Panchakarma therapy can be likened to a surgical operation in which the pre-operative and post-operative procedures are of critical importance. Without the preparatory procedures of snehana and swedana, internal cleansing is superficial and does not remove the basis of disease. Once the toxins and waste products are eliminated from the gastrointestinal tract by nasya, vamana, virechana and nirooha bastis, both the digestive agni and the dhatus must have the opportunity to rebuild themselves.
The set of procedures that follow the main eliminative treatments of Panchakarma and assist this rebuilding process are called, collectively, Paschatkarma. They assure the re-establishment of healthy metabolic function and immunity. If these post-procedures are neglected, digestion does not normalize. Weak digestion generates new ama and the tissues continue to receive toxic material instead of nutritive, strengthening substances. The body then finds it difficult to re-establish its natural immune function and is more likely to fall ill again.
While the digestive fires are rekindling, it is important to respect the somewhat vulnerable state of the physiology. Energy resources are not at their full capacity and, as a result, we cannot do as much as we will be able to do once the dhatus are rebuilt and up to speed. It is therefore crucial for the success of Panchakarma that the patient follow a regulated diet and lifestyle immediately after treatment. Two aspects of the post-procedures — samsara-jana krama and dinacharya raise the system to a much higher efficiency level than it had before. A third aspect of Paschatkarma, called rasayana therapy, is not technically part of Panchakarma, but is particularly helpful in rejuvenating the dhatus.
SAMSARAJANA KRAMA: GRADUATED DIET
Digestion is the first aspect of the physiology that needs to be reconstructed. The Panchakarma treatments dramatically affect the digestive process because the G-I tract provides the primary route for the elimination of toxins. The digestive fire is weakened by the process of ama being drawn back into the digestive tract and expelled from the body.
Since faulty digestion creates the potential for illness to arise in the first place, special attention is given to strengthening digestion at the conclusion of Panchakarma. This assures that the dhatus are nourished, immunity is re-established, and health is maintained.
Samsarajana krama constitutes the primary post-treatment procedure for digestion. This term literally means “a graded administration of diet.” It consists of a specially prepared diet designed to re-establish full digestive capacity and prevent the formation of new ama.
Charaka uses the following example to show the similarity between digestive agni and fire. If someone wants to kindle a fire that can consume a large quantity of dense wood, he must begin with a spark and some blades of dry grass. Once the grass is burning, small splinters and twigs can be added, then small branches and finally heavy logs. Once the logs are burning, the fire can consume any wood added to it. If, however, a log is added to the first spark and the few blades of burning grass, it extinguishes the fire.
In the same way, food is the fuel that ignites our activities. If, at the end of the main procedures, the food we ingest is too heavy for our exhausted digestive fires to manage, then little or none of that food will be metabolized and transformed into usable nutritive substances. It all becomes ama and the disease process starts anew. This is an unpleasant thought, but luckily it is a situation that is completely avoidable through correct administration of diet.
The diet given to the patient immediately after Panchakarma consists of nutritive and easily digested preparations of rice and split yellow mung dal (lentil). The diet is structured in stages, going from more liquid preparations to increasingly solid ones. It begins with easily digestible rice water, and eventually incorporates dal. These stages of digestibility are called manda, peya, vilepi, odana, yusha and kichari. Once this regimen has nurtured our digestive fire back to health, as signaled by a strong, consistent appetite, the person can return to a normal diet.
Manda: Rice Water
Manda, meaning “liquid,” is the first meal after vamana or virechana. It is normally taken when the appetite returns, which for most people is about four hours after completing these procedures. Manda is mainly just the water in which basmati rice was boiled. It should be eaten lukewarm with a little ghee and a pinch of black salt (saindhava). It might seem absurd to give only rice water after these major procedures, but the importance of going slowly at this time, due to depleted digestive capacity, cannot be emphasized enough.
Peya: Rice Soup
The patient takes the next meal, called peya, two to three hours later. Peya means “soup” and is traditionally made with eight parts water to one part rice. The rice is cooked until it is very soft, so that it has the consistency of a thin, light porridge.
Vilepi: Thick Rice Soup
Vilepi, or “thick soup,” describes the third and fourth meals after vamana or virechana. Vilepi consists of a slightly thicker porridge of soft, cooked rice grains and is made with a ratio of four parts water to one part grain. A little black salt and dried sugarcane juice can be added for taste. In order to add some strength to the digestive fire, one can lightly saute a little fresh ginger, turmeric, cumin, coriander or fennel in a small amount of ghee and add them to the porridge. All these spices are high in agni bhuta.
Odana: Cooked Rice
Odana, which means “cooked rice” and has the consistency of normal, soft, cooked rice, is given as the fifth meal.
Yusha: Mung Lentil Soup
Dal is added to the sixth meal, which the patient eats on the second day after virechana and vamana. Yusha, or “soup mixture,” is rice with some yellow mung dal (split, hulled mung lentils) added. It is important that each of these preparations should be made fresh daily.
Kichari; Rice and Dal Mixture
The patient now gets kichari for a number of meals. Kichari contains a mixture of basmati rice and split yellow mung dal cooked together with a pinch of black salt and the sauteed spices mentioned above. This nourishing food forms the basis of the traditional purification, recuperation and rejuvenation diets in Panchakarma therapy. It is easy to digest, provides complete and balanced nutrition, and is suitable for people with all types of constitutions since it balances all three doshas. It strengthens all the dhatus while assisting the detoxification process.
The length of time it takes for patients to return to a normal diet depends on their digestive capacity. On the average, it takes six to seven meals. However, some people may only need three or four meals while others may require eight to ten. The Ayurvedic physician monitors the strength of the patient’s digestive agni and adjusts the diet according to the strength of his appetite.
One of Ayurveda’s strongest prescriptions is to eat only when hungry. This .is doubly true of the time immediately following Panchakarma. The patient should only eat when his appetite is strong. A good appetite is our body’s signal that digestion, assimilation and elimination are working well. One of the best ways to help quickly restore the appetite is to drink freshly grated, ginger root tea morning and afternoon.
Since proper digestion is essential to maintaining good health, it is important to maintain the strength of the digestive fires once they are up to full force. Ayurveda offers the following as some general guidelines for doing this. Some of these points have already been mentioned in previous chapters.
1. Only eat when you have an appetite.
2. Do not eat to full capacity. Always leave a little room in your stomach at the end of each meal.
3. Avoid drinking cold liquids with your meals.
4. Eat your main meal at noontime when the environmental agni is strongest, and eat a lighter meal at night.
5. Eat in a calm atmosphere and sit down when you eat.
6. When possible, avoid snacks between meals and avoid eating just before going to bed.
7. Once every week or two, fast or eat lightly to give your digestion a much needed rest.
8. Avoid foods that are deep-fried or too heavy.