June 201636 THE ANTISEPTIC

Introduction:

Childhood is very crucial period where child picks up growth and development with respect to physical, physiological and social aspect.Dosha,dushya and mala present in body are identical to adult but present in lesser quantity in children. The diseases that manifesting adult can also manifest in a child but with a lesser involvement of Dosha and with less intensity.1

Dhatri stanya dushti is the main cause for diseases in Ksheerada avastha. Hence Shodana should be done both in dhatri and Shishu.

Acharya Kashyapabeing pediatrician advises Panchakarma therapy from first year of life. However in today’s time it is observed that with a certain set of precautions along with proper drug and dose Panchakarmatherapiescan be administered in Baala.

In present situation there

Administration of Panchakarma in Paediatric Age Group – A Classical ReviewVANITA T. HAVINAL, AZIZ I. ARBAR, VEENA K.H.

Dr. Vanita T. Havinal, 3rd year PG Scholar, Dr. Aziz I. Arbar, MD(Ayu.), Reader, Dr. Veena K.H., MD(Ayu.) HOD, Department of Kaumarbhritya KLE University’s Shri BMK Ayurveda Mahavidyalaya Shahapur, Belagavi.

Specially Contributed to "The Antiseptic" Vol. 113 No. 6 & P : 36 - 40

ABSTRACT

According to Acharya Charaka in children the role of dosha, dushya & mala in variousdiseases are similar to the adults but in lesser intensity based on body weight, age & agni of child. Whatever the disease the adult suffers the child also suffers. Panchakarma constitutes unique therapies in Ayurveda System of Medicine. They are equally beneficial in the prevention and cure of the disorders there by improves the life span of the individual. In pediatric practice these therapies are helpful when administered with due consideration of stage of the diseases, dosage of medicines, proper method, vaya and Bala of the children. Care should be taken in the prevention of complications. Shodhana is advised to eliminate the vitiated doshas and to bring the doshas to normal condition. Kashyapa being kaumarabhritya physician advised panchakarmatherapies like vamana, virechana, basti, niruha, yapana and anuvasana bastiin bala starting from infancy.Whereas he contraindicated raktamokshana in children. He attributes complete siddhisthana to explain this. At various places he explained doses of sneha, vamana and virechanadravya and mentioned the quantity of basti as per different age. Key Words: Anuvasana basti, Niruha basti, Snehana,Vamana matra, Virechana, Nasya.

is difficulty in administering panchakarma in children becauseof lack of standardization of the doses of medicine in children and also difficulty in deciding the dosage of snehana etc. Considering all these factors, an effort is made in this article to discuss the dose fixation as per different age in Baala Panchakarmawhich can be used for various research purposes.Purva karma: Deepanaand Pachana

Before Shodhana karma, deepana and pachana should be done to attain niramavastha of doshas. This relieves ama at the level of Koshta.

Common formulations used for pachana in paediatrics are Agnitundivati, Sankhvati, Trikatu, Sunthichurna, Panchakola etc.Pachana is usually done with mridu Bheshajam having Anulomana property.2

Flowchart of Deepana Dravya Karma

Deepana

Kosta Laghava

Increases Agni

Promotes Digestion and Absorption

Flowchart of Pachna Dravya Karma

Pachana

Dhatu

Increases Dhatw Agni

Promotes Dhatu Parinama

Pachana is usually done with Laghu, Ruksa, Ushna, Teekshna Bheshaja whichreleives Ama at the level of Kosta.Sneha Matra

Varsha Badve et al. (2003, Jamnagar) have formulated agni bala index for fixing the dose of sneha. During snehapana agni vriddhi is expected.This ignited agni has thus more power to digest more quantity of sneha in the same stipulated time.Pachana kala and quantity thus play a very important role while calibrating the

37 THE ANTISEPTIC June 2016

agnibala. As agnibala increases,the pachana kala is bound to decrease. Assessment of agni is done as follow: A.I (Abhyavaharana

Index) = Test dose T(Time)Given dose

Time required for the digestion of sneha i.e., jarana shaktiand Abhyavaharana Shakti should be considered for snehamatra. Abhyavaharana Indexcan be calculated as follow. For example, if 30ml of sneha digests in 1 hour then Abhyavaharana Shakti index on 1st day would be 30/30X1=1. Therefore, it can be understood that if Abhyavaharana Shakti is more than 1 then it is tilting towards decrease of Agnibala and if Abhyavaharana Shakti is less than 1 then it shows the improvement of Agni.

