Received date:October 21, 2016; Accepted date:November 26, 2016 ; Published date:December 05, 2016
In Ayurveda, Panchkarma: Therapy is an unique and a complete holistic approach,to the elimination of the root cause of every chronic disease.In India, Chronic diseases contribute 53% of death and 44% of disability adjusted life year lost.Charakacharya has described that moderate imbalance in Doshas can be pacified by Shamanai.e .palliation, such as administration of drugs ,diet & life style modification ,but deep rooted imbalances in Doshas can be completely eliminated by the administration of Shodhana therapies (Bio-purification) such as Panchkarma, including Vamana, Virechana, Anuvasana&AsthapanaVasti&NasyaKarma.
These therapies detoxify,strengthen tissues & enhance cell’s inner intelligence to facilitate self-healing to help, eliminate chronic diseases &promote longevity.Chronic diseases such as Arthritis, Asthma, Cardiac disease, Cancer,Stroke, Skin disease,Obesity & Epilepsy are among the most common,costly & preventable of all health problems in India.
Panchkarma Therapies are widely practiced across the country & also getting Global attention,so there is urgent need to standardize the procedurewith respect to its safety &efficacy. With this intent the attempt is made to assess the role of different panchakarma therapies in various chronic diseases.These therapies are found applicable to all chronic cases, covering a wide range of preventive, curative and promotive aspects.
Ayurveda, the Indian system of Medicine,has been in vogue from times immemorial to impart natural healing for various ailments.The system was nurtured by ancient scholars on the basis of sound underling philosophy,oriental methodology and practices prevalent in that era. This system is believed to be quite safe and free from side effects as it is more close to nature.
Chronic diseases are the diseases of long duration and slow progression such as Heart disease, Stroke, Cancer, Diabetes, Obesity, Arthritis, Spine disorders, and Epilepsy.These are the leading causes of mortality in the world, representing 63% of all deaths,out of these 36 million people who died from chronic disease in 2008.in which 9 million were under 60,and 90% of these premature deaths occurred in low and middle income countries, which can be prevented. In India chronic diseases contribute 53% of death and 44% of disability adjusted life year lost. Health damaging behaviors particularly tobacco use,lack of physical activity and poor eating habits are major contributors to the leading chronic diseases .In Ayurveda, chronic diseases are the Yapya conditions having unstable features, multiple focus of disease with deep seated pathology, affecting vital organs requiring regular and comprehensivetreatment .
The Ayurvedic approach to prevention and cure of disease swings around two broad principles viz.1) NidanParivarjan i.e. elimination of cause of disease.2).SampraptiVighatani.e reversal of pathogenesis.in many early and reversible conditions, SampraptiVighatanaspontaneously follows Nidanparivarjan without any treatment ,but in chronic diseases sampraptiVighatana may not occur even after palliative treatment procedures because a vicious circle is set and the system of the body learns to function in a pathological order and as the pathology becomes physiology of the altered state, Therefore a chronic disease is to be treated in a comprehensive manner, if a real cure is to be achieved. Ayurveda advocates two fold approach to cure i.eSamshaman or palliation such as administration of drugs, diet and life style modifications, and Shamshodhan(Panchkarma) or Bio-purification-The curative detoxification which aim to purify the body from organ to cellular level and to clear various channels of the body .It does not just treat the diseased organs and tissues it treats and manages Dosha, the biological forces responsible for any kind of pathogenesis in our body and thus reverts the disease mechanism itself. It is also claimed that a disease cured by Shamshodhan never relapse or re-occur, as this therapy eradicates the very root cause of disease.
Need of study
According to Ayurveda, human body is made up of innumerable channels or srotheses –Srothomayam hi Shariram,the dynamics of which keeps our body healthy i.e. the functional and biological aspects of which is interrupted progress to further structural distortion and if allow to continue it gives way to different kinds of disease depending upon the nature and extent ofsrotas-distortion and its site.Panchkarma therapy is essentially designed to restore the integrity of this dynamic system in the body. Thus in short Panchkarma therapy is the axis on which the Ayurvedic management of diseased conditions and its maintenance of positive health revolve. On other hand, a view of the changing world around us reveals the entry of numerous exogenous deleterious elements into the body in the form of food or pollution of the environment .This has increased incidence of the chronic illnesses, truly attributed to the accumulation of toxins in the body. Growing standard of living and a better literacy has improved the awareness regarding such grave conditions and this changed scenario, Panchkarma therapies are stood up to the challenges in negating the detrimental effect of the changed environment that too without taxing the body organs .
These therapies are widely practiced across the country and also getting Global attention that’s why there is an urgent need to standardize the procedure with respect to its safety and efficacy in different clinical conditions,with this intent the attempt is made to assess the role of different panchkarma procedures in various chronic diseases, by sticking on to the strong fundamentals of these treatment modalities.
