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Clinical Panchakarma
Clinical Panchakarma
Description
Foreword

Ayurved is the most ancient system of Medicine in the world, its antiquity going back to the Vedas and it is considered the Upaveda of Atharvaved. Considering many original and unique facts and fundamentals of Life, Health and Medicine, hitherto unknown even in Vedas, many scholars prefer to consider Ayurved as an independent Sastra and suggest to give it the status of Pancam Veda. However, one thing is sure that it is only the Ayurved which has described fully the Science of life in biological terms extending the knowledge in a systematic manner describing the Phenomenon of health, disease, methods of diagnostics, prognostics and health care both Promotive, Preventive and Curative. Because of such developments Ayurved could emerge as a complete system of Health Science and Medicine.

When one compares Ayurved with contemporary Western Medicine may perceive that Ayurved is an Experiential Science in contrast to Western Medical Science which is largely Experimental. Ayurved is a classical Holistic health science as compared to modern medicine which is essentially a Reductionistic science. Ayurved is dominantly Philosophical and Physiological in its presentation while modern medicine is more physical and anatomical. Ayurved is strongly Pro-Nature as compared to modem medicine which may appear many times Anti-Nature. It is a diet & life style oriented system of health science in contrast to the drug and surgery oriented nature of modem Medicine. Ayurved is strongly promotive and preventive system of medicine as compared to western Medicine where the main concern is disease and cure. Thus Ayurved is a highly positive system of Medicine and Health Science.

The Ayurvedic approach to prevention and cure swings around two broad principles viz (1) Nidana Parivarjana i.e. elimination of the cause of disease and (2) Samprapti Vighatana i.e. reversal of Pathogenesis. In many early and reversible conditions Samprapti Vighatan spontaneously follows Nidana Parivarjana without any treatment. But in chronic diseases Samprapti Vighatana may not occur even after Nidana Parivarjan or even after palliative treatment procedures because a vicious circle is set and the system of the body learns to function in a pathological order and as such the pathology becomes physiology of the altered state. Therefore a chronic disease is to be treated in a comprehensive manner if a real Cure is to be achieved.

Ayurved advocates two fold approach to Cure i.e. Samsodhana i.e. Bio-purification and Samsamana or Palliation. Ayurved propounds the doctrine of Srotas depicting that living body is made up of innumerable channels which carry biological fluids, energies and impulses as well as the nutrients and medicaments used time to time for therapeutic purposes. These channels or Srotamsi loose their integrity, competence and inherent functioning due to day to day physiological wear and tear, senescence, environmental pollution, stress and disease. It is essential to restore the competence of the Srotas System by specialized care. The classical idea of Srotas system is comparable to the bio-Membrane system is the continuum from endothelium of all hollow organs upto the individual cell membranes which need to be dynamic enough to permit the transfer and flow of their contents.

Ayurved propounds the theory of Sansodhan i.e. bio-purification and elaborately describes the Panca Karma Therapy, i.e. the Five-Fold Therapy in order to tackle the issue of impurity and incompetence of Srotamsi. If the channels are washed and purified periodically by appropriate Samsodhan procedure time to time one can easily prevent many diseases. Similarly if one attempts to purify the channels in morbid states one may successfully achieve the target of Samprapti Vighatana of a disease and a Cure becomes possible.

Ayurvedic Texts describe Five major Karmas or therapeutic procedures namely Vamana, or emesis is a specific purificatory method for eliminating Kapha Dosa, Virecana or Purgation for elimination of Pitta Dosa and Vasti i.e. Enemata therapy for elimation of Vata Dosa in view of the seasonal preponderance of Kapha, Pitta & Vata in respective Ritus or seasons, the texts describe specific Karmas for different Ritus too as an important preventive & promative care.

The Samsodhana therapy of Ayurved is an unique concept. It envisages not only the visceral cleansing rather it aims at the total bio-purification upto molecular level. A suitably administered Samsodhana Karma is expected to cleanse the hollow organs, cells, cell membranes and their pores effective the bio-purity of intracellular and extra-cellular contents and structures. When a patient in vomiting during Vaman Karma it is not only his stomach which is getting evacuated rather every cell of the body is 'Vomiting' and is getting cleansed. So is the case with all Karmas.

