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Panchakarma - Ayurvedic Science of Rejuvenation and Detoxification

by Dr Deepika Rodrigo(more info)

listed in ayurveda, originally published in issue 78 - July 2002

The Western lifestyle, while having many advantages, also has the disadvantage of throwing up many minor as well as major health problems. These range from minor skin disorders and food allergies to the more serious problems such as hormonal imbalances, myalgic encephalomyelitis (ME), multiple sclerosis (MS) and cancers. The causes of some of these disorders are traced to poor diet, stress, pollution and the general fast, frantic way in which we live today. When we fall ill we tend to want a 'quick fix' from our GP, in the form of an antibiotic or painkiller, but rarely do we stop to think that it is our diet and lifestyle that have caused the problem and that by changing what we eat and how we live our lives we can help ourselves to maintain our health and equilibrium.

Patient in traditional Ayervedic steam chest
Patient in traditional Ayervedic steam chest

Balance and Imbalance – Prakruti and Vikruti

For those of us that are in poor health, the science of Ayurveda offers us a way to regain our health and equilibrium by giving us advice on changing our diet and lifestyle to suit our own particular 'prakruti', which means our true nature or our natural state. This term is used to describe our own particular psychological and physiological make-up. Our prakruti is a combination of three 'doshas', dosha literally meaning 'fault' or 'error'. The three doshas (tridosha) of vata, pitta and kapha are forces that bind to the five elements – ether, air, fire, water and earth.

Vata is composed of the elements air and ether. Pitta is composed of the elements fire and water and the kapha dosha is composed of the elements water and earth. The food we eat and the way we live our lives affect our doshas, causing them to become out of balance and in turn causing ill health and discomfort to the individual. There are also many subtle variations in the combinations of the tridosha that make up our particular prakruti or constitution.

The particular combination of the doshas vata, pitta and kapha that makes up our individual prakruti is determined at the moment of conception. It is a combination of our parents' constitutions or prakruti and gives us our particular and unique biological, psychological and emotional characteristics of the body and mind. This includes our size, shape, complexion, hair colour, eye colour, immunity and physical strength. When we understand our prakruti, or our true natural state, we can attain an ideal state of health. Sadly, it is not possible for us to attain a perfect state of health constantly and there will be times when we become ill and in discomfort. This is because we move from our natural balanced state, or our prakruti, to an unbalanced state where our doshas (vata, pitta and kapha) become distorted. This unbalanced state is called our vikruti, the opposite of our balanced state or our prakruti.

This situation occurs because one or two (or sometimes all three) of our doshas become disturbed or out of balance and it is usually the dosha – either vata, pitta or kapha – that predominates in our constitution that causes the imbalance. For example, if a person who has a pitta predominant prakruti, that means a person who already has a lot of metabolic heat in the body (because of the elements of fire and water that make up the pitta dosha) overindulges in eating spicy foods and drinks alcohol, the heating qualities of the spicy food and alcohol will increase the metabolic heat in the body. This increase in metabolic heat will manifest itself in the body in ailments such as skin conditions like rashes or acne or in the stomach as hyperacidity. The same situation applies to the other doshas of vata and kapha.

If a person of a predominantly vata dosha (which is made from the elements air and ether) eats foods which are very dry in nature (like cereals and snack foods) or tries to fast or diet too much, then this will manifest in the person in such ailments as feeling light-headed or weak and psychological problems such as anxiety.

If the person who has a predominantly kapha (earth and water) prakruti eats foods which are heavy and watery in nature (cheese, melons, potatoes) this action will lead to such ailments as obesity and congestion of the lungs and sinuses.

This same theory of 'like increases like' applies to the environment that we have to work and live in and the seasons we pass through every year. Autumn and winter or cold, dry, windy places cause the vata predominant person to become irritated and imbalanced. Winter and spring or cold, damp places cause the person who is kapha predominant to become imbalanced. Summer and autumn or hot, stressful environments cause those of a predominantly pitta constitution to become imbalanced.

There are some people who seem to maintain a good state of health constantly and there are those who always seem to be in bad health. But there is one thing that these two examples have in common and that is that they will both gradually, from day to day, accumulate toxins or 'ama' in the body. First we will look at how the toxins or ama manifest in the body over a period of time.

