Differential diagnosis based on nidana

Differential diagnosis based on saṃprāpti ghaṭaka

Differential diagnosis based on sthĀna

Differential diagnosis based on rūpa

Differential diagnosis based on modern aspect

AREAS OF RESEARCH IN PAÑCAKARMA

Āyurveda and Pañcakarma is gaining worldwide popularity now a days. Even though Āyurveda is a time-tested medicine still there is need of systematized scientific research. It can be conducted at Government and Private Āyurveda Colleges for PG, PhD levels, Government Research Institutes like CCRAS and its peripheral institutes like NARIP and other NGO’s.

The CCRAS has been executing its research programmes with a network of 30 peripheral Institutes/centres/units with the headquarters office at Delhi responsible for control, monitoring and supervision.

The broad areas of Research comprise:

• Clinical Research
• Fundamental Research
• Pharmacology Research (Pre clinical Safety/Toxicity and Biological Activity Studies)
• Medicinal Plant Research (Medico-Ethno Botanical survey, Cultivation, Pharmacognosy) Drug standardization Research
• Literary Research & Documentation [i]

There are lots of area in Pañcakarma where research can be conducted. The National Āyurveda Research Institute for Pañcakarma, Cheruthuruthy, Kerala was started on 21st June, 1971 and has over the years grown tremendously in terms of infrastructural facilitates and the number of patients who are being treated, both in OPD and IPD.

AREAS OF RESEARCH IN SNEHANA

These are some of the areas where research can be conducted.

1. Research on Śodhanārtha – Śamanārtha and Bṛṃhaṇa Sneha
2. Research on Pravicāraṇa Sneha
3. Research on Śodhanāṅga Sneha on Lipid Profile
4. Research on Caturvidha Sneha and its effect on body
5. Vardhamāna Sneha Mātrā
6. Standardization of Sneha Mātrā in different Snehapāna
7. Effect of Medicated and Non-Medicated Ghee
8. Sadyo Snehana
9. Agni and Koṣṭha Parīkṣā before Snehapāna
10. Mode of action of Snehapāna
11. Research on Avapīḍaka Snehapāna and its effect in diseases
12. Research on Uttarabhaktika Snehapāna and its effect in diseases
13. Sneha Pāka and its role in various treatments.
14. Effect of various Anupānas in Snehapāna
15. Assessment of Sneha Jīryamāna and Jīrṇa Lakṣaṇas
16. Assessment of Samyak – Ayoga and Atiyoga Lakṣaṇas
17. Procedural Standardization of different Mūrdhataila
18. Procedural Standardization of different Bāhya Basti
19. Śirodhārā with various Dravyas
20. Bāhya Basti and its effect in various diseases
21. Modifications in materials used in various Bāhya Basti
22. Procedural Standardization of various Bāhya Basti

AREAS OF RESEARCH IN SVEDANA

These are some of the areas where research can be conducted.

1. Carakokta Trayodaśa Sveda and its modifications
2. Caturvidha Sveda and its modifications
3. Niragni Svedas
4. Mode of action of Svedana
5. Samyak – Ayoga and Atiyoga Lakṣaṇas of Svedana
6. Effect of various Piṇḍa Svedas on the body in different diseases
7. Effect of Kāyaseka on the body in different diseases
8. Effect of Kāyaseka with different Dravya on the body in different diseases
9. Modern techniques of Svedana / Steam Bath
10. Effect of Dhānyāmla Dhārā in different diseases
11. Svedana for Bāla
12. Different types of Thermotherapies and Svedana
13. Procedural Standardization of different Bāhya Basti
14. Procedural Standardization of different Piṇḍa Sveda
15. Procedural Standardization of different Dhārā
16. Effect of Svedana on different body parameters.

AREAS OF RESEARCH IN VAMANA

These are some of the areas where research can be conducted.

1. Standardization on the dose of Vāmaka Yogas in Kalpa Sthāna
2. Vamana with different Vāmaka Yogas told in Kalpa Sthāna
3. Sadyo Vamana Procedure
4. Sneha Pūrvaka Vamana and Sadyo Vamana
5. Various Vamanopaga Dravyas
6. Assessment of Vegikī Śuddhi
7. Assessment of Mānikī Śuddhi
8. Assessment of Āntikī Śuddhi
9. Assessment of Laiṅgikī Śuddhi
10. Pittāntha Vamana and its analysis
11. Samyak – Ayoga and Atiyoga Lakṣaṇas of Vamana
12. Effect of Vamana in various diseases
13. Comparative study of Vamana and Virecana in various diseases.
14. Mode of action of Vamana
15. Effect of Vamana on various body and laboratory parameters.
16. Study of different type of unique Vāmaka Yogas in Kalpa Sthāna
17. Standardization of Vamana Karma
18. Saṃsarjana Krama according to Śuddhi

AREAS OF RESEARCH IN VIRECANA

These are some of the areas where research can be conducted.

