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A Critical Review on Area of Research in Standardization of Panchakarma

Procedures

Article in Indian Journal of Forensic Medicine & Toxicology · May 2021

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4386 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2

A Critical Review on Area of Research in Standardization of

Panchakarma Procedures

Swati Tikale1, Shweta Parwe2, Nandkishor Umale2, Sonali Wairagade3, Madhulika Tiwari3
1
Associate professor, Panchakarma department, Datta Meghe Ayurveda Medical College Hospital & Research
Centre, Nagpur, 2Professor & Head Dept. Of Panchakarma, Mahatma Gandhi Ayurveda College (DMIMS),
Saklod, Wardha, 2Associate Professor, Panchakarma Department, Parul Institute of Ayurveda and Research
Vadodara, Gujrat, 3Professor & Head Dept. of Kayachikitsa, Datta Meghe Ayurveda Medical College Hospital
& Research Centre, Nagpur, 3Assistant professor, Sharir Rachana department, Datta Meghe Ayurveda Medical
College Hospital & Research Centre, Nagpur

Abstract
Background: Panchakarma procedures belonging to a class of cleansing procedures called shodana
therapy (purification) in Ayurveda. The unusual fact Panchakarma now convening is, the same Panchakarma
procedure is giving different percentage of efficacy rate in different regions, in patients with the same
disease and base-line parameters. To ensure uniformity of the procedures and achieving maximum efficacy,
standardization of these Panchakarma procedures became an emergency necessity.

Aim: The present article focus at exploring the area of research in standardization of Panchakarma
procedures and to enhance and make sure standardized Panchakarma procedures should be followed
everywhere thereby certifying maximum possible safety and uniform efficacy.

Review Results: The methodology for Standardization of Panchakarma procedures has to be implemented
in an emergency basis to ensure complete safety and maximum efficacy.

Discussion: The methodology for Standardization should be prepared by absorbing the concept of
Panchakarma on scientific lines and should be well ordered, practical and cost-effective.

Conclusion: The present article outlines the concept behind Panchakarma procedures, the methodology for
Standardization and area of research in it.

Keywords: Panchakarma, Standardization, Research

Introduction Concept regarding evolution of Panchakarma

therapy:
The nature has taught the man how to be healthy
before science has discovered the law of health1. In In Ayurveda textbook it is explained that our body
Ayurveda Panchakarma procedure is practised for both is made up of sthula and sukshma srothas2 (macro and
healthy and diseased person. Panchakarma therapy is micro cellular channels) through which body elements
called as purificatory therapy in Ayurveda because of its are as well as ejection of metabolic waste materials are
detoxification action. Panchakarma, a comprehensive, going on. Due to various reasons including improper
and an essential part of Ayurvedic treatment and food habits, sedentary life- style, attack of germs etc,
having its role in each therapeutic condition. Due to its these cellular channels get slowly and slowly assemble
long lasting and absolute relief of chronic diseases, it with “aama” 3 or accumulated cellular toxins. When
is now evolving globally. In other way we can sense, blockages of these srothas are occurring, Ayurveda
Panchakarma is nothing other than the peculiar trans- calls it as a beginning of pathological procedure called
cellular bio-purificatory mechanism ever evolved2. as “aavarana” or blockage. This aavarana, according
to Ayurveda, is causing not only hiddenness to free
 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2 4387

movement of vaata dosha or free transport of body The principle methodology behind the selection of
elements and metabolic wastes, but also, make the toxic which type of snehana and swedana procedure needed
elements or vitiated dosha which will get deposited in to be administered for a patient can be developed by
prone areas in body. As per the site of its sthanasamsraya following the steps of dasavidha pareeksha (ten levels
(deposition), the disease appears as amavata, vatarakta, of examination)9.
(rheumatoid problems), kushta (skin problems) etc4.
So, the very first step required while preparing a (ii) Standardization of methodology of
panchakarma protocol is eradicating these cellular preparation:
toxins by pooling them into digestive tract. When prepration of pinda sweda is concerned,
1. Standardization of Idea behind formulating of its ingredients, quantity of each ingredient required
a Panchakarma protocol: for pottali sweda and preparation method should be
standardized. As per patient’s health factor, quantity
The occulted cellular toxins (aama) have the of each ingredient can be scientifically altered. For
peculiar property of pichilatwa (stickiness). So, the example, when the patient has more kapha dosha dushti
initial step needed is to bring it into the digestive symptoms like Swelling and feeling of heaviness,
tract is nothing other than causing its liquefaction and quantity of coconut scrapings in Patra Pinda Pottali
therefore increasing its volume (abhishyandana)5 Sweda can be reduced and quantity of lemon which
which is achieved by a poorvakarma procedure called have anti-inflammatory property can be increased. The
“snehapana” in which medicated/non-medicated, standardization should also be done for order of steps for
ghee/oil/ fat is given orally in a properly increasing the preparation of potali sweda.
dose under controlled conditions for maximum up to
7-9 days or up to the development of samyak snigdha (iii) Standardization of administration of
lakshana (symptoms of proper oleation)6. After causing procedure:
liquefaction of cellular toxins through snehapana The methodology in which a procedure is carry
procedure, next step is swedana (sudation)7 through out should be standardized and authenticate or in other
which these liquifacted toxins will be assisted towards words, authentification of Standard Operative Procedure
alimentary canal. When these cellular toxins reach (SOP) should be finished for snehapaana, abhyanga,
digestive tract, it can be removed out as per the adjacency pinda sweda, pottali sweda or any poorvakarma
by Vamana (vomiting) therapy or Virechana (purgation) procedure.
therapy. If the patient’s age or any other parameters is
contraindicated for snehapaana or swedana procedures, (iv)Standardization of samyak lakshana
alternative procedures like abhyanga (external oleation), (symptomatologies) and authentification of tool to
pinda sweda (pottali sudation) etc can be selected. Once assess the procedure:
poorvakarma procedures are done, then according to the
adjacency and site of dosha, vamana procedure (emesis) Development of pro forma can be done under the
or virechana procedure (purgation) can be opted. following steps:
Usually, enema (Basti) procedure is doing after the a. Collection of symptomatologies:
initial level of detoxification or can be done previously
for some specific medical indications and even during It should be selected particularly from all the
emergency conditions. When doshas are localized on available Ayurveda classical literature.
head and neck area, nasya therapy (nasal administration
b. Item Scrutiny:
of medicine) is recommended8. This Idea behind the
developing of a protocol for Panchakarma procedure This include cutting of lakshanas (symptoms)
should be standardized. which have similar meanings. Each and every collected
lakshanas (symptoms) should be examined by its root
2. Standardization of poorva karma procedures:
word, meaning, implication etc by thorough analysis
(I) Standardization of medicine required for and which symptoms having same meaning should be
poorva karma (oil/ghee/pottali): cut out and only one lakshanas (symptoms) should be
selected.
4388 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2

