The Ayurvedic Treatment Strategy:
Ayurveda has a strict structure for approaching treatment. Once all factors have been properly assessed, e.g. etiology, symptomology, the physician must proceed with consideration of treatment. There are basic features in a treatment protocol:
Ayurveda subscribes to the tenet: bija kshetra siddhanta (theory of seed & field). This doctrine holds that the body has the natural ability to heal itself. This process can be promoted / re-instituted by simply removing the cause. Often the physician need prescribe nothing more for the patient. Often, however, disease is obstinate, and long entrenched; extraction of systemic factors, when otherwise not contraindicated, is the most powerful, effective, hence shortest strategy available. Even though extraction may be nearly complete, the body has a memory of prior physiology, which translates into a tendency to go back to “bad habits” and recreate old symptoms. To counter this tendency balancing activities, diet, lifestyle, herbs, etc. are utilized. This ensures continuity of healthy physiology. Finally, cell components, tissues, and organs benefit from re-constituting herbs and activities—called rejuvenation and virilization. More details of some of these 4 features follow below.
Location of Origin of Disease and Treatment:
The disease origin often dictates the treatment...Drug administered through mouth destroys the diseases of amashaya (stomach and small intestines as in pitta and kapha), that through the nose destroys the diseases of head (vata and kapha especially), and that through the anal route diseases of the pakvashaya (colon as in vata disorders). Ca. Ci. XXX.294
A morbid dosha located in its own site becomes more powerful. Therefore, first of all, such doshas should be subdued by the administration of appropriate therapies like emesis, purgation, and medicated enema and alleviation therapies. Ca. Ci. XXVII.198.5-199
Doshic Movement and Treatment:
Treatment depends upon dosha gati (movement or vector). For example, if the doshas are moving downward, accelerate that gati and push the dosha out by using basti (enema). If the doshas are moving upward, then induce vomiting therapy and use their movement to eliminate the doshas out of the body. If the doshas are moving horizontally, we must do more snehana (oleation), svedana (sudation) and panchakarma to bring the doshas back first to the gastrointestinal tract and then use a specific kind of doshic cleansing program.
The deranged vata having moved into any specific seat of pitta should be medicinally treated as a case of pitta aggravation. Similarly for aggravated pitta and kapha changing their respective places should be treated as the dosha in whose location it is found. Vata aggravated tends to expand and deviate from its own/right passage and gives rise to a swelling or distention of the abdomen, accompanied by a rumbling sound in the intestines. Pitta similarly gives rise to heat and a sort of sucking, burning pain in the affected part plus a sensation of radiation or evaporation of the heat from its surface. Kapha similarly, would usher in a complete aversion to food, inertness of the limbs, vomiting, and impaired digestion. This is the first occasion for medical intervention. Su. Su. XXI.39
In discussion of treatment consider that medicine opposite to doshas may be opposite to tissues too. This factor complicates treatment as in pitta with exacerbated fat accumulation when proposing to use yashtimadhu (licorice root) for example.
The medical treatment is a case where two or all of the aggravated doshas are involved, consists in pacifying the strongest one but not by aggravating the others especially in case of sannipata. Su. Su. XXI.48
Three types of treatment:
Shodhana, shamana, brihmana (elimination, pacification, and rejuvenation, resp.): Pancakarma or five actions / therapies, is the basis of elimination therapies. It is formally described as having 3 discreet elements: purva karma (preparatory actions), pradhana karma (the principle actions), pashcat karma (follow-up actions). The preliminary actions include non-elimination actions of oleation and fomentation. The principle actions are eliminative: vomiting for kapha, purgation for pitta, enema for vata, nasal administration for vata and kapha, and blood letting for pitta. The follow up therapies are--rejuvenation and virilization--and include (predominantly) herbal preparations, but also behavioral guidelines (some regarded as rejuvenative in their own right).
