In India's traditional medicinal system, Ayurveda is still less famous in the West. This observational study investigated the effects of participating in Panchakarma, a 5-day Ayurvedic cleansing retreat. http://ayurvedablog2.website2.me/panchkarma

1. Panchakarma
In India's traditional medicinal system, Ayurveda is still less famous
in the West. This observational study investigated the effects of
participating in Panchakarma, a 5-day Ayurvedic cleansing retreat.
Quality of life, psychological, and behavior change assessments
were conducted on 20 female participants. Measurements are
essential before the program begins, immediately after the
program ends, and three months later. However, both self-efficacy
in using Ayurveda to improve health and reported positive health
behaviors were significantly enhanced. Furthermore, three
months after the patients returned to their home environment,
their social support and depression showed significant
improvements. Considering the complex intervention of
Panchakarma as a behavior change program, our preliminary
findings suggest that it may help assist one's expected and
reported adherence to new and healthier behavior patterns.
While numerous pilot studies have demonstrated
Ayurveda's efficacy in treating specific disorders, this
is the first scientific examination of the Ayurvedic
treatment of Panchakarma in a western country.
Panchakarma aids in the cleansing of the body of
pollutants that can cause disease. Ayurveda is a
complete and holistic medical system. Researchers
must first conduct descriptive or observational
studies to examine complicated, multidimensional,
or traditional medical methods properly.
In 2005, one of the authors (LC) began descriptive work at an Ayurvedic school in Stockbridge, Massachusetts, to better
understand Ayurvedic procedures. The school is at the Kripalu Institute for Yoga and Health, a yoga and Ayurvedic training
center. The author began with descriptive observational work, which included several trips to the location to conduct
informal interviews with students at Kripalu's Ayurvedic school and meetings with the Ayurvedic program designer (HG)
staff. The goal was to find a practice that would be an ideal candidate for an observational study. The author concentrated
on a single Ayurvedic therapy package known as Panchakarma. Panchakarma is a rejuvenation and cleaning procedure
that has been used for centuries to help people cope with seasonal and societal changes (e.g., menopause). The
Panchakarma procedures are in detail below. This method was chosen because of its theoretical relevance in Ayurvedic
medicine and the fact that the start and end of treatment are clearly defined, providing a clear pre-and post-test mark for
evaluating results and gathering data for a later controlled trial.

2. Other Ayurveda holistic therapies, such as, typically list improved or reinforced
social connections as one of the therapy's benefits. Indeed, holistic treatments
that treat an individual's body, mind, and spirit may provide benefits through
psychosocial mechanisms. For example, Ayurveda's early descriptive work at
Kripalu highlighted the importance of social aspects in healing. As a result,
measures of psychosocial change incorporates into the design of this
observational experiment.
The 5-day onsite therapy treatment was measured before the program
began, immediately after the program, and three months later. After
therapy compared to baseline, significant improvements were observed,
and the effectiveness was maintained after three months. In preliminary
findings, Panchakarma was found to help assist one's expected and
reported adherence to new and healthier behavior patterns as a
behavior change tool. The results also suggest that the treatment
effectively changes people's perceptions of social support in the short
and long term. It's critical to determine which aspects of the
treatment plan were most effective in causing these changes. Different outcomes can help you decide which parts of the
intervention were the most beneficial. More importantly, research into the overall complex structure of this treatment
provides insight into the development of healthy health interventions in general.
We chose to investigate societal mechanisms of change due to the theoretical importance. The study aimed to discover if
Panchakarma, an Ayurvedic holistic health program, has salutogenic effects. These include more incredible social support,
quality of life, and healthy lifestyle choices. The therapeutic effects of social support are documented in western scientific
literature. High levels of reported or observed social support have been linked to improved health outcomes in human
and animal studies. Individuals with low levels of social support, for example, have altered immunological function, a
finding that replicates in both animal and human observational and experimental research. Social support may help to
buffer or modulate stress responses and maintain a healthy immune system. Many different types of research have
yielded evidence for this hypothesis: Chronic stress has been shown to alter immune function and cytokine production
and reduce the immune system's response to anti-inflammatory signals. The chronic stress reason for low socioeconomic
status in childhood is to have an inverse relationship with immune function, regardless of later socioeconomic status.
People who have more meaningful connections feel more respected and are generally healthier.
Given the importance of social variables in health, significant
research is important to modify or augment social support,
particularly in high-risk populations, though changing this
aspect can be difficult. Natural emotional support, for example,
appears to increase cognitive resilience after a stroke[18], but
not when additional help is prescribed[19]. This demonstrates
that perceived social support has an emergent quality. If they
exist at all, societal change mechanisms may necessitate
immediate changes in the subjects' perceptions of themselves
in their interpersonal setting. Specific health and behavior
change programs include changes to environmental factors.

