Ayurveda the divine science of life -12

Ayurveda the divine science of life

11.6 Pa?a karma: virecana

(PURGATION)

Virecana or purgation therapy is generally instituted

after vamana is complete. It is considered to be

a treatment to both pitta and kapha, as well as the

hepatobiliary system and the small intestine,

expelling the vitiated dos

˙

as by force via the large

intestine and anus. Although virecana is an important

component of pa?a karma, it is specifically

stated to be helpful in the treatment of a number of

diseases, including chronic fever, skin conditions

such as leprosy, certain digestive disorders such as

constipation, parasites and haemorrhoids, jaundice,

ophthamological disorders, inflammatory joint

disease, and genitourinary tract disorders. Virecana

is contraindicated in wasting diseases, fatigue,

weakness, indigestion, diarrhoea, intestinal or rectal

prolapse, acute fever, colds and flus, heart disease and

pregnancy. Like vamana, virecana is a potentially

debilitating therapy and should be administered only

with experienced supervision.

Specific guidelines are given in the classical texts for

the types of virecana dravyas that are administered,

Treatment of disease 143

depending upon bala?(‘strength’), vikr

˙

ti (‘disease’),

and prakr

˙

ti (‘constitution’) of the patient, and

whether the patient has a kru칞a (‘hard’), madhya

(‘medium’) or mr

˙

du (‘soft’) kos

˙

t

˙

ha (‘bowel’). In the

case of a kru?ra kos

˙

t

˙

ha, i.e. va칣a, dravyas used in

virecana should have a snigdha (‘oily’) and us

˙

n˙

a

(‘hot’) quality, such as Eran

˙

d.

a seed oil (Ricinus communis)

or A?ragvadha fruit (Cassia fistula), mixed

with dravyas such as Pippalı?(Piper longum) and

saindhava. Initiating purgation in a kru?ra kos

˙

t

˙

ha,

however, can be difficult, and as a result such measures

are often combined with more powerful purgatives

such as Jayapa칕a fruit (Croton tiglium) and

큦ulapra큦amana (‘antispasmodic’) dravyas such as

S´

u칗

˙

t

˙

hı?rhizome (Zingiber officinalis) to prevent griping.

For a madhya kos

˙

t

˙

ha, i.e. kapha, the dravyas

are similarly us

˙

n˙

a but have more of a ru칔s

˙

a (‘dry’)

quality, and are given in smaller amounts. Examples of

dravyas used for a madhya kos

˙

t

˙

ha include Trivr

˙

t

root (Operculina turpethum), Harı칣akı?fruit (Terminalia

chebula) and Kat

˙

uka rhizome (Picrorrhiza kurroa),

combined with dı칛anapa칌ana dravyas such as

S´

u칗

˙

t

˙

hı?rhizome (Zingiber officinalis) and Pippalı?fruit

(Piper longum). In the case of a mr

˙

du kos

˙

t

˙

ha, i.e.

pitta, purgative dravyas such as Trivr

˙

t are given in

comparatively smaller doses, along with medications

that have 큦ita (cool) quality, such as a decoction or

juice of Dra칔s

˙

a?fruit (Vitis vinifera), A칖alakı?fruit

(Phyllanthus emblica), Udı칌ya root (Pavonia odorata),

and Candana bark (Santalum album). Among the

purgative dravyas Trivr

˙

t is considered to be the best

and safest, and when used in the appropriate dosage

and combined with the appropriate dravyas, can be

used in almost all patients. The following is an example

of the appropriate use and dosage ranges of Trivr

˙

t

in formulation, for each type of patient:

● Kru?ra kos

˙

t

˙

ha: Eran

˙

d.

a taila (30 mL), Trivr

˙

t

(10–15 g), S?u칗

˙

t

˙

hı?(2–3 g) and saindhava (1–2 g),

taken with a little warm gruel

● Madhya kos

˙

t

˙

ha: Trivr

˙

t (10–15 g), Harı칣akı?(5 g)

and S?u칗

˙

t

˙

hı?(2–3 g); taken with warm water

● Mr

˙

du kos

˙

t

˙

ha: Trivr

˙

t (10 g) and A?malakı?(5 g);

taken with sugar and tepid water.

Prior to virecana therapy the patient must have

undergone a previous course of vamana, followed by

another course of snehana and svedana over a

period of 3–8 days, depending on the nature of the

bowel (i.e. fewer days for a mr

˙

du kos

˙

t

˙

ha, and longer

for a kru?ra kos

˙

t

˙

ha). On the evening before treatment

the patient is given food that is both snigdha (‘oily)

and us

˙

n˙

a (‘hot’) in nature. The next morning, at least

2 hours after sunrise when kapha is in its ascendancy,

the patient is given the appropriate virecana

recipe in the appropriate quantity, and within a few

hours the patient will begin to purge. If virecana is

delayed the patient can drink warm water and the

abdomen is massaged in a clockwise direction: cold

water is to be avoided. If the treatment causes pain

and discomfort the patient can hold a hot water bottle

over the abdomen. The number of bouts and volume

of faecal material passed will depend upon the

amount of the dravya given and the nature of the

kos

˙

t

˙

ha, from 5 to 15 bouts and between a half to two

litres of faecal material. During the therapy the

patient should abstain from food, rest and try to stay

in a positive frame of mind. If purgation is not successful,

however, the patient is allowed to eat a thin

rice gruel in the everning and then the virecana

recipe is given again on the following day, using the

same procedure. The following day after successful

treatment the patient can eat again, breaking the fast

by consuming a thin rice gruel, and over the next 5–7

days consuming a diet that is light and easily

digestible.

