Standardization of Panchakarma Procedures

Attn to: drsvdeshpande@yahoo.com

Scenario of Panchakarma standardization
Prof. Dr. K. Shiva Rama Prasad, M.D.(Ay) COP (German), M.A, Ph.D. (Jyotish)
HOD Kayachikitsa (PG), DGM Ayurvedic Medical College, Gadag
Introduction
At the age of 17 I began training in Ayurveda. It started as an alternative later as hobby, a way to get in
shape and increase my self-confidence, soon turned into a passion. I unexpectedly found myself on a path.
This path was one of self-exploration and development. As I progressed in rank and understanding and
began to appreciate the benefits of improved health, discipline, and self-esteem, as did so many students
before me, I developed a desire to teach and pass on what I had been taught. After a number of years of
assisting, several fellow instructors and I opened up in to my self.
The word Panchakarma is a fabulous tempted word in Ayurveda. The word bears “Pancha” – five and
“Karma” – treatment. When the “Karma” is “Chikitsa” why the need of “Shodhana” termed with
“Panchakarma”? Whether these putative eliminative procedures, do they yield any specificity? Or simply a
fantasized curative excogitates. How far these procedures stand in front of scientific community for
evidence based medical methods is evaluated in course to state whether Panchakarma is for Futurity or
Futility.
Standardization is word brought forward by the science, where the act of checking or adjusting (by
comparison with a standard) the accuracy of a measuring instrument /procedure. In such case the good old
traditional holism built Ayurveda able to pass the hurdles of scientific reasoning, where the present set of
materialistic community expect every thing in terms of “Standard” and “Statistics”.
What are the standards undertaken by the ancient scientists of Ayurveda? Are they sufficient to standardize
the results repeatedly? If so, the validation is required and new entrepreneurs are expected to launch
different gadgets for the successful step by step graduated procedural that could stand for the test
legitimacy. Here in this paper we discuss the Panchakarma standardization at present day.
What is happening?
• Ayurveda Panchakarma is thought as inherited property and not accepted / subjected
for any changes
• Terminology of the Ayurveda especially Panchakarma were not properly understood /
ignored to practice colloquially
• Patient thorough examination and fitness is not followed but only textual disease
reference is considered
• Instruments are of traditional (used for ages) and not subjected for the present day
technology and improvised utility

Scenario of Panchakarma standardization by Dr. K. Shiva Rama Prasad 1

• It is the same in case of the time, drug, proportion, route, etc of administration in
Panchakarma
Scientific method has been practiced by Ayurveda since its incarnation and improved it for at least two
thousand years. The adaptations of scientific approaches are in different headings. Experience -
Explanation – Deduction – Test are the four fold methods of scientific approach followed.
1. Experience based: Recording the experience on the basis of considering the problem to make
sense of it, there after following the previous explanations the righteous act is amended.
2. Conjecture an explanation: When nothing else is yet known or recorded, try to state your
explanation, to someone else, or to your work.
3. Deduce a prediction from that explanation: If both of above were true, then state a consequence
of that explanation.
4. Test: Look for the opposite of that consequence in order to disprove Explanation. It is a logical
error to seek Deduction directly as proof of explanation. This error is called affirming the
consequent.
Ludwik Fleck (1896-1961) and others found that we need to consider our experiences more carefully,
because our experience may be biased, and that we need to be more exact when describing our experiences.
A linearized, pragmatic scheme of the four points above is sometimes offered as a guideline for proceeding:
1. Define the question
2. Gather information and resources (observe)
3. Form hypothesis
4. Perform experiment and collect data
5. Analyze data
6. Interpret data and draw conclusions that serve as a starting point for new hypothesis
7. Publish results
8. Retest (frequently done by other scientists)
What means standardization?
Standardization (standardisation) is the process of developing and agreeing upon technical standards. A
standard is a document that establishes uniform engineering or technical specifications, criteria, methods,
processes, or practices. Some standards are mandatory while others are voluntary. Some standards are de
facto, meaning a norm or requirement which has an informal but dominant status. Some standards are de
jure, meaning formal legal requirements. Formal standards bodies such as the International Organization
for Standardization (ISO) or the American National Standards Institute are independent of the
manufacturers of the goods for which they publish standards (Wikipedia).
The goals of standardization can be to help with independence of single procedure, compatibility,
interoperability, safety, repeatability, or quality.


