Poorva Karma (Preparatory Techniques)
After doing a detailed examination of the patient through the different diagnostic methods, a physician decides whether patient should undergo a samana (pacifying) therapy of sodhana (purificatory) therapy. Before starting Panchakarma one has to undergo two types of preparatory treatments called Poorvakarma (preparatory techniques). This consists of snehana (Oleation) and svedana (sudation). Oleation helps in making the blocks (created by the metabolic waste materials in the body channels) slimy and non-cohesive. After making them unctuous, svedana (fomentation) is done to bring all these waste materials into the Koshta i.e. the open spaces in the body and expelled through Panchakarma.
a. Snehana (oleation)
The word "sneha" in this context donates unctuousness or oily nature. The technique of snehana involves making the body oily or unctuous by giving materials that are oily in nature in high quantity either internally or externally. According to the classical taxts, there are four types of sources for these unctuous materials.
"sarpirmajja vasataila sneheshu pravaram matam" [Ashtanga hridayam]
Sarpi (ghee), majja (bone marrow), vasa (adipose/fat tissue), taila (oil) are four unctous materials. These four are used for treating different conditions. E.g. Oil is used in conditions such as tumours, sinus ulcers, or diseases of kapha and vata and those who have hard bowels. Similarly fat is used for pain in joints or bones, vital organs etc. At times combination of two (yamaka), three (trivrit) or four (mahan) of the above are also used in treatment.
The method of administering high doses of unctuous material internally is known as snehapana. According to the dose in which this is administered, there are four categories. Hrasiyasimatra (smallest dose), hrasva (small), madhyama (medium), uttama (maximum) are these four. These categories are decided according to severity of the condition, its stage, age, digestive capacity of the patient etc. The mathra (dose) is named small, medium or maximum based on the time taken for the medicine to digest when taken internally.
The time and method of administration are also very important. For instance, the method of administration could either be applying outside, enemas, nasal drops, applying on the head, ears or eyes or taking internally. It is also used along with food based on the different diagnosis. There are 64 recipes mentioned based on the different permutations and combinations of adjuvant. But usually before purification therapy sneha (unctuous material) is given alone. For pacifying it is given when the patient is hungry. For brimhana (nourishment), it is given with other materials like meat soup etc. Specifications are mentioned on how to prepare the medicine for different type of applications.
"Tailam pravrishi varshante sarpiranya to madhave
mase sadharane sneha sastohni vimale ravou" [Astanga hrdayam]
Oil is used in rainy season, ghee in autumn; fat and bone marrow are used in spring; and usually snehapana has to be done on days when there is bright sun.
Snehana course is decided based on severity of the condition as well as the nature of the patient. Maximum oleation is given for seven days. There are also details of the symptoms of the person who has undergone a good snehana or effects of an improper oleation and their management mentioned in the classical literature.
While taking snehana the patient has to follow strict pathya (dietary and activity restrictions), which is also prescribed for every treatment in Panchakarma.
Sneha yogya (suitable for sneha)
Usually oleation is done for people who are to undergo sudation (svedana) and purification (sodhana), those who indulge in alcohol, excessive sexual intercourse, physical strain such as exercise, those who think too much, the aged, children, the emaciated, those who have dryness (rookshata), people with depleted blood and reproductive tissue, who are suffering from vata types of disorders, having specific eye diseases (syanda, timira) and those who have difficulty in waking up early.
Ayogya (unsuitable for sneha)
Oleation should not be done for those who have a weak or strong digestive activity, who are obese, who are suffering from stiffness of thighs, diarrhoea, metabolic dysfunction (ama), diseases of throat, affected by some kinds of poisons like gara (artificial poison), enlargement of abdomen due to fluid accumulation, who are in the state of unconsciousness, who are suffering from vomiting, anorexia, increased kapha, thirst, alcoholic intoxication, who had abnormal delivery and who are on nasal medication, enema and purgation.
Guggulutiktakam, mahatiktakam, indukantam, panchagavyam, kalyanakam, Dadimadighritam, tiktakam, brahmi ghritam are some of the commonly used ghee preparations also available in the market. Tuvaraka (Hydnocarpus laurifolia), sarshapa (Brassica juncea), arista (Azadirachta indica), nikumbha (Baliospermum montanum), aksha (Terminalia bellerica) and karanja (Pongamia glabra) oil are a few types of oil mentioned in the literature.
Sneha pana is effective in conditions like amlapitta (acid gastritis), tamakasvasa (bronchial asthma), antravriddhi (hernia), kushtam & visarpa (skin diseases), vatarakta (arthritic conditions)
b. Svedana (sudation)
As mentioned earlier, after oleation, the waste materials blocked in the body channels become unctuous, and the channels become lubricated. Through svedana these waste materials are brought into the main body channel (mahakoshtha) before it is expelled through the main techniques of Panchakarma. According to Astanga hridaya, one of the major classical texts (600 AD), there are four different methods by which one can administer sudation. They are taapa (fomentation by applying heat), upanaaha (warm poultice of different medicinal materials) usma (steam) and drava (pouring warm liquid). According to Caraka samhita, there are two types of sveda called agnisveda (with fire) and anagnisveda (without fire). Agni sveda is divided into 13 types where as anagni into 10 types.
These different techniques are used according to the condition and strength of the patient. Many of these techniques are not used in present day practice. Contemporary practices involve mainly steam method, pouring of hot liquid to the body or massages. Sudation can also be mild, moderate and maximum according to the disease, patient, habitat and season. It is also prescribed that sudation should be mild in groins and it should not be done in eyes, scrotum and in the area of heart. It is also to be noted that detailed prescriptions are given in case of complications of sudation.
Persons having breathing disorders, cough, running nose, hiccup, constipation, hoarseness of voice, diseases of vata, kapha, metabolic dysfunction (ama), stiffness, feeling of heaviness, aches, sprains, catch in different parts of the body, enlargement of scrotum, sprains, dysuria, tumours, reproductive conditions etc.
Persons who are very obese, dry, weak, unconscious, weak due to chest injury, emaciation, who have disease related to excessive alcohol intake, specific eye disorders, enlargement of abdomen due to fluid collection, specific skin diseases, consumption, those who have gout, those who have had some types of food like milk, curds etc, who have undergone purgation, those who are suffering from prolapse or burns of rectum, exhaustion, anger, grief, fear, excess hunger and thirst, jaundice, anaemia, various types of diabetes, and diseases of pitta origin, women who are menstruating or pregnant or delivered recently. In case of emergency in these conditions, it can be done mildly.
Apart from being the preparatory techniques for Panchakarma these two methods (sneha, sveda) are often used as part of samana treatment as well. Present day Ayurvedic massages or steam baths without purification techniques can be grouped under this category.