When virecana is administered correctly and the

treatment is successful there is an enhancement in

mental and sensory acuity, lightness of the body,

and improved appetite. If these symptoms are noted

during treatment but the patient continues to purge,

an emetic recipe is given to remove the virecana

dravyas from the kos

˙

t

˙

ha. Symptoms of inadequate

or asamyaka virecana are a vitiation of the dos

˙

as,

lethargy and confusion, headache, weakness of

appetite, vomiting, catarrh, heaviness of the

abdomen and chest, body pain, constipation, skin

rashes and urinary obstruction. In such cases the

patient should be purged again the next day: if the

cause is due to a kru?ra kos

˙

t

˙

ha the patient can be

treated with a herbal suppository or an enema, followed

by the administration of the virecana

recipe the next day. If this still does not produce a

purging the patient undergoes another course of

snehana and svedana over a 10-day period, and the

process is repeated. Symptoms of excess or atiyoga

virecana is a depletion of one, two or all three

dos

˙

as, exhaustion, tremors, numbness, fainting,

thirst, pallor, abdominal pain, rectal discharge or

144 PART 1: Theory and Practice of A¯ yurveda

haemorrhaging, and rectal prolapse. In the treatment

of atiyoga virecana the Cakradatta recommends

dravyas that have a 큦ita (‘cooling’) and

gra칑ı?(‘astringent’) property, such as Padmaka

bark (Prunus cerasoides), U큦ı칞a root (Vetiveria zizanioides),

Na칐ake큦ara flower (Mesua ferrea), and

Candana bark (Santalum album); useful formulations

include S?an.ka bhasma, Ja칣ı칛hala칍ya cu?rn˙

a

and Kut

˙

aja aris

˙

t

˙

a.

While virecana is an important component of

pa?a karma it is also used in patients who have

a small increase of the dos

˙

as, on a periodic basis,

usually at the beginning of spring and autumn. In

such cases mild amounts of virecana dravyas such

as Trivr

˙

t and Harı칣akı?can be used every day for

a week, along with dı칛anapa칌ana dravyas such as

Tvak bark (Cinnamomum zeylanicum), Patra leaf

(Cinnamomum ta¯mala) and Marica fruit (Piper

nigrum).

11.7 Pa?a karma: vasti (ENEMA)

Vasti or enema therapy is directed to the colon, the

seat of va칣a in the body. By directing treatment to the

colon, vasti therapy indirectly treats the activity of all

aspects of va칣a in the body, including the activity of

the sub-dos

˙

as. The term vasti is derived from the traditional

usage of an animal ‘bladder’ to administer the

medication, although in modern practice synthetic

materials are commonly used. There are two basic

forms of vasti therapy: niru?ha vasti, or enemas prepared

with herbal decoctions, and anuva칢ana vasti,

enemas that require the use of oil. According to

Caraka these two types of vasti therapy account for

two components of pa?a karma; in contrast,

Sus´ruta states that vasti only accounts for one aspect

of pa?a karma, and includes rakta moks

˙

an

˙

a or

‘venesection’ as the fifth. There is a third type of vasti

therapy not discussed in this text; it is called uttaravasti

and is administered into the vagina (i.e.

douche) or urethra.

Vasti therapy is implemented after vamana and

virecana, after kapha and pitta have been eliminated.

Vasti is highly valued in A- yurvedic medicine,

regarded as both an eliminative and restorative therapy,

expelling excess va칣a as well as normalising its

function. Depending upon the type administered,

vasti therapy can be used to treat a wide assortment

of diseases and is also used outside of pa?a karma

as a stand-alone therapy. For preventative measures,

the ancient texts recommend the practice of vasti

approximately three times a year (i.e. once every

4 months).

Vasti therapy is traditionally administered by using

an animal bladder, such as that from a deer, pig, buffalo

or goat. The ‘enema bag’ or vasti putaka must be

without holes, well cleaned, properly tanned, dry and

soft before use. The medication is placed into the bladder,

the sides of the bladder gathered together and tied

to a nozzle (vasti netra), traditionally fashioned from

some kind of metal such as gold, silver or copper, or

from bone, bamboo, horn, or a plant stalk.

Vasti therapy is performed only after 7 days have

passed since virecana treatment and the patient’s

digestion has returned to normal. Prior to the administration

of vasti the patient undergoes abhyan . ga

and svedana. Anuva칢ana vasti, or ‘oil enema’, is the

first type of vasti treatment to be implemented, and is

used in an alternating fashion with niru?ha vasti, or

‘decoction enema’. The length and scope of vasti

therapy depends upon several factors: the benefit to

be obtained, the vikr

˙

ti (‘disease’) and prakr

˙

ti (‘constitution’)

of the patient, and the nature of the bowel.

In a kru?ra kos

˙

t

˙

ha, the treatment is longer; in a madhya

kos

˙

t

˙

ha, the treatments are of a medium duration;

in a mr

˙

du kos

˙

t

˙

ha, the treatments are of a short

duration. The longest vasti regimen is karma vasti,

consisting of alternating anuva칢ana and niru칑a

vasti over a 24-day period, followed by 6 days of

anuva칢ana vasti to total 30 days. Ka칕a vasti consists

of alternating anuva칢ana and niru?ha vasti for

12 days, followed by 3 days of anuva칢ana vasti to

total 15 days. Yoga vasti involves alternating

anuva칢ana and niru?ha vasti for 6 days, followed by

2 days of anuva칢ana to total 8 days of treatment.

