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=== Introduction ===

== Introduction ==

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[[Upakalpaniya Adhyaya]] is a part of the ''Kalpana Chatushka'' tetrad and follows the chapters on pre-purification (''snehana'' (oleation) and ''swedana'' (sudation)) procedures. The sequence of chapters suggests that after completing the pre-purification procedures, the vitiated ''doshas'' come into ''koshtha'' (gut) and should be expelled out by suitable procedures like therapeutic emesis or therapeutic purgation. Guidelines for managing the purification therapies as well as for setting up a good [[Panchakarma]] hospital with all infrastructure and equipment required for patient care have been described in this chapter. The rationale for providing guidelines for setting up a hospital is that, should complications arise, prompt medical care could be provided to the patient. Special emphasis has been given to the need for planning of relevant equipment and medicines required for [[Panchakarma]] and any medical care it may necessitate. It is incredible to think that 3000 years back when there were hardly any indoor hospital facilities available in other parts of the world, there were thinkers and practitioners who could conceive of such a hospital management system as described in this text.  

[[Upakalpaniya Adhyaya]] is a part of the ''Kalpana Chatushka'' tetrad and follows the chapters on pre-purification (''snehana'' (oleation) and ''swedana'' (sudation)) procedures. The sequence of chapters suggests that after completing the pre-purification procedures, the vitiated ''doshas'' come into ''koshtha'' (gut) and should be expelled out by suitable procedures like therapeutic emesis or therapeutic purgation. Guidelines for managing the purification therapies as well as for setting up a good [[Panchakarma]] hospital with all infrastructure and equipment required for patient care have been described in this chapter. The rationale for providing guidelines for setting up a hospital is that, should complications arise, prompt medical care could be provided to the patient. Special emphasis has been given to the need for planning of relevant equipment and medicines required for [[Panchakarma]] and any medical care it may necessitate. It is incredible to think that 3000 years back when there were hardly any indoor hospital facilities available in other parts of the world, there were thinkers and practitioners who could conceive of such a hospital management system as described in this text.  

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===Sanskrit text, Transliteration and English Translation===

==Sanskrit text, Transliteration and English Translation==

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Now we shall expound the chapter upakalpaneeyam (guidelines for hospital management), thus said Lord Atreya.[1-2]

Now we shall expound the chapter upakalpaneeyam (guidelines for hospital management), thus said Lord Atreya.[1-2]

==== Guidelines for physicians before commencing treatment ====

=== Guidelines for physicians before commencing treatment ===

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A physician willing to administer various purification therapies, especially to a king, royalty or a wealthy person, should arrange various necessary drugs and equipments well in advance of the procedures and know correct administration of counter-acting drugs in case of complications. Because, in case of emergency, if complications occur, it is not possible to easily and immediately arrange drugs through sale or import.  [3]

A physician willing to administer various purification therapies, especially to a king, royalty or a wealthy person, should arrange various necessary drugs and equipments well in advance of the procedures and know correct administration of counter-acting drugs in case of complications. Because, in case of emergency, if complications occur, it is not possible to easily and immediately arrange drugs through sale or import.  [3]

==== Query by Agnivesha about success of treatment ====

=== Query by Agnivesha about success of treatment ===

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==== Reply by Atreya ====

=== Reply by Atreya ===

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Lord Atreya replied, “Oh Agnivesha!, it is possible for us to treat the patients successfully and also impart instructions for correct administration. But there is none who is able to grasp such instructions or having grasped it, is able to apply it or put it into practice.  The variations in conditions of dosha, drugs, place, time, strength, body, diet, suitability, mind pattern, constitution, and age are subtle to understand. While considering these factors, when even a person with great intellect and pure knowledge gets confused, then what will be the condition of a person with less intellect?  [5]

