Saturday, July 21, 2018

Diabetes; An Intro to the Ayurvedic Perspective


Diabetes is becoming a global problem with 450 million people diagnosed worldwide.
In 2015, 23.4 million people in the United States were diagnosed with diabetes, compared to only 1.6 million in 1958.

In Adolescents, cases of type 2 diabetes in 1980 were ZERO and cases of type 2 diabetes in 2010 were 57,638. For decades, type II diabetes was considered an adults-only condition. In fact, type II diabetes was once called adult-onset diabetes. What was once a disease mainly faced by adults is becoming more common in children. Among people under the age of 20, type I diabetes rose 23 percent between 2001 and 2009, and among all ages its Quadrupled Worldwide Since 1980. 

Ayurveda defines health as an optimal balance of the three doshas, with a healthy bio-fire, or enzymatic and digestive capacity (agni), balanced tissue metabolism and waste disposal, combined with an enthusiastic nature, clarity of sense perception and balanced mind and emotions. Thereby a healthy person is physically, psychologically, socially and spiritually sound and Ayurveda is truly a holistic medicine and way of life. (Doshic questionnaire).


To understand Ayurveda, it is important to understand the tri-doshic theory as the source of the universe and the key to elucidate the pharmacological, pathological and therapeutic factors in the treatment of diseases. (click here and scroll down for article about the doshas).


Disease is assessed based upon the person’s elemental constitution at birth or one’s genetic combination, or their dosha, as seen in their physical and psychosomatic make up, which plays a key role in the disease or healing process.

The disease we call Diabetes, can be found in Ayurvedic texts dating back over 1,000 years in the Charaka and Susruta Samhitas, where it is called madhumeha and/or prameha, which mean profuse urination, with all disorders that present with excessive urination are a type of madhumeha, and include 20 major categories, with each treated according to the doshas involved. 

Ayurveda sees madhumeha not as one disease, but as a multifaceted syndrome with various, complex metabolic disorders. It includes diabetes mellitus types I and II, and calls these prameha and includes the systems involved, the complications of the disease and the state of mind that assists in pain management. So its definition is way more intricate than the modern medical definition of this disease which only differentiates 2 main types: mellitus and insipidus.

Diabetes Mellitus and its associated disorders, is a metabolic disorder of the metabolic transformation or digestive capacity (agni). When there is a dysfunction of the agni, the carbohydrate metabolism, or the earth and water elements, are disturbed, characterized by increased blood sugar, the passing of sugar in the urine, and dysfunction and damage to the urinary system, which are the water carrying channels and is especially due to a dysfunction of the agni of the pancreas and production of insulin.

Diabetes is classified as either insulin dependent (IDD)-type I or non-insulin dependent (NIDD)-type II. Diabetes insipidus, at least in the beginning, is an imbalance of the diuretic hormone vasopressin. It is rare and occurs most often in young people.
(Ayurvedic Perspectives On Selected Pathologies, Vasant Lad, BAMS, MASc).
 

Our tissues (dhatus) have a normal level of moisture or liquid (kleda). One function of kleda is to maintain the body’s water-electrolyte balance. It also nourishes and lubricates all the tissues. It is associated with kledaka kapha in the stomach and in the spreading stage of prameha, kledaka kapha overflows from the GI tract and enters the blood plasma (rakta dhatu), and as it spreads, this kledaka kapha disturbs the kleda present in all the tissues (dhatus). The function of urine is to remove excess liquids, so when kleda is increased, urination is also increased, called polyuria, hence the profuse urination.

The first 3 stages of any disease are called accumulation (sanchaya), provocation (prakopa) and spreading (prasara). High blood sugar is described in Ayurveda as increased kapha in the rasa and rakta dhatus (circulatory and lymphatic systems). The increased kledaka from the dhatus starts leaking via the digestive system, through the kidneys and into the bladder, causing the symptoms of diabetes that occur after the dosha enters the third stage of the disease process.

During this period, one may accumulate tarter on the teeth, sticky sweat even after a bath, an increase in nasal crust, ear wax, sebaceous secretions and smegma. Excess urination, nocturnal urination, and at the end of urination the anal sphincter muscles constrict and create goose bumps. It’s common to have a sweet taste in the mouth, the breath to smell like vinegar, and the pulse becomes slow and sluggish with the stomach pulse showing a kapha spike. 

