Panchakarma is Ayurveda’s therapