejuvenation treatment program.
Virechana is one of the Panchakarma therapies wherein purgation is induced by drugs and it specifically
aims at the elimination of excessive Pitta Dosha from the body. Normally, after Virechanakarma, patient
does not complain of having any untoward like those present after diarrhea due to dehydration.
Virechana Chikitsa, or Purgation therapy, is the elimination of toxins from the body using herbal
laxatives. The resulting bowel movement rids the system of harmful Pitta-related impurities. Organs in
the lower torso - small intestine, kidney, colon, liver, and spleen - are cleansed during this therapy.
After successful Virechana, the patient feels clean, light and strong and the mind clears. Abdominal
bloating and heaviness dissipate.
For a healthy life, every person should undergo Virechana Panchakarma in each summer season and
in the month of October to detoxify the body and prevent of diseases arising from Pitta Dosha.
The first step in producing healthy sperm and eggs is to ensure metabolism is working well. This is
achieved through a deep internal cleansing to balance the doshas and remove toxins (ama), ensuring
optimal metabolism. Virechana is the best treatment.

Basti - Therapeutic Purification And Rejuvenation of the colon -

Basti therapy is the most powerful of the five procedures of Panchakarma (see Panchakarma). Basti is
the introduction of medical liquids into the colon through the rectum. Since colon is linked with all of the
other organs and tissues basti has a wide-ranging influence in the body, effecting all the doshas and
dhatus (tissues).
Basti differs completely from enemas or colonics. Enemas treat symptoms of constipation by promoting
evacuation. They clear the last eight or ten inches of the colon. Colonics clean accumulated fecal matter
from the entire colon through repeated flushing with water sometimes experimenting with adding other
substances to the water.
In Panchakarma basti used with preparatory procedures of Snehana (inner and outer oleation) and
Swedana (warm bath or steam box) cleans far more than just the colon. It helps purify toxins from all
over the body, which further is nourished through a healthy colon.
Basti is most effective for Vata disorders such as chronic constipation, low back pain, and sciatica,
rheumatism, gout, arthritis, neuromuscular disorders, Alzheimer’s disease, Parkinson’s disease,
multiple sclerosis, dystrophy and atrophy of the nerves and muscles, and osteoporosis. It benefits
epilepsy, mental retardation, and sensory dysfunction.
As in all Panchakarma procedures, proper preparation is crucial for successful Basti treatment. First
Snehana (Oleation) and Swedana (warm bath or sweat box) must loosen ama (toxins) and open the
channels so it can be moved out.
Basti fulfills many needs, so there are a number of basti types according to the intended purpose of the
treatment. Panchakarma employs two of them Nirooha (cleansing) basti and Anuwasan (nourishing)
basti.
Nirooha (Niruha) Basti cleanses toxins from the tissues and colon and is capable of cleansing the entire
body. Approximately 400 ml (1-3/4 cups) of decoctions of purifying herbs are given, and the liquid is
retained in the colon for about forty eight minutes. Some of the ingredients get absorbed during this
time and their purifying influence moves throughout the body. The rest gets expelled along with fecal
matter and toxins.
Anuwasan (Anuvasana) Basti nourishes the body through the application of herbalized oils. Typically 3
ounces of herbalized sesame oil are given and retained for longer period of time, ideally for three – six
hours. However patients are instructed never to strain to hold any basti, but to go with their natural
response. In rare cases when vata is high, the colon can become extremely dry, and much of the basti
water is absorbed to compensate for that dryness. In that case patient receives an oil basti to lubricate
the colon before any further cleansing bastis are given.
The Ayurvedic physician always closely monitors the basti treatments and makes specific adjustments.
It is essential to end treatment with nourishing basti to leave the colon lubricated and nourished. When
properly administrated, basti treatment does not interfere with normal intestinal flora.
Basti as part of Panchakarma is a special, powerful procedure requiring guidance from a properly
trained medical staff. It is performed individually for each person with his or her constitution and medical
condition in mind and requires close observation at every stage. I wouldn’t go to someone with a modest
amount of Ayurvedic training for this procedure. Talk to the doctors and patients and check reviews and
recommendations.

