Precautions in Panchakarma w.s.r to Parihara Vishaya

150 Journal of Ayurvedic and Herbal Medicine 2021; 7(2): 150-154 Review Article ISSN: 2454-5023 J. Ayu. Herb. Med. 2021; 7(2): 150-154 Received: 03-04-2021 Accepted: 15-06-2021 © 2021, All rights reserved www.ayurvedjournal.com DOI: 10.31254/jahm.2021.7214 *Corresponding author: Dr. Swarnakant Jena PG Scholar, Dept. of Panchakarma, All India Institute of Ayurveda, New Delhi, India Email: swarnakantjena[at]gmail.com Precautions in Panchakarma w.s.r. to Parihara Vishaya Swarnakant Jena 1* , Arshathjyothi PS 1 , Prasanth Dharmarajan 2 1 PG Scholar, Deptt of Kayachikitsa, AIIA, New Delhi, Inda 2 Asst. Professor, Deptt of Panchakarma, AIIA, New Delhi, India ABSTRACT Global acceptance of Panchakarma is increasing day by day. It is the duty of responsible Vaidyas that to maintain the essence of the scientific wisdom during this developmental stage. All the procedures have their own precautions and complications specifically mentioned in classics. One who has excellent knowledge as well as practical experience in Panchakarma should perform these procedures with utmost care. If we explore the various classical precautions mentioned in Ayurveda we can find scientific and logical reasons for the advises.So it is the need of the hour to review on the precautions of Panchakarma. A standardised operating procedure should be needed nationally and internationally including necessary precautions for ensuring better clinical practices.Also extensive researches should be done in this area to develop evidence based conclusions. Keywords: Panchakarma , Precautions, Parihara Vishaya . INTRODUCTION In Ayurveda there are two major concepts that has to be followed in treatment aspect ie Shamana and Sodhana [1] . Sodhana mostly deals with the Panchakarma therapies which expels the morbid doshas from body in a sequential manner. Every therapy has its own specific regulations to conduct and to get the desirable result. Just like an operation planned to be conducted for a specific pathology, Ayurveda also have its specific sequences for specific pathology. It must to be planned before conducting the procedures. It was observed that the growing interest to take Ayurveda for health. Nowadays panchakarma is considered as a treatment which leads to detoxification of the body and strengthening of the immune system, thus, restoring balance and well-being with resultant rejuvenation [2] . It is important to note that all these procedures should be done under careful supervision of qualified Vaidyas to ensure that the Malas are removed and doshas are balanced. This would be an add on responsibility for an Ayurveda practitioner to give utmost care to patient. In the present scenario specific areas of application of Panchakarma therapy are - 1) Promotive and Preventative health care as a component of Swasthavrutta regime. 2) As an integral pre requisite of Rasayana therapy and Kayakalpa . 3) Curative treatment option of chronic diseases.It was found that the specific precautionary measures are not much explored in Ayurveda.So this is an attempt to review on the Parihara vishayas of Panchakarma. METHODOLOGY Assessment of the significance of precautions in Panchakarma from classical Ayurvedic literature, scientific articles and practical experiences. Data mining was carried out from various texts, peer reviewed journals and some websites of the concerned subjects. Evaluated them using scientific basis and practical aspects. This article is based on a review of Ayurvedic texts. Materials related to relevant topics have been collected. The main Ayurvedic texts used in this study are Charak Samhita, Sushruta Samhita, Ashtang Samgraha, Ashtang Hridaya, Bhava Prakash, and Sharangdhar Samhita , and available commentaries on these DISCUSSION a) Need of precaution in Panchakarma Panchakarma popularly known as metabolic bio -purification. It deals with expelling or maintaining the comorbid Doshas which gradually get vitiated by our own day to day living Ahara and vihara (diet &life style) [3] . Dosha vitiation takes place in sequential manner and it has to be removed from our body through step by step. The identification of vitiated Dosha and its management is based on Shadkriyakala explained in Ayurveda . Prime motive of Panchakarma is to removal of Malas and maintaining the similarity among