Lord Atreya replied, “Oh Agnivesha!, it is possible for us to treat the patients successfully and also impart instructions for correct administration. But there is none who is able to grasp such instructions or having grasped it, is able to apply it or put it into practice.  The variations in conditions of dosha, drugs, place, time, strength, body, diet, suitability, mind pattern, constitution, and age are subtle to understand. While considering these factors, when even a person with great intellect and pure knowledge gets confused, then what will be the condition of a person with less intellect?  [5]

==== Equipments and arrangements for purification therapy ====

=== Equipments and arrangements for purification therapy ===

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==== Arrangements for hospital staff and accessories ====

=== Arrangements for hospital staff and accessories ===

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==== Preparation of patient before therapeutic emesis ====

=== Preparation of patient before therapeutic emesis ===

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==== Procedure of therapeutic emesis ====

=== Procedure of therapeutic emesis ===

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मदनफलकषायमात्राप्रमाणं तु खलु सर्वसंशोधनमात्राप्रमाणानि च प्रतिपुरुषमपेक्षितव्यानि भवन्ति; यावद्धि यस्य संशोधनं पीतंवैकारिकदोषहरणायोपपद्यते न चातियोगायोगाय, तावदस्य मात्राप्रमाणं वेदितव्यं भवति||१०||  

मदनफलकषायमात्राप्रमाणं तु खलु सर्वसंशोधनमात्राप्रमाणानि च प्रतिपुरुषमपेक्षितव्यानि भवन्ति; यावद्धि यस्य संशोधनं पीतंवैकारिकदोषहरणायोपपद्यते न चातियोगायोगाय, तावदस्य मात्राप्रमाणं वेदितव्यं भवति||१०||  

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==== Dose of emetics ====

=== Dose of emetics ===

The dosage of the decoction of the fruit of ''madanaphala'' (Randia dumetorum Lam.) and also of all the other drugs used in purification therapy should be decided according to the needs of an individual. A dose that produces the desired effects of purification of the vitiated ''dosha'' and does not cause excess or inadequate purification is regarded as the ideal dose for the patient. [10]

The dosage of the decoction of the fruit of ''madanaphala'' (Randia dumetorum Lam.) and also of all the other drugs used in purification therapy should be decided according to the needs of an individual. A dose that produces the desired effects of purification of the vitiated ''dosha'' and does not cause excess or inadequate purification is regarded as the ideal dose for the patient. [10]

==== Observation of patient after giving dose ====

=== Observation of patient after giving dose ===

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After administration of the decoction, the patient should be observed for one muhurt (approximately 48 minutes). The first noticeable effect will be perspiration indicating liquification of dosha. Thereafter, the patient would exhibit horripilation showing movement of dosha from its own position. The third stage will produce distension of the abdomen indicative of the doshas having shifted to the gut. Nausea and salivation occur in the fourth stage, indicating the upward movement of dosha. At this stage, the patient should be asked to sit on a comfortable chair of knee height, which is well-covered with bed sheet and have towel, pillow and cushion at its side. Good friends, whose presence is not embarrassing to the patient, should attend him and support his head, press his navel, and massage his back in order to facilitate emesis. [11]

After administration of the decoction, the patient should be observed for one muhurt (approximately 48 minutes). The first noticeable effect will be perspiration indicating liquification of dosha. Thereafter, the patient would exhibit horripilation showing movement of dosha from its own position. The third stage will produce distension of the abdomen indicative of the doshas having shifted to the gut. Nausea and salivation occur in the fourth stage, indicating the upward movement of dosha. At this stage, the patient should be asked to sit on a comfortable chair of knee height, which is well-covered with bed sheet and have towel, pillow and cushion at its side. Good friends, whose presence is not embarrassing to the patient, should attend him and support his head, press his navel, and massage his back in order to facilitate emesis. [11]

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==== Instructions to patient during procedure ====

=== Instructions to patient during procedure ===

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==== The signs of proper and improper emesis procedure ====

=== The signs of proper and improper emesis procedure ===

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==== Post procedure instructions ====

=== Post procedure instructions ===

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==== Rehabilitation diet after purification ====

=== Rehabilitation diet after purification ===

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The patient should take bath with lukewarm water.