When our prakruti or balanced state becomes vikruti or an imbalanced state, our digestion can become impaired. This impaired digestion affects the way our food is digested. Our digestion relies on the quality of our 'agni' or digestive fire.

Shirodhara Therapy
Shirodhara Therapy

Abbyanga Therapy
Abbyanga Therapy

Agni – The Digestive Fire

When our agni or digestive fire is incorrect, then the food we eat will not be digested properly. When our agni or digestive fire is low, this condition is called mandagni and we cannot digest even the lightest foods and we feel heavy and sluggish. This type of digestion is associated with the person of a kapha type prakruti or constitution.

When our agni is too high, then the food we eat will be 'burnt up' and we will not get the benefit of the nutrition from the food and we will not be nourished properly. This 'high agni' is called tikshagni and will cause such problems as hyperacidity and thirst and is mainly associated with the person of a pitta type prakruti or constitution.

If we have an irregular digestion that fluctuates between high and low agni, then this kind of digestion is called vishamagni. This irregular digestion will cause conditions such as flatulence and constipation and is associated with the person of a vata type prakruti or constitution.

When our digestive fire or agni is correct, then we will have correct digestion and the food we eat will give us maximum nourishment. This balanced state of digestion is called samagni.

Out of all the different levels of digestion or agni, samagni is considered to be the best. The remaining three agnis produce illness and are classified as mandagni or incorrect digestion and therefore to be avoided. The method used to correct the digestion is called agni deepana in Sanskrit.

By using specific Ayurvedic preparations to increase or correct the digestion and improving one's daily eliminations by administering mild purgatives, we can bring the digestion back to its correct level to improve digestion, or agni, and appetite.

The result of this incorrect digestion is the accumulation of ama in the gastro- intestinal tract (GIT). If the digestion is not corrected and the ama continues to accumulate, then it will overflow from its site in the stomach into one of three different pathways:

1. The superficial pathway or shaka. This pathway incorporates the blood vessels and the skin. When the accumulated ama flows into this pathway it can cause disorders such as eczema, acne, psoriasis and gout;

2. The intermediate pathway or marmasti sandhi. When the ama overflows into this site it can cause ailments such as arthritis, osteoporosis and enzyme disorders such as infertility, obesity, diabetes and cellulite;

3. The medial pathway or kosta marga, which incorporates the GIT. The flow of ama into this site will cause ailments such as peptic ulcers, gastritis, abdominal distension, constipation and irritable bowel syndrome (IBS).

The flow of ama into the three different sites can occur in any order and affect one, two or three sites simultaneously, depending on the case in question, and it will manifest itself in the part of the body or the organ in the body that is weakest. If the ama is left to continue through the pathways unchecked, then it will eventually saturate the tissues of the body and can lead to serious illnesses like cancer.

The Seasons

The junction of the seasons is the best time to administer the Pancha Karma therapy. Throughout the year, each dosha is affected by the particular seasons that have a similar quality.

For example, the vata dosha will accumulate through the summer because the summer season's dryness will affect the dry quality of the vata dosha (air and ether). This accumulation through the summer will finally reach its maximum in the autumn when the season changes and becomes colder, aggravating the cold nature of vata. This is the best time to administer Pancha Karma elimination therapies to the vata predominant person.

The pitta dosha will accumulate through the summer because the heat created during the summer months will help to increase the metabolic heat already present in the pitta dosha (fire and water). Again, the best time to perform Pancha Karma therapy for the pitta predominant person is in the autumn.

The beginning of spring is the best time to administer Pancha Karma therapy to the kapha prakruti person. This is because during the cold and damp of the winter months the elements of kapha begin to accumulate in the body. When the season begins to change to spring and becomes warmer, the accumulation of kapha begins to 'melt' and so this is the best time for the therapy.

Pancha Karma Therapy

The Pancha Karma (Pancha – five, Karma – action) system of therapy refers to the five therapies used to cleanse the body of ama or toxins and reduce or eliminate the build up of excess doshas in the body. The Pancha Karma system will cleanse the body of toxins and will also heal, rejuvenate and beautify the body and is therefore beneficial for the healthy as well as the unhealthy. The therapy also includes Ayurvedic massage and the use of the marma points, anatomical points at the joints of the muscles, nerves, ligaments, blood vessels and bones. Ayurvedic massage also uses medicated massage oils and different massage techniques to relax and aid the release of unwanted toxins or ama in the body. The massage is important because it is a part of the preparation treatment of Purva Karma to the main Pancha Karma treatment. The choice of medicated massage oil used will also depend on your constitution or prakruti, as there are many different medicated oils to choose from to suit your particular condition and needs. The Pancha Karma system of therapy has two main categories of shamana and shodhana.

