CRITICAL REVIEW OF EFFICACY OF PANCHAKARMA IN PREVENTING DIS- EASES THROUGH THE WAY OF IMMUNITY (STRESS RESPONSE HORMESIS)

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CRITICAL REVIEW OF EFFICACY OF PANCHAKARMA IN PREVENTING DIS-
EASES THROUGH THE WAY OF IMMUNITY (STRESS RESPONSE
HORMESIS)
Chandaliya Sachin Shantilal1, Chandaliya Deepali Sachin2, Sane Varsha Nitin3, Jadhav
Mayura Vishwasrao4.
1,3 Associate professor, 4Assistant professor,Department of Panchakarma, College of Ayurveda
and Research Centre, Akurdi, Pune, Maharashtra, India
2Associate Professor and Head of Department, Department of Rasashstra, S M B T Ayurveda
College, Dhamangaon, Nashik, Masharashtra, India
INTRODUCTION
“Panchakarma” is the special term
used by Charaka which includes five specia-
lised proedures viz Vamana (Act of Vomit-
ing), Virechana (Act of purgation), Niruha
Basti - Anuvasana Basti (Acts of medicated
enema) and Nasya (Act of medicated nasal
instilation). In medical sciences, there is an
established pattern of treatment. The whole
part of treatment is divided in two broad cat-
egories viz Medicines and Surgery. Diseases
are cured by giving medicines or correcting
by surgical intervention. Panchakarma is the
way of curing the ailment in a slightly dif-
ferent manner. It definitely does not fall in
the category of Surgery. It is not the medi-
cinal way of treating the diseases too. So it
definitely holds some different way of action
over all the systems.
Role of Panchakarma in prevention of
Diseases -
A. Role in preventing the diseases al-
ready cured -
“The treatment modules like Lang-
hana-Pachana-Rukshana-Stambhana etc.
though might be helping to pacify provo-
cated humours and decrease the quantity of
Review Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
Panchakarma has Samshodhana as a main objective. Four out of five procedures expel the
humours for purificatory purpose. Though all the procedures are different in methods, they are tied
in one bunch. It indicates they are something very common among them. It probably is the nature
of their action.Panchakarma procedures are Apakarshana (scrapping) in nature. They are quite
stressful in nature. They create a lot of stress over the metabolism during their course. Any type of
stress over the body invokes immunity response from the body. This immunity work is carried out
through the ways of endocrinal secretions, lymphocyte mobilisation or response to inflammation
created by the stress. So there are a lot of chances that Panchakarma procedures might be stimulat-
ing the immunity system to reduce the ailments by producing a lot of antistress metabolites in the
blood stream. This can be understood if studied the “Stress Response Hormesis”.
Keywords: Panchakarma,Samshodhana,immunity
CRITICAL REVIEW OF EFFICACY OF PANCHAKARMA IN PREVENTING DIS-
EASES THROUGH THE WAY OF IMMUNITY (STRESS RESPONSE
HORMESIS)
Chandaliya Sachin Shantilal1, Chandaliya Deepali Sachin2, Sane Varsha Nitin3, Jadhav
Mayura Vishwasrao4.
1,3 Associate professor, 4Assistant professor,Department of Panchakarma, College of Ayurveda
and Research Centre, Akurdi, Pune, Maharashtra, India
2Associate Professor and Head of Department, Department of Rasashstra, S M B T Ayurveda
College, Dhamangaon, Nashik, Masharashtra, India
INTRODUCTION
“Panchakarma” is the special term
used by Charaka which includes five specia-
lised proedures viz Vamana (Act of Vomit-
ing), Virechana (Act of purgation), Niruha
Basti - Anuvasana Basti (Acts of medicated
enema) and Nasya (Act of medicated nasal
instilation). In medical sciences, there is an
established pattern of treatment. The whole
part of treatment is divided in two broad cat-
egories viz Medicines and Surgery. Diseases
are cured by giving medicines or correcting
by surgical intervention. Panchakarma is the
way of curing the ailment in a slightly dif-
ferent manner. It definitely does not fall in
the category of Surgery. It is not the medi-
cinal way of treating the diseases too. So it
definitely holds some different way of action
over all the systems.