The general pathogenesis (samprapti) almost always begins with increased kapha, as seen in most of the signs and symptoms. Later, vata and pitta can enter the picture, because prameha is a complex syndrome that can involve all three doshas.

Prameha is most often due to hyperglycemia or an increased blood sugar, caused by diminished insulin production by the pancreas (kloma) due to its faulty agni. It is a chronic endocrine disorder that affects the metabolism of carbohydrates, proteins and fats as well as the water–electrolyte balance. It can cause functional and structural changes in the body’s cells, and create complications of the eyes, kidneys, nervous system and other organs.

There can be other causes of prameha, classified as kapha types of which there are 10, Pitta types 6, and vata types 4. Some are:
·Secondary condition to pancreatitis, a pitta disorder. Viral infections can create pancreatitis.
·Heredity plays a role in the destruction of beta cells in the pancreas, which can cause pancreatitis or neoplasm or tumor of the pancreas, leading to diabetes.
·A tumor of the pancreas-pitta/kapha
·Autoimmune dysfunctions-tejas (inflammation) burns ojas (immunity or antibodies) and affects the pancreas, pitta/kapha.
·Obesity, usually associated with non-insulin dependent diabetes; a metabolic disorder of kapha.
·Wrong diet, emotional overeating and excess consumption of heavy, damp and cold foods and sugar, kapha.
·Pregnancy, when there is an excessive demand for insulin that can lead to gestational diabetes. Also there is a natural increase in kapha, as kapha is responsible for the creation of the new baby and placenta. That kapha can inhibit the pancreatic function, which can also lead to gestational diabetes.
·Liver diseases, including hepatits and cirrhotic changes can lead to portal hypertension and affect the pancreatic function, resulting in diabetes, pitta/kapha.
·Corticosteroid therapy is a drug induced cause of diabetes. Steroidal hormones are kapha provoking and steroid toxicity may create underactive thyroid, water retention, hypertension and obesity. It also compromises kidney functions and causes “moon face”, which results in a swollen and fatty appearance of the face, kapha.
·Worry, anxiety, fear and anger are all connected to cerebral kloma (form of kapha or kleda) and these can affect glandular functions and lead to prameha, vata/pitta/kapha.
·Stress affects the nervous system, which governs all the functions of the body and mind. It affects blood flow, inhibits rejuvenation, increases stress hormones, affecting the endocrine system, hormones, triglycerides, cholesterol and blood sugar.
Primarily aggravated kapha, are fatty tissue, muscle tissue and body fluids.
Moderately affected pitta, are bone, blood, and plasma. 

Chronic conditions deplete the body, especially lymph, muscle, vata, and ojas - the healthy and refined form of kapha that governs immunity and our ability to love and be loved. 

(Charaka Samhita: 6/4) The etiology or (Nidana):
·Sedentary lifestyle
·Excessive sleep or sleeping during the day
·Meat soup or meat made of domesticated, aquatic or animals from a swampy habitat
·Milk or dairy products
·Recently harvested grains or drinks
·Preparations made of unrefined cane sugar or jaggery 
·That which aggravates kapha: 
(Ashtanga Hrdayam: Ni. 10/1-3)
·Food, drinks and activities that cause an increase of fat (medas), urine (mutra)     and kapha are the primary causes for prameha such as:·Food which is Sweet,   Sour, Salty, Fatty, and not easily digestible, slimy and cold,
 
·New grains
 ·Beer 
 ·Sugar cane juice 
 ·Molasses 
 ·Milk 
 ·Always sitting in one place, sedentary lifestyle
 ·Sleeping at inappropriate times or during the day

Purva Rupas – Premonitory Signs & Symptoms:
Sweating
Body odor
Flabbiness of the body
Desires constant rest and sleep, or sitting, has an easy life, laziness
Heaviness in the cardiac region
Exudation from eyes, tongue and ears
Overweight, excessive growth of hair and nails
Liking of cold comforts
Dryness of throat and palate
Sweet taste in the mouth
Burning sensation of the hands and legs
Swarming of ants especially near urine

Diagnosis of Dosha involvement
An Ayurvedic consultation includes visual observations, pulse, questioning and urine analysis to assess and classify in order to choose the proper treatments.
For urine analysis, take some urine in a cup and put a drop of sesame oil into the urine.
· If the urine takes a snake like image it is a Vata disease· If the urine takes an "umbrella" shape it is Pitta disease· If the urine takes a pearl shape it is Kapha disease
Oil Drop
· If the oil drop attains Mandala (circular shape) Vata is predominant,  · If the oil drop attains Budbuda(bubbles) shape Pitta is predominant· If the oil drop attains Bindu (globule or droplet) and sinks in the urine Kapha is predominant.

