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Text book of Panchakarma -2nd edition

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 2d Edition

Text Book of

Panchakarma Prof. Vasant C. Patil

20+Modeof
actioncharts

60 procedure and Glinical Examination

video link
 Chapter

Introduction To Pañcakarma

Paneakanma presents a unique approach of Ayurveda with specially designed five

proredures of internal purilication of the body through the nearest possible route. Such
purification allows the biological system to return homeostasis & to rejuvenate ran.
to
idly &also facilitates the desired pharmaco-therapeutic effects of
medicines adminis.
tered thereafter. Pañcakarma has a full therapy role as
promotive, preventive & curative
procedure. Pañcakarma is the specialty branch of Kayacikitsä, deals with five maior
therapies, as well as preparatory procedures and post-operative procedures.
Revival of interest in Ayurveda has
provided drift to medical tourism in the coun-
try. There has been a phenomenal increase in the demand for
specialized therapies of
Ayurveda, particularly Pañcakarma, not only for treatment of diseases but also for pre-
ventive & promotive health care. As a result,
many health centers and tourist resorts
providing Pañcakarma therapy have come up in the country.
Pañcakarma is not merely a Sodhana therapy as it is understood, but also has wider
range of therapeutics such as Brimhana, Lekhana, Stambhana, Rasyana, Vrishya etc.
Pañcakarma not only eliminate
the disease-causing toxins but also revitalizes the tis-
sues. This is why it is
popularly known as rejuvenation therapy. Pañcakarma is not only
good for alleviating the disease but is also a useful modality of treatment in preserving
and promoting the perfect health. Ayurveda advises
undergoing specific
Pañcakarma
according to season to purify the body, relax the mind, improves the digestion and
metabolism. In today's world more and more people are
falling victim to the adverse
effects of stress and anxiety, which is leading to diseases like
of
improper digestion, lack
sleep. allergies, heart diseases, diabetes, chronic fatigue,
osteoporosis
cancer, etc.
These diseases caused mainly due to deeply seated metabolic toxins. Pañcakarma elimi-
nates these metabolic toxins from the body, allowing permanent healing of tissues and
channels.
Besides the application in the treatment of disease, they are also used as
preparäd
tory measures before surgery and before administration of Rasyana (Rejuvenation
therapy) and Vaj+karana therapy and in Kshetrikarana treatment (before internal admi
istration of mercurial & metallic
preparations).
The order of treatment is : Pcana,
Snehana & Svedana, which can be termed
Purvakarma; Pradhäna Karma includes Vamana, Virecana, Niruha &
Anuvsana bus
Nasya; Pa[cät Karma includes Samsarjana Krama, Rasyandi Karma Samana ry
&
(Cikits Kalik 69-70).
 2 Text Book of Pañcakarma Vijnana

Definition

The science which deals mainly with five purificatory therapies for elimination of
Doshas and also Snehana, Svedana, Brimhana, Rukshana, Lekhana, Stambhana etc.
therapies for the benefit of healthy and patients to maintain the health and radical cure
of diseases is known as Pañcakarma. Panca' means five and 'Karma' means action or
therapy. So Pafñcakarma means five actions or therapies.

Cakra on Ca.Sk.2/15
The Lakshana of Karma is Bahu-Ati Kartavyatyogi (capacity of multiple and broad
spectrum action) & having the capacity of eliminating the Dosha.
References Of The Word Pañcakarma In Classics:
A)Caraka Samhitã- Ca.Sk.2/15, 34, 35, Casa.28/27, Ca.Sa.29/7, Ca.Sü.30/65.
Ca.Ci.30/160, Ca.Si.1/60, Ca.Si.2/3.
B) Su[ruta Samhitä- Su.Sk.33/9, Su.Ci.13/19
C)Astänga Hridaya- A.H.Sk.27/8, A.H.Sa.7/108
D) Mdhava Nidna- Kushtha nidna 3rd Zloka
E) Bhävaprak[a -
Pkrva Khanda -5/1
References regarding the sequence of Pañcakarma:

