Panchakarma पञ्चकर्म

The five purificatory procedures · Third (Final) Professional (Tritiya Varsha) · AyUG-PK

Papers

• Paper I — Panchakarma

Units in this subject

Study notes

The five purificatory procedures, with everything that surrounds them. Most of the marks in this paper are not in the five procedures themselves but in the preparation before and the regimen after, and in knowing what goes wrong.

Purvakarma

• Deepana and Pachana first, because shodhana on an ama state is contraindicated.
• Snehana: internal (snehapana) and external. Achcha, Vicharana and Pravicharana sneha. Samyak snigdha lakshana — oily skin, aversion to fat, soft stool, lightness.
• Snehapana is given in increasing quantity over days until samyak snigdha lakshana appear. Atisnigdha and asnigdha lakshana are both examinable.
• Swedana: thirteen types by Charaka; sagni and niragni; samyak swinna lakshana.

The five karma

• Vamana: the treatment for kapha. Indicated in kapha disorders, shwasa, kasa, prameha. Given in Vasanta. Madanaphala is the principal dravya. Vegiki, Maniki and Laingiki shuddhi are the three measures of adequacy.
• Virechana: for pitta. Given in Sharad. Trivrit is the foremost and is mrudu virechana. Adequacy measured the same three ways.
• Basti: the foremost treatment for vata, and called half of all treatment. Niruha (asthapana, decoction) and Anuvasana (sneha). Matra basti, Karma, Kala and Yoga basti schedules.
• Nasya: for disorders above the clavicle. Types — virechana, brimhana, shamana, navana, marsha, pratimarsha.
• Raktamokshana: by shringa, alabu, jalauka (leech) and siravedha. Jalauka is for pitta and rakta disorders; it is the gentlest and is used in children and the weak.

Paschat karma and complications

• Samsarjana krama: the graded return to normal diet over peya, vilepi, akrita and krita yusha, and mamsa rasa — the number of meals depending on the degree of shuddhi (pravara, madhyama, avara).
• Vyapad of each karma and their management — this is where most marks are lost.
• Vamana vyapad: adhmana, hrillasa, vibhramsha, jivadana, stambha. Parikartika is a vyapad of VIRECHANA and of basti, not of vamana. Basti vyapad and their specific management.
• Contraindications for each procedure, which are examined as lists.

Regional and modern practice

• Keraliya procedures: Pizhichil, Njavarakizhi, Shirodhara, Shirovasti, Kativasti, Udvartana.
• Panchakarma in specific conditions, and the evidence position stated honestly.
• Setup, hygiene, consent and the practical conduct of a procedure.

Nasya

• Types: Virechana (shodhana), Brimhana (snehana), Shamana; by method Navana, Avapida, Dhmapana, Dhuma, Pratimarsha, Marsha.
• Pratimarsha nasya may be done daily and has the fewest contraindications, which is why it appears in dinacharya.
• Indications: disorders above the clavicle. Contraindications: immediately after a bath, meal, alcohol, in acute coryza, in pregnancy.
• Samyak yoga lakshana and the vyapad of excessive and insufficient nasya.

Keraliya and regional procedures

• Pizhichil (sarvanga sneha dhara), Njavarakizhi (shashtika shali pinda sweda), Shirodhara, Shirovasti, Shiropichu, Kativasti, Janu vasti, Udvartana, Talapothichil.
• These are regional elaborations of snehana and swedana rather than separate karma, and an answer should say so.
• Duration, temperature and the practical conduct of each.

Panchakarma in specific conditions

• Basti in vatavyadhi, amavata and sandhivata; the choice between niruha and anuvasana by the state of the patient.
• Virechana in kushtha, prameha and pittaja conditions.
• Vamana in tamaka shwasa, prameha and kaphaja skin disease.
• Nasya in urdhva jatru disorders. Raktamokshana by jalauka in vatarakta and localised pitta conditions.
• Absolute contraindications shared across all: pregnancy, extreme age, extreme weakness, immediately after another shodhana, and an unresolved ama state.