Kaphaja Prameha (10)
Urine resembling water, Hydruria
Urine resembling sugar cane juice, Glycosuria
Dense Urine, Chyluria
Dense urine at the bottom and clear at top, Belluria
Whitish urine
Urine containing seminal fluid, Spermaturia
Urine which is cold, Phosphaturia
Urine contain sand like substances, Graveluria
Urine passing slowly
Urine containing slimy material, Pyuria

Pittaja Prameha (6)
Urine resembling the mixture of alkalis, Alkalinuria 
Urine that has a blackish color, Melanuria
Urine having bluish color, Indigouria
Urine having blood in it, Hematuria
Reddish color urine, Hemoglobinuria
Bright yellow urine, Urobilinuria

Vataja Prameha (4)
Urine mixed with nervous tissue (majja), Myelouria
Urine mixed with muscle fat, Lipuria
Urine mixed with lasika or lymph, some consider this Diabetes Insipidus
Urine that is sweet like honey and mixed with ojas, Diabetes Mellitus 
If kapha/pitta type of prameha are left untreated, then they may develop into Madhu meha – indicating chronicity and hence also the involvement of vata.
If vata type of prameha is the primary manifestation, then it is considered incurable.

Types of Premehi Patients
  1. Obese and strong–Sthoola Pramehi  (kapha/pitta)
  2. Lean and weak–Krisha Pramehi  (kapha/vata) 

Kaphaja: Curable –due to compatibility of treatment. Since bitter and pungent drugs (herbs and spices) are advised for this condition, and they also alleviate kapha, there is no contradiction in the line of treatment.

Pittaja:  Palliable – due to mild contradiction of therapies. Drugs (herbs and spices), which are pungent in taste, cannot be used in pittaja types as they would further aggravate pitta, lymph (rasa) and blood (rakta).

Vataja: Incurable –due to incompatible intervention, as a result of chronicity of the disease with complications, as well as contradictory therapies. They tend to be severe and associated with complications.

Treatment–Chikitsa
The prevailing strategy in conventional medicine for managing DPN focuses on stringent glycemic control by intensive maintenance of target blood sugar level to slow the progression. The symptomatic treatment in painful diabetic neuropathy includes tricyclic antidepressants, SSRI group drugs, antiepileptic drugs and opiods. Such medical intervention may not always produce effective results and are associated with known adverse effects. 













The line of Ayurvedic treatment of prameha, however, is determined as per therapeutic classification. 

Herbs or insulin, if necessary, can regulate blood sugar, and there also needs to be a holistic treatment program to treat this syndrome. That usually includes proper diet, daily exercise, yoga, hygienic measures, an appropriate lifestyle and panchakarma cleansing, all according to the individual’s constitution and the particular type of prameha.

For those who are strong (Sthula pramehi) – Bio Purifactory Panchakarma therapy (Shodhana) is a strong cleansing or elimination of excess kledaka kapha and includes therapeutic emesis and/or therapeutic purgation, as well as avoiding the causes already listed, followed by palliative care after the panchakarma and the kleda kapha has been removed.

For those who are lean and weak (Krisha Pramehi) – Palliative management (Shamana) – Mild cleansing followed by stronger rejuvenation and strengthening therapies with Ayurvedic formulas and diet considering the individual’s constitution and condition and the specific complications.

Peripheral Neuropathy is a common and costly complication of both type I and type II diabetes. Prevalence of neuropathy is estimated at about 8% of newly diagnosed patients and greater than 50% in those with longstanding disease. In classical Ayurvedic texts, the clinical features of peripheral neuropathy are described in the context of prameha and its various stages called burning palms and soles (khara pada daha).

Complications in pitta types of prameha include urinary tract infections, testicular hypo functioning, recurrent hypoglycemia, causing dizziness and early neurological symptoms like paresthesia, especially burning, GI symptoms including GERD, and diabetic diarrhea.
Complications of vata type of prameha are emaciation, urine retention, and neurological symptoms as various types of pain, palpitation, and vata types of respiratory features characterized with dry cough and breathing difficulties. Other classical texts mention sparsha vatra and tvak shunyata, characterized by severe pain, burning sensation and absolute loss of sensation. Tvak shunyata presents as lack of ability to differentiate hot and cold or soft and rough.  (Ayurveda Journal Of Health, vol 15 issue 4).

