Ayurveda the divine science of life -11

Ayurveda the divine science of life

Chapter 11

TREATMENT OF DISEASE

In reviewing the text thus far you should be familiar

with the dynamics of tridos

˙     

a (Chapter 2), the structure

of dravygun

˙

a (‘pharmacology,’ Chapter 6), vikara

(the ‘causes of disease,’ Chapter 8), da큦avidha

parı칔s

˙

a?(‘case history,’ Chapter 9) and the as

˙

t

˙

a칢tha칗a

parı칔s

˙

a?(‘diagnosis techniques,’ Chapter 10). Chapter

11 introduces the fundamental therapeutic approaches

used in ka칪a cikitsa?(‘internal medicine’), detailing

pa?a karma, rasa칪ana karma and 큦amana

karma.

As mentioned in 6.9 (Karma: therapeutic action),

treatment strategies are described as being of two basic

types:

1. S?odhana: treatment strategies that seek to purify

the body of the accumulated dos

˙

as by direct means.

2. S?amana: treatment strategies that seek to pacify

the aggravated dos

˙

as by indirect means.

The 큦amana therapies are br

˙

mhan

˙

a (‘nourishing’),

langhana (‘depleting’), svedana (‘heating’),

stambhana (‘cooling’), ru칔s

˙

ana (‘drying’) and snehana

(‘moistening’). Unlike the 큦odhana or pa?a

karmas, these therapies are suited for use on an outpatient

basis, but still require an experienced hand in

their administration and appropriate usage. Each of

the 큦amana therapies is used to treat a particular

vikr

˙

ti, or ‘disease’ tendency.

11.1 THE pa˜nca karmas

S´

odhana karmas are commonly referred to as the

pa?a karmas, and are vamana (‘vomiting’), virecana

(‘purgation’), vasti (‘enema’), nasya (‘errhine’),

and rakta moks

˙

an

˙

a (‘venesection’). Pa?a karma is

used in different ways according to the prakr

˙

ti and

the vikr

˙

ti, and thus there is no standard treatment.

OBJECTIVES

● To understand specialised techniques of

physical and mental purification in

A -

yurveda.

● To understand and review therapeutic

techniques to rejuvenate the body.

● To understand and review therapeutic

methodologies in the treatment of disease

in clinical practice.

134 PART 1: Theory and Practice of A¯ yurveda

What follows is only an outline of the basic approaches

in pa?a karma, not an exhaustive exposition of the

many different techniques and procedures that are

used. Pa?a karma is a potentially debilitating therapy

that must be performed under the supervision of

a trained A- yurvedic physician, and is usually followed

by rasa칪ana (‘rejuvenative’) treatments. Pa?a

karma is not a therapy that can be performed on an

out-patient basis and any treatment that claims to be

pa?a karma and is not performed in a hospital or

a similar facility cannot be pa?a karma.

Pa?a karma is performed only after the use of the

pu?rva karmas, specific preparatory measures that

rid the body of a칖a, including include dı칛ana

(‘enhancement of digestion’) and pa칌ana (‘cooking’ of

a칖a), and techniques to mobilise the vitiated dos

˙

as for

elimination, such as snehana (‘oil massage’) and

svedana (‘sudation’).

After an assessment of the prakr

˙

ti and vikr

˙

ti by

the physician the pu?rva karmas are begun. Pu칞va

karmas are essential to prime the dos

˙

as for their subsequent

removal during pa?a karma, to promote the

movement of a칖a and the dos

˙

as from the ‘tissues’ of

the body (shakha) to the ‘digestive tract’ (kos

˙

t

˙

ha) for

elimination. Sometimes the pu?rva karmas are the

only treatments employed, a technique that is especially

common in the Keraliya school of A - yurveda.

11.2 Pu-rva karmas:a - mapa-cana

As mentioned previously, pa?a karma is begun only

once the body has been purified of a칖a, called

a칖apa칌ana. To this end an A- yurvedic physician uses

two distinct classes of remedies:

● Dı칛ana: remedies that stimulate agni

● Pa칌ana: remedies that have a special capacity to

cook or ‘digest’ a칖a.

In almost all cases an a칖apa칌ana remedy will

contain aspects of both dı칛ana and pa칌ana. These

remedies are often given along with ghr

˙

ta, which has

a special capacity to bring a칖a to the digestive tract.

Normally ghr

˙

ta is contraindicated in a칖a conditions

because it tends to weaken agni due to its guru

(‘heavy’) and snigdha (‘oily’) properties, but in this

case is used as a medicine to coax a칖a from the tissues

to the digestive tract. A- yurvedic physicians

employ a number of remedies in a칖apa칌ana, including

cu?rn˙

a (‘powders’), gut

˙

ika?(‘tablets’), kva칣ha

(‘decoctions’), ghr

˙

ta (‘medicated ghr

˙

ta compounds’),

and asava/aris

˙

t

˙

a (‘natural fermentations’). These

include:

● Cu?rn˙

a: Trikat

˙

u cu?rn˙

a, Avipattika칞a cu?rn˙

a,

Hingvas

˙

t

˙

aka cu칞n˙

a

● Gulika: Citraka칍i vat

˙

ı¯, Agnitun

˙

d.