Ca.Sü.7/47
After the oleation and fomentation
therapies, emesis, purgation, Basti and Nasya
Karma should be administered regularly by the
intelligent physician.
Discussion regarding number of therapies:
In some texts including the Snehana and Svedana seven
but it is not correct, as Sneha and Sveda lack of
therapies have been told
capcity to eliminate the Doshas and
actually they does pacification Doshas. Sneha and Sveda are popular because they
of
are used
along with Panchakarma not like Vamana etc. which does the elimination of
Doshas. Even though the Anuvasana Basti lack of
capcity to eliminate the Doshas in
large quantity like Vamana etc. but it evacuates the stool present in colon and hence
 Snehana (Oleation) 67

Benefits of Pravicharana in palatability and perception

taste
1. Pravicharana can change the physical nature of sneha by addition of differen
ent
substances.
2. It may change chemical property to some extent by samskara (transformation
3. It can stimulate or inhibit cholecystokinin- pancreozymine secretions.
4. Also, sneha can be made more palatable and pleasant to mind by considerino
taste. (http://www.carakasamhitaonline.com)
Difference between Accha & Vic rana Sneha
Feature Accha Sneha VicraFa Sneha
Kevala or Odandi Misrita
Form | Kevala Sneha
Route Internal External
Jathargni Sambhanda Essential Not essential
Dose Uttama Alpa
Koshtha Sthiti Niranna Sänna
Effect Quick & more Short & less
Parihra (Restrictions) Obligatory |Not needed
Vypad Chances are more Rare
Purpose Mainly for Dosha Mainly for Dhtu.Brmhana &|
Utklesha & Dosha Samana |Dosha Utklesha
Duration Sodhana Accha Sneha-Till BrmhaFa Snehana- till
Samyaka Snehana Samana |Samyak Brmhana Sadyo-
Accha Sneha- till roga
snehana-till Doshoutkle-
Samana shana
Merits Best Least
Types 2-Sodhana & Samana |24 types
64 types-Rasa Bhedhnusra
MaharshiAtreya's Rule for Accha & Vicrana Sneha
Accha Sneha= Kevala Sneha+ Jathargni Sambhanda
Vicärana Sneha= Anna Mishrit Sneha+ Jathargni Sambhanda or Kevala Sneha +
Na Jathargni Sambhanda

Sneha Paka (Processing of Sneha)

 Text Book of Pañcakarma
84 Vijnana

ARshitarpana
Oeular drug alpsorption

Comeal route
Vaidya Vasant Patil Conjuctival and Scleral route
(through tear-film) (Capiliary &lymphatic flow)

enters Anterlor chamber

nourlshes lens, iris, aqueous

humour, lens capsule, cillar
body
nourishes through choroidal circulation and
Tarpaka- trans-scleral pathway
kapha
enters posterior chamber

DOrishes Vir ous nou

chorold tssue retna

bycorrectng cor0a nourlshet racti muscles nourisn na and optic

Curvatur yand igam

Cursretna dorders.l
helps in correction of correct ptosistabouus diabetic ratin
Retractive error compute vlalon aydrome rtensve
y tugmu chron

KarnapkraFa
Fillig of ear by lukewarm Sneha for a stipulated period of time is called Karmapkrana.

Procedure
Purvakarma: examination of ear for ruling out tympanic membrane perforation.
rateint is advised to lie on the massage table on supine position. Abhyanga should be
One over the ear and surrounding area and neck followed by Mridu Svedana (Nãdi
Sveda).
 Snehana (Oleation) 91

Sirobasti
The word "Basti" is used here to indicate, "to retain or to hold", thus in Sirobasti
the oil is made to retain on the scalp for a prescribed time.
u7-f9TTaFATETI (Arunadatta on A.H.Su.16/14-15)

Nourishing therapy of head is called as Sirobasti.

