Pain Management with Panchakarma ( Ayurveda), Dr KIRAN K G

1. PAIN MANAGEMENT
WITH PANCHAKARMA
D R K I R A N K G
P H Y S I C I A N
A R Y A V A I D Y A S A L A K O T T A K K A L A H & R C , D E L H I
D R K I R A N K G @ G M A I L . C O M

3. CHIKITSA
SHODHANAM SAMANAM
AHARAM ACHARAM

4. SHODHANAM
ANTA PARIMARJANAM
BAHI PARIMARJANAM
SHASTRA PRANIDHANAM

5. ANTA PARIMARJANAM
VAMANA
VIRECHANA
VASTHY
NASYA
RAKTA MOKSHA
BAHI PARIMARJANAM
ABHYANGA
SWEDHANA
PARISHEKA
UDVARTHANA
DHAARA, PIZHICHIL etc KERALEEYA CHIKITSA

6. IMPORTANCE OF SHODHANA

8. IMPORTANCE OF POORVA KARMA
 To bring Sakha gata dosha to koshta
 To detach the leena dosha from dhatu’s
 For uthkleshana
 To minimize the strain
 To prevent Vata prakopa
 To prevent complications

9. PANCHA KARMA
Bio Cleansing regimen
Better bio availability of the pharmacological therapies
Homeostasis of dosha

10. KERALEEYA PANCHAKARMA
Kerala special procedures + Panchakarma
Pizhichil, Jambhira pinda sweda + Vasthy, Nasyam

11. KERALA SPECIAL PROCEDURES
They are modified therapeutic procedures of Snehana & Swedhana.
Can be done as purva karmas & as Samana chikitsa in specific conditions.

12. KERALA SPECIAL PROCEDURES
SHIRODHARA
• THAILADHARA
• THAKRADHARA
• KSHEERADHARA
KAYA SEKA
• PIZHICHIL
PINDA SWEDA
• SSPS
• CPS
• PPS
• JPS
ANNA LEPA
• NAVARA THEPPU
SIROLEPA
• NELLIKKA PATTU
• KURUNTHOTTY
PATTU

13. PAIN
“An unpleasant sensory and emotional experience
associated with, or resembling that associated with, actual
or potential tissue damage.” [ IASP]

14. ORIGIN
POENA { LATIN} - PENALTY
PEINE { OLD FRENCH}
PAIN { ENGLISH}

15. Describing pain only In terms of intensity is like describing music only interms of its loudness.
Pain may not be directly proportional to amount of tissue injury and there by it is highly
subjective.
Pain is a signal in your nervous system that is something may be wrong.
Pain can be helpful in diagnosing a problem
Pain is the commonest complaint which brings a patient to a doctor

16. PAIN
1. Acute Pain
1. Chronic Pain
Types Types
1. Nociceptive pain
2. Neuropathic pain
3. Phantom pain
4. Psychogenic pain

18. Directly related to soft tissue damage
Sprained ankle or a paper cut
Resolves as the injured tissue heals
Due to long term illnesses
Cancer
Degenerative diseases
Fibromyalgia
Inflammatory diseases
Acute Chronic

19. NOCICEPTIVE PAIN
1. Radicular pain – Occurs when the nerve roots are irritated. Goes down your arm or leg
Causes Numbness, Weakness & Tingling
2. Somatic pain- Happens when any of the pain receptors in your tissues such as muscles
bone or skin are activated. Eg: Headache, Cuts
3. Visceral pain- Happens when internal organs such as involuntary muscles in
the heart are injured or inflamed. Described as aching.

20.  Bruises
 Burns
 Cuts
 Fracture or broken bones
 Pain caused by joint damage, such as Arthritis or Sprain

21. NEUROPATHIC PAIN
Often is the result of a nerve damage or a malfunctioning nervous system.
Often a shooting or burning pain
Eg. Pain in CNS disorders, Diabetic neuropathy, Shingles, Trigeminal neuralgia etc

22. PHANTOM PAIN
Pain is felt in a part of the body that has been lost or from which the brain no longer receives
signals.
It is a type of neuropathic pain
Eg: Pain from Amputed hand

23. PSYCHOGENIC PAIN
Pain caused, increased, or prolonged by mental emotional or behavioural factors.
Head ache, Stomach ache, Back pain are sometime Psychogenic.

