SHASHTIKA SHAALI PINDA SWEDA OR NAVARAKIZHI

Shashtika shaali pinda sweda also known as Navarakkizhi is a Kerala specialty of treatment in which the whole body or any specific part is made to perspire by the application of heated medicinal rice (Navara) puddings externally in the form of boluses tied up in a cotton cloth in a specific manner for specific period of time.These procedures are very commonly used in Keraliya Panchakarma.

'Navara' means special rice which is harvested in 60 days. 'Kizhi' means bolus bag.

Bashpa Sweda or Steam Bath in Ayurveda Treatment

BASHPA SWEDA or STEAM BATH

This is kind of sudation by which medicated steam is applied to the patients body for a certain periods of time to get perspiration.It removes stiffness,heaviness and coldness from the body.(ref:A.H).

For this purpose Bashpa Sweda Yantra (A steam bath chamber) is required.Medicinal herbs decoctions is kept boiling in the Bashpa Sweda Yantra from where the steam is generated and applied all over the body or any specific part through a tube or pipe.The patient is advised to lie down inside the steam chamber after massage with warm oil (20-22C). A thick cotton sheet may be used to cover the body to get proper perspiration.

WRIST PAIN AND NUMBNESS/ CARPAL TUNNEL SYNDROME AND ITS AYURVEDA TREATMENT

CARPAL TUNNEL SYNDROME AND ITS AYURVEDA MANAGEMENT

Carpal tunnel syndrome or median neuropathy at the wrist, is a medical condition in which the median nerve is compressed at the wrist leading to paresthesia numbness, pain and muscle weakness in the hand. It is caused by an inflammation or collapse of carpal tunnel that allows nerves to pass through the wrist. It is a common complaint of office workers, drivers and is usually associated with repetitive activities such as typing, etc. Because the nerves of the tunnel run through the neck and arms before reaching the wrist. Tension in the neck and shoulders can also aggravate the condition. Some predisposing factors like diabetics, pregnancy, hypothyroidism, and heavy manual work or work with vibrating tools may also cause the symptoms.

KERALIYA AYURVEDA PANCHAKARMA

KERALIYA PANCHAKARMA

Panchakarma procedures are utilized for the purpose of preservation, maintenance and conservation of health and the promotion of longevity.

While checking the history of Ayurveda we can see that,with the spread of Buddhism to the southern parts of India,Ayurvedic treatment got popularized as it was practiced in the monasteries.After the decline of the Buddhism,many of these monasteries where converted to the temples and the practice of Ayurvedic treatment through these temples still continues in Kerala. Panchakarma procedures where not confined to the higher societies only.Rather lower classes of the society also contributed to the promotion,progress,and development of these specialized techniques.Due to these fact modified technique of Panchakarma treatments developed in Kerala unlike north part of the India.

Based on Ayurvedic principles and own experiences, the Ayurvedic scholars in south India have modified certain techniques or procedures according to dosha, Prakriti(body constitution),Kala (season),drug availability etc.and found them quite effective.Later on thees procedures got popularized as Keraliya Specialties of Panchakarma which are extensively practiced in India and abroad as main procedures. With the modernization and globalization of Ayurveda,more and more peoples are showing interest in these treatment procedures due to their effectiveness in addition to the conventional Panchakarma practices.

Some of the main procedures are:

• Shashika Shali Pinda Sweda
• Pizhichil
• Shirodhara
• Shirovasthi
• Shirolepana

These procedures are specialized varieties of snehana and swedana which have more nourishing effects than bio-cleansing or depleting effect.

Sankara Sveda in Ayurveda treatment

SANKARA SWEDA in AYURVEDA TREATMENT

Samkara means mixing of dravyas like Tila,masha,etc together should be rubbed into pinda (ball like) made Luke warm and kept over the painful part of the body.This is a ideal procedure for application of heat to a selected part of the body.Depending on the drug used it can be  ruksha or snigdha.

Fomentation by means of hot bolus of prescribed drugs with or without being wrapped in a cloth.

