Different routes of administration are adapted for the different therapies. Nasya is administered through the nasal route, abhyanga through the skin, the Sneha Pana through the gastrointestinal tract, basti through the rectal route and so on. On the other hand, it is also true that most of the shodhana therapies that include therapeutic emesis, therapeutic purgation, and therapeutic enema are administered through the gastrointestinal tract. Even the snehapana, a purvakarma in the shodhana therapy is also administered through the same system. Hence optimal functioning of this system is essential for the effective administration of these therapies. This optimal functioning may be achieved by the employment of pachana chikitsa prior to the administration of any of these shodhana procedures. Therefore pachana chikitsa is categorized as one among the purvakarma. As this pachana chikitsa involves augmenting the functioning of agni, this therapeutic measure is also referred as dipana-pachana chikitsa.
Pachana chikitsa refers to the oral administration of certain medicines that augments and assists the process of digestion, thus ensuring the optimal state of gastrointestinal tract. Thereby one can expect proper digestion and assimilation of the drugs administered as well as the desired results from the shodhana therapies that follow.
Two distinct state of morbid dosha is probable in any given illness. It is named a theapakva and pakva state. Apakva state of the morbid dosha refers to an unformed state in which the dosha firmly adhere to the dhatu (body tissues) and srotas (channels). Further, in this state of dohsa, it can not be mobilized into to the gastrointestinal tract. Mobilization of the morbid dosha into the gastrointestinal tract is essential to expel them from the body either by vamana, virechana or basti procedures. Contrary to this pakvastate of the morbid dosha refers to the formed state, in which morbid dosha are separated from the dhatu (tissues) as well as srotas (channels) and therefore can be mobilized into the gastrointestinal tract, where from it is later expelled by any of the shodhana procedures. Process of transformation of morbid dosha from its unformed state to formed state is hastened by the employment of pachanachikitsa. Pachana chikitsa when administered augments the gastric fire, which in turn activates the biotransformation at the dhatu as well as srotas level. Assisting the mobilization of the dosha from the site of lesion to the site of elimination is the purpose of subjecting to pachana chikitsa and is carried out prior to the administration of any of the shodhana procedure.
Sluggish functioning of the gastrointestinal tract associates many of the diseases. Febrile illness, acid peptic disease, diarrhea,abscess are the few examples. In such states the digestion is incomplete; as a result there occurs the accumulation of the undigested foods. Also this partially digested food gets assimilated to some extent and adds to the morbidity of dosha. The resultant of the partial digestion is known as ama and has an incriminatory effect on the body. The dosha that associate this ama is known as samadosha. And the samadosha tend to adhere to the dhatu and srotas rendering difficulty in its mobilization into the gastrointestinal tract. To carry out the shodhana procedures, optimal functioning of the gastrointestinal tract is essential, as well as morbid dosha has to be brought into this tract of elimination. This is best achieved by the pachana therapy, as this augments the digestive process and clears the ama state.
More to say, the amount of dosha vitiation varies in different patients suffering from different disease. If the amount of dosha vitiation is moderate the pachana chikitsa alone is effective in curing the illness. This belongs to the category of langhana chikitsa in shadupa krama. Pachana chikitsa augments the gastric fire, and the augmented gastric fire in turn activates all mechanisms of biotransformation at different levels in the body negating the morbidity of dosha. Pachanachikitsaactivates the inherent body mechanism of healing and allow it to clear the illness.
Thus the pachana chikitsa renders the optimal functioning of the gastrointestinal tract, causes the formed state of the morbid dosha, mobilizes it into the gastrointestinal tract, clears the ama and reactivates the body mechanism of healing.