The dosages used for anuva칢ana and niru?ha vasti

can vary to a large degree, depending on factors

including the patient’s age and the predominant dos

˙

as

of the disease. The typical dose for niru칑a vasti begins

with a half a prasr

˙

ta (48 mL) for a child of 1 year,

which is increased by a half a prasr

˙

ta for each year of

life up to the age of 12, at which point the total volume

will be equal to six prasr

˙

ta (576 mL). The volume of

the medication used in anuva칢ana is one-fourth, onesixth

or one-eighth the volume that is calculated for

niru?ha vasti, for vitiations of va칣a, pitta and kapha,

respectively. Thus, the initial dose used in anuva칢ana

Treatment of disease 145

vasti for a child of 1 year is 12 mL in va칣tika conditions,

8 mL in paittika conditions, and 6 mL in

kaphaja conditions, and by the age of 12, the total

volume of medication will be 144 mL for va칣a, 96mL

for pitta and 72 mL for kapha. After the age of 12 the

volume to be used for niru?ha vasti is increased by one

prasr

˙

ta (96 mL) for each year of life, up to the age of

18, at which point the total volume will be equal to 12

prasr

˙

ta (1152 mL). This dose is maintained in most

people up until the age of 70, after which the total volume

for niru?ha vasti is decreased to 10 prasr

˙

ta (960

mL). By the age of 18 the respective doses for

anuva칢ana vasti are 288 mL for va칣a, 192 mL for

pitta, and 144 mL for kapha, and after the age of

70 is reduced to 240 mL for va칣a, 160 mL for kapha,

and 120 mL for kapha.

Anuva - sana vasti

Anuva칢ana vasti is the administration of a medicated

oil into the colon via the anus. It is specifically indicated

when the patient suffers from va칣tika conditions,

such as constant hunger, dryness of the skin and

mucosa, and neuromuscular disorders. It is contraindicated

in acute fever, congestion and catarrh, lymphadenitis,

infection, indigestion and poor appetite,

poisoning, abdominal heaviness, splenomegaly, jaundice,

intestinal parasites, diarrhoea, constipation,

haemorrhoids, urinary diseases, obesity, diabetes and

anaemia. Anuva칢ana vasti is never administered on

an empty stomach, and is given during the va칣a time of

day, i.e. early morning or late afternoon.

The prodedure for administering anuva칢ana calls

for the patient to undergo abhyan . ga and svedana

first, followed by a small easily digestible meal and

a short walk, eliminating any faeces or urine at this

time. To administer the vasti the patient lies in the

recovery position on his or her left side (left leg

straight, right leg bent at the knee), and a sheet is

draped over the patient’s body for privacy and comfort,

exposing only the buttocks. The medication is prepared

and the vasti putaka is filled. The anus is

anointed with oil, and then the nozzle or vasti netra

is lubricated and then gently inserted into the anus.

The practitioner then slowly squeezes the contents of

the vasti putaka into the rectum with a steady and

constant pressure, ensuring that only the dravya and

not air is being squeezed into the rectum. As the vasti

is being administered the patient is advised to not

yawn, cough or sneeze. After administering the medication

the patient lies in a supine position, extending

the legs outwards, and then after a few minutes

repeatedly brings the knees to the chest several times,

and flexes the arms. During this time the feet, buttocks

and abdomen are also massaged, and a hot water bottle

can be applied to the abdomen. Following this the

patient then assumes the recovery position by lying on

the right side, directing the vasti dravyas deeper into

the large intestine. The patient is then covered with a

blanket and is allowed to rest for some time until the

urge to eliminate is made known. Following the elimination

of the oil the patient can have a normal meal.

If the oil is not eliminated after 9 hours the patient can

either be given a suppository or a virecana dravya to

eliminate oil, or it can be retained until the niru칑a

vasti is given on the following day.

The dravyas used in anuva칢ana are fairly simple,

consisting of some kind of oil or fat such as taila. The

maximum amount of saindhava used is approximately

one kars

˙

a (12 g), a weight equal to 1/24 the

total volume of oil administered, e.g. 12 g per 288 mL

of oil for anuva칢ana vasti, 8 g per 192 mL of oil in

pitta anuva칢ana, and 6 g per 144 mL of oil in kapha

anuva칢ana.

Niru - ha vasti

Niru?ha vasti is used after anuva칢ana on the following

day, and is always administered on an empty stomach,

during the va칣a time of day. The procedure for

administering niru?ha vasti is identical to that used in

anuva칢ana, with the exception that it be performed

on an empty stomach. For practical purposes niru칑a

vasti is best administered during the early morning,

but may also be administered in the late afternoon.

Niru칑a vasti is used in the treatment of conditions

including chronic fever, chest pain and cardiac disorders

caused by the upward movement of va칣a, retention

of flatus and faeces, hepatomegaly and

splenomegaly, intestinal parasites, lumbago, sciatica,

arthritis, gout, paralysis and spasm, weakness, psychosis,

genitourinary disorders and infertility. Niru칑a

vasti is contraindicated in the presence of a칖a, indigestion,

vomiting, anorexia, hunger, thirst, diarrhoea

and dysentery, malabsorption syndromes, intestinal

obstruction, haemorrhoids, asthma, cough, diabetes,

ascites, skin diseases such as leprosy, and pregnancy

(before the eighth month).