Standardization in Panchakarma is defined as best technical application consensual wisdom inclusive of
processes for selection in making appropriate choices for ratification coupled with consistent decisions
for maintaining obtained standards. This view includes the case of "spontaneous standardization
processes", to produce de facto standards.
In Ayurveda, social bindings along with economics are expected to observe when the idea of
standardization is close to the solution for a coordination problem, a situation in which all parties can
realize mutual gains (health for patient and practice for the physician), but only by making mutually
consistent decisions.
Types of standardization process in Panchakarma
• Emergence as de facto standard or traditional standards, Author (Acharya) domination, etc.
• Written by a Standards organization:
o In an impositive process: written by edict by a regulator, etc.
o In a closed consensus process: Restricted membership (for example, a trade association)
and having formal procedures for due-process among voting members
o In a full consensus process: usually open to all interested and qualified parties and with
formal procedures for due-process considerations.
A technical standard is an established norm or requirement. It is usually a formal document that
establishes uniform engineering or technical criteria, methods, processes and practices.
A technical standard can also be a controlled artifact or similar formal means used for calibration.
Reference Standards and certified reference materials have an assigned value by direct comparison with a
reference base.
A primary standard is usually under jurisdiction of a national standards body. Secondary, tertiary, check
standards and standard materials may be used for reference in a metrology system.
Types of Standards
The primary types of technical standards are:
• A standard specification is an explicit set of requirements for an item, material, component,
system or service. It is often used to formalize the technical aspects of a procurement agreement or
contract. For example, there may be a specification for a turbine blade for a jet engine which
defines the exact material and performance requirements.
• A standard test method describes a definitive procedure which produces a test result. It may
involve making a careful personal observation or conducting a highly technical measurement. For
example, a physical property of a material is often affected by the precise method of testing: any
reference to the property should therefore reference the test method used.
• A standard procedure (or standard practice) gives a set of instructions for performing operations
or functions. For example, there are detailed standard operating procedures for operation of a
nuclear power plant.

• A standard guide is general information or options which do not require a specific course of
action.
• A standard definition is formally established terminology.
Models of scientific inquiry 1
Classical model
The classical model of scientific inquiry derives from Aristotle2, who distinguished the forms of
approximate and exact reasoning, set out the threefold scheme of abductive, deductive, and inductive
inference, and also treated the compound forms such as reasoning by analogy.
Pragmatic model
Charles Peirce (1839-1914) considered scientific inquiry to be a species of the genus inquiry, which he
defined as any means of fixing belief, that is, any means of arriving at a settled opinion on a matter in
question. He observed that inquiry in general begins with a state of uncertainty and moves toward a state of
certainty, sufficient at least to terminate the inquiry for the time being.
Peirce held that, in practical matters, slow and stumbling ratiocination is not generally to be automatically
preferred over instinct and tradition, and held that scientific method is best suited to theoretical inquiry.
What recommends the specifically scientific method of inquiry above all others is the fact that it is
deliberately designed to arrive, eventually, at the ultimately most secure beliefs, upon which the most
successful actions can eventually be based 3, 4,5. In 1877, he6 outlined four methods for the fixation of
belief, the settlement of doubt, graded by their success in achieving a sound settlement of belief.
1. The method of tenacity -- persisting in that which one is inclined to think.
2. The method of authority -- conformity to a source of ready-made beliefs.
3. The method of congruity or the a priori or the dilettante or "what is agreeable to reason" --
leading to argumentation that gets finally nowhere.
4. The scientific method.
Peirce characterized scientific method in terms of the uses of inference, and paid special attention to the
generation of explanations. As a question of presuppositions of reasoning, he defined truth as the
correspondence of a sign (in particular, a proposition) to its object and, pragmatically, not as any actual
consensus of any finite community (i.e., such that to inquire would be to go ask the experts for the
answers), but instead as that ideal final opinion which all reasonable scientific intelligences would reach,
sooner or later but still inevitably, if they pushed investigation far enough7.
In tandem he defined the real as a true sign's object (be that object a possibility or quality, or an actuality or
brute fact, or a necessity or norm or law), which is what it is independently of any finite community's
opinion and, pragmatically, has dependence only on the ideal final opinion. Those are an opinion as far or
near as the truth itself to you or me or any finite community of minds. Thus his theory of inquiry boils
down to "do the science." He characterized the scientific method as follows8:


