Bahya Kriya Karmas-PANCHAKARMA

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    The modern equation of disease:Damage done by Harmful agent + Bodys reaction =

    Disease

    Our science follows a distinctive discretion of thedisease, centered for the purpose of treatment:

    Vikara prakrti : adhnntari: hetuviea =upakramam.

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    Ayurveda never visualizes cohorts but it views through individual phenotypes.

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    In clinical medicine dont be satisfied byseeing the flower (the obvious), try to seethe insect sitting over it (the minute); butmissing the obvious and seeing theminute is unpardonable.

    Dr Kashinath padhiary

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    Concept of disease in routine ayurvedic clinical

    practice . .-

    ka punarasau roga iti. avasthviio

    doa.narasihabhyam. 1-1

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    -

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    Message from Caraka

    -

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    Line of treatment

    R.V.Su.-

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    Cikits

    Apakaraa Prakrti vighta nidna tyga

    bhyantara bhya bhyantara

    Bhya abhyagasvedapradehapariekdi

    Prakrtivighta duasya dode dehasthasya amanasmyakaram

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    Vikprakrti :

    General components analysed (Like dovastha) : ma, lna, utkliha etc.

    Specific disease pattern, like (roge dovasth)Raktotleda ( rakta pitta , visarpa)Bahu, abaddha medo-msa arraja kledaRakta mrga nihanana (vtarakta)Dhtu aithilya (pu, kutha )Sahata doa (otha)

    And the basic knowledge ofsmnya vydhinntmaja vydhi

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    vikraprakrti

    smnydodyavsth

    vydhiviiha

    dovastha

    duyvasth

    Smnyaja or nntmaja vydhisvabhva

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    odhana

    And

    Bhya kriy kram

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    Kutha opha- visarpaotha Visarpa kutha

    Tridoa tridoa tridoaTvak tva tvaMsa lask laskAsrk asrk asrk

    mia mia

    Bahi sir bahi sir tiryagg sir

    Sahata sopha utklita svabhva dayanti lath krtya

    odhana Nirhrte asre odhana- less Viuddhe anta

    Doe tva-mmsa Saraye

    bahi kriya

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    Vta vydhi

    Kevala varaaja vta oita

    Dhtu srata kaya pratibandhakatvt margvaraa and rakta dui

    Sneha svedau odhana meda-kapha smevaraa

    Sauddhasya hya vtokta sveda,Utthite agni vidhi

    laghana-

    pcana

    Sneha svedau vta oitak

    Kriykevala

    vtacikits

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    Kevala vta- dhtu srakaya

    Sneha Sveda

    Sauka dhtn vakraPuti stabdha

    Bala savedanaAgni bala Pui yatheha namayitu

    akyatePrcbhivardhayati

    E x i { M: nSxEh* vx i Mhi v **

    SSV

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    Role of the different modes ofbhya sneha / sveda

    To meet the different nuances of doas / expression of same disease

    Ayurveda never visualizes cohorts but it views through individual phenotypes.

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    vte kaphe dvayo

    snigdha rka sdhra

    The variant forms ofsveda and the clinical states where they have to beadministered are well expounded in Brhadyogataragi.xi {E]Ox*Jnhb{ix S xn{Vi**>i VpInnx EE:**xiRMRESRMnOl:*nxi: Cl: nxS MVi*+{ixh xh SEii:*+RMIi E{EE inx**n h xnxi*

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    In conditions like bhyyma, antaryma,

    prvala, kaigraha, khall, dapatnaka,sneha sveda is the first line of management. In conditions like rustambha rka svedahas to be implemented primarily. In vmana, agasakoca, bhaga,bheda,graham and vyath sveda is indicated. In agaraukya, stambha, kampa, krya,

    toda, daurbalya, sphuraa, bhraasnehamardana is recommended.

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    Bhya kriykram

    Mrdha sekdividaya sahitsvapi scit.Keralydrta cai sdhuvakye kriykrama.