Role of Panchakarma in prevention of
Diseases -
A. Role in preventing the diseases al-
ready cured -
“The treatment modules like Lang-
hana-Pachana-Rukshana-Stambhana etc.
though might be helping to pacify provo-
cated humours and decrease the quantity of
Review Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
Panchakarma has Samshodhana as a main objective. Four out of five procedures expel the
humours for purificatory purpose. Though all the procedures are different in methods, they are tied
in one bunch. It indicates they are something very common among them. It probably is the nature
of their action.Panchakarma procedures are Apakarshana (scrapping) in nature. They are quite
stressful in nature. They create a lot of stress over the metabolism during their course. Any type of
stress over the body invokes immunity response from the body. This immunity work is carried out
through the ways of endocrinal secretions, lymphocyte mobilisation or response to inflammation
created by the stress. So there are a lot of chances that Panchakarma procedures might be stimulat-
ing the immunity system to reduce the ailments by producing a lot of antistress metabolites in the
blood stream. This can be understood if studied the “Stress Response Hormesis”.
Keywords: Panchakarma,Samshodhana,immunity
CRITICAL REVIEW OF EFFICACY OF PANCHAKARMA IN PREVENTING DIS-
EASES THROUGH THE WAY OF IMMUNITY (STRESS RESPONSE
HORMESIS)
Chandaliya Sachin Shantilal1, Chandaliya Deepali Sachin2, Sane Varsha Nitin3, Jadhav
Mayura Vishwasrao4.
1,3 Associate professor, 4Assistant professor,Department of Panchakarma, College of Ayurveda
and Research Centre, Akurdi, Pune, Maharashtra, India
2Associate Professor and Head of Department, Department of Rasashstra, S M B T Ayurveda
College, Dhamangaon, Nashik, Masharashtra, India
INTRODUCTION
“Panchakarma” is the special term
used by Charaka which includes five specia-
lised proedures viz Vamana (Act of Vomit-
ing), Virechana (Act of purgation), Niruha
Basti - Anuvasana Basti (Acts of medicated
enema) and Nasya (Act of medicated nasal
instilation). In medical sciences, there is an
established pattern of treatment. The whole
part of treatment is divided in two broad cat-
egories viz Medicines and Surgery. Diseases
are cured by giving medicines or correcting
by surgical intervention. Panchakarma is the
way of curing the ailment in a slightly dif-
ferent manner. It definitely does not fall in
the category of Surgery. It is not the medi-
cinal way of treating the diseases too. So it
definitely holds some different way of action
over all the systems.
Role of Panchakarma in prevention of
Diseases -
A. Role in preventing the diseases al-
ready cured -
“The treatment modules like Lang-
hana-Pachana-Rukshana-Stambhana etc.
though might be helping to pacify provo-
cated humours and decrease the quantity of
Review Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
Panchakarma has Samshodhana as a main objective. Four out of five procedures expel the
humours for purificatory purpose. Though all the procedures are different in methods, they are tied
in one bunch. It indicates they are something very common among them. It probably is the nature
of their action.Panchakarma procedures are Apakarshana (scrapping) in nature. They are quite
stressful in nature. They create a lot of stress over the metabolism during their course. Any type of
stress over the body invokes immunity response from the body. This immunity work is carried out
through the ways of endocrinal secretions, lymphocyte mobilisation or response to inflammation
created by the stress. So there are a lot of chances that Panchakarma procedures might be stimulat-
ing the immunity system to reduce the ailments by producing a lot of antistress metabolites in the
blood stream. This can be understood if studied the “Stress Response Hormesis”.
Keywords: Panchakarma,Samshodhana,immunity

Chandaliya Sachin Shantilal Et Al: Critical Review Of Efficacy Of Panchakarma In Preventing Diseases Through The Way Of
Immunity (Stress Response Hormesis)
1754
www.iamj.in IAMJ: Volume 3; Issue 6; June- 2015
humors significantly, they are not that much
effective as that of Panchakarma. Former
modules of treatment as explained above
may be helpful in decreasing the diseases by
passifying the humors, but the residual hu-
mors after the treatment may get provocated
immediately if they got the boost from the
similar properties to them gained from caus-
ative factors. But the humours if passified or
removed by Panchakarma may not get pro-
voacated with same strength again.1The dis-
ease passified by the treatment of Pancha-
karmabecomes ‘Apunarbhava’means it will
never occur again once cured by Pancha-
karma treatment2”.
B. Role in prevention of the diseases -
“If one pursues Vishamaswastha-
vrutta, it will create diseases and if one fol-
lows swasthavrutta, one will enjoy Aroga.
