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PURVA KARMA THERAPIES

Ilakkizhi (Patrasweda)
Patra and Ila mean leaf. Kizhi means "bundle. llakkizhi or Patrasweda is a kind of sudation therapy using herbal leaves. Leaves of Arka (Calotropis gigantea), Karanja (Pongamia glabra). Dhatura (Datura metel) and so on are chopped and mixed with grated coconut, mustard and rock salt. The proportion of the ingredients varies according to the symptoms of the disease. The mixture is warmed in a pan smeared with coconut oil and then tied up in linen bundles to he used for fomentation. Prior to fomentation, oil is applied to the crown. As sudation is the primary aim of fomentation, the kizhis have lo be kept at a constant high temperature by warming them every now and then. In rheumatic pains and associated swelling of the joints, fomentation and massage with Ilakkizhi (bundles containing leaves) bring relief.

Abhyanga
Abhyanga means oil massage. In Abhyanga, medicated oil is massaged all over the body. The Abhyanga that is part of the daily routine lasts for five to fifteen minutes where as that which is performed for treating diseases may take about 45 minutes. Massages in Abhyanga can be effectively done with two therapists working on either side of the patient who lies on the droni. The droni is the wooden bed on which the patient is made to lie while undergoing treatment. Special care is to be taken for padabhyanga or foot massage. The marmas or vital points on the soles of the feet are closely related with certain internal organs. The sole of the right foot is massaged in clockwise movement and the left foot in anti clockwise. The patient reclines in seven standard positions. This begins with the person seated in an upright position, supine or flat on the back, turning to the right side, supine again, turning to the left side, supine once again, and finally sitting as in the beginning. Sometimes the position of lying face down is also adopted.

Snehana (Oil therapy)
Snehana means oil. Snehana is the term used for oleation or the application of oil. Oil may be administered either internally or externally. Application of herbal oil in either way saturates the body and loosens up the glutinous Amam that has accumulated in the Dhatus / tissues. Vegetable oils, ghee (clarified butter), animal fats and fat from bone marrow are the substances used for oleation. Ghee and sesame oil to which various herbs have been added are commonly used.

Snehapana (Abhyantara Snehana)
In Snehapana, a prerequisite in Panchakarma, Tikta ghritam or ghee infused with herbs is orally administered to the patient for a specific period. This ghee is made from clarified butter (obtained from cows milk) from which the protein content has been removed. It is then cooked with various herbs. Snehapana is done in the morning after attending to the calls of nature, on an empty stomach. The health, age, dosha condition and digestive capacity of the patient need to be taken into consideration .

Podikkizhi (Choornasweda)
Podikkizhi is a method of therapeutic sweating. The body is fomented thoroughly with linen bags (kizhis) containing drugs in powdered form. Horsegram, blackgram, sesame seeds and curative ingredients are powdered and tied up in bundles.  As moderate heat is required to sweat the body, the kizhis have to be warmed up by heating them in a pan smeared with castor or neem oil to prevent the kizhis from charring.

Four kizhis must be kept ready for use at all times. It is important that the kizhis retain a constant temperature, tolerable to the patient, throughout the treatment. After fomentation, the patients body may be wiped clean with a towel. This is followed by a short period of rest and then a bath. Application of oil on the body and head is recommended before bathing. Podikkizhi is good for ailments due to disrupted Vata and Kapha doshas.

Navarakkizhi
Navurakkizhi,  Keralas unique contribution to Ayurveda, involves fomentation of the body with u boluses of cooked rice. Shastika or navara, a particular kind of rice known for its nutritional value, is cooked in milk and a herbal decoction made of kurumthotti (Sida rhombifolia). Four boluses arc made of this cooked rice and tied up in linen bags.

The fomentation begins with the patient sitting upright on the dhoni with legs outstretched. The masseurs on cither side perform the fomentation process in an identical manner. The movement of the hands during both fomentation and massage should always be downwards. It is very important to keep the kizhis at a constant temperature. The treatment is over once fomentation has been carried out in all the seven standard positions.  After the specified duration of treatment, the paste is wiped off with palm leaf scrapers. A suitable type of oil is applied all over the body before the bath.