Sneha matra — the numbers that are always asked

• Hrasva matra digests in about three hours (one yama), madhyama in about six, uttama in about twelve. The matra is chosen by koshtha and agni, not by weight.
• Sharangadhara gives the working quantities: hrasva roughly 30 ml, madhyama roughly 60 ml, uttama roughly 90–120 ml, escalated day by day in shodhananga snehapana.
• Shodhananga snehapana runs three to seven days, increasing daily until samyak snigdha lakshana appear. Shamana sneha is a fixed small matra and is NOT escalated — confusing the two is the commonest error.
• Samyak snigdha lakshana: vatanulomana, agni deepti, snigdha and mridu anga, adhastat sneha darshana (oily stool), and glani. Atisnigdha shows pandu, gaurava and aruchi.
• Achha sneha is sneha taken plain, vichārana is sneha in food, and sadyo sneha is the rapid single dose. Three routes, three purposes.

Basti — the counts, the quantity and the schedule

• KARMA BASTI 30: fifteen niruha and fifteen anuvasana, beginning and ending with anuvasana. KALA BASTI 16: six niruha and ten anuvasana. YOGA BASTI 8: three niruha and five anuvasana. These three counts are asked in every paper.
• Niruha quantity by age (Sharangadhara): roughly 12 ml at one year, rising by about 12 ml per year to twelve years, then a fixed adult quantity of about 720 ml (twelve prasrita). Anuvasana is roughly a quarter of the niruha.
• Niruha basti dravya order in the vessel: madhu, saindhava, sneha, kalka, then kwatha — mixed in that order and no other. The order is examined because emulsification depends on it.
• Samyak niruha lakshana: the basti returns, followed by mala, mutra and vata, with laghuta and agni deepti after. Ayoga is retention without return; atiyoga shows glani, tamas and shoola.
• Basti vyapat eight: adhmana, atiyoga, ayoga, klama, angashoola, hikka, hridaya upasarana and parikartika. Parikartika — cutting pain — is the one that names itself.
• Basti is called ardha chikitsa, and in Sushruta chikitsa ardha, because it reaches all three doshas through the pakvashaya, the seat of vata.

Vamana, virechana and the samsarjana krama

• Vamana vega counts: pravara 8, madhyama 6, avara 4. Virechana vega: pravara 30, madhyama 20, avara 10. Quantity — vamana pravara about 1.5 prastha; virechana pravara about 4 prasrita.
• SHUDDHI GRADES AND SAMSARJANA: after pravara shuddhi the samsarjana krama runs seven annakala; after madhyama five; after avara three. Peya, vilepi, akrita and krita yusha, akrita and krita mamsa rasa, then normal diet.
• The four measures of adequate shodhana are Vegiki, Maniki, Laingiki and ANTIKI — antiki being the appearance of the next dosha in sequence, and the one most often left out of a list of four.
• Vamaka dravya: madanaphala is the agrya. Virechana: trivrit is the agrya, and aragvadha is the mildest and so the one for children and the elderly.
• Vamana is done in kapha kala — forenoon; virechana after the food is digested, in pitta kala. Doing either at the wrong kala is an examinable error.

Nasya, raktamokshana and the kshara sutra numbers

• Nasya by karma: virechana, brimhana and shamana — three. By method: navana, avapida, dhmapana, dhuma, pratimarsha — and pratimarsha is the small daily one that can be done at fourteen stated times of day.
• Nasya matra in bindu: hrasva 4, madhyama 6, uttama 8 bindu per nostril for marsha; pratimarsha is 2 bindu.
• RAKTAMOKSHANA BY DOSHA — the mapping that is always asked: shringa for vata, jalauka for pitta, alabu for kapha, prachchana and siravyadha for rakta and for sarvadaihika vitiation.
• Jalaukavacharana: savisha and nirvisha leeches, six of each named. Only nirvisha are used, and the classical antidote for a savisha bite is haridra and madhu.
• KSHARA SUTRA: eleven coats of snuhi latex, seven of snuhi latex with apamarga kshara, and three of snuhi latex with haridra churna — twenty-one in total, applied in that order. The count and the order are the question.

Where the texts disagree

• Charaka's five are vamana, virechana, anuvasana basti, niruha basti and nasya. Sushruta's five replace the two basti with one and add raktamokshana. Know which list the question wants.
• Whether raktamokshana is a shodhana or an upakrama is answered differently by the two texts.
• The number of vega expected in samyak vamana is given as eight for pravara shuddhi, but the intermediate counts vary between recensions.

Commonly confused

• Anuvasana (sneha) basti and Niruha (kashaya) basti.
• Gandusha (mouth filled) and Kavala (mouth partly filled).
• Marsha and Pratimarsha nasya - quantity and frequency, not material.
• Snehana (oleation) and Swedana (sudation) - the order is fixed and is examinable.

Practise it, and prove it