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)
0 comments:
Post a Comment