Purva-karma and Pradana-karma in Ayurveda


Purva karma

We have seen in the last article that one way of classifying Ayurvedic treatment is purva-karma (pre-procedures), panch-karma (five important procedures) also known as pradhan-karma (main procedures) and pashchat-karma (follow-up treatment). Amongst these three procedures, purva-karma includes snehan (olation therapy) and swedan (fomentation therapy).

Ayurveda believes that the cause of chronic diseases is deep rooted faults in the dosha (basic body elements)-dhatu (body tissues)-mala (waste products) system of the body and a diseased person needs one or more panch-karma to cleanse the body so as to achieve a status of health again. Nonetheless, the desired effect of panch-karma can be achieved only after proper purva-karma i.e. preparation of the body to receive panch-karma or pradhan-karma.

Purva-karma is done by snehan and swedan under the supervision of an Ayurvedic therapist. In scheduled treatment, snehan is followed by swedan.

Snehan: This can be done in two ways:

Internal snehan:

In this type of snehan, sidhdha ghrut (medicated clarified butter) or sidhdha taila (medicated edible oil) is given by oral route in the dose recommended by the Ayurvedic therapist. This ghee (ghrut) or oil is called sneha. It works as a lubricant to the body system. Snehan helps in reducing dryness. It enters the dhatu (body tissues) and strotasa (body passages). This ultimately helps in driving impurities out of the body during panch-karma. Snehan mobilizes unwanted stuff lodged in the body and adds to the results of panch-karma. Elimination of ama (toxins) becomes easy if purva-karma is carried out properly, which can otherwise be a difficult task. Ghee (ghrut) prepared from cow milk is the best according to Ayurvedic scholars.
External snehan:
This comprises all kinds of partial and total body massage done with the help of sneha in a guided manner. Sidhdha ghrut or sidhdha taila is applied to the skin. Our skin, being a semi permeable membrane, accepts some amount of sneha. A chartered program of body massage for 1, 3, 7 or more days as needed, is executed to achieve the desired level of snehan. Lustrous skin is a marker of external snehan. This type of snehan is beneficial for skin problems, for body wasting, for prolonged bed ridden conditions, etc.
Swedan: This is generally executed after snehan. Swedan means dry or wet fomentation or heat therapy. Different types of fomentations are possible. These include taking a sunbath, sitting in a specially prepared wooden sweat box, pouring warm water on the body, sitting in a bath tub or taking a steam bath. Variations like swedan for the whole body (below the neck), for the diseased part of the body (e.g. only extremities), sitz’s bath (for perineal region) can be used according to the need of the patient.

Many kinds of warm solids like cloth, sand bags, heat pads and liquids like warm water, water with milk, herbal decoctions and medicated oil can be used for fomentation. Here too, the decision of the Ayurvedic therapist is essential.

To summarize, snehan and swedan are purva-karma (pre-procedures) which help in liquefying the accumulated ama (toxins), in cooling the irritated dosha (basic body elements), in opening the blocked strotasa (body channels) and in lubricating the passages of mala (waste products). Effective purva-karma adds to the results of the panch-karma or pradhan-karma.

There are two main things required by purva karma, namely:

Snehana (oleation)

The literal meaning of this term is to make smooth or to oleate. It is the main purva karma procedure and is a specific treatment for vatic disorders.

Example: oily preparations, ghee, oils, fats etc.

Following are the indications of snehana:
Sexual exhaustion
Dryness of the body
Snehana is also given to the patients of vimana and virecana.

The procedure followed involves the administration of oily preparations within fifteen to thirty minutes after sunrise. The quantity, duration and the type of preparation is pre decided and certain dietary restrictions are prerequisite. Warm, well-regulated liquid diet is preferred but one with stickiness or oleaginous is incompatible. The following signs will indicate the effectiveness of the remedy:

Accelerated digestive power
Intolerance to fat
Loose motions
Lightness of the body
Smoothness of the body
Passage of flatus
Visible fat in the stool
After the treatment patients are advised to abstain from sexual activities, to use of warm water; sleeping only at night; avoiding anger, anxiety or loud talk.

