Ayurveda is a science of life. The chief object of this science are the preservation of health and prevention of disease. Jain Acharya Ugradittacharya wrote a book namely ‘Kalyankarak’ in which he used edible oil and jaggery in medicines.
The so called Keraleeya five course treatments are snehana (Olecation), Swedana (Diaphoresis), Vamana (Vomiting), Virechana (Purging) and Vasti (Enema). Nasya (instillation of nasal drops) and Raktamokshan (Blood letting) these classical Ayurvedic Panchakarma have been excluded from Keraleeya Panchakarma Therapy. As there are no hard and fast rules in the principles explained in the Ayurvedic Science there occurred a broad scope for developing new methodologies according to the expediency of the Physicians. The Keralite treatment became unique because the genius of the medical tradition converted many clues in the Ayurvedic Literature to practical ones. This led to the development of varieties of treatment methodologies explained in the classics or new treatment techniques in Kerala, which are yielding excellent results in Vata (Neurological ) disorders.
Vata is the most important among doshas as it is the controller of human machine (tantra yantra dhara’), effector of physical activities and physiological actions. Its role in morbidity is projected by its synonym ‘prabhanjan’, effector of catabolic reactions. Pain which is body’s alarm to detrimental reactions taking place in the body , is the most pronounced distress produced by Vata. Crippling diseases like Arthritis, Paralysis, Low back ache, Spondylosis etc have become rampant in the society and as these diseases persist for a longer period they make life miserable. Improper management by modern doctors who are still in chaos regarding these vatic ailments and the side effects of modern medicine signify the relevance of Keraleeya Panchakarma.
Abhyanga (External Oil Application) :
Appling oil on the body is called’ Abhyanga’ and this is advised to be practiced daily. Ayurvedic Saints (preceptors) included this in the daily routine of healthy and is prescribed in diseased also. The adipose tissue under the skin which is present all over the body helps to protect the body from heat, cold etc. Skin contains many nerve endings and helps in the sensation of touch, pain temperature etc. The oil when applied on the skin penetrates via transfollicular route and transpidermal routes. The fat layer of the body attracts and adsorbs fat from herbal drugs.
The hotness of the oil, slight pressure applied, enzyme hyaluronidase, hair movements, duration, speed , dilation of blood vessels, nervous stimulation all help the entry of fatty substances. For healthy its benefits are to preserve youthfulness, allaying vata(neurological) troubles, increases the perception of eyes (eye tonic), strengthens the body, sound sleep, increases skin lusture, and for long life. Abhyanga on head, ears and below the feet should be strictly followed daily for health maintenance. The nature of oil or fatty substance is to be determined according to the temperament. For healthy mixture of seasame oil and ghee is the best. The whole body Abhyanga can be practiced daily for vata temperament, Pitta on alternate days and Kapha on every fourth day.
(Kuzhampu is yamaka sneha and is usually mixture of sesame oil, castor oil and ghee in the ration 4:2:1, sometimes tallow (Vasa) is also used. To remove oil from the body instead of soap, powders of horsegram, greengram and Albezia lebbek are suggested for vata, Pitta and Kapha temperaments respectively. The water that is to be used for bath can also be medicated with Vitex nigundo leaves, Veteverria zizanoides and gooseberry leaves (or Terminalia Chebula) for vata, Pitta and Kapha temperaments respectively.
Phamacodynamics of Abhyanga (External Oil Application) :
Lipid soluble substances can easily pass through the cell membrane and nourish the tissues. Medicated oil when applied externally penetrates the skin via transfollicular and transepidermal routes. Slight hotness of the oil facilitates diffusion and increases penetration power. Slight pressure application , speed, hair movements, duration of the process etc activate nerve endings. Then ‘Axon reflex’ takes place. It has been noted that a sensory nerve has a vasodilator branch and cause Vasodilatation of the arteriole. So there will be increased blood flow and absorption takes place through subcutaneous tissue facilitated by the action of enzyme hyaluronidase. The water and lipid soluble substance present in the medicated fat thereafter reach the target structure where it reduces the catabolic inflammation and nourish the tissue. [ Fats are medicated by processing fats with decoction (or water) and herbal powders. First the powder is mixed in decoction or water and then the fat is added. Water extraction and fat extraction of the herbal powder take place.] External application in most cases produce only temporary immediate relief. External medicine complemented with internal medicines with pathya pave the way for’Sukha Saadhyata’.