The patient should take bath with lukewarm water.

===== First, Second and Third meal =====  

==== First, Second and Third meal ====  

His first meal should consist of a lukewarm gruel (''manda'') prepared with an old, red variety of ''shali'' rice (Oryza sativa Linn.), well cooked with fourteen times water by volume. The gruel should be very thin and liquid, taking into consideration the weakened digestive power of the patient. It should be repeated for the second and third meal.  

His first meal should consist of a lukewarm gruel (''manda'') prepared with an old, red variety of ''shali'' rice (Oryza sativa Linn.), well cooked with fourteen times water by volume. The gruel should be very thin and liquid, taking into consideration the weakened digestive power of the patient. It should be repeated for the second and third meal.  

===== Fourth, Fifth and Sixth meal =====

==== Fourth, Fifth and Sixth meal ====

For the fourth meal, a gruel (''vilepi'') prepared with four times water by volume and with red ''shali'' rice, well cooked, warm and without  unctuous substance or salt, or with a small quantity of unctuous substance and  salt should be given. Warm water is to be taken after the intake of gruel. The same type of diet is to be continued for the fifth and sixth meal.  

For the fourth meal, a gruel (''vilepi'') prepared with four times water by volume and with red ''shali'' rice, well cooked, warm and without  unctuous substance or salt, or with a small quantity of unctuous substance and  salt should be given. Warm water is to be taken after the intake of gruel. The same type of diet is to be continued for the fifth and sixth meal.  

===== Seventh, Eighth and Ninth meal =====

==== Seventh, Eighth and Ninth meal ====

For the seventh meal again, well cooked rice (''odana'') prepared with red ''shali'' rice of two ''prasrita'' (approximately 160 gram) along with a very thin soup of ''mudga'' ( green gram, Phaseolus mungo Lines.) , added with a small quantity of unctuous substance and salt should be given. Warm water should be given to the patient after his consuming the porridge. The same diet is to be repeated for the eighth and the ninth meal.  

For the seventh meal again, well cooked rice (''odana'') prepared with red ''shali'' rice of two ''prasrita'' (approximately 160 gram) along with a very thin soup of ''mudga'' ( green gram, Phaseolus mungo Lines.) , added with a small quantity of unctuous substance and salt should be given. Warm water should be given to the patient after his consuming the porridge. The same diet is to be repeated for the eighth and the ninth meal.  

===== Tenth, Eleventh and Twelth meal =====

==== Tenth, Eleventh and Twelth meal ====

For the tenth meal, a thin meat soup of common quail, grey partridge etc., prepared with water and salt should be given. Warm water is to be taken after this. This is again to be repeated for the eleventh and twelth meal.  

For the tenth meal, a thin meat soup of common quail, grey partridge etc., prepared with water and salt should be given. Warm water is to be taken after this. This is again to be repeated for the eleventh and twelth meal.  

Thereafter, the patient should take food having different tastes and should start taking his normal diet from the seventh night. [16]

Thereafter, the patient should take food having different tastes and should start taking his normal diet from the seventh night. [16]

==== Procedure of ''virechana'' (therapeutic purgation) ====

=== Procedure of ''virechana'' (therapeutic purgation) ===

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==== Benefits of purification therapy ====

=== Benefits of purification therapy ===

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The benefits of a properly administered purification therapy include elimination of vitiated ''dosha'', alleviation of disease, improvement in strength, complexion and longevity. [22]

The benefits of a properly administered purification therapy include elimination of vitiated ''dosha'', alleviation of disease, improvement in strength, complexion and longevity. [22]

==== Summary ====

=== Summary ===

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Thus ends the fifteenth chapter on “Prerequisites for therapeutic ([[Panchakarma]]) treatment” of [[Sutra Sthana]] , of Agnivesha’s work as redacted by Charak.

Thus ends the fifteenth chapter on “Prerequisites for therapeutic ([[Panchakarma]]) treatment” of [[Sutra Sthana]] , of Agnivesha’s work as redacted by Charak.