1. Standardization on the dose of Virecana Yogas in Kalpa Sthāna
2. Virecana with different Virecana Yogas told in Kalpa Sthāna
3. Sneha Pūrvaka Virecana and Sadyo Virecana
4. Various Virecana Dravyas
5. Assessment of Vegikī Śuddhi
6. Assessment of Mānikī Śuddhi
7. Assessment of Āntikī Śuddhi
8. Assessment of Laiṅgikī Śuddhi
9. Kaphānta Virecana and its analysis
10. Samyak – Ayoga and Atiyoga Lakṣaṇas of Virecana
11. Effect of Virecana in various diseases
12. Comparative study of Vamana and Virecana in various diseases.
13. Mode of action of Virecana
14. Effect of Virecana on various biochemical and haematological parameters.
15. Study of different type of unique Virecana Yogas in Kalpa Sthāna
16. Standardization of Virecana Karma
17. Standardization of Virecaka Yogas w.s.r to Koṣṭha
18. Standardization of Anulomana – Sraṃsana – Bhedana – Virecana
19. Saṃsarjana Krama w.s.r to Śuddhi
20. Ṛtu Trivṛt Yogas
21. Śodhana Vyāpat

AREAS OF RESEARCH IN BASTI

These are some of the areas where research can be conducted.

1. Standardization of Basti Procedures
2. Standardization of dose of Nirūha and Anuvāsana Basti
3. Pharmacokinetics of Nirūha Basti
4. Pharmacokinetics of Anuvāsana Basti
5. Effect of Basti on Biochemical and Haematological Parameters
6. Mode of action of Basti
7. Samyak – Ayoga and Atiyoga Lakṣaṇas of Nirūha Basti
8. Samyak – Ayoga and Atiyoga Lakṣaṇas of Anuvāsana Basti
9. Effect of different kinds of Basti in various diseases
10. Standardization of the dose of Mātrā Basti
11. Standardization of the dose of Anuvāsana Basti
12. Standardization of the dose of Nirūha Basti
13. Anuvāsana Basti in Ārohaṇa Krama Mātrā
14. Mātrā Basti  and Snehapāna
15. Karma – Kāla – Yoga Basti Krama
16. Different kinds of unique Basti Yogas in various Saṃhitās
17. Traditional and modified Basti Netra and Basti  Puṭaka
18. Basti Netra and Basti  Puṭaka Doṣas
19. Standardization of Basti in new modifications
20. Assessment of Basti Pratyāgamana Kāla on various parameters
21. Parihāra Kāla in Basti
22. Standardization of Basti Netra measurements according to age.
23. Standardization of Basti dose according to age
24. Uttara Basti and Catheterization
25. Standardization of Uttara Basti in Male
26. Standardization of Uttara Basti in Feale
27. Mode of action of Basti
28. Basti Vyāpat
29. Caturbhadra Kalpa Basti
30. Cūrṇa Basti
31. Comparative study of various Basti Yogas in different diseases
32. Mode of action of Basti
33. Yāpana Basti
34. Modifications of Basti Netra and Basti  Puṭaka in present day
35. Procedural Standardization of Basti

AREAS OF RESEARCH IN NASYA

These are some of the areas where research can be conducted.

1. Standardization of different Nasya
2. Dose of Nasya in present day measurements
3. Nasya with Āvartita Taila and regular Taila
4. Sneha Pāka and Nasya
5. Different Sneha Dravyas for Nasya
6. Samyak – Ayoga and Atiyoga Lakṣaṇas of different Nasya
7. Mode of action of different Nasya
8. Modifications in different Nasya
9. Nasya Vyāpat
10. Paścāt Karma in Nasya
11. Different types of Nasya and Medicines used for the same.

AREAS OF RESEARCH IN RAKTAMOKSHA

These are some of the areas where research can be conducted.