Rejuvenative (Anabolic) Treatment Methods.
Rejuvenative therapies are mainly Pizhichil, Shahtika Pinda Sweda and Shashitika Annalepa. All these Sneha- Sweda effect and as they are done as rejuvenative therapies, they are done only after purifying the bosy with Vamana, Virechana and Vasti.
Dhara is pouring a liquid (oil, Milk, Vinegar etc) continuously on the body from a certain height, for which liquids and duration are assessed and determined accordingy. While Pizhichil (Oleation and sudorification done together) is pacifying as will as a Rejuvenative therapy, ‘Takra dhara’ has its importance in E. N.T disease and certain skin diseases, While Dhanyamla dhara is anti – inflammatory and analgesic. Thus different ‘dharas’ have wide range of different actions. Dhara is classified according to :
1) The nature of liquid.
2) The area of the body on which it is done (local, all over the boy, on
3) The strength of the patient (Alpa bala done once in 406 days, Madhya once in 2- 3 days, poornabala everyday or on alternate days).
Droni, vessel for dhara, liquid fro dhara, vartti (Roll of cloth), oil and powder ( Rasnadhi/ Kachoradi choornam) for Talam, hot water, internal medicine, Attendants.
The table on which ‘Dhara is done is called droni. It is usually made of wood of Strychnos nuxvomica or Deodar or Pine or Mango tree. A separation is made where the neck of the Patient is kept. So it has a head portion. Structure of the droni should be such that the oil should not remain in the centre and should flow on to the sides and to the outlet made at the lower end from where oil could be collected easily. The dimension needed is.
Body portion of the Droni – 72” x 18” x 18”
Head portion of the Droni – 18” x 18”
Vessel for dhara (Specific for dhara)
Can be made with metals or clay . The hole in the vessel through which liquid is poured should be large enough to allow the insertion of the small finger of the patient. The Vessel used for “Sirodhara’ (dhara on the head) should have a capacity 3 – 4 litres. Optimum quantity for liquid needed for whole body dhara is 16 prastas.
Liquid for Dhara
a) Vata – 4 fatty substances together or
sesame oil (Yamaka, Trivrit or Mahan)
b) Pitta rakta (PR) – ghee
c) Vata + PR – Sesame oil
d) Kapha + PR – Sesame oil & Ghee
e) Kapha + PR – Sesame oil + quantity ghee.
Takra Dhara (Butter Milk)
Preparation of medicated butter milk :-
Prepare Ksheerapaka with the tubers of Cyperus rotundus (30 gm), milk 480 ml and water 4 times the quantity of milk and from that butter milk is fermented. This mixed with mixed with same quantity of the decotion of gooseberry and used for dhara. Other than cyperus other suitable drugs like veteveria, sandalwood etc could also be used.
Camphor or dry ginger or gorochana or Elis (aloe juice solidified) is added in 24 palam cow’s milk or decoctions of milk with suitable drugs and used mainly in Pitta vikaras.
Raw materials required are Shashtika rice, Flattened rice and Horsegram 13.5 litres etc. floured shastika rice – 55 litres and Italian millet, Papsalum scrobiculatum
( varaka rice), Sliced lime 5.5 litres each. Bundle is made with dry ginger cut fine anf ajawan seeds three separately. All raw materials are taken in a well-baked earthen vessel into which 270 litres of water is poured. It is constantly kept on fire for 8 day and the vinegar formed can be used. This is made in early days in every houses and is very efficacious in vatic disorders.
