A Guest lecture organised by Agnivesha Ayurveda Academy Bangalore; have invited to Dr. Lohith B. A. M.D., PhD. Head & Professor, Department of Panchakarma , SDM college of Ayurveda & Hospital, Hassan
To deliver the lecture on "Panchakarma and its advancement" on 27/04/2017
2. Panchakarma
Dr. B.A.Lohith M. D., Ph. D.
Head and Professor
Dept. of Panchakarma
SDM College of Ayurveda & Hospital
Hassan, Karnataka, India- 573 201
+91-9886749168,
Email- lokithbadr@yahoo.co.in
2
3. Contents
• Importance of Panchakarma
• Research updates
• Applications of different basti
• Gridhrasi
• Vatakantaka
• Cupping method
4. Treatment (Chikitsa)
• Shamana -Palliative (Pacification of vitiated Dosha)
• Shodhana- Purification (Purification of metabolic
wastes)
4
5. • Due to incompatible food (ahara) and life style
(vihara) etc… certain pathological changes
manifest in channels (Srotas) there by affecting
nutrition to the tissues. This in turn leads to the
disease process.
• Hence to restore normalcy, purification
(Shodhana) is very useful.
Need of purification
5
6. • If a very clean crystal pot filled with pure water, in due
course, some sediments get precipitated over the
surface of the crystal and it becomes slimy.
Contd….
6
7. • Unique treatment modality
• Method of bio-purification
through natural route.
• Real pathogenesis breaker
• “Na Punarudbhava” – Long
lasting effect
Why Panchakarma only?
7
10. Preventive
• Alimentary toxins- Indol, Phenol, Cresol, Indican,
Ammonia, Choline, Muscarin, Botulin, Turamine,
Sepsin, Idolathylamine, Sulpherroglobine.
• The people with high risk group can be significantly
prevented from disorders. Anxiety, Cholesterol,
Diabetes, Hypertension, Musculoskeletal disorders
etc.
10
12. • Efficacy of all sense organs
• Digestive strength
• Provides youthful state of body
• Good body luster
• Bestows longevity and disease free
state
• Promotes immunity and strength.
Promotive
12
14. Effect on Amavata
(Rheumatic Fever)
Lab
parameter
BT AT
ESR 40 mm/hr 18 mm/hr
ASLO 1385 IU/ml 213 IU/ml
CRP 69.5 IU /ml 10.7 IU/ml
Symptoms BT AT After
Samsarja
na
Follow
up
Swelling in
joints
+++ + Nil Nil
Tenderness +++
+
+ Nil Nil
Pain +++ + Nil Nil
Ref:
Journal of Ayurveda and Holistic Medicine|May 2013|Vol 1|Issue 3
Decreased Anti- streptolysin O (ASLO) titer has
Suggested that Vamana is a definite answer for auto
immune disorders
14
15. Researches……
VIRECHANA
On blood sugar levels in diabetes mellitus
By lowering the hepatic glucose production helps to control
Reduction in FBS and PPBS levels by 56%
Ref:
AYU journal jul-sep 2013, Vol 34, Issue 3
15
17. GIT has
ENS(enteric
nervous
system) which
is connected
to CNS
through Vagus
nerve
ENS works in
synergism
with CNS
Stimulation of
ENS with
basti either by
Chemo or
Mechano
receptors
This leads to
stimulation of
concerned part
of CNS
Thus
precipitating
the results in
respective
diseases.