146 PART 1: Theory and Practice of A¯ yurveda

Unlike anuva칢ana, the formulations used for

niru?ha vasti vary to a large degree, depending on the

vikr

˙

ti and prakr

˙

ti of the patient, and always contain

some kind of aqueous preparation, often mixed with a

herbal paste, saindhava, honey and some kind of oil

or fat. Dravyas used in the preparation of niru칑a

vasti to be used in va칣tika conditions should comprise

madhura, lavan˙

a or amla rasas, such as Bala?root

(Sida cordifolia) and A큦vagandha?root (Withania somnifera),

mixed with an oil or fat and saindhava

Dravyas used in preparing vasti for paittika conditions

should consist of madhura, tikta and ka큦a칪a

rasas, such as Yas

˙

t

˙

imadhu root (Glycyrrhiza glabra)

and Gud.u칌ı?vine (Tinospora cordifolia), mixed with

milk, ghr

˙

ta and sugarcane juice. Dravyas used in

preparing vasti for kaphaja conditions should be

composed of tikta, ka큦a칪a and kat

˙

u rasas, such as

Nimba leaf (Azadirachta indica) and Marica fruit

(Piper nigrum), taken without fat or oil of any kind.

Niru?ha vasti can be, and is, sometimes administered

more than once in a single session, the first administration

targeting va칣a, the second pitta, and lastly

kapha.

Although a great number of potential formulations

can be used in niru?ha vasti one of the more common

ones used is Madhutailika, consisting of:

● fresh honey, 320 mL

● saindhava, 20 g

● taila, 320 mL

● Shatapus

˙

pa?herb (Anethum graveolens) cu칞n˙

a, 20 g

● Eran

˙

d.

a root (Ricinus communis) kva칣ha, 320 mL.

The ingredients above are mixed together in the order

listed, in a pot made of gold, silver or bronze. The

Eran

˙

d.

a root decoction is added last, and should be

quite warm. When the ingredients are mixed together

well, and it is not too hot, the preparation is administered

rectally. Madhutailika is safe for all three dos

˙

as

and can be used in both pa?a karma and as a standalone

treatment.

Niru?ha vasti is usually retained for only a short

period of time, between 5 and 15 minutes, after

which it should be eliminated by having the patient

sit on their heels, into a vessel that can be later

examined by the attending physician. If the niru칑a

vasti is retained longer than 48 minutes measures

are immediately taken to eliminate the retained

enema by administering another vasti that has a

purgative activity, composed of a solution medicated

with dravyas such as Triphala, Trikat

˙

u,

cow urine, honey or Yavaks

˙

a칞a (Hordeum vulgare

ash). Alternatively, a herbal suppository with laxative

properties can be used, or virecana dravyas

such as Trivr

˙

t root and Eran

˙

d.

a taila are administered.

Following each vasti treatment the patient

can take a bath and eat a meal: a rice gruel or kicari

(see Box 11.1) for kaphaja conditions; rice cooked

in milk for paittika conditions; and rice cooked in

meat broth for va칣tika conditions. After treatment

the patient should avoid excessive exercise and emotional

stimulation, sexual activity, travel and sleeping

during the day.

When vasti therapy is properly administered there

is an increase in the appetite, the unobstructed movement

of urine, flatus and faeces, lightness of the body,

enhanced mental and sensory acuity, the abatement of

disease symptoms, and increased strength. Features of

Box 11.1 Preparing kicari

Kicari is one of the more common dietary articles

used during pa?a karma, specifically used in

kaphaja conditions. It can be consumed at other

times, however, during periods of periodic fasting, or

in the treatment of minor illnesses such as a cold or

flu, or digestive problems. There are a great many

varieties of kicari, but the key ingredients consist of

mung bean and rice, cooked with spices such as ginger,

turmeric, coriander, cumin, black pepper and

saindhava. In patients with very weak digestion the

rice can be a partially milled rice, or even basmati rice,

and the mung beans can be the washed variety, in

which the outerskins have been removed. Where the

digestion is stronger, the unwashed ‘whole’ mung

beans can be used in preference. The heaviest and

most difficult to digest version of kicari is made with

whole grain brown rice and whole mung bean, but is

also very nutritious. To prepare kicari, add one cup

of mung and one cap of rice to a pot, and cover with

eight cups of water. Add five or six slices of fresh ginger,

one teaspoon of saindhava and bring to a boil,

stirring often. Reduce to a simmer, and add two teaspoons

of ground coriander seed, one teaspoon of

ground cumin seed, one teaspoon of turmeric, and

a half a teaspoon of fresh ground black pepper. Allow

to simmer for a few hours, until it begins to thicken

and the rice and mung are soft. Kicari can be eaten

three times a day, over a period of 10 days to promote

detoxification and restore digestion.

Treatment of disease 147

asamyaka or inadequate vasti therapy include

a poor appetite, nausea, abdominal pain, flatulence,

retention of urine, dyspnoea, coldness and stiffness.

Features of atiyoga or excessive vasti therapy include

numbness, exhaustion, weakness, drowsiness, psychosis

and hiccough. In cases of atiyoga vasti treatments

are used to enhance agni through the use of

dı칛anapa칌ana and gra칑ı?dravyas.

11.8 Nasya (ERRHINES)

Nasya or errhine treatment is the administration of

medications into the nostrils, used specifically in

the treatment of disorders of the head and neck,

including the brain and central nervous system, the

upper respiratory system, the eyes, ears, mouth and

throat, and the glandular structures of the neck.

Apart from these local effects nasya also has a systemic

effect through its action upon the ida and pingala

?na칍. ı칢 that terminate in the left and right nostrils

respectively, and thus corrects and improves the flow

of pra칗

˙

a in the body.

A number of different dravyas can be administered

in nasya, including water, oils and fats, herbal

decoctions and juices, herbal powders and pastes,

milk, meat broth and even animal blood, depending

upon the indications. The timing of the administration

of nasya is dependent upon the dos

˙

a to be

treated: thus kaphaja conditions are best treated

during the kapha time of day and during spring;

paittika conditions during the pitta time of day and

during summer; and va칣tika conditions during the

va칣a time of day, and during autumn. Nasya is contraindicated

in patients that have just eaten food or

have consumed some kind of beverage (including

asava or aris

˙

t

˙

a), in those who have just bathed or

want to bathe after administration, in acute rhinitis,

dyspnoea and cough, in those that have just undergone

internal snehapa칗a, vamana, virecana or

vasti, in children, pregnant women and the elderly,

and is avoided when the weather is cloudy and cold,

or excessively warm.

