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Definition

Ayurveda is the science of life. The term  "Ayur" means life and "Veda" means science or knowledge. Ayurveda is not merely a system of medicine but a way of life, a science that offers man a means to live his life to the full.
According to Indian philosophy, human life has four purposes, Dharma (perform one's duty), Artha (to amass enough wealth), Kama (to fulfil one's wishes) and Moksha (to attain salvation). To accomplish these four goals one needs perfect health and Ayurveda suggests the ways and means to attain and maintain ideal health and the quality of life

Two Broad Divisions of Ayurveda


 Ayurveda has two components
           1. Swasthavritha (preventive health care)
           2. Athuravritha (therapeutic health care)

Swasthavrithaaims at maintaining health by practising a proper life style designed for the changing seasons and the health status as well as the constitution of the individual. Dinacharya (daily routine) and Rithucharya (seasonal routine) form the basis of Ayurvedic preventive health care. Ayurvedic texts provide comprehensive instructions about the lifestyle to be followed from the birth to death of a human being.

Athuravritha is the part dealing with diseases and their management. Various diseases, their aetiology, prodromal symptoms, signs and symptoms, treatment and prognosis are all described in detail

8 Branches of Ayurveda


The concept of specialization was there in Ayurveda from the early ages onwards. Ayurveda is divided into eight specialities:

Kayachikitsa
Balachikitsa
Grihachikitsa
Urdhwangachikitsa
Salyachikitsa
Vishachikitsa
Rasayanachikitsa
Vajeekaranachikitsa

(Internal medicine)
(Paediatrics)
(Psychiatry)
(Otorhinolaryngology and ophthalmology)
(Surgery)
(Toxicology)
(Rejuvenate therapy)
(Virile therapy)

History and Evolution

The practise of medicine dates back to the primitive man searching for roots and plants that can cure his ailments. Like all ancient healthcare practises, the science of Ayurveda also evolved with the human race. Ayurveda as we perceive now is a compilation of the accumulated knowledge and experiences of generations, refined through extensive discussions which was later documented in a well organised format by established schools of the age. One distinct advantage of Ayurveda is its sound theoretical framework based on Indian philosophy of life which distinguishes it from folk medicine.

The Concept of Divine Origin
Authentic Text Books of Ayurveda
The most authentic books in Ayurveda are Charakasamhitha, Susruthasamhitha, Astangasamgraham and Astangahrudayam. Other significant texts include Kasyapasamhita, Madhavanidanam, Chakradatham, Sargadharasamhita, Bhaishayaratnavali, Bhavaprakasam, Rasaratnasamuchayam and Rasaratnakaram

Through the Centuries the chaotic geopolitical developments and frequent wars and conquests have resulted in the destruction of many of these treasured traditions of natural medicine. But Ayurveda managed to withstand the turmoil and actually benefited from its exposure to other systems of medicine. Social developments like the rise and fall of Buddhism also left its impact on the science. The practise of surgery became extinct as the Buddhist principle of Ahimsa prohibited all procedures which involved blood shedding.
Even during the British rule in India, the patriotic zeal of the people, their leaders and benevolence of the rulers of Princely States initiated the revival of Ayurvedic system of medicine.

Ayurveda in Independent India


After India's independence in 1947, the Central as well as State Governments initiated many programmes to integrate Ayurveda into the mainstream health care system. With the increasing awareness about a more natural way of life and safer healing systems, the popularity of Ayurveda is on the rise over the last two decades. There is lot research going on about the efficacy of herbal medicines all over the world, especially in life style related diseases and degenerative diseases.

Basic Principles of Ayurveda

The philosophical base of Ayurveda is based on two central doctrines- Panchabhuthas (Five Elements) and Tridoshas.
Ancient Indian philosophy postulates that the whole universe is made out of Panchabhuthas (Earth, Water, Fire, Air and Space), so is the human body which is a reflection of the outside world. This concept explains the homology between the human body and its environment.
The physiology of the human body is explained by the Tridosha concept.
Earth + Water  => Kapha
Fire                   => Pitha
Air + Space      => Vatha

The body tries to maintain a dynamic equilibrium of the three forces which are susceptible to changes in the external and internal environment. Doshas are described with the functions that they perform in the human body.