ı?vat

˙

ı¯,

Gandha칔a vat

˙

ı¯

● Kva칣ha: Pippalya칍i kva칣ha, Jı칞aka칍i kva칣ha,

Dha칗ya칛a?aka kva칣ha

● Ghr

˙

ta: Pippalya칍i ghr

˙

ta, Dra칔s˙

a칍i ghr

˙

ta,

S´

u칗

˙

t

˙

hı?ghr

˙

ta

● Asava/aris

˙

t

˙

a: Pippalya칍ya칢ava, Da큦amu?la

aris

˙

t

˙

a, Jı칞aka칞is

˙

t

˙

a.

While these formulas have long been used in A- yurveda,

simpler formulations can also be used, composed

of dı칛anapa칌ana herbs such as S?u칗

˙

t

˙

hı?dried rhizome

(Zingiber officinalis), Pippalı?fruit (Piper longum),

Harı칣akı?fruit (Terminalia chebula) and Yava칗ı?fruit

(Trachyspermum ammi). A number of other non-Indian

herbs can also be used in a칖apa칌ana including

Bayberry bark (Myrica cerifera), Cayenne fruit (Capsicum

annuum), and Barberry root (Berberis vulgaris).

A¯

mapa칌ana is given over a period of several days,

up to 2 weeks, with a strict attention to diet, avoiding

foods that promote kapha, i.e. those that contain 큦ita

(‘cold’), guru (‘heavy’), snigdha (‘oily’), and picchila

(‘sticky’) properties (e.g. flour products, dairy, oily

foods, excessive meat, sweets, excess fruit, etc.). When

a칖apa칌ana is performed properly the appetite will be

noticeably improved, eliminatory functions will normalise

and there will be a feeling of lightness and

renewed energy. While a칖apa칌ana is used therapeutically

as a preparatory measure for pa?a karma, it

can also be used periodically as a preventative approach

to eliminate a칖a and enhance agni.

11.3 Pu-rva karmas: snehana

(OLEATION)

After a칖apa칌ana has been successfully implemented

the next stage in pu?rva karma is snehana therapy, or

oleation, used to mobilise the dos

˙

as from their respective

locations in the body so they can be eliminated

during pa?a karma. According to A- yurveda, oil has

a special capacity to move into the most minute

srota칖. si (‘channels’) of the body and influence the

Treatment of disease 135

activity of the dos

˙

as. A number of different oils, both

unprocessed and medicated, are used in snehana

therapy, the most common of which is taila (‘sesame

oil’) and the various medicated preparations made

from it. The As

˙

t

˙

a?ga Hr

˙

daya mentions a number of

other oils, however, that can also be used in snehana,

including ghr

˙

ta, vasa (‘animal fat’), and majja¯

(‘marrow fat’). Beyond these, A- yurvedic practitioners

have added a number of other oils to take advantage of

their different qualities, including coconut oil, almond

oil and castor oil. In most cases, however, the oil used

is taila or ghr

˙

ta, often medicated with different herbs

to yield a distinct therapeutic activity.

Snehana therapy has a number of indications and

contraindications, depending on the signs and symptoms

of the patient, the qualities of the oil to be used,

and the season and climate. Generally speaking,

snehana therapy is best in va칣tika and paittika conditions,

and is generally contraindicated in kaphaja

conditions. Taila is best used in va칣tika conditions,

and to a lesser extent in kaphaja conditions, and is

often contraindicated in paittika conditions. Ghr

˙

ta is

best used in va칣tika and paittika conditions, and

is often contraindicated in kaphaja conditions. Both

vasa and majja?are only really used in va칣tika conditions,

majja?being the heaviest and most nourishing

of the oils. Generally speaking, snehana therapy

should only be undertaken when the weather is warm

and the sky is clear, and is avoided in both very hot and

very cold weather.

Snehana consists of both external and internal

therapies, ensuring that there is a complete penentration

of the oils throughout the entire body. The following

details both external and internal snehana.

External snehana

The most common form of external snehana is

abhyan . ga, in which a fairly large volume of oil

(250–1000 mL) is massaged over the entire body,

either a plain oil such as sesame or ghr

˙

ta, or a specific

medicated oil. Typically the oil is applied at room temperature

but may be used at higher temperatures in

va칣tika conditions. In such cases where warm oil is

used, relatively stable oils such as sesame, olive, ghr

˙

ta,

vasa or majja?should be used in preference to oils rich

in polyunsaturated fats such as hemp, flax, safflower

and sunflower, which tend to go rancid quickly. For

each patient the oil is re-used over a 3-day period

before it is discarded.