1. Different types of Jalaukā
2. Jalaukā Saṅgrahaṇa and Saṃrakṣaṇa
3. Procedural Standardization of Jalaukāvacaraṇa
4. Procedural Standardization of Pracchāna
5. Procedural Standardization of different areas of Sirāvyadha
6. Procedural Standardization of Śrṛṅga Avacaraṇa
7. Procedural Standardization of Alābu Avacaraṇa
8. Cupping Therapy
9. Assessment of various haematological and bio chemical parameters during Raktamokṣaṇa
10. Assessment of Water and Electrolyte Imbalances, Shock etc.
11. Assessment of different Raktamokṣaṇa in various diseases

SCOPE OF RESEARCH IN STANDARDIZATION OF PAÑCAKARMA PROCEDURES

There is a good research article by Dr. Devi. R on this topic[ii]. The findings of the same are explained below.

STANDARDIZATION OF CONCEPT BEHIND DESIGNING OF A PAÑCAKARMA PROTOCOL

The accumulated cellular toxins (Āma) have the characteristic property of Picchilatva (stickiness). So, the first step needed to bring it into the alimentary canal is nothing other than its liquefaction and increasing its volume (Abhiṣyandana) which is done by a procedure called “Snehapāna” in which medicated/non-medicated ghee/oil/ fat is given orally in a systematically increasing dose under controlled conditions for maximum upto 7-9 days or upto the development of Samyak Snigdha Lakṣaṇa (symptomatology of proper oleation). After making liquefaction of cellular waste through Snehapāna, next step is Svedana (sudation) by which these liquifacted wastes will be directed towards alimentary canal. When these cellular waste reaches alimentary canal, it can be expelled out as per the proximity by Vamana (vomiting) therapy or Virecana (purgation) therapy. If the patient’s age or health status is not suitable for Snehapāna or Svedana therapy, alternative methods like Abhyaṅga (Bāhya Snehana), Piṇḍa Svedas (Poṭalī sudation) etc can be opted.

After proper administration of  Pūrvakarma procedures, according to the proximity and location of Doṣa, Vamana therapy (emesis) or Virecana therapy (purgation) can be planned. Usually, enema therapy (Basti ) is doing after the initial level of purification or can be done prior under specific medical indications and some emergency conditions. In the case of Doṣa localized on head and neck, Nasya therapy (nasal administration of medicine) is beneficial.

This concept behind the designing of a Pañcakarma protocol should be standardized.

STANDARDIZATION OF PŪRAKARMA PROCEDURES

(I) Standardization of medicine (Oil/Ghee/ Poṭalī ):

The criteria behind the selection of which type of Snehana and Svedana method needed to be administered in a given patient can be designed by following the steps of Daśavidha Parīkṣā.

(ii) Standardization of methodology of preparation:

As far as Poṭalī / Piṇḍa Sveda are concerned, its ingredients, quantity of each ingredient and method of preparation should be standardized. As per patient’s health status, quantity of each ingredient can be scientifically altered.

For example, if the patient has more Kapha Doṣa symptoms like swelling, quantity of coconut scrapings inside Patra Piṇḍa Sveda can be reduced and quantity of lemon which is anti-inflammatory can be increased. The order of steps of preparation of Poṭalī Sveda should be also standardized.

(iii) Standardization of administration of procedure:

The methodology in which a procedure is administered should be standardized and validated or in other words, validation of Standard Operative Procedure (SOP) should be done for Snehapāna, Abhyaṅga, Piṇḍa Sveda or any Pūrvakarma procedure.

(iv)Standardization of Samyak Lakṣaṇa (symptomatologies) or development and validation of tool to assess the procedure:

Development of proforma can be done under the following steps:

1. Compilation of symptomatologies

Should be collected meticulously from all the available classical literature.

1. Item analysis:

Which include reduction of symptoms which are similar words and similar meanings. Each and every collected symptom should be analysed by its root word, meaning, implication etc by thorough analysis and those symptoms having same meaning should be reduced

and only one should be selected.

1. Literature review:

Current available research works and publications should be thoroughly analysed to look for any other additional symptoms noticed during the performance of the procedure.

1. Clinical observation:

With this developed pro forma, the researcher has to go to the Pañcakarma theatre for observation of these symptoms in patients.

1. Finalization:

As per the degree of clinical observation, finalization of pro forma should be made.

This developed pro forma should be subjected to different stages of validation like face validity, content validity by subject experts, construct validity and criterion validity which involve the comparison of developed pro forma with available gold standard.