On the day of treatment, the patient must have an

empty stomach, properly eliminated both faeces and

urine, and cleansed the mouth with tikta (‘bitter’),

ka큦a칪a (‘astringent’) and kat

˙

u (‘pungent’) dravyas.

The patient is then taken to a specially prepared room

that is free of dust and direct breeze, and undergoes

abhyan . ga with medicated oils such as Kshirabala¯

taila, Dha칗vantara taila or Bala?taila, paying particular

attention to gently massage the face, head and

neck. Upon administering nasya the patient should

assume a supine position, the arms extended outwards,

the feet slightly raised, and the head slightly

lowered and gently tilted back. The nasya dravya is

then warmed to room temperature and instilled in

each nostril, closing the nostril that is not receiving

the medication during administration. After instillation

the patient is counselled to gently inhale the medication

deep into the nose, taking long deep breaths,

and remains in a supine position for approximately

2 minutes. During this time the patient is vigorously

massaged over the soles of the feet, the palms of the

hand, and the neck, face and ears. The patient then rolls

to one side and attempts to spit out the instilled nasya

dravyas until none remains. In this way, nasya can be

administered two or three times in one session.

During this procedure the patient should avoid

speaking, blowing the nasya dravyas out through

the nose, or swallowing the medication. If the patient

appears drowsy or faints cold water is sprinkled over

the body. After the procedure is complete the patient

sits up and gargles with warm water to remove any

remaining kapha dos

˙

a or medication. If after this

procedure kapha dos

˙

a remains, with symptoms such

as headache, catarrh, or cough, dhu칖a (‘smoke’) is

then administered, using herbs such as Yas

˙

t

˙

imadhu

root (Glycrrhiza glabra), Guggulu resin (Commiphora

mukul), Haridra?rhizome (Curcuma longa), mixed with

a little ghr

˙

ta (see 5.2 Dina칌arya? the daily regimen).

After treatment the patient should avoid sleep,

bathing, cold water and wind, and eat a light, easily

digestible meal. Va칐bhat.a recommends that nasya

karma be performed over a 7-day period, but Sus´ruta

indicates that the regimen can be followed for a maximum

of 21 days.

When nasya is performed correctly it enhances

mental and sensory acuity, promotes mental clarity

and emotional happiness, clears the nasopharynx of

obstruction, bestows a clear voice, promotes lightness

of the body, and eliminates the symptoms of disease.

Features of asamyaka or inadequate nasya therapy

include mental and sensory confusion, catarrhal

conditions of the head and neck, lethargy, and no

abatement in disease symptoms. Features of atiyoga

or excessive nasya therapy include mental confusion,

headache, weakness, itching and excess salivation.

148 PART 1: Theory and Practice of A¯ yurveda

According to the As

˙

t

˙

a?ga Hr

˙

daya there are

three basic types of nasya: virecana (‘purgation’),

br

˙

mhan

˙

a (‘nourishing’) and 큦amana (‘pacifying’). In

the case of br

˙

mhan

˙

a, nasya is both a treatment and

a preventative measure to maintain health, depending

on the amount used. The dosage of the dravya used in

nasya is usually quite small compared to other treatments,

more if the treatment has a therapeutic objective,

and less if it is being used as a preventative

measure.

Virecana nasya

Virecana nasya is a powerful 큦odhana therapy,

used more for kaphaja conditions, as well as the treatment

of headache, stiffness of the neck, drowsiness,

chronic rhinitis, diseases of the throat and neck, skin

diseases, epilepsy, loss of consciousness, and psychosis.

Virecana nasya is subdivided into two types of treatment:

avapı칍.a and pradhma칗a nasya. Avapı칍.a

nasya is the administration of a svarasa (‘herbal

juice’), kalka (‘herbal paste’) or ka큦a칪a (‘herbal

decoction’),whereas pradhma칗a nasya is the administration

of a cu칞n˙

a (‘herbal powder’). Both are administered

by instilling and inhaling the dravyas directly

into the nose, or in the case of pradhma칗a nasya

specifically, blown into the nose of the patient by the

practitioner with the help of a small tube, traditionally

a small bone or hollow plant stalk. Both avapı칍. a and

pradhma칗a nasya act as strong purgatives to the

head, irritating the mucus membranes of the nose,

sinus and pharynx and promoting a profound

expectoration. This activity clears the head of blockages,

and in the case of mental disorders removes

obstructions and impurities of the mind and consciousness.

Depending upon the complaint a number of different

dravyas are used in avapı칍.a nasya, including

the fresh juices of Tulası?(Ocimum sanctum), Las큨na

(Allium sativum) or S?u칗

˙

t

˙

hı?(Zingiber officinalis), decoctions

of herbs such as Vaca?rhizome (Acorus calamus)

or Kus

˙

t

˙

ha root (Saussurea lappa), and honey and water

mixed with saindhava. The dose of the various

dravyas used in avapı칍.a nasya depends upon the

nature of the condition, divided in small (hı칗a),

medium (madhya) and large (uttama) doses:

● hı칗a avapı칍.a nasya: four drops

● madhya avapı칍.a nasya: six drops

● uttama avapı칍.a nasya: eight drops.