28. ANALYSIS OF PAIN
A. Site of pain
B. Radiation of pain
C. Severity
D. Timing & duration
E. Character
F. Occurrence or aggravation
G. Relief

29. PAIN TERMINOLOGY IN AYURVEDA
 VEDANA
 KLESHA
 VYADHA
 SHOOLA
 DUKHA
 TODHA
 BHEDANA
 RUK

30. VEDANA STHAPANA GANA

32. VASTHY
 "Vasthy vataharaanaam sreshta"
 There is no pain without Vata
 Vasthy with disease specific and vedanahara medicines makes the pain relief
 Also called ARDHA CHIKITSA
ASTHAPANA VASTHY= MAKSHIKAM+ LAVANAM+SNEHAM+ KALKAM+ KWATHAM
ANUVASANA VASTHY= SNEHA

33. KASHAYA VASTHY
DWIPANCHAMOOLADI VASTHY
MADHUTHAILIKA VASTHY
ERANDA MOOLADI VASTHY
BALAGULUCHYADI VASTHY
 CHURNA VASTHY
 VAITARANA VASTHY

34. ANUVASANA VASTHY/MATRA VASTHY
 DHANWANTARAM MEZHUKUPAKAM
SAHACARADI MEZHUKUPAKAM
SATAHWADI VASTHY TAILAM
THIKTAKA GHRITAM

35. VIRECHANAM
 SNEHAPANA + VIRECHANA
SADHYO VIRECHANA
 NITYA VIRECHANA

36. VIRECHANA AUSHADHAS
 GANDHARVAHASTHADI ERANDA TAILAM
TRIVRILLEHYAM
 DASAMULA HARITAKI LEHYAM
 MISRAKA SNEHAM
AVIPATHY CHURNAM

37. IMPORTANCE
 Most popular & commonly employed shodhana therapy
 Easiest administration, least complication, easy to perform, maximum efficacy, wide field of
utility, Highly cost effective

38. EFFECT OF VIRECHANA
 Eliminates sancita pitta & kapha malas
 Tridosha samana- Mainly pitta kapha samana & vatanulomana
 Purifies Rasa & Rakta maintaining the homeostasis & electrolyte balance
 Enhances Agni at Koshtha & Dhatu level
 Removes Srotorodha by correcting lymphatic obstructions

39. MODE OF ACTION
 Removes the vitiated doshas
 Gradual enhancement of metabolic power
 Detoxfication
 Correction of hormonal abnormalities
 Correct circulatory problems
 It’s a unique procedure that eliminates the endotoxins that are formed in liver, unabsorbed
residues of GIT resulted due to metabolic activities, things that are excreted through intestinal
mucosa etc.

40. NASYAM
Medicaments administered through nose
Jathrurdhwa rogas
Best method to eliminate & alleviate the vitiated doshas of uttamanga
Better chance of absorption through blood vessels
Gives snehana, swedana & shodhana together
 Brimhana, Samana, Sodhana acc to type of Nasya

41. 1. ANU TAILAM
2. KSHIRABALA 101 A
3. DHANWANTARAM 101 A
4. MAHARAJA PRASARANI TAILAM

42. RAKTAMOKSHAM
JALOUKA ALABU SIRAVYADAM
PRACHANAM SRINGA

43. o Pitta rakta prasadana, dushta rakta sodhana, Vatanulomana
o Checks the inflammation, Improves Circulation
o Cures venous diseases and thrombosis
o Pain relieving effect

44. BENEFITS OF PANCHAKARMA
Detoxification
Functional optimization of enzymatic complex
Restoration of premorbid condition
Immune modulation
Rejuvenation

