Pañca-karma applied in the West

by Elmar Stapelfeldt, Germany

internal purification

advantages

• strongest measure amongst Ayurvedic treatments

• often successful, where other therapies show less results

• unique amongst other medical approaches

• classics: inevitable!

• centuries of empirical data

• customer bonding (cure programs); special trend

disadvantages

• intense training required

• costly and lengthy procedures

• side-effects and complications possible (strict rules)

• considered to be „dirty“

What is pañca-karma?

• traditional procedures of internal cleansing

• Ayurv. developed a unique complex concept (pañca-karma)

• combination of different approaches and techniques

• 5(6) classical procedures

emesis (vamana)

purgation (virecana)

decoction-enema (nirÚha-basti)

oil-enema (anuvÁsana-basti)

nasal applications (nasya)

blood-letting (rakta-mokÒa)

effects

• systemic effect

• 3 phases

pre- and post-treatments

fat- and water-solubility

• general effect

removal of roughage/ aggravated doÒas

change in milieu interior / metabolism

liberating body's own healing potentials

• increases efficacy of medicaments

• action on specific symptoms is difficult to predict

• multiple indications

effects according to classics (CS SÚ. 15.22, Si. 1.53)

• removal of wastes (mala)

• healing diseases

• promoting health

• stimulating agni

• increasing strength and nutritional status

• increasing luster

• increasing vigor

• increasing quality of sperm and ovum

• producing clarity of the senses

• increasing mental strength

• preventing senility

• increase of life-span

good results (personal experience)

• skin diseases (esp. psoriasis)

• respiratory diseases (like hayfever, recurrent upper respiratory tract infections, bronchitis and bronchial asthma

• hypertension (primary forms, kapha-pitta-prakéti)

• obesity

• migraine (pitta-dominated)

• bowel problems

• multiple symptoms

general contraindications

• any critical state or weakness

• any insufficiency of vital organs, esp. heart, brain, kidney

• any very advanced situation

• any emergency

some modern contraindications

• cardiac insufficiency (> 2nd grade)

• recent myocardial infarction

• advanced coronary sclerosis

• strong arrhythmias

• hypertensive crises

• strong cerebral circulation defficiency/ edema/ aneurysms

• Macumar™-medication

• bleeding tendencies (incl. tumours)

• advanced destructive conditions of inner organs

• hormonal and metabolic crises

• strong dysregulations of water/ electrolytes

• uncontrolled psychic conditions…

phases of pañca-karma

1. pre-phase pÚrva-karma
oleation	snehana	mobilizing pathological factors
sudation	svedana	stimulating srotas to transport the factors to GIT
2. main phase pradhÁna-karma
eliminating procedures	Ðodhana- karmas	removing the factors from GIT
3. post-phase paÐcÁt-karma
rest food scheme	saÞsarjana-krama	regeneration of strength and body functions (esp. agni)
conventional therapies	Ðamana	specific treatment for symptoms individual prevention

pre-treatment ( pÚrva-karma )

• thourough anamnesis and examination

• indications and contra-indications

• explanations (rules, procedure, effects, possible side effects and complications: legal side/ compliance)

• preparatory measures

diagnostics

• classical and modern techniques inevitable (complications!)

• experience of the doctor as main factor (be self-critical)

• usually a careful anamnesis and examination plus

• routine check of blood and urine with

• emphasis on vital organs and

• bleeding tendencies are enough

• special care in vamana!

• ask patient for any modern investigation of (recent) past

vamana rule out esophagal erosions/ varicosis; ulcers; thorasic tumours, aneurysm, heart problems

heart ECG, treadmill or sonography

bleeding blood parameter in lab, if necessary further investigations

anal bleeding and painful defecation: procto- or coloscopy (piles?)

obesity lipid-profile and blood sugar

diabetics ketone bodies in urine

young ladies pregnancy to be ruled out

alcohol abuse, biliary stones: transaminases, sonography of abdomen

ideal framework

food (CS. SÚ. 5.1-13; 13.60, 62; 15.15-16; 25.1-39; 27)

• always warm

• no heavy or abhiÒyandÍ (blocking srotas): cheese, yoghurt, butter, deep-fried, raw (except: small amount of carrots, cucumber, beetroot)

• no eating between meals

• always fresh and of good quality (organic)

• sattvic food (uplifting the psyche): no garlic, mushrooms, no meat/ eggs/ fish

• no sour food: (irritates mucosa, supports inflammations, blocks srotas): tomatoes, lemon, vinegar, sour-dough, yoghurt, chutneys and pickles, berries und most fruit (incl. peaches, pine-apple, sour apples and plums, oranges)

• not too spicy or salty

• "intoxicants" (black tea, coffee, tobacco, alcohol, drugs…)

• no dry food: pulses (exc. Mung), leafy vegetables, corn, millet

• enough moisture and good fats (ghÍ, sesamy oil)

• no wrong combinations (rakta, long-term 'toxic effect', srotas): special care with milk

• good are: brinjal, pumpkin, zucchini, carrots, potatoes, lady-finger, cauliflower, cucumber, rice, artichocken, mung, ghÍ, sesamy oil, wheat, quinoa, papaya, sweet apples, grapes, honey, warm milk, warm water

wrong behaviour = aÒÔa-mahÁ-doÒa (CS Si. 12.10ff.)

