Pramathi Annapana, Meaning, Context, Clinical utility

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

Pramathi Annapana – What is it?

The word Annapana has two terms in it, Anna – means solid food and Pana – means liquid foods. These two terms cover almost everything we eat and drink on a daily basis. Though there are four kinds of food according to Ayurveda, these two are the main kinds of foods we consume almost every day.

When we look at ‘Pramathi Annapana’ it looks like a specialized food directed towards some therapeutic action. Very rarely some special terms like ‘pramathi’ are added as prefixes or suffixes with ‘annapana’. When used, it indicates strong and mandatory inclusion.

Pramathi meaning

निज वीर्येन यद् द्रव्यं स्रोतोभ्यो दोष सञ्चयं।
निरस्यति प्रमाथि स्यात् तद्यथा मरीचं वचा।शा.सं.४/२४।
nija vīryena yad dravyaṃ srotobhyo doṣa sañcayaṃ|
nirasyati pramāthi syāt tadyathā marīcaṃ vacā|śā.saṃ.4/24|

Any drug / herb which expels the accumulated doshas or malas from the internal channels of the body due to their specific activity and potency is called as Pramathi Dravya. Examples – Maricha – Piper nigrum and Vacha – Acorus calamus.

Going into the deeper meaning of the word ‘pramathi’ we can understand that the drugs which carry this property would remove blocks from the channels in the body. Seeing their broader concept, they can also be applied to remove clots from the blood vessels or for decongestant action.

This verse does not indicate the use of pramathi dravyas in treatment of constipation, which is also an obstruction occurring in the colon.

But the word pramathi has been used along with annadravya by Master Charaka. This shows that apart from maricha and vacha, there are also some foods which have ‘pramathi’ action and act on the principles of the same.

Context of Pramathi Annapana

पक्वाशयशिरःशूलं वातवर्चोऽप्रवर्तनम् | पिण्डिsकोद्वेष्टनाध्मानं पुरीषे स्याद्विधारिते||
स्वेदाभ्यङ्गावगाहाश्च वर्तयो बस्तिकर्म च| हितं प्रतिहते वर्चस्यन्नपानं प्रमाथि च||च.सू.७/८,९ ||
pakvāśayaśiraḥśūlaṃ vātavarco’pravartanam | piṇḍiskodveṣṭanādhmānaṃ purīṣe syādvidhārite||
svedābhyaṅgāvagāhāśca vartayo bastikarma ca| hitaṃ pratihate varcasyannapānaṃ pramāthi ca||ca.sū.7/8,9 ||

In the context of treatment of ‘Pureesha Vega Avarodha Janya Vyadhi’, consumption of ‘Pramathi Annapana’ has been mentioned. Pureesha Vega Avarodha means forcible withholding of urge to defecate. This causes imbalance of vata which would move in its abnormal direction i.e. upward direction and cause udavarta disease. Constipation is one of the symptoms produced as a result of ‘habitual practice of withholding defecation reflex’. Pramathi Annapana are those foods and drinks which help in clearing the obstructions caused in the channels of the body. Here, these foods would act on the principle of Pramathi Dravya.

In this case the ‘pramathi annapana’ would remove the obstruction in the colon i.e. constipation. So, any foods and drinks which would relieve constipation and balance vata are pramathi in nature.

Symptoms of or diseases caused by Pureesha Vega Dharana i.e. suppression of urge to defecate

–         Pakvashaya shula – Pain in colon / abdominal colic
–         Shirashula – Headache
–         Vata varcho apravartanam – Non elimination / retention of feces and flatus
–         Pindikodveshtanam – Cramps in the calf muscles
–         Adhmanam – Distension of the abdomen

Pramathi Annapana, apart from relieving constipation and removing blocks / obstruction in the colon, would also relieve the other symptoms / diseases caused by forcible suppression of defecation reflex mentioned above.

The other treatment options for these conditions include –

–         Swedana – Sudation / fomentation
–         Abhyanga – Massage with herbal oils,
–         Avagaha – Sitz bath / tub bath or immersion in medicated liquids like decoctions, oils etc prepared with vata mitigating herbs

–         Varti – Suppositories
–         Bastikarma – Therapeutic enema

Pramathi Annapana works in constipation in the best possible way with regular practice. These laxative foods along with the above-mentioned therapies, when skillfully administered, would yield good results in treatment of chronic constipation.

Studies and research works in shortlisting and categorizing pramathi annapana are required in this direction.

Can fiber foods be considered as Pramathi Annapana?

Some foods rich in soluble fibers and some insoluble fibers may be considered under pramathi annapana.

Foods cooked with vegetables like carrot, beetroot, cucumber, cauliflower, broccoli and green leafy vegetables like palak leaves, lettuce etc. mentioned above, and foods having whole grains and foods like coconut water, buttermilk, lemon water and green tea may be considered as pramathi annapana.

Excessive fibres may also cause vata aggravation. Therefore, it is always necessary to understand the limitations of using fibers in the treatment of constipation. Fiber rich foods shall be a part and parcel of ‘constipation treatment’ and not the main treatment.

Fiber rich foods shall be heated, boiled or processed with vata alleviating herbs, appetizers, digestant medicines, oil and ghee, salt and addition of sour substances so as to avoid the wrong effects of fibers in those suffering from constipation.

Fiber foods are dry in nature. That is the reason that they can increase vata when used in excess. It is important that the fiber foods shall be sweet in taste and sweet or sour in ‘post digestion effect’. Or fiber foods with oily ingredients should be selected. Only such fiber foods are helpful in balancing vata and curing constipation.

Root causes of constipation should be traced and isolated. Dosha and disease specific medicines, diet and therapies are the main strategies for treating constipation and fiber foods are small inclusions. Vata aggravating etiological factors shall be avoided. One should not withhold natural urges of the body. The causative factors responsible for udavarta, adhmana, atopa and anaha too shall be avoided.