45. BENEFITS OF PANCHAKARMA
 It eliminates the metabolic wastes & toxins
 It cleanses the macro & micro channels in the body
 It helps early repair of tissues , improve nourishment & tissue
perfusion.
 It prevents early ageing , relaxes both body & mind
 It increases the bio availability of drugs & excretion of unwanted
substances

46. ABHYANGA
 The biological effect is brought about by the combined action of the medicine, the
temperature & the force/pressure due to massage
 The oil medium decreases friction, gentle movement increases the surface contact, reduce
surface tension, liquefies sebum & favours drug entry.
 Relieve pain because of rubrificient action applied over the toxins accumulated in the
neurolemma
 Medicaments suppresses the nerve impulses to reach the pain center

47. PINDA SWEDA
CHURNA PINDA
SWEDA
PATRA PINDA
SWEDA
JAMBHIRA
PINDA SWEDA
SHASHTIKASALI
PINDA SWEDA
MANJAL KIZHI
VALUKA
SWEDA

48. Selection of medicine is usually based on the basic disease that produces the pain.
 Heat makes the local area inflamed , so the blood rush to the local area, supplies more
nutrition to recover
Vasodilation facilitate the toxins to transfer from sakha to koshta

49. DHANYAMLA DHARA
 Vatarogas especially with kaphanubandha, Diabetic neuropathy
 Spasticity, Cervical spondylosis, Lumbar spondylosis, OA Knee with edema
 Acute subacute joint diseases, Acute subacute inflammation & pain
 Relieves pain, stiffness and swelling associated with arthritis & other painful conditons
 Highly effective in combating Ama
 Local fomentation with Dhanyamla can be given to relieve pain

50. PIZHICHIL

51.  Pizhichil is a modified form of Kayaseka developed by kerala vaidyas & is extensively practiced.
 It is a snigdha sweda in which warm medicated oil is poured all over the body squeezing a
cotton cloth dipped in oil followed by gentle massage
 Duration – 1 hour

52. PROCEDURE
 Warm the prescribed thaila for head by pathrapaka technique
 Warm the prescribed thaila for body to 42 – 45 ℃
 Ask the patient to sit comfortably on the dhroni with legs extended
 Take position on either side of patient
 Apply the prescribed thaila over the vertex
 Apply thaila over the back & then over the body
 Soak the cotton cloth in the warm thaila & squeeze it with right hand from 8 cm above the body
allowing the warm thaila to flow as dhara through the right thumb to the patients body.
 Massage the patients body with left hand in anulomana direction at the same time
 Continue massage in the sitting posture for 5 min, then ask the patient to lie in supine position.
 Continue the process

53. 7 POSITIONS

54.  Prone position can be adopted if necessary.
 Wipe off the thaila & sweat from the head and body with a clean and dry towel after the
stipulated time.
 Apply Rasnadi churna on vertex
 Ask the patient to take rest for one hour

55. INDICATIONS
 Vata vikara, vatha anubhandha roga, apabahuka, kshataja vikara, katigraha, grudhrasi
 Antharayama, bahirayama, pangu, vatarakta, hanusthambha , Padadaha, vatagulma, udavarta
 Neuro musculars disorders – Hemiplegia, paraplegia, IVDP, Lumbar & Cervical spondylosis
 Scoliosis, AVN, Ankylosing spondylitis, post traumatic conditions, degenerative diseases
 OA, Chronic RA with deformities, peripheral neuropathy, Chronic inflammatory diseases with
degeneration

56. EFFECTS
 It enhance the endurance, nourishment and strength of the body
 Relieves body pain & muscle spasms, promotes development of muscles
 Improves skin complexion, anti ageing & rejuvenating, ensures better blood circulation
 A soothing & relaxing procedure
 Promotes vasodilatation & increase peripheral circulation/ through promoting perspiration
 It helps in eliminating metabolic wastes, maintains proper tension of muscles & tendons,
promotes functional ability of nerves.