Dathus (Tissues)
Dathus (tissues) explain the body in the Anatomical way. The seven Dathus are as follows:

       Rasa
       Raktha
       Mamsa
       Medus
       Asthi
       Majja
       Suklam

-- the absorbed nutrients from the food
-- blood
-- flesh
-- fat
-- bones
–- bone marrow
–- sperm or the ovum

Ayurveda postulates that the food that is consumed, through the action of Agni (the metabolic fire) gets converted into the Dhatus and thereby nourishes the body. Of these Dhatus, Vatha is related to Asthi, Pitha to Raktha and Kapha to the other five.

Malas (Waste Products)
There are three Malas (Metabolic Wastes)

      Pureesham
      Moothram
      Swedam

(stools)
(urine)
(sweat)

Health is a state of equilibrium of all these entities in the human body and any pronounced deviation from this state of balance is manifested in the form of diseases. Lifestyle, dietary habits and environmental factors can influence this equilibrium.

CONSTITUTION IN AYURVEDA


Prakruthi
Prakruthi implies the particular genetic constitution that determines the physical and mental characteristics of the individual. It is dependent upon the male and female reproductive cells (sperm and ovum) from the parents, the time (time of fertilization and season of the year), food habits and life style of the mother during pregnancy and maternal health.

Types of Prakruthis
Depending upon the predominance of the Doshas in the individual, there are seven Prakruthis:


Vatha
Pitha
Kapha
Vatha Pitha
Vatha Kapha
Sannipathika

(combination of all the three Doshas)

From the physical and mental characteristics of the individual, his / her Prakruthi can be identified. The features of Vatha, Pitha and Kapha Prakruthis are described below.
Characteristics of Vatha, Pitha and Kapha Prakruthis


Physical/ mental Features

Vatha

Pitha

Kapha

Built

Lean and tall

Moderately built

Broad hips and shoulders

Weight

Low

Medium

Heavy

Extremities

Big calf muscles, skinny hands and feet

Palms and soles are coloured like copper

Well formed and solid joints

Strength

Poor

Fair

Good

Pulse

Fast and not rhythmic

Moderate, jumping

Slow and steady

Skin

Dry, rough, dark, lustreless, cold and wrinkled

Soft, fair, pigmented, excessive sweating and body odour

Oily, smooth, shiny

Hair

Dry cracked and curly. Dark brown to black in colour

Brown and scanty. Prone to grey hairs and baldness

Oily, dense and straight. Dark in colour

Teeth

Large, protruding and not in order

Medium size, yellowish

White and large

Eyes

Dry, lustreless, round and not lively. The eyelids partially open while sleeping

Small, brown and sensitive. Few eyelashes

White, clear and moist. Thick eyelashes

Voice/ speech

Fast, interrupted, often irrelevant

Precise, can be aggressive or abusive

Low pitched but loud, speaks less and slow

Physical activity

Restless, gets tired quickly. joints make cracking noise while walking

Hard working, orderly and meticulous

Slow but steady, good stamina

Appetite/ digestion

Unsteady

Strong thirst and hunger

Moderate to low

Bowel movements

Tends to be constipated

Regular to frequent

Regular

Taste / food preference

Sweet, salty or sour. Oily, hot and heavy food

Sweet, bitter and astringent. Heavy and cold food

Bitter, pungent and astringent. Dry, light and hot food

Emotional state

Fearful, anxious, insecure, jealous, unpredictable, shifting loyalties unsteady thoughts and interest

Brave and proud, intelligent, magnanimous, aggressive, irritable, angry and quarrelsome