Ref:
Gyanendra D.Shukla, Shwetha Pandey, Anup B. Thakur; Pharmacodynamic understanding
of Basti : A contemporary approach. IJPBA 2012;3(4):893-896
17
19. Research
Subjected for massage Relaxing videotapes
Decreases : Anxiety
Cortisol
Depressed
No changes observed
Ref:
Aggressive Adolescents Benefit from Massage Therapy
Journal article by Miguel A. Diego, Tiffany Field, Maria Hernandez-Reif, Jon A. Shaw,
Eugenio M. Rothe, Daniel Castellanos, Linda Mesner; Adolescence, Vol. 37, 2002 19
21. Chronic Fatigue syndrome
Advised bed rest Therapeutic massage
Reduce individual activity
level as much as 50% for
a period of 6 months
Fatigue related symptoms
particularly like anxiety, somatic
symptoms, depression,
difficulty in sleep and pain
21
22. Effect on EEG pattern
Increased frontal delta waves (suggesting relaxation)
Decreased frontal alpha and beta waves (suggesting
enhanced alertness)
Ref :
International Journal of Neuroscience. 86, 197-205.
22
23. Effect of Massage on Smoking cessation
• Intense cigarette cravings, anxiety and depressed mood
were seen - severe withdrawal symptoms.
• Effect: Self-massage may alleviate
Smoking-related anxiety
Reduce cravings
Withdrawal symptoms
Improve mood and
Reduce the number of cigarette smoking.
Ref:
Hernandez-Reif, M., Field, T., and Hart, S. (1999). Smokingcravings are
reduced by self massage. Preventive Medicine, 28, 28-32.
23
24. Shirodhara
•Rejuvenating therapy designed
to eliminate mental exhaustion
as well as relieve stress and
ill effects on central nervous system.
•Indicated in insomnia, stress, anxiety, hair loss,
fatigue, depression, obsessive-compulsive disorder,
schizophrenia, stroke, hypertension and migraine.
24
25. Effect on Neuro-chemicals
When a person is under severe emotional stress
or unresolved emotional pain
Produces high levels of the stress hormone
CORTISOL
Which directly suppress immune system functioning and is
linked with depression, stress and many diseases including
cancer.
25
26. Effect of Shirodhara
Increases the SEROTONIN , DOPAMINE and
NOREPINEPHRINE (“feel good” hormones) by 31%
CORTISOL levels by 31%
Ref :
International Journal of Neuroscience Volume115, Issue 10 October 2005 ,
pages 1397 - 1413
26
27. • Abhyanga- Regular fitness
• Udvarthana- Obese
• Regular application of oil to scalp, foot and ear
• Pratimarsha nasya – Eliminate the risk of diseases related to
head and neck
Panchakarma in daily routine
27
28. Functioning of gastric fire
Remission of disease
Purity of sense organ
Purity of mind
Purity of intellect
Therapeutic effect of
panchakarma in general
Body complexion
Improvement of body physique
Enhancement of sexual vigor
Aging process being slowed
Healthy living for long time
Beneficial in both normal and diseased person
28
30. IMPORTANCE OF BASTI
• Basti - Ardha Chikitsa/Sarva Chikitsa
• Bastihi Vate-Pitte-Kaphe-Raktecha Sasyate
• Basti-Multi Dimensional therapeutic effect
30DR B A Lohith
31. BASTI AS MAIN TREATMENT
TREATMENT PRICIPLE :
• Amavata- Langana, Swedana, Tikta Deepna
Katu, Virechana, Basti.
• Ghridrsivata-Sira Vyadhana, Agnikarma, Basti.
31DR B A Lohith
32. SCHEDULE OF BASTI
• Importance to Roga Marga….
Gambheera
Utthana Vikara
E.g.:
Yoga Basti- Sandhigata Vata!
