When the kidney function fails, or falls below tolerable limits, metabolic wastes accumulate in the blood, which normally are excreted with the urine. Diagnostically, this state is indicated by a marked increase of the urea concentration in the blood. Urea is a characteristic component of urine and therefore the condition is known as uraemia. The urea by itself is not regarded as toxic; however, it is produced in such high amounts that it may accumulate in quantities which the body cannot handle (as the legendary medieval European physician Paracelsus said: 'Everything is either wholesome or poisonous - it is merely a matter of quantity.')
The only effective treatment known for the state of uraemia in western medicine is the artificial kidney. The common procedure is 'dialysis' in which blood is passed from an artery to a vein over a semi permeable membrane, separated from another flow of a degassed and isotonic solution at body temperature.
Substances which have a higher concentration in the blood diffuse through the membrane according to Fick's law, driven by the concentration gradient. Water balance is restored by means of a mild, controlled suction through the membrane. Certain substances which should not be eliminated, are contained in the solution in appropriate amounts, so as to counterbalance the blood concentration.
The patient who has no residual kidney function has to undergo this treatment twice or, more commonly, three times a week. Without such treatments, he would live for a very short time, two weeks or up to a month.
His mean life expectancy since the start of the treatment, based on European statistics, seems at present to fall somewhere between 12 and 15 years, subject to further increase as development proceeds. Today, there are patients who have been kept alive this way for more than 20 years.
Another version of the artificial kidney, used in the treatment known as hemofiltration, is the ultrafiltration device which is similar to a dialyzer, but has a membrane more permeable to fluid flow. Instead of passing a solution over the 'outer' side (in relation to the blood), a high degree of suction is used and the filtrate, passing through the membrane, is collected and drained off. It carries with it waste substances as well as necessary solutes. In order to replace both the latter and the water lost, an isotonic replacement liquid, containing certain electrolytes and other substances, is constantly being infused throughout the treatment in a controlled way- less the desired water loss which balances the intake between the treatments. The advantage of the method is that the permeation of blood solutes is fairly constant, but a disadvantage of hemofiltration is higher cost and higher potential risks. Typically, 18-20 litres of filtrate are drained in the course of a treatment, and almost the same volume replaced. Typical treatment durations are about 5 hours for hemofiltration and 6-8 hours for hemodialysis.
In my personal view, the general use of the artificial kidney is actually a sign of failure of official western medicine. Since modern medicine cannot heal typical and common kidney diseases, it has to resort to organ function replacement when uraemia develops and kidney failure is final. In typical cases, the final failure is merely pushed ahead a few years with synthetic drugs, until the inevitable fate of the artificial kidney must be faced.
The treatment by means of the artificial kidney is prohibitively expensive for developing countries. It is the privilege of the relatively wealthy. The cost per clinical patient a year amounts in central Europe to about Rs. 100,000. In India, it may perhaps be half as much, due to less personnel costs, but hardly less. Accordingly, dialysis treatment is widespread only in North America and Europe, and in countries like Japan and Australia. The rest of the world has very few or no such treatments.
For this reason, the interesting work of Dr. Tze-Kong-Young, National Defence Medical Centre. Taipei. Republic of China (Taiwan), which is sponsored by NIAMDD. Dept of N.I.H. (USA) is very valuable. He uses the gastrointestinal tract of his patients as a 'dialyzer' and thus keeps a number of them alive and active. This work may offer an inexpensive and practical alternative not only for developing countries but also as emergency treatment for dialysis patients, somehow cut off from the artificial kidney.
According to Dr. Young, if a hypertonic saline solution is drunk, it will be absorbed only in minor quantities in the intestines. It may even osmotically extract fluid, at least locally. Thus, it is passed through the alimentary canal and if taken in sufficient quantities, causes a water diarrhoea, eventually a clear solution being expelled through the rectum, large quantities can be passed this way. In a similar manner to the artificial kidney of the dialyzer type, the solution takes up waste substances, which diffuse from the blood, through the intestinal wall. The membrane is less permeable here, but this is to quite some extent compensated by a much higher contact surface.
As a result, water diarrhoea turns out to be a practicable way to replace the kidney function. It needs no special equipment or sterile solutions and conditions, but only water, salt and a certain amount of patience.
