Procedures of Panchakarma
Snehan
Snehan implies oleation of the body and is described as one of the important Purvakarma (precursor) to Panchkarma. As Vata Dosha (Dhatukshayjanya) gets pacified by Sneh (oleation), this therapeutic procedure includes lubrication of body chiefly with medicated oil. As per the patients’ requirement, Snehanis classified as Abhyantar Snehan (Internal oleation) and Bahya Snehan (Outer oleation). To understand the pacification of pain by BahyaSnehan, we need to understand the role of TilTail (Sesame Oil) and Neuro-hormonal effects within the body due to Bahya Snehan. Til Tailis considered the best among Sthavar Sneha (Oil derived from Plant source), and also used as base for preparations of various medicated oil, as sesame seeds has strong vitamin E activity and helps in regulation of eicosanoids that cause inflammation (production of good eicosanoids from omega 3 essential fatty acids which inhibits inflammation).16 Neuro-hormonal effects due to Bahya Snehan has been established, stating that massage increases levels of Dopamine, increases availability of serotonin, may elevate epinephrine (adrenaline) and release of endorphins. (Research conducted at TOUCH Research Institute at the University of Miami). All these neuro-hormones alter brain chemistry which in turn reduces response to pain sensation.
Swedan
Swedan implies hot fomentation which is also the precursor procedure to Panchkarma which helps in inducing sweating to the patient. This procedure is done to curb the Vata Dosha vitiated due to increase in its Sheeta property. The role of Swedan is best understood with Transient Receptor Potential Channels. These receptors are mainly found in nociceptive neurons of peripheral nervous system. Upon further literary search, it is known that TRPV1 channels are responsible for perception of heat and pain both thereby, facilitating the role of Swedan in Management of pain.
Agnikarma
Agnikarma (Intentional Heat burn Therapy) is one of the most effective para surgical procedure mentioned for the management of pain which is done with the help of shalaka (metal probe). This unique procedure helps in relieving pain in various painful conditions chiefly ofMusculoskeletal pain like Parshnishool (heel pain-Calcaneal spur), Sandhigatavata (Osteoarthritis), Avabahuk (Frozen shoulder); According to Ayurveda, due to ushna guna produced during helps in pacification of Vata-Kapha Dosha and helps in increasing theDhatvagni thereby reducing pain. Mechanism of action of Agnikarma can be understood with the help of afferent spinothalamic tract. As stated earlier, the ascending neurons are the pathway for conduction of Pain (lateral spinothalalmic tract-Aδ & C Fibres), Pressure (ventral spinothalamic tract –Ruffini endings), Temperature (lateral spinothalamic tract).
When perception of pressure and temperature factor isincreased, pain perception is reduced which helps us to understand the role of Agnikarma inreliefof pain. Moreover, another hypothesis suggests that the released heat could have caused irritation on the superficial sensory nerve endings thereby relieving pain from the concept of ‘counter irritation’. It has also been suggested that pain may be possibly caused as a result of the accumulation of metabolic waste products in the tissues, and an increased flow of blood (vasodilatation due to heat) in the region is the possible mechanism that is responsible to remove these substances and relieve pain. Another possibility is that the pain releasing mechanism is associated with muscle relaxation.
Jalaukaavcharan
Jalaukaavcharan (Hirudotherapy) is one of the therapeutic procedures of Raktamokshan (Bloodletting). This therapy of pain relief involves application of Nirvish Jalauka (Nonpoisonous Leeches –Hirudo medicinalis) for removal of vitiated blood at the site of pain.It is hypothesized that the strong sensory stimulus caused by the pain and burning sensation of the leech bite can alleviate the symptoms of the patient through the “gate theory”. Moreover, review of components of Medicinal Leech saliva reports Hirudin which inhibits blood coagulation by binding to thrombin, Calin inhibits collagenmediated platelet aggregation, Destabilase dissolves fibrin, Hirustasin inhibits kallikrein, trypsin, neutrophytic cathepsin G, Bdelins acts as anti-inflammatory and inhibits trypsin, Eglins acts as anti-inflammatory and inhibit activity of cathepsin G, Carboxypeptidase A inhibitors increases the inflow of blood at thebite site, Histamine like substance, acetylcholine acts as vasodilator and Anesthetic substance which causes anesthesia at the bite site.