Swedana (fomentation)

This refers to the remedy that involves practices involving heat to make the patient sweat. Following are the conditions for which swedana is given to patients:
On the second day of swedana, vamana is given and virecana after three days` interval. In case there is a need to give basti, nasya, rakta mokasana to the patients then they are given immediately after swedana.
The following signs prove the effectiveness of the therapy:
Disappearance of corrhyza
Relief from pain and stiffness
Remission of the disease
After the remedy the patients are advised to avoid cold water and take a nap after a light meal


Vamana Karma

This term literally means to expel the vitiated doshas through the oral route and is the pradhan karma of the panchakarma therapy. Vamana or the expelled material may consist of undigested food, kapha, and pitta.

Vamana karma is a specific therapy for kaphaja disorders and following are the indications of vamana:
Nasal discharge
Acute fever
Sore throat
A variety of vamana drugs are used induce purva karma before vamana as they are suitable in mobilizing the doshas.

Following indicates the effectiveness of vaman: ·
Maximum elimination of doshas with minimal dose
Minimization of the disease
Absence of complications
Pleasant taste smells and colors
After vamana the loud speech, overeating, continued sitting, too much walking, anger, anxiety, coitus, retention of natural urges should be avoided.

Virechana Karma

Literally meaning the expulsion of doshas through the anal passage, virechana is the specific therapy for pitta dosha disorders. Under the panchkarma therapy virechana karma is the next pradhan karma.

Virechana expels pitta from the amashaya (stomach and upper part of the small intestine) and is neither stressful nor painful and is the easiest procedure, usually unaccompanied by any complication. Following are the indications for virechana: ·
Skin diseases
Splenetic disorders
Abdominal swellings
Jaundice gout
Gastrointestinal disorders
After virechana karma it is advisable to the patient to take plenty of rest and light diet.

Basti Karma

The term basti has been derived from the fact that the Basti yantra (apparatus) used for introducing medicated materials is made up of Basti or animals' urinary bladder. Basti is among the major panchkarma procedures and is used to cure vatic disorders. This remedy is applied to restore the balance of the doshas and has the following effects also:
Increases weight in emaciated people
Decreases weight in the obese
Improves vision
Prevents aging
Brings back luster and strength
For health and longevity
The Basti procedure that is applied through the anus may be Niruha basti.That consists of the use of decoction of appropriate drugs Following are the indications for Niruha Basti:
Retention of flatus
Retention of urine
Retention of stools
Loss of strength
Dosha deficiency
Splenetic diseases
Abdominal swelling and pain
Anuvasana basti
In which oily substances are used. Following are the indications for Anuvasana basti:
Increased appetite
Increase of vata dosha
Following indicates the effectiveness of adequate basti:
Proper passage of wind and urine
Proper balance of doshas
Feeling of lightness in the body
Pleasant feeling
Increased appetite and strength
After the remedy of basti the patient must take light diet along with the following activities that are to be avoided after basti, such as:
Sitting for a long duration
Standing for it long duration
Excessive talking
Sleeping during the day
Sexual relationship

Sirovirechana Karma

Also known as nasaya it is generally the last step in pradhanakarma of the panchkarma therapy. This refers to the applications of medicines or medicated oils administered through the nasal passage spread throughout the head-and its constituent parts and influence all the doshas and the diseases situated in these parts.

It is referred to as the best and the most specific procedure for diseases related to head (shiro- roga).

Nasya karma prevents the diseases of the eyes, ears, throat, oral cavity and improves the speech, delays aging; and bestows a pleasant oral smell.

Following are the indications for the use of shirovirechana:
Stiff neck stiff jaw
Chronic corrhyza
Shoulder ache
Hoarseness of voice
Alteration of voice
Following are the four types of nasya procedures that can be administered:
Navana nasya
It refers to the instilling of the drops of medicated oil in the nose.

Auapida nasya

It refers to the instilling of the juice (extract) of a drug through the nasal passages.

Dhamapana nasya and Pradhdmana nasya
It refers to the inhalation of fine powder (if drugs in the nasal passages with the help of a nadi- yantra. In Dhumanasya medicated fumes are inhaled through the nasal passages and are eliminated through the oral route.

During the nasya procedure, the head should not be excessively flexed or bent, and the patient should be supine.
The patient must avoid following things:
Clearing his throat
Following indicates the effectiveness of adequate nasya:
Lightness of the body
Good sleep
Lightness of the head
Feeling of pleasure
After the remedy of nasya the patient should avoid cold water, oil, ghee, alcohol, head bath and inhalation of dust and fumes.