Pizhichil
Pizhichil and Sarvangadhara are technically the same. Pizhichil literally means squeezing. Here, warm medicated oil is squeezed over the patients body from a piece of cloth that is periodically dipped in a vessel containing the oil. In Sarvangadhara, oil is poured over the patients body from pitchers. The oil used for Pizhichil is kept in two vessels, one on either side of the patient who is seated on the droni with legs outstretched. Two pieces of linen, 15 to 18 inches square, folded to the thickness of the palm are used for dipping in the oil and -squeezing over the body. Before beginning Pizhichil, a suitable type of oil should be applied to the head and body of the patient. In some cases, a talam is also applied on the head and bandaged with leaves. The masseurs usually begin by squeezing oil on to the shoulders and then down the hands of the patient who sits in an upright position. Each masseur uses one hand to pour the oil while massaging with the other. Pizhichil is recommended for diseases caused by a vitiation of the Vata humour— Pakshagliata (Hemiplegia), paralysis and muscle spasms and other degenerative diseases that affect the muscles.

Dhara
Dhara is the pouring of warm medicated oil or a herbal decoction over the body. Dhara with oil is one among the major oil therapies. While in Shirodhara, oil is poured only on the forehead, in Sarvangadhara, it is poured all over except on the head. However, any dhara with oil is generally called Snehadhara. When medicated buttermilk replaces oil (snehci), the therapy is called Takradhara.

Dhanyamladhara
An infusion prepared from some cereals (dhanyam) and vinegar (amlani) obtained from citrus fruits is called dhanyamlam. Navara rice, horse gram, millet, sliced citrus fruits, dried ginger and so on are bundled separately in pieces of linen and then immersed in a large pot containing water. The water is then boiled for a specific period during which the extracts mix with water to make vinegar. A dhara treatment with this liquid is called dhanyamladhara. Dhanyamladhara is very effective for diseases caused by the derangement of Vata.

Ksheeradhara
Dhara with medicated milk is called Ksheeradhara. Usually cows milk but sometimes buffalos milk is used. Decoctions of various herbs are added to the milk. Ksheeradhara may be either for the head alone - Shirodhara, or for the whole body except the head - Sarvangadhara. A Sarvanga Ksheeradhara is usually prescribed for diseases caused by disorders of the Pitta. As a first step, a suitable type of oil is applied on the head. At least three attendants, two to pour the fluid and another to refill the vessels are required. The treatment is conducted while the patient goes through the standard seven positions. A nozzled pitcher is ideal for pouring the milk.

Netradhara
Extracts of herbs that possess preventive and curative properties are used for Netradhara. The procedure of the treatment is very simple. A stream of herbal extract is gently poured into the eyes of the patient who lies on the droni. The patient is made to lie on both sides in order that both eyes are thoroughly washed.

The extract is poured through a funnel made of the leaf of a jackfruit tree. Any device that lets out a small, continual flow may substitute for the leaf funnel.

Shirodhara (Moordhanya dhara)
For carrying out Shirodhara - dhara on the forehead, a droni alone is not enough.  A vessel with a hole at the bottom is used. For a gentle, continuous flow, a small device made of the shell of a coconut to which a cotton wick has been tied, is fixed inside.

To begin with, some oil suited to the patients dosha condition is applied on the crown. A headband (yartti) is tied just above the ear level to prevent oil from flowing into the eyes. The patient is then made to lie on his back on the droni with the head rested properly. The position of the head should be such that the stream from the vessel falls at the center of the forehead. The therapist then fills the vessel. When the oil that trickles down the wick starts to fall on the patients forehead, the therapist moves the vessel to and fro gently to ensure that the oil covers the entire region between the temples while he gently massages the area with his other hand.

The duration of a dhara is usually between 25 and 75 minutes. However, if the disease is very severe, it may take longer. A dhara is generally good for diseases due to a disorder of the tridosha. Herbal oil, tender coconut water, milk, ghee, dhanyatnlam (a mixture of cereals and citrus fruits) or buttermilk may be used for various kinds of dharas. The treatment is indicated for insanity, severe illnesses due to disorder of the Vara, chronic cold, sinusitis, diseases of the eyes, ears and so on.

Avagaha Sweda
Avagaha means immersion. Avagaha Sweda is sweating by immersion. Here, the patient is made to sweat while seated in a large tub. For treating diseases like hernia and painful urination, warm medicated liquid is filled up to the navel and for cases of severe rheumatism or other disorders of the Vata dosha, up to the neck. In some cases, a blanket is kept as a hood over the tub to facilitate sweating.

The liquid used is usually water that has been boiled with anti-Vata herbs. Dhanyamlam (see Dhanyamla Dhara) is also used.

Bashpasweda
Bashpasweda (bashpa means steam) is a type of sudation therapy. Here, herbal steam is applied evenly to the entire body.