32DR B A Lohith
33. DOSE OF NIRUHA
• Classical Dose…
• Modification may be done-
Age, Bala, Type of Basti
Eg:
Ardhamatrika, Padaheena, Prasrita Yogika
Basti
33DR B A Lohith
34. DOSE OF ANUVASANA
• Classical Dose :
• Sneha Basti : 300 ml
• Anuvasana : 150 ml
• Matra Basti : 75 ml (50-75-100 ml)
• Modification may be done - Agni, Bala,
Type of Sneha
34DR B A Lohith
35. AROHANA DOSE OF
ANUVASANA BASTI
• Arohana Dose –
• Start with 100 ml, increase 50 ml (Uttama – 300
ml)
• Start with 50 ml, increase 25 ml (Madhyama –
150 ml)
• Start with 25 ml, increase 15 ml (Avara
Matra – 75 ml)
DR B A Lohith 35
45. DRAVYA PRAMANA %
MADHU 2 PRASRITA 16.67
SNEHA 3 PRASRITA 25
KALKA 1 PRASRITA 8.33
KWATHA 4 PRASRITA 33.33
AVAPA 2 PRASRITA 16.67
TOTAL 12 PRASRITA 100%
GENERAL MATRA
45DR B A Lohith
46. DRAVYA 12 Prasrita
(Ml)
UTTAMA MADHYA
MA
AVARA
MADHU 192 160 128 96
SNEHA 288 240 192 144
KALKA 96 80 64 48
KWATH 384 320 256 192
AVAPA 192 160 128 96
TOTAL 1152 960 768 576
PROPORTION OF INGREDIENTS
46DR B A Lohith
47. OUSHADHA-ANUVASANA BASTI
•Paka of Sneha-Moorchita Sneha
•Addition of Churna
• Shatahva, Saindhava, Devadaru,
Vacha, Rasna, Kusta –
• 6, 4, 2 gm for Uttama, Madhyama,
Avara Matra of Sneha Basti
47DR B A Lohith
48. TIME OF
BASTI ADMINISTRATION
• Niruha- Noon…..
Kshara/Vaitharana Basti
• Anuvasana-Day/Night
• Matra Basti
48DR B A Lohith
49. Remember !
• Basti Putaka Vs Enema can
• Enema can- Cleanliness of Can, Pipe,
Catheter
• Avoid contamination of Oushadha-Freshly
prepare medicine
49DR B A Lohith
50. • Filtering of Basti Oushadha
• Temperature of Basti Oushadha
• For Niruha Paschat karma like Lifting leg,
patting buttocks etc not needed
Remember !
50DR B A Lohith
51. • How much time patient is allowed to lie down
in table after Basti administration-?
• Retention of Basti more than 48 minutes -?
• Basti evacuation- Indian commode Vs
Western commode
• Diet after Basti Pratyagamana.
Remember !
51DR B A Lohith
52. • Patient with Piles
• Not passed stool- Shodhana Niruha/Manual
Evacuation/ Phala Varthi
• Niruha Basti Oushadha getting blocked in
Catheter-
Thick consistency, Not filtered, catheter tip
blocked, Patient not passed stool
• Resistance while inserting catheter-ask patient to
breath through mouth
Remember !
52DR B A Lohith
53. ANUVASANA ADMINISTRATION
• Procedure-Abhyanga, Swedana, Snana, Ahara
• Nature of food/Quantity.
• Gap between food and Anuvasana- Avasta
Paka of Ahara
• Again consumption of food before Anuvasa
Basti Pratyagamana.
• Is forceful retention of Basti is indicated.
53DR B A Lohith
54. • EXPECTING THE RESULT OF BASTI-
Immediate-Delayed
• Pathya Plan during Basti Parihara Kala-
Desirable/Not desirable
• Prescribing Shamanoushadhis during the days of
Basti administration- Desirable/Not desirable
• Prescription of Nasya, Abhyantara Snehana
during Basti course- Desirable/Not desirable
54DR B A Lohith
55. COMMONLY ENCOUNTERED
COMPLICATIONS OF NB
• Pain abdomen
• Fullness of abdomen
• Atisara
• Debility
• Restlessness
• Burning sensation in abdomen
• Longer retention time
• Headache
• Parikartika
55DR B A Lohith
56. COMMONLY ENCOUNTERED
COMPLICATIONS OF SNEHA BASTI
• Agnimandya
• Atisara
• Udarashula
• Burning sensation in abdomen
• Jwara
• Heaviness of body
56DR B A Lohith
68. Samprapti gatakas
Dosha– Vata & Kapha
Vyana vayu-- Kshepana and uthkeshpana Apana vayu –
the site is Kati Sakti
Sleshamaka kapha –Resides In Sandhi
Dushya–
Pain & stiffness of leg symptom , inabilty of
walking sankocha are all suggestive of
mamsa affection.