151 Journal of Ayurvedic and Herbal Medicine|April-June|2021 three Doshas without causing any harm effect to the body. If one of the Dosha increased its amount or get accumulated in body then it leads to various pathological symptoms. ‘ Vikruti Dhatu Vaishamyam’ , differentiation of any one among these three Doshas termed as Vikriti or diseased [4] . Every intervention has its own specific importance. Any disturbances with its pattern may break all the pre-planned therapy or may bring undesirable result. Classical Panchakarma requires sequential intervention for both preventive and curative purpose. Each therapy depends upon some factors to analysis before enter to these. During the process it is mandatory to access the Roga bala of patient and Dosha itself. Roga bala determines the selection of Shodhana and Shamana . Supervision of a qualified Vaidya is also one of the factors to conduct this purification therapy. The one who called as main pillar in Padachathustaya .Must have both theoretical and applied knowledge of every aspect. Vaidyas mentioned as Karta , one who conduct or whom appearance must be needed for treatment. It may be difficult to remove the lodged Dosha from body to outside without proper procedure or gaining appropriate knowledge of the consequences during or after the procedure which can leads to Vyapad . Foremost references for Panchakarma itself denotes that Panchakarma should be done when after the vitiated Dosha is in Upasthita avastha [5] . After accumulation of Dosha in Kostha it’s easy to expel its out from body through nearest orifices. Comprises with Pachakarm a have also some preoperative procedure s called Poorvakarma which were doing to gets the Upasthita Dosha . Where Deepana, Pachana, Snehana and Sodhana are the basic Karma mostly adopted to attain this. Deepana and Pachana does its effect to fire the Agni which is considered as Mula of Sharira and its deficit bring all disorder in body. Snehana helps to break the lodged Dosha in Sakha or Srotas to get detached and also makes the body suitable to sustain next procedures. Swedana with its Suksma and Ushna Guna bring the clenainess in Srotas by which the detached Doshas comes to Kostha easily from where we can remove it out from body [6] . Other factors also interfere in the result of Panchakarma like Matra , Kala etc. therefore we have to ascertain all these accurate factors and karma to fulfil our results before going to conduct Panchakarma. Proper precaution in every step must be needed to achieve supreme results of Panchakarma . b) Chikitsa Chatuspada and its role The Charak Samhita describes that these four pillars are the main to correct accumulated Doshas . For maintaining the balance of these Doshas Vaidya, Bhesaja, Upasthata and Rogi are essential. four specific qualities which acts as main role in treatment. Efficiency of these Chatuspada increases rate of improvement in results in therapeutics. By adding all these characters, a total of sixteen qualities which promotes treatment. Collective effects of all these are necessarily kept in mind before going to Therapies. Minute observations are needed to fulfill Chatuspada along with Dasavidha pareeksha bhava which includes Dushya, Desha, Vala, Kala, Anala, Prakriti, Vaya, Satmya, Satva, Ahara . Each of the factors has meaningful impact in treatment to avoid complications. Prior assessment before administrating the next procedure gives better result in therapies [7] Figure 1: Shows Chikitsa Chatuspada . Role of Bhisak /physician A qualified physician is he who is well acquainted with the principles of treatment who is wise, is well-versed in classics and is prompt in action. The patient who is administered proper emesis and purgation therapies by such physician surely attains happiness and the other hand, if a person who only claims to be physician without having any grounding (in the science of medicine) administers these therapies, the patients would subject themselves to further complications because of the excessive or inadequate administration of this therapies. According Ashtang hridya the Physician must be efficient having learnt the science in all its meaning (implication)from a preceptor, must have witnessed the therapies (gained practical experiences) and pure/clean (in body, mind and speech [8, 9] . The role of physician can be listed as in these main headings 1 Selection of Yogya and Ayogya : before starting any treatment, it should be mandatory to selection of appropriate patient for a suitable treatment. Like before entering into Panchasodhana it is more important that to selection of Bahudosha avastha in patients. After selection of patients, other factors 2 like season where Sodhana indicated, timing to administering Sodhana procedures, appropriate disease conditions where Sodhana given in terms of age, native, digestive power, palatability etc. precautions to be taken where to go and where to avoid should makes great results in Panchakarma 3 Sambhara samgraha : knowledge of each and specific instruments are only with the Vaidyas who conduct the procedures. Good qualities and suitable instruments are made and arranged by physicians also needed. 4 Roga and Rogi Pariksha : all types of examinations include Trividha, Shadvidha and Dashavidha pariksha are elaborated by Samhitas are adopted by physician to get clear diagnosis and making decision of accurate treatment principle for manage diseased. Also, precaution have to made before entering or conducting therapies. Role of Bhesaja /medications Ayurvedic pharmacologic action of a drug is determined by according