Calm, logical, agreeable, friendly, stubborn, charitable, forgiving and grateful

 

 

 

 

Habits

Likes music, humour, gambling and hunting

Likes eating and drinking, adventurous and desirous of grandeur

Harbours enmity for long, humble, and perseverant

Sleep

Short, disturbed

Moderate

Deep and long

Dreams

Of roaming in mountains, or moving in the sky

Of fire and lights, bright flowers

Of water bodies, lotuses, birds and clouds

Sexual urge

Frequent

Moderate

High

Life span

Less

Moderate

Long

 

For Vatha Pitha, Vatha Kapha, Pitha Kapha and Sannipathika Prakruthis, the individuals will have a mixture of the above mentioned features.        

Significance of Prakruthi
Determination of Prakruthi helps the physician to make a proper diagnosis and to chart an appropriate treatment programme. But while deciding the treatment schedule, the state of vitiated Doshas is of prime importance. Prakruthi is just one of the ten factors that the physician needs to consider while making a therapeutic decision. Being of a particular Prakruthi is no disease; it is the genetic make up of a person.. Prakruthi cannot be corrected or altered. External application of some oils or consumption of some medicines or health supplements cannot make any change in a person’s Prakruthi.
In the preventive health care aspect Prakruthi is of more significance. Prakruthi can be an indicator of a person’s vulnerability to a particular disorder. Specific daily and seasonal routines and appropriate food habits suitable to the individual form the backbone of Ayurvedic preventive healthcare.

Health


Health according to Ayurveda is a dynamic equilibrium of Doshas, Agni, Dathus and Malas and is a state where the Atma (soul), Indriya (senses) and Manas (mind) are pleasant and joyful. This definition coined some 3000 years back is very much in tune with the current concept of positive health.
Nowadays, health is not merely the absence of disease; it is the functional and/or metabolic efficiency of an organism, at any moment in time, at both the cellular and global levels. It is an organism's ability to efficiently respond to challenges (stressors) and effectively restore and sustain a "state of balance," known as homeostasis.

Preventive Health Care
With the ever increasing cost of healthcare, the world is getting more and more attuned to the concept of preventive healthcare. Ayurveda has a well developed preventive health care concept starting from the moment of conception (or even before that - there are specific procedures to prepare the man and the woman to create an ideal progeny.) till one’s last days. There are proper guidelines for daily routine (Dinacharya) and seasonal routine (Rithucharya)

Dinacharya (Daily Routine)

The daily routine suggested by Ayurveda is in tune with the lifestyle prevalent some 2000 or 3000 years back. So the concepts have to be modified according to the needs of the present day life.
Waking up from sleep- One is expected to wake up in the last three hours of night (from 3 a.m to 6 a.m.). Early hours of the morning are considered the best time for intellectual activities but how to fit it into the modern day professional life is the big question.
Attending to the calls of nature

Oral hygiene
Application of Anjana (medication in the eye for better vision)
Nasyam (Nasal medication) - Two drops of suitable oil (usually Anuthailam, a commonly available Ayurvedic medicine) is applied into both the nostrils.

Gandoosham (Gargling) – with suitable oils or decoctions

Abhyangam (Oil massage) – Oil has to be applied all over the body, especially on the head, ears and the feet. It helps to pacify Vatha and retards the ageing process. Abhyangam enhances vision, promotes growth and induces good sleep.

Vyayamam (Exercise) – Physical activity is highly recommended after the oil application. Persons of Pitha and Vatha constitutions are advised not to over exert themselves.

Snanam (Bath) – The head should be washed in cold water and the body should be washed in warm water. Using warm water for the head adversely affects the health of eyes and hair. Suitable natural materials like green gram powder can be used to wash off the oil from the body completely. Excess use of soaps and shampoos is not advisable.

Annapanaseva (Consumption of food and drinks) – One should take suitable food after making sure that the food from the previous day is completely digested.