Pachanachikitsa is indicated prior to the administration of any shodhana therapy as it helps in transformation of apakvastate of the morbid dosha into the pakva state. Moreover, pachana chikitsa is especially indicated as purvakarma in vamana, virechana and basti, as optimal functioning of the gastrointestinal tract is also achieved by this treatment. Since pachanachikitsa has curative effect it is also indicated in the following conditions:
Madhyamadoshavastha:- Moderate amount of dosha vitiation
Madhyamabalatura :- Clients having average physical
Kapha-pitta :- Morbidity of the pitta as well as
Chhardi :- Vomiting
Atisara :- Diarrhea
Hridroga :- Disease of the heart
Visuchika :- Disease characterized by vomiting and
diarrhea like gastroenteritis
Alasaka :- Failure of digestion leading to accumulation of
undigested food in the abdomen
Jvara :- Febrile illness
Vibandha :- Constipation
Gourava :- Feeling of heaviness in the body
Udgara :- Excessive belching
Hrillasa :- Nausea
Arochaka :- Lack of taste in the mouth
For the pachana chikitsa, different herbal or herbomineral combinations may be prescribed for oral administration in different forms like tablet, decoction, infusion, or powder etc. From the following list of medicines any one may be prescribed in accordance with palatability or availability.
Medicines For Pachana Chikitsa And Their Dosage
Panchakolaphanta :- 50ml t.i.d. preferably before meals
Citrakadivati :- 500mg t.i.d. along with water
Chitrakasava :- 02ml t.i.d.
Agnitundivati :- 250mg t.i.d. with water
Hingvashtakachurna :- 3grams t.i.d. along with the first spoon
Dried ginger powder :- ½ to 1 gram twice daily before meals
(Zinziberofficinale) with honey or milk
Pippali powder :- 3 grams t.i.d. with water
Shankhavati :- 500 mg t.i.d. with water
OBSERVATION OF THE CLIENT FOR THE EFFECT
Following the administration of the pachanachikitsa, it is continued for certain period till the client develops the desired effect. The therapist should observe the client regularly to appreciate the appearance of symptoms indicating the proper effect of the pachanachikitsa. As the pachanachikitsa belongs to the category of langhanachikitsa, appearance of the following symptoms of proper langhana is also suggestive of proper effect of pachanachikitsa.
SYMPTOMS OF PROPER LANGHANA/PACHANA
Vatavisarga :- Proper passing of the flatus
Mutravisarga :- Proper evacuation of the bladder
Purishavisarga :- Proper evacuation of the bowel
Gatralaghava :- Subjective feeling of lightness in thebody
Hridayashuddhi :- Feeling of clarity in the precordial region
Kanthashuddhi :- Clarity of the throat
Udgarashuddhi :- Clear belching devoid of any odor and
Asyashuddhi :- Clarity of the mouth
Tandra gate :- Disappearance of drowsiness
Klamagate :- Disappearance of tiredness
Svedejate :- Proper sweating
Ruchaujate :- Appearance of proper taste in the mouth
Kshutpipasa- :- Development of hunger and thirst,
sahodayeand inability to withstand the same.
DURATION OF THE PACHANA CHIKITSA
There is no any predetermined duration for the pachanachikitsa. In general the pachanachikitsa is continued till the client develops the above mentioned symptoms of proper effect. In an average it takes about 2 to 7 days for the development of the desired results. As this treatment belongs to the category of apatarpanachikitsa, this causes reduction in the body and most clients may not be able to tolerate this procedure for a longer period. Further, over effect of pachanachikitsa has deleterious effect on the body. Hence physician should prevent the over effect of pachana by all means. Or to say, the pachana treatment should be continued till the client shows desired effect and should be abruptly terminated if he develops any symptom of over effect.
SYMPTOMS OF OVER EFFECT OF LANGHANA/PACHANA
Parvabedha :- Pain in joints of the fingers
Angamarda :- Body ache
Kasa :- Cough
Mukhashosha :- Dryness of the mouth
Kshutpranasha :- Absence of hunger
Aruchi :- Lack of taste in the mouth
Trishna :- Excessive thirst
Srotradaurbalya :-Impairement of hearing
Netradaurbalya :-Impairement of vision
Manasahsambhramah :- Confused state of mind
Urdhva-vata :- Reversal in the course of vatadosha
Tamo-hridi :- Discomfort in the chest
Deha-nasha :- Loss of body weight
Bala-nasha :- Loss of physical strength
Agnibala-nasha :- Loss of digestive fire
TREATMENT FOLLOWING PACHANA CHIKITSA
Ascertaining the desired effect of the pachana chikitsa, as per the predetermined course of Panchakarma, snehapana is administered from the next day onwards. In some clients sluggishness of the gastrointestinal tract may relapse by the discontinuation of the pachanachikitsa. In such situations continuing the oral medication of the pachanachikitsa along with snehapana is advisable.