1. Abduction (or retroduction) is Generation of explanatory hypothesis. From abduction, Peirce
distinguishes induction as inferring, on the basis of tests, the proportion of truth in the hypothesis.
Every inquiry, whether into ideas, brute facts, or norms and laws, arises as a result of surprising
observations in the given realm or realms, and the pondering of the phenomenon in all its aspects in the
attempt to resolve the wonder. All explanatory content of theories is reached by way of abduction, the most
insecure among modes of inference. Induction as a process is far too slow for that job, so economy of
research demands abduction, whose modicum of success depends on one's being somehow attuned to
nature, by dispositions learned and, some of them, likely inborn.
Abduction has general justification inductively in that it works often enough and that nothing else works, at
least not quickly enough when science is already properly rather slow the work of indefinitely many
generations.
Peirce calls his pragmatism as "the logic of abduction"9. His Pragmatic Maxim is: "Consider what effects
that might conceivably have practical bearings you conceive the objects of your conception to have. Then,
your conception of those effects is the whole of your conception of the object". His pragmatism is a method
of sorting out conceptual confusions by equating the meaning of any concept with the conceivable practical
consequences of whatever it is which the concept portrays. It is a method of experimentational mental
reflection arriving at conceptions in terms of conceivable confirmatory and disconfirmatory circumstances -
- a method hospitable to the generation of explanatory hypotheses, and conducive to the employment and
improvement of verification to test the truth of putative knowledge. Given abduction's dependence on
mental processes not necessarily conscious and deliberate but, in any case, attuned to nature, and given
abduction's being driven by the need to economize the inquiry process, its explanatory hypotheses should
be optimally simple in the sense of "natural" (for which Peirce cites Galileo and which Peirce distinguishes
from "logically simple"). Given abduction's insecurity, it should have consequences with conceivable
practical bearing leading at least to mental tests, and, in science, lending them to scientific testing.
2. Deduction is Analysis of hypothesis and deduction of its consequences in order to test the hypothesis.
Two stages:
i. Explication is a Logical analysis of the hypothesis in order to render it as distinct as possible.
ii. Demonstration (or deductive argumentation) defined as Deduction of hypothesis's consequence,
Corollarial or, if needed, Theorematic.
3. Induction. The long-run validity of the rule of induction is deducible from the principle
(presuppositional to reasoning in general) that the real is only the object of the final opinion to which
adequate investigation would lead10. In other words, if there were something to which an inductive process
involving ongoing tests or observations would never lead, then that thing would not be real. Three stages:
i. Classification is classing objects of experience under general ideas.
ii. Probation (or direct Inductive Argumentation): Crude (the enumeration of instances) or Gradual
(new estimate of proportion of truth in the hypothesis after each test). Gradual Induction is