CLASSIFICATION OF SVEDA KARMA/FOMENTATION THERAPY IN AYURVEDA

Svedana karma- classification

1.Niragni Sveda (without fire) and 2. Saagni sveda(with fire)

(ref: susurutha and vaagbhata)

Niragni sveda:                                   Saagni Sveda

1. Vyayama (Exercise)                   1.Tapa Sveda -done with hand
2. Ushna sadana                            Kaansya,Kapaala,Kanduka,Vaaluka and
3. Guru pravarana                         vastra (cloth)
4. Kshudha                                  2.Upanaha Sveda-bandhan,pradeha,potali
5. Bahupan                                  3.Ushma sveda-done with kapaala,Pashana
6. Bhaya                                      Loha ball,Sankar,Kumbhi,Prasthala,bhru etc
7. Krodha                                  4.Drava sveda-Done with parisheka,and
8. Upanaha                                   avagaha.
9. Ahava
10. Aatapa

CASE-3

Let us discuss about my third case...it was a case of CTS- CARPAL TUNNEL SYNDROME as i think.

the case was presented as
don't want to mention the patient name,aged 62 years,he was an accountant abroad,now he retired and settled in Kerala.
Presenting complaint:
numbness and pain for both palms especially over first three fingers(thumb,index and ring)-about 20yrs.
weakness for both hands- 10yrs
unable to grip objects-10yrs

SWEDANA OR STEAM THERAPY IN AYURVEDA

SWEDANA OR STEAM THERAPY IN AYURVEDA

It is like Snehana is an independent upakarma,as a purvakarma(post operative) measures generally done after Pachana and snehana, before administration of sodhana treatment,pradhanakarma(main procedures) like Vamana, Virechana,etc.

Swedana is a process to induce sweating artificially in a patient who had already undergone Snehana,etc.The heat is generated directly (saagni) or indirectly (niragni).Swedana liquifies the doshas,clears the obstruction of channels of circulation and directs the doshas to selective places from where they can be expelled easily.

A dry or wet method of sweating is called swedana.It may be full body steam therapy.Special herb decided on the basis of nature and intensity of doshas are fused into the steam and together the heat and herbs dilate the channels allowing the stored ama (toxins) to move back into the digestive system.in swedana the body is made to perspire to loosen and excrete the toxins.by this method as next is to remove toxins from the body through panchakarma(sodhana therapy).

Abhyanga or Oil Massage Therapy in Ayurveda

ABHYANGA or Oil MASSAGE THERAPY

Abhynga is type of oleation therapy used in Ayurveda.Abhyanga can be defined as the procedure of application of Sneha Dravya/medicine over the body with mild pressure.The word abhyanga is derived from terms "abhi" and "anga". Thus it is a treatment comprised of Taila/ ghritha/ vasa etc, are rubbed over the body in directions comfortable to the patient.It improves strength and alleviate Vata.It is a type of bahya Sneha. It can be performed as therapeutic procedure as well as preventive procedure.Abhyanga can be done as part of the steps of panchakarma therapy, especially in the first stage: Purva Karma (pre-treatment), or as its own therapy. It is often followed by swedana therapy, a warm bath, yoga or laying out in the sun. Many times abhyanga is performed by two or more massage therapists working in sync but it can also be done by oneself. Oils used can vary depending on the season and the individuals constitution (dosha) It is mainly used an Vata aggravated diseases because oil has the effect reducing vata.In Ayurveda it also mentioned as a daily regimen.In Kerala it is largely used as therapeutic as well rejuvenation and also as seasonal therapy.

SNEHA PAANAM and its Procedures

 SNEHAPANA IN AYURVEDA TREATMENTS

Internal administration of Sneha or fat materials in the body is called Sneha panam/ Abhyantara Sneha.It is again classified into two Achapana Sneha and Vicharana Sneha.This type of snehana mainly used prior to the shodhana therapy as preparatory procedure and also to prepare the body and other morbid doshas to purification therapy. By doing so our body will be softened etc.
Before doing all these procedures one should understand patients condition like age,disease condition,season, digestive capacity etc. And also have some pre and post operative procedures before and after this Snehana therapy.