Viharam (Activities) – One should engage in his profession or activities in a righteous manner without causing hurt or misery to himself or his fellow beings.
Rithucharya (Seasonal Routine)
Rithucharya is the seasonal lifestyle to be followed by an individual to maintain health. Ayurveda considers man as a part of the universe and so the seasonal and environmental changes will certainly find its reflections in the human body.
There are six Rithus (seasons)

Sisira
Vasantha
Grishma
Varsha
Sharad
Hemanta

Late winter
Spring
Summer
Rains
Autumn
Winter

The Relevance of Rithucharya
The first three seasons form the Adana Kala and the sun takes away the strength of the body in this period. The last three seasons form the Visarga Kala and the body gains strength during this period. The Doshas also undergo various changes along with the seasons with Vatha aggravating in Varsha, Pitha aggravating in Sharad and Kapha aggravating in Vasantha. The routines for the seasons are designed in such a way that all these factors are taken care of. The diet, work schedule as well as rest and sleep patterns should be modified in accordance to the change in the external and the internal environment. There are routines for purifying and rejuvenating the body that are beneficial in preventing the attack of seasonal diseases.

Diet – A Vital Aspect of Health


Diet plays a vital role in maintaining health as well as in curing ailments. The right type of diet according to one’s constitution, age, seasons, profession and life style is of at most importance in preventive healthcare. The same principle is behind the concept of Pathyam (Desirable food and routine) extensively used in Ayurvedic treatments.
According to Ayurveda the human body is a reflection of the universe. The universe as well as the human body is made up of Panchamahabhuthas (Five Basic Elements). The balance of these elements in the body can be maintained by suitable food habits or daily routine.

Rasas
Ayurveda defines six Rasas (Tastes). Even though all the six tastes are present in all substances, some are dominant while others can be hardly detected. The primary taste that the tongue can detect is the Rasa and the secondary taste is the Anurasa. Each Rasa creates a particular response in the human body.
The six tastes are

Madhura
Amla
Lavana
Thiktha
Katu
Kashaya

Sweet
Sour
Salty
Bitter
Pungent
Astringent

Of these, sweet, sour and salty tastes pacify Vatha, bitter, pungent and astringent reduces Kapha and bitter, astringent and sweet reduces Pitha. This classification helps to identify food and drinks that fit the various constitutions and disease conditions.

How to eat and what to eat
According to Ayurveda, seven factors have to be considered while selecting the right food. They are natural property of the food, combination, processing, quantity and source of food, the habitat of the eater, seasons and the mode of consumption. Virudhahara (antagonistic foods) can cause a variety of diseases. The use of milk is not advised along with fish, sour fruits or fermented products. The use of ghee and honey together is also harmful. Heating honey is strictly prohibited and the use of honey with warm water is not appropriate as per Ayurvedic guidelines.
Right eating habits
Ayurveda instructs that before eating one should thank the universe and should feed others (humans and animals depending on him for their survival). Sweet and oily food should be eaten first, sour and spicy food in the middle and bitter and astringent food in the end. This is aimed at maintaining the balance of Doshas that can be disturbed during the process of digestion. Half of the stomach should be filled with solid food, one quarter with liquids and the remaining one quarter should be kept empty. Rice, wheat, barley, grapes, green gram, jaggery, ghee, milk and honey can be used daily. Curd is not advisable for every day use and should not be consumed at night.
Eat right for your constitution
Over eating and irregular and improper eating habits are considered as one of the most important causes of diseases in Ayurveda. Most of the present day life style disorders are due to the metabolic imbalances, overeating and lack of physical activity. There are well thought out diet plans for different seasons and age groups. For example, in winter, one is allowed to eat meat and take alcohol, but in summer, the use of alcohol is not advised. Too much of alcohol and spices are not advised for people of Pitha predominant constitution. Kapha predominant persons are advised not to take too much of fatty and oily stuff as well as non vegetarian food. But they are advised to have enough physical activity to counter the tendency to develop diseases like atherosclerosis, obesity or diabetes. Vatha predominant individuals should include sufficient quantity of oils and ghees as well as meat and fish in their diet and should ensure enough rest and sleep to avoid neurological and musculo-skeletal disorders.