Viddhakarma
Also known as Vedhan is one of the eight Shastrakarma (surgical measures) mentioned in Sushrut Samhita.24 This is a sterile procedure which includes piercing the points with special hollow needles considering the anatomy of Marma (vital points) as per Ayurveda. The piercing leads to painful mechanical stimulus which causes release of endorphins thereby, causing immediate pain relief. Another procedure called as Vidhaagni (combination of Vedhankarma and agnikarma) is also practiced in painful conditions with varied results.
Lepankarma
Lepankarma is application of medicated paste on skin. Classical texts describe the utility of Lepa in treatment of Vatrakta. Sushruta has mentioned Lepankarma in Twakgat vata (vitiated Vata in skin) as reference cited in Vranshoth chikitsa (inflammatory condition), Mansagata Vata (vitiated Vata in muscles) and Snayuroga (Diseases related ligaments).25,26 Mode of action of lepankarma can be explained with the help of Transdermal absorption of drugs. Epidermis behaves as a lipid barrier whereas; Dermis is freely permeable to solutes. Inflammation increases cutaneous blood flow and also enhances absorption. Moreover, thermoreceptors in the skin have cold receptors (thin myelinated Aδ fibres) and warm receptors (unmyelinated C fibres) which help in understanding the regulation of Pralepa and Pradeha respectively. Probable role of Pralepa can be explained with the mechanism of transduction of cold thermoreceptors as for example Menthol sensation is perceived via TRPM8 channel;m whereas role of Pradeha can be explained with TRPV1 channels and furthermore certain Warm receptors also beingsensitive to painful stimuli function as nociceptors and thus, mediate action of herbs with hot consistency.
Bastikarma
It is one of the chief therapeutic procedures of Panchkarma in which the drugs are administered into the rectum of the patient. It is multidimensional treatment procedure offering wide range of clinical benefits in different diseases due to its synergistic effects. Sensation of Pain is attributed to vitiated Vata Dosha and in order to correct this doshic imbalance Basti is the chief treatment of choice as origin of Vata Dosha is from Pakwashay and hence, described Ardhachikitsa (as treatment of choice for numerous diseases) in Charak Samhita Probable mode of action of Basti and mediation in Pain management is that the rectum has rich blood and lymph supply and the drugs can cross the rectal mucosa like other lipid membrane. The unionized and lipid soluble substances are readily absorbed from the rectal mucosa. This is because short chain fatty acids are more water soluble and allows directdiffusion from epithelial cells into the capillary blood of the villi. It is proposed that Basti has a feature to regulate sympathetic activity, thereby, balancing the autonomic nervous system. Hypothalamus-Pituitary-Adrenal axis (HPA) gets activated with the visceral afferent stimulation, involving the release of neurotransmitters from adrenal gland called cortisol, a neuroendocrine hormone, acts as a potent anti-inflammatory systemically.
Uro-Basti (HridayBasti)
Specially prepared luke warm medicated herbal oil is poured over the chest and retained inside black gram paste boundary for 20 to 30 minutes. The healing properties of herbal oils used for this massage enriches the blood and builds and maintains strong muscle and connective tissues of heart & chest.
This is a stimulating and therapeutic treatment for muscular chest pain.
Benefits :
- Weak Cardiac Muscles
- Angina Pectoris
- Other Cardiac Diseases
- Muscular chest pain
Greeva vasti (Manyabasti)
Specially prepared warm medicated herbal oil is poured over the neck and retained inside the black gram paste boundary for the required duration. The healing properties of herbal oils used for this therapy deeply cleans and enriches the blood, builds and maintains strong muscles, bones and connective tissues and lubricates the joints keeping them flexible and pain free.
Greeva Vasti alleviates neck and upper back conditions like Cervical Spondylosis, Stiff Neck Pain
Benefits :
- Loosens stiff joints
- Helps to cure cervical spondylitis, neck pain, paralysis and numbness of hands
- Stimulates and nourishes nerves relieving pain and numbness
Kati Basti
Specially prepared warm medicated herbal oil is poured over the lower back and retained inside the black gram paste boundary for the required duration. The healing properties of herbal oils used for this therapy deeply cleans and enriches the blood, builds and maintains strong muscles, bones and connective tissues and lubricates the joints keeping them flexible and pain free.
This is a stimulating and therapeutic treatment for muscular chest pain.