Raktamokshana –

Raktamokshana, or bloodletting, it is an important part of the clinical therapeutic use of Panchakarma

in the management of several important disease conditions.

Raktamokshana is an effective blood purification therapy, in which carefully controlled removal of small
quantities of impure blood is conducted to neutralise accumulated toxins.

when excess toxicity of rakta and pitta has occurred so much so that it cannot be cured by herbs or
any other procedure, raktamokshan comes to rescue.
Although Raktamokshana is the most limited of the five major procedures, it provides a rapid and
sometimes dramatic reduction of symptoms in certain acute disorders where there is no time for the
various phases of Panchakarma like Purvakarma (Preparation for Panchakarma), etc. Raktamokshana
can be helpful.

Diseases occurring due to vitiation of blood and pitta shall be dealt with bloodletting.
Raktamokshana is effective in conditions like allergies, tonsillitis, sciatica, gout, acne, migraine,
eczema, psoriasis, Lyme disease, filariasis, glaucoma, liver & spleen disorders, osteoarthritis,
rheumatoid arthritis, frozen shoulder, rheumatic disease, diabetic wounds, non-healing ulcers, varicose
veins, elephantiasis, abscesses, tumours, erysipelas, sexually transmitted diseases, breast
diseases, hypertension, thrombosis (blood clot), and alopecia, psychological
problems, vishamjwar (fever), epilepsy etc.

Indications of bloodletting therapy –

Bloodletting therapy (raktamoksha) is mainly indicated in diseases due to blood (rakta)

and pitta dosha. This includes skin diseases, abscess, diseases pertaining to earlobes etc.
Contraindications of bloodletting therapy- Raktamoksha is contraindicated in following conditions:

• Too emaciated patients

• Generalized edema, anemia
• Pregnant women
• In too cold and too hot climate
• Immediately after other panchakarma therapies

Bloodletting is divided into two types

1. With surgical instruments (sashastra)

2. Without surgical instruments (ashastra)
Bloodletting with surgical instruments is of two types

• Puncturing (pracchana)
• Venesection (siravyadha)
Bloodletting without surgical instruments is of four types

• Application of leeches (jalaukavacharana)

• Application of horn (shringaavacharana)
• Application of gourd (alabuavacharana)
• Application of pot like instrument (ghatiavacharana)
Nowadays, indigenous methods like using animal horns (shringaavacharana), gourd
(alabuavacharana) and pot (ghati) are rarely used in practice. These might have been prevalent during
ancient times. In current times, the most common methods for bloodletting are puncturing, leech
therapy and venesection. These three methods are described in details.
Puncturing (pracchana)
Pracchana is indicated in patients with good strength and if blood is accumulated locally or in clotted
state.
Procedure
The body part is cleaned and a tourniquet is tied above the site. A sharp instrument like scalp blade is
used to puncture skin over the affected site till appearance of small amount of blood. The puncturing is
done from lower end in upper direction. Once punctured site should not be punctured again. Puncturing
in oblique manner should not be done and it should be neither too deep nor too shallow.
Venesection (siravyadha)
Siravyadha is indicated in the following conditions-

• If there is generalized vitiation of blood.

• In patients with good physical and mental strength.
• If the vitiated blood is spreading from one place to another.
• If blood is vitiated by all the three dosha
• In emergency conditions like poisoning .
Contraindication of siravyadha:

• If the patient is weak, old person, children, pregnant lady, coward, debilitated due to
diseases or due to excessive physical strain like excessive walking, sex etc.
• Immediately after purificatory procedures like therapeutic emesis, purgation, enema etc.
• In too cold and hot climatic conditions.
• In the diseases in which bloodletting is contraindicated as mentioned above.
The procedure of siravyadha is described in three steps:

• Pre-therapeutic procedure (purvakarma)