• too much walking, sitting or travelling (cause pain, vÁta)

• sexual activities (cause dhÁtu-kÒaya)

• too much talking (causes pain, vÁta)

• day-time sleep (causes kapha, suppression of agni)

• suppression of natural urges (vega-dhÁraÆÁ)

• climatic stressors (heat, cold, wind, bath, draught)

• emotional arrousal (aggression, grief etc.; also induced by literature, movies and other media)

inner oleation = sneha-pÁna

according to agni:

• 2x daily medicated or pure ghÍ

• with hot water and pinch of saindhava

• start with 30-40 ml (madhyama-mÁtra)

• daily increase 10-15 ml

• until body is saturated (3-7 days)

• = until features during fat-digestion become very strong (jÍryamÁna-lakÒaÆa)

• lots of warm water, light diet and sufficient rest

jÍryamÁna-lakÒaÆa (SS Ci. 31.33)

• giddiness or unrest

• thurst

• increased salivation

• flatulence

• headache

• drowsiness, sleepyness or heaviness (in stomach and/ or whole body)

• loss of appetite

• long eructation of ghÍ-(taste)

• nausea (aversion to ghÍ)

side-effects and their management

headache

• chewing Cloves; sipping hot water; PathyÁdi-kvÁtha

loss of appetite, heavyness, sticky saliva, coated tongue, long eructation of ghÍ-(taste)

• Tri-kaÔu (1-2g 2x, honey p.c.)

• CitrakÁdi-vaÔÍ (500mg 1-2x, warm water p.c.)

nausea (aversion to ghÍ)

• close nose while drinking ghÍ;

• have Fennel or Cardamom afterwards

• Cardamom, Cloves, Ginger (500mg-1g, every 20-30 min.)

• Chardi-ripu (1g, Honey, every 60-90 min.)

vamana

• strongest procedure in the armoury of Ayurveda

• side effects and complications possible

• many Ayurvedists don't perform it (even in India)

• but no fear is necessary

• it is not a pathological vomitting situation

• intelligence of the medicament

• relax and drink continuously

• many good effects

selected indications (from CS Si. 2.10 )

• kapha-disorders

• upper respiratory tract infections (also with fever)

• hay-fever

• bronchitis

• bronchial asthma

• obesity

• skin diseases (especially psoriasis)

selected contra-indications (from CS Si. 2.8 )

• all general contra-indications (careful investigation!)

• bleeding sources (especially upper passage)

• ulcers

• cancer

• narrowed passage

• strong fear or aversion

• strong vÁta

• heart diseases? (CS: contra-indication; SS: indication)

material needed

• wind free, warm room , armchair

• large bowl (80cm/ 30cm), bucket, 2 glasses

• warm water (5l); liquorice-tea (50g/ 1l hot water)

• 3g Madana-phala (Randia dumet.; -ipecacuanha?)

• honey

• tons of tissue paper, towels, waste bin

• BP, stetoscope, infusion equipment

• emergency drugs

preparation

after completion of internal oleation

• one day: abhyaÉga and svedana (vÁÒpa-)

following day (= day of pradhÁna-karma)

• morning: liquid rice-soup (peyÁ)

• abhyaÉga and svedana (vÁÒpa-)

pradhÁna-karma: Átyeyika-vamana

• drinking maximum (Á-kaÆÔha) luke-warm water

• 3g Madana-phala (Randia dumetorum) with honey

(substitute: Randia ipecacuanha?)

• wait 15-20' : vomiting will start! (relax; let it come)

• "the art of drinking water" (or liquorice-tea)

• until bile comes (bitter taste): vomiting will stop!

complications (don't over-estimate yourself – call help!!!)

• stop vomiting Chardi-ripu (1g, honey)

• burning throat liquorice-tea

• abdominal pain Anethum graveolens (1g 1-2) or ÏaÉkha-vaÔÍ (1-2 Tabl.)

• head-ache GodantÍ (300 mg 1-2x, honey)

• bleeding ÀmlÁ, Lodhra, NÁga-keÐara (1g each)

• hyperventilation rest, calming, assuring, slow breath

• psychic sympt. rest, calming, assuring, Tagara

• low BP/ puls/ fluid infusion, electrolytes

post-treatment (paÐcÁt-karma)

• rest whole day (no mental or physical work)

• no daytime sleep

• bath not before 4 p.m.

• no climatic stresses (heat, coldness, wind)

• strictly keep the rules for behaviour (CS SÚ. 15.14f.)