Before starting therapy, the patient is given cool liquids to avoid dehydration and then made to lie down on his / her back. In this position, the entire body except the head is exposed to the steam. It is important to maintain the normal temperature of the head.

PRARDHANA KARMA THERAPIES

Shamana (palliative) Nasya
In Shamana Nasya the same substances as in Virechana and Brumhana Nasya are used but in combination with certain drugs that bring immediate relief.

As a preparatory procedure (Purvakanna), the patients shoulders, neck and face are to be massaged with herbal oils like Ksheerabala or Dhanwantaram. This is followed by sweating. Fomentation with a towel dipped in hot herbal juice is used to work up a sweat. It is important that the patients bowels and bladder be emptied before undergoing Nasya. The patient must be made to lie on his / her back on the droni with head lowered a bit by placing a pillow under the neck. The drug can then be safely administered in drops into the nostrils and should be drawn in by the patient. Soon after this, the attendants should massage the patients nose, cheeks, neck, shoulders, palms and feet gently. After some time, the patient feels the mucus oozing down from the nasal region to the throat. This can be spat out. A warm water gargle after this is good for the throat.

Nasya
The nostrils are the entrance to the head and the effect of the drugs administered through the nostrils spreads and alleviates the illness thereby protecting the upper as well as the lower regions of the human body," says Vagbhata, the great scholar. The administration of herbal oils, decoctions and powders through the nostrils is called Nasya. The therapy is used not merely as a nasal decongestant but also to cure many serious ailments like loss of consciousness, stupor, insomnia, hysteria, hemiplegia and facial paralysis.

Virechana (purgative) nasya
Virechana nasya cleanses the nasal zone using medicated oil or ghee, decoctions, herbal juices and so on. This type of Nasya is good for chronic headaches, throat diseases, catarrh, epilepsy, and certain types of skin diseases. "Marsha Nasya and Pratimarsha Nasya are names that denote the two doses in Virechana Nasya, when medicated oil is used. Marska varies according to the severity of the disease butPratitnarsha is always two drops. When a decoction or paste is used, Virechana Nasya is also known as "Avapeeda Nasya and when medicinal powder is used, it is known as Dhmana Nasya.

PASCHAT KARMA THERAPIES

Snana (Bath)
Snana is not an ayurvedic treatment. A daily bath after an Abhyanga or self-administered oil massage is part of the ayurvedic dinacharya (daily routine). If a suitable type of oil is used, Abhyanga helps to soothe Vata. A different type of oil that is suited to ones ailment can be used for the head. While applying oil all over the body, care should be taken to ensure that the face, ears and soles of the feet are also massaged gently.

A bath in warm water is preferable after an Abhyanga. Roots, barks and leaves of herbs suited to ones prakruti (constitution) and ailments may be boiled in this water, which should be cooled to a moderate temperature before being used. Never use hot water for the head. Cleaning agents like green gram paste should be used for the body, and a herbal shampoo for the hair. Avoid bathing at noon, while the environment is hot. Baths can be had in the morning or afternoon, before sunset. Bathing immediately after meals is not recommended. Application of some choorna (herbal powder) on the crown helps to prevent colds. Choornas or herbal powders like Rasnadi, Panchagandham or Kachoradi may be used.

Pathya (Diet regimen)
Pathya is an integral pan of Ayurvedic treatment. The patient is advised to follow a new diet regimen during and for sometime after the treatment. The diet regimen during the course of treatment is aimed either at increasing the potency of the drugs or preventing their side effects. The physician recommends a paihya that would achieve the desired result.

Peyadikrama
During the Panehakarma therapy, ihecttiuini (toxins) accumulated in thcdhutus and various channels of the body are brought into the gaslro-inleslinal tract, from where it is expelled. In this process of elimination, the digestive fire naturally gets weakened. The patient is therefore advised to take semi solid foods for some time to re-establish the digestive capacity.
Peyadikarma  is the diet schedule, which begins with Peya as the first semi-solid food. Peya is rice soup made of broken rice. It is ideal if shastika rice is used. From the fourth meal onwards, the patient is given Vilepi. Vilepi is rice soup of thick consistency. After the seventh or eighth meal the patient can resume a normal diet.