STANDARDIZATION OF PRADHāna KARMA PROCEDURES

Vamana Karma

Vamana therapy is nothing other than medically induced vomiting by consumption of prescribed drug which involve the stimulation of Chemoreceptor Trigger Zone (CTZ), solitary tract nucleus and finally the vomiting centre medulla oblongata which stimulate phrenic nerve, vagus nerve and intercostal nerves to induce vomiting. The medicine used, collection and processing of Vamana medicine, its dosage, Anupāna should be standardized along with the standardized implementation of Vamana protocol and patient regimen.

Virecana Karma

As far as Virecana therapy is concerned, prior diet, level of Virecana needed in the particular disease, procedure of Virecana as a whole, tool to assess Samyak Virecana Lakṣaṇa in a particular disease, time of administration of Virecana medicine etc need standardization. Level

of Virecana needed, whether it is Anulomana or Sraṃsana or a Bhedana Karma, depends on several criteria including strength of  Doṣa vitiation, Rogi Bala etc. For example, in Pakṣāghāta (hemiplegia), only Anulomana is indicated whereas in Kuṣṭha, due to Bahudoṣāvasthā (huge vitiation of Doṣa), classical Virecana is needed.

Basti  Karma

Include both Nirūha Basti (enema with medicated Kvātha) and Anuvāsana (enema with medicated oil). It can be done as scientifically designed packages like Kāla Basti , Yoga Basti  etc or can be done alone in specific conditions like Āmavāta (vaiswanara Cūrṇa Basti ). The criteria for going into packages or doing it alone need standardization. Standardization of Basti  procedure also involve standardization of Pīḍana Kāla (pressing time of Basti bag), standardization of procedure of mixing of Basti  Dravya, positioning of patient, diet during Basti, time of administration of Basti  etc.

Nasya Karma

Modern research works point out to the existence of naso-brain pathway which is the fastest promising drug delivery route. To enable fastest drug absorption directly to the brain, drug has been believed to be absorbed through arachnoid matter sleeve which extends along olfactory nerve. For that standardization of nasya procedure has to be performed including points like positioning of head of patient while during Nasya Karma, standardization of Hasta Svedana technique which may provide facial efferent stimulation, standardization of dose and Bindu Pramāṇa w.s.r.to each Nasya Dravya, standardization of time, tool development for Samyak Nasya Lakṣaṇa etc.

STANDARDIZATION OF DIET DURING PAÑCAKARMA PROCEDURES

Food items used during Pañcakarma treatment course cannot be standardized fully owing to the cultural sensitivity of the patients of different regions in which Pañcakarma is practised. Even though food items cannot be standardized, the principle behind diet used during different stages should be standardized. Scientifically designed diet protocol just after Pañcakarma therapy aiming at the restoration of body elements which were medically-disturbed during procedure is known as Saṃsarjana Karma. The principle of Saṃsarjana Karma, which begin with carbohydrates then proteins ending with fats should be standardized and implemented. Also, the dietary regimen advised during Snehapāna , Svedana, Basti  etc should be standardized on scientific lines. Efficacy of Vamana and Virecana therapy largely depends on the diet consumed on previous day or prior diet which is known as utklesana diet designed for liquefaction of Kapha and Pitta Doṣa respectively also need standardization.

STANDARDIZATION OF PAÑCAKARMA THEATRE

Pañcakarma theatre should be set and standardized as per NABH criteria which includes proper light supply and ventilation, hygienic, with separate hand – washing area, storage area, recovery room, hot water supply etc with accurate instruments. The room should be also

free from vectors.

STANDARDIZATION OF INVESTIGATIONS DURING PAÑCAKARMA

Investigations done during Pañcakarma procedure is to ensure the safety of the procedure and to make scientific assessment on parameters. Vitals should be checked before and after every procedure. The specific investigations vary as per the procedure, for example, Raktamokṣa or bloodletting therapy should not be conducted in case of low Hb level, abnormal bleeding and clotting times. Portal hypertension and oesophageal varix should be screened before Vamana therapy. In case of bleeding haemorrhoids, Basti  cannot be administered. Hypotensive patients cannot be done a purgation therapy. The investigation list needed to be done prior to each Pañcakarma and after therapy should be made scientifically and validated.

[i] http://ccras.nic.in/content/research-Āyurveda

[ii] https://www.worldwidejournals.com/indian-journal-of-applied-research-(IJAR)/article/scope-of-research-in-standardization-of-Pañcakarma-procedures-a-critical-review/MTQyNjM=/?is=1&b1=49&k=13