Procedure of Sarvanga Dhara (Whole Body)
Powder of medicines according to the doshas is mixed with suitable liquid like oil. Castor oil, lemon juice milk, buttermilk and by heating or without heating made into paste form and kept in the 4 angula are (3’’) on the crown (bregma region) of the head with 1 angula thickness. This mode of powder application is called talam. This is beneficial for people who are easily succeptible to cold, inflammations etc. Usually talam is done with paste of Rasnadi choornam in suitable oil. Other talams commonly used are venns talam (in facial palsy) and Nellikka talam’. This is removed after 11/2 hours and powder alone is applied just then or after bath. A roll of cloth is tied around the head (above the ears) to prevent head from rise in temperature during the process.
Months July-August, October –November, February- March are considered the best keralite climates for this treatment. The droni is arranged in a suitable room which is protected from wind, with its head towards east. The patient should be ready after having attended the calls of nature. When the food of the previous day has digested well and after 8.00 a.m. (also done in the evening) the patient is asked to sit on the droni. After the auspicious ceremony the patient should be anointed with oil on the head first (or talam is kept) and then on the ears. Then the vartti (Roll of cloth) is tied around the head just above the ears and eyebrows with its knot on the side. According to the patients condition or disease, Kuzhampu (yamaka sneha-sesame oil +1/2 qty. castor oil +1/4 qty. ghee) is selected and its paka is usually chikkana as this oils has to be heated again and again. Kuzhampu is applied all over the body and gently massaged. Then the warm liquid for dhara is taken in the nozzied vessel. Four attendants should do the process so that all the parts of the body are anointed simultaneously and continuous pouring is maintained. Two attendants are needed to heat the liquid and maintain the temperature of the liquid. Along with dhara, mild massage is done in the downward direction. Dhara is done in different position (of the patient ) so that whole body unction is done comfortably.
The oil is wiped and applied again and gently massaged for some time, after which he can take First head is washed with cold (room temperature) water (medicated) , wiped and covered with a cloth. Then the body is washed with warm water. Powder of greengram, horsegram etc. are used to remove oil. After wiping well, medicated powder is rubbed on the crown. Then he is given the prescribed medicine (usually Gandharva hasthadi kashaya.) In some cases the medicine is given just before the process commences which gives a laxative effect after the process. Usually the process (dhara) is done for 7 days/14 days or according to the severity of the disease. On the eighth day castor oil or madhutailika enema is given so that the wastes that get accumulated in the alimentary canal by this unction and sudorification is completely evacuated out. The time duration of dhara is 1 ½ hours
This is an excellent therapy for ‘vata dosha . This allays vata and is also a rejuvenative therapy: This is combined form of oleation and sudorification therapy. For those who are eligible for lubrication and sudorification therapies pizhichil can be done
For diseased pizhichil can be done in any climate after rectifying the climatic errors (excessive cold excessive hot etc.) Only unctuous liquids are used for pizhichil. The main difference from dhara is instead of vessel, a broad & thick folded cloth is dipped in the oil and squeezed and poured on the patient’s body from a height of 12 anguli (9”) The flow of the oil should be uniform and continuous through the thump. While the oil is poured with one hand, with the other hand mild massage in the down ward direction is done.
Total quantity of oil usually used is 5 litres (though daily using fresh oil is the best one). For the first 3 days 2 ½ prastas oil next 3 day fresh 2 ½ prastas oil and on the last day mixture of these two is used.
Usually duration of pizhicil is one and a half hours. The process is done on the first day for 45 minutes and on the 4th day 1½ hrs by increasing the time daily by 15 minutes. Then from fifth day 45 minutes the process is done. Pizhichil is done in 7 position viz sitting. lying in the supine position, right lateral recumbent, again supination, left lateral recumbent, again supination and sitting positions. If needed sirodhara (on the head) is done simultaneously. All other processes are same as in dhara. If the patient is not paralytic or of facial palsy, he can take bath. Otherwise only wiping is done. The oil penetrates through the hair follicles with in 300 ‘maatra’. The oil penetrates 7 layers of skin and reaches all the 7 dhatus (tissue elements) in 7 days.