3. Like other holistic medical systems, Ayurveda attempts to directly influence the external world by considering the
individual in their situation. Such programs may provide insight into how to best provide health behavior programs to be
more effective and adhered to. A preliminary investigation occurs in this area. For example, all
measures of psychosocial status, including felt social support,
improved statistically significantly after a 12-week Tai Chi exercise
program that examined perceived psychosocial quality [20]. Another
study found a significant positive relationship between greater well-
being and feelings of increased connectedness to others in cardiac
rehabilitation patients who participated in an educational and
experiential retreat program[21]. This program included group
discussions, instructional seminars on nutrition, fitness, stress management strategies, and hands-on activities in
communication skills, yoga, and meditation. Following the retreat, participants reported a significant increase in their
sense of connection to others. Based on these promising findings, other types of complementary and alternative
medicine (CAM) therapies may further support the role of psychological factors in improving health outcomes.
According to Ayurveda, an ancient Indian medical school, the human body is composed of derivatives of the essential
elements of ether, air, fire, water, and earth. To become healthy, these derivatives must maintain an equal balance within
the body. The healing and preventative approach of Ayurveda differs from that of Western biomedicine in that it depends
on the philosophy of health promotion rather than disease removal. According to Ayurvedic theory, poisons, or "ama,"
accumulate and saturate the body's tissues when equilibrium disrupts. This can result in illness. Like other holistic,
multidimensional systems, Ayurveda can provide medical care with a different healing process for each patient. This
process preserves the individuality that is lacking in some western medical therapies. As with other holistic therapies, the
patient's social world is an active factor in health and illness. Indeed, one definition of holism is considering the subject in
the context of his or her social environment. In an Ayurvedic diagnosis, the quality of social ties and social support are
critical aspects of disease causation, and treatment plans adjust to balance the patient's social context. As a result, it
makes sense to test the hypothesis that Ayurvedic treatments will improve the patient's perception of social support and
overall understanding of the social world.Panchakarma is a well-known Ayurvedic technique for restoring body balance.
At Kripalu, specific, theoretically driven alterations to the classic
Panchakarma procedure were made under the author's direction and by
a qualified Ayurvedic practitioner. These changes are to make
Panchakarma more accessible to an American audience. The length of
the program was reduced, and some of the approaches took a back seat.
Traditional Panchakarma is typically performed in India at a retreat or
even a hospital setting for at least two weeks, more commonly four weeks.
Depending on the imbalances discovered, two common treatments
include vomiting (or "vamana") and bloodletting (or "rakta moksha").
Americans dislike vomiting, are unaccustomed to it as a healing method,
and are frequently unwilling to participate in this treatment. Another
treatment, Rakta moksha, is performed with live leeches, which are
frowned upon in the United States. All other aspects of the treatment,
such as massage, enemas, and dietary changes, were kept and proven
effective. The Kripalu Panchakarma program has the following timetable:
Patrons of Kripalu's Panchakarma program

4. receive a pre-retreat phone consultation with an
Ayurvedic practitioner at least three weeks before
the retreat date, during which their diet and
lifestyle habits are evaluated. Customer should
change their diet and begin taking herbal
supplements widely available.Participants go
home to complete the final two weeks of the
cleanse and receive lifestyle advice for long-term
balance.
We expected that the Panchakarma experience
would immediately improve participants'
perceptions of social support following the program.
Second, the respondents' perceived and reported
ability to control their health should improve
through the personalized and tailored program.
Finally, the program should increase their overall
happiness. Finally, we wanted to see if any positive
effects would last after the program ended and the
participants returned to their everyday lives.
Therefore, we also collected measures of
psychological health (e.g., anxiety with the Beck
Anxiety Inventory), physical health (e.g., general
health with the SF-12 Health Survey), and
psychosocial changes (e.g., Bandura's single item of
self-efficacy [22]) to gather preliminary data on
potential mechanisms of evolution.
METHODS
The procedure was evaluated and approved by
the institutional review board of the first author.
Each subject signed an informed consent form.
When conducting this descriptive observational
clinical trial, we kept in mind the importance of
not interfering with the therapeutic process that
the program was supposed to elicit. Naturalistic
data is available, but the patients' healing
interests are safe.

