Purvakarma: Preparatory Procedures of Panchakarma

The whole of panchakarma involves the complex and stepwise measures of prepping (called purvakarma), main procedure (called pradhankarma), and after procedures (called paschatkarma). The preparatory procedures are used to increase the effectiveness of panchakarma therapy. These include (1) digestive juice stimulants (Dipana), (2) digestants (Pachana), (3) oleation (Snehana), and (4) sudation (Swedana). Dipana is the process for stimulation of the digestive juices and fire (Jatharagni) using medicines; Pachana involves intake of digestants. Then is the process of internal as well as external oleation – essentially ingesting medicated oil or ghee and also applying it externally. The process is known as Snehana. The process of Snehana goes hand in hand with the process of Swedana (Sudation). Any preparation is usually administered for three to seven days, depending on the age, disease and the condition of the patient.

Dipana and Pachana

The process of Dipana and Pachana improves the jatharagni or the digestive fire improving the digestive as well as cellular digestion. Normal digestion is achieved with the administration of medicated dehydrated butter (ghee) mixed with digestants and digestive juice stimulants. Dehydrated butter is a potent biofire stimulant agent. Along with the dehydrated butter, we commonly administer digestive stimulants such as Chitrak (Plumbago), Trikatu (combination of dried ginger, black pepper, and Indian long pepper), compositions of nux vomica, etc. During Pradhankarma, the digestive fire gets unusually mollified thus a sort of “initial incendiary shock” is given such that this fire may not get extinguished.

Snehana

Snehana refers to those procedures which increase the lubrication of your body insides as well as the outsides. It may be administered independently for disorders of Vata but also is given in preparatory procedures. This mobilizes the toxins from their respective site of lodging and thus when you administer the main procedures of Panchakarma the toxins readily come out of the body. Oleation may be done externally by applying oily materials on the skin and internally via ingestion. Depending on the health or diseased state of the body the use of oils may vary. Oleation therapy is indicated prior to sudation as purvakarma but also for conditions such as dry skin, Vata dominance, excessive loss of blood, and eye disorders. It is contraindicated in patients with aggravated Kapha and all conditions where panchakarma is contraindicated. Internally medicated ghee is given for three to seven days at the break of dawn (6 to 7 A.M.), based on the person’s constitution and digestive power (Prakriti and Agni) and/or pathological notion of the body. External oleation can be done with the same medicated ghee or done on the basis of patients’ personal constitution. Oleation is followed by massage therapy and it is to be done for fifteen to thirty minutes.

Swedana

The production of sweat in various ways is known as Swedana or sudation therapy. It relieves stiffness, heaviness, and coldness of the body and induces sweating. It is administered to liquefy the oleated toxic materials which are spread throughout the body and direct them to the alimentary canal for elimination by Panchakarma. Swedana may also be a specific treatment for a number of disorders, especially in Vata-dominant diseases where it may be the main treatment.

Swedana may be applied with the use of direct application of heat (steam bath, sauna, and selective sudation – Naadi) or indirect application of heat (e.g., exercise, wearing heavy clothes, exposure to sun rays, etc.). Swedana may be applied either to one part of the body as a localized Swedana or to the whole body as a generalized Swedana. During and after Swedana, the blood pressure, pulse rate,

respiratory rate, and temperature are monitored to make sure they are within normal limits. Direct exposure to cold water or cold air should be avoided at least for one hour, and a bath in lukewarm water is indicated after Swedana. After completion of all aforementioned therapy, we perform the main procedures.

These procedures should be performed under the guidance of a trained Panchakarma expert. Despite appearing seemingly innocuous these procedures invariably may produce some unforeseen results (as any medicine does). Oil is to be applied meticulously covering all part of the body, Dipana and Pachana are to be given with proper dosing according to body weight, and sudation should be given carefully so as not to cause dehydration. A watchful and experienced eye of the physician is the need of the moment. Thus, an initial assessment followed by an extremely careful approach to therapeutic procedures is a definite requirement.