Localized vata/pitta clinical presentations may be effectively managed with internal administration of kshira bala taila 101, and external applications of shata dhouta ghrita (100X medicated ghee)  and a treatment of Takra Dhara: pouring medicated buttermilk over the entire body.
For other vata/pitta cases where vata is predominant or for lean or emaciated diabetic individuals, medicated rice bolus poultice (shashtika pinda sveda) is commonly practiced which improves muscle bulk and strength. 


In autonomic or peripheral neuropathy associated with insomnia or loss of balance and coordination, shirodhara (medicated oil poured on the forehead) is beneficial.


For Vata predominant cases, pour medicated oil, 4-5 liters over the entire body, followed by an abhynaga massage with the same medicated oil at home.


Ayurvedic preventive diabetic foot care includes foot massage (pada abhynaga) with medicated oil.

In kapha/vata presentations, where kapha is predominant, as in diabetic amyotrophy, a medicated powder massage (udvarttana) is performed and a hot medicinal powder poultice (curna panda sveda) are beneficial. 


In autonomic neuropathy with gastrointestinal symptoms like constipation or GERD, judicious use of mishraka sneha, shows to improve gastrointestinal motility. It is useful in obstinate constipation, colic, pain and inguino-scrotal swellings and various diseases due to vata manifesting in the GI tract. Maha dhanwantaram tablet may be used as a palliative formula for GERD with symptoms like nausea, dysphagia, epigastric discomfort, and gastroparesis.

In chronic diabetic cases at the vata predominant stage, dhanwantaram ghrita is indicated for internal administration.

For erectile dysfunctions seen in diabetic peripheral neuropathy patients, milk decoctions of ashwagandha and bala yields promising results.

In diabetic foot ulcers medicated ghee with turmeric is effective for internal administration and external application.

For diabetes retinopathy a therapy called tarpana with patoladi ghrita applied to the eyes has shown remarkable improvement in visual acuity.


            Dietary modifications are also very important in management of diabetes. 


A beneficial diet includes: Turmeric, cinnamon, feneugreek, barley, honey, roasted meat, corn meal, green gram (mung dal),  cooking foods with ghee and spices. 


Consume one meal per day of medicated gruel, with Mishraka Sneha, effective in maintaining euglycemia and improving quality of life.  

Dashamula medicated gruel is successfully practiced in various stages of diabetes as a diet therapy.

Avoid foods and drinks that are cold, moist, heavy, fried, boiled, fermented or carbonated.

Lifestyle – Exercise!!

Body Treatments–Several are already listed above. There are a variety of body treatments, selected according to the person’s constitution, condition and disease classification. Including Shirodhara or Takra Dhara, which are classically recommended for many types and conditions of pramehaThey are a stream of either warm herbalized oils or takra poured on the forehead. This is deeply relaxing, sooths and calms the nervous system, synchronizes brain waves, calms the mind, and enhances blood circulation to the brain. The affects of the deep relaxation are valuable to the body, mind and energy. 

We can use udvartana massage to dry and reduce a heavy and moist person. This also increases lymphatic circulation and drainage, so we want to reduce some of the kleda first with diet and lifestyle rather than circulate it, then introduce this treatment.  If the person is not very damp we can provide an abhyanga massage, which is the signature massage of Ayurveda, that is a lymphatic drainage performed with warm herbalized oils, preceded by garshana silk glove and completed with a hot towel compress.  


Nasya is often helpful, which is a tri-fold treatment of neti pot, nasya oil and gargle, cleansing and nourishing of the sinuses, head and neck.  


Medicine: Ayurvedic Herbs: (Aushadha) to include: Triphala, Shilajatu, Chardunika (Gymnema Sylvestre), bilva leaf, guduchi, and Guggulu preparations. Gymnema Sylvestre showed similar glucose lowering effects as the corticosteroid-inhibiting drug, ketoconazole. Experimental and clinical studies revealed anti-diabetic and adaptogenic properties of the aqueous extract of bitter gourd (momordica charantia or karavellaka). The aqueous extract of the fruit was more effective in diabetes than the powder of the dried fruit. 