5. Initially, the head of the Panchakarma program
informed potential subjects about the study (HG).
If a likely subject expresses interest in
participating in the study, the director provides
the subject with contact information for the
study director (LC) to begin the screening
procedure. All volunteers who expressed an
interest and demonstrated the ability to
complete the protocol were included in the study.
There were no subjects omitted.
When the subject (all of whom were women) arrived onsite to begin the program, one of the authors (LC) met with her to
go over the study in greater detail and the informed consent process. At this point, the baseline measurement packet is
available. Individuals were measured with paper and pencil three times: upon arrival at Kripalu, on the last day of the five-
day program, and three months later. The results of these psychological and general health tools focus on this
manuscript.
The Health-Promoting Lifestyle Profile II is a 52-item behavioral evaluation scale. The frequency of self-reported health-
promoting actions is recorded using a four-point response format. The Kripalu Center's treatment includes individual
assessments, Ayurvedic massages, a detox diet, medicated enemas, group discussions on stress reduction, a customized
yoga session, and a culinary class. Five days are spent in this part of the retreat. Health responsibility, physical activity,
nutrition, spiritual growth, interpersonal relationships, and stress management are addressed. Questions are about how
frequently the behavior occurs (never, Occasionally, Frequently, Routinely). It has a high level of reliability and validity and
is available in numerous published studies.
The SF-12 is a reliable and valid self-reported measure of the quality of life and general health and function. A single
measure of self-efficacy was used to assess the subject's belief in her ability to solve her problems with Ayurvedic
techniques. The Beck Anxiety Inventory is a 21-item questionnaire in which each item represents a common anxiety
symptom. It has good psychometric properties and is well-represented in the literature.
The Interpersonal Support Evaluation List is a 14-item scale that assesses a
person's confidence in receiving social support in various situations. A modified
version of the Sarason Social Support Questionnaire was also used to
determine how many social support respondents had and how satisfied they
were. This six-item scale captures subjects' perceptions of the three primary
types of helpful interpersonal interactions: emotional, informational, and
instrumental. We chose to use two social support measures, each of which
assesses social support slightly differently. For example, the former provides
specific examples, whereas the latter raises more general concerns. In addition,
we wanted to ensure that we had enough time in the study to capture any
changes in social support, which is one of our main constructs.

6. The Perceived Stress Scale is a fourteen-item questionnaire that asks how frequently stress comes up in various areas of
one's life. It is well-known and has strong psychometric properties. All data administration and analysis were carried out
using the SPSS data collection system. The results were derived from paired data. Student's t-tests of difference in
means were used to test the hypothesis that means did not differ significantly over time for each measure. In addition,
the baseline study results were compared to the 5-day retreat results. The significance of change over time is
determined by comparing baseline, and 3-month post-program mean values.
The information was gathered from February to
November 2006, including four Panchakarma
sessions. A typical session has four to eight people—
the study's original sample of 20 women aged 27 to
54 years old. Two of them were Asian, while the
others were Caucasians. The majority had a
bachelor's degree from a four-year college or
university and an annual income of $50,000. The
entire sample was measured after therapy, and 12
women were followed for three months.
One tricky aspect of evaluating such a cleansing treatment is that patients may feel less healthy before feeling better.
Ayurveda refers to the body's cleansing function, whereas other complementary and alternative medicine systems refer to
such reactions as "healing crises." The researchers were astounded that no significant adverse effects were observed, and
only a small number of mild side effects, such as gastrointestinal upset or temporary sleeplessness, were identified. At the
start of the study, 21% of participants experienced moderate side effects, most likely caused by pre-program dietary
changes and everyday living. However, after five days at the retreat, the average level of reported side effects increased
insignificantly to 26%. While this is a positive result, we were disappointed that our main hypothesis was not validated;
there were no significant changes in overall symptoms as measured by the SF-12, either positive or negative. There could
be several reasons: a genuine lack of improvement in overall quality of life, the harmful effects of the cleansing procedure
outweighing any positive results, or the self-report measurement being insensitive in this population. We were also
surprised to discover that anxiety levels dropped dramatically three months after treatment, though not immediately; this
could be due to situational anxiety caused by the thorough cleaning procedure and a lack of capacity to rely on home-
based behavior patterns and routines.
While we found no evidence that using Panchakarma as a behavior change program improved overall quality of life, our
preliminary findings suggest that the complicated intervention may be useful in assisting one's actual and predicted
adherence to new and healthier behavior patterns. Following the intervention, the Lifestyle Profile II revealed a higher
frequency of favorable patterns with statistical significance. In addition, individuals reported increased self-efficacy in
using Ayurveda to make positive health changes.
It also suggests that the perception of social support may play a role
in these changes. With a larger sample and proper controls, we could
model social support as a mediator or modifier of behavior change.
However, viewing the digital world as an essential component of a
comprehensive strategy may be more acceptable. While social factors
may influence one's ability to achieve a specific result, seeing such
changes solely in a linear fashion, at least at the outset of the research,
would limit our ability to discern how elements interact. According to