152 Journal of Ayurvedic and Herbal Medicine|April-June|2021 to its Rasa, Guna, Virya, Vipaka, Doshaghnata also have to know before using it. There are various Vyapads are mentioned in texts by using drugs in inappropriate time, with lower or high dosage, adopting wrong formulations etc. taking a wrong medication are same as to intake of boiled water with metallic interference with Tamra , poison, sharp instruments. Therefore, precautions have to take for medications also used for Panchakarma. 1 Drug selection: From Purvakarma to Pradhankarma , in every steps selection of drug is necessary to avoid complication. According to disease severity and condition, Pachana and Deepana drug selection useful to initiate Jatharagni . Doshavastha and Roga also having its specific importance to selection of drugs as which can be used in Vyadhis and meant for which Karma. 2 Dose sele ction: ‘ Matravat Oushadha Samanaska Pibet’ is a known quotation found in Siddhi Sthana of Charaka samhita where every Panchakarma Procedure have mentioned classical doses [10] . Excess or lesser quantity produces complication so special precautionary measure should be taken for doses. 3 Qualities of drug: drugs for Panchakarma should be like that; a) Where with taking of lesser amount it could produce more Vega b) Expelling more Doshas from body c) Good taste and palatable d) Having the potency to destroy disease. Role of Upasthata/ masseur In Panchakarma most debilitated patients are came for better management and hope for improving him lifestyle. During treatment they are undergone with various Purvakarma , Pradhanakarma and Paschata karma where physical and manual work done by masseur. They take care in most of the treatment with their skills and according to advised by physicians. Major precautionary measures have to take to successfully conduct and complete procedures. Whole time spend by a patient with masseur are greater than a physician so he plays a major role in precautions. 1 Preparation of patient: collecting general condition of patient before going to therapy room, prepare and instruct the patient according to therapy planned for given. Proper conducting of therapy and continuously perform the Purvakarma like in Abhyanga , they will do first thoroughly from Shira, Shravana /ear, Pada/feet. In Swedana special avoidance to give sudation on patients Hridaya, Basti and Netra . In Vamana there may needed assistant for Nabhi prapidana , Parswa unmardana , Lalatagrahana along with other patient care. During Basti special attention of a masseur needed for patient positioning and administering Basti dravyas . Bastidata Vyapadas are mentioned as improper Basti administrating leads to complecations like Savate, Atidrute, Utkshipte etc. [11] During Nasya also Patient positioning like mild elevation of feet with supine and slight depression of forehead needed. So, precaution is to be taken by a masseur for smooth functioning of Panchakarma. 2 Preparation of medicines: Panchakarma theatre or therapy room are under maintained by well skilled masseur. Skilled technician needed for quick arrangement of ingredients or instruments during procedure. Potali making to Shastika shali pinda Sweda preparation are taken in observation with attendant. Precautions should be taken in preparation of these Potali, Basti Dravya etc. 3 Hygiene: cleanliness is maintained by attendant in whole Panchakarma procedure room. By maintaining the biomedical waste management rules like putting used instruments or used medicines and its disposable are undertake with attendant in theatre. Role of Rogi /patient: Whole process applied in Panchabhutatmaka sareera ie din a living body by differentiating the ongoing physiological or pathological process using Dravyas . So key role of patient is needed in maintain all precautionary measures. Minute disturbances will affect in greater extent. From diet to behaviour and daily living habits all have needed to small modification. Satvavan and Jnapaka is one of the four qualities of patient described in Samhita. Both the above characteristic denotes that patient have to follow all the instructions given by physicians and he should not lie to doctors. 1 Astamahadoshakar bhava : 8 major avoidable factors are always kept in mind that should be avoid in every therapies. These 8 have specific complication if taken during therapies. 2 Specific therapy wise precaution: Purva, Pradhan and Paschat all have specific measures to avoid during conduct these therapies. Like there are specific references for Snehana, Swedana etc. that have to follow by patients. 3 Pariharya kala : Dwiguna Kala have to follow after according to therapies given. Total days taken for procedure should double to follow. 4 All measures are can be divided into three major categories like Aahara, Vihaara and Manashika which continuously affect to patients health. Ahitabojya , Vishamasana and foods taken in Ajirna conditions comes under Ahara . Like this Uchhe Bhasya , Rathaksobha, Atichamkramana, Atiasana, Divaswapna comes under Viharas. Manasika Doshas includes Bramhacharya, Vicharya Krodha, Shoka during Panchakarma should always avoid. Precautions according to Trividha Karma : Whole process come across through three categories where all are depends upon each other and the result of one interpret with another. Therefore, proper planning and interpret with all these three bring desirable result without harming to patients. 