In this case, and in every case in which a drop or bindu

is administered in nasya, the classical texts define

a drop as that which drips off the clean index finger

when it is immersed in a liquid. While this technique is

suitable for self-administration, for therapeutic purposes

the practitioner will typically use a small dropper

or absorbent cotton soaked in the dravya, which is

then squeezed into the nose.

In the case of pradhma칗a nasya only a ‘pinch’

(micyuti) is administered in each instance, the

amount of which depends upon the nature of the condition

to be treated and the results to be obtained, once

again, divided in small (hı칗a), medium (madhya) and

large (uttama):

● hı칗a pradhma칗a nasya: two gu?as (250 mg)

● madhya pradhma칗a nasya: three gu?as

(375 mg)

● uttama pradhma칗a nasya: four gu?as

(500 mg).

Examples of dravyas used in pradhma칗a nasya

include Pippalı?fruit (Piper longum), Marica fruit

(Piper nigrum), S?u칗

˙

t

˙

hı?rhizome (Zingiber officinalis),

Kat

˙

phala bark (Myrica nagi) and Vid.

an.ga fruit

(Embelia ribes).

Br. mhan. a nasya

Br

˙

mhan

˙

a nasya is a kind of ‘nourishing’ nasya

treatment, indicated more for va칣tika complaints, as

well as conditions such as migraines, alopecia and premature

greying, tinnitus, eye diseases, laryngitis, difficult

speech, mucosal deficiency, facial paralysis, and

frozen shoulder. Examples of medicaments used in

br

˙

mhan

˙

a nasya include medicated oils (sneha

nasya), meat broth, fresh animal blood, and the

svarasa (‘juice’) of herbs that are madhura (‘sweet’)

in taste or that otherwise reduce va칣a.

The most common form of br

˙

mhan

˙

a nasya is

sneha nasya, which can be divided into two basic

forms of treatment: mar큦a and pratimar큦a. Mar큦a is

the administration of a relatively large volume of oil by

a practitioner during pa?a karma. Pratimar큦a is

the use of a much smaller volume of oil over a longer

duration, self-administered by the patient and used as

a method of preventative health care.

Mar큦a is typically used over a 7-day period, with

ten, eight and six drops being the maximum (uttama),

medium (madhya) and minimum (hı칗a) dosage of

Treatment of disease 149

the indicated dravyas. Like the other forms of nasya,

mar큦a nasya is stated as having a potential to cause

complications and aggravate the dos

˙

as, and hence the

contraindications for nasya discussed previously

apply here as well; i.e. before or after food or bath, concurrent

with other pa?a karma therapies, in acute

rhinitis, dyspnoea and cough, in children, pregnant

women and the elderly, and in excessively cold, wet or

warm weather.

Whereas mar큦a involves the application of up to

eight drops of the medication in each nostril, pratimar

큦a is the administration of no more than two

drops. It is safe for all ages, and can be used on an

ongoing basis, usually first thing in the morning on an

empty stomach, before bathing (see 5.2 Dina칌arya?

the daily regimen). Pratimar큦a may also be used at

other times of the day, however, such as after strenuous

exercise or sexual activity, to revitalise the mind

after work or study, after the consumption of food,

after vomiting, after sleeping during the day, at the end

of the day or night to cleanse the srota칖. si, after the

elimination of wastes, after public speaking to pacify

va칣a, and after cleansing the oral cavity to strengthen

the teeth. Pratimar큦a can also be used in conjunction

with neti and pra칗

˙

ayama techniques such as na칍. ı¯

큦odhana for added benefit.

There are a number of medications that are used in

sneha nasya, perhaps the most common of which is

the formula An

˙

u taila, as well as medicated ghr

˙

ta

compounds prepared with herbs such as Bra칑mı?leaf

(Bacopa monniera) and Vaca?rhizome (Acorus calamus).

When sneha nasya is properly administered, the

patient should be able to breath without difficulty, sleep

well, and arise refreshed and experience enhanced

mental and sensory acuity. With continuous usage

br

˙

mhan

˙

a nasya confers the benefit of improved skin

texture and complexion, stops or delays greying hair

and alopecia, and strengthens the neck, shoulders and

arms. Feelings of mucosal dryness and a feeling of

lightness in the head are symptoms of inadequate or

asamyaka administration. Itching, a feeling of heaviness

in the head, excessive salivation, anorexia and

rhinitis are signs of excessive or atiyoga sneha nasya.

S´

amana nasya

S´

amana nasya is a treatment to pacify the vitiated

dos

˙

as, used more for paittika conditions, as well as

disease such as alopecia, eye diseases, dermatitis, boils

and acne. Examples of medicaments used in 큦amana

nasya include milk, coconut water and cool water, as

well as some of the medicaments used in br

˙

mhan

˙

a

nasya. S?amana nasya also includes jala neti:

the administration of an isotonic solution of water to

irrigate the nasal passages and sinuses (see 5.2

Dina칌arya¯: the daily regimen).

11.9 Rakta moks.an. a (VENESECTION)

According to Sus´ruta, rakta moks

˙

an

˙

a or ‘venesection’

is the last of the pa?a karmas to be implemented.

The use of rakta moks

˙

an

˙

a is based upon the

idea that the blood is a kind of dos

˙

a. In actuality, blood

or rakta is a subset of pitta, and when pitta is vitiated

waste products remain in the blood that impair

the circulation of nutrients and ojas. Rakta moks

˙

an

˙

a

is indicated in conditions such as skin diseases,

tumours, fever and inflammatory joint disease. It is

generally contraindicated in persons suffering from

va칣tika diseases, as well as in both pregnant and postpartum

women, in anaemia, and in children and the

aged.