Pre-Sneha measures/poorva karma/preparatory measures:

One day before the actual administration of snehapana(internally),the concerned individual should be given food in the moderate quantity. The food should be liquid, hot and anabhishyandi(free from stickyness,etc),that does not cause avarodha/obstruction to the channel of circulation(srothas).

The food should be Drava(liquid), ushna (hot), pramana (proper quantity),not snigdha(excess),Asamkirna (Avirudha veerya) and one should not consume food quickly or slowly.Food should be taken calmly (without talking,should not laugh while taking food,and one should take the food, which is favorable and conductive to his body constitution(saatmyahara).

Materials Required:

Before initiating the snehapana always check the all emergency and routine things.because in an emergency situation some times it may not poosible to get the required drugs,etc.Further all anupana dravya like ushna jala/hot water,yusha etc.should be kept ready.

since snehapana in certain individual may cause some complaints,especially such drugs which control these effects should be kept ready.(if required).

some of the complaints are:

Agnimandya (indigetion)-Hinguvachadi vati,chitrakadi vati.

Arochaka (anorexia) -Ashtachurna,etc

Sula (pain)- Shanka basma,etc

Bhrama (giddiness)-Pravala pishti,etc

Murcha -Kamadugdha ras,etc.

and medicines required for vamana and virechana.

• Medicated Ghee or oil according to the requirement.
• Measuring glass.
• Hot water drinking.(boiled with Shundi+ Dhanyaka).

Medicines commonly used:

• indukantham ghritham
• Gulgulu thikthakam ghritham.
• Mahatikthakam ghritham.
• Sukumara ghritham.
• Ksheera bala tailam.
• Dhanwantaram tailam,etc.

Man Power:

• Ayurvedic Physician: 1
• Attendant/ Nurse: 1

Dosage of Snehapana:

Four types of Snehapana dosage schedules  are indicated-

1. Pravara Matra-Sneha digest in 24 hrs.
2. Madhyama Matra- Sneha digest in 12 hours.
3. Avara Matra - digest in 6hrs.
4. Hrasiyasi Matra with arohana krama-digest in minutes

These to be fixed,keeping in view the various factors like state of agni, clinical condition, Prakruti of patient,etc.and aim of snehapana.
Minimum dosage for snehapana is approximately 50ml,this can be increased gradually by 25 or 30ml every day for 3,5,and 7 days desired by the physician.

Procedure of Snehapana:

Agnibala (digestive power) may be assessed in the patient prior to Snehapana,so as to assess the dose of sneha dravya(unctous substances).For the patients with unknown doshas,agni,etc one may start with Hrasiyasi Matra (which digest in 2 yamas).

The patient who is intended to under go snehapana is to take sneha in the early morning (within 15mts of sunrise) in the prescribed dose based on his Agnibala,nature of the diseases,condition of the body,etc.The usual dosage is between 50 to 75mlof ghritha and 30 to 50ml for Taila on the first day.The dose for the next day should be fixed after assessing the time taken for digetion. Hot water boiled with piece of sundi (dry ginger) + Dhanyaka (dry coriander seeds)is given in small doses toenhance the digetion.

Snehapana (internal administration of unctuous substances) may be continued till Samyak snigdha lakshana (symptoms of disired effects) are observed and usually it is obtained within 3 to 7 days.

Step-wise procedure:

1. instructed to offer prayer to the god (according to one's faith).
2. Patient should be assured about the safety of treatment and confidence and courage levels should be raised.
3. selected Sneha should be heated to Luke warm water.
4. In Vata vyadhi- ghee mixed with little saindhava (rock salt), in Pitta diseases- pure ghritha should be used, in kapha diseases-powders of pippali,shundi,and maricha should be mixed before giving orally.
5. medicine should be given in early hours of morning at the time of sunrise in an empty stomach.(after patient completes daily routines like brushing,evacuation etc.
6. Patient asked to sit comfortably on a knee high chair.
7. The patient asked to drink the sneha.If the patient has some aversion to consume,he should be asked to close his eyes and nostrils and to drink (to avoid smell and appearance).
8. Hot liquids should be given as anupana.If required hot water should be taken repeatedly up to six hours of snehapana,especially when large dose is taken.