Benefits :
- Loosens stiff joints
- Helps to cure Lumbar spondylosis, lower back pain and numbness of lower limbs
- Stimulates and nourishes nerves relieving pain and numbness
Pristha Basti
Specific warm medicated herbal oil is poured over the entire back and retained inside the black gram paste boundary for the required duration. Hare also the healing properties of herbal oils used for this therapy deeply cleans and enriches the blood, builds and maintains strong muscles, bones and connective tissues and lubricates the joints keeping them flexible and pain free.
Greeva Vasti alleviates neck and upper back conditions like Cervical Spondylosis, Stiff Neck Pain
Benefits :
- Loosens stiffness of back & relieves pain.
- Helps to cure Lumbar-Cervical spondylosis, Helps to cure upper back pain and numbness of limbs
- Stimulates and nourishes nerves relieving pain and numbness
Janu vasti
This is a special treatment in which warm medicated oil is retained inside black gram paste boundary over the knee joint. This treatment is very effective in treating different conditions of the knee joints like arthritis, degenerative conditions etc.
Benefits :
- Relieves cracking of the Knee joints.
- Relives pain in arthritis of Knee Joints.
- Helps in degenerative conditions of the Knee joint.
Netra tarpanam
A special treatment in which pure medicated cow's ghee is retained inside black gram paste boundary over the eyes. This procedure takes 15 minutes.
Benefits :
- Relieves the strain due to constant glaring to the computer & TV screen.
- Helps in preventing early formation of Cataract.
- Reduces pain and burning sensation in the eyes.
- Offers a good relaxation and cooling effect to the eyes.
- It is very useful in conditions like Dry Eye.
Udwarthanam
This is a specialized herbal treatment for weight reduction. A herbal paste or powder is applied all over the body and deeply massaged with specific movements by therapists for one hour.
Benefits :
- Removes extra oiliness of skin
- Removes Kaphadosha from body
- It reduces extra fat
- Weight reduction
- Removes Cellulite
Thalapothichil
A herbal paste is applied to the entire head for 45 minutes.
Benefits :
- Hypertension
- Calming
- In Insomnia and Depression
- Hyper active conditions
- Burning sensation in the eyes and headache
Shiro pichu
A thick layer of cotton wool soaked with warm medicated oil is applied over the affected area. The oil is recycled periodically to make it warm. Medicated oil is applied to the head for 45 minutes in a special manner.
Benefits :
- Improves memory
- In Dermatitis of the scalp, Dandruff
Recommended in Neurological disorders like Paralysis, facial palsy etc.
Shiroabhyamgan
A soothing massage of the head, neck & shoulder for 15 minutes using warm herbal oils.
Benefits :
- In Insomnia & for relaxing
- Cooling to the eyes
- In headache, Pre-mature graying & hair loss
- Helps to spread natural oils over the scalp thus protecting and conditioning the length of the hair
- Promotes natural blood circulation
- Nourish the hair from the roots
- Removes accumulated toxins
- Cooling to the eyes
Lepam
Aapplication of herbal paste externally over the affected area is called Lepam. The herbal powder and the medium to make the paste are selected as per the condition. This therapy is used in wide range of conditions as from cosmetic purpose to severe skin disorders.
Very effective in :
- Skin Diseases:- Dermatitis, Scabies, Fungal Infections, Pimples, pigmentation,
- Arthritis with swelling & pain,
- Injuries
Upanaham :
Hot herbal paste is applied over affected area.
Very effective in Local anti inflammatory diseases, hair fractures of bones.
Uttara Basti :
Medicated oil or decoction is administered in to the uterus through cervix in female is called Uttarbasti.
Useful in genitourinary diseases and infertility of female.
Jalaukavacharana / Raktamokshana (Leech Therapy)
The application of leeches to suck the impure blood locally from a body part is called as Jalaukavacharan in Ayurved. It is a type of blood-letting technique performed under all aseptic precautions. The area is cleaned and leech applied. After specific time the leech gets detached and wound is compressed.
Benefits :
It helps to let impure blood and remove toxins within. It helps to reduce inflammation and pain at the site. It helps to improve the micro-circulation of the affected site.
How it works :
Leech is capable of sucking blood up to 20ml from the affected and surrounding area. The accumulated toxins and impurities are also drained along with the sucked blood. This helps in healing the affected part.