Diagnosis & Treatment


Ayurveda defines health as a dynamic equilibrium of the various forces in the external as well as the internal environment. The changes in the external environment and the life style and the dietary habits of the individual can alter the homeostasis in the internal environment. Genetic predisposition also can influence the body’s response to a stimulus. When the equilibrium of the Doshas, Dathus, Agni and Malas are disturbed or when the Atma, Indriyas or Manas are agitated, Ayurveda defines it as ill health or disease.
Roganirnayam (Diagnosis)
When the equilibrium of the Doshas is vitiated the body will exhibit signs and symptoms that correspond to the imbalance. Ayurveda evaluates this signs and symptoms to reach a diagnosis. Various physical and environmental factors (Ashtasthana Pareeksha & Dasavidha Pareeksha) that should be taken into account for a proper diagnosis are listed out in the texts. Ayurvedic diagnosis is all about identifying the state of vitiation of the Doshas. It has to be specially noted that Prakruthi is just one of the many factors that has to be taken into account while making a diagnosis.

Modern Technology in Diagnosis
Today Ayurvedic Physicians are also using all the modern diagnostic tools and tests. Students of Ayurveda are exposed to the modern practises in clinical medicine in their University life. The popular myth about a traditional Ayurvedic Vaidya making a miraculous diagnosis by just feeling a patient’s pulse is far from the present day reality.

Chikitsa (Treatment)
Chikitsa or treatment in Ayurveda is aimed at bringing the internal environment back to equilibrium. Ayurveda states that most of the disorders are due to the impairment of Agni (Metabolic fire) and great importance is given to normalising the Agni. Use of medicines both internal and external and life style changes are advised for the patients to bring the Doshas back to equilibrium.

Two major divisions of Chikitsa
In the human body to disturb the equilibrium there are only two possibilities. One is shortage and the other is excess. So the treatment procedures also can be generally classified into two – one to refill the shortage and the other to remove the excess. Santharpana (Brumhana) is nourishing therapy to manage the shortage and Apatharpana (Langhana) is depleting therapy to handle the excess.

Santharpana (Brumhana)
Brumhana is ideal for Vatha predominant constitutions, children and the aged and for individuals who are emaciated by diseases, medicines, exertion and stress. The treatments are mainly nourishing and regenerating. It increases the Kapha in the body and helps to gain weight and strength. Brumhana is achieved by the use of milk, meat, ghee, sugar, honey, medicines and treatment procedures like oil massages and enema. Rest, sleep and peace of mind form part of the nourishing therapies. Rasayanachikitsa (Rejuvenative treatment) also is a part of Brumhana.
Apatharpana (Langhana)
Langhana increases the Vatha and decreases the Kapha. It is of two types:  

Sodhana (Purification Therapy)
Samana (Palliative or Pacifying Therapy)

 Sodhana
Sodhana is employed when there is a pronounce imbalance of Doshas in the body that that has to be eliminated. There are five evacuative procedures commonly called Panchakarmas.

Vasthi
Vamana
Virechana
Nasya
Asra Visruthi

(Therapeutic Enema)
(Therapeutic Emesis)
(Therapeutic Purgation)
(Nasal Medication)
(Blood letting)

Before the Panchakarmas are employed, there are preparatory procedures called Poorvakarmas. They include intake of medicated ghee or oil, external oil applications and massages, sudation processes and specific diets and lifestyle. After the purification procedures, the individual should follow a routine that allows the body enough time to recuperate from the illness.
Samana

Samana is aimed at bringing back the disturbed Doshas back to normal. The strategy here is to help the body to regain the equilibrium by enhancing its own metabolic activities.
Samana therapy is of 7 types:


       Deepana
       Pachana
       Kshuth
       Thrit
       Vyayama
       Atapa
       Marutha

Use of digestive drugs
Use of carminative drugs
Fasting
Creating thirst
Exercise
Exposure to sun
Exposure to wind

Salient features of Ayurvedic Treatments
Ayurveda looks at a patient as a human being, not as a “case”. The psychological and emotional aspects of ill health are also taken into account while treating a patient. The purpose of the therapy is to eliminate the root cause of the disease and not to silence the symptoms. The science has immense opportunities for personalisation of the treatment procedures. Ayurvedic medicines being milder and of natural origin are free of side effects (if used under proper medical guidance) and are ideal for long term use in chronic ailments. In metabolic and degenerative diseases and in preventive health care, Ayurveda has tremendous possibilities.

Dosage Forms
Bhaishajyakalpana


Bhaishajyakalpana means the preparation of medicinal products. It involves the identification, selection, preservation, standardisation, preparation and dispensing of medicines. According to Charakamhitha, the ideal drug should have the following qualities:

 

 

 

       · Effective even in smaller doses
       · Can correct even a major imbalance in Doshas
       · Easy to digest and assimilate
       · Palatable
       · With proper physical qualities like smell, colour, taste & consistency
       · Without adverse effects

Evolution of Ayurvedic Pharmacy
Man was using medicines to cure his ailments from pre-historic times onwards. Before the invention of fire, he was either eating the herbs as such or was using pastes or juices. Once man mastered fire, decoctions and other dosage forms slowly evolved. The basic purpose was to convert the medicinal content in the herbs to forms that are easy to consume and absorb. Preserving the drugs for seasons where they were not available also was a major concern for the ancient man.
Sarngadharasamhita written in the 13th century is considered as one of the most authentic text books in Ayurveda pharmacy. Other than the mechanisation and sophistication that happened with the use of modern technology, the basic practises of Ayurvedic pharmacy remains almost the same. New dosage forms like Kashayam Tablets (Decoctions in Tablet form), extracts and capsules have been added to the repertoire recently.

Dosage forms of Classical Ayurveda
There are seven commonly used dosage forms in classical Ayurveda.

Kashaya
Asava & Arishta
Arka
Rasakriya
Gutika
Bhasma
 Sneha

(Aqueous extract)
(Fermented liquid)
(Distillate)
(Concentrated fluid)
(Tablet & Pill)
(Incinerated powder)
(Oil & Ghee)

Kashaya Kalpana
There are 5 dosage forms mentioned under this Kalpana.

Swarasam
Kalkam
Kwadham
Himam
Phandam

Freshly expressed juice of the herb
Ground paste of herbs
Aqueous extract of herbs
Cold infusion
Hot infusion

Asavas & Arishtas
They are fermented liquids prepared by keeping drugs in aqueous extracts or juices mixed with jaggery or sugar for a specific period of time. Fermentation results in the formation of alcohol which serves as a medium of extraction as well as a preservative.

Arka
This is a suspension of the distillate in water. Herbs are soaked in water for specified periods and are distilled using a distillation apparatus to produce Arka.

Rasakriya
They are semisolid preparations made by concentrating the herbal extracts by adding jaggery or sugar, powdered medicines and ghee or honey. Lehyam (marmalade like preparation), Netranjanam (for external application in the eyes) and Vatakam (drier semisolids) are some of the commonly used Rasakriyas.
Gutika
Gutikas are tablets or pills made out of finely powdered medicines that are later on rolled or punched into the desired form. Other than the powdered herbs, liquids (decoctions or juices), jaggery or Guggulu is used as a binder in making Gulikas.