With the help of Abhyavaharana Shakti one can calculate Agnibala. To perceiveAgnibala the second factor to be considered is kala i.e., the time required to digest the given dose of sneha.

For example in a person if 70ml of sneha digests in 3 hours on 2nd

day then the Abhyavaharana Shakti index=30/703=1.29. On 3rd day if 100ml of sneha digests in 3.5 hours the Abhyavaharana Shakti index=30/1003.5=1.05. Second day Abhyavaharana Shaktiindex is 1.29 which is reduced to 1.05 on 3rd day which indicates the increase of Agni that occurs by sneha. In similar way Abhyavaharana Shakti index should be calculated till the completion of snehana.Lesser the Abhyavaharana Shakti index more will be the Agnibala.2

TABLE -1

Swedana

Swedana is defined as the process by which the sweat or perspiration is produced in the body by using various methods.

Types of sweda according to Acharya Kashyapaare Hasta,

Pradeha, Nadi, Prastara, ankar, Upnaha, Avagaha and Parisheka After gradual disappearance of delicacy and appearance of toughness the sudation of these children should be increased.Bala taila parisheka sweda is given in newly born according to Acharya Vagbhata. Hasta sweda-upto 4 months of

age. Pata sweda- up to 6 years Pradeha- From Age of 4th month

onwardsFor Shodhana purpose usually

these Swedana should be done in children.

Among above mentioned types following swedana are commonly employed in pediatric practice.Pariseka2:

Pouring of Ushnakwatha,taila,Ghrita,dugdha,kanji,gomutra etc liquids over the body from a specific height is known as Pariseka.Kayaseka is one of the most important treatments for vata diseases.

This is generally indicated in paralysis, hemiplegia, Apatantraka, Antarayama, Bahyayama.Avagaha Sveda4,5:

A good sized tub is filled with hot decoction of vata alleviating drugs,milk,oil,meat,soup or water and uncted patient lies in this.Nadi Sweda4,5:

The drugs,flesh of dear or birds, Kanji (Sour drink), Salt, Oil,

Urine and milk etc. as per need are boiled in a big pot with mouth sealed with a saucer or another pot having a hole preferably in Centre, which is fitted with a flexible pipe either resembling trunk of elephant or bent at three places.The hot vapor Coming out of this is used for Sudation.Vamana

Vamana is a process in which vitiated Dosha are expelled through the upper route i,e mouth.Administration6

Vamana is a treatment of choice for kapha disorders especially in children who have predominance of kapha. Mridusadyo Vaman is advisable. No purvakarma procedures are required in infancy and early childhood required because Bala shareerais snigdha.

For Ksheerapa, vamanais administered when baala is Tripta with stanya.

For Ksheerannada, vamanais administered when baala is Tripta with dudha and peya.

For Annada, vamanais administered when baala is Tripta with peya and ghrita.Application-6

Ksheerada:

Apply vaman drug like madan pushpa, pippali, saindhav, Madhu over the breast of mother and after it dries up, wash it and then baby is made to feed which leads to easy vaman.