Procedure

Pürva Karma
The Pürva Karma includes- Sambhra Sangraha and Siddhat.
Materials required
Rexin/leather (75 cm X 20 cm) 1
Black gram flour 200 gm
Taila 1.5 litres
Cotton ribbon (120 cm X 10 cm) 2 strips
Spoon
Vessel (2 litre)
Large vessel 1
Rsndi CkrFa 6 gm
Oil for Abhyanga 100 ml
Soft towel 2
Hot waterbath 1
Armed chair of knee-height
Therapist 2
Atura Siddhat- It includes the procedure of Sodhana by Vamana and Virecana
Karma. Sirobasti is often done without adopting the above said preliminary measures. It
is certain that the treatment will be effective if the patient has been subjected to the
purification.
 92 Text Book of Paficakarma Vijnana
Pradh na karma
Pradhana Karma includes,
Bastiyantra DhraFa
Taila Dhrana
Observation of Samyak Yoga Lakshana
-
Removal of Taila and Basti Yantra
The patient is made to sit erect on a chair; one strip of cloth, smeared with
Mshakalka is pasted around the head, above the ear. Then leather sheet of about 12
angulas, applied with Msha Kalka at the bottom of the inner surface of it is tied around
the head, so that the lower part of the leather sheet is attached to the strip of the cloth.
The two ends of the leather sheet are attached together by using Msha Kalka. Another
strip of cloth pasted with Msha Kalka is wrapped on the leather sheet. Now the Basti
Yantra is ready.
Then the suitable medicated oil warmed by keeping in hot water is poured on the
inner surface of leather cap slowly and carefully. Also one can pour the oil on the coco-
nut leaf. This helps to prevent sudden falling of warm oil on the head. The quantity of
oil should be 2 angulas above the scalp i.e., 1 ínch above the scalp. Care must be taken
to keep the temperature of oil constant.

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Video on "Shirobasti"
 Snehana (Oleation) 99

Kshira Dh r with human breast milk

This type of Dhär is especially indicated in typhoid fever in place of ice generally
used by allopathic practitioners for reducing the temperature.
Human breast milk (about to 2 Prastha) is mixed with a little powdered camphor
prior to application, care should be taken that the milk is used as soon as it is obtained so
that there will be no chance of fermentation. It should also be quite cold. Unlike other
Dhar, the patient in this case should not be anointed with any medicated oil either on
the head or on the body. After performing the Dhr for 1 or 2 hours according to the
particular case, the head of the patient is well wiped with a clean dry piece of cloth.
Then a little Rsndi powder is to be rubbed on the head to prevent penetration of
wetness to the head. Then the patient is advised to take rest. This treatment is good for
delirium in typhoid fevers as well.

Mode of action of Sirodhr

SHIRODHARA

Drip

Fore
Head

Vibrations
ImpulseS
Carried to the
HYPOTHALAMUS

Vaidya Vasant Patil

NEUROLoGICAL ENDOCRINAL PSYCHOLOGICAL

EFFECTS EFFECTS5 EFFECTS

Sympathetic Catacholamines Stross

Activity Serotonin Anxiety

Melatonin Relaxation

JBlood Pressure
helps In cure of insomnla, Strene, DAD
Pyohologland Paychosomato disordlers
 100 Text Book of Pañcakarma Vijnana
Abhyantara Snehana
Snehya (Fit for Oleation Therapy)

TEZEPaierTATYTHTAT: TE4TATGHNT FET: aturataa:

aTaTdtafafrraraurufaafta:1APT.
(A.H.Sk.16/5-6)
Sr.No. Snehya Ca. i. K.
As Pürva Karmal
1. Svedya [fit for sudation]
2 Samsodhya [fit for purification]
According to age
3. Vriddha [elder] +

4 Bäla [child]
In different Vih ras
5. Vyayma nity
6. Stri sakta [desire of coitus]
7. Cintaka [who think more]
8. Madya asakta [desire of alcohol] +
In different diseases
9 Väta Vyãdhi
10. Kshina Rakta
11. Kshina Retasa
12. Abhishyandi [conjunctivitis]
13. Timira refractive disorders]
14. Daruna Pratibodana [difficulty in awakening]
According to constitution1.
15. Ruksha [dry]
16. Krisa [thin]
17. Abala[weak]
Asnehya (Unfit For Oleation Therapy) (Ca.Sk.13/56)

Afrtarunfrqagdm:u
36AAfAaTTSSATTTTTTTT:I qUTEWEgtafayaurquHAa tifsat:u
 Svedana (Sudation) 185
Griva Basti

Retaining the oil for 8000 Mätr on the nape (back of neck) is called Griv Basti.
Procedure: Same as Kai Basti
Indications: Cervical Spondylosis, neckstiffness, Avabhuka, Disc Disease

Note: Now a days steel rings or fiber rings are available in small, medium and
big
sizes, which can be used with great ease. It is less time consuming and black gram
dough requirement is less.
Prushta basti
Retaining the oil on the thoracic spine area with making 2-4 segments depending
upon the case.