The classical texts indicate that when rakta is

healthy it is slightly madhura (‘sweet’) and lavan˙

a

(‘salty’) in taste, and is neither too hot nor too cold.

Evidence of the five maha칋hu?tas (‘elements’) can be

seen in healthy rakta by the following features:

unpleasant odour (pr

˙

thvı¯), liquid (ap), bright red

(tejas), flowing (va칪u) and light (a칔a?sa). Symptoms

of vitiated rakta are based upon the dos

˙

as. When

rakta is vitiated by va칣a the blood has purplish-red or

bluish hue, and is thin, dry, frothy, and flows quickly.

When rakta is vitiated by pitta the blood has a yellowish,

green or blackish hue, a foul smell, flows

quickly, and is warm to the touch. When rakta is vitiated

by kapha the blood is pale in colour, oily, thick,

slow moving and cool to the touch. When vitiated by

two or more dos

˙

as, rakta displays the associated features

in combination.

The ancient texts describe a number of methods,

instruments, and locations to perform rakta

moks

˙

an

˙

a. Among the different implements discussed

are knives of various shapes and sizes, lancets, needles,

and scissors, as well as sharpened animal horns,

bones, stones, or glass. Caustic alkalis and extreme

heat are also used in venesection. One of the more

common methods used in rakta moks

˙

an

˙

a is the use

150 PART 1: Theory and Practice of A¯ yurveda

of non-poisonous leeches (Hirudo medicinalis), which is

a comparatively safe and effective method of venesection.

The location of the area to be venesected depends

upon the location of the disease. In all cases only veins

are venesected and never the arteries. Sus´ruta mentions

a number of locations in the body that must not

be injured or cut during any kind of surgical procedure,

called marmas (‘death points’). To perform

rakta moks

˙

an

˙

a correctly the physician should understand

these different locations.

Before rakta moks

˙

an

˙

a is begun the patient undergoes

abhyan . ga. Once the proper location for venesection

is determined (usually local to the affected area),

the physician begins the procedure. If required, a piece

of gauze with a small hole cut into the middle of it,

approximately 1 cm in diameter, can be applied to the

area to be venesected, to direct the leech’s activity.

A leech is then applied to this location and is allowed to

suck the blood of the patient until it becomes engorged

over a 30–60 minute period of time, or until the

patient begins to feel a pricking or itching sensation.

A little saindhava is then applied to the leech to

remove it, and the wound is cleaned with cold water

and covered with anti-infective and antihaemorrhagic

dravyas such as Haridra?rhizome (Curcuma longa)

powder, Triphala and alum. The leech is then dipped

in a solution of taila and saindhava and then massaged

and gently squeezed so that the blood is removed

from it, which is then examined for its qualities.

Va칐bhat.a states that this procedure is repeated the

next day and the quality of the blood once again examined,

and if determined to still contain a great volume

of the vitiated dos

˙

as, the procedure is repeated again

after 2 weeks have passed. If the rakta is determined

to contain only a small component of the vitiated

dos

˙

as the treatment is discontinued and internal therapies

to purify rakta can be given.

11.10 Rasa?yana AND vajı칔aran.a

karma

Once pa?a karma treatment has been completed,

and the patient has been allowed to rest for 7 days,

rasa칪ana or ‘rejuvenative’ treatment is begun. The

purpose of rasa칪ana is to strengthen the body and

mind after the dos

˙

as have been eliminated through

pa?a karma. The reason why rasa칪ana treatment

is given only after pa?a karma is analogous to

a piece of cloth that one wishes to dye. In order for the

cloth to hold the dye and get an even distribution of the

colour, the cloth must be washed beforehand, otherwise

the dye will not hold and the fixative will allow the

dirt to become ingrained. Likewise, unless the body has

been purified prior to rasa칪ana treatment, a칖a will

become strengthened and the vitiated dos

˙

as will hold

fast to the body.

There are different kinds of rasa칪ana therapy that

can be implemented, with different goals in mind. On a

mundane level, rasa칪ana therapy is used to tonify the

body after pa?a karma, to improve the overall quality

of health. On a supramundane level, however,

rasa칪ana therapy is used to enhance spiritual

potency, and as the tradition speaks, to achieve immortality.

In this latter form of rasa칪ana the patient

undergoes therapy to transform the ojas into amr

˙

ta,

the nectar of immortality.

Two kinds of rasa칪ana treatments are generally

recognised in A- yurveda: kut

˙

ı칛ra칥e큦ika rasa칪ana

and va칣a칣apika rasa칪ana. In kut

˙

ı칛ra칥e큦ika

rasa칪ana, the treatment is longer, requires great

discipline and patience, and confers a greater benefit. It

is a treatment that is generally considered to be

reserved for those who wish to leave this world of

sam. sa칞a, who have disentangled themselves from the

day to day responsibilities of life. In va칣a칣apika the

treatment is shorter, confers a lesser benefit, and

requires little discipline other than to cultivate

a healthy lifestyle and take the rasa칪ana dravya on

a regular basis. Thus, these two forms of rasa칪ana

therapy, kut

˙

ı칛ra칥e큦ika and va칣a칣apika, are for

brahmacarya칢 and householders respectively. A third

form of rejuvenative treatment, called vajı칔aran

˙

a, is

a subset of va칣a칣apika, and is implemented specifically

to rejuvenate the reproductive organs, as well as

treat infertility.

11.11 Rasa칪ana karma: kut.ı칛ra칥es큛ka

The term kut

˙

ı칛ra칥e큦ika is derived from the word

kut

˙

ı¯, which means ‘hut’, and pra칥e큦ika, which

means ‘to enter into’. Thus kut

˙

ı칛ra칥e큦ika therapy is

administered to a patient residing in a specially constructed

hut. The person who wishes to undergo

kut

˙

ı칛ra칥e큦ika therapy must reside in this hut during

the course of treatment without visitors, except for visits

from the physician who is administering the therapy.