If the body is biologically purified and cleansed the physiology is restored optimumly and pathology reversed. The nutrients reach their desired destinations easily and their bio-availability is enhanced. The entire process of Dhatu Posana and Dhatu Parinam is accelerated and the mechanism of Kedari Kulya Nyaya, Khale-Kapota Nyayu and kshira-Dadhi Nyaya and accomplished well. Similarly the medicaments administered in Samsuddha Sarira reach their sites easily and effectively and possibly even a relatively smaller dose of a medicine may produce greater effect. In other words if Samsodhana is done prior to administration of a medication, possibly a lesser done may suffice. On the other hand when the Srotas system is purified the administered drugs and their metabolites may not stagnate unduly long in the body and hence the drug toxicity and side effects may get reduced. This is why Pancakarma is advocated as a pre-requisite for Samsamani Chikitsa.

Because of such fundamental benefits the Pancakarma therapy has received great scientific recognition in present times and it is believed that Pancakarma could also be an useful adjunct for practice of modern medicine and Pancakarma is currently advocated as a pre-requisite of modern chemotherapy too to help to reduce dosage and toxicity. Thus there is a great need to standardize Pancakarma therapy on scientific lines and to popularize its use. There is also a need to improve its technology to make it more non-invasive and user-friendly.

In recent years some such efforts have been made. The Ayurvedic Physicians of Kerala have played tremendous role to preserve the Traditions alive while certain research groups in different parts of the country have contributed significantly to the revival of Pancakarma therapy on scientific lines. The work of Singh RH et' al of Banaras Hindu University Varanasi, Kasture HS of Ahemdabad, Yadaiah P. of Akola and Nambudari et' al of CCRAS deserve mention in this context.

I had the pleasure to go through the pre-press copy of the present book "Clinical Pancakarma" authored by Dr. Polepally Yadaiah who has a long standing reputation in the field of Panch Karma therapy as a capable teacher, a scholar and above all a successful practitioner of this special branch of Ayurved. I have known Dr. P. Yadaiah for many years through his sustained work in this special field and I admire him for his continued interest and fruitful work and progressive outlook.

This comprehensive book deals with the literature and practice of the full range of the procedures of Pancakarma therapy encompassing the Purva Karma, Pradhana Karma and Pascat Karma practices. Besides, it includes research reports and interesting case reports treated by the author through Pancakarma and a very informative write-up on nine common Chronic intractable diseases and their management through Pancakarma such as Swasa, Parinamasula, Amavata, Paksaghata, Gridhrasi, Grahani Roga, Sthoulaya and Madhumeha.

The book is written in a lucid manner and its scientific temper is obvious. The entire subject is dealt in practical perspectives and hence this new book may prove to be a useful reading for all those readers who could be interested to practice Pancakarma in contemporary settings. I congratulate the author for this brilliant contribution to Ayurvedic literature.

Preface

I never heard a single word about Panchakarma from any one when I was a student in Ayurved College between 952 to 957. Rarely the teachers used the word panchakarma in their lectures and even the subject of panchakarma was not included separately for examination except in kayachikitsa subject. No one should be surprised if I say that very few people who were practicing Ayurveda knew about this subject, but I am sure nobody is practicing it in real classical way. Some times it looks as an exaggerated statement but it was fact. In Kerala 'Pizichil,' Pindaswedana (Navarakizi), Bastis were practicised in some institutes under the title of "Traditional treatment of Kerala.

In 1958 Dr. P. N. V. Kurup completed H.P.A. the post graduate course of Ayurveda from Post Graduate Center in Ayurveda, Jamnagar, and he was appointed as a Panchakarma Physician in the same institute. Later on, he was appointed to teach panchakarma subject in P.G. Center. After completion of my post graduation in 1960 I got an opportunity to work as an Assistant Panchakarma physician under him. After that, the same post were converted as Professor of panchakarma and Assistant professor of Panchakarma.