Table-1Sneha Matra according to Acharya Sushruta3

Dose Time required Action Indication for Digestion Prathama Matra 3 Hours Agnidipti Alpa DoshaDvitiya Matra 6 Hours Vrushya Madya DoshaTritiya Matra 9 Hours Brimhana Bahu DoshaCaturtha Matra 12 Hours Snehaniya Glani, Murchana, MadaPanchama Matra 24 Hours Pujaniya Kushta, Visha, Unmada, Graha, Apas-mara

June 201638 THE ANTISEPTIC

Ksheerannada:

Administer madan,vacha along with breast milk.Annada:

The decoction of madan,vacha with Saindhavis given for emesis.Age Indication:-6

Table No.2 showing indication of Vamana at different age by various Acharya

Acharyas AgeVaideha janaka InfancyVriddha Kashyapa 4th or 8th monthKashyapa 6 yrs.

According to Kashyapa Vamana therapy is suitable to the children only after age of 6 years. He describes it to be best to use the milder potency drugs in small quantity for the same.Vamana dravya dosage:

The dosage of various vamana formulations by different acharyais described below. Kashyapa - Vidanga phala /

Amalaka matra Vaideha janaka- 2-3 seeds of

Apamarga + Madhu + Sharkara Vriddha kashyapa11/2 to 2

phalaMode of administration

The vamana medication is administered in Kalka / kwatha form mixed with enough sharkara & Madhu.

Following herbs are used in kwatha form

Shwetha sarshapa, Vacha, Saindava, Pippali and Madana beeja

Pradhana Karma7

Based in the assessment of strength and weakness of children and of theDosha, decoction is prepared withfruits of Madana [4anjali(120ml), 3anjali(90ml), 2anjali(60ml)] and mixed with Honey and Rock salt which is

1/8th of kwatha, thenmixed with either pippali and sarshapa or Patola,arista and vatsaka orpaste of priyangu and madhuka (3gm) to induce Vamana.Treatment of inadequate/improper emesis

Water mixed with the available drugs out of triphala,citraka,danti etc are mixed with goats milk in half of its quantity. Parched paddy of good qualityof Sali rice should be given in sufficient quantity, for inducing vomiting immediately.Paschath karma6

Post vamana following procedures are to be done. Ushnajala prakshalana and

kavala Nidra in Nirvata pradesha

Shali prepared with Apamarga

/ Pippali / Shirisha Ardraka samskaritha jala for

pana Virechan8

The process in which the elimination of Dosha through the adhobhagais known asVirechana

Except kashyapa acharya all othersmentioned baala as ayogya for virechan. Pradhan karma- (Ka Si 3/15-16)

Any one of the herbs out of danti, shyama, kampillak, neelika,vacha,vishanikais takenin 1 karsha or ½ pala dosethen1 prastha of wateris added and boiled and reduced up to 1/4th of its quantity. Later gomutra is added to it to induce Virechana. The same formulation in the form ofleha can be administered with butter.Paschat karma:

Post virechana all the proceduresas mentioned under vamana are to be done.Medicinesfor Virechana:6

1. Pathya mixed with pippali and rocksalt or trivruta

2. Fruit of Aragwadha treated with milk or soup (meat soup)

3. Trivruta or Triphala mixed with ghrita, vyosa, rocksalt

4. Gandharva taila is best for unctuous purgation

5. Trivruta, draksha and abhaya mixed either with decoction of dasamula or meat-soup of wild animals or decoction of draksha or water of appetizing drugs or cows urine.Aragwadha is madhura,mrudu

and does not produce much complication. Aruna variety of trivrit is best in children as it is mrudu.

I f v i b a n d h a a n d dahaare associated then, Aragwadhaphalamajja with Draksha is administered for rechana.Basti9

The karma in which the medicine is administered through anal canal reaches up to the nabhi pradesha,kati pradesha,parsva,kukshi churns the accumulated Dosha and purisha spreads the unctuousness all over the body and easily comes out along with the purisha and Dosha is called basti.