So everybody shall pursue swasthavrutta to
be fit and to stay healthy3. In the months of
Chaitra-Shravana-Margashirsha, respective
humors like accumulated Kapha-Vata and
Pittas shall be expelled from the body by
appropriate procedures. After obtaining
proper Oleation- Sudation, one must remove
humors from upper and lower routes of the
body (i.e.Vamana and virechana). Follow-
ing that one should perform Basti and
Nasya. This must be followed in an appro-
priate way and in appropriate sequence. The
person who knows the management is ac-
cording to’ time’ must use approved medi-
cines from Rasayana and Vrushya catego-
ries4.“The person who follows the above
cited process will never get affected by the
diseases. One’s Dhatus will stay in normal
levels qualitatively as well as quantitative-
ly.Dhatus will be strengthened and the per-
son will be able to delay the process of age-
ing. This system of treatments is explained
to prevent the Nija diseases from occur-
ance5.Panchakarma acts in both the ways
that it prevents the diseases to arise in future
as well as the diseases which once get
cleared shall not appear again too. This
function mimics to that of vaccines. “A vac-
cine” is a biological preparation that pro-
vides active acquired immunity to particular
disease. It stimulates the body's immune sys-
tem to recognize the agent as a threat, de-
stroy it, and keep a record of it, so that the
immune system can more easily recognize
and destroy any of these microorganisms
that it later encounters.Thus, Panchakarma
might be working on the lines of Immunity
over the whole body6. One must try to un-
derstand the hypothesis on the basis of five
logical steps which lead to establish a ‘Sid-
hanta (Principle)’viz. Pratidnya-Hetu-
Udaharana-Upanaya-Nigamana as follows.
Aims and Objectives (PRATIDNYA):
1. To study the nature of action of Pancha-
karma over the body.
2. To study the effect of stress over the
immunity and overall physiology of the
body.
3. To study the beneficial effect of stress
through the produres of Panchakarma
over the body.
4. To establish the process of “Stress Effect
Hormesis” through Panchakarma.
Materials:
1. Literary review of various definitions,
nature, indications and effects of Pan-
chakarma.
2. Literary review of stress Response hor-
mesis, physiology of immunity, pub-
lished experiments done to evaluate the
effects of stress over the body.

Chandaliya Sachin Shantilal Et Al: Critical Review Of Efficacy Of Panchakarma In Preventing Diseases Through The Way Of
Immunity (Stress Response Hormesis)
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Methods:
1. Role of Panchakarma in prevention of
the diseases were studied.
2. Collection and analysis of all the refer-
ences were done.
3. The collected data of references was
compared and processed logically to ve-
rify the concept and to arrive at conclu-
sion.
OBSERVATIONS:
HETU -Logical thought behind the Hypo-
thesis - Effect of Panchakarma over physi-
ology - Panchakarma procedures need
strength of the body to face the removal of
provocated and quantitatively huge Hu-
mours from the body. They are done with
caution after excluding all the burdening pa-
thologies which might put stress over the
body. If done excessively, they might create
harm or it is said they are bound to create
complications if anyone of the doctor-
Medicines-Patient and Nurse performs a
mistake7. So Panchakarma do definitely put
stress over the body. It can be perceived
from the following examples too.
1. “After removal of provocated humours
and bloodletting, Vata might get aggra-
vated immediately occupying the ‘Shud-
ha Koshtha‘ (evacuated Gastro intestinal
tract)’ in a ‘weakened patient (of Kush-
tha)’. So he must be supplied with enogh
quantity of strength (Bala) through the
way of unctuous material8”. So, this nar-
ration indicates that ‘Shodhana (Purifi-
catory) procedures’ put “stress over the
body” which may deplete the strenghth.
2. Four out five processes are included in
‘ten types of Langhana (Fasting) way of
treatment (Chatushprakara Samshud-
hi)9.’Langhana brings lightness to the
body tissues10. This will not happen
without excreting extra or excess hu-
mours are removed from the metabolic
system. So Langhana basically im-
proved excretion by fastening catabol-
ism.
3. These procedures create “kshobha” in-
side the physiology of the body11. There
is a lot of turbulance inside the body
whenever these procedures take place
inside the body. They definitely influ-
ence the physiology. These processes put
a lot of stress over the normal mechan-
ism. Throwing away the humours is the
apparent thing. But at the backdrop of
these procedures, metabolic rate gets in-
creased. Increase in blood pressure,
pulse, temperature during the process of
Vamana is the indication of the turnover
of the metabolites taking place during
the processes.
4. Even during explaining the treatment
after shodhana expecially by Virechana
in “Chikitsa prabhrutiya”, the expres-
sion is used for the effects over the body
in the words as “Bheshaja Kshapite”12.
So the effects after using the Samshod-
hana medicines over body are consi-
dered “weakening” of the body. In the
present context - Just like weakening of
provocated humors, as a result of Sam-
shodhana; weakening of Dhatus also
takes place13.