Ayurveda regards Pancakarma (PK) as one of its primary treatment strategies. In the most technical sense this is a series of protocols aimed at treating the body, although mental aberrations are sometimes amenable through treating the body. A theme that surfaces in the context of this section – treatment – is that PK meets the criteria of treatment as well as those for medicine. It is however, first an extraction technique (cleansing is also apt here), which works with natural reflexes of the body—vomiting, purging, secreting, voiding—to eliminate physical entities out of the body. Blood letting, of course is a forced extraction in the technical sense of the term. Because PK works with herbalized materia medica, which operate on the basis of their chemical constituents, some elements of a PK treatment will cross into the area of medicine in the sense of our distinction—treatment versus medicine. This just emphasizes the point that Ayurveda recognizes the value of guna and karma as comprising a fuller picture of therapy.
We can give some detail about the PK process to help the reader appreciate its scope. The preliminary or preparatory techniques to elimination are oleation and sudation (snehana and svedana). Oil is used internally and externally to soften the body and to bind up “the undesirables” (mainly doshic substances) in cells and clinging to their membranes. This affects tissues and organs by promoting the removal of substances interfering with processes at microscopic and macroscopic levels. The heat, applied following oleation, further softens, dilates, and “energizes” the circulatory system to pick up and remove the undesirable doshic components and to bring them to the purifying organs and tissues—mainly the liver, but also the kidneys, skin, and lungs. Thus we observe that this process is not much chemical, until drugs are used to help redirect aberrant physiological processes. It aims at removing interfering substances, the absence of which permits of normal, balanced functioning.
The Extraction techniques of vamana (vomiting), virecana (purgation), basti (enema), rakta moksha (blood letting), and nasya (nasal administration) follow in this sequence in order to complete the removal of the doshic substances. Caraka and others write extensively on the many techniques, and countless drugs and drug formulations for accomplishing and successfully managing these practices. In nearly all, drugs are utilized to facilitate the movement of things; the body reacts to their presence and starts moving things. In vomiting (vamana) salt water, calamus root, licorice are convenient substances long noted for their ability to promote emesis. Castor oil is a popular purgative (virecana), while for some only milk or raisins are necessary. Enemas (basti) are of several types but their use helps the colon function better—peristalsis and absorption improve by cleansing—and the drugs administered in the enemata are absorbed and circulate systemically. These drugs change physiology for the better. Caraka has declared that basti may comprise 50% or more of the total treatment of vata disorders. Nasal administration (nasya) is a way to move dosha out of the head. Generally, the substances are irritant to the mucus membrane; this causes a secretory reaction that eliminates things out through the nasal passage. Included is snuffing or inhaling of smoke of burning herbs. Blood letting (rakta moksha) may be accomplished with leeches, scalpel, aspiration, etc. Sushruta declares: “an act of venesection, properly performed, gives more speedy relief than that derived from the application of medicated oil, etc. and or of plaster as well. Venesection (bleeding) properly performed is half of the treatment described in surgery as the application of basti karmas in therapeutics.” Su Sa. VIII.55
The 6 Actions of the 5 Pancakarma techniques:
1. Langhanam (light)
2. Rukshanam (dry)
3. Stambhanam (cold)
4. B¶hmanam (heavy)
5. Snehanam (oily)
6. Svedanam (hot)
1. Lightness—whatever produces lightness in the body is known as langhana
a) The drug possessing light, hot, sharp, clear, rough, minute, coarse, unstable and hard properties has got mostly the reducing effect.
b) Reducing therapy may be applied in various forms such as four types of evacuation, thirst, exposure to wind and sun, digestive measures, fasting, and physical exercise
1. Those having big body and strength, abundant kapha, pitta, blood and excreta, and aggravated vayu should be subjected to reducing by evacuation measures.
2. Those afflicted with diseases of moderate severity and caused by kapha and pitta such as vomiting, diarrhea, heart disease, cholera, alasaka (indigestion with stasis), fever, constipation, heaviness, eructation, nausea, anorexia, etc. should be treated mostly with digestives in the beginning by learned physician.
3. Those diseases having less severity should be overcome with control of thirst and fasting
4. Diseases of moderate and little severity in strong persons should be treated with physical exercise and exposure to sun and wind.