While abhyan . ga can be performed on a normal

massage table covered with a sheet to soak up the

excess oil, specially constructed tables called taila

dron

˙

i are used in India, traditionally carved from

a solid piece of wood from species such as Panasah.

(Artocarpus integrifolia), Nimba (Azadirachta indica) or

Ulkat.ah.

(Polyalthia longifolia). Although there are several

different kinds of taila dron

˙

i, the basic dimensions

are 228 cm long by 76 cm wide.26 The table

comprises two sections: one where the head rests, and

the other where the body lies. Under the head portion

is a basin carved into the wood that collects the oil

applied to the head, and along the sides of the body

portion are channels carved into the wood that collect

the excess oil, which drains into a hole at the bottom.

In order to facilitate the movement of the oil

downwards the table is slightly elevated at the head,

and after the session the excess oil is scraped from the

table into the drainage channels and collected in a

vessel underneath the drainage hole. A traditionally

made taila dron

˙

i is quite expensive, even in India,

and such tables are hard to come by in the West. As a

result, a table can be made with other woods that are

more easily obtainable – or even heat-resistant fibreglass.

The application of the oil in abhyan . ga can vary

depending upon the need. In both va칣tika and kaphaja

conditions the oil is applied quite warm, whereas the

oil in paittika conditions is applied at room temperature.

When the oil is applied to the head, however, the

oil is always applied at room temperature. Abhyan.ga

is typically performed with two or four practitioners,

one or two on each side of the patient’s body working

in tandem, but it can also be done with just one practitioner.

The patient must be unclothed, and as a result

the room must be quite warm. For the added warmth

and comfort of the patient a sheet can be draped over

the areas of the body not being worked on.

There are six basic positions that are used in

abhyan . ga, with the patient’s head pointing in an

easterly direction:

● Seated position: the patient sits upright and the oil

is rubbed into the head, ears and neck.

● Supine position: the patient lies face up and the oil

is massaged into the chest, and anterior portions of

the arms, legs and feet.

136 PART 1: Theory and Practice of A¯ yurveda

● Left lateral position: the patient lies on the left side of

the body, and the oil is rubbed into the right sides of

the torso, arms, legs and feet.

● Prone position: the patient lies face down and the oil

is massaged into the back, and posterior portions of

the arms, legs and feet.

● Right lateral position: the patient lies on the right

side of the body, and the oil is rubbed into the left

sides of the torso, arms, legs and feet.

● Seated position: the patient again sits upright and

the oil is rubbed into the head, ears and neck.

When the oil is applied to the head first, working

down towards the feet, the effect is to relieve pain.

Abhyan.ga can also be administered by applying the

oil to the feet first, however, moving up the body and

finishing with the head. This latter method is more

appropriate to ground or centre the patient in mental

or emotional stress.

There are a number of different massage techniques

used in abhyan . ga depending upon the prakr

˙

ti and

vikr

˙

ti of the patient. Mardana is the use of vigorous,

deep massage strokes, used more often in kaphaja or

pitta-kaphaja conditions, when the patient’s body is

thick and heavy. Sanvahana is the application of gentle,

light massage strokes, used more often in va칣tika

conditions when the patient’s body is thin and light.

Other techniques include:

● pidhana: patting and beating with the flat of the

hand, used to relieve pain and spasm

● avapidhana: thumb pressure, to enhance circulation

● uthve큦tana: circular movements, used over large

joints to reduce va칣a

● paripidhana: gently beating and rubbing the body

with the bottom part of the closed fist, to invigorate

the body

● ma칖. sa mardana: rolling a smooth wooden or

copper dowel with both hands over the muscles, to

relieve pain and congestion.

Other massage techniques such as lymphatic

drainage, myofascial release, reiki, polarity and cranial

sacral therapy can all be used in abhyan . ga. Care

should be taken to ensure that the oil is well absorbed

by the patient’s skin and particular attention should be

paid to the major joints of the axillary skeleton, including

the shoulders, elbows, wrists, hands, hips, knees,

ankles and feet.

Generally speaking, certain herbs are best used in

the preparation of a medicated oil in the treatment

of a specific dos

˙

a or dos

˙

as (see 6.11 Bhais

˙

ajya

vya칔hya칗a: principles of pharmacy):

● To reduce va칣a, warming and strengthening herbs

such as Bala?root (Sida cordifolia) and A큦vagandha¯

root (Withania somnifera) can be used to medicate the

oils. Formulations to reduce va칣a include Da큦amu칕a

taila, Na칞a칪an˙

a taila and Bala?taila.

● To reduce pitta, cooling and anti-inflammatory

herbs such as Nimba bark (Azadirachta indica),

Ma?is

˙

t

˙

ha?root (Rubia cordifolia) and S?ata칥arı?root

(Asparagus racemosa) can be used to medicate the oil.

Examples of formulations to reduce pitta include

Candana칍i taila, Ks

˙

irabala?taila and S?ata칥arı¯

ghr

˙

ta.