Scan this QR code to see the

Video on Prushtabasti"

Urobasti

Procedure: Retaining the luke warm oil (38° C) over the chest region for a period
of 6000 Mätr is called Urobasti. The area covered depends on the pathological condi-
tions of chest.
Indications: Angina, chest pain of musculoskeletal origin, chostochondritis, and
post rib fracture union.
 186 Text Book of Pañcakarma Vijnana

Scan this QR code to see the

Video on «"Urobasti'

Hrid Basti

Retaining the luke warm oil (38° C) over the cardiac region for a period of 6000
Matr is called Hrid Basti.
Procedure: Same as Kati Basti but the temperature should be just lukewarm.
Precautions: The oil should be just luke warm.
Duration: 30 minutes
Oil used: Mahnryana Taila, Ksh+rabal Taila, Dhanvantaram Taila
Indications: Chest Pain, Costochondritis
Janu Basti

Retaining the hot oil over the knee joint region for a period of 10000 Mtr is
called Jänu Basti.
Procedure: Procedure is same as Kai Basti.

Scan this QR code to see the Video on

Janu Basti"

Indications: Sandhigata Vta, Sandhi Skla, ligamental injury etc.

Yoga Ksh+rabal Taila+Nirgundi Taila
Mahmsha Taila+Murivenn Taila
 242 Text Book of Pañcakarma Vijnana
a. Pitta Pradhâna Vydhi
b. Vãta Pradhna Vydhi
c. Kapha Pradhna Vydhi
d. Rakta Dushi Pradhna
Vydhi
e. Salya-Sälkya Sadhya Vydhi
f. Annavaha Srotas Vydhi
g. Manasa Roga
h. Marga Bheda
i. Anyaroga
Virecana Yogya (Indications) Ca. Su. A.S. A.H.

Pitta Pradh na Vydhi

Jvara (fever)
Pändu (anaemia)
Kämal (Jaundice)
Halimaka (chlorosis) +

Netradaha (burning in eye)

Mukhadaha (burning in mouth
Paitika Vydhi
Vata Pradhna Vydhi
Pakv[aya Ruj (pain in large intestine)
Sirahsüla (headache)
Par[va[üla (pain in lateral sides of thorax)
Gulma (abdominal swelling)
Vätarakta (peripheral vascular diseases & Gout)
Kapha Pradh na Vydhi
Prameha (diabetes)
Netrasrava (discharge from eye)
|Asyasrva (salivation)
Näsãsrva (nasal discharge)
 340 Text Book of Pañcakarma
Vijnana
Mustãdi Yäpana Basti (R jayäpana Basti)
As the name suggests Rjayäpana Basti is superior amongst all the Basti. It is the
king of Ypan and is the best Rasyana (A.S.Ka.5).

Dravya Dose
Madhu
, Prastha
Saindhava
| , Karsa
Ghrita TPrasrita each
Kalka Dravya-Sathv, Madhuka, Kutaja Phala, 1 Karsa each
Rasanjana, Priyangu
Kvtha Dravya- Must, US+ra, Bal, Rsn, Aragvadha, 5 Prasruta
Gudüci, Manjishh, Kauki, TryamäFa, Punarnav,
Vibhitaki, Sthirdi Pancamkla (1 Pala each),
Madanaphala- 8Jala-1 Adhaka reduced to 'h+
Kshïra-2 Prastha; reduced to Ksh+rva[esha
Avapa- Mmsarasa h C, Prastha)
Guna and Indications-The application of Rjaypana Basti cures Kshataksh+na,
Kasa, Gulma, Skla, Vishamajvara, Bradhna, Vardhma, Udvarta, Kukshi[kla,
Mktrakricchra, Raktapradara, Visarpa, Pravhik, Siroruj, Jnugraha, Janghgraha,
Bastigraha, ASmari, Unmda, Ar[a, Prameha, Adhmna, Vätarakta, and Pitta[leshma
Vyädhi. It promotes Bala, Mmsa and Sukra. It is Sadyobalajanana and Rasyana.
(Ca.Si.12) It is Balya, Vrishya, Sanjivana, Cakshushya and energises the body (Su.Ci.38/
106-111).
Erandamüldi Nirkha
Dravya Dose.
Madhu Prastha
Saindhava , Karsa
Ghrita and Taila 1 Prasrita each
Kalka Dravya-`athv, Madhuka, Kutaja Phala, 1 Karsa each