7. research in this area, adding social support, even as part of a comprehensive intervention, may be ineffective. One of the
most critical mechanisms in complicated CAM systems is that the patient is considered a whole, in context, which
patients prefer. Social support is an emergent quality of the system, not an add-on feature. Other studies show that the
more relevant the messages are or how thoroughly the program is integrated into the person's daily life, the more
effective the behavior change program is. When a behavior change program is made relevant to the subject, it works
better. Improving perceived social support could increase salience, and holistic systems can enhance social support.
If this is the case, new questions in health behavior research arise.
One source of frustration for health behavior researchers is that
essential components of people's social lives are frequently
unmodifiable. For example, many of our health risks are influenced
by environmental factors such as ethnicity, gender, and education,
which are difficult to change. However, because complex CAM
medical therapies act primarily on the level of the subject's
interpersonal world, the outcomes of these social determinants—
anxiety, low self-efficacy—may be adjustable in complex CAM medical interventions. But how do we know we didn't just
create new interpersonal bonds by changing people's perceptions of social support? We wanted to investigate this
question even though it was not a primary study outcome. As a result, we assessed the subjects' reported social network
index at the exact three data collection times. The social network index is a quantitative measure of a person's contacts
and how they are used. There have been no significant changes in this structural metric due to Panchakarma. This is
intriguing because it supports the theory that perceived social support could be increased without affecting the social
network structure. Even if no new individuals are added, the subject's perception of his or her societal world changes; this
is a perceptual and phenomenological change, not a structural one. Adding supportive individuals may be beneficial, but
this study shows that changing one's perceptions without adding people may be equally significant.
In numerous studies, perceptual characteristics such as quality of life and health expectations predict overall health.
Therefore, holistic health interventions may provide insight into how to change one's daily life. Variables or symptoms that
can be handled in such a comprehensive worldview are lived or phenomenological experiences. Three qualitative
interviews were conducted as part of this project: before the retreat, shortly afterward, and three months later. The
qualitative interview data is viewed as part of this study in the future. This will allow us to contribute phenomenological
knowledge of the process and possibly link phenomenology to standardized outcomes. If the qualities of one's lived
experience are linked to eventual disease outcomes, then studying and changing such traits could aid in disease
prevention. This concept has been used in other well-studied health sciences, so learning more about how Ayurveda
models such linkages will most likely contribute to our scientific understanding of health and healing mechanisms.
Although these findings are encouraging, the sample's generalizability is a
significant limitation. In addition, this is a self-selected cohort, and no data on
those who dropped out were collected, so we don't know if those who stayed in
the study had a more positive experience. Finally, adding a control group,
selecting biomarkers of health state, and further investigating dropouts would
enhance future research. Nonetheless, our preliminary assessment of this
program is encouraging, not only in terms of feasibility but also in terms of
statistical significance for the measures chosen. Furthermore, because we used a long-term follow-up, we were able to
see that the positive impacts achieved throughout the program were maintained three months after the program ended.
After that, the participants returned to their everyday lives.The National Center for Complementary and Alternative
Medicine funded the study with Grant Number 1K24 AT004095 (NCCAM).