Bhasma
Bhasma is powder prepared by incinerating the medicines in special furnaces. Bhasmas are the preferred dosage form in treatment methods using metals and minerals.
Snehas are preparations in an oil or ghee base. Ghees and oils can be used for internal as well as external applications and are essential for Panchakarma. Medicines are added as decoctions, juices, pastes or powders and boiled with ghee or oil so that the active medicinal ingredients are transferred into the medium and filtered off at the prescribed time. For preparing Ghees, the ghee made out of cow’s milk is the preferred medium. Sometimes ghee from goat’s milk is also used. For preparing Oils, sesame oil, coconut oil or castor oil are used as the medium depending on the formulation.

Other Dosage Forms
Mamsarasam, Yoosham, Mandham, Ksheerapakam, Pramadhya, Panakam, Lavanakalpam, Ksharakalpam, Satwam, Varthi, Lepam, etc. are other dosage forms suggested in Ayurveda.

Modern Dosage Forms
Kashayam Tablets
One of the major drawbacks associated with Ayurveda was the poor palatability, especially of Kashayams. The concept of Kashayam Tablets introduced by Arya Vaidya Nilayam is a glowing example of modern technology enriching an age old science. Kashayams are further concentrated and dried to remove the water content and the resultant solid medicinal content is punched into tablet form. Methods to ensure the solubility and consistency of the tablets are employed in the manufacturing process. This technique also helps to reduce the use of preservatives to a great extend. The new dosage form was widely appreciated by the scientific community and at present most of the classical Ayurvedic Kashayams are also available in the Tablet form. By employing the latest packing technologies, the shelf life of the preparations have also been greatly improved.

Capsules
The use of capsules has become very popular in the Ayurvedic medicine manufacturing industry. Hard capsules are used for powders and soft / flexible capsules are used for liquids and semi-solids. Capsules help to mask the unpleasant smell and taste of medicines and are easy to swallow.

Liniments, Ointments and Creams
Ayurvedic liniments and ointments for relieving pain and inflammations are widely available. The wisdom of Ayurveda has been successfully employed in the development of cosmetic products, especially for skin and hair care.
Other Dosage Forms
Nowadays Ayurvedic medicines are available as syrups, granules or emulsions. Ayurvedic food and nutritional supplements are also becoming increasingly popular.

Therapeutic Procedures


Ayurveda gives equal importance to the internal and external application of medicines. Internal medicines are used for Samana and Brumhana or Rasayana and for preparing the body for Sodhana by Snehapana (intake of large quantities of medicated Ghee or Oil). Medicines (predominantly medicated Oils) are applied externally as Poorvakarma (preparation for Sodhana) and for Brumhana or Rasayana. The treatment procedures can be effectively utilized in preventive health care also.
Poorvakarma
Before attempting to drain the vitiated Doshas out of the body, therapeutic measures to bring the Doshas to the suitable excretory pathways have to be undertaken. These preliminary procedures are called Poorvakarmas. Intake of medicated Ghee or Oil and external application of medicated Oils and sudation procedures form part of Poorvakarmas.

Snehapana
The intake of medicated Ghee or Oil orally is called Snehapana. The choice of the medicine and the duration of the procedure depend on the patient and the state of the disease. The quantity of intake is increased daily till the patient develops Samyaksnigdhalakshana (signs of proper Snehana). In healthy individuals also Snehapana can be conducted as part of preventive healthcare programmes.

Abhyanga
Abhyanga is the external application of oil and subsequent massage all over the body. Oils for the massage are selected based on the patient's age and health and the disease involved. Abhyanga is advised as part of Dinacharya in healthy individuals also as it helps to retard the ageing process. Massages can be very effective in stress relief and insomnia.
Swedana
Ayurveda advices sudation process after oil application. With the coating of oil on the skin, body heat is retained and with the application of steam or other suitable modes of external heat there is profuse sweating. This procedure of inducing increased sweating is called Swedana. It can be used as a preparatory procedure for Sodhana.

Pizhichil
This is combination of Snehana and Swedana. Warm oil is poured continuously all over the body followed by a massaging stroke. Pizhichil is employed in neurological, musculo-skeletal and degenerative diseases. The choice of oil varies according to the patient and the disease.