Qualitative or Quantitative; if Quantitative, then dependent on measurements, or on statistics, or on
countings.
iii. Sentential Induction. "...which, by Inductive reasonings, appraises the different Probations
singly, and then their combinations, then makes self-appraisal of these very appraisals themselves,
and passes final judgment on the whole result".
Applied aspect of standardization in Panchakarma
The first thing to notice is that there is no where in the decision tree of patient care to plug in either the P
value or the hazard ratio of any clinical trial. In fact, ratios are well known to have little value for making
decisions. If it is told that a certain drug had some nasty side effects but halved your risk for a particular
ailment, you'd want to know what your baseline risk was before deciding to take it. If the drug in question
prevented the disease, and patient had a family history, probably we want to think about it; if the target
disease is very rare, say, 1 in 10,000, it is doubtful that you'd find reducing your risk to 1 in 20,000 to be
worth suffering through the drug's toxicities11.
Antediluvian Ayurvedic scientists approach to the knowledge of perfection is Syllogism or of “Pancha –
Avayava- Vakya”. For the present even, it is thought that to standardize Ayurveda Panchakarma the
Pragmatic model is the best suitable along with the standardization method that follows Experience -
Explanation – Deduction – Test approach. It requires to start with a standard definition of the test subject
followed by standard test method that has a standard specification and standard procedure (or standard
practice) which establishes the standard guide of practice for Ayurveda Panchakarma.
The standardization in Panchakarma become an Herculean task as it bears the multi stage multi centric
biased standardization method, i.e. any procedure by whole can not be brought in to a single strategy or
standardization.
Anthropocentric (Human-centered)
Conformity assessment is any activity to determine, directly or indirectly, that a process, product, or
service meets relevant standards and fulfills relevant requirements.
Conformity assessment activities may include12:
• Testing
• Surveillance
• Inspection
• Auditing
• Certification
• Registration
• Accreditation
Creativity techniques are heuristic methods to facilitate creativity in a person or a group of people. They
are most often used in creative problem solving. Generally, most creativity techniques use associations
between the goal (and the problem), the current state (which may be an imperfect solution to the problem),

and some stimulus (possibly selected randomly). There is an analogy between many creativity techniques
and methods of evolutionary computation. In problem-solving contexts, the random word creativity
technique is perhaps the simplest such method. A person confronted with a problem is presented with a
randomly generated word, in the hopes of a solution arising from any associations between the word and
the problem. A random image, sound, or article can be used instead of a random word as a kind of
creativity goad or provocation13-14-15.
Method specifications
It is very much necessary to understand well before to start a Panchakarma standardization technique
adaptation, whether the sequence is with mathematical or scientific model.
Mathematical method Scientific method
Understanding Characterization from experience and observation
Analysis Hypothesis: a proposed explanation
Synthesis Deduction: prediction from the hypothesis
Review/Extend Test and experiment
Conclusion:
Acharya Charaka (Pareekshya Bhava), Susruta (tantra Yukti, Tantra Dosha), Ibn al-Haytham, 965–1039,
Aristotle, Charles Peirce (1839-1914) and Basra, Ludwik Fleck (1896-1961) many more time to time
added values to standardize the science. Ludwik Fleck (1896-1961) and others found that we need to
consider our experiences more carefully, because our experience may be biased, and that we need to be
more exact when describing our experiences. Thus a hypothetico-deductive model for scientific method
was formulated as - Use your experience - Conjecture an explanation - Deduce a prediction from that
explanation and Test.
The science of Ayurveda - (the ancient Indian system of healing) practitioners took up the dissection of
corpses, practiced surgery, developed popular nutritional guides, and wrote out codes for medical
procedures and patient care and diagnosis. Chemical processes associated extraction of metals (in metal-
extraction/purification) were studied and documented. Such magnificent scientists’ successors kept mum
and left the people at their own fate, dreaming of their past fame. Ultimately it is understood in
Panchakarma standardization, it is a new adoptive method of Multi stage standardization of Multi Marker
Management method. "Truth is sought for its own sake. And those who are engaged upon the quest for
anything for its own sake are not interested in other things. Finding the truth is difficult, and the road to it is
rough. ..." Shivaram


