The Mukkutrams are Vali, Azhal and Iyam which are further classified into 20 branches.

Bio-cleansing method in Siddha balancing therapy is considered as first line of treatment explained by Saint Yugimuni, Therar, Agathiar in their texts which are followed as standard operative procedures by Siddha physicians for treating a diseases or patient. Modified techniques of Samanamarutthuvam employed to balance deranged kutram is going to be popularized soon for its wide range of applications and their effectiveness in addition to the conventional treatments.

The introduction of Samanamarutthuva procedures is compiled with a view to impart simple and basic knowledge of these procedures to the users and it has also been organized with various textual references.

It is the process of elimination of toxic elements received and stored in the body from body metabolism causes toxicity and long term harmfull effect to health.

It is the process of removal of fat soluble toxic materials stored in liver, small intestine, skin etc.

It is the process of elimination of volatile substances like carbon-di-oxide, volatile gases through lungs and skin.

Diffusion and osmosis are the processes in which the molecules having different concentrations moves from one to another when separated by semi permeable membrane. The outer skin and the mucous membrane of gastro intestinal tract provide an excellent prospectiveness for this manoeuvre. Siddha balancing therapy procedures like Vamanam (Therapeutic Emesis), Kazhicchal or Virechanam or Bethi (Therapeutic Purgation), EnnaiPeetchu (Medicated Oil Enema), Ennaimuzhukku (oil bath) and Thokkanam (Physical manipulation) use medicated oil liberally, thereby removing toxic fat soluble waste materials and volatile gases.

Preparatory therapies like Ennathokkanam (Oil massage) and Viyarvaimarutthuvam (Mutrudalvedhu and pugai) are given to the patient to remove the liquid water soluble toxic materials from the body.

In general Ennaithokkanam is main therapy and Viyarvaimarutthuvam is performed prior to other main therapies like Peetchu (enema), Vamanam (emesis), Kazhicchal (purgation), Nasiyam (nasal liquid application) and Kuruthivaangal (blood-letting).

Vedhu (neeravi) procedure using hot steam helps to increase the local skin blood flow thereby enhancing the exchange process and simultaneously reduces the subcutaneous fat and mesenteric fatty acids in the gut layers.

The various balancing therapy procedures, application of more amount of medicated oil all over the skin helps to diffuse fat soluble toxins through skin pores when exposed to hot therapies. Repetition of these procedures over several days will largely remove the water soluble and fat soluble toxic wastes by concentration gradient and diffusion. Siddhar balancing therapy is safe and easy to retain and restore health without any major side effects.

Peetchu is the method of insertion of liquid medicines to excrete or wash the internal organs using a piston and pipe. The instrument used to perform Peetchu is called as Peetchukaruvi.

Vamanam or Satthi or Kakkal means to induce vomiting. It is a bio-cleansing measure meant for the elimination of Azhalkutram accumulated in the upper gastro intestinal tract.

Kazhichal is the procedure by which the vitiated kutrams are eliminated through the anal route. It is the treatment of choice for Vali (Vaatham) predominant conditions.

Nasiyam is a method of instilling liquid into both nostrils. Fresh plant parts are crushed and filtered or boiled and filtered or the semi solid prepared medicine is dissolved in solution and filtered or prepared fatty oil is instilled into nostrils. It is widely employed to treat the diseases of ear, nose and throat and strengthens the organs above neck.

Nasikaparanam is defined as the method of application of dry nasal powder into nostrils. It is otherwise called as nasal snuff or nasal powder. Dry raw drugs are crushed, finely powdered and filtered using a fine cloth. The fine powder about Panaiedai (488 mg) is used to apply.

Kalikkam is defined as a method of ophthalmic liquid application (Eye drops). Kalikkam is prepared by crushing and extracting the liquid juice from fresh plant parts or packed in a cloth and soaked in a liquid and then the liquid juice extracted. The extracted juice is instilled into eyes. Kalikkam (Ophthalmic drops) is first instilled into left eye and then into right eye. Generally Kalikkam is instilled into medial eyelid of the eye up to 1-5 drops.

Mai is defined as a soft external application mostly lined on the eye lashes in smaller quantity to treat eye diseases. Lining of eye lashes is usually performed by a specific probe. Mai is otherwise called as Anjanam.

It is furthwe divided into two types.

Application of medicinal leech to suck blood

Kuruthivaangal is defined as the method of leaking and removing the excess blood in specific areas. It is commonly known as instrumental blood-letting.

Thokkanam is a complex therapeutic procedure usually done by the physician and therapist hands and legs. Generally it is done with or without the application of medicated oil. It is employed for curative, palliative and preventive purposes.

The following nine methods viz. Thattuthal, Irukkal, Pidithal, Murukkal, Kai kattal, Azhutthal, Izhutthal, Mallatthal and Asaitthal are performed on the affected area or all over the body of the patient under certain force called as Mandham (mild force), Matthimam (moderate force) and Sandam (severe force) according to the applied pressure exerted by the physician or the therapist during massage.

It is a method of oil bath in which fatty oil is applied on the head, followed by instilling nasal drops, ear drops and eye drops. The oil is kept over the head or body or both and retained for a stipulated time. Ennaimuzhukku stands for lubrication of skin and related organ system by the administration Application of fatty substances externally is an important preparatory procedure for bio cleanising therapies. Plant oil, Cow’s ghee, Fat and Bone marrow are generally used for ennaimuzhukku in which cow’s ghee is better.

Sevithuliis done by using the same oil by pouring 2-3 drops in to the ear openings. Kalikkam and Nasiyam done during thokkanam is already followed as main procedure

Viyarvaimaruthuvam is a process to induce artificial sweating (sudation) for a patient who has already undergone Ennaipootchu (external oleation) or ennaithokkanam (oil massage).

It is one of the preparatory therapy employed to balance deranged humours especially Iyam. Before inducing sweat therapy the fatty balance of the patient is assessed by adipose tissue and previous intake of fatty foods like milk and ghee.

After exposure to heat therapy patient gets sweating. Generally vamanam (emesis) and pugai (nasal fumigation) is advised after getting sweat.

Table: 4 - Differntiation of heat and sweat