Treatment of disease 151

The kut

˙

ı?must be constructed in an auspicious

location, close to the herbs that will be used during the

treatment, protected from harsh winds and the activity

of other people. The structure of the hut itself

actually consists of three huts, having an outer, middle

and inner portion, and the main entrance faces

north. The kut

˙

ı?should be constructed in such a way

that there is adequate ventilation and light but the

inner sanctum should be free of direct breeze and sunlight.

Once constructed, the walls are painted white

with slaked lime. Within the kut

˙

ı¯, the interior should

be clean, free of pests and rodents, as well as free of

any kind of distracting stimuli, such as radios, computers

and televisions.

Kut

˙

ı칛ra칥e큦ika rasa칪ana is begun during the

uttara칪an˙

a, when the sun is in the northern hemisphere,

when there are auspicious and favourable

astrological indications. Before the treatment is begun

the patient undergoes a short course of purification:

undergoing abhyan . ga and svedana, eating a gruel

prepared from barley, and taking a recipe consisting of

Harı칣akı?fruit (Terminalia chebula), A?malakı?fruit

(Phyllanthus emblica), Haridra?root (Curcuma longa),

Vaca?rhizome (Acorus calamus), S?u칗

˙

t

˙

hı?rhizome

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

Vid.

an.ga fruit (Embelia ribes), saindhava and jaggery,

taken with warm water. This regimen lasts 3, 5 or 7

days, depending upon whether the patient has a

mr

˙

du (‘soft’), madhya (‘medium’) or kru칞a (‘hard’)

kos

˙

t

˙

ha (‘bowel’). Once the kos

˙

t

˙

ha of the patient is

determined to be purifed, the patient undergoes a ritual

purification and enters into the kuti.

While residing in the kuti the patient is given

a rasa칪ana dravya based upon their prakr

˙

ti. This

rasa칪ana is fed to the patient throughout the day, as

much as he or she can comfortably ingest, followed by

an evening meal of rice that has been boiled in milk.

During the course of the therapy the patient should

avoid vigorous exercise, although the practice of gentle

hatha yoga a칢anas may be undertaken. The

patient should awaken during the brahma칖uhurta

and retire with the setting sun, and maintain a positive

and reverential attitude throughout the day. It is

said that after eleven days of treatment the teeth and

hair of the patient begin fall out, to be replaced by new

hair and teeth. In total, kut

˙

ı칛ra칥e큦ika rasa칪ana

should take anywhere from 30 to 40 days.

There are many different kinds of rasa칪ana

dravyas that are used in kut

˙

ı칛ra칥e큦ika rasa칪ana,

some of which are also suitable in va칣a칣apika

rasa칪ana and in the treatment of various diseases:

see Table 11.1.

11.12 Rasa칪ana karma: va칣a칣apika

As it is not everyone that can follow through on the

strict protocols of kut

˙

ı칛ra칥e큦ika, there is another

form of rasa칪ana treatment called va칣a칣apika. The

term va칣a칣apika means ‘sun and wind’, and refers to

a kind of rasa칪ana treatment that does not require

the patient be sequestered in a specially constructed

hut (and thus is exposed to sun and wind), or follow

specific guidelines other than to cultivate a healthy

lifestyle. Kut

˙

ı칛ra칥e큦ika is treatment utilised by brahmacarya

칢 and has a greater effect, not only to promote

intelligence and longevity, but to enhance

spiritual potency. Entering into the kuti and remaining

there for an extended period of time is to re-enter

the womb, to become ‘born again’. Va칣a칣apika on the

other hand is orientated towards the maintainence of

the patient’s health and youthful vigour, but does not

confer the same degree of benefit. Typically,

va칣a칣apika rasa칪anas are relatively simple formulations,

not the complex formulae like Cyavanapra?sa

rasa칪ana. If kut

˙

ı칛ra칥e큦ika rasa칪anas are used in

va칣a칣apika the dosage will be much less.

Perhaps the most famous of the va칣a칣apika

rasa칪anas is Triphala cu칞n˙

a, the combined finely

ground powders of the fruits of A?malakı?(Phyllanthus

emblica), Harı칣akı?(Terminalia chebula) and Bibhı칣aka

(Terminalia belerica). Triphala is said to cleanse the

dha칣us, improve agni, nourish the indriya칢 (‘senses’)

and enhance ojas. The dosage used is 2–5 g, taken with

ghr

˙

ta and honey once or twice daily, before meals.

Another commonly used va칣a칣apika rasa칪ana is

Na칞asimha ghr

˙

ta, a medicated ghr

˙

ta named for its

ability to make a ‘lion’ (simha) out of a ‘man’ (nara).

Na칞asimha ghr

˙

ta is said to impart fearlessness and

courage, helps to retain one’s youth and vigour,

increases prosperity and attractiveness, and protects

one from the influence of the asuras (‘demons’). The

dosage is 10–12 g, taken with milk and honey.

Punarnava?root (Boerhavia diffusa) is another

medicinal botanical used in va칣a칣apika therapy,

esteemed for its capacity to revitalise one’s health,

indicated by its name ‘once again’ (puna) ‘new’

(nava¯). The dose is 10 g of the powdered root made

152 PART 1: Theory and Practice of A¯ yurveda

into a paste with milk, taken twice daily for 15 days,

2 months or 6 months, dependent upon the degree of

rejuvenation required.

Medicinal plants that have rasa칪ana properties are

discussed in Part II of this text.

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)