Number of day’s the liquid for dhara can be used:
a) Milk – only for one day
b) Dhanyamla (vinegar) – for three days
c) Oils – 3 days
Shashtika Pinda Swedam (SPS – Jnavar Kizhi)
This is purely a keralite rejuvenation therapy. This is used as a rejuvenative therapy as well as an alleviating one. It is done below the neck and in some cases like cranial nerve lesions it is done on the face also (the eyes are protected).
The Pinda (bolus) made with shashtika rice rubbing on the patient’s body is termed Jnavara kizhi. Balaroot)sida cordifolia) decolction is made in 16 litres of water and reducing to 4 litres. Equal quantity milk is also taken. In 4 litres mixture of decoction and milk. Shashtika rice (720 gms) is boiled and prepared. The remaining 4 litres of mixture is boiled and used to reheat the boli. The processed rice is put in a piece of cloth and made as bolus with a handle length of about 3 inches.
Preparation of the patient, applying oil etc. are done similar to that of pizhichil. 4 bodi are dipped in the mixture and is made hot and massaged on the patient’s body with agreeable warmth. Massage will have to be across and upwards and sometimes according to the direction of the nerves. At the same time the rest 4 boil are made warm and when the first 4 bundles loose heat they are replaced by the latter 4 bundles. Thus temperature and continuity is maintained. The process can be done up to a maximum time of 90 minutes. Finally the rest of the rice remaining the boli are opened and pasted on the body. All the duties after the process are like pizchichil.
Shashtika Annalepam (Jnavarr Payasam Theppu)
Balaroot – 180 gm.
Water – 4 litres
Decoction – 1 litre
Milk – 1 litre
Powder of Shashtika – 240 gm.
Shashtika rice is processed and made a paste (payasam). From that half portion is taken and applied on the patient’s body (after preparing him similar to that of pizhichil) with little warmth. When the paste becomes cool little more fresh paste is mixed and the process is continued. It is done in supine and pronation positions for half to one and a half hours.
Oleation therapy is usually followed by sudorification therapy as both are prerequisites therapies. The Diaphoresis is done alone in certain disease and in some diseases it is a post requisite. Secretion of sweat is under ANS( autonomic Nervous System) control. The hairs of the skin are tactile sense organs. Sudorification can bring about changes indirectly in Ans and heat can bring about changes in the conduction of nerve stimuli by changing Na concentration. Othere than shashitika sweda other types of sudorification are Ila Kizhi, Podikizhi, Naranga Kizhi, Mamsakizhi and Ksheera dhoomam. The hers a that are used have anti – inflammatory, analgesic, lubricant, anabolic etc effects.
Pharmacodynamics of Swedana
Sweat is a mixture of water, salts, urea, uric acid, amino acids, ammonia, sugar, lactic acid and ascorbic acid. To understand the actual action of Swedana, knowledge of inflammation is dispensable.
The cause of inflammation in Ayurveda is ‘ Aama’. Inflammatory responses occur when accumulation of metabolities in the tissue takes place and peptides are released from phagocytic leucocytes. Due to infection or inflammatory process or immunological reaction there will be accumulation of metabolities. So irrespective of catabolic or anabolic responses these processes can occur. So in accordance with the nature of accumulated metabolities (‘Aama’) and body’s reaction, signs and symptoms manifest. Mediators effect inflammatory reaction. Macrophages during active phagocytosis can release or secrete a number of factors, which trigger chemical mediators of inflammation. Of these mediators production of pain is by bradykinin and prostaglandins in tissues deprived of their nervous connections. Prostaglandins also produce fever, by activating temperature regulatory centre, hypothalamus. As immune response is more in high temperature, sweating will not occur (Swedavaha sroto rodha). Increased bloods flow to the injured site produces hyperaemia (redness) and warmth. Effect hydrostatic pressure will be vascular permeability oedema occurs and tissue tension increases which produces pain in places where nervous connections are intact. Intracellular water accumulation also takes places when sodium pump failure occurs as a result of damage to mitochondria. Sodium pump failure occurs as a result of damage to mitochondria. Sodium enters the cell in exchange of potassium resulting in net influx of water. Thus inflammation is a localized protective response to tissue injury designed to destroy, dilute or wall off the infecting agent or injured tissue characterized by redness, pain, heat, swelling and sometimes loss of function. So the best treatment principle that could be adopted for acute response, which is a body’s natural mechanism to eliminate irritants and to prevent adverse effects by enhancing immunity thus producing an environment congenial to the proper processing of metabolities. So the best treatment method to reduce inflammation is Swedana.