Ac Su Kandara
Arochaka,Stamitya,Gaurava--- Rasadhatu
Numbness and Parasthesia --- Twak & Raktha
Radiating from buttock to heel ---Sanyu
69. Srotas
Rasavaha,Raktavaha,Mamsavaha,& Asthivaha
Srotodrusti–– Sanga
Agni—In vataja not effcted
In Vatakaphaja Jataragni mandhya
Udbhavasthana– Pakvashaya
Sancharaya sthana– Low back region to heal
indicative of lower half of the body.
Adhistaana –Sphik, Kati,Uru, Prusthi,Janu,
Janga,Pada,& Anguli.
70. Line of treatment
• Siravedhana
• Basti
• Agnikarma (C.S. Chi. Stha 28/100-101)
• Siravedhana (S.S. Chi. Stha 5/23)
• A.H.Chi Stha 15 as Charaka
73. Swedana --- P. P. S. N.S. Avagaha Cha.Chi.28/78
• Valuka Sweda is better option for evident reason.
Avagaha – C.D, V.S, B.R.
74. Vamana
• After the Snehana and Svedana, S’odhana is
indicated in Gridhrasi.
• The authors like Cakrapaani and Bhaavamis’ra opine
that without S’odhana of body Basti Cikitsa will not
give desired effect in patients of Gridhrasi.
• S’odhana in the form of Vamana is advised in
patients suffering Gridhrasi and is specially
preferred in Vaatakaphaja Gridhrasi for evident
reasons.
75. Virechna
Virecana has an important role in Gridhrasi.
The action of Virecana is not only limited to
particular site, it has effects on the whole body. In
Vaatavyaadhi most of the authors mentioned
Mridu Virecana.
Oral administration of ‘Erand’a Sneha’ along
with milk is ideal for the Virecana purpose.
This will help in both Vaata Anulomana as well
as smooth excretion of Mala. The Sneha Virecana
clears obstruction in the Srotas and relieves Vaata
vitiation very quickly.
76. •Thus Sneha Virecana of Mr’du nature
helps in controlling S’oola in Gridhrasi
Virecana has an important role in
Gridhrasi.
•If we are observing the samprtpthi
Ghatakas like sira dhamani kandars are
upadhatus of the Raktha so the line of
treatment of the Raktha and Pitta are
one and the same.
77. Basti
• Madhura rasa leads to Vatashamaka if Dhatuksahya
janya then it helps in samprapti vigatanas.
• Katu, Tikta, Kashaya, leads to Kaphanashaka
Santarpaka karana leads to the Gridhrasi then basti
helps.
78. • Makshika—
• Contains- Glucose, Fructose, Viscous substances,
vitamins & calcium etc
Helps in Asthimajjagata vikars
Sneha–
Contains-Phospholipids phosphrous--
Lipids– Nerve cells
Pakvashaya-- Seat of vata
Seat of Purishadhara kala - Apana
vata doshik level
Seat of Asthidhara kala (Su in
visha vaga context
Most of drugs are agnideepaka & Amapachaka acts
at agni level
79. Agnikarma
• In Mamsa, sira, Snayu, Asthi, Sandhi where vata give rise to
tivra ruja (Su.Su12/10)
• Heating the tissues results in rise in temperature which
results in
• Increased metabolic rate or activity
• Increased blood flow.
• Stimulation of neural receptors in skin and tissues
May be local, general, or remote effect.
Their extent depend on
Size of area heated
Intensity of heat.
Method of applications.
80. • The location between Kand’ara and Gulpha is
opted to perform the Agnikarma as envisaged by
Aacaarya Caraka.