Usual practice of increasing order of snehapana dosage:

First day :          50ml.

Second Day :    100ml

Third day:         150ml

Fourth Day :      200ml

Up to 7th day :  350ml.

When to terminate the course of Snehapana:

The standered procedure of snehapana and pathya should be continued with gradual increase of Sneha (as described) for a maximum period of 7 days. During the treatment, every day the patient's condition should be assessed to "note the effect of snehapana".
This procedure of snehapana should be stopped on the day the patient/person develops the Samyak Jirna Lakshana.
The time of feeling of hunger and appearance of the Sneha (Fat) in the stools, are the correct indicators samyak snigdha hence further Sneha pana should be terminated.
If any adverse effects of Atisnigdha or Asnigdha occurs suitable treatment should be given.

Observation of Jeerna Lakshana:

After the intake of Sneha on first day as well as in the rest of days of treatment, the patient/person is likely to experience certain symptoms,which indicate the jeerna or ajeerna of consumed sneha.Hence observation is essential for continuing further treatment,because in certain instances, it may not be proper to continue.

Symptoms indicative of progression of digestion (Sneha Pachyamana Lakshana)Ref A.S.Su:

• Shirorug (head ache).
• Bhrama (giddiness).
• Nishti (Excess-salivation).
• Murcha (Fainting)
• Sada (Tiredness)
• Klama (feeling of tiredness even during rest).
• Trsna (Thirsty feeling)
• Daha (burning sensations) and
• Arati (Restlessness).

Symptoms indicative of complete digestion (Samyak jirna Lakshanas):

• Disappearance of all symptoms stated under pachyamana.
• Laghuta (Feeling of lightness in the body).
• Vatanulomana (Proper passage of the flatus).
• Kshut (appearance of proper hunger).
• Trshna (Proper thirst).
• Udgara shudhi (Clear erection with out any taste, odor,etc.).

After Snehapana:

After snehapana is considered as completed,after matching with symptoms of proper Snehana the individual should be subjected to abhyanga and swedana from the very next day as per the planned Panchakarma treatment by the concerned physician.

Paschat Karma(pathyapathya)/post operative regimen during Snehapana:

During Snehapana treatment one should use hot water, observe bhramhacharya (celibacy), should not sleep during day time or suppress urge like urine (mutra),etc.

He should avoid physical exercise, loud talking,anger,anxiety,cold,wind,sun,etc.These measures should be continued some more time even after the completion of snehapana. If one indulges in wrong regimen during the course of snehapana, is likely to suffer from serious upadravas (complications).

Take rice gruel after feeling hungry (when consumed sneha is digested).

Indications of Snehapana:

• Swedya, Samshodya (Persons eligible for sudation and bio cleansing procedures).
• Ruksha Sarira (Roughness in the body).
• Nithyamadya (Alcoholic).
• Krisha (emaciated).
• Timira (Premature cataract).
•  Vata roga (Neuromuscular disorders).
• Kasa (cough)
• Swasa (dyspnoea)
• Hikka (Hiccough).
• Swarabheda (Hoarseness of noise), etc.

Contra indications of Snehapana:

• Sthoola (Obese).
• Kaphaja Vikaras (Kapha disorders)
• Atisara (Diarrhoea)
• Raktapitta (Bleeding disorders).

Complications and managements:

• Indigestion.
• Vomiting.
• Nausea.
• Anorexia.
• Headache.
• Constipation.etc.

In such conditions Snehapana should be discontinued and fasting ,Deepana (Stomachic), Pachana (Digestive),drugs may be given based on the patients condition.

Benefits and Observations:

Oleation pacifies Vata,lubricates and softens the doshas.It improve digestion,regularizes bowels,improves the strength and complexion and prevents premature aging,etc.

Other experiances with disease descriptions:

If readers have any additional experiences in Snehapana related to particular diseases can also add their opinions here,which will help other to cure the conditions and get a chance to practice.Other doctors ,students,vaidyas can also add their experience here which will  act as additional benefits to Ayurveda and Of course to patients and to other physicians.

