Shank prakshalana

Etymology

Shankā शंका
Prakshālana प्रक्षालन – prakshaalana, prakshalan : ablution, cleansing, wash.
Śaṇkha: (Sanskrit: शंख, Śaṇkha)

Introduction

Shank prakshalana, also known as varisara dhauti, is one of the six Hatha Yoga Kriyas. It is a simple technique consisting in flushing the gastro-intestinal tract with salty water. In a sense it is like submitting your GI tract to a shower.

Dysfunctions of the GI tract

Among the pathologies associated with the GI tract, prolonged transiting (constipation) results in various degrees of subjective symptoms (substantial discomfort, abdominal cramping, and a general feeling of malaise) and is associated with abnormalities (i.e., colonic diverticular disease, hemorrhoid disease, anal fissures) that occur secondary to an increase in colonic luminal pressure and intravascular pressure in the hemorrhoid venous cushions." The prevalence of constipation in the US is about 2% of the population. The "subjective symptoms" alone lead to over $ 800 millions laxative market in the US only.

Second, colon cancers, ranking second with cardiovascular diseases in the US, have established associations with diet. 80% to 90% of all cases of colorectal cancer seem to be linked to dietary factors and the prevalence of colorectal cancer is mainly due to diet – high intake of meat products and animal fat and relatively low in dietary fiber. , Figure 1 presents the incidence of colon cancers per location on the colon. The scientific literature is sparse on establishing causative links between locations and inductive factors. There are suggestions on the possibility of curvatures linked to increased exposure to irritants or toxics.

Figure 1 – Incidence of colon cancers per location

Rational of Shank prakshalana

This technique is unique in that is eliminates the entirety of the sediments of the entire digestive tract from the stomach to the anus. Other than oral sodium phosphate solution, the laxative preparation for barium tests, techniques allowing simple and complete intestinal cleansing are poorly studied.

The water is absorbed through the mouth and goes into the stomach. Guided by simple movements easily executed by all, the water circulates through the intestines and exits through the anus. The procedure continues until the exiting water is as clear as the entering water. The procedure presents no major difficulties and no known danger. It is suggested as a cleansing technique or a reeducation technique in dysfunctions of the GI tract. However, the technique must be strictly followed and the contraindications are listed below.

Preparation

Salt is added to warm water to make a solution slightly less saline that the physiological serum.

Amount of water Amount of salt
1 liter 5 to 6 grams one teaspoon per liter
1 gallon 19 to 23 grams four teaspoons per gallon

The water should be warm, ideally body temperature, to avoid all phenomena associated with cold water being in contact with the GI membranes (i.e. vasoconstriction). The water is made saline because if it was pure it would be absorbed by osmosis through the mucosa and follow the normal metabolism of water with evacuation through urine.

Adequate time for the procedure
The best time for this procedure is in the morning, while fasting. The complete cleansing takes about one hour for an experienced practitioner. The first few times make demand one to four hours. The procedure must be followed by a quiet day without exercises or yoga. The person must keep warm at all time after the exercises.

Procedure
The following is the sequence of the procedures, except the movements insuring the water transit through the digestive tract. These movements are presented separately.

1. Drink 1 glass of warm salted water (body temperature or higher).
2. Execute the series of movements

Repeat Steps 1 and 2 until six glasses of water have been drank.

Note that the series of movements bring the water out of the stomach and the sequence should therefore not generate a bloating of the stomach or nausea.

Once six glasses of water have been introduced into the GI tract, go the toilet and try to initiate a bowel movement. Normally, a first voiding should occur. The shape and color of the feces is initially normal and then the feces quickly become watery and yellowish.

If voiding does not occur immediately, wait 5 to 15 minutes, do the movements again without absorbing more water and then try to induce a bowel movement. Once the cleansing starts, the rest of the cleansing follows naturally and without the discomfort associated with diarrhea.

Note: some practitioners suggest the following:
1/ To trigger the siphon if it does not occur naturally, use an enema kit (i.e. rectal bulb syringe).
2/ Some practitioners lubricate the anal skin to prevent irritation that may occur from repetitive voiding.

After the first voiding
/ Repeat the sequence of drinking one glass of water/execute the movements. Go back to the toilet. Voiding should occur. Continue this series until the water goes out as clear as it came in. This corresponds to approximately 10 to 14 glasses of water.
Once satisfied with the results, the protocol ends by either:
1/ Doing nothing. There may be several other voiding and increased urination in the next hour or so
2/ End the procedure with vamana dauthi, the stomach cleansing. Drink 1 to 3 glasses of non-salted water and expel it. This cancels the siphon and empties the stomach. Vamana-Dauthi is traditionally done after Shank Prakshalana.