57. Mode Of Action OF PURVAKARMAS
• Sweat induced by application of heat
• Causes cutaneous vasodilation
 The absolute amount of blood in the skin can vary from nearly zero during periods of maximal
vasoconstriction as in cold stress to as much 60 % of cardiac output distributed over the body surface
during maximal vasodilation in heat stress.
• When the stimulus is withdrawn, body tries to keep the thermal homeostasis by causing cutaneous
vasoconstriction
 Blood flow increases in internal organs
•Waste excretion to gut is facilitated

58. KATI VASTHY / GREEVA VASTHY
A type of local snigdha sweda
 Sula hara, sroro vivarana, vata samana, nadi balya, rejuvenative etc
Indications : katigraha, grudhrasi, Degenerative diseases of spine, IVDP, Sacroilitis, Comprssion
fracture, Spondylolisthesis, Cervical spondylosis

59. SIRODHARA
 Sirodhara is a procedure in which various liquids are continuously poured over forehead and
then allowing to flow over the scalp from a specific height (4-5 cm)for a specific period of time
(45 min - 1 hour)
VATA THAILA
PITTA KSHEERA
KAPHA THAKRA

61.  The impact of Shirodhara on pain acts as hypnotic & sedative along with pain center
suppression
 Beneficial in Psychological pain
Sirastoda, sirodaha, nidranasa, ardhavabhedaka, Migraine etc

62. UPANAHA
Means to tie/ bandaging
A type of ekanga sweda
 Indicaion – Chronic sandhigata vata, OA, Vatakantaka, Calcaneal spur, IVDP, Sula, sankocha,
sthambha, Tennis elbow, Frozen shoulder
 Duration – Min 1 hour to 12 hours

63. LEPA
 External application of medicated paste
It is a passive method
Last for long time
Easy to apply
Kottam chukkadi churna, Jatamayadi churna etc

64. AGNIKARMA
Agnikarma/ Therapeutic cauterization is a para surgical procedure where actual heat is
transmitted in to the tissue to nullify the disease.
Resulting coagulative necrosis of tissues
It is a sterile process & is considered to be superior among other managements
Simple, fast, economical & effective technique that gives immediate pain relief

65. INTERNAL MEDICINES

66. KASHAYAM
1) Rasnasaptakam kashayam
2) Dashmoolam kashayam
3) Cheriya rasnadi kashayam
4) Valiya rasnadi kashayam
5) Ashtavargam kashayam
6) Sahacharadi kashyam
7) Sahacharabaladi kashayam
8) Mustadi marma kashayam

67. I. Guggulu thiktakam kashayam
II. Kokilaksham kashayam

68. CHURNAM
Brihat vaiswanara churnam
Panchakola Churna
Hingvastaka Churna
Shaddharanam churnam

69. TABLETS
Yogaraja Guggulu
 Kaisora Guggulu
Vatagajaankush Rasa
 Agnikumara rasam
 Cheriya antrakutaram
Shaddharanam churnam tab
Surya prabha
Vettumaran tab

70.  RHUKOT TAB
OSTIKOT TAB
 MIGRAKOT TAB

71. ARISHTA & ASAVA
1. Dashamoolarista
2. Balarista
3. Amrutarishtam
4. Nimbamruthasavam

72. GHRITAM
1. VARANADI GHRITAM
2. GUGGULUTHIKTAKAM GHRITAM
3. RASNADI GHRITAM

73. EXTERNAL MEDICINES
1) MAHANARAYANA TAILAM
2) VALIYA SAHACHARADI TAILAM
3) MURIVENNA
4) DHANWANTARAM TAILAM /7 A/21A
5) KARPURADI TAILAM
6) KOTTAM CHUKKADI TAILAM
7) PINDA TAILAM

74. I. RHUKOT LINIMENT
II. RHUKOT PLUS CREAM
III. RHUKOT GEL
IV. PAIN BALM
V. PAIN SPRAY
VI. DHANWANTARAM CREAM

75. i. KOTTAM CHUKKADI CHURNAM
ii. JATAMAYADI CHURNAM
iii. NAGARADI CHURNAM
iv. RASNADI CHURNAM
v. VALIYA MARMA GULIKA
vi. KARUTHA GULIKA