After taking the charge of "Advisor of Ayurveda, Ministry of Health & Family Welfare, Government of India" Dr. Kurup took great efforts to include the Panchakarma subject in P.G. Syllabus and later on it was also included in the syllabus of B.A.M.S. and devoleped as a separate subject.

The first scientific or complete summarized book written in Hindi by me (Dr. Kasture) "Ayurvedic Panchakarma Vijnan" which was published by Baidyanath Bhawan Nagpur in 1970. Since then, in 35 years many books were published in this subject but the book written by Dr. P. Yadaiah is useful and dedicated to the subject. Really speaking, I never saw such type of book since past few years.

Dr. P. Yadaiah is a learned professor in R.T. Ayurvedic college Akola Maharashtra and Head of the department of kayachikista and Panchakarma, a very senior person in Ayurvedic field and well-known teacher, a good physician in Panchakarma, and also working as a Vice president of National Academy of Panchakarma and Research (NAPAR), all India level Why this book is commendable.

This book contents 15 chapters in which first seven chapters give us the details of theory of Snehana, Swedana, Vamana, Virechana, Basti, Nasya and Raktamokshana. The author has given practical photographs at every stage to give us exact understanding of karmas which is the speciality of these chapters. All positions of Abhyanga, method of following it, Shirodhara, Shirobasti and different types of angapratyanga bastis. The same procedure is followed to describe Pradhanakarama-Vamanadi etc. In Basti chapter he described common basti with procedure and their results with classical references. The descriptions of theory is very simple and convenient for students to understand.

He has given the chapter of instruments in short with pictures which will be helpful for physicians to use in their clinics Most admirable thing of this book comes later on when he gives clinical reports with statistics of numerous patients on each and every karma in different dieases which shows his research interest. Probably nobody has given such a huge record in the books uptill now. This chapter is very worthwhile and I am confident that not only students of Ayurveda but vaidyas, teachers and research scholars would definitely be benefited and would get new spirit to work with confident.

Lastly his chapter on management of few diseases by panchakarma is extra-ordinary type where he briefly gives panchakarma treatment like Juvenile diabetes, acute myeloid leukemia, SLE, submucous fibrosis, avascular necrosis, intestinal perforation, spondylolesthesis, etc which are consider as difficult diseases or asadhya, apya diseases, with real case study report.

In my opinion, describing the practicals is different matter but explaining practicals on real work on each case in different diseases is a very specific work. That is why the book by Dr. P. Yadaiah stands at very high level of practical as well as classical work. I can definitely say that there are very few authors in this division who have done such great work in Ayurvedic field. However Dr. Yadaiah gets this credit to show praised path to future writers to utilize their experienced knowledge in their book so as to make Ayurvedic literature more competent and skillful.

I hope that we will be able to get more and more scientific books like this from Dr. P. Yadaiah in future. I wish him good health and long life to serve Ayurveda with strong hands and mind.

Contents

Introduction1-4
PART - I
Chapter i. Snehana Karma (Oleation Therapy)7-40
Chapter ii. Swedana Karma (Fomentation Therapy)41-52
Chapter iii. Vamana Karma (Vomiting Therapy)53-64
Chapter iv. Virechana Karma (Purgative Therapy)65-74
Chapter v. Basti Karma (Enema Therapy)75-98
Chapter vi. Nasya Karma (Errhine Therapy)99-108
Chapter vii. Raktamokshan (Blood Letting)109-114
Chapter viii. Panchakarma Instruments115-118
PART-II : Research Reports
Chapter i. Clinical Reports of Snehna and swedana121-134
Chapter ii. Clinical Reports of Vamana135-158
Chapter iii. Clinical Reports of Basti, Nasya Karma and 159-224
Raktamokshana
PART – III : Case Reports
Chapter i. Common Diseases & Panchakarma
Management261-286
Chapter ii. Exercises & Supports287-293
Bibliography294-296
Glossary297-303
Index304-307