Rasänjana, Priyangu
Kvätha Dravya-Erandamüla-6 Pala, Palsa, Laghupanca- 5 Prasruta
mkla, Rsn, A[vagandh, Gudüci, Punarnav, Devadru,
Aragvadha (1 Pala each), Madanaphala-8+ Jala-1 Adhaka
and Ksh+ra-1/4th of Jala
390 Text Book of Pañcakarma
Vijnana
Dhumapana

Dhumapana Dravya

Enters Sukshma Srotas

by Sukshma guna of
drugs

Nasal drug delivery system Pulmonary drug delivery system

Vaidya Vasant Patil

Highly vascularised nasal Larger surface area for
mucosa absorption & rich blood supply

Commonly used Dhumapana

Drugs transferred across the drugs are rich in Katu Ushna
single epithelial cell layer Laghu Ruksha Guna

Acts as anti-inflammatory,
Liquifies the Doshas by Ushna anti-allergic, bronchodilator,
and Tikshna Guna mucolytic & mucokinetic in
action

Eliminates the Doshas from

oropharynx and nasal cavity

of Dhuma
Fig: Mode of action
strict security system that human brain has.
blood, brain barrier is
a
Moreover
administration for inhalation of anaesthetic
route of
The nose is used as a

materials. hormone (Fink G. et.al. 1973) &

Nasal administrations of leutinizing
 Physiotherapy 427
shock
DIsadvantages:Burns,injury to eye, and electric

Shortwave Diathermy

Scan this QR code to see the Video on "Shortwave Diathermy

Short waved diathermy is the therapeutic elevation of temperature in the tissue by

means of an oscillating electric current. Short Wave diathermy current is a high fre-
guency alternating current. The heat energy obtained from the wave is used for giving
11 meter. The
relief to the patient. Its frequency is 27.12 Mhz and the wavelength is
tissue and body organs are overheated, which increases local metabolism, supports ab-
sorption of chronic inflammatory, post-injury and post-operation infiltrates, improves
tissue elasticity and has analgesic effects.
Types of Applications
The condenser field method (commonly used)
Cable method

SHORT WAVE DIATHERMY

sPECIFICATION:
Operadng Voltage : 220V AC 50 Hz
Absorpion : 800-Watts Max
Fuses :BAmp.
Output :500WIContinuous)
Frequency RF :27.12MHz
Wage Length :11 meter
Display :Fiement Voltage VAc, Outpurt Intencity mA
Timer :Digital Timer0-99 Mintutes Programmable
AVALABLE MODEL SWD with Digital Timer, SWD Pulsed

Indication of Shortwave Diathermy:

Inflammation of shoulderjoint
.Inflammation of Elbow Joint (Tennis Elbow)
.Degeneration of joints of neck (Cervical Spondylosis)
 Chapter