    Abhyaga seka picavo vasticaiva caturvidha.

    Dvitya secana tatra pradhnam r ibhi smr tam. SSV

    The bhya kriykrams are basically grouped into four categories viz.abhyaga; seka ; Picu Vasti

    And the variant procedres; of which seka is given higher importance.

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    irodhra21

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    Seka

    Procedure:

    irassekaKya seka

    Dravya

    KayaKraDhnymla

    SnehaTakra

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    irasseka

    1. fever with burning sensation & dizziness milk Y 2/57

    2. nocturnal fever ,, Y -23. Arocaka ,, C.M4. Somaroga ,, C.M

    5. Svarasda rodhr and vasti Y 11/16.jvara (antarvraa) takradhra Y 2/767. ardita irodhra and kyaseka

    With baltaila Y 408. Prameha Takradhra Y 26

    9. asrgdhara milk Y 2610. ardhvabhedaka irodhra AKD

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    Experiments on irodhr elucidate some of its actions over thephysiological and psycho-somatic strata of the body.

    irodhr induced bradycardia, and the expired gas analysis showed adecreased tidal volume and CO2 excretion. A power frequency analysis of R-R variability in ECG duringshirodhara, in order to assess the balance of the autonomic nervoussystem, indicated that the cardiac sympathetic activity was suppressed

    during and after irodhra.The EEG results monitored during the process ofirodhr indicatedrestful alertness in which the frontal lobe, limbic system and medullaoblongata were activated. These metabolic, ECG, and EEG findingssupport the reported experiences of relaxed and low metabolic states

    during irodhr.The differences in heart rate, CO2 excretion, sympathetic tone, and EEGwere quite similar to the findings reported in the study of meditation, andthey indicate a change in the function of the frontal lobe, limbic system,brain stem, and autonomic nervous system.

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    The assessment of POMS (Profile of Mood States) score after acourse ofirodhr revealed anxiolytic effects. The result indicateda significant decrease of tension and anxiety, and a tendency towardsa decrease in exhaustion. It also showed some kinds of ASC (AlteredStates of Consciousness). The highest ASC scores were obtained inthe domains of trance, passiveness, timeless sensation, wordlesssensation, and concentration.

    A study showed that irovasti and irodhra, in progressivedegenerative cerebellar ataxia showed subjective improvement inwalking and there was a statistically significant improvement in theoverall and anteroposterior balance indices of dynamic stability.

    - Sriranjini SJ, etal Improvement of balance in progressivedegenerative cerebellar ataxias afterAyurvedic therapy: Apreliminary report. Neurol India 2009;57:166-71; Department ofNeurology, National Institute of Mental Health and Neurosciences,Bangalore

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    26

    Kya seka

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    In Dhrkalpa we find a very brief mentioning of theprocedure, kyaseka. The first detailed description

    regarding the procedure ofkyaseka is found in theHrdayapriya of Paramevaraivadvija (VaikkaittuPccumuttatu):

    vatavatottara rogarukshitanga

    Duration - yamardha

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    Sneha seka Benefits

    Drudhatha of DhathusVrushatha, Deha, Agni, Varna, OjasSthairyamIndriyapatavamJaraso mandyam, Chira jeevitham

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    Indications of kyasekayma

    oa vtaPakghta apabhukakepakaApatanra

    jihvstambha hanugrahagrdhrasvivcrakta vta

    kampastambhaPrasuptiSramsa vysa vyathsarvga ekga vta gulma mehdikeu api

    KPC.

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    Kyaseka

    1. burning sensation and thirst

    inprameha sarvga takradhra

    2. kepa , yma,and apatnaka Snehadhr and

    ika pia sveda Y 40

    3. Ati vta vikras taila ghrta CM

    4. apatnaka traivritsneha Suruta

    5. bhyyma, paguvta rasataila AKD

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    Picu

    dapatnaka vtani taila AKD

    manystambha vtan tailadhnvantara taila

    Nasal discharge / blockWithout oil sigru / thulasi swarasa withbreast milkWith Eranda thaila with thrikatu etc

    irovastiArdita trimiraka taila

    baldhtrydi taila Y 40

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    Oil is warmed tocomfortabletemparature

    Oil poured into thevasthiputaka through astrip of cloth &coconut leaflet which

    touches the scalp Filled up to a height of

    2-3cm above the hairroot.