Clinical Panchakarma

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2008
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Foreword

Ayurved is the most ancient system of Medicine in the world, its antiquity going back to the Vedas and it is considered the Upaveda of Atharvaved. Considering many original and unique facts and fundamentals of Life, Health and Medicine, hitherto unknown even in Vedas, many scholars prefer to consider Ayurved as an independent Sastra and suggest to give it the status of Pancam Veda. However, one thing is sure that it is only the Ayurved which has described fully the Science of life in biological terms extending the knowledge in a systematic manner describing the Phenomenon of health, disease, methods of diagnostics, prognostics and health care both Promotive, Preventive and Curative. Because of such developments Ayurved could emerge as a complete system of Health Science and Medicine.

When one compares Ayurved with contemporary Western Medicine may perceive that Ayurved is an Experiential Science in contrast to Western Medical Science which is largely Experimental. Ayurved is a classical Holistic health science as compared to modern medicine which is essentially a Reductionistic science. Ayurved is dominantly Philosophical and Physiological in its presentation while modern medicine is more physical and anatomical. Ayurved is strongly Pro-Nature as compared to modem medicine which may appear many times Anti-Nature. It is a diet & life style oriented system of health science in contrast to the drug and surgery oriented nature of modem Medicine. Ayurved is strongly promotive and preventive system of medicine as compared to western Medicine where the main concern is disease and cure. Thus Ayurved is a highly positive system of Medicine and Health Science.

The Ayurvedic approach to prevention and cure swings around two broad principles viz (1) Nidana Parivarjana i.e. elimination of the cause of disease and (2) Samprapti Vighatana i.e. reversal of Pathogenesis. In many early and reversible conditions Samprapti Vighatan spontaneously follows Nidana Parivarjana without any treatment. But in chronic diseases Samprapti Vighatana may not occur even after Nidana Parivarjan or even after palliative treatment procedures because a vicious circle is set and the system of the body learns to function in a pathological order and as such the pathology becomes physiology of the altered state. Therefore a chronic disease is to be treated in a comprehensive manner if a real Cure is to be achieved.

Ayurved advocates two fold approach to Cure i.e. Samsodhana i.e. Bio-purification and Samsamana or Palliation. Ayurved propounds the doctrine of Srotas depicting that living body is made up of innumerable channels which carry biological fluids, energies and impulses as well as the nutrients and medicaments used time to time for therapeutic purposes. These channels or Srotamsi loose their integrity, competence and inherent functioning due to day to day physiological wear and tear, senescence, environmental pollution, stress and disease. It is essential to restore the competence of the Srotas System by specialized care. The classical idea of Srotas system is comparable to the bio-Membrane system is the continuum from endothelium of all hollow organs upto the individual cell membranes which need to be dynamic enough to permit the transfer and flow of their contents.

Ayurved propounds the theory of Sansodhan i.e. bio-purification and elaborately describes the Panca Karma Therapy, i.e. the Five-Fold Therapy in order to tackle the issue of impurity and incompetence of Srotamsi. If the channels are washed and purified periodically by appropriate Samsodhan procedure time to time one can easily prevent many diseases. Similarly if one attempts to purify the channels in morbid states one may successfully achieve the target of Samprapti Vighatana of a disease and a Cure becomes possible.

Ayurvedic Texts describe Five major Karmas or therapeutic procedures namely Vamana, or emesis is a specific purificatory method for eliminating Kapha Dosa, Virecana or Purgation for elimination of Pitta Dosa and Vasti i.e. Enemata therapy for elimation of Vata Dosa in view of the seasonal preponderance of Kapha, Pitta & Vata in respective Ritus or seasons, the texts describe specific Karmas for different Ritus too as an important preventive & promative care.

The Samsodhana therapy of Ayurved is an unique concept. It envisages not only the visceral cleansing rather it aims at the total bio-purification upto molecular level. A suitably administered Samsodhana Karma is expected to cleanse the hollow organs, cells, cell membranes and their pores effective the bio-purity of intracellular and extra-cellular contents and structures. When a patient in vomiting during Vaman Karma it is not only his stomach which is getting evacuated rather every cell of the body is 'Vomiting' and is getting cleansed. So is the case with all Karmas.