Pañcakarma in Various Diseas

Pakshaghta
A) Kevala Vâtajanya (due to hemorrhage)
In case of stroke associated with unconciousness
a. Kevala Vâtajanya (due to hemorrhage)- Stambhana Nasya, Sita Ksh+ra Dhr,
STta Siropicu
b. Avaranajanya (Thrombo-embolism)- T+kshna Pradhamana Nasya, Sarpi
Abhyanga (Dr.Ravishankar Pervaje, Dr. P. Yadaiya)
Emergency treatment-
Loss of consciousness-
T+kshna Pradhamana Nasya -Katphala Ckrna
Sarvänga Abhayanga with Ghrita
Kshira Dhr- Zatvari+Must+Candana+Karpkra+rose water
Siropicu- Himasgara Taila/Balguducydi Taila
Vatahara & Brimhana Nasya- K.B. Taila 101
B) Avaranajanya (due to thrombo-embolism)
Sadyo Virecana -Eranda Taila & Sunthi Kashya
RajaYpanaBasti/Mdhutailika Basti/ Erandamkldi Niruha for
8-16 days (Anuv sana with MN Taila/KB Taila 8 times).
Sarvanga Abhyanga -Mah m sha Taila, Bal [vagandh di Taila,
Mahlakshdi Taila
Nävarakhizhi for 7-14 days
Ardita
Abhyanga- Krpassthydi Taila/ MM Taila
Kshiradhkma- Da[amüla, Bal, Eranda Kashya +Milk+Mmsarasa
Nasya with K.B. Taila101/Dhanvantaram Taila 101/MM Taila
Kärp sa asthy di Taila
 Chapter

13 Clinical Examination

General Clinical Examination

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on Complete Clinical Examination" Video on Physical Examination"

Nervous System Examination

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on "Nervous System Examination" on Neurological History taking'

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Motor Sensory and Reflexes examination" Video on "Facial Palsy Examination'"

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Peripheral Nervous System Examination" Upper Limb Neurological Examination'"|
 About the Author
Prof. Vasant C. Patil graduated from SVM Ayurvedic College, lkal
affiliated to RGUHS, Bangalore. He completed M.D. (Panchakarma) in August
2006 from Institute for Post Graduate Teaching & Research in Ayurveda
in Classical
(IPGTRA), GujratAyurved University, Jamnagar. He is well versed
since 2001 and engaged
&Keraliya Panchakarma. He is practicing Ayurveda
in teaching since 2006.
He published 15 papers in research journals &5 articles in magazines.
Author also reviewed more than 15 articles of Peer Reviewed International Journals. Currently he is

working as executive editor for Journal of Ayurveda and Holistic Medicine (JAHM).
Recipient of 2 prize in an essay competition on "Rationale behind Panchakarma Therapy"

organized by Punarnava Ayurveda, Mahabalipuram (2006).

Dr.
Recipient of 1" prize in an essay competition on "BahirparimarjanaCikitsa" organized by
Ishwara Reddy Memorial Trust, at Bellary(2007).

Books Published:
"Snehana Therapy in Ayurveda", Chaukhambha Publications, New Delhi, June 2008.
2. "A Comprehensive Guide on CharakaSamhita", Chaukhambha Publications, New Delhi, August 2009

3. "Principles & Practice of Panchakarma (For UG, PG, Researchers & Practitioners)', 3" Edition, Atreya
Ayurveda Publications, Ilkal, 2011 (ISBN:978-81-910286-0-7)
Clinical Diagnosis in Ayurveda, 1" edition, Atreya Ayurveda Publications, 2011 (ISBN:978-81910286-1
4)-In press
5. Essentials of Practical Panchakarma therapy, Chaukhambha Publications, New Delhi 2014

6. A Guide to Ayurvedic Cinical Practice (for interns, practitioners,PG scholars) Choukhambha Sanskrit
Pratishtana, New Delhi, 2016

7 Text book of Panchakarma (for BAMS students), Chaukhambha Publications, New Delhi 2014
8. Text book of research methodology and statistics, Choukhambha Sanskrit Pratishtana, New Delhi, 2016
(in press)
9. SUSRUTA SAMHITA OF MAHARSHI SUSRUTA With English Translation of Text and Dalhana's
Commentary with Critical Notes. Vol. -I (Sutra Sthana), Vol. - II (Nidaana, Sharira and Cikitsa Sthaana),
Vol.-Im (Kalpa Sthaana and Uttara Tantra), Chaukhambha Publications, New Delhi, 2019

CHAUKHAMBHA PUBLICATIONS ISBN 78.93 16tX 91

NEWDELHI (INDIA)|
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