● To reduce kapha, pungent and clearing herbs

such as Pippalı?fruit (Piper longum), Guggulu

resin (Commiphora mukul) and S?u칗

˙

t

˙

hı?rhizome

(Zingiber officinalis) can be used to medicate the oil.

Examples of formulations to reduce kapha include

Sahacara칍i taila and Da큦amu?la taila.

Abhyan.ga is used prior to and in between each

pa?a karma treatment. In most circumstances,

abhyan . ga is applied every 12 hours over a 4-day

period before vamana (‘emesis’) is begun. Prior to

virecana (‘purgation’), abhyan . ga is again implemented

every 12 hours over a 3–8 day period.

Thereafter abhyan . ga preceeds the application of both

vasti (‘enema’) and nasya (‘errhine’) on each separate

occasion they are administered.

Other forms of external snehana include dha칞a¯,

큦iro dha칞a¯, 큦iro vasti, picu, pizhichil, kati vasti, and

kavalagraha. Dha칞a?(‘dripping’) is the application of a

constant stream of oil over a specific area of the body,

whereas 큦iro dha칞a?(‘head dripping’) is the application

of a continuous stream of oil over the area between the

hairline and the eyebrow (i.e. the a칓??cakra). The kind

of oil used in dha칞a?or 큦iro dha칞a?is dependent upon the

signs and symptoms of the patient. Commonly used

herbs to make medicated oils used in 큦iro dha칞a?include

Bala?root (Sida cordifolia), A큦vagandha?root (Withania

somnifera), and Bra칑mı?leaf (Bacopa monniera), prepared

in taila, ghr

˙

ta, milk, buttermilk or water.

Important formulas include Candana칍i taila, Bala¯

taila, Jyotis

˙

matı?taila and Nı칕ı칋hr

˙

n .

ga칍i taila.

Among the more common preparations in 큦iro dha칞a?is

Ks

˙

irabala?taila, which comprises:

Treatment of disease 137

● Bala?root (Sida cordifolia), 4 parts (by weight)

● Bala?root kalka (paste), 1 part (by weight)

● taila, 4 parts (by volume)

● cow’s milk, 4 parts (by volume)

● water, 64 parts (by volume).

The above ingredients are mixed together and boiled

until only one-quarter of the volume remains. The

preparation is then strained, cooled and bottled for

later use.

Both dha칞a?and 큦iro dha칞a?are traditionally performed

by the use of a broad-bottomed pot called

a dha칞a?pa칣ra, made from clay, wood or metal, with

a capacity of about 2–3 litres. The dha칞a?pa칣ra is

securely suspended over the patient’s body at a distance

of about 20 cm. Inside this suspended vessel is

a hole through which a cotton wick is placed. The

wick is tied to half a ripe coconut shell that has little

grooves fashioned on its edge to allow the oil to pass

underneath it, through the hole, down the wick. In

this way the coconut shell regulates the flow of oil in

the dha칞a?pa칣ra down the wick. The distance of the

cotton wick from the body should be no more than

four finger-breadths (6–8 cm). To ensure that the oil

moves down the wick properly it should be premoistened

beforehand by soaking it in oil.

After abhyan . ga, the dha칞a?pa칣ra is positioned

over the location to be treated, such as the large joints,

or locations on the spine that correspond to specific

cakras. In 큦iro dha칞a?the dha칞a?pa칣ra is positioned

over the patient’s forehead and a bandha칗a is rolled

up and loosely tied around the patient’s head just at

the eyebrow level or over the eyes to prevent the oil

from seeping into them. The oil is then placed into the

dha칞a?pa칣ra and as the oil streams down onto the

patient’s forehead the dha칞a?pa칣ra is moved back and

forth so that the stream of oil slowly migrates from

one side to the other. The path of the oil should not be

moved back and forth across the patient’s forehead in

a straight line, but rather, follow a meandering zigzag

path: if it is done in a straight line it is thought to disturb

the mind. As the oil washes down across the body

it is collected into a basin that lies below the body part

being treated, or in the case of 큦iro dha칞a¯, a basin that

is carved into or attached to the table itself. The oil is

then scooped up with half of a coconut shell and

poured back into the suspended dha칞a?pa칣ra. Thus

dha칞a?traditionally requires two practitioners, one to

regulate the stream of oil across the patient’s forehead

and the other to scoop the oil back into the vessel.

An innovation on this traditional method is an electric

pump that collects the oil from the basin and pumps it

back up to the dha칞a?pa칣ra with a hose, avoiding the

need for two people. As the oil is collected it may

need to be reheated, depending on the body part

treated.