1 Purvakarma: prior assessments will be led to good procedures. Choosing drugs before starting Deepana , Pachana according disease and health status of patients. It augments the gastric fire and transform Sama into Nirama . 2 Diet options are Manda, Peya, Yusha, Mamsarasa etc. For drinking advised, because it have the properties like Kaphakshina, Vatanuloma and Agnivriddhi . Food must be taken in lesser amount as compared to normal diet. After completing Purvakarma assessment of each Lakshana of each therapy needed. Without getting the symptoms of Deepana, Pachana one can never enter into administrating Snehana and Swedana . During Snehana there are number of precautions or regimen are taken. Before and during Snehapana, one should take luke warm, liquid diet in proper quantity. The food should not increase secretions,

153 Journal of Ayurvedic and Herbal Medicine|April-June|2021 possess unctuousness or material with opposing properties. Drava ahara gets digested easily, takes lesser time to get clear from stomach. Ushna ahara stimulates the digestive process, gets digest quickly, normalise functions of Vata dosha and reduce Kapha dosha . Avoid Abhisyandi Aahara because it causes obstructions in channel. Precautions also should take by avoiding exercise, loud voice, anger and bad emotions. After completing and getting Snehana Lakshana , Swedana is planned. In this one should not go directly into the cold condition; it can result in Swedavaha Srotodushti and cause skin problems. One the day of Swedana one should not undergo physical workout. It can lead to Vataprakopa that can cause various Vataprakopa 3 Pradhana karma : Pradhana Karma with all the main therapies given to a patient includes various precautionary measures to follow. Vamana and Virechna both will conduct after assessing the Doshavastha and Kala . Then after smooth conduction of the procedure will takes having maintaining all the therapeutic measures. After completion of therapies assessment of Vega according Maniki, Lainghiki etc. Table 1: Precaution during Vamana and Virechana Aahara Vihara Mansik Avoid Aatyasana, Virudha- Ajirna-Asatmya-Akala- Pramitasana Su-Prakshalita-Pani-Pada Avoid anger, stress Guru-Vishama Bhojana Muhurtam-Ashvaas Kapha Utklesha Aahara Astha mahadoshakara Bhava Follow Samsarjana Krama Comprising of symptomized And gradual administrating Of wholesome diet just after Vamana karma Hima Aatapa-Avashyaaya- Atipravata Table 2: Precautions during Basti Aahara Vihara Mansik Diet comprising of Shastika Rice along with Jangala Mamsarasa Position of patient, Instruments being used, Administration technique Should be well considered. Avoid stress and other disturbing factor. Kshira, Yusha, Mamsarasa as per Per Dosha involved. Bath with luke warm water Sunthisrita Jala for drinking Amount of diet should be 3/4 th Or ½ or Heena matra of full Meal as per Agni and Dosha Table 3: Precaution during Nasya : Aahara Vihara Mansik Diet comprising of Shastika Rice along with Jangala Mamsarasa Position of patient, Instruments being used, Administration technique Should be well considered. Avoid stress and other disturbing factor. Kshira, Yusha, Mamsarasa as per Per Dosha involved. Bath with luke warm water Sunthisrita Jala for drinking Amount of diet should be 3/4 th Or ½ or Heena matra of full Meal as per Agni and Dosha Aahara Vihara Mansik Laghu Aahara Day sleep Avoid stress and other mental Factors. Sukhosna Jala Cold water Yavanna, Shali, Mudga, Dhatri, Saindhva Cold environment Precaution in Paschatkarma : post therapeutic measures depends on whole process done in Pradhankarma . Selection of type of Samsarjana Krama in form of Peyadi, Tarpanadi and Rasa samsarjana . Peyadi used in most of the patients but in specific health condition like Madyapite, Akshina Kapha Pitta, Durvala where Tarpnadi Karma should be used. Preparation of Peyadi will under supervision with precautionary measures. These Karma should also followed until Pratytma Lakshna found. But after the Lakshna to double days have to follow all the precautions. These all Karma followed with suitable selection of Shamana and Rasayana medication for a diseased. Precaution of Bio Medical Waste The Panchakarma Clinic shall be authorized by the prescribed authority for management and handling of biomedical waste. The occupier shall apply in the prescribed form and get approval from the prescribed authority e.g. pollution control board/committee. It shall adhere to the various requirements specified in the bio-medical waste management rules. It is important that health services are offered in a scientific and reliable manner by trained and competent professionals. Accreditation provide a framework which helps a healthcare organization to establish objective systems aiming to improve patient safety and quality of care [12] . National Accreditation Board for Hospitals and Healthcare Providers (NABH) in order to operate specific accreditation program for Panchakarma clinics, has developed these accreditation standards with the help of experts in this field.