This article is not meant for any diagnosis or treatment, but rather to provide Ayurvedic education to get an idea of how an Ayurvedic professional will analyze a case and organize a health plan according to the individual’s constitution and condition. Please do not attempt to self treat. Always seek the consultation and supervision of an experienced and properly educated Ayurvedic Practitioner along with your doctor.

The earlier we notice imbalances, especially within the first 3 stages, the easier it is to correct them. The longer the imbalances are ignored, the harder it will be to reverse them. Articles and mid level workshops are tools for people to become aware of the Ayurvedic wisdom of life. It is advised to seek the analysis and guidance of a properly educated and experienced Ayurvedic Practitioner to pinpoint the root causes of imbalance and create a well rounded and appropriate health plan and keep you on track to a life well lived.

Chaya has been an Ayurvedic Practitioner, Ayurvedic Yoga Therapist and Massage Therapist at some of the largest yoga and health centers in the country for 20 years. She can be reached at her private practice in Gainesville, The ChayaVeda™ Integrative Healing Arts Studio, by visiting ChayaVeda.com

Ayurvedic Perspectives on Selective Pathologies, Vasant Lad, BAMS, MASc
Referenced from DIABETES MELLITUS (MADHUMEHA) AND AYURVEDIC MANAGEMENT: AN
EVIDENCE BASED APPROACH;  Article in WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES · August 2015

Thursday, June 28, 2018

The Wonder of the Breath



The breath governs movement, integration and connection, and is the link between mind and body as an integral part of the interplay within a dynamic feedback loop of our thoughts, breathing and nervous system, which includes the vagus nerve, proven to govern all the organs and functions of the body and mind. This energy network corresponds to the nervous system, in yoga terms, called the nadis, the subtle channels where energy is absorbed and flows through the body and mind. Therefore, when we control our respiration we control every aspect of our being. 

Different patterns of breathing result in various affects, and understanding how to use this system is foundational to the science and practice of yoga, and constructing an appropriate and effective yoga posture sequence coordinating specific breathing methods with specific yoga postures that are tailored to the individuals constitution and condition and for the purpose of integrating the nervous system, resulting in a calm mind, clear senses and perception to become free from our repeated thought patterns. The first limb of yoga practice begins with using the breath to move our attention from desires to focusing on our goals.

Breath is often referred to as prāna, or life force. The system of Hatha Yoga is yoga postures coordinated with breathing that is based on balancing and increasing the flow of life force in the body in addition to balancing the nervous system. Prāna exists in all things, and is abundant in air, food, sunlight and water, and expressed through the breath. The key to understanding prāna and energy is breath. One who has strong lungs and good breathing capacity usually has abundant energy and when the mind is clear and balanced, the breath is even and rhythmic and the parasympathetic nervous system or “rest and digest” is dominant. When the mind is nervous and tense, the breath is strained and erratic and the autonomic nervous system or “fight or flight” is dominant. When we are in the “fight or flight” mode, our body and mind go into a cascade of chemical changes creating toxins and inflammation, putrefying and dulling our senses so that they are unable to perceive directly or interact with life skillfully.

When we can increase the prāna in our system by increasing our lung capacity, and steadying the breath to become even and rhythmic, the mind becomes clear and the nervous system becomes balanced with parasympathetic dominance. When the mind is nervous or tense, the breath is strained and erratic, depleting energy, and causing stress, strain and confusion or sympathetic dominance. 

A Yoga and Breathing practice that is appropriately tailored to each individual, removes obstacles that inhibit clear perception and prepares the mind for the process of directing it towards a chosen goal.

Wednesday, March 28, 2018

PANCHAKARMA



PANCHAKARMA and seasonal cleansing are purifying and rejuvenating programs for the body, mind and consciousness. They are known for their beneficial effects on overall health, wellness and self-healing, and are the signature treatment of Ayurvedic Medicine also known as the science of life or life knowledge that is beyond ordinary perception.

The majority of clinical trials in Ayurveda have been conducted in more than 40 research institutions in India, many supported by the government, with findings published in India and European scientific journals. Because Ayurveda has been outside the Western model of health care and scientific system, research in America lags but is growing and modern scientific studies are using their own language to recently say the same things that Ayurveda has been demonstrating for thousands of years (1).