Dha칞a?is typically performed during the va칣a

dominant times of day, in the early morning or late

afternoon, between 30 and 90 minutes: longer in

va칣tika conditions, a medium amount of time in

paittika conditions, and only for a short time

in kaphaja conditions. S?iro dha칞a?is typically

administered over a period of 7–14 days, but for no

more than 21 days. Although 큦iro dha칞a?is a pu?rva

karma it is also a stand-alone treatment, used in

EENT disorders, vertigo, insomnia, headaches and to

correct the flow of pra칗

˙

a va칪u. It may also be used

in the treatment of mental disorders such as anxiety,

depression, schizophrenia and epilepsy. S?iro dha칞a¯

is contraindicated in fever and it is recommended

that the patient avoid sleep for some time (3–5 hours)

after treatment in order to prevent the aggravation of

kapha. Figure 11.1 S ’ iro dh¯ara¯ .

138 PART 1: Theory and Practice of A¯ yurveda

S´

iro vasti is another snehana technique that is

applied to the head. In this technique a wide leather

band about 40 cm high is placed around the patient’s

head and stitched together to essentially make a kind

of vessel. Inside this vessel is placed a paste of flour to

seal the cracks that lie between the band and the

patient’s head. Once this is done a large volume of

medicated oil is then poured over the head where it is

contained by the leather band and penetrates into the

scalp. In most cases patients are required to cut their

hair quite short or shave their head prior to the therapy.

S´

iro vasti treatment usually lasts between 30

and 45 minutes and is performed in the early morning

or late afternoon during the va칣a time of day. S?iro

vasti is used to treat diseases such as facial paralysis,

insomnia, alopecia, sinus disorders, migraines and

psychiatric disorders. Dravyas used to medicate the

oils used in 큦iro vasti are similar to those used in 큦iro

dha칞a¯. Specific medicated oils used in 큦iro vasti

include Bhr

˙

n .

gara칓a taila, Bala칍ha칣rya칍i taila

and Nı칕ı칋hr

˙

n .

ga칍i taila.

Picu is the use of a piece of linen that has been

soaked in a medicated oil and is applied over the head.

A bandha칗a is then tied over the top of this linen to

hold it in place. The types of oil used in picu are similar

to those used in 큦iro dha칞a?and 큦iro vasti.

Pizhichil is somewhat similar to dha칞a¯, but is

really a combination of both snehana and svedana

techniques. The masseuse soaks a piece of linen in

a bowl of very warm oil and wrings it out over the top

of the patient. The masseuse may focus on specific

areas of the body, such as the hips, or it may be a generalised

application. It is best to have at least two people

administering pizhichil, one to administer the

treatment and the other to collect the oil, warm it back

up to the desired temperature, and make it available

for the masseuse to use.

Kati vasti is the application of medicated oil over

the kati, the lumbar and sacral region of the back.

Apaste is made from urad bean flour and is formed into

a circular wall that circumnavigates the lower back

region to form a vessel. A very warm medicated oil such

as Gandha칞vahasta taila or Pin

˙

d.

a taila is placed

inside this vessel, and is allowed to soak into the skin for

30 minutes. As the oil cools it is removed with

absorbent cloths and replaced with warm oil. Kati

vasti is indicated in lumbago and sciatica. This technique

can also be performed on any part of the body.

When it is applied in the eyes it is called netra vasti, in

which case simple oils such as ghr

˙

ta are used in the

treatment of opthalmologic disorders, but also medicated

oils such as Triphala ghr

˙

ta and herbal decoctions.

Note, however, that the oils used in netra vasti

are never used warm or hot. Applied over the chest this

technique is called hr

˙

daya vasti, and medicated oils

such as Dha칗vantara taila are applied in the treatment

of heart disease.

Kavalagraha is the use of a decoction (ka큦a칪a

kavalagraha) or medicated oil (sneha kavalagraha)

as a mouthwash. Ka큦a칪a kavalagraha is used in oral

diseases such as gingivitis, apthous ulcers and tooth

decay. Examples of herbs used in ka큦a칪a kavalagraha

include Nimba leaf (Azadirachta indica),

Guggulu resin (Commiphora mukul), Haridra?rhizome

(Curcuma longa) and Triphala cu칞n˙

a. Used concurrently

with the application of medicated oils massaged

into the head and neck, sneha kavalagraha is helpful

in temporomandibular joint (TMJ) syndrome.

Karn˙

a tarpan

˙

a is the instillation of a medicated oil

into the ears (karn˙

a) in the treatment of disease of

the ear. In the treatment of otitis media kapha and

pitta reducing herbs are used to medicate the oil, such

as Guggulu resin (Commiphora mukul), Haridra?rhizome

(Curcuma longa) and La큦una bulb (Allium

sativum). In conditions such as tinnitus va칣a reducing Figure 11.2 S ’ iro vasti.

Treatment of disease 139

herbs are used to medicate the oil, such as Bala?root

(Sida cordifolia).