If the body is biologically purified and cleansed the physiology is restored optimumly and pathology reversed. The nutrients reach their desired destinations easily and their bio-availability is enhanced. The entire process of Dhatu Posana and Dhatu Parinam is accelerated and the mechanism of Kedari Kulya Nyaya, Khale-Kapota Nyayu and kshira-Dadhi Nyaya and accomplished well. Similarly the medicaments administered in Samsuddha Sarira reach their sites easily and effectively and possibly even a relatively smaller dose of a medicine may produce greater effect. In other words if Samsodhana is done prior to administration of a medication, possibly a lesser done may suffice. On the other hand when the Srotas system is purified the administered drugs and their metabolites may not stagnate unduly long in the body and hence the drug toxicity and side effects may get reduced. This is why Pancakarma is advocated as a pre-requisite for Samsamani Chikitsa.

Because of such fundamental benefits the Pancakarma therapy has received great scientific recognition in present times and it is believed that Pancakarma could also be an useful adjunct for practice of modern medicine and Pancakarma is currently advocated as a pre-requisite of modern chemotherapy too to help to reduce dosage and toxicity. Thus there is a great need to standardize Pancakarma therapy on scientific lines and to popularize its use. There is also a need to improve its technology to make it more non-invasive and user-friendly.

In recent years some such efforts have been made. The Ayurvedic Physicians of Kerala have played tremendous role to preserve the Traditions alive while certain research groups in different parts of the country have contributed significantly to the revival of Pancakarma therapy on scientific lines. The work of Singh RH et' al of Banaras Hindu University Varanasi, Kasture HS of Ahemdabad, Yadaiah P. of Akola and Nambudari et' al of CCRAS deserve mention in this context.

I had the pleasure to go through the pre-press copy of the present book "Clinical Pancakarma" authored by Dr. Polepally Yadaiah who has a long standing reputation in the field of Panch Karma therapy as a capable teacher, a scholar and above all a successful practitioner of this special branch of Ayurved. I have known Dr. P. Yadaiah for many years through his sustained work in this special field and I admire him for his continued interest and fruitful work and progressive outlook.

This comprehensive book deals with the literature and practice of the full range of the procedures of Pancakarma therapy encompassing the Purva Karma, Pradhana Karma and Pascat Karma practices. Besides, it includes research reports and interesting case reports treated by the author through Pancakarma and a very informative write-up on nine common Chronic intractable diseases and their management through Pancakarma such as Swasa, Parinamasula, Amavata, Paksaghata, Gridhrasi, Grahani Roga, Sthoulaya and Madhumeha.

The book is written in a lucid manner and its scientific temper is obvious. The entire subject is dealt in practical perspectives and hence this new book may prove to be a useful reading for all those readers who could be interested to practice Pancakarma in contemporary settings. I congratulate the author for this brilliant contribution to Ayurvedic literature.

Preface

I never heard a single word about Panchakarma from any one when I was a student in Ayurved College between 952 to 957. Rarely the teachers used the word panchakarma in their lectures and even the subject of panchakarma was not included separately for examination except in kayachikitsa subject. No one should be surprised if I say that very few people who were practicing Ayurveda knew about this subject, but I am sure nobody is practicing it in real classical way. Some times it looks as an exaggerated statement but it was fact. In Kerala 'Pizichil,' Pindaswedana (Navarakizi), Bastis were practicised in some institutes under the title of "Traditional treatment of Kerala.

In 1958 Dr. P. N. V. Kurup completed H.P.A. the post graduate course of Ayurveda from Post Graduate Center in Ayurveda, Jamnagar, and he was appointed as a Panchakarma Physician in the same institute. Later on, he was appointed to teach panchakarma subject in P.G. Center. After completion of my post graduation in 1960 I got an opportunity to work as an Assistant Panchakarma physician under him. After that, the same post were converted as Professor of panchakarma and Assistant professor of Panchakarma.