To Assess the Concept of Shodhana( Panchkarma) In the management of Chronic Diseases.
1.To assess the efficacy of Panchkarmaprocedures w. r. t. Vamana, Virechana, Asthapana&AnuvasanaVasti and Nasyakarmain various chronic diseases.
2.To establish an effective and simple treatment modality for various chronic diseases
The Panchkarm procedures are Vamana (Therapeutic Emesis), Virechana (Therapeutic purgation), Anuvasana (Medicated oil Enema), AsthapanaVasti (medicated Decoction Enema) and Nasya (Nasal insufflations) [7-9].
Vamana-It is the therapeutic procedure adopted for expulsion of vitiated Doshas through urdhvamarga (oral route), by the administration of prescribed Vamanoushadhi.
Virechana–-It is a procedure in which the prakupitaDoshas are expelled through adhomarga (rectal route), by the administration of prescribed Virechanaoushadhies through oral route.
AnuvasanaVasti- -Administration of medicated oil through anal route and vitiated Dosha are expelled out through same route.
AsthapanaVasti--The process in which medicated Decoction, honey, rock salt, medicated oil and herbal paste are mixed in specific manner and vitiated Doshas are expelled out.
Nasyakarma–-It is a procedure wherein medicaments are instilled in to nasal cavity to expel Doshaspertaining to Uthamanga(ENT & Head) [10,11].
The study was conducted in clinically diagnosed patients of various chronic diseases, 502 cases were randomly selected from OPD & IPD of SushrutAyurved Hospital & Research Center, Udgir(MS),.India; out of which 59 cases were rejected.As per the selection criteria all the patients were interviewed, examined and randomly selected.
1. Patients of either sex between 10-70 age groups.
2. Patients who are fit for each Panchkarma procedure.
3.Patients with chronicity from 1 to 20 years.
1. Patients below 10 years and above 70 years of age.
2. Patients who are not fit for each Panchkarma procedure.
3.Patients with chronicity below 1 & above 20 years.
4. Patients having complications & critical illnesses.
Selection ofProcedure,Drugs, Dose & Duration
The complete process of Panchkarma consists of three steps. Poorvakarma, Pradhankarma & Paschatkarma.
Pachana & Deepana: Trikatuchurna -500 mg BD for 3 to 5 days; Udvartana & Valukasweda: Kottamchukkadi and kolkullathadichurna3to 7days as per clinical condition; Snehpana(internaloilation):PanchtiktakGhrut for Vamana &TrifalaGhrut for Virechana, 3 to7 days; Abhyanga: Whole body massageby Seasome oil 1 to 3 days; Swedana:Steam bathby the Decoction of DashmulBharad 1to 3 days.
Procedure of Vamankarma
Selection of Vamanarha patients; ClassicalVamanakarmawas performed and sansarjankarma (Diet Regimen) wasfollowedfor3days.
Procedure of Virechankarma
Selection of Virechnarha patients; Classical Virechanakarma was performed and sansarjanakarma was followed for 3 days.
Procedure of Vastikarma
Selection of patients who were fit for Vastikarma; AsthapanaVasti –classical DashmuladiNiruha,Madhutailik,VaitaranPicchaVasti were given as per clinical condition in Yogvasti format alternately with dose of 500 to1000 mL; AnuvasanaVasti –Tiktaksheer, Goat Majja(bone marrow), or Medicated oils used as per condition in the form of Matravasti or Yogvastiwith dose 75 to 120 mL.
Procedure of Nasyakarma
Selection of patients & conditions, indicated for Nasyakarma; Classical Navan Nasyawas performed by Panchendriyavardhan tail or Anu tail in as per condition with 5 drops in each Nostril.
According to clinical condition and their chronicity Shamana therapies were given as per classics for 1 month. All the patients were studied along with the registration by noting their demographic profile like age, sex,occupation, education, socio-economic status etc. Detailed physical, general and systemic examinations were performed as per textual references.
Criteria of Assessment
During the trial and follow up study, the patients were assessed after completion of treatment and follow up was done.
All the patients under trial were specially asked for any changes or improvement in their growing feeling of wellbeing, either physically or mentally and their clinical manifestation produced by the procedure.
All symptoms to be taken for assessment of clinical improvement in each condition. The incidenceof presenting features were worked out and severity of symptoms was rated in each case.
Obeservations and Result:
In following tables the data is analyzed according to various parameters of observation and results shown(Tables 1-7).
Acid Peptic Diseases
Table 1: Disease wise Distribution of 443 patients of Different chronic Diseases.
Table 2:Age wise Distribution of 443 patients of Various Chronic Diseases.
Table 3:Panchakarma Procedure wise Distribution of 443 Patients.