Shamana and Shodana

Shamana is the preparatory, post-therapy and management part of the Pancha Karma procedure, while shodana refers to the main five Pancha Karma elimination therapies proper. The shamana therapies can be used separately from the main Pancha Karma therapies as they are essential for rejuvenating and strengthening the body, but the main Pancha Karma treatment itself must be used in conjunction with shamana therapy because the Pancha Karma therapy itself has the effect of releasing and removing while the shamana therapy has the effect of strengthening and rejuvenating.

Purva Karma (Preparation)

This comprises five stages:

1. Assessment/Preparation: the Ayurvedic physician will assess the patient and their prakruti and vikruti or the patient's natural constitution and any imbalance they are suffering from. If the patient is in need of the Pancha Karma therapy then the physician will ask the patient to take internally a small amount of medicated oil or ghee for four or five days. The administering of this medicated oil will help to dislodge the ama or toxins from their sites in the body's tissues. This part of the therapy is called sneha pana;

2. Abhyanga, or massage with warm medicated oil, using different massage techniques to help absorb the oil into the skin;

3. Pinda sweda, or massage with hot herbal pouches. The hot medicated pouches are used around the joints and over the entire body to open the pores of the skin to help release toxins or ama;

4. Shirodhara, or warm oil poured over the forehead, along with Ayurvedic head massage utilizing the marma points of the head. This therapy is very good for patients who suffer from headache and migraine;

5. Swedana, or herbal steam bath. The hot medicated steam opens the pores of the skin aiding the release of ama from the body.

Pancha Karma (Main Treatment)

Pancha Karma involves the elimination of toxins from the body using five different methods:

1. Virechana – using strong purgatives to eliminate toxins from the lower pathway. This form of treatment is very effective in treating patients of a pitta type prakruti and helps to cleanse the stomach and purify the blood;

2. Vasti – using medicated oil enemas. This therapy is good for those of a vata type prakruti and helps to remove excess vata dosha from the large intestine;

3. Vamana – using an emetic to eliminate toxins from the upper pathway (vomiting). This therapy is very good for the kapha type prakruti as it helps to remove congestion from the lungs and is beneficial to those who suffer from bronchial and asthmatic conditions;

4. Nasya – the use of medicated oils and powders administered into the nasal passages to eliminate phlegm and catarrh from the sinuses. Again, a very good treatment for those of a kapha type prakruti as it removes catarrh and phlegm from the sinuses and improves the flow of air through the sinuses;

5. Rakta moksha – bloodletting using leeches. (This practice is rarely used in India or Sri Lanka and is illegal in Europe and the USA.) The process of withdrawing a small amount of blood from the body to help relieve blood tension and eliminate toxins from the body. Especially good for people with a pitta type constitution as it helps to purify the blood and relieve skin problems such as rashes and eczema, etc.

Paschat Karma (Management)

Rejuvenation therapy. The Ayurvedic physician will advise the patient on how to continue to maintain their health and prescribe certain Ayurvedic remedies for rejuvenating and strengthening the body like medicated herbal pastes and jams (avaleha), Ayurvedic pills (guti) and medicated herbal powders (churna). Diet and lifestyle advice will also be given to help the patient maintain their health, happiness and equilibrium.

The Pancha Karma system of therapy has had beneficial results in the treatment of chronic disorders such as psoriasis, arthritis, eczema, MS, ME, hormonal imbalances, drug addiction and all abdominal disorders such as IBS.

Case Studies

1. Bernadette – aged 46 – menopausal symtoms
Bernadette had a hysterectomy five years ago due to fibroids and was also continuing a course of HRT. She was also suffering from hot flushes, insomnia, mood swings, lack of energy and becoming angry and frustrated.