• Therapeutic procedure (pradhanakarma)
• Post therapeutic procedure (pashchatkarma)
Pre-therapeutic procedure (purvakarma):
On the day of therapy, the person should undergo proper oleation and fomentation. Thick gruel is
advised before the therapy.
Procedure of venesection with respect to site:
Venesection is done in a comfortable position either sitting or lying down. The torniquet is tied above
the site of venesection. The site of puncture is cleaned, and superficial visible vein is punctured to let
the blood out. The method of venesection in various sites like head, legs, arms, pelvis, back, shoulder,
abdomen, chest, flanks, penis (erected), tongue, palate and root of teeth is described.
Clinical features of optimal bloodletting

• The blood flows out in a stream and it ceases by itself (without any treatment)
• Feeling of lightness
• Reduction in features of disease
• Feeling of wellbeing [Su.Sa.Sutra Sthana.14/32-33][3]
• If it is properly punctured, the blood flow may occur maximum for a period of 48 minutes (1
muhurta). [Su.Sa.Sharira Sthana 8/12][3]
Clinical features of inadequate flow during bloodletting
If the blood flow is inadequate, it will lead to the formation of swelling, burning sensation, redness,
ulceration and pain. [Su.Sa.Sutra Sthana 24/29][3]

Clinical features of excess flow during bloodletting

Excess blood loss in bloodletting leads to headache, blindness, giddiness, depletion of tissues,
seizures, burning sensation, hemiplegia, hiccups, dyspnea, cough, anemia and death. Complications
During leech therapy: Itching at the site of bite and non healing of bite wound are the common
complications in leech therapy. Allergic reactions may also happen during leech therapy.
During venesection and puncturing: Fainting is the most common complication during these
procedures. There may be secondary infections at the site of puncture.
Safety precautions
General precautions prior to procedure:

• Examination of blood for contagious diseases like HIV

• Blood examination for Hb%, TC, DC
General precautions during procedure:

• Use personal protection measures like hand gloves by the physician

• Avoid the procedure if the patient is hungry and during extreme climatic conditions.
General precautions after procedure:

• Proper care of the wound with aseptic media.

• Proper disposal of procedure wastes like blood, blood stained swabs, needle, scalpel etc.
Precautions for leech therapy:

• Proper selection of leeches is very important.

• Healthy, non poisonous leech must be used for therapy.
• The leech should be preserved at ideal conditions. The container should be clean and
water should be changed periodically.
• Once used leech should never be used before the stipulated time.
• Leech used for a patient with contagious disease should never be used again.
Precautions for venesection:

• Eyes of the patient can be closed.

• Try to perform the procedure in sitting or lying posture
• If the procedure is to be performed in standing posture, manual assistance must be given
to the patient.

Importance in preservation of health and prevention

In healthy person, bloodletting is indicated in autumn season.[Sha.Sa.Uttarakhanda.12/2] [4] During
this period, there is natural vitiation of pitta dosha and its abode rakta dhatu (blood tissue).
Bloodletting therapy removes impurities due to vitiated pitta and rakta and thus prevents diseases.
Bloodletting at regular intervals prevents occurrence and recurrence of diseases due to blood ( rakta)
such as skin disorders, tumors, edema.
Importance in management of disease
Bloodletting is the principal treatment in diseases due to vitiation of blood. In treatment of visarpa,
raktamoksha is the most effective treatment. Different modes of bloodletting are prescribed in the
treatment of gouty arthritis (vatarakta) with other medical treatments.Venesection (siravyadha) is
considered as half of the entire treatment in the field of Ayurvedic surgical procedures . The diseases
that are not responding to oleation etc. treatment modalities,are immediately relieved through
venesection.
Mode of action
The removal of vitiated blood (rakta) in bloodletting therapy, results in removal of vitiated pitta and thus
purifies the body. The blood loss due to the bloodletting results in the formation of fresh and pure blood.
Thus, the amount of vitiated doshas gets reduced.
Contemporary views
Nowadays the methods of bloodletting as a treatment procedure includes the following
 • Therapeutic Phlebotomy: Puncturing the veins or arteries to treat certain ailments.
• Cupping therapy (wet): Drawing the blood with the help of specialized cup like structures
especially to reduce pain.
• Medicinal leech therapy: Application of leeches to remove blood from particular sites.