Table 4:Sex wise Distribution of 443 patients of various Chronic Diseases.
Sedentary life style
Table 5:Occupation wise Distribution 443 patients.
Table 6:Chronicity wise distribution of 443 patients.
Table 7:Result wise Distribution of 443 patients.
Chronic Diseases are compared with YapyaVyadhi in Ayurveda. These are difficult to cure, after a lot of advancement in field of modern medicine, management of chronic diseases are still remaining a challenge.The characteristicfeatures observed during this study are,incidence of different chronic diseases were found in 443 patients in which Arthritis - 132 (29.79%), Diabetes mellitus - 18 (4.06%), obesity- 26 (5.86%), Hypertension- 34 (7.67%), Stroke - 19 (4.28%),APD- 60 (13.54%), Asthma -71 (16.02%), SkinDiseases- 43 (7.70%), others- 54 (12.18%).Incidence of sex in 443 cases were found in male about 247 (55.75%), while in female were 196 (44.24%).Incidence of Panchkarma procedures performed in this study were Vaman-99(15.76%), Virechana-225(35.82%),Asthapana vasti-137 (30.92%),AnuvasanaVasti -102(16.24) while Nasyakarma-65 (10.35 %).
Overall clinical response of 443 cases were found, complete relief In 203 (45.82%), Marked relief in 125 (28.21%),Moderate relief in 99 (22.34%) while No response in 16 (03.61%) cases.It is observed that there are various factors which cause chronic diseases such as excessive tobacco use, lack of physical activity, poor eating habits and sedentary life style.
Probable mode of action of different panchkarma procedures
These procedures cleans the channels by the removal of accumulated waste products ,undigested material and the toxins mainly from gut i.e.upper & middle Gastrointestinal tract (elimination of vitiated Kapha and Pitta Doshas),which removes the obstruction of channels (Shrotorodha) and helps to enhance bioavailability which improves appetite ,power of digestion and absorption of food & drugs.it gives clarity of mind, strength to the sense organs,stability to the tissues and slow down of Ageing Process .
Acharya charaka described that, TasmatchikistardhamitiBruvantiSarvamChikistamapiBastimeke.
It cleans the waste materials which are accumulated in body from cellular level. It revitalize and improves the efficiency of the body also enhances the ageing process.
It pacifies the Doshas, improves the body nutrition and enhances the nonspecific immunity in the body.
Astringent action –it absorbs the fluids in the body.
It improves the weight of lean person.
Lekhanvasti significantly reduces the body weight and lipid profile.
Balatailmatra&madhutailikvasti has improves muscle powers in paralysis patients. It may be due to decrease in cerebral oedema.
It nourishes bone tissues & shown improvement in degeneration of bone tissue and it nourishes the cartilage tissues.
It effects on heamatology; improves Hb%, decrease ESR,increases serum proteins, sero negativity /ASO titre[14,15].
This procedure stimulates vital centers in the brain, clears the channels by draining mucosal secretions and removes congestion, which results in improving cerebral circulation, nourishing the nervous tissues, corrects the neuro-vascular anomalies and improves sensory perception.
There may be a possibility of direct entry of Nasya medicines to CSF (mastulunga), possible transaxonal transportations, Secondary effects of olfactory stimulations-like pheramonal effects(Ghreyaprayoga),Entry to intra cranial space through special venal anastomosis (shringataka).
Chronic diseases are the diseases of long duration and slow progression such as heart disease, stroke, cancer, diabetes, obesity, arthritis, spine disorders, and epilepsy.These are the leading causes of mortality in the world, representing 63% of all deaths.Health damaging behaviors particularly tobacco use, lack of physical activity, poor eating habits and modern life style are major contributors to the leading chronic diseases.In Ayurveda, chronic diseases are the Yapya conditions having unstable features, multiple focus of disease with deep seated pathology, affecting vital organs requiring regular and comprehensivetreatment.
The Ayurvedic approach to prevention and cure of disease swings around two broad principles viz.1) NidanParivarjan i.e. elimination of cause of disease.2). SampraptiVighatan i.e. reversal of pathogenesis. in many early and reversible conditions, SampraptiVighatanaspontaneously follows Nidanparivarjan without any treatment,but in chronic diseases sampraptiVighatana may not occur even after palliative treatment procedures because a vicious circle is set and the system of the body learns to function in a pathological order and as the pathology becomes physiology of the altered state. Therefore a chronic disease is to be treated in a comprehensive manner.
It does not just treat the diseased organs and tissues. It treats and manages Dosha, the biological forces responsible for any kind of pathogenesis in our body and thus reverts the disease mechanism itself. It is also claimed that a disease cured by Shamshodhannever relapse or re-occur, as this therapy eradicates the very root cause of disease.
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