OTHER THERAPIES

Kativasti
The central portion of" the body is called Kati Vasti implies a container. Kativasti is an effective therapy for Katisula, which is the term for lower backache or stiffness or pain felt along the back.
A small receptacle of black gram dough is made on the lower back, around the lumbo-sacral area. After ensuring that this is leak-proof, lukewarm herbal oil, which alleviates pain and strengthens the bone tissues, is slowly poured into it. The oil and receptacle are removed after about half an hour. The affected area may be gently massaged with the same oil. The patient is then advised to take rest for a short while. For Ihe severe conditions of gridrasi (sciatica) and osteo-arthritis of the hip, a disease condition characterized by severe pain radiating down the leg, a combination of shanmna (palliative) and shodhana (eliminatory) measures is necessary if a relapse is to be avoided.

Netravasti (Akshitarpana)
Netmvcisti is a treatment for the eyes. To undergo this treatment the patient is made to lie on his back on the droni as in Urovasti. A receptacle is built around the eyes with black gram dough for the retention of the medicated ghee (ghrittim) used in the therapy. The receptacle around the eyes should be one and a hall" inches high and totally leak-proof. After the ghee is poured over the patients closed eyes, he/she is asked to open them slowly. The ghee is normally kept in the receptacle for less than five minutes after which it is gently removed while the patient keeps his eyes closed. Exposure to strong sunlight must be avoided for some time after this treatment. Netravttsti is indicated for glaucoma, conjunctivitis and night blindness.

Pichu
Pichu and Shirovasti are theoretically the same except for the modes of application which vary slightly. Both treatments are for ailments affecting the region above the neck, especially due to disrupted Vata dosha. Pichu is also used to treat some ailments of the cranial nerves. The patient should sit or lie down comfortably with an upright head. To begin with, oil is applied to the crown and a headband (yartti) tied just above the ear level. A piece of cloth about nine inches square, folded to the thickness of the palm, the Pichu is then dipped in the prescribed herbal oil and placed gently on the patients crown.

As it is essential to keep the pichu drenched in oil throughout, oil should be dripped on to it periodically. If not restricted by the physician, the patient may have a bath after a session of Pichu,.

Shirovasti
Shirovasti considered more of a palliative (Shamana) treatment than an elimi-native (Shodluma) one. The treatment is usually preceded by oleation (Snehami) and sudation (Swedtina}. A leather sleeve of about six to eight inches in length is placed on the shaven head of the patient and a band (mrtti) tied around the forehead to keep it in place. Kneaded dough is used to line the inside of this sleeve and ensure thai it does not leak. Oil is then poured into the sleeve and allowed to remain on the head for a while. T The length of time the oil should he kept there is determined by the severity of the disease. Usually it is upto fifty minutes for diseases caused by severe M/« disorders.
This treatment is prescribed for disorders like facial paralysis, cataract, deafness, earache, insomnia and other diseases that afflict the cranial nerves.

Urovasti
Urovasti is administered to the urns or the chest to treat pain in the sternum. As in Kativasti, a small receptacle is made on the chest with black gram paste. Oil is poured into this and allowed to remain there for some time.

Upanahasweda
An Upanahasweda* or poultice is a local application of a medicinal paste to treat pain associated with swelling.
A medicinal paste is prepared out of various substances. Seeds having anti-inflammatory and pain-reducing properties are ground in herbal oils or herbs are cooked with grains like wheat or Navara rice to make the paste.A moderately thick layer of the hot paste is applied to the affected part. Often the area is then bandaged with cloth or leaves. The bandage is usually kept on for over twelve hours..

Talam
Medicinal paste applied on the crown or forehead is called Talam. Different kinds of talams are prescribed according to the nature of the illness. Treatments like Pizhichil, Navarakkizhi and Sarvangadhara are preceded by the Talam.
Talapotichil
Covering of the head with medicinal paste is known as Talapotichil. It is an important treatment for many minor and major diseases that afflict the head. The hair on the head should be completely shaven or cut short. The paste is applied on the crown to a thickness of 3 cms. After a prescribed time the paste is removed and a fresh coating applied. The duration of the treatment is specified by the physician.

Karnapoorana
Karnapoorana literally means filling the ears. The patient is made to lie on one side. The ear lobes are gently massaged with oil as in Purvakarma. Lukewarm, purified medicated oil is gently poured into one ear. After remaining in the same position for about five minutes, the patient is turned and the process is repeated in the other ear.

Lepana
Lepana is the external application of medicinal paste on the body where pain associated with inflammatory condition persists. The ingredients of the paste vary according to the nature of the ailment.  

Udwartana
Udwanana means to elevate or to promote. The name can be attributed either to the treatments ability to improve the body condition or to the upward strokes used in massage here, unlike in other ayurvedic treatments.