After taking the charge of "Advisor of Ayurveda, Ministry of Health & Family Welfare, Government of India" Dr. Kurup took great efforts to include the Panchakarma subject in P.G. Syllabus and later on it was also included in the syllabus of B.A.M.S. and devoleped as a separate subject.

The first scientific or complete summarized book written in Hindi by me (Dr. Kasture) "Ayurvedic Panchakarma Vijnan" which was published by Baidyanath Bhawan Nagpur in 1970. Since then, in 35 years many books were published in this subject but the book written by Dr. P. Yadaiah is useful and dedicated to the subject. Really speaking, I never saw such type of book since past few years.

Dr. P. Yadaiah is a learned professor in R.T. Ayurvedic college Akola Maharashtra and Head of the department of kayachikista and Panchakarma, a very senior person in Ayurvedic field and well-known teacher, a good physician in Panchakarma, and also working as a Vice president of National Academy of Panchakarma and Research (NAPAR), all India level Why this book is commendable.

This book contents 15 chapters in which first seven chapters give us the details of theory of Snehana, Swedana, Vamana, Virechana, Basti, Nasya and Raktamokshana. The author has given practical photographs at every stage to give us exact understanding of karmas which is the speciality of these chapters. All positions of Abhyanga, method of following it, Shirodhara, Shirobasti and different types of angapratyanga bastis. The same procedure is followed to describe Pradhanakarama-Vamanadi etc. In Basti chapter he described common basti with procedure and their results with classical references. The descriptions of theory is very simple and convenient for students to understand.

He has given the chapter of instruments in short with pictures which will be helpful for physicians to use in their clinics Most admirable thing of this book comes later on when he gives clinical reports with statistics of numerous patients on each and every karma in different dieases which shows his research interest. Probably nobody has given such a huge record in the books uptill now. This chapter is very worthwhile and I am confident that not only students of Ayurveda but vaidyas, teachers and research scholars would definitely be benefited and would get new spirit to work with confident.

Lastly his chapter on management of few diseases by panchakarma is extra-ordinary type where he briefly gives panchakarma treatment like Juvenile diabetes, acute myeloid leukemia, SLE, submucous fibrosis, avascular necrosis, intestinal perforation, spondylolesthesis, etc which are consider as difficult diseases or asadhya, apya diseases, with real case study report.

In my opinion, describing the practicals is different matter but explaining practicals on real work on each case in different diseases is a very specific work. That is why the book by Dr. P. Yadaiah stands at very high level of practical as well as classical work. I can definitely say that there are very few authors in this division who have done such great work in Ayurvedic field. However Dr. Yadaiah gets this credit to show praised path to future writers to utilize their experienced knowledge in their book so as to make Ayurvedic literature more competent and skillful.

I hope that we will be able to get more and more scientific books like this from Dr. P. Yadaiah in future. I wish him good health and long life to serve Ayurveda with strong hands and mind.

Contents

Introduction1-4
PART - I
Chapter i. Snehana Karma (Oleation Therapy)7-40
Chapter ii. Swedana Karma (Fomentation Therapy)41-52
Chapter iii. Vamana Karma (Vomiting Therapy)53-64
Chapter iv. Virechana Karma (Purgative Therapy)65-74
Chapter v. Basti Karma (Enema Therapy)75-98
Chapter vi. Nasya Karma (Errhine Therapy)99-108
Chapter vii. Raktamokshan (Blood Letting)109-114
Chapter viii. Panchakarma Instruments115-118
PART-II : Research Reports
Chapter i. Clinical Reports of Snehna and swedana121-134
Chapter ii. Clinical Reports of Vamana135-158
Chapter iii. Clinical Reports of Basti, Nasya Karma and 159-224
Raktamokshana
PART – III : Case Reports
Chapter i. Common Diseases & Panchakarma
Management261-286
Chapter ii. Exercises & Supports287-293
Bibliography294-296
Glossary297-303
Index304-307
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