1. Sneha pana with Gulgulu tikthaka ghritha,found great effective in reducing high cholesterol.

Thank you,

By: Dr.Rimin Razak

Ref:Charaka Samhita,Ashtanga hridaya,etc.

Indications and contra indications for Sneha therapy

Sneha yogya Purusha or General indications for Sneha Therapy: 

Sneha chikitsa in generally is recommended for the following:

• For those who are given to be swedana or shodhana therapies like Vamana,Virechana etc.
• For those who are Rukshana (roughness in the skin).
• Vatavyadhi (vata aggravated) patients.
• For,those who indulge in physical exercises(more).
• Who drinks more and indulge in excess sex,etc.
• Persons of mental stress (Chintaka).
• Aged persons.etc

Sneha Ayogya Purusha or Contra Indications:

 Sneha chikitsa is generally contra indicated in the following:

• Who are fit for the rukshana type of treatment(opposite to sneha therapy),except for the purpose of samshodhana therapy.
• To those in whom Kapha and Medas are aggravated.
• To those who are having mandagni (weak digetion).
• Trishna piditha, murchita, Gharbhini stree(pregnant lady).
• Who are annedweshi (aversion for the food).
• Suffering from Chardi (vomiting).
• suffering from digestive disorders.
• gara visha piditha (poisoned),weak,emaciated.
• Sneha dveshi (who dislikes sneha), etc.

to such persons to such conditions ,sneha should not be given,if administered it may causes sever diseases.

By: Dr.Rimin Razak
Ref:Charaka samhitha,kayachikitsa.

SNEHANA OR OLEATION THERAPY IN AYURVEDA

It is a type of Poorva karma(pre operative) procedures in Panchakarma.Snehana stands for lubrication of  the body systems by the administration of fatty substances internally or externally.Internal administration of Sneha/oil is called Snehapanam.It is an important preparatory procedure for Panchakarma.
Mainly four types of Snehana dravyas.medicines are used for this purpose.they are Ghritha (Ghee), Taila (Oil),Vasa (Fat) and Majja (bone marrow). Out of these Ghritha is considered as the best.

Snehana types:

• Abhyanthara Snehana (Internal oleation)
• Bahya Snehana (External oleation)

Abhyanthara Sneha/Snehapanam (internal oleation):

it is again classified in to Achapana and Vicharana Snehapana.
Achapana Snehapana is the oral intake of medicated or non medicated Sneha (ghee/oil) without mixing with food or other medicinal preparations and used for the purpose of softening and lubricating the body tissues prior to the Sodhana therapy or Panchakarma.
Vicharana Snehapana is the intake of oil along with other food items or with some Ayurveda medicines as a divided quantity.
Internally it can also be given as through rectal route like Vasthi,through nasal route like Nasya karma.

Bahya Sneha (External oleation):

Externally sneha dravya are used in the following forms of treatments like:

• Gargles (oily) oil pulling,etc
• Head massage (Siro Abyangam)
• Oil massage (Abhyangam)
• Lepa (external application, etc..

Classification of Snehana:

From combination point of view:

1. Yamala Sneha: combination of any two varieties of fat substances.eg: Sarpi (Ghee) + Taila (oil).
2. Trivrit Sneha: combination of any three varieties of fatty substances. eg: sarpi+ Taila+ Vasa.
3. Maha Sneha: combination of all the three.Eg: Sarp+Taila+Vasa+Majja.

From therapeutic point of view:

depending on the therapeutic effect it can be divided into three:

1. Brhimhana Sneha: Sneha given with little amount of food or drink for nourishment purpose. Eg: Sarpi (10ml)+ milk (100ml).
2. Shamana sneha: given with processed drugs in moderate dosage for the purpose for treating small to moderate deranged doshic conditions.In these various medicated ghrithas or tailas are given in various diseases.Eg: Pancha thikthaka gritha in warm water.,ksheerabala.
3. Shodhana Sneha: Medicated sneha when given orally in the full therapeutic dose to cause vamana,etc. Eg:use of eranda taila,Sneha given under poorva karma for shodhana procedure is also known as Shodhana sneha.