Exploring larger evidence-base for contemporary Ayurveda is being studied, one by Ram Harsh Singh in the International Journal of Ayurveda Research states:  “Ayurveda represents the most ancient and classical knowledge base pertaining to life science, health and cure. It seems to have been the world view of its time, although subsequently the world view of this knowledge base shrank to India alone and India remained its sole custodian till the end of the 20th century. Because of its unique pro-nature vision, Ayurveda once again is gaining global relevance” (2).

Another interesting study was performed in the Netherlands with a group of patients with chronic illnesses, including asthma, bronchitis , hypertension, and diabetes, that were treated with panchakarma and other Ayurvedic remedies. Strong results were observed, with nearly 80% of the patients improving and some chronic conditions being completely cured. Other studies have shown that panchakarma can lower cholesterol and improve digestive disorders. Diabetes, acne and allergies have been successfully treated with Ayurvedic remedies, and many Ayurvedic herbs have been proven effective in lab tests. Ayurvedic treatments, including panchakarma, have been used successfully to support the healing process of patients undergoing chemotherapy (3).

One study by the Journal of Ayurveda and Integrative Medicine showed the effect of panchakarma and Ayurvedic treatment in postpartum rheumatoid arthritis to be beneficial in causing remission after 4 months of treatment.(4)

Currently, the National Institute of Health (NIH) is also funding studies on Ayurveda. Outside of scientific research, there are many patients who give testimonials to the effectiveness of panchakarma, which may be obtained from Ayurvedic clinics (4).
Significant improvements were found in self-efficacy towards using Ayurveda to improve health and reported positive health behaviors. In addition, perceived social support and depression showed significant improvements 3 months post program after the subjects had returned to their home context. As a program of behavior change, our preliminary results suggest that the complex intervention, panchakarma, may be effective in assisting one's expected and reported adherence to new and healthier behavior patterns (4).

There are many testimonials for Ayurveda and specifically it’s panchakarma therapy, in that it eliminates physical & mental toxins, restores physical, constitutional & emotional balance, improves physical, mental & emotional health, strengthens physical & emotional immunity, deepens physical & mental relaxation, improves physical & mental energy, improves physical & emotional vitality, improves physical & mental clarity, improves gut health, improves brain health, improves circulation, improves digestion, improves skin, improves the microbiome, improves the RhinoSinoBiome, slows the aging process and increases one’s sense of well-being.

Panchakarma is used in Ayurvedic medicine to treat almost all diseases, particularly those that are chronic, metabolic or stress-related in origin. Panchakarma has been used to treat allergies, asthma , arthritis, cancer, chronic fatigue syndrome , colitis, high cholesterol, depression , diabetes, digestive disorders, heart disease, hypertension , immune problems, infections , inflammation, insomnia , nervous disorders, obesity , skin problems, and ulcers. Panchakarma may be used alongside intensive conventional treatments including chemotherapy and surgery, to support healing and recovery. Panchakarma is safe and non-toxic, and can be used as prevention and to increase general well-being. Panchakarma is limited in treating traumatic injuries, acute pain, and conditions requiring immediate surgery or invasive procedures (5).

Panchakarma is based on central concepts of Ayurveda, which state that disease is caused by the build-up of toxic substances in the body and by imbalances in the body and mind (5).

The ideas behind panchakarma have influenced other alternative treatments. Environmental medicine studies how the accumulation of environmental substances in the body may cause disease, and detoxification therapy utilizes cleansing the body as its central treatment (5).

The first step of any Ayurvedic treatment is a thorough examination and diagnosis by an Ayurvedic practitioner, who determines the type and extent of panchakarma treatment required. According to Ayurvedic theory, physical and emotional traits are classified as three doshasvata, pitta and kapha. Each individual has all three doshas with one predominating. If an imbalance occurs, diseases/conditions appear. Panchakarma rebalances the doshas, bringing them back to equilibrium and the individual back to good health. The physician may prescribe herbal remedies and recommend dietary and lifestyle changes that may be enacted before, during and after panchakarma (5).

Ayurvedic doctors believe that disease generally starts in the digestive tract. Due to poor diets, bad health habits, and other causes, digestion can be impaired, causing a toxic substance called ama to accumulate in the body. Ama interferes with normal functioning and the flow of energy, creating imbalances and disease. One goal of panchakarma is to cleanse the body of excess ama, and to restore the body's digestive integrity (agni ) (5).