So during shodhana, along with pro-
vocated humours, there is a loss of Dha-
tus too. It results ultimately in weaken-
ing of the patient for some time. It is not
automatically corrected and needs fur-
ther attention of the physician. The wea-
kened body of the patient is further rep-
lenished with the “Pathyakara Ahara, the
food articles like Ghee-mutton soup-

Chandaliya Sachin Shantilal Et Al: Critical Review Of Efficacy Of Panchakarma In Preventing Diseases Through The Way Of
Immunity (Stress Response Hormesis)
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milk-soup of lentils along with food
which will be good to heart. All these
food articles must be of Brumhana prop-
erties. This treatment is accompanied by
Gentle body massage with oils-pastes,
bathe –Anuvasana and Niruha Basti. All
these treatments will provide good
health and longevity to the person14.”
5. It is precisely made clear while stressing
the importance of Snehana and Swedana
before Panchakarma. Both Snehana and
Swedana are useful in preventing aggra-
veted Vata which ultimately is increased
due to “irritation or turmoil or turbulence
caused by Panchakarma.15”The said ci-
tation proves that Panchakarma proce-
dures ‘put stress over the physiology’
and by compelling body to remove the
stagnant material - which already has
become burden fo the body.
6. It is advised to keep a gap of seven days
in both the treatments viz. Virechana
and Basti. One shall not administer basti
after finishing the complete procedure of
Virechana. He also claims in reverse too
that one shall not be allowed to undergo
Virechana process before seven days af-
ter completion of Basti treatment as
these processes do ‘Injury or Harm to
the body16.Chakrapani clarifies the term
‘Vikaset’ as Vikaset iti Himsayam17. .
“Himsayam“ literally means ‘violence
or physical injury to the body.18
7. The word “Vikas” is made from two
roots “Vi + Kas.” The root ‘Vi’is used
in a lot of ways19. It sometimes intensi-
fies that idea. So, the word ‘Vi-kas’
means to burst, become split or divided.
So the process makes the split divide
bursts intensively.20
From above inferences it must be
understood that Panchakarma creates
stress over the body. Strenuous proce-
dures like Samshodhana treatments in-
volve all the cells and channels inside
the body and make them ready to expel
the provocated humors from the system
by the nearest route as possible.
Role of stress in Human physiology21 –
Stress can have many profound ef-
fects on the human biological sys-
tems. Biology primarily attempts to explain
major concepts of stress using a stimulus-
response paradigm, broadly comparable to
how a psychobiological sensory system op-
erates. When a stressor acts upon the body,
the endocrine system is triggered by the re-
lease of the neurotransmitter noradrenalin by
the autonomic nervous system. Noradrenalin
stimulates the hypothalamic-pituitary-
adrenal axis (HPA) which processes the in-
formation about the stressor in
the hypothalamus. This quickly signals
the pituitary gland and finally triggers
the adrenal cortex. The adrenal cortex re-
sponds by signaling the release of
the corticosteroids cortisol and corticotropin
releasing hormone (CRH) directly into the
bloodstream. During an alarming situation in
which a threat is detected and signalled to
the hypothalamus from primary sensory and
limbic structures, cortisol is one way the
brain instructs the body to attempt to regain
homeostasis –by redistributing energy (glu-
cose) to areas of the body that need it most,
that is, toward critical organs ( Heart &
Brain) and away from digestive
and reproductive organs, during a potentially
harmful situation in an attempt to overcome
the challenge at hand.

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Immunity (Stress Response Hormesis)
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Hormesis -
This whole phenomenon may be
called as “Stress response Hormesis. Hor-
mesis refers to the beneficial effects of a
treatment that at a higher intensity is harm-
ful. In one form of hormesis, sub lethal ex-
posure to stressors induces a response that
results in stress resistance. The principle of
stress-response hormesis is increasingly
finding application in studies of aging,
where hormetic increases in life span have
been seen in several animal models22.The
principle of “Stress-response hormesis” can
be seen in action in many contexts.
E.g. Low levels of insecticides can induce
chemical resistance by increasing xenobiotic
detoxification (Calabrese et al., 1999). Or
induction of drug metabolizing enzymes by
xenobiotic chemicals can provide protection
against carcinogenesis (so-called chemopro-
tection) (Talalay et al., 2003)
UDAHARANA (Example to prove the hy-
pothesis)–
An experiment23 was performed on rats, in
which they were subjected to mild stress by
confining them (gently, and with full venti-
lation) in transparent Plexiglas enclosures to
induce stress. Blood was drawn several
times over a two-hour period and, for each
time point, measured levels of three major
hormones —nor epinephrine, epinephrine
and corticosterone (the rat analog of cortisol
in humans) —as well as of several distinct
immune-cell types in the blood. It caused a
massive mobilization of several key types of
immune cells into the bloodstream and then
onto destinations including the skin and oth-
er tissues. This large-scale migration of im-
mune cells, which took place over a time
course of two hours, was comparable to the
mustering of troops in a crisis. Similar im-
mune-cell redistribution in patients expe-
riencing the short-term stress of surgery pre-
dicts enhanced postoperative recovery.