On mode of administration:

1. Achapeya: Administering orally the pure sneha without adding anything in large dose.
2. Sadya sneha:is a rapid actilng sneha generally given with addition of Lavana.it causes Snehana within 3 days.
3. Pancha prasrutiki peya:100gm each of ghee,taila,vasa,majja and rice are combined together and cooked into peya(rice soup) form and given orally.it cause snehana in 2 to 3 days.

On the basis of paka:

1. Mridu Paka:In this Sneha prepared with minimum frying and subjected to Mridu paka. It is specially used in Nasya procedures.
2. Madhyama paka: Moderate frying used for internal and external purpose.
3. Kharapaka:sneha is obtained by subjecting to maximum frying.used only for external application.

On the basis of Maatra(dose):

1. Hrasiyasi matra (digest in minutes): oral administration of sneha for seven days almost,starting from the smallest amount,gradually increasing day by day.it is a test dose.
2. Hrasva matra: (digest in 6 hours): given in small amounts only.
3. Madhyama matra (digest in 12 hours): medium dose given orally for therapeutic benefits.
4. Uttama matra: (digest in 24 hours): big dose.

Attributes(qualities) of Sneha dravya/medicine:

The effect of the fatty substances on the body is mainly based on some qualities.they are

1. Snigdha guna: greasy or oil like character.which helps to decrease VATA DOSHA and increase the quality of kapha.thereby promotes softness of the body,colour,complexion,etc.
2. Guru guna: indicates heavy character.act a VATA HARA,pushti kara(nourishing) and as an anabolic agent.
3. Sita Guna:give cooling effects to the body,pacify thirsty feeling,burning sensation etc.helps to constrict and contract the body organs thereby imparts firmness and stability of the body.
4. Mridu guna:give softness to body channels/srothas.
5. Drava guna: liquid nature.spread quickly and bring moistening effect.
6. Pichila guna: cause slimness to the body.thereby helps in the integrity,firmness of the body parts etc.cause kapha dosha increase.
7. Sara guna:
8. Manda guna:cause sluggishness of activity of sneha dravya.
9. Sukshma guna: this penetrating character of sneha is responsible for quick action.

Seasonal prescription of Sneha dravya:

1. Sharat hritu (Autumn): since PITTA DOSHA is aggravated in this season ghee should be given as it is good pitta samana.
2. Grishma hritu (Summer): VASA  and MAJJA are suitable.because of excessive depletion due to heat takes place.
3. VARSHA, SARAT, and HEMANTHA: VASA and MAJJA are suitable.
4. Pravrit hritu: TILA TAILA is suitable.because in these season VATA dosha is dominent so tila taila is vatahara in nature

(indications and contra indications of snehana)


by: Dr.Rimin Razak.
Ref:Panchakarma texts.

KERALIYA PANCHAKARMA- TREATMENTS IN AYURVEDA

PANCHAKARMA CHIKITSA/TREATMENTS IN AYURVEDA

Ayurveda treatments comprises of two major parts,Samshodhana Chikitsa (Bio cleansing therapy) and Samshamana Chikitsa (Pacifying Therapy).Samshamana Chikitsa consist of conservative treatment like Langhana,Pachana, drug administration etc.Samshodhana Chikitsa  envisages Pancha karma treatment which is basically a Bio-cleansing regimen indented to eliminate the toxic element from the body and thereby enhances the immunity of the body.Samshodhana Chikitsa is considered superior to Samshamana Chikitsa as the chances for recurrences of the diseases so treated are remote.

Panchakarma increases the acceptability of body to various therapeutic regimens like Rasayana (Rejuvenation) and Vajikarana (Aphrodisiac). Thus Panchakarma therapy is believed to impart radical elimination of diseases causing factors and maintain the equilibrium of  Doshas.

Types :

Five fold measures comprehended as Panchakarma are:

1. Vamana (Therapeutic Emesis)
2. Virechana (Therapeutic Purgation)
3. Anuvasana (Medicated Oil enema)
4. Asthapana (Medicated Decoction Enema)
5. Nasya (Nasal Insufflations) [ref: C.S Kalpa sthana,S.S Chiktsa, A.H. Sutra sthana].