Causes of failure
If voiding does not occur, for example after ingesting four glasses of water, this indicates that the pyloric sphincter does not open. There should also be a sensation of repletion up to experiencing nausea. In such case, repeat the movements and going to the toilet but do not drink more water. The disappearance of the nausea indicates that the pyloric sphincter has opened. Once the siphon induced, the flushing is initiated. Sometimes a slow siphon may be associated with local gas pockets due to fermentation. In such cases, a gentle stomach massage in the clockwise direction or the inclusion of Sarvangāsana in the series of movements should eliminate the clog. In the case where no voiding occurs, simply stop and:
1/ Doing nothing. There may be several other voiding and increased urination in the next hour or so.
2/ End the procedure with Vamana-Dhauti, the stomach cleansing. Drink 1 to 3 glasses of non-salted water and expel it. This cancels the siphon and empties the stomach.

After the exercise: The practitioner must rest and keep warm.

The first meal

After Shank Prakshalana, the following instructions must be imperatively executed.
Eat at the earliest 30 minutes after the procedure and no later than one hour after. The digestive tract must imperatively not be left empty for more than an hour: The rhythm of the body has been temporarily disturbed; however, fifty minutes after completion of the practice the digestive organs resume their functions.
The first meal consists of white rice (the cellulose of complete rice will irritate the intestinal mucosa), overcooked in water with at least 40 grams of butter or ghee, a class of clarified butter. Slightly salty tomato sauce, without pepper, lentils or well cooked carrots can be added to the meal. An alternate meal would be khicheri, a creamy lentil and rice dish.

The two components of ghee rice and the three components of khicheri are helpful in the restoration of correct digestive function. The clarified butter is necessary to coat the intestinal walls until the body produces a new lining. The rice provides a simple, easily digestible packing material in the form of carbohydrate, and creates mucus, which also protects the inner lining of the alimentary canal. The lentils supplement the diet by giving the body an easily digestible source of protein. A sufficient quantity of khicheri must be eaten to reline the intestines and keep the walls of the gut stretched; otherwise they may cramp due to the absence of the bulk to which they are accustomed. This bulk not only maintains the tone but also aids the intestines to resume peristalsis. It is also important in order to prevent indigestion, diarrhea, and constipation.

Having eaten, further rest is necessary. However, it is important not to sleep for at least three to four hours after the initial meal. Sleep during this period may lead to physical lethargy and headache. Complete rest should be taken for the remainder of the day and also the following day. During this period it is advisable to keep silence and avoid physical or mental work. Khicheri should also be prepared for the late afternoon or evening meal, about seven hours after the first special meal. The stomach must be filled to capacity at both meals, even if there is no feeling of hunger.

Important
Milk, yoghurt, all acid food and drinks, fruits and raw vegetable are forbidden for 24 hours
Bread is allowed starting with the second meal. All fermented and white cheeses are forbidden (i.e., brie, camembert). Semi-hard or hard cheeses are allowed (i.e., gruyere). Alcohol and tonic or stimulant drinks must be avoided.
After the 24-hours period, the normal diet can be reintroduced, while avoiding excessive consumption of meat.

Drinks
The absorption of salty water has drained by osmosis part of the body fluids towards the digestive tract. This is part of the cleansing process. It is therefore normal to experience thirst after the exercises. Do not drink before the first meal as the fluid will mostly go through the intestinal tract. On the other hand, during and after the first meal, the practitioner should drink water, mild infusions or medicinal teas (only under the guidance of an experienced therapist).

Stools after the exercise
Voiding should occur 24 to 36 hours after the procedure. The stools will initially be yellowish and without smell.

Frequency of Shank Prakshalana
It should be performed twice a year at least and 4 times a year on the average, at the changes of seasons. It is feasible to practice it once a month and frequent practices should be under the guidance of an experienced therapist. Variations of Shank Prakshalana exist, with specific purposes. For example, a weekly half-procedure (absorbing six glasses of water only) will help reeducate the intestine in some cases of constipations. Compared to colonic techniques, the colon does not undergo local distention.

Benefits

The fist benefit is the total flushing of the gastrointestinal tract, elimination of fecal matter and elimination of residues that may otherwise have long transit time. Second, the osmosis of the intestinal wall is reversed, and the blood is cleansed as toxins are drawn from the major organs of the body by the action of the salty water.