Effects of Swedana
a) Speeds up the inflammatory process.
b) Increses bloods flow.
c) Facilitates sweating.
d) Reduces Oedema by changing Sodium ion concentration.
e) Autonomic Nervous System is activated. [ Stress response – Streesor (heat, cold, toxins etc) initiates homoeostatic mechanisms that counteract stress. Sympathetic tone increases produces – epinephrine, norepinephrine and cortisol which are lipolytic hormones).
f) Mobilises ‘Aama’ and expels either through sweat glands or displaces into general circulation.
g) Sneha sweda softens fibrotic changes, increases mobility and nourishes the structures.
Ila Kizhi ( Patra Potala Sweda- PPS) – Leaf Sweating
Herbs required are finely cut leaves of Chincha (Tamarindus indicus), Arka ( Calotropis gigantean, Castor) Karanja (Pongamia pinnata), Dhatura (Dhatura metel), Vatamololli (Justicia gendarussa) etc. small pieces of lemon, scraping of coconut, powder of methika (trigonella graceum), mustard, fenugreek, dill and rock salt. All are mixed in a pan and fries in castor oil. When these get properly fries they are put in two pieces of cloth and bolus is made. Rice bran water or cow’s urine or decotion or oil is heated and the boil are made or cow’s urine or decotion or oil is heated and the boli are made warm by dipping in it, Upto anointing all processes of pizhichil are done. The bundles are rubbed on the body with one hand simultaneously massaging with the other hand. The temperature and continuity are maintained. All other steps are like pizhichil.
Podi Kizhi (Powder Sweatting)
Powder of many ‘vata’ alleviating drugs are taken and rock salt is added and fried. Then it is made as bolus and done sweating as IIakizhi.
Dhanaya Kizhi (Grain Sweating)
Masha (Phasseolus rox burgi), greegram, sesame, shastic, mustard , Kulatha (Dolicus biflorus) etc. grains are fried and powdered and used as IIakizhi. To make the boli warm, cow’s milk can be used. Dhanya kizhi and Podi Kizhi are opted for sudorification with dry heat (or without applying oil).
Naranga Kizhi ( Jamberra Pinda Sweadam – JPS)
Lemon is first fried in a suitable oil. Crushed lasuna (Allium sativum ) 250 gm, powder of methika, sathahwa (Anethum graveolens), turmeric and kulatha 100 gms each and rock salt 50 gms are added and fried. Then these are made boli and applied. These are mainly prescribed for local pains. For chronic ailments with Oedema (Niraama . JPS is preferred rather than PPS.
Ksheera Dhooma (Vapours of milk)
Milk decoction of balaroot (sida cordifolia) is boiled in a closed vessel into which a tube is inserted. Through the other end vapours come out and is directed towards patient’s body. Anointing and other preparations are the same. Eyes are covered with lotus leaves, to protect them from vapour and heat. This is done for 20-40 minutes or till sufficient salivation occurs. This is mainly indicated in degenerative nervous disorders.
Sneha Sweda Application in Certain Diseases
Rheumatoid Arthritis (RA)
RA is the commonest form of Chronic inflammatory joint disease. In its typical form RA is a symmetrical, destructive and deforming polyarthritis affecting small and large peripheral joints with associated systemic disturbance, a variety of extra articular features and the presence of circulating antiglobulin antibodies. This causes crippling knee disease. Injury to semilunar cartilage mayh occur. The mode of onset is insidious with joint pain, stiffness and symmetrical swelling of a number of peripheral joints.