154 Journal of Ayurvedic and Herbal Medicine|April-June|2021 Figure 2 CONCLUSION The Parihara vishayas are unexplored areas of Ayurveda with supreme importance.It is clear that that in every procedure we should ensure these key points.There should be a Standard Operative Procedures for each and every procedures verified by experts. SOPs are an integral part of a successful quality system. It provides information to perform a procedure properly and consistently to achieve pre-determined specification and a quality end-result.It is interesting to note that the precautionary measures mentioned has significant scientific basis.In Sneha vyapad chikitsa takra is advised, consumption of buttermilk may be associated with reduced cholesterol concentrations in men and women, primarily through inhibition of intestinal absorption of cholesterol [13] . Knowledge in Parihara vishaya is an integral part of Practical Panchkarma and multicentric researches should be done to attain evidence based conclusions. Conflict of Interest None declared. Financial support and sponsorship Nil. REFERENCES 1 Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutra Sthana. In: 1 st ed. Jadavaji Vaidya, Aacharya Trikamji., editors. 16/20. Varanasi: Krishnadas Acadamy; 2000. p. 97 2 Charaka Samhita of Agnivesa Charaka-english Commentary by P. V. Sharma part 2, Chaukamba Orientalia Varanasi, reprint edition, Chikitsa Sthana, 2005; 1/1/7-8: 4 3 Gaur BanwariLal, Ashtanga Hrudayam, Sutrasthan 2/1, 1 st edition, Chaukhambha Orientalia, Varanasi, 2010 4 Sharma R.K., Dash Bhagwan, Caraka Samhitā with English translation, sutra sthana, Dirghajivatiya Adhyaya 1/53, Chaukhambha Sanskrit series office,Varanasi,UP.INDIA 2009; 39 5 Charaka Samhita Sutrasthana 2/15 with Ayurved Dipika Commentary of Chakrapanidatta by Pt. Kashinath Shastri Edited by Vaidya Yadavaji Trikamji Acharya, Chaukhambha Surbharati Prakashan, Varanasi. 2009 6 Shushruta Samhita Sutrasthana 46/515 Edited by Vaidya Yadavaji Trikamji, Reprint ed. Chaukhambha Subharati Prakashan, Varanasi. 2010 7 Yadavaji Trikamaji, editor. Charaka Samhita of Charaka, Vimana Sthana, chapter 8, verse no.94. 1 st edition, Varanasi; Chowkhambha Sanskrit Series; 2004; p.276 8 Vaidya Yadavji Trikamji.Charaka Samhita. Nidana Sthana Chapter 10 Chaukhambha Prakashan; Reprint 2011.Varanasi, p 66. 9 Lochan K. Varanasi: Chaukhambha Sanskrit Bhawan; 2003. Practise of medicine. Medicines of Early India: With Appendix on a Rare Ancient Text. Ch. 5; pp. 104 – 20. 10 Yadavaji Trikamaji, editor. Charaka Samhita of Charaka, Siddhi Sthana, chapter 2, verse no.94. 1 st edition, Varanasi; Chowkhambha Sanskrit Series; 2004 11 Yadavaji Trikamaji, editor. Charaka Samhita of Charaka, Siddhi Sthana, chapter 5, verse no.10. 1 st edition, Varanasi; Chowkhambha Sanskrit Series; 2004 12 https://www.nabh.co/Panchkarma.aspx 13 Conway V, Couture P, Richard C, Gauthier SF, Pouliot Y, Lamarche B. Impact of buttermilk consumption on plasma lipids and surrogate markers of cholesterol homeostasis in men and women. Nutr Metab Cardiovasc Dis. 2013 Dec;23(12):1255-62. doi: 10.1016/j.numecd.2013.03.003. Epub 2013 Jun 17. PMID: 23786821. HOW TO CITE THIS ARTICLE Jena S, Arshathjyothi PS, Dharmarajan P. Precautions in Panchakarma w.s.r. to Parihara Vishaya . J Ayu Herb Med 2021;7(2):150-154. DOI: 10.31254/jahm.2021.7214 Creative Commons (CC) License- This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY 4.0) license. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. (http://creativecommons.org/licenses/by/4.0/).

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