First I had to assess her constitution, which was found to be a combination of vata and pitta. Her imbalance, or vikruti, was pitta. This meant that too much heat was manifesting itself in the body. Her diet consisted of too many foods of a heating nature, so I recommended the reverse and told her to eat foods of a cooling nature. I also prescribed cooling Ayurvedic medicine to reduce the heat in the body and to regulate her hormones. The Ayurvedic Pancha Karma therapy was also performed to help reduce her imbalance and to remove ama from the body. A strong Ayurvedic purgative was prescribed to help elimination and also to remove toxins. For exercise I prescribed gentle yoga asanas and pranayama.
After her treatment, the pitta imbalance had been reduced and the hot flushes had gone along with the mood swings and lack of energy, and she was feeling much better. She had also completely stopped taking HRT.

2. Stephen – aged 32 – fluid retention and overweight
Stephen came to me suffering from oedema of both ankles and knees joints. He was also overweight and an alcoholic. He had been having medical treatment from the age of 17 because of a damaged ankle from playing football. His ankle injury gradually became worse and very painful. He could barely stand for more than two hours and the pain eventually forced him to leave his job. He became depressed and turned to alcohol. The alcohol only made the fluid retention and the weight problem he was suffering from worse. He was prescribed antidepressants but had no help with his weight and fluid retention.

The first time Stephen came to me for a consultation he weighed 141/2 stone (he is only 5ft tall) with both knee and ankle joints very swollen. I had firstly to assess his particular constitution or prakruti. This was predominantly kapha with a kapha imbalance or vikruti (which means the kapha dosha is very high causing the extra weight, etc.) I first recommended a change in diet, suggesting that he should eat foods that are much lighter and more spicy to increase the metabolic rate.

I also prescribed Ayurvedic herbal preparations to help increase his digestive fire or agni and to improve his elimination and increase urination to help remove excess fluid and faeces. I also told him to get plenty of exercise. He came to the clinic to have a full Pancha Karma treatment to help remove ama from the body. Stephen came to see me regularly every two weeks over a two-month period and in that time he managed to lose 21/2 stone and the swelling in his joints had reduced significantly. He has also stopped his alcohol consumption and antidepressants and gained new employment.

Victoria – aged 32 – irregular periods

Victoria had recently married and had one daughter from a previous marriage. She had been having irregular periods for a time, then the periods completely stopped. She was diagnosed as peri-menopausal and was prescribed HRT by her GP who said she would have to continue the therapy until she was in her sixties.

She first came to see me with heavy flooding type periods after taking the HRT. These periods were lasting 12 to 14 days every month. She was also suffering from loss of energy, mood swings, hot flushes, weight gain, depression and was smoking heavily.

First I assessed her constitution as vata prakruti and her imbalance was pitta vikruti. Her diet was very bad, with too much spicy food and too much fast food. I changed Victoria's diet, telling her to eat cooling foods and more fresh produce and avoid any fast foods and junk foods.

For the first month I prescribed Ayurvedic preparations alongside the HRT but told her to stop the HRT after the one-month period and to continue with the Ayurvedic preparations alone. The Ayurvedic preparations I prescribed were cooling herbs to reduce the heat in the body and to help balance her hormones.

After taking the Ayurvedic preparations I had prescribed and stopping the HRT, Victoria had her first normal period. She continued with the dietary advice and taking the Ayurvedic herbal preparations for the next three months and her condition continued improving. Her energy levels returned to normal and she felt happy in herself. She had also lost the weight she had gained while taking the HRT and had stopped smoking, and her periods had returned to normal.

She is now waiting to have the full Pancha Karma detoxification treatment.


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About Dr Deepika Rodrigo

Dr Deepika Rodrigo, BAMS is one of the few qualified Ayurvedic physicians from her native Sri Lanka. She has studied Ayurveda for seven years and holds a degree in Ayurvedic Medicine and Surgery (BAMS) from the University of Colombo. She worked in the Ayurvedic Government Hospital in Colombo before coming to the UK. Dr Deepika has been practising Ayurvedic medicine for many years and runs successful Ayurvedic practices in London and Surrey. Dr Deepika is also the principal lecturer of the International Institute of Ayurveda, which is offering a three-year diploma course in Ayurveda. Other courses that are available are: Ayurvedic Head and Body Massage and Ayurvedic Beauty Therapy. Details of all courses can be obtained from her at The International Institute of Ayurveda, The Ayurvedic Clinic, 172 Brighton Rd, Purley, Surrey CR8 4HA. Tel/Fax: 0208 4054407; Mobile: 07961 446251;

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