c. Review of Literature: Vasti (Enema) therapy:

Recent available research, review works and Vasti by its action on moolasthana get control
monograph should be systematically analyzed to search on vata all over body12. Vasti therapy consists of
for any other additional lakshanas (symptoms) observed both niruha vasti (enema with medicated kwatha)
during the performance of the procedure. and anuvasana (enema with medicated oil). It can
be performed as specific designed packages like kala
d. Clinical observation: vasti, yoga vasti, karma vasti or can be done alone in
With this developed pro forma, the researcher has specific conditions like amavata (Vaitarna Vasti), anaha
to go to the panchakarma theatre for inspection of these (Vaiswanara churna vasti). The selection for designing
lakshanas (symptoms) in patients. to perform into packages or doing it alone needs
standardization. Standardization of vasti therapy also
e. Conclusion: includes standardization of peedana kala (pressing time
of vasti bag), standardization for mixing of vasti dravya,
After clinical inspection of lakshanas, concluded pro positioning of patient, diet taken during vasti, time of
forma should be made. This concluded pro forma should administration of vasti etc.
be tested to various stages of validation like face validity,
content validity by subject experts, construct validity Nasya (Errhinne) Therapy:
and criterion validity which involve the comparison of
developed pro forma with existing gold standard. Nasya (Errhine therapy) is said to be effective
in curing diseases of Urdhvajatru (supraclavicular
Standardization of Pradhaana karma: region)13. Many Modern research works enlightens the
existence of naso-brain pathway which is the fastest drug
Vamana (Emesis) therapy: delivery route. To ensure rapid drug absorption directly
Vamana therapy is exactly medically promoted to the brain, drug has been considered to be absorbed
vomiting by intake of prescribed drug which causes through arachnoid matter sleeve which extends along
the activation of Chemoreceptor Trigger Zone (CTZ), olfactory nerve14. For that standardization of nasya
solitary tract nucleus and finally the vomiting centre therapy has to be observed including for factors like
medulla oblongata leads to activate phrenic nerve, vagus position of patient head while performing nasya karma,
nerve and intercostals nerves to activate vomiting10. standardization of hastaswedana procedure which may
The medicine which are used, collected and processed cause facial efferent stimulation, standardization of doze
for vamana, its dosage, anupana should be standardized and also bindu pramana15 as mentioned in ayuvedic
along with the standardized achievement of vamana classics w.s.r.to each nasya dravya, standardization of
protocol and patient regimen. time, tool implemented for samyak nasya lakshana etc.

Virechana (Purgation) therapy: Standardization of diet taking during

Panchakarma treatment protocol:
Regarding virechana therapy is concerned, prior
diet, level of virechana needed in the peculiar condition Habit of food taking during panchakarma therapy
of disease, procedure of virechana as a whole, tool course cannot be authetified fully because of the
to asses samyak virechana lakshana in a particular cultural sensitivity of the patients of various regions
disease, time of intake of virechana medicine etc need where Panchakarma is practised. Even though we
standardization. Level of virechana karmukta should be cannot standardize food habits, the idea behind diet
selected, whether it is having anulomana or sramsana used during various stages should be standardized.
or a bhedana karma, it depends on various factors Scientifically arranged diet protocol implemented after
including strength of dosha vitiation of dosha, rogi bala panchakarma procedure aiming at the rejuvenation of
etc. For example, in pakshaghatha (hemiplegia) disease, elements in body which were medically-altered during
only anulomana11 is advised whereas in kushta, due procedure is mentioned as samsarjana karma16. The
to bahudoshavastha(huge vitiation of dosha), bhedana principle idea of samsarjana karma for panchakarma
virechana is indicated. procedure, which starts with carbohydrates followed by
proteins and ends with fats should be standardized and
implemented. The dietary food items prescribed while
 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2 4389

doing snehapana, swedana, vasti etc should also be make sure its absolute safety with uniform and maximum
standardized on scientific basis. Efficacy of vamana and viable efficacy and thereby expurgate Ayurvedic medical
virechana procedure mainly depends on the dietary food sciences.
items consumed on previous day which is mentioned
as utklesana diet planned for liquefaction of kapha and Conflict of Interest: Nil
pitta dosha respectively also need standardization17. Source of Funding: Nil
Standardization of Panchakarma theatre Room: Ethical Clearance: taken from institutional ethics
Panchakarma procedure room should be set and committee
standardized as per NABH criteria which involves
proper electricity and proper ventilation, hygienic, with
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