UPANAYA:
Action of Shodhana through stress mechan-
ism - Samshodhana treatments have the na-
ture of “Apakarshana.” The word ‘Apakar-
shana’has the meanings24 (MW 48) like
forcing away, removing-diminshing-
dragging down and abolishing. Even the
word “Karshana” in it, is having the mean-
ings25 (M W 260) like pulling to and fro,
dragging, tormenting, vexing, pulling off,
trigging, hurting, injuring, ploughing.
During any type of Samshodhana,
when one administers a large amount of de-
coction of medicines inside the gastrointes-
tinal lumen, it causes irritation in the muc-
ous membrane of GIT. During the forceful
removal of accumulated humours repeatedly
for evacuation, it scraps the mucosal layer
over the gastric mucosal surface. This stimu-
lates a series of several steps by the defense
mechanism of the body, to protect, further
damage, through the means of inflammation.
These types of changes may compel
cortisol to be secreted in large amounts dur-
ing the process of any type of Samshodhana.
Actually cortisol is secreting to achieve im-
mediate effect of blocking most of the fac-
tors that are prompting the inflammation.
But in addition the rate of healing is en-
hanced. This probably results from the same,
mainly the undefined factors that allow the
body to resist many other types of physical
stress when large quantities of cortisol are
secreted.26 Thus, by this path Samshodhana
procedures might be helping to root out
many ailments with the complex pathogene-
sis. Following is one of the examples to
comprehend the action of Samshodhana.

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Immunity (Stress Response Hormesis)
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Kushtha (Skin disorders): In the modern
medicine, cortisol has been used mostly for
topical application for a longer period and
for systemic use upto shorter time in the
cases of skin disorders. Cortisol is helpful
but needs a longer duration in chronic cases.
So, one dose of steroid or secretions of the
same for only shorter tenure are not suffi-
cient. So, Vamana must have been suggested
after every 15 days, Virechana after every 1
month, Nasya for every 3 days and Rakta-
mokshana once in six months in the treat-
ment of Kushtha.27 Thus, an extra cortisol
secreted through single procedure may not
provide the sufficient amount of cortisol.
Hence repeated purifications are suggested
so that the body will get enough doses with-
in shorter period. Body will fulfill the needs
of remedy from time to time.
DISCUSSION
The working pattern of Samshodhana is just
like this only. Immunity starts working hard
when any stress is apparent over the body or
any open threat to the body. Immediately it
starts producing very strong metabolites in
the form of WBCs –Lymphocytes –
Monocytes- Tcells-Bcells-Helper cells etc.
So it will not be so untrue to claim that Pan-
chakarma might be working slightly on the
terms of the ‘system of Immunity.’ Pancha-
karma might be yeilding its effects by creat-
ing physical stress to the body and igniting
defence response by challenging the immun-
ity to fight against it (The process of “Stress
Response Hormesis).
CONCLUSIONS
1. Samshodhana procedures need strenghth
of the body i.e. BALA to perform
them.Weak patients (DURBALA) cannot
bear them.
2. They purify the body by improving or
fastening the catabolism of the body.
3. They create physical insult or injury to
the body which ultimately challenge the
immune system to react and fight the at-
tack. Thus “awakening the body immun-
ity” might be the way of prooving its ef-
ficacy.
4. Thus procedures in Panchakarma work
in the similar way of ‘Stress Effect
Hormesis’.
5. These processes must be boosting im-
munity through putting stress over the
physiology in the body.
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Chandaliya Sachin Shantilal Et Al: Critical Review Of Efficacy Of Panchakarma In Preventing Diseases Through The Way Of
Immunity (Stress Response Hormesis)
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Chandaliya Sachin Shantilal Et Al: Critical Review Of Efficacy Of Panchakarma In Preventing Diseases Through The Way Of
Immunity (Stress Response Hormesis)
1760
www.iamj.in IAMJ: Volume 3; Issue 6; June- 2015
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CORRESPONDING AUHTOR
Dr. Chandaliya Sachin Shantilal
Associate professor, Department of Pancha-
karma, College of Ayurveda and Research
Centre, Akurdi, Pune, Maharashtra, India
Email: shantipushpa@gmail.com
Source of support: Nil
Conflict of interest: None Declared