Because abhyan . ga and oleation therapies are

primarily a treatment for va칣a, not all patients require

oil. Two techniques, ghars

˙

ana and udavartana, are

best suited to relieving pitta and kapha. Ghars

˙

ana

makes use of special gloves of raw silk, worn by

the masseuse. It is best for relieving the symptoms

of excess kapha and has a stimulating and

invigorating effect on the body. Udavartana is the

application of certain herbal powders, such as Gud.u칌ı¯

vine (Tinospora cordifolia), Guggulu resin (Commiphora

mukul), Triphala or Trikat

˙

u cu?rn˙

a to relieve

kaphaja conditions such as lymphatic congestion,

cellulite, oedema and obesity. Sometimes udavartana

is used after external snehana, especially in va칣akapha

or va칣a sa칖a conditions.

Other external techniques include avaga칑a

(‘baths’) and lepana (‘poultice’). Avaga칑a includes

both whole-body baths and local applications such as

sitz baths. Lepana involves the use of a paste prepared

from powdered medicinal plants and applied to the

body. S?iro lepana (‘head poultice’) is the application

of a herbal paste to the middle of the head in the treatment

of central nervous system disorders such as multiple

sclerosis, paralysis and parkinsonism. One 큦iro

lepana recipe used in disorders of the central nervous

system calls for equal parts of the recently dried finely

sieved powders of Man

˙

d.

u칔aparn˙

ı?leaf (Centella asiatica),

A¯

malakı?fruit (Phyllanthus emblica) and

Candana wood (Santalum album), mixed together with

cool milk to make a thick paste. The paste is applied

over the shaved head of the patient, and is allowed to

sit for 1–2 hours, once daily.

Internal snehana

Internal snehana therapy, or snehapa칗a (‘oil drinking’),

is the internal application of progressively

larger amounts of oil, used concurrently with external

oleation techniques such as abhyan . ga. The purpose

of snehapa칗a is similar to the external

application of oil, to loosen and liquefy a칖a from the

ba칑ya rogayana (‘outer pathway’) and madhyama

rogama칞ga (‘middle pathway’), and draw it to the

a?arma칞ga (‘inner pathway’, gastrointestinal tract)

Figure 11.3 Kati vasti.

140 PART 1: Theory and Practice of A¯ yurveda

for elimination. Additionally, snehapa칗a therapy

lubricates the gastrointestinal tract for the elimination

of a칖a and the dos

˙

as during pa?a karma. Any

kind of appropriate oil may be used for this purpose,

but the safest oil is ghr

˙

ta. Taila, or sesame oil, is best

used in the treatment of tumours, sinus ulcers, parasites

and kaphaja or va칣tika conditions. Vasa (muscle

fats) and majja?(marrow fats) are best used in the

treatment of va칣tika conditions, excessive sexual

activity, cachexia, exhaustion, abdominal pain, burns,

earaches and headaches. In the West, olive oil is commonly

used to treat gall bladder disease and also has

utility in A- yurvedic medicine.

There are two forms of snehapa칗a: vicarana?and

acchapa칗a. In vicarana?snehana, only a small

amount of oil is consumed, mixed with the dietary

articles such as rice, broth, meat, milk, vegetables, etc.

The effect is limited and takes a much longer period of

time to be efficacious. It is indicated specifically in persons

who have an aversion to fats and oils, when agni

is weak, when kapha predominates, in a mr

˙

du

kos

˙

t

˙

ha, or in cholelithiasis, all of which are contraindications

for acchapa칗a snehana.

Acchapa칗a snehana is the consumption of an

oil in large volumes over a maximum period of 7 days,

50 mL the first day, with each successive day adding

50 mL until a maximum total of 350 mL of oil is consumed

on the seventh day. The number of days of

administration and hence the amount of oil consumed

depends upon the nature of the digestive tract: when

the kos

˙

t

˙

ha (‘bowel’) is mr

˙

du (‘soft’), treatment is limited

to 3 days; when the kos

˙

t

˙

ha (‘bowel’) is madhya

(‘medium’), treatment is limited to 5 days; when the

kos

˙

t

˙

ha (‘bowel’) is kru칞a (‘hard’), treatment can be

implemented to the maximum of 7 days (for a description

of the different types of kos

˙

t

˙

has see 4.1 Agni: the

fire of digestion and metabolism). After the consumption

of the oil, a little warm water is drunk and the

patient does not eat until hunger returns and their

belches are free of the taste of the oil. Acchapa칗a

sneha is performed early in the morning or late in the

afternoon, when va칣a predominates. Foods to be taken

the day before administration and after the digestion of

the oil should be soupy, warm and bland, such as rice

and mu칗g bean soup. The signs of properly administered

acchapa칗a are increased appetite after therapy,

fatty and semi-solid faeces, aversion to fatty foods,

and lassitude. Symptoms of excessive snehapa칗a

include lacrimation and mucus congestion, as well

as a yellowish-white pallor. Acchapa칗a should be

used with extreme care in liver disorders and

cholelithiasis.