The saline solution used by Dr. Young is administered at a temperature of 37 degrees in quantities of about 200 ml. every 5 minutes for about 3 hours (i.e. a total quantity of about 7 litres). The treatment is done at home 3 times a week. Elimination starts about 45 minutes after beginning the treatment and ends about 25 minutes after it is finished. Typical clearance values are about 27 ml./min. for urea and 7 ml./min. for creatinine.
Now, this method will seem familiar to many an Indian reader. It is actually a derivative of the ancient method of shankhaprakshalana cleansing technique in hatha yoga. Other names for this procedure are varisara dhauti or sang pachar kriya. This procedure of Dr. Young has basically been known for certainly 2000 years (probably more) in India. Now, the modern work of Dr. Young has thrown new light on the somatic effects of shankhaprakshalana. Not only does it cleanse the intestines, but also the blood and the whole body.
In Gheranda Samhita (v: 1/18-19) we read about varisara dhauti as follows: 'Varisara is to be kept strictly secret. It cleanses the body and through its practise, one attains a shining body. Of all dhautis, varisara is the best. The one who practises this zealously, cleanses his unclean self and attains a divine body.' In the edition used, the translator explains: 'A divine body can be understood as a healthy body.'
This unique exercise is practised by drinking a large quantity of saline water and then performing uddiyana bandha at least 10 times in a sequence. The exercise forces the water through the small intestine. Thereafter, as a next stage, one performs an exercise called lauliki nauli (see v. 52) an equal number of times, which forces the water through the large intestine, and after a few minutes it comes out through the rectum.'
In 'Asana Pranayama Mudra Bandha' a modern text book on yoga by Swami Satyananda Saraswati, we read the following instructions regarding varisara dhauti or shankhaprakshalana: 'A clean container should be filled with lukewarm water. Some salt must be added to the water, not too much and not too little, but just enough so that the water tastes salty. Drink 2 glasses of salty water as quickly as you are able. Then perform the following 5 asanas, 8 times each: tadasana, tiryaka tadasana, kati chakrasana, tiryaka bhujangasana, udarkarsanasana.'
The author explains how those exercises aid the transport of the water through the gastrointestinal tract. 'After completing these 5 asanas, drink 2 more glasses of salty water. Repeat all 5 asanas 8 times. Then drink 2 more glasses of salty water and again perform the 5 asanas 8 times. Now go to the latrine and try to evacuate the bowels. Do not strain. Then drink 2 more glasses and perform the 5 asanas 8 times again' and so on. 'At first solid material will start to be evacuated, then probably water and stool mixed. Carry on drinking the glasses of water, doing asanas and sitting on the latrine. Eventually, only perfectly clear water will be evacuated. On average, between 16 and 25 glasses of salty water must be consumed before the perfectly clean water is evacuated.'
After the exercise, one should drink another 2 glasses of water and induce vomiting (vamana dhauti or kunjal kriya), and pass water through the nose (jala neti). Following this, one must rest for 45 minutes without sleeping and then eat some khichari, rice and lentils with ghee (clarified butter). The oily ghee is considered important since it is said to internally coat the freshly washed intestinal walls. As a benefit of the exercise, the author explains: 'A complete cleansing of the digestive tract allows the blood to become pure, which manifests in a noticeable improvement in the health of the entire body.'
I myself have practised shankhaprakshalana a few times according to these instructions at a yogashram in Switzerland. I quite easily came to pass the clear solution after 20-30 glasses. Comparing this personal experience with the publications of Dr. Young et al., I have no doubt that shankhaprakshalana is a practicable, low cost alternative to dialysis, in any case, as a temporary replacement but most probably as a sufficient treatment alone for many patients.
As an alternative to dialysis, shankhaprakshalana is no doubt effective and practicable, but at vastly reduced costs. It has also been used successfully in cases of cholera, with the purpose of continuously supplying the bowels from above with liquid to be expelled, so that this has not to be extracted from the body fluids in greater amounts, preventing dehydration and demineralization. Once again modern medicine confirms the remarkable insights of the ancient Indians who even before Buddha, had devised a simple yet effective way of bringing shining health to the body.