Preparation for Panchakarma: Oil Therapies And Sudation Therapies

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
It is always indicated to conduct oil therapies and sudation before doing Panchakarma therapies. They are also the mandatory procedures and preparatory steps for successful accomplishment of Panchakarma therapies.
Read – Ayurvedic Panchakarma Treatment: Introduction, Benefits, Dosha Relation

Panchakarma Therapies

Panchakarma therapies are purification therapies in Ayurveda. They are used electively for cleansing the body of its impurities and morbid doshas. They are five in number –

Vamana – therapeutic emesis
Virechana – therapeutic purgation
Niruha Vasti – herbal decoction enemas
Anuvasana Vasti – medicated oil / ghee enemas
Nasya / shirovirechana – nasal medication

Anuvasana Vasti wherein oils/ghee /mixture of many kinds of medicated fats are mixed to give enema is not strictly a cleansing therapy. It is more supportive and nourishing therapy and has less of a cleansing role.

According to other schools Asthapana and Anuvasana Vasti are clubbed into one (as they are types of enema) and Raktamokshana (bloodletting) is included. Thus the 5 therapies are emesis, purgation, enema, nasal medication and bloodletting.
Read – Basti Chikitsa: Benefits, Routes, Types, Indications, Equipment

What are the oil therapies?

Oil / fat therapies include two types. They are –

1. Bahya Snehana – external administration of medicated fats. This mainly includes herbal oil massages.

2. Abhyantara Snehana – oral administration of medicated fats such as ghee or oil (as needed) in metered increased doses until the body is saturated with fats . This is also called Snehapana.

Both these therapies are used for preparation of the patient for Panchakarma therapies and are mandatory unless specified.
Read – Snehana – Oils and Fats Treatment – Ashtanga Hrudayam Sutrasthana 16

What is sudation?

Sudation means sweat inducing therapies. It is called swedana in Ayurveda. They too are used in 2 forms –

1. Sagni sweda – sudation using heat – like steaming methods

2. Niragni sweda – sudation wherein heat is not used – like staying in concealed room, sleeping with thick blankets covered over the body, exposure to heat of sun etc

The first form of sudation is generally used while preparing the patient for panchakarma. It is also mandatory unless exempted.
Read – Sweating Treatment – Swedana Types And Methods – Charaka Samhita 14

Should oil therapies and sudation be done before all Panchakarma measures?

Before emesis and purgation

When therapeutic emesis and purgation are administered in a classical way, it is mandatory to follow oleation and sudation before administering the main therapies.

Oleation is done with oral administration of medicated ghee / oil for 3, 5 or 7 days depending on the nature of cleansing that has been planned. Actually the rule is obtaining signs of proper oleation. Once these classical signs are obtained, the oral fat therapy should be stopped immaterial of the number of days the medicine has been given.

After the oleation days, sudation should be given. On the days of sudation, external oil therapies – herbal oil massage shall be done. This means to say that an oil massage should be given before administering sudation. This will also provide lubrication and buffer against the head provided in sudation.

Sudation too should be given until signs of proper sudation are obtained and immediately stopped. Sudation beyond this point will cause complications.

Once the oleation and sudation have been administered properly until the signs of their proper administration are obtained, emesis or purgation shall be administered as planned. Following this graduated dietetic regimen shall be given (samsarjana krama).

If emesis and purgation are administered one after the other, oleation and sudation should be administered before each procedure. The sequence should be as given below –

Oleation → Sudation → Emesis → Graduated dietetic schedule → Oleation → Sudation → Purgation → Graduated dietetic schedule
Read – Vamana Virechana – Emesis and Purgation – Ashtanga Hridayam Sutrasthana 18

Before Niruha and Anuvasana enemas

Oleation and sudation before unctuous or decoction enema are not mandatory. Even if they are administered there should be no problem. Local administration of oil therapy and sudation is preferable wherein oil massage is done over the abdomen before administration of enemas.

In these therapies oral administration of ghee / oil is not given since oil or ghee is also part of enema material and fats cannot be given both by oral and anal routes simultaneously. Unctuous enemas are given with ghee or oil. Ghee or oil is a small part of decoction enemas.
Read – Niruha Basti Panchakarma Method, Benefits, Side Effects, Management

Before nasal medication

In nasal medication oil or ghee are not given orally. The medicines are administered through the nasal route. Just as in enemas, administration of oil or ghee by two routes simultaneously is not allowed.

Body massage with medicated oils and sudation for the entire body is not necessary to be done before nasal medication but even if they are administered there should be no problem. Oil massage to the face and facial steaming are allowed as pre-procedures for nasal medication.
Read – Nasya Karma Procedure, Types, Benefits, Contra Indications

Why are oil therapies and sudation needed before administration of panchakarma therapies?

Diseases, according to Ayurveda, are caused due to the doshas getting lodged in the tissues. When this happens the doshas will start damaging the tissues. The interaction of the morbid doshas and ama with the tissues leads to the formation of disease and its symptoms.

Treatment procedure in Ayurveda targets breaking this vicious amalgamation of morbid doshas and susceptible tissues under attack.

These morbid doshas and metabolic wastes will also block the channels of the body in the disease process and cause deformity of the channels. The channels are not different from the tissues and materials they convey.

To break the amalgamation of the doshas and tissues they should first be mobilized from the tissues to the stomach / gut. The doshas would have lodged in the tissues and stubbornly adhered to the inside of their cells.
Read – Chikitsa: Treatment Types, Ayurvedic classification

The methods of bringing the doshas from tissues to the gut are –

Vriddhi – temporary increase of doshas in the tissues by causing them to bulge and preparing them to exit the cells
Vishyandana – dissolution of doshas in the tissues – to make the doshas blocked and sticking to the tissues flow towards the stomach, the doshas should be liquefied
Paka – digestion of doshas and make them free from ama attached to them
Srotomukha Vishodhana – opening up the blocked channels of the body
Vayu Nigraha – controlling the vitiated vata

The oleation will help in causing the doshas to bulge in the tissues. Sudation therapy will help in liquefying the doshas and preparing them to flow towards the stomach. If the doshas are associated with ama they stick to the tissues and it is difficult to remove them. The ama shall be digested by administering ama digesting medicines but the same will also be achieved by sudation therapy. Sudation following oleation therapy will also help in opening up and cleansing the channels. This will help in free flow of the stagnated doshas from the tissues and channels towards the stomach. Vitiated vayu will cause the transit of morbid doshas from gut to tissues and make them settle in the tissues. Oleation (internal and external) and sudation are the best remedies to control vitiated vata.

Thus, oleation and sudation when administered methodically will help in mobilizing the morbid doshas from tissues to the stomach. This is a mandatory procedure which needs to be done before elimination of doshas from the body. It is only after the doshas reach the gut, they can be removed through the cleansing therapies, mainly emesis and purgation. When there is kapha predominance, it shall be removed by administering emesis. When there is predominance of pitta, it shall be removed by administering purgation.
Click to Consult Dr Raghuram Y.S. MD (Ayu)