    Sirovasthi

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    Time - between 3 to 6 pm

    Pre operative procedure:

    Shave the headcompletely.

    Make sure to empty boweland bladder

    Keep cotton /cloth in bothears

    to prevent the entry ofoil in to the ear.

    Do generalisedabhyanga.

    Siro Vasthi

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    Sirovasthy - indications

    Arditha Thrimisraka thaila / baladhathryadi

    Darunaka

    Darunaka thailam / durdhoorapathradi Sirograha

    sirovasthi with dasamoola, mathulunga etc. >>> oil

    Insomnia, Indriyasada, dryness of eyes etc

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    Piasveda

    C.S.Su.14/25-26

    Tila Ma

    Kulattha Odana mia Ghrta Taila

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    The indications ofikasveda

    .

    A.S.Ci.23

    sarvanga ekanga sosha ghoreshu anila vyadhishu

    Ayama- akshepa Sankoca stambha pakshavadhadishu

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    1. It is clear from Agasagrahakra, vtavydhi cikitsa that the diseasedcondition of vta which is not associated with any other do-s (i.e., kevalnilaavasth), is ideal for administration of pia sveda.

    2. The first reference regarding this procedure is detected in the rjayakma cikits-adhikra of Carakasahit; wherein svedana with a preparation of grains boiled inmilk is mentioned in condition of la( caused by vta doa) in the regions of thehead (ira), flanks (prva) and shoulder blade (asa).

    A.H. Ci. 4/143. The reference from vsa also clarifies that the svedana using milk etc., is ideal inconditions where the benefits of svedana are looked for but the patient is not suitablefor the svedana.

    4. ikapia sveda is advocated in vtika ksa associated with emaciation

    5 In vsa ikapiasveda and sneha dhr with ghee and oil is beneficial

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    6. ika piasveda and snehadhr are also employed similarly in the m anagementof hiccup (hidhm)

    7. In hemiplegia (pakghta), sudation with the bolus of sesame seeds or ika rice

    is recommended, or godhmapiasveda processed in the milk decoction of bal andthe flesh soup of wild cock is also recommended

    8. ika piasveda is also advocated in the management of chardi, udvarta,halmaka, vtalemajmar.9. In the management of diseases of vta (vtavydhi) ikapiasveda plays anessential role, it is prescribed in the treatment of ardita, apabhuka, kepa, yma,sarvgavta, jaghgraha, rugraha, trikagraha, prhagraha and kaigraha,sakthisvpa, jihvstabha, saktioa and la.

    10. In khalyakhaja, godhma pidasveda processed in milk and saireyakadecoction is indicated11. ika pia sveda is indicated in khaja vta.12. Sveda with tilakalka is advocated in vtaja la

    13. In ardhvabhedaka and sryvarta sudation with tila triturated in milk and jvanyagroup of drugs is beneficial;

    14. I n vtaja mtrakrcchra, snigdha sveda, lepa, seka and avagha are indicated.

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    ma sveda

    The other treatment processes which are in vogue at Kerala are:

    patra poala sveda,jabra poala sveda,dhnya poala sveda andcra poala sveda.

    A.H.Su. 17/6

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    Some of the materials used for ma sveda are:

    utkrik - It is a ball-like cake prepared by boilinggrains or pulses and seeds like atas, kusubha etc.

    loa - earthen lumpkapla - brick fragmentsupala - stone

    psu - sandpatrabhaga - chopped leavesdhnya - grains and pulseskara - dung of cow and other animalssikat - gravelstua - husk.