Benefits include an immediate regulation of the GI functions and slower results including decreased body odor, freshness of the breath, enhancement of certain skin conditions and improved complexion.
Other reported
Other benefits reported include a general regulation of digestive functions and sugar regulation.
This intestinal flush has also been used in the cases of intestinal parasites such as oxyuriasis (pinworms) and dysentery.

Counter indications
Without appropriate supervision, the following are strict counter indications.
1. All structural pathologies of the lining of the GI tract including ulcers.
2. Metabolic pathologies including dysentery, Crohn's disease, acute colitis, acute appendicitis, intestinal tuberculosis and cancer.
3. Disturbances of renal function and water and electrolyte balance

The series of movements

Movement 1: Tiryak Tadāsana
Standing up with the feet spread apart by about 30 cm, the arms are raised, the fingers crossed and the palms turned upwards. The back is straight and the breathing regular.
Without rotating the torso, lean first to the left then come back and lean to the right.
This total movement is repeated four times and takes about 10 seconds.
This exercise opens the pylorus and a certain quantity of water goes into the duodenum and the intestine at each inclination.

Figure 2 Tiryak Tadāsana

Movement 2 - Kati Chakrāsana कटी चक्रासन
This movement moves the water in the small intestine.
The starting position is the same, standing up with the legs spread out by about 30 cm. Extend the two arms vertically and bend the left one so that the thumb and second finger touch the right clavicle. Then rotation the trunk and bring the right arm to the back as far as possible while looking at the fingers. Repeat this movement to the left.
This double movement is done four times and takes about 10 seconds to complete.

Figure 3 - Kati Chakrāsana

Movement 3 - Tiryak Bhujangāsana
This movement progressively guides the water through the small intestine. The exercise consists in a variation of bhujangāsana, the cobra. Only the palms of the hands and the the toes rest on the ground. The body and thighs hang over the ground, feet spread apart by about 30 cm. This distance is important as it allows the correct rotation of the trunk. Once in this position, rotate the head, shoulders and trunk until you can see the opposite ankle. The movement starts with a rotation to the left, until you can see the right ankle. From there, without stop, rotate to the right.
This composite movement is repeated four times and last about 10 to 15 seconds.

Figure 4 – Tiryak Bhujangāsana

Movement 4 - Udarakarshanāsana

Ethymology: udara उदर: abdomen; karsana कर्षण; pulling, drawing out, drawing to and fro

Once the water reaches the extremity of the small intestine, it needs to be moved into the colon through the fourth and last movement. For people suffering from knee problems, a variation is included below.
Starting position: a) kneeling down, feet apart by about 30 cm, the heels are placed outside of the thighs and not under the buttocks. The hands rest on the knees, spread by about 50 cm. b) Rotate the trunk and put the left knee on the ground by the right foot. The abdominal wall props against the right thigh and the right hand is used to increase the pressure between the abdominal wall and the thigh. The head continues the rotation of the trunk and turns further to the right. This increases the intra-abdominal pressure.
The movement is then done on the other side.
As for the previous exercises, the sequence is done four times for about 15 seconds.

Figure 5 - Udarakarshanāsana

Variation for Movement 4: Movement 5 – Variation of Ardha-Matsyendrāsana

If the previous exercise cannot be done, it can be substituted by a variation of ardha-matsyendrāsana. First, the right foot rests on the right of the left knee and the left arm and hand comes to the right and rests upon the right leg. The left arm is used as a level on the leg to exert pressure on the right side of the abdominal wall. The trunk and neck rotate to the right. The left hand rests on the ground behind the back. Differing from ardha-matsyendrāsana, only the lower abdominal wall is compressed.

Figure 6

Synopsis of the entire sequence

1. Drink one glass of warm salty water
2. Execute the series of four bilateral movements.
3. Repeat 1. and 2. until six glasses of water have been used.
4. Go to the toilet and attempt a bowel movement. If failure, repeat 1. and 2. without drinking water. If still failure use a mild enema.
5. Start the cycle again
6. The procedure stops according to your decision. The complete procedure ends when the exiting water is as clear as the entering water.
7. End the procedure with vamana dhauti or by doing nothing. In the second case the water still in the stomach will continue its motion in the GI tract.
8. Wait 30 minutes to 60 minutes and eat. Do not drink anything before you eat.