• As opined by Aacaarya Sus’ruta and Aacaarya
Vaagbhat’a, conditions like Snaayugata Vaata and
Sandhigata Vaata should be treated by Agnikarma.
• Thus the Gridhrasi Roga, in which the vitiated
Vaata afflicting the Snaayu is the primary
pathology, subjecting the patient of Gridhrasi to
Agnikarma would be a rational approach.
81. • Aacaaryas have clearly mentioned the place of Agnikarma
as the posterior aspect of the leg 4 An’gula below the
Indrabasti Marma.
• Aacaarya Cakrapaani is of the opinion that if the usual
treatment of Gridhrasi fails to give desired improvement
then Agnikarma is performed to the little toe.
• Haareeta has specified the Lohas’alaka for Dahana Karma.
82. Siravadha
• Rakthamokshan is considred as half treatment,By
Su.
• Dal mentioned Siravedhana is indicated in Shonita
avrita vataja gridhrasi.
• Vag– Rakthadoshaja vyadhi A.H.30/8
• Sirabasti is the site Su.Su 8/16
83. cont,
Sus’ruta and Vaagbhat’a have advised Siraavyadha where
in Sira located about 4 An’gula above or 4 An’gula below the
Jaanu Sandhi should be opted.
It is a general rule that, when the regular treatment with
Shadvidhopakrama fails to give any relief in any disease, one
should consider the involvement of Rakta Dhaatu in the
pathogenesis and is best treated by Raktamokshana. This rule
is also applicable in Gridhrasi Roga.
84. Pithaarivata Daha, Ushana, Bramha,& Tama
So line of treatment is
Virechna,
Rakthamookshna,
Kshera Kashaya basti
Kapharivata—Shautya,Gowrava
Niruha basti,
Agnikarma
Sth.abh.Nadisweda
Ratharivita—Daha, Sparsadwesha & Shoola
88. Causes
Most common cause – Plantar fasciatis
Less common cause –
• Sciatica
• Tarsal tunnel syndrome
• Entrapment of lateral plantar nerve
• Plantar fascial rupture
• Calcaneal apophysitis
91. • Not only calcaneal spur rather it may be
sprain, strain and acute suppurative
arthritis
• If Gulpha sandhi - Ashraya stana for
Vata kantaka – Sthanika chikitsa along
with Vata shamanopaya
92. Nidana
• Aharaja , Viharaja, Manasika
• Walking in an uneven surface /
excessive walking.
• Wearing high heeled & hard foot
wears
• Over weight lifting / being
Overweight
93. 1. Feet that flatten and roll inwardly
2. Shoes with inadequate arch support
3. Sudden turns that put great stress on
the ligaments
4. Running on hard surfaces or uphills
94. Treatment Principles to follow…
• Assessment of condition
• Acute pain management
• Local treatment
• Proper follow up
• Surgical intervention
95. Before entering in to treatment….
• If Gulpha sandhi is considered as the Ashraya stana -
Dosha nimittaja
• Agantuja karana - Sprain, strain etc
• Adoption of Rakta mokshna as the major line of
treatment should be re-thought on the basis of karya
karana sambandha
• Calcaneal spur- Agni karma is done routinely at the most
tender points in the heel.
99. Isthika Sweda
• Ushma sweda
Procedure :
1. Preparation to patient -
Snehana by Tila taila
2. Hot isthika –pour (ganji /kanji
/dashamoola kwatha)
3. Others: lavana pinda sweda
and kulatha sweda, Arka
pushpa sweda
100. • Regulates Vata
• Helps to discharge morbidity from micro channels and
counteracts Vata
• Counteracts the stiffness, heaviness and coldness
• Relaxation of muscle and tendons
• Improves the circulation and activates the local
metabolic process which may be responsible for most of
relief in pain, swelling and stiffness
• Massage during sweda may cause displacement of
exudates and thus may reduce the tension and the pain
How it works?