According to Hindu belief, fats and oils are generally

associated with Laks.mı¯, the goddess of prosperity,

wealth and fortune. Thus the use of oil brings this

quality of abundance to the body, and herbs medicated

in oil are potentised in the way. Based on this property,

fats and oils are br

˙

mhan

˙

a and are thus indicated as a

큦amana treatment in deficiency conditions. Where

there is excess and the need for langhana therapies,

both the topical and internal use of snehana therapies

should be avoided or used sparingly.

11.4 Pu?rva karmas: svedana

(SUDATION)

The last component of the pu?rva karmas is svedana,

or sudation therapy. Svedana therapies are used after

snehana therapies to maximise the absorption and

effect of the medicated oil, and to further mobilise the

dos

˙

as for elimination. Svedana therapies enhance

agni and communicate its activity from the digestive

tract outwards to the skin. Svedana is a particularly

helpful therapy in both va칣tika and kaphaja conditions,

but may be contraindicated where pitta predominates,

including inflammatory conditions of the

nervous system such as multiple sclerosis.

Any number of svedana techniques may be used,

dependent upon the condition, but they can be broadly

separated into ru칔s

˙

a (‘dry’) and snigdha (‘wet’) applications.

In any sudation technique, however, it is

important that the head and eyes are protected from

the heat. Dry sudation techniques such as a dry sauna

are used in kaphaja conditions but are typically

avoided when va칣a is aggravated. In dry saunas a

moist towel or cloth can be placed over the head to keep

it cool. Wet sudation techniques are employed by the

use of a svedana chamber or tent that covers the body

(but not the head) of the patient lying on the massage

table and into which steam is channelled. Even simple

techniques such as covering the patient from the neck

down with a blanket and placing a steaming pot of

water underneath a chair that the patient sits on can

be helpful. If a proper svedana chamber is not available

a steam bath or sweat lodge is an acceptable alternative,

or if these cannot be found, a hot shower. Other

forms of svedana include sunbathing, which is particularly

helpful in skin conditions such as leprosy and

psoriasis, and vigorous exercise.

Treatment of disease 141

Svedana treatments can also be localised rather

than the more generalised treatments described above,

and can utilise steam from sources other than boiling

water. One technique called na칍. ı?sveda involves the

collection of steam from a herbal decoction, such as

Bala?root (Sida cordifolia) decocted in milk. In this

case the steam is collected with a rubber surgical hose

attached to a spout on a pressure cooker. The steam is

then directed to the specific area that requires attention,

or is generally distributed across the body. Special

care must be taken not to hold the hose too close to the

skin to avoid burning the patient.

Another svedana technique that is commonly used

is pind.a sveda, used after abhyan . ga. Pind.a sveda

involves the use of legumes and grains such as urad,

rice, oats and barley that are cooked until very soft in

a previously prepared herbal decoction. Once cooked

and the water evaporated away the mixture is tied in

linen to make little balls or pind.a about the size of one’s

palm. Prior to treatment the pind.a are soaked in a very

warm decoction or oil, and while they are still quite

warm the pind.a are stroked over the body, the force of

the strokes causing some of the contents and the moisture

of the pind.a to escape onto the skin. To ensure that

the application is even at least two attendants should

perform the massage, standing on either side of the

body, mirroring each the other’s actions. As the pind.a

loses its moisture it can be put back into oil or decoction

and be used again during the session. Any number of

herbs may be used to medicate the pind. a, depending on

the condition being treated and the dos

˙

a or dos

˙

as that

predominate. Pind. a sveda is an invigorating and

strengthening procedure that helps to both stimulate

agni and promote the digestion of a칖a. It is used therapeutically

in conditions such as depression and fatigue,

and in the treatment of arthritis. Pind.a sveda is performed

on alternate days up to a maximum of 28 days.

Still another svedana method is the use of heated

saindhava, or rock salt, roasted until brown and

applied to the body at a tolerably warm temperature. It

is both stimulating as well as liquefying to kapha, and

promotes the elimination of a칖a. Sometimes saindhava

is added to a taila to achieve a similar effect.

11.5 Pa?a karma: vamana (EMESIS)

Vamana, or emetic therapy, is usually the first of the

pa?a karmas to be implemented, and is a treatment

given specifically to kapha. If we recall from 2.4

(Stha칗a: residence of the dos.

as), kapha resides in

the upper portions of the body, in the kapha stha칗a.

Vamana therapy marshals the upward-moving activity

of uda칗a va칪u, acting from the diaphragm

upwards to eliminate excess kapha via the mouth.

Vamana therapy is only used during in the morning

when kapha predominates, after snehana and

svedana.

Vamana is a technique that must be carefully

supervised and is conducted only when the patient

fully understands and accepts the process to be undertaken.

The emetic dravyas given to induce vomiting

can be harsh, and as vamana utilises the upwardmoving

energy of uda칗a va칪u it can also aggravate

va칣a, causing apa칗a va칪u to move upwards and

weaken agni (uda칥arta).