Among all therapeutic procedures, basti is superior because it like nectar in both bala and aged group.Kashyapa acharyaclassified

basti into karma, kala, yoga, Chaturbhdra Kalpa.Table-3 Classification of bastiAccording to sankhya

Basti No. of BastiKarma 24 Anuvasan+ 6 NiruhaKala 12 Anuvasan+ 3 NiruhaYoga 5 Anuvasan+ 3 NiruhaChaturbhdra Chaturbhdra

39 THE ANTISEPTIC June 2016

Table-4 Classification of Basti according to various quantity of sneha

Acc.to Sneha basti Anuvasan basti Matra bastiSarangdhar (Ut.Kha.5/20) 1/4th of total quantity ½ of of total quantity Dose which digest of niruha of sneha basti. in 6 hr. ½ of anuvasanSushruta ------------- 1/4th of total quantity 1/4th of sneha i.e of niruha(300ml) 75mlDalhann 6 pala 3pala 1 ½ palaChakrapani 6pala 3pala 1 ½ pala

Table-5 Dose of Basti as per Acharya Kashyapa-(10)

Sneha basti Niruha basti (3 times of sneha) Age Matra Matra Upto 3 year 3 karsha(45ml) 9 Karsh 4-5 year 1 pala(50ml) 3 pala 6-11 year 2 prasruta 6 prasruta 17 year and above 4 prasruta 12 prasruta Old age Matra is to be decrease Table-6 Limits of matra basti as perAcharya Kashyapa –[11]

Matra basti Dose Uttam 2Prakunch(50ml) Madhyam 1 ½ Prakunch(75ml) Hina 1Prakunch(100ml)

Nasya

Nasya karma is a therapeutic measure where the medicated oil,kwatha,svarasa,curna etc are administered through nose to eliminate the vitiated Dosha situated in sirafor the treatment of Urdhvajatrugata vikaras

Types of Nasya:mainly classified according to its mode of action Shodhana,Samana etc.

Marsha nasya cannot be given below 7 years and after 80 years of age.In Infants (Kashyapa)

Kaphaja disorders12– katu taila with Ghrita and saindava (2 – 3 drops)

In Older Children

Kaphava ta ja d i sorders – Prishnaparni, pippali, Apamarga, Ardraka, Swarasa, MadhuSpecially to breast fed children,

mustard oil or Ghrita mixed with rock salt should be used. Two or three drops should be instilled in each nostrils following which the nostrils should be closed with finger for a short while. With this shleshma disease of child gets cured.

Table-7 Dose calculation of niruha bastias per differentacharyas6

Age in year Acc. To charak & vagbhatta Acc.to kashyap in Prasruta In ml 1 ½ 50 2 1 100 3 1 ½ 150 4 2 200 5 2 ½ 250 6 3 300 7 3 ½ 350 8 4 400 9 4 ½ 450 10 5 500 11 5 ½ 550 12 6 600 13 7 700 14 8 800 15 9 900 16 10 1000 17 11 1100 18-70 12 1200 >70 10 1000

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Herbsused In Nasya (As per Acharya Kashyapa) In the predominance of Kapha

and vayu Pippali, Iksvaka, Ksavaka,

Lasuna, Mayuraka, Rocksalt, Sauvarcala, jyotishmati, and Vishwabheshaja, twaka.

Paschaat karma

It includes post panchkarma procedures likePeyadi samsarjana karma & rasayan sevana.

In Vata kapha dominant roga anupan is Usna udakaRakta- mokshan13

Siravyadha variety of raktmokshanis contraindicated throughout the childhood period till 16 years. However Jalauka14

variety of bloodletting is mentioned and suitable for children.Discussion

The Dose of Snehapana is completely dependent upon the Agni, Koshtha, Prakriti, Dosha along with Bala, Satmya, Satva, Vaya etc., which place the physician in trouble while deciding the Dose and duration for achieving adequate snehana. But Snehana should be given till the appearance of Samyaka Snigdha Laxanas viz., agni deepti,tvak mardavata, purisha snigdhata etc6

According to Acharya Kashyapa, Vamana therapy is suitable to the children only after age of 6 years.before 6 years,Vamana should not be administered because in children, Vamana Vyapad (complications)if occur, will be difficult to treat. According to strength of patient and disease Pravara,Madhyama, and AlpaVirechana should be achieved respectively in Uttama, Madhyama

and AlpaBala patients and disease.Acharya KashyapamentionedBasti should be administered at crawling stage when child starts to take solid food. The reason behind this is the child becomes more stable after 1 year of age. Among all 5 types of Panchakarma therapies, Basti (medicated enema) therapy is the most commonly used treatment modality as it is safe and noninvasive therapy.