Vagbhata in Ashtanga Hridaya has enumerated five types of Samshodhana are:

1. Niruha
2. Vamana
3. Virechana
4. Nasya
5. Rakthamokshana

Prior to these five Pradhana Karma (main procedure), Poorva Karma (pre operative),and Paschat(post operative) Karma has to be done.some of the Poorva Karma are:

• Pachana and Deepana (correct digestion and Ama condition by using digestive or and appetizer medicines)
• Snehana (oleation) and
• Swedana (Sudation).

After the main procedures, Paschat karma a special diet and life regimen is advocated as post operative measures.Pancha karma therapy plays a definite role in the management of disease especially of neuromuscular, rheumatological and gastro intestinal origin.In addition to this Panchakarma procedures are utilized for the purpose of preservation,maintenance and conservation of health and the promotion of longevity.
Based on Ayurvedic principles and own experiences,the Ayurveda Scholars in South India have modified certain procedures according to Dosha,Prakriti, Kala/season and found them effective.Later these got popularized as Keraliya Panchakarma.some of theses practices are:

• Shashtika shali pinda sweda
• Pizhichil
• Shirovasthi
• Shirodhara
• Shirolepana,etc which will explain later.

These procedures are specialized varieties of Snehana and Swedana which have more nutritive/nourishing effects than bio cleansing or depleting effects.
Before administering of Panchakarma procedures,one must carefully select,assess and prepare the patient explaining all the procedures to be followed.The doses of drugs,vegas/urges and frequency of procedures may vary according to the condition of the patient and severity of the diseases.While undergoing the procedures,it is duty of the physician to asses the patient's strengths,Constitution,age,diseases stage and other relevant factors.(ref A.H.Su)
The Samshodhana Chikitsa of Ayurveda,which include Panchakarma treatment,basically indent to eliminate the toxic elements from the body and thereby enhanced the immunity of the body.The toxic products of the body metabolism can be broadly divided into water soluble,fat soluble and volatile substances.the volatile substances like carbon dioxide can easily be removed from the body through the lung.While there are number of mechanisms available to get rid of the water soluble toxic materials through Kidney,Sweat and other body secretions, removal of fat soluble toxic material is very difficult and only liver can play a small role.Hence it is likely that there would be accumulation of fat soluble toxic products in the body.Liberal use of oil and ghee in various Panchakarma procedures makes it possible to eliminate these toxic products.In modern day medicines ,we can see that molecules moves from higher concentration to lower when separated by a diffusion membrane.The skin and the mucous membrane provide an excellent opportunity for this maneuver.While skin of an average adult provides a surface area of less than 2 sqr mm,the gastro intestinal tract is many meters long with highly permeable mucous membrane.The mucous membrane of the gut has many folds and projections in the form of villi and micro villi,which helps to increase the total exchange area.Various Panchakarma procedures like Vamana,Virechana,and Anuvasana use oil liberally,thereby removing toxic fat soluble waste materials.Prior to the Pradhana Karma,Poorva karma ie,Bahya Snehana (External Oleation) and Sarvanga Swedana(Whole body Sudation) are given to the patient.These procedures further helps in removing toxic materials from the body.Swedana procedures using hot steam increases the local skin blood flow there by enhancing the exchange process.It is known that the fat soluble toxic substances are stored in the body fat.Fat in the body is largely located below the skin and inside abdomen around the mesentry of the gut.During various procedures exposure of skin and gut mucous membrane to a quantity of oil seems to be logical and ideal procedures.repetition of these procedures over several days will largely remove the toxic wastes by concentration gradient.The Ayurvedic medicines added to the oil might give additional benefits.
One of the important features of these procedures is the safety and easiness  by which these can be administered without any major side effects(if done properly). In Ayurveda practice of Panchakarma, Dosha (humoral factors), Prakriti (body constitution), Kala (season), drug availability etc are always prime concern.

Scope of Panchakarma:

 The important aims and objectives are:

1. Curative approach
2. Preventive approach
3. Promotive approach
4. Preparatory approach
5. Vishahara/toxicology etc

By:Dr.Rimin Razak

Ref: practical hand book of panchakarma.