=== ''Tattva Vimarsha'' / Fundamental Principles ===

== Tattva Vimarsha (Fundamental Principles) ==

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*It is necessary to manage the [[Panchakarma]] hospital properly, equipping it with good quality medicines and skilled staff for assuring successful administration of purification therapies.

*It is necessary to manage the [[Panchakarma]] hospital properly, equipping it with good quality medicines and skilled staff for assuring successful administration of purification therapies.

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=== ''Vidhi Vimarsha'' /Applied Inferences ===

== Vidhi Vimarsha (Applied Inferences) ==

   

   

==== Construction of a hospital ====

=== Construction of a hospital ===

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#A well equipped facility with the following recommended criteria is needed for various ayurvedic purification treatments:

#A well equipped facility with the following recommended criteria is needed for various ayurvedic purification treatments:

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[[File:Swedana.png]]

4. Vamana karma-

4.Vamana karma-

After proper purvakarma (or pre-purification activities), key purification procedures such as  therapeutic emesis are administered to the patient, using substances such as  madanaphala along with honey, rock salt, phanita (jaggery) and the powder of madhuka.  

After proper purvakarma (or pre-purification activities), key purification procedures such as  therapeutic emesis are administered to the patient, using substances such as  madanaphala along with honey, rock salt, phanita (jaggery) and the powder of madhuka.  

Benefits of vamana karma (therapeutic emesis): Vamana karma is a procedure indicated for the removal of toxins, especially kapha-pitta dosha situated in the upper part of gut. Vamana is done before virechana karma because if virechana is administered before vamana, the provoked kapha descends downwards to grahani [duodenum part and site of agni] and covers it, resulting in a feeling of heaviness and indigestion. The vamana procedure is initiated with a dose of decoction of madanphala mixed with honey, madhuka, rock salt and phanita.  Madanphala is a widely used medicine for therapeutic emesis due to its potency. All other ingredients aid in the process of emesis and removal of toxins. Rock salt has the potential to carry drugs to microchannels and increase secretions to expel out toxins. [9-10]

Benefits of vamana karma (therapeutic emesis): Vamana karma is a procedure indicated for the removal of toxins, especially kapha-pitta dosha situated in the upper part of gut. Vamana is done before virechana karma because if virechana is administered before vamana, the provoked kapha descends downwards to grahani [duodenum part and site of agni] and covers it, resulting in a feeling of heaviness and indigestion. The vamana procedure is initiated with a dose of decoction of madanphala mixed with honey, madhuka, rock salt and phanita.  Madanphala is a widely used medicine for therapeutic emesis due to its potency. All other ingredients aid in the process of emesis and removal of toxins. Rock salt has the potential to carry drugs to microchannels and increase secretions to expel out toxins. [9-10]

It is necessary to clinically assess movement of dosha from shakha (peripheral tissues) to the koshtha (gut) to expel the vitiated dosha from the body. Symptoms and signs of each stage are as follows:

It is necessary to clinically assess movement of dosha from shakha (peripheral tissues) to the koshtha (gut) to expel the vitiated dosha from the body. Symptoms and signs of each stage are as follows:

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=====• Five day diet schedule for post therapeutic regimen in case of moderate therapeutic emesis: =====

==== Five day diet schedule for post therapeutic regimen in case of moderate therapeutic emesis: ====

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=====• Justification of diet:=====

====Justification of diet:====

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=====Virechana karma [therapeutic purgation]:=====

====Virechana karma [therapeutic purgation]:====

G. After completion of the post therapeutic dietetic program, the pre-therapeutic procedures like oleation and sudation should be administered again for therapeutic purgation. All the procedures should be similar to therapeutic emesis except medicated smoking. It is not done after purgation.

G. After completion of the post therapeutic dietetic program, the pre-therapeutic procedures like oleation and sudation should be administered again for therapeutic purgation. All the procedures should be similar to therapeutic emesis except medicated smoking. It is not done after purgation.

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