Within the classical texts recommendations are

given for the number of bouts of vomiting and the

number of days during which vamana should be

implemented. Typically, vamana is used for 3 days in

va칣tika conditions, with no more than four bouts of

vomiting per day; 5 days in paittika conditions, with

no more than six bouts of vomiting per day; and

7 days in kaphaja conditions, with no more than

eight bouts of vomiting per day. In each vamana

session the therapy is ceased when the patient vomits

the same volume of liquid that was originally

consumed immediately prior to emesis, or when the

vomit itself is yellowish in colour (indicating the

elimination of pitta).

Vamana therapy is especially indicated by

kaphaja symptoms such as sluggish digestion, a thick

coating on the tongue and mucus congestion, and

may be safely performed by most people if performed

only occasionally, and not more than once per season.

Vamana therapy is avoided in weakness, debility,

malabsorption syndromes, constipation, intestinal

parasites, pregnancy, fever, coryza, rhinitis, pharyngitis,

tracheitis, and in the elderly. Vamana therapy is

also contraindicated in those persons who have a

particular aversion to or fear of vomiting. It is essential

for the patient to relax during the therapy, allowing

the oesophagus to be free of any kind of muscular

constriction.

The evening prior to vamana therapy the patient

should be directed to consume a meal of fatty and

sweet foods that aggravate kapha, such as gruel

prepared from rice, urad bean, sesame seed, meat or

fish. Upon rising the next morning, the patient is

given a weak of decoction of Yas

˙

t

˙

imadhu root

142 PART 1: Theory and Practice of A¯ yurveda

(Glycyrrhiza glabra) to drink, consuming between one

and two litres. The patient is instructed to consume

this preparation as quickly as possible, and after 10

minutes the patient is given a vamana formula, such

as the following:

● Madanaphala fruit (Randia dumetorium) powder,

6–10 g

● Vaca?rhizome (Acorus calamus) powder, 3–5 g

● honey, 20 mL

● saindhava, 3–5 g

● milk or warm water, 100 mL.

The above ingredients should be mixed well and then

administered immediately. In this recipe both

Madanaphala and Vaca?act as emetics and should

be adjusted based on the age and strength of the

patient, and the dos

˙

a or dos

˙

as that predominate. If

given in full doses these herbs will promote a more

profound emesis, suitable for kaphaja conditions

and in those who are strong; if given in smaller

quantities the emetic activity will be less, which is

better in va칣aja conditions, and in persons who are

weak.

After the administration of the vamana formula

the patient is positioned over a large bowl or bucket,

and induced to vomit by having them place their index

and middle fingers of the right hand down the throat,

with the left hand gently massaging the stomach in

a counter-clockwise direction. If this technique does

not induce vomiting within a few minutes, an

additional dose of the vamana formula can be

administered, or another standard emetic such as

Syrup of Ipecac. Upon emesis there will be voiding of

much liquid, mucus (kapha), undigested food, and, at

the end, a yellowish bilious secretion (pitta). After

vamana therapy the patient should lie down for

10–20 minutes, and afterwards drink small amounts

of a mild dı칛anapa칌ana remedy such as weak Ginger

tea. After a few hours the patient can consume a small

amount of rice or some vegetable soup, and make sure

to rest for the remainder of the day. If vomiting is not

successfully induced the result is usually virecana, or

purgation.

When vamana is properly administered the

patient will have little difficulty in vomiting, there will

be a feeling of physical lightness, enhanced sensory

acuity, the appearance of hunger, and an improvement

in disease symptoms. Features of inadequate or

asamyaka vamana include an inability to vomit,

heaviness of the body with itching, eruptions and

burning sensations, and an increase in catarrh. In

such cases the patient is either given the vamana

dravyas again, or is required to fast for the rest of that

day. Features of excess or atiyoga vamana include

weakness, excessive belching, cough, hiccough, dyspnoea,

dry heaves, confusion, thirst, jaw pain, throat

constriction, fainting, haematemesis and diarrhoea.

In such cases the patient is sprinkled with cold water

after massaging them with ghr

˙

ta, and given a

drink prepared with sugar and honey. In cases of

haematemesis the patient should be given haemostatic

dravyas such as Na칐ake큦ara flower (Mesua ferrea) or

Va칢aka leaf (Adhatoda vasica) to stop the bleeding.

Additional measures include the use of 큦ulapra큦amana

or antispasmodic dravyas such as Jı칞aka fruit

(Cuminum cyminum) and Dha칗yaka fruit

(Coriandrum sativum), and demulcents such as

Yas

˙

t

˙

imadhu root (Glycyrrhiza glabra). In the case

of diarrhoea the patient needs to be monitored for

electrolyte loss, and can be given oral rehydration

therapy consisting of a thin rice gruel.

 

Om Tat Sat

                                                        

(Continued...) 

(My humble salutations to   Sreeman Todd Caldecott, Elsevier’s Health Sciences and others other eminent medical scholars and doctors   for the collection)