We have tried to decide the dose and drugs which are used in Baal Panchakarma but for Drug and dose fixation in Baala Panchakarma standardization is required where lot of research is essential.Conclusion

By going through the above points one can understand that Panchakarmais the unique therapy in Ayurveda System of Medicine. They are equally beneficial in the prevention and cure of the disorders there by adding quality to life and improving the life span of the individual.

In pediatric practice also these therapies are helpful

provided administered with due consideration in stage of the diseases, dosage of medicines, proper method, vaya and Bala of the children. Care should be taken in the prevention of complications.REFERENCE:1. Charaka Samhita 30th chapter Acharya Vidyadhara

shukla and professor ravidatta tripati Chaukambha Sanskrit pratishthan Delhi edition2007

2. Principles and practice of Panchakarma by Dr Vasanta.C.Patil Atreya Ayurveda Publication

3. Susruta Samhita Kaviraja Ambikadatta Shastri Choukamba Publication.

4. Susruta Samhita Kaviraja ambikadatta shastri Choukamba publication chikitsa sthana 31/25-29

5. Charaka Samhita Acharya Vidyadhara shukla and professor ravidatta tripati Chaukambha Sanskrit pratishthan Delhi edition2007 sutrasthana 14/34-35

6. Susruta Samhita Kaviraja ambikadatta shastri Choukamba publication chikitsa sthana 32/13

7. Kashyapa Samhita Vriddhajivakiya tantra P V Tiwari Choukambha Vishvabharati Varanasi

8. Kashyapa Samhita Vriddhajivakiya tantra P V Tiwari Choukambha Vishvabharati Varanasi Khilasthana 7th chapter 45-54

9. Kashyapa Samhita Vriddhajivakiya tantra P V Tiwari Choukambha Vishvabharati Varanasi Siddhisthana 3/15-16

10. Kashyapa Samhita Vriddhajivakiya tantra P V Tiwari Choukambha Vishvabharati Varanasi siddhisthana 1-9

11. Kashyapa Samhita Vriddhajivakiya tantra P V Tiwari Choukambha Vishvabharati Varanasi Khilasthana 8/106-109

12. Kashyapa Samhita Vriddhajivakiya tantra P V Tiwari Choukambha Vishvabharati Varanasi khilasthana 8/ 104-105

13. Charaka Samhita Acharya Vidyadhara shukla and professor ravidatta tripati Chaukambha Sanskrit pratishthan Delhi edition2007 siddhisthana

14. AstangaHrudayam sutrasthana 27th chapter /6 Nidansthana by BrahmanandaTripathi Chaukhamba Sanskrit pratishthan Delhi.

15. Susruta Samhita sutra sthana 13/3 kaviraja ambika datta shastri choukamba Sanskrit sansthan Varanasi 2007

Table-8 Basti netra size according to the age as told by charaka

Age Size in Angula Increment per year Diameter of the agrabhaga1-6 yr 6 -- Mudgavahi7-12 yr 8 1/3 Kalayvahi13-20 yr 12 ½ Kolasthivahi

Table-9 Samsarjana-12

Day Samsarjana 1 Pradhan karma jeerana bhakta sukhosita jala and mand 2 Yavagu panam 3 Deepaniya, Ruksha,ushna,saindhav siddha vilepi 4 Mudga mand sadhita odan 5 Phalamla mudga manda sadhita odana 6,7 Ghrita mudga manda yukta odana 8 Jangal mamsa rasa & odan 9 Ghrita yukta mamsa rasa & odana 10-11 Ghrita lavan amla mamsa rasa yukta odana