• slowly kindling agni with food of

increasing thickness (saÞsarjana-krama):

saÞsarjana-krama (avara-Ðuddhi)

day	time	food	sanskrit
1. (pradhÁna)	4 p.m.	thin rice soup	peyÁ (1:14)
	dinner	(thin rice soup)	(peyÁ)
2. (rest-day 1)	morning	–	–
	lunch	thick rice soup	vilepÍ (1:4)
	dinner	rice + mung (no fat)	akéta-yÚÒa= khicaÕÍ
3. (oleation)	morning	ghÍ, pk-food

virecana

• strong cleansing effect, but generally safe

• commonly performed

• even at home

• starting again with ghÍ, ending with saÞsarjana-krama

• usually no hesitation from patients

• very broad indication-spectrum

selected indications (from CS Si. 2.13)

• pitta-disorders

• skin diseases (especially psoriasis)

• liver (and bile) diseases

• gout

• inflammations

• constipation and flatulence

• obesity

• mild in vÁta-vyÁdhi

selected contra-indications (from CS Si. 2.11 )

• general contra-indications (weakness of any kind)

• bleeding sources and cancer (esp. lower passage)

• diarrhoea

• inflammation and fissures of GIT-mucosa

• narrowed passage

• acute fever

• strong vÁta

• heart diseases? (also controvery in classics: relative contra-indication)

material needed

• wind free, warm room, reading material, CDs

• ghÍ (anus protection: use less tissue paper)

• warm water (5l)

• 6-10g DiÆÕayÁla-cÚrÆa (aa Ajwain, Saindhava, Senna)

10-30ml Castor-oil (according to koÒÔha / strength)

• red Grape juice, Fennel seeds

• BP, stetoscope, infusion equipment

• emergency drugs

preparation

after completion of internal oleation

• two days: abhyaÉga and svedana (vÁÒpa-)

following day (= day of pradhÁna-karma)

• morning: no food (no warm milk; not much water)

• abhyaÉga and svedana (vÁÒpa-)

pradhÁna-karma of virecana

• take virecana-yoga (with closed nose)

• wash mouth and chew Fennel-seeds

• walk slowly for 20 min.

• start drinking more water afer 45min. - 1h

• after 1 - 2,5h: stools will start! (count every vega)

• drink a lot!!! (stool will turn more liquid)

• after about 5h: stools will reduce (reduce drinking)

• expect about 10-15 vegas

• follow same procedure for after care as in vamana

complications (see vamana)

• nausea Cardamom, Cloves, Chardi-ripu (1g, honey)

• no stool Castor-oil (10ml),

• to stop stool Nutmeg (500mg-1g frequently), KuÔaja-ghaÆa-vaÔÍ (3-4 tabl.)

• abdominal pain Anethum graveolens (1g 1-2x), ÏaÉkha-vaÔÍ (1-2 Tabl.)

• hyperventilation rest, calming, slow breath

• psychic sympt. rest, calming, assuring, Tagara

• low BP/ puls/ fluid infusion, electrolytes

basti

quote (CS Si. 10.5)

"There is no therapy (karma) comparable with bastis, since they clean the body fast and mildly. Both, reduction (of increased body material), as well as building up (of decreased tissues) is achieved in minimal time without any danger of complications."

• cleaning: ÁsthÁpana- or nirÚha-basti

• nourishing: anuvÁsana- or mÁtra-basti (classics: alternating)

• decreasing all three doÒas (esp. vÁta) (CS Si. 4.51, Si. 11.17f.)

• "half" therapy (CS Si. 1.40)

• especially: sceletal system, nerves, psyche and old age

• parental action; autonomous nervous system

• realm of apÁna-vÁta; colon is seat of vÁta

• easy to perform

some indications (from CS Si. 1.32ff.)

• contractures / stiffness of different limbs or joints

• paresis and paralysis

• fractures

• faltulence/ meteorism

• hard stool

• abdominal colics and other pains

anuvÁsana-basti

• nourishing

• inner "massage"; soothing

• pÚrva-karma for ÁsthÁpana?

• after meal (best between dinner and sleep)

• keep over night

• easy; can be done by oneself

preparation

• NÁrÁyaÆa-taila 30-40ml

• pinch of fine salt

• no air

• ghÍ for anus

• insert while exhaling

• friendly clap

• turning every 5 min.

(left – middle – right)

ÁsthÁpana-basti

• cleaning (substitute for virecana, good for elders)

• very broad indication spectrum

• not derranging agni, but watch vÁta!

• contraindications: anal bleeding (piles), diarrhoea, pregnancy, menstruation, 'blockage'

• long term action

• on empty stomach (best: before lunch)

• local massage and svedana

• keep 5-20 min. (no suppression of urge)

preparation

1. paste 35g (staying in haustra; anulomana):

VacÁ, Fennel, PippalÍ, Anethum grav.-powder

keep in water over night

2. kvÁtha 300ml (vÁta-reducing, vehical, cleaning):

75g DaÐamÚla (TriphalÁ) boil with 1200ml water

3. Saindhava 5g (resorption)

4. honey 50g (binding, sticking to mucosa)

5. sesamy oil 50ml (vÁta-reducing, "inner massage")

• mix well (3.-4.-5.-1.-2); ghÍ for anus and apply warm

• (at home: 500ml water + 0.5 teespoon salt)