80. COMMON DISEASES & THEIR
TREATMENT

81. Osteoarthritis
 Internal medicines
i. Guggulu thiktakam kashayam
ii. Sahacharadi kashayam
iii. Cheriya rasnadi kashayam
iv. Valiya (Maha) rasnadi kashayam
v. Gandha thailam/ Bala thailam/ Dhanwantaram 101 A
vi. Pravala bhasmam
vii. Ostikot
viii. Rasnadi ghritam
ix. Guggulu thiktakam ghritam
x. Balarishtam + Aswagandharishtam
xi. Punarnavasavam + Nimbamritasavam
 External applications
i. Mahanarayana thailam + Karpuradi thailam
ii. Valiya sahacharadi thailam + Murivenna
iii. Kottam chukkadi thailam + Pinda thailam
iv. Dhanwantaram 21 A + Mahamasha thailam
v. Gandha thailam
vi. Rhukot ( Liniment/gel, plus cream)

82. osteoarthritis
 Choorna pinda sweda
 Pizhichil
 Shashtika shali pinda sweda
 Ragi kizhi
 Upanaham
 Janu vasthy
 Dwipanchamooladi vasthy
 Dwipanchamooladi vasthy
 Erandamooladi vasthy

83. Lumbar spondylosis
 Internal medicines
i. Dhanvantaram kashayam
ii. Sahacharabaladi kashayam
iii. Cheriya rasnadi kashayam
iv. Ksheerabala (101 A/ 21 A/ 7 A)
v. Yogaraja guggulu
vi. Suvarnamuktadi gulika
vii. Rasnadi ghritam
viii. Gugguluthiktakam ghritam
External applications
i. Mahanarayana thailam + Karpuradi
thailam
ii. Valiya sahacharadi thailam + Murivenna
iii. Sahacharadi kuzhambu
iv. Dhanwantaram 21 A + Mahamasha
thailam

84. Lumbar spondylosis
 Pizhichil
 Jambhira pinda sweda
 Churna pinda sweda
 Kati vasthy
 Dwipanchamooladi vasthy
 Erandamooladi vasthy
 Madhu thailika vasthy

85. Cervical Spondylosis
 Internal medicines
i. Ashtavargam kashayam
ii. Prasaranyadi kashayam
iii. Ksheerabala 101 A
iv. Maharaja prasarani thailam
v. Suvarnamuktadi gulika
vi. Rasnadi ghritam
 External applications
i. Karpasasthyadi thailam
ii. Murivenna
iii. Valiya prasarani thailam
iv. Dhanwantaram thailam

86. Cervical Spondylosis
 Pizhichil
 Churna pinda sweda
 Jambhira pinda sweda
 Siro vasthy
 Greeva vasthy
 Nasyam

87. Diabetes Mellitus
 Internal medicines
i. Katakakhadiradi kashayam
ii. Nisakatakadi kashayam
iii. Vairyadi kashayam
iv. Niruryadi gulika
v. Abhrabhasmam cap/ Yasada bhasmam cap/
Kanmada bhasmam cap
vi. Chandraprabha vati
vii. Amrita mehari churna / Glysikot granule
viii. Vasantakusumakara rasam
 External medicines
i. Nisoseeradi thailam
ii. Valiya amritadi thailam
iii. Valiya sahacharadi thailam
iv. Dhanwantaram thailam

88.  Abhyanga
 Thakradhara
 Navaratheppu
 Madhuthailika vasthy - Spl

89. MIGRAINE
 INTERNAL MEDICINES
1) PATHYAKSHADHATHRYADI KASHAYAM
2) MIGRAKOT TAB
3) VARANADI
GHRITAM/KASHAYAM/KWATHAM
4) AGNIKUMARA RASAM
5) SUVARNAMUKTADI GULIKA
6) DASAMULAHARITAKI LEHYAM
 EXTERNAL MEDICINES
1) BALAHATADI TAILAM
2) KSHIRABALA 101 A/21A
3) MIGRAKOT OIL

90.  THAILADHARA
 DASAMULA KSHEERADHARA
 ABHYANGA + SWEDANA
 PIZHICHIL
 NASYAM
 VIRECHANA