References:

1
Scientific method - Wikipedia, the free encyclopedia.htm (16 of 37)1/9/2008 9:06:51 PM
2
Aristotle, "Prior Analytics", Hugh Tredennick (trans.), pp. 181-531 in Aristotle,Volume 1, Loeb Classical
Library, William Heinemann, London, UK, 1938
3
Peirce, C.S., "Lectures on Pragmatism", Cambridge, MA, March 26 – May 17, 1903. Reprinted in part,
Collected Papers, CP 5.14–212, Eprint. Reprinted with Introduction and Commentary, Patricia Ann Turisi
(ed.),
4
Pragmatism as a Principle and a Method of RightThinking: The 1903 Harvard "Lectures on
Pragmatism", State University of New York Press, Albany, NY, 1997. Reprinted, pp. 133–241, Peirce
Edition Project (eds.),
5
The Essential Peirce, Selected Philosophical Writings, Volume 2 (1893–1913), Indiana University Press,
Bloomington, IN, 1998.
6
Peirce, C.S. (1877), "The Fixation of Belief", Popular Science Monthly, vol. 12, pp. 1–15. Reprinted
(Chance, Love, and Logic, pp. 7-31), (Collected Papers vol. 5, paras. 358–387), (Philosophical Writings of
Peirce, pp. 5-22), (Selected Writings, pp. 91-112), (Writings of Charles S. Peirce: The Chronological
Edition, vol. 3, pp. 242–257), (TheEssential Peirce: Volume 1, pp. 109–123), (Peirce on Signs, pp. 144-
159). Eprint. InternetArchive Popular Science Monthly 12.
7
Peirce, C.S. (1877), "How to Make Our Ideas Clear", Popular Science Monthly, vol. 12, pp. 286–302.
Reprinted (Chance, Love, and Logic, pp. 32-60), (Collected Papers, vol. 5, pp. 388–410), (Philosophical
Writings of Peirce, pp. 23-41), (Selected Writings, pp. 113- 136), (Writings of Charles S. Peirce: The
Chronological Edition, vol. 3, pp. 257–276), (The Essential Peirce: Volume 1, pp. 124–141), (Peirce on
Signs, pp. 160-179). Eprint. Arisbe Eprint. Internet Archive Popular Science Monthly 12
8
Peirce, C.S. (1908), "A Neglected Argument for the Reality of God", Hibbert Journalvol. 7, pp. 90-112.
Reprinted (Collected Papers, vol. 6, paras. 452-485), (SelectedWritings, pp. 358-379), (The Essential
Peirce: Volume 2, 434-450), (Peirce on Signs, pp. 260-278). Internet Archive Hibbert Journal 7.
9
The Logic of Abduction", Collected Papers, vol. 5, paras. 195-205, especially para. 196. Eprint
10
Peirce, C.S., (1878) "The Probability of Induction", Popular Science Monthly, vol. 12, pp. 705-718.
Reprinted (Chance, Love, and Logic, pp. 82-105), (Collected Papers vol. 2, paras. 669-693),
(Philosophical Writings of Peirce, pp. 174-189), (Writings of Charles S.Peirce: The Chronological Edition,
vol. 3, pp. 290-305), (The Essential Peirce: Volume 1, pp. 155-169). Popular Science Monthly 12 Eprint at
Internet Archive.
11
(http://www.medscape.com/viewarticle/564710
12
http://en.wikipedia.org/wiki/Conformity_assessment#cite_note-0
13
http://en.wikipedia.org/wiki/Creativity_techniques.html,
14
http://ideaflow.corante.com/archives/2003/05/09/more_on_idea_generation_tools_and_techniques.php
15
http://mitsloan.mit.edu/vc/Ideationpaper022805.pdf


Standardization of Panchakarma Procedures

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