Inflammation of synovial membrane.
Synovial fluid accumulates
Abnormal granulation – (distortion of fingers)
Erodes articular cartilage
Fibrous tissue develops
Initially pain may be experienced only on movement of joints, but rest paid and especially early morning stiffness are characteristic features of all kinds of active inflammatory arthritis. In the acute phase the disease is ‘Saama’ (Kapha predominant) as the paid increases after rest, early morning etc. the initial stage of all inflammatory arthritis should be treated as ‘Saama Vaata’. Dry heat with ‘Vaaluka Sweda’, Podi kizhi (with vata alleviating drugs), dhaanya kizhi (with powder of grains) etc. will bring down the pain quickly. ‘Dhaanyamala dhaara’ if gever is absent could be done. Chronic stage of the disease identifies with ‘Vaataadhika Vaata rakta’. In this stage ‘Gambheera Vata rakta cikitsa’ could be applied. ‘Phizhichil’ abd Upanahana with suitable medicines along with Virechana, Aasthapana and Snehapana would prove beneficial in this stage.
Rheumatic fever, Osteoarthritis, frozen shoulder (Supraspinatus tendinitis & subdeltoid bursitis), plantar fascitis, cervical spondylitis etc have similar ‘Saama’ stage. In all these cases oil application is contra indicated in the initial stage. In all these cases oil application is contra indicated in the intial stage. Other external treatments like patrapotala. Sweda and Jambeera pinda sweda along with appropriate internal medicine according to the ‘Niraama’ stage yield tremendous results.
Inter Vertebral Disc Prolapse (IVDP)
Disc consists of nucleus pulposus and annulus fibrosus (fibrous ring). Weakness of the concentrically arranged annulus fibrosus results in posterior protrusion of nucleus pulposus which is termed as IVDP. This when occurs between 4th and 5th lumbar vertebrae or 5th lumbar and sacrum it compresses sciatic nerve producing the disease sciatica.
Here treatment principle of ‘Snaayu gatha Vaata’ viz. ‘Kateevasti’, Upanahana, Patrapotala sweda will help to alleviate the symptoms.
Similar treatment (region wise modified ) could be adopted in tennis elbow, carpel tunnel syndrome, cervical spondylosis, chronic statge of frozen shoulder etc.
Bell’s Paralysis (Ardita)
This is commonest type of infranuclear type of facial nerve palsy. This is due to primary ischaemia of the nerve due to Vasospasm.
The cause of ischaemia should be removed first. To impart strength to facial muscles to stimulate the nerve endings and to increase blood supply ‘ksheerta dhoomam’ is the treatment of choice. Ksheera or milk is emulsified fat and can easily penetrate cells and can reach deeper structures.
In paralysis Pizhichil and Shashtika Pinda Sweda are done as Rasayana Therapies after performing all ‘Shodhana therapies’. In muscular dystrophy, cervical spondylosis, muscle wasting, atrophy etc. ‘Maamsa Pinda and ‘Shashtika Pinda Sweda’ (or ‘Anna lepa’) have proven beneficial.
Keraliya Panchakarma Therapy proven to be effective in curing all types of disorder especially joint on disorders, degenerative & neurological disorders.
Date: 16th March 2011
Author: Dr. Santosh Chavan — B.A.M.S, M.D.(Ay. Medicine)
About: Dr. Santosh Chavan has studied at the National Institute of Ayurveda, Jaipur by Govt. of India and is an Associate professor in Dept. of Panchakarma Bharti Vidyapeeth. He is also pursuing Ph.D in Panchakarma. He is also on the panel consultant atthe Deenanath Mangeshkar Memorial hospital Ayurveda Department in Pune and is independently practicing in 2 places in Pune. Dr. Santosh Chavan has a website from WebsiteForDoctors