5. The person suffering from skin disorders, diabetes, and those using excess unctuous, channel-blocking and promoting diet and also patients of vatika disorders should be subjected to reducing therapy in the shishira (late winter)
(The symptoms of proper and excessive application of reducing therapy are the same as those of roughening therapy.)
c) Physicians pacify the diseases caused by hot with cold and conversely. For other diseases, the therapy consists of that which is contrary to the etiology such as there is no alleviation of the diseases caused by desaturation without saturation and conversely. Desaturation is of three types—lightening, lightening with digestives, and dosha elimination. Lightening is for those cases involving weak doshas. In this manner agni and vata are increased which dries up the little dosha as in wind and sun drying up a little water. Lightening with digestive therapy is used when doshas are of medium strength. In this manner the excess dosha is dried up as with sun, wind, and some absorptive dust sprinkled on it. In the case of heavy dosha only elimination of dosha is suggested. There is no remedy for overflowing of a small pool except by breaking down the walls. Thus works the therapy of elimination of doshas (Ca. Vi. III.41-44).
2. Promoting therapy—whatever promotes bulk of the body is known as brimhana
a) The drug possessing heavy, cold, soft, unctuous, solid, gross, slimy, dull, stable and smooth properties is mostly promoting in effect.
1. Undamaged flesh of adult animals, fish, birds living in suitable environments and killed with non-poisonous weapons is suitable for promoting
2. The persons wasted, wounded, lean, old weak, constantly traveling on foot and indulged in women and wine and the summer season are suitable for promoting therapy.
3. Those suffering from consumption, piles, disorders of small intestines, and wasted by other similar diseases, the light meat soup of carnivorous animals is the best promoting one.
4. Bath, anointing, sleep, enema with sweet and unctuous substances, sugar, milk, and ghee are universal promoters.
5. On proper administration of promoting therapy one gets strength and corpulence and gives up the defects of the lean.
6. On excessive application of promotive therapy one suffers from obesity.
3. Roughening—that which produces roughness, coarseness, and clarity/non-sliminess is r³kshana
a) The drug possessing rough, light, coarse, sharp, hot, stable, non-slimy and hard is mostly roughening in effect.
1. Roughening therapy consists of the regular intake of pungent, bitter, and astringent items, sex, oil cakes, buttermilk and honey, etc.
2. The roughening therapy is indicated in the diseases which are caused by blocking of channels, strong doshas and located in the vital parts (marmani) and in stiffening of thighs (³rustambha).
3. The roughening therapy should be regarded as properly administered when there is proper elimination of wind, urine, and feces, lightness in the body, cleansing of heart, eructation, throat, and mouth, disappearance of drowsiness and exhaustion, appearance of sweat, relish and both hunger and thirst together, and also the feeling of well-being. Pain in joints, body-ache, cough, dryness of mouth, loss of hunger, anorexia, thirst, weakness of hearing and vision, confusion of mind, frequent eructation, feeling of darkness, loss weight, digestive poser and strength—these are the symptoms of excessive reducing therapy.
4. (The symptoms of proper and excessive application of roughening therapy are the same as those of reducing therapy )
4. (Unction, persons suitable for unction, sweating, and persons suitable for sweating have been explained earlier chapters.) Uncting—that which produces unction, oozing, softness and moistening is snehana
a) The drug possessing liquid, minute, non-stable, unctuous, slimy, heavy, cold, dull and soft is mostly uncting in effect.
b) Those to be fomented and evacuated, who are rough, having vatika disorders, who indulge in physical exercise, wine, and women, and mental work are persons to be uncted (Ca. Su. XIII.52)
c) Ghee should be taken in autumn, fat and marrow in spring, and oil in early rains; one should not take uncting substance in weather too hot or too cold. Ca. Su. XIII.18 One, having aggravation of vata and pitta and in summer, should take unction at night; aggravated kapha and in winter one should take it in day with clear sky. Ca. Su. XIII.19
d) There are three doses: superior, medium, and mild and should be administered according to strict guidelines (Ca. Su. XIII.29-40).
e) There are 4 uncting substances: gh¶tam, tailam, vasa, majja and are administered according to strict guidelines ( Ca. Su. XIII.41-50).
