Panchakarma (Pancha-five, karma- therapy), mainly consist of Vamana (Emesis) Virechana (purgation), Nasya (nasal administration of medicine), Nirooha Vasti and Anuvasana Vasthi (Rectal, administration of medicine – a type of enema). Another very close terminology is Panchasodhana karma, in which instead of Anuvasana vasthi, Rakthamoksha (bloodletting) is included. Panchakarma is a special branch in Kayachikitsa (general medicine) which deals with the five main therapies as well as its preparatory and post operative procedures. The procedures are specially designed in the purification of the body based on dosha predominance and seat of doshas and elimination through the nearest possible route. Such purification allows our body to return to normalcy, get cured of the disease for which therapy has been administered and help in the better bioavailability of the medicines administered thereafter. The whole Ayurvedic treatments can be understood under three main headings of preventive, promotive and curative aspects. Panchakarma acts in all three levels.
In Ayurveda, Skin disorders are mainly categorized under Kushta vyadhi, [Mahakushta and Kshudra kushta – group of skin diseases] Visarpa (group of skin diseases which are having fast spreading nature), Switra (vitiligo), Seetapitha, Udarda & Kota, (urticarial lesions) and skin manifestations seen in Vathasonitha avastha (Rheumatic spectrum diseases and some autoimmune disorders) which are all dealt in detail by our Acharyas. Some skin manifestations are also seen as symptoms of certain eruptive fevers, hemorrhagic diseases etc. In skin disorders involvement of dhatus [tissues like skin, blood, muscles, and lymph] are mainly seen. Sometimes involvement of all tissues are found in some chronic skin diseases.
While dealing with skin diseases, Ayurvedic approach involves proper clinical examinations like morphological evaluation, assessing the causative factors, evaluating the status of the doshas and dhatus involved by which an Ayurvedic diagnosis can be reached. In dermatological diagnosis, we also have to consider types of lesions, distribution and configuration of lesions, associated symptoms, age of onset, aggravating and relieving factors, etiological factors/ organisms, toxins, allergy, autoimmune, traumatic or may be due the latent effect of any systemic disorders for which lab investigations and biopsy also helps.
According to the dosha predominance, the suitable panchakarma is selected, which is preceded with poorva karmas (preparatory procedures) and followed by paschat karma (post-therapy procedures). Sometimes more than one of the panchakarma may be needed, for the management of the disease, during the course of treatment, which is based on the status of dosha.. Unhealthy food and life habits like excessive intake of curd, milk, fish, meat products, sesame, jaggery, incompatible foods etc. lead to many skin disorders. Vitiation of doshas along with the involvement of deranged tissues, impaired digestive fire and even the involvement of a stressful mind can be seen in almost all skin disorders. As a physician our major role is to identify the cause of the vitiated doshas, and decide whether shamana chikitsa (palliative medicines) or shodhana chikitsa (purificatory therapies) or both are needed in that particular patient. Depending upon the intensity of vitiated doshas, appropriate therapies can be selected. Minor quantities of dosha vitiation can be managed with palliative medicines, but if the quantum of dosha vitiation is more, if deeper tissues are involved, if the disease is chronic, based on the condition of the patient, purificatory therapies can be adopted. In the initial phase of skin diseases, medications like Amrithotharam kashayam, Manjistadi Kashayam, Patolakatukurohinyadi kashayam, Sudarshanam gulika, Vilwadi gulika etc can be used. Later based on the dosha predominance and based on the disease, purificatory therapies can be done.
Snehanam (oleation therapy)
In Vata predominant skin diseases, Bhallathaka tailam, Tuvaraka tailam, Sarshapatailam etc. are indicated whereas in pitta predominant skin diseases Tiktaka ghritha, Mahatiktakaghritha, Panchathikthaka ghrutha etc. can be used. In vatha kapha predominant skin diseases Gulguluthikthaka ghrutha, Aragwadha mahathikthaka ghritham, Vajraka ghritha, Mahavajraka ghritha, etc are indicated and can be selected for preparatory procedures.
Swedanam(sudation)
Sthira Kadhina mandalanam kushstanam pottalair hita swedam.(A.H Chi-19)
Due to the involvement of pitta and raktha, Swedana is usually contra indicated in skin diseases, but in skin diseases which presents as thick, elevated and hard as in gajacharma (elephant skin like lichenification) etc, shastika shali pinda swedana prepared in Aragwdhadi/Nalpamaradi kashayam is found beneficial. It helps to soften the lesions. Ooshma swedam/parishekam (pouring of medicated kashayam, tailam etc), using appropriate kashayas is found effective in the management of vatha kapha predominant conditions.
Shodhana Karma (Vamana/Virechana)
Vathothareshu sarpir.
Vamanam sleshmothareshu kushteshu
Pitthothareshu mokshorakthasya virechana
chaagre……. (A.H Chi)
In Vata predominant skin diseases, oleation therapies is indicated, in kapha predominant skin diseases, emesis becomes the main line of purification, whereas in pitta predominant skin diseases rakthamokshana (bloodletting) is indicated. Purgation is a less complicated purificatory procedure which can be done in various skin disorders. In clinical experience, emesis therapy is found to be effective in skin diseases like Sheethapitta, Udartha, Kodha(urticaria), Darunaka(severe dandruff) and Sidhma kushta (psoriasis). In conditions of Vicharchika(eczema), dadru (tinea infestations) and in pitta dominant skin diseases, purgation can be done using Patolamooladi kashayam, Manibhadra gulam, Truvruth lehyam, Avipatti choornam etc.
Nasya karma
Skin disorders mainly seen in Urdhwajatrubhaga (above neck and shoulder region), can be managed with nasya (nasal administration of medicine) after the initial purificatory procedures. In conditions of hair fall, darunaka(dandruff), indraluptha (alopecia), psoriasis capitis nasya can be done using Anu tailam, Shadbindu tailam etc.
Vasthi karma
Even though direct reference of anal administration of medicines in skin diseases, is not mentioned in classics, in conditions of Vathasonitha spectrum of diseases [ like psoriatic arthritis, Vasculitis- purpuric etc.] and when the disease is vata predominance, vasti karma may be done after careful consideration of dosha and condition of the patient.
Rakthamokshana
Snigdhasya shodhana yojyam visarpam
yatudahritham
Lalatahastapadeshu sirasysa vimokshayethu.
Prachanam alpake kushtam sringadyashcha
yadhayadham. (AH CH-19)
After proper oleation and purificatory therapies, siravyadhana(bloodletting) is indicated in certain skin diseases. If the amount of vitiated doshas are less, then prachana karma (bloodletting by scrapping) is indicated and if more doshas are vitiated then sringa (horn) can be used as a method of bloodletting. The purificatory therapies and bloodletting has to be done several times in repeated intervals based on the disease condition, strength of the patient till we get the desired results.
In clinical conditions of vicharchika (eczema), Vathasonitha uthana, jaloukavacharana (leech therapy) is usually done. Prachana karma (bloodletting by scrapping) shows promising results in conditions like indralupta (alopecia).
Conclusion
Majority of chronic skin diseases are chira sanchitha doshodha (occur due to the long-term accumulation of doshas) and hence involvement of deeper tissues is more prominent in such conditions. For managing such diseases panchakarma has got a significant role. After purification, if some doshas still remain, it can be managed with palliative medicines and then to avoid recurrence of the disease, Rasayana karma (rejuvenating therapies) can be done.