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    Patrapoala sveda

    The process of sudation using a bolus of chopped leaves is calledpatrapoala sveda.This procedure is extension of the verse patrabhagena in m sveda. ridsapaitaexplain thatpatrabhaga refers to a cluster of chopped leaves and sprouts.

    Aruadatta.

    , ridsapaita

    A direct reference regardingpatra poala sveda is available in the traditional text ofKerala, rogya kalpadruma, under the context ofvtavydhi cikits.

    A.K.D. 17/36,37

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    The leaves of the following plants are usually used for this purpose, either entirely orselectively as necessary:eraa - Ricinus communis Linn.arka - Calotropis gigantica R.Br

    Dhattra - Datura metel.Linn.nirgu - Vitex nigundo Linn.igru - Moringa oleifera Lam.varaa - Crataeva religiosa Forst.vsa - Adhatoda vasica Nees.karaja -Pongamia pinnata(Linn)vrkmla - Tamarindus indica Linn.

    Method of preparationThe fresh leaves are cut into small pieces and fried in a pan with grated coconut

    and a suitable medicated oil till it assumes a brownish colour. In certain cases,powdered drugs may also be added. This mixture is divided into two or four equalparts, added into the pieces of cloth and tied in the form of a bolus with a tuft ofcloth above it to hold.

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    Some of the clinical conditions wherepatrapoala sveda is indicated are: patrapoala sveda with castor leaves and coconut gratings is beneficialin painful state ofntravrddhi

    sveda with the leaves of tamarind and coconut gratings is indicated inudvarta

    the samepoala is also beneficial inpakghta and sarvga vta

    the sudation with the leaves of castor is indicated in kagraha

    inprvala, poala sveda with arkapatra is applied after anointingeither with dhnvantara taila, krabal taila or vtan taila.

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    Vluksveda

    The sveda from vluka is also a variety ofma sveda.

    In the early texts the vluksveda is indicated for sanniptajvara; and in thelater texts it is extended to other conditions like mavta. Vluksveda is oneof the primary treatment processcess in tridoaja jvara and in vtakapha jvaraThe purpose of its indication is mainly to eradicate the kapha, by which the

    pitta and vta can be pacified easily. By the depletion ofkapha the channelsget clarified resulting in lightness of the body.

    It is in Bhvapraka and later texts that the vluk sveda is indicated in thetreatment ofmavta.

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    1. Udvartana with tvak, patra, rsn, aguru, igru, kuha, vac and athv trituratedin dhnymla cures khalland viscik.

    2. Udvartana with the paste ofsiddharthaka, rajan, prapunna , tila mixed in oil is recommendedin tapitta.

    3. Eldi gaa is also used for udvartana.

    4. Udvartana withpicumana and other drugs is indicated in rustambha.

    5. Nimbdi and mustdi udvartana formulations are also mentioned. Udvartana with the leaves of

    ragvadh, kkamctriturated in buttermilk is mentioned in kha.

    6. In sidhma, udvartana with the friut ofdhtr, sarjarasa, pkya (yavakra), triturated in sauvrais beneficial.

    7. Rk udvartana is advocated inprameha.8. In kaya, udvartana with the paste ofavagandha, apmrga, nkul, gaurasarapa, til and

    bilva is indicated.

    9. Udvartana with burnt turmeric removes the bad odour of the body10. Udvartana with tila andother drugs cures the bad odour caused by vitiated medas.

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    7. In sidhma, udvartana with the friut ofdhtr, sarjarasa, pkya (yavakra), triturated insauvra is beneficial.

    8. Rk udvartana is advocated inprameha.

    9. In kaya, udvartana with the paste ofavagandha, apmrga, nkul, gaurasarapa, tiland bilva is indicated.

    10. Udvartana with burnt turmeric removes the bad odour of the body

    11. Udvartana with tila andother drugs cures the bad odour caused by vitiated medas.

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    Na amula likhyate kicit na anapekita muchyate

    ubha