Current researches
Removal of blood in a controlled manner is effective in treating many diseases. Bloodletting influences
the body physiology at multiple levels. Bloodletting results in leucocytosis and decreases the activity of
heart and other body functions for a short duration. After that, the blood is formed by hyperleucocytosis;
acceleration of tissue changes takes place and the nervous system also gets stimulated. Increased
levels of ferritin and body iron affect insulin resistance and may result in metabolic syndrome. This can
be prevented by reducing its levels in the blood through bloodletting and thus can improve health.
Therapeutic phlebotomy
A study conducted on 64 hypertensive patients reported that the therapeutic phlebotomy results in
reduction of body iron store, reduction in blood pressure and improvement in markers of cardiovascular
risks and glycemic control. Phlebotomy leads to the reduction of viscosity of blood which results in the
reduction of risk for thrombotic events like cardiovascular disease, cerebrovascular disease, arterial or
venous thromboembolism etc. Since phlebotomy reduces the excess iron load in the body and reduces
the blood viscosity, it is also proved to be effective in treating conditions like hemochromatosis,
Porphyria cutanea tarda, Sickle cell disease and hyper-ferritinemia.

Leech therapy
Medical leech therapy is widely used in the field of reconstructive and plastic surgery. Leech saliva
contains more than twenty bioactive substances including several analgesics and anti-inflammatory
substances. Leech bite may have an antinociceptive action. Leech therapy may result in muscle
relaxation as a result of decongestion due to blood and lymph loss and improvement of micro circulation.
Placebo effect also may play a role in the overall effect of leech therapy.Bdellins and Eglins present in
leech saliva have anti-inflammatory actions. Broad spectrum anti-bacterial action against both Gram
positive(S.aureus) and Gram-negative (Sal. Typhi and E. coli) bacterial strains is found in leech salivary
secretions. Hirudin, calin and destabilase present in the leech saliva increase the micro circulation by
reducing the viscosity of blood. Histamine and carboxypeptidase A inhibitor present in the leech saliva
act as vasodilators and thus increase the blood flow at the site of bite. Leech saliva promotes the local
immunity also. n a study, it is reported that pain, stiffness, swelling and tenderness associated with
osteoarthritis significantly reduced by the leech therapy. In a study conducted on 14 patients, leech
therapy is found effective in reducing the symptoms of eczema like itching, burning sensation, redness
etc. n a patient with nevus pigmentation, 5 session of leech therapy reported to reduce the
pigmentation. Pitta is the responsible dosha for skin color. Leech therapy is the best treatment in case
of vitiated pitta dosha. Leech application is also reported to reduce the tenderness, pain and edema in
thrombosed piles, in a study conducted on 12 patients. The antimicrobial and mucolytic properties of
leech help to subside the pus and mucous discharge in thrombosed piles. Moreover, leech application
has thrombolytic action. Leech therapy in a patient having nasal furunculosis is reported to be effective
in reducing the throbbing pain, erythema and inflammation.
Cupping therapy
Through the cupping therapy, sub-atmospheric pressure suction is applied over a particular area which
promotes peripheral blood circulation. It may also improve immunity. Altering the microenvironment
through skin stimulation could transform into biological signals and may activate the neuroendocrine
immune system. Some of the reported effects of cupping therapy are increasing pain threshold,
improving local anaerobic metabolism, reducing inflammation, modulation of cellular immune system,
promotion of skin’s blood flow and changing of biomechanical properties of skin. The physiological and
mechanical signals produced as a result of mechanical stress on skin and local anaerobic metabolism
during cupping therapy may activate or inhibit gene expression. During wet cupping, the superficial
scarifications also may activate the wound healing mechanism and gene expression.
Obesity - Obesity is a complex disease involving an excessive amount of body fat. Obesity isn't just a
cosmetic concern. It's a medical problem that increases the risk of other diseases and health problems,
such as heart disease, diabetes, high blood pressure and certain cancers. Obesity is generally caused
by eating too much and moving too little. If you consume high amounts of energy, particularly fat and
sugars, but don't burn off the energy through exercise and physical activity, much of the surplus energy
will be stored by the body as fat. Overview. Overweight and obesity are defined as abnormal or
excessive fat accumulation that presents a risk to health. Day-to-day problems related to obesity
include:

• breathlessness.
• increased sweating.
• snoring.
• difficulty doing physical activity.
• often feeling very tired.
• joint and back pain.
• low confidence and self-esteem.
• feeling isolated.
Class 1 (low-risk) obesity, if BMI is 30.0 to 34.9. Class 2 (moderate-risk) obesity, if BMI is 35.0 to
39.9. Class 3 (high-risk) obesity, if BMI is equal to or greater than 40.0. Choosing healthier foods (whole
grains, fruits and vegetables, healthy fats and protein sources) and beverages. Limiting unhealthy foods
(refined grains and sweets, potatoes, red meat, processed meat) and beverages (sugary drinks)
Increasing physical activity. Limiting television time, screen time, and other “sit time”
Health Effects of Overweight and Obesity –

• All-causes of death (mortality).

• High blood pressure (hypertension).
• High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (dyslipidemia).
• Type 2 diabetes.
• Coronary heart disease.
• Stroke.
• Gallbladder disease.

Arthritis-

Arthritis is the swelling and tenderness of one or more joints. The main symptoms of arthritis are joint
pain and stiffness, which typically worsen with age. The most common types of arthritis are osteoarthritis
and rheumatoid arthritis.
Most forms of arthritis are thought to be caused by a fault in the immune system that causes the body
to attack its own tissues in the joints. This may be inherited genetically. Other forms of arthritis can be
caused by problems with the immune system or by a metabolic condition, such as gout.
Inflammation of one or more joints, causing pain and stiffness that can worsen with age.
Different types of arthritis exist, each with different causes including wear and tear, infections and
underlying diseases.
Symptoms include pain, swelling, reduced range of motion and stiffness.
Medication, physiotherapy or sometimes surgery helps reduce symptoms and improve quality of life.
In general, the first sign of arthritis is pain, also called arthralgia. This can feel like a dull ache or a
burning sensation. Often, pain starts after you've used the joint a lot, for example, if you've been
gardening or if you just walked up a flight of stairs. Some people feel soreness first thing in the morning.
There is no cure for arthritis. The treatment goal is to limit pain and inflammation and preserve joint
function. Treatment options include medicines, weight reduction, exercise, and surgery.
A person cannot die from rheumatoid arthritis (RA). However, RA can increase the risk of developing
complications, such as heart disease. Some of these can be life threatening. RA is a chronic medical
condition that involves increased levels of inflammation in tissues throughout the body.
Parkinson’s Disease –
Parkinson's disease is a brain disorder that causes unintended or uncontrollable movements, such as
shaking, stiffness, and difficulty with balance and coordination. Symptoms usually begin gradually and
worsen over time. As the disease progresses, people may have difficulty walking and talking.
Parkinson's disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra.
Nerve cells in this part of the brain are responsible for producing a chemical called dopamine.

Parkinson's signs and symptoms may include:

• Tremor. A tremor, or rhythmic shaking, usually begins in a limb, often your hand or fingers. ...
• Slowed movement (bradykinesia). ...
• Rigid muscles. ...
• Impaired posture and balance. ...
• Loss of automatic movements. ...
• Speech changes. ...
• Writing changes.