In panchakarma, there are two main types of therapy.  Shamana are the supportive therapies that include the preparation and post-therapy measures. The main treatment is called shodhana and refers to pancakarma's five main cleansing and elimination procedures. During preparation for panchakarma, internal and external oil therapy (termed snehana in Ayurveda) is the first treatment. Patients are given oil massages—abhyanga is is a rhythmic full-body massage that promotes arterial and lymphatic circulation and drainage that facilitates cleansing, rejuvenation, and deep relaxation. The heated Ayurvedic oils are selected according to one’s dosha and condition, and shirodhara where warm Ayurvedic oil is poured in a gentle stream onto the forehead in specific patterns alleviates stress and related mental  and emotional conditions, is good for brain health and nourishment, and soothing and calming the nervous system, by synchronizing brain waves, stilling the mind, enhancing blood circulation to the brain, nourishing the hair and scalp and aiding in the release of stress and tension, it is energizing yet relaxing. Sweating therapy (swedana ) is another treatment that uses sauna, steam, heated towels, herbal poultices, and exercise, depending upon the person. They are also fed dietary oils to lubricate the digestive tract. This internal oleation therapy may be used for up to a week before the main treatment. Oil enemas are sometimes recommended as well(5).

After cleansing methods are performed, patients go through an important aftercare stage called paschata karma or rasayana therapy. Patients are advised to rest, avoid certain activities, and often receive additional and continued attention and guidance from their Ayurvedic Practitioner, which may include Ayurvedic psychological care and counseling as part of the healing program, as panchakarma strives to cleanse the patient of emotional problems in addition to physical ones. Patients are also educated about preventative practices. Dietary changes are carefully planned, and lifestyle considerations are examined and recommended. Exercise programs, such as yoga , and stress-management techniques, including meditation or yoga nidra , may be introduced to patients during or after panchakarma, and herbal remedies may be recommended as well (5).

Panchakarma treatment can vary in length from a couple days to several weeks. Some clinics offer in-patient services, during which patients are intensively treated around the clock with medical supervision, dietary therapy, exercise, yoga, meditation, massage, and other therapies. Most clinics offer out-patient services, during which panchakarma treatments may take two or more hours per day until completed. Some clinics provide housing arrangements for visiting patients (5).

Patients should be thoroughly assessed and cared for by a qualified Ayurvedic practitioner. Patients should seek panchakarma treatment from reputable clinics with adequate staff and facilities(5).

Precautions
Certain panchakarma methods are not appropriate for specific health problems, and some should not be performed or should be modified for children, pregnant women, and the elderly. Panchakarma treatments should only be administered by qualified and experienced practitioners (5).

ChayaVeda's programs are tailored according to each individual’s constitution, age, condition and specific needs and are a unique, natural, holistic, health-giving series of therapeutic treatments that consist of a balance of cleansing and rejuvenating body therapies that remove deep seated toxins, open the subtle channels of the body and mind and are life-enhancing, improving energy, vitality, inner peace, confidence and well-being.  Chaya’s Ayurvedic Consultation and Health Coaching, assure proper assessment, therapies, education and support life enriching and sustained results.

1 . Journal of Research in Ayurveda, Ayurvedic research and methodology: Present status and future strategies
Ashutosh Chauhan, Deepak Kumar Semwal,1 Satyendra Prasad Mishra,2 and Ruchi Badoni Semwal3
Ayu. 2015 Oct-Dec; 36(4): 364–369.doi:  10.4103/0974-8520.190699
2 . Exploring larger evidence-base for contemporary Ayurveda, Ram Harsh Singh
Int J Ayurveda Res. 2010 Apr-Jun; 1(2): 65–66.
doi:  10.4103/0974-7788.64394,PMCID: PMC2924985,PMID: 20814517
3 . Journal of Ayurveda and Integrative Medicine Volume 8, Issue 1, January–March 2017, Pages 42-44 Effect of panchakarma and Ayurvedic treatment in postpartum rheumatoid arthritis (amavata): A case study Author links open overlay panelShailesh V.DeshpandeaVaishali S.DeshpandebShraddha S.Potdara
4 . Ayurveda and Panchakarma: Measuring the Effects of a Holistic Health Intervention
L. A. Conboy, 1 ,* Ingrid Edshteyn, 1 and Hilary Garivaltis 2 ScientificWorldJournal. 2009; 9: 272–280.
Published online 2009 Apr 27. doi:  10.1100/tsw.2009.35
5 . Gale Encyclopedia of Alternative Medicine
COPYRIGHT 2005 The Gale Group, Inc.