f) Carmination, stimulated digestion, unctuous and unformed stool softness and unctuousness in body parts, these are signs observed in those who are properly uncted. Ca. Su. XIII.58
g) Nodulous and rough stool, unfavorable vayu, mild digestion, coarseness and roughness of body parts are the signs of under unction.
h) Pallor, heaviness, feeling cold, undigested stool, drowsiness, anorexia, and nausea are the signs of over unction. Ca. Su. XIII.59
i) See also Ca. Su. XIII.23-50 for the 24 ways to oleate, etc.
j) See also Ca. Su. XIII.29-40 for three doses
5. Sweating—that which produces sweat and alleviates stiffness, heaviness and cold is svedana
a) The drug possessing hot, sharp, unstable, unctuous, rough, minute, liquid and stable is mostly sweating in effect.
b) Diseases due to vata, vata-kapha, and kapha (Ca. Su. XIV.3-12) and amenable to fomentation are alleviated; feces, urine and semen are never obstructed; in cases of vata in stomach and kapha in colon fomentation should be rough and unctuous, respectively. Testicles, heart, and eyes should not be fomented, or if necessary only mildly; groins require medium fomentation; in remaining parts of the body fomentation should be as necessary.
c) (Ca. Su. XIV.20-24) Indications: coryza, cough, hiccup, dyspnea, heaviness, pain in ear, back of neck and head, hoarseness of voice, choking in throat, paralysis of face, one limb, whole or half body, bending of body, harness of bowels, constipation, suppression of urine, excessive yawning, stiffness of side, back, waist, and abdomen, sciatica, dysuria, enlargement of scrotum, body-ache, pain and stiffness in feet, knees, thighs, shanks, swelling, contracture, conditions of ama, cold, shivering, vatakan»aka, contraction, extension, pain, stiffness, heaviness, numbness in organs and general disorders.
d) Fomentation should be stopped when cold and pain subsides, stiffness and heaviness are controlled, softness and sweating produced.
e) Diseases due to cold and strong persons are indications for strong fomentation; in the medium and weak persons it should be medium and mild respectively.
f) Vitiation of pitta, fainting, malaise, thirst, burning sensation, weakness of voice and organs are symptoms of over-fomentation. In such cases, the regimen prescribed for summer, particularly sweet, unctuous, and cold should be followed.
g) Contraindications: habitual users of medicinal extracts, wine, pregnancy, internal hemorrhage, pitta and diarrhea, rough persons, diabetics, burns, prolapse and inguinal hernia, poisoning, alcohol, fatigue, unconscious, plumpy, pittaja meha, thirsty, hungry, angry, aggrieved, jaundice, abdominal enlargement, injury, weak, emaciated, suffering from diminished ojas, blurred vision.
6. Checking therapy—that with checks the movement of mobile substances is stambhana
a) The drug possessing cold, dull, soft, smooth, rough, minute, liquid, stable, and light is mostly checking in effect.
1. All the drugs and measures consisting of liquid, thin, stable, cooling and having sweet, bitter and astringent tastes constitute the checking therapy.
2. It is indicated in pitta, burns with alkali and fire, vomiting, diarrhea, excessive application of poisons and sweating.
3. The checking therapy is regarded as properly administered when the disorders are overcome and strength is gained.
4. On excessive application of the checking therapy the patient is afflicted with blackishness, stiffness in body parts, uneasiness, lockjaw, and obstruction in heart (function) and excretion of feces.
All these therapies should be known generally as not adequately administered when the treated doshas are not pacified but rather aggravated. Caraka describes a prolonged type of panchakarma (one year long for some) with a description of indoor and out door treatment protocols for rasayana. In some circles this is otherwise described as kayakalpa. The preparations are meticulously spelled out and have a similar ring to the preparations for panchakarma—purgation, unction, and heat. (The purgative is hot water and haritaki, amalaka, saindhava, jaggery, vaca, vidanga, haridra, pippali and shunthi.). Descriptions of numerous possible rasayanas are given including brahma rasayana, cyavanaprasha, amalaka rasayana, haritaki rasayana, and so on.
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