Sirodhara
Sirodhara is one of the most popular Ayurvedic treatments. This is the streamlined pouring of lukewarm oil over the forehead with the patient lying on his back on the massage table. Sirodhara is very effective in relieving stress and anxiety.

Kizhi
Kizhi means a small bag of medicines. The medicines (herbs, powders, etc. depending on the purpose) are tied in a cotton cloth and are dipped in warm oil and are used to massage the body. This treatment can be applied all over the body or on any specific part. Kizhis are effective in Vatha predominant disorders. Njvarakizhi, using a special variety of rice is a variant of Kizhi used in musculoskeletal and degenerative diseases.

Kativasthi
This is a treatment for low back problems. Warm oil is retained on the lower back within a structure made of flour for a stipulated period of time. The patient will be lying on his belly during the treatment.

Ksheeradhooma
Steam produced by boiling milk with suitable medicines is applied to the affected area. Ksheeradhooma is useful in cases of paralysis, especially of the face.

Sirovasthi
Medicated oil is retained on the head for a prescribed period by using a special hat made for the purpose. This process is called Sirovasthi. It can be used effectively in neurological and psychological disorders.

Akshitharpana
This is a procedure where medicated lukewarm Ghee is retained over the eyes for a specific period of time. Tharpana is effective in a variety of eye diseases.

Udwarthana
Massage with warm herbal powders is called Udwarthana. This is effective in disorders due to increased Kapha and Medus like obesity.

Panchakarma
There are five therapeutic procedures in Ayurveda that are suggested for the evacuation of morbid Doshas from the body. They are collectively termed as Panchakarmas. These procedures can be utilized also for Samana and Brumhana and are an integral part of Ayurvedic preventive health care programmes. All these treatments require elaborate Poorvakarmas (preparatory procedures) and Paschatkarmas (specific lifestyle and dietary regimen to regain optimum health).

Vamana
Vamana is the procedure of evacuating the vitiated DoshasM, especially Kapha through the oral route by inducing vomiting. The patient is prepared for the procedure with Snehana and Swedana and after Vamana is advised to follow a specific dietary and lifestyle pattern to regain normal health.

Virechana
Elimination of morbid Doshas, especially Pitha from the lower gastrointestinal tract by inducing purgation is called Virechana. The patient has to undergo the Poorvakarmas and on the day of Virechana has to take the selected medicine through the oral route. The medicine induces purgation and after the procedure the patient is advised to follow a restricted diet and to rest before returning to the normal routine.

Vasthi
The administration of liquid medicine through rectal, urethral or vaginal route is commonly referred to as Vasthi. Therapeutic enema through the rectal route can be used for Sodhana, Samana or Brumhana, the effect varies with the ingredients involved. It is the ideal treatment for vitiated Vatha and is considered superior to other purification procedures. Vasthi can be used in a wide range of diseases, it is effective and easy to administer and is well tolerated by the patients. Vasthi where the ingredients are predominantly decoctions is called Asthapana and where the ingredients are mainly oils are called Anuvasana. In Charakasamhitha, these two are mentioned as two separate procedures in the list of Panchakarmas omitting Rakthamokshana (blood letting) from the list.  

Nasya
The procedure of introducing the medicines through the nasal route is called Nasya. Medicated oils, herbal juices or powders can be used for Nasya. It is predominantly used to treat ailments related to the head. In preventive health care also nasal administration of medicated oils is indicated in a lesser dose on a daily basis. Nasya can induce Sodhana, Sthambhana, Samana or Brumhana according to the medicines used.

Rakthamokshana
Process of inducing controlled bleeding from a particular part of the body is called Rakthamokshana. This can be achieved by making a cut on a blood vessel or by making many smaller punctures on the skin in a limited area. Bloodletting by using leech is also a preferred method.