Tremors, muscle stiffness and slowness of movement are all common early symptoms of Parkinson's
– but there are also other signs to be aware of. Sleep and night-time problems are common in
Parkinson's. People with Parkinson's are more likely to experience insomnia due to certain symptoms
which can disrupt sleep.
Parkinson's disease does not directly cause people to die, but the condition can place great strain on
the body, and can make some people more vulnerable to serious and life-threatening infections. But
with advances in treatment, most people with Parkinson's disease now have a normal or near-normal
life expectancy. There's currently no cure for Parkinson's disease, but treatments are available to help
relieve the symptoms and maintain your quality of life. These treatments include: supportive therapies,
such as physiotherapy. medication.
Parkinson's patients suffer from the same pain other people have, often amplified by the motor
dysfunction, but they also have additional pain problems unique to PD. Lower back pain and back of he
neck pain are most common. Strengthening exercises or stretching may be helpful.
One clear risk is age: Although most people with Parkinson's first develop the disease after age 60,
about 5% to 10% experience onset before the age of 50. Early-onset forms of Parkinson's are often,
but not always, inherited, and some forms have been linked to specific alterations in genes.

Insomnia and Depression –

Primary insomnia is common in subjects with depression, and it usually follows depressive illness. On
the other hand, secondary insomnia often precedes the onset of depressive illness.
Sleep problems may be one of the first symptoms of major depressive disorder -- a serious, but treatable
mental health problem, more commonly known as depression. Not only a symptom of depression, some
sleep problems, like insomnia, may also help cause depression.
If you've been diagnosed with depression, you may be having trouble getting to sleep or staying asleep.
There's a reason for that. There is a definite link between lack of sleep and depression. In fact, one of
the common signs of depression is insomnia or an inability to fall and stay asleep.
This short-term therapy is the first-line treatment for insomnia and is also often used to treat depression.
CBT is led by a mental health professional who helps you learn how to identify and change thoughts
and behaviors linked to insomnia or depression. While insomnia can be a symptom of psychiatric
disorders, like anxiety and depression, it is now recognized that sleep problems can also contribute to
the onset and worsening of different mental health problems, including depression, anxiety, and even
suicidal ideation.
Chronic pain-
Persistent pain that lasts weeks to years.
The pain may be be caused by inflammation or dysfunctional nerves.
The primary symptom is persistent pain that lasts weeks to years.
Treatments include medication, acupuncture, electrical stimulation, cognitive behavioural therapy and
surgery.
Chronic pain-is long standing pain that persists beyond the usual recovery period or occurs along with
a chronic health condition, such as arthritis. Chronic pain may be "on" and "off" or continuous. It may
affect people to the point that they can't work, eat properly, take part in physical activity, or enjoy life.

Bronchial Asthma-
A condition in which a person's airways become inflamed, narrow and swell and produce extra mucus,
which makes it difficult to breathe.
Asthma can be minor or it can interfere with daily activities. In some cases, it may lead to a life-
threatening attack.
Asthma may cause difficulty breathing, chest pain, cough and wheezing. The symptoms may
sometimes flare up.
Asthma can usually be managed with rescue inhalers to treat symptoms (salbutamol) and controller
inhalers that prevent symptoms (steroids). Severe cases may require longer-acting inhalers that keep
the airways open (formoterol, salmeterol, tiotropium), as well as inhalant steroids.
Long-term control medications such as inhaled corticosteroids are the most important medications used
to keep asthma under control. These preventive medications treat the airway inflammation that leads
to asthma symptoms. Used on a daily basis, these medications can reduce or eliminate asthma flare-
ups.

Irritable Bowel Syndrome-

Irritable bowel syndrome is a group of symptoms that occur together, including repeated pain in your
abdomen and changes in your bowel movements, which may be diarrhea, constipation, or both. With
IBS, you have these symptoms without any visible signs of damage or disease in your digestive tract.
An intestinal disorder causing pain in the stomach, wind, diarrhoea and constipation.
The cause of irritable bowel syndrome isn't well understood. A diagnosis is often made based on
symptoms.
Symptoms include abdominal pain, bloating, diarrhoea and constipation.
Some people can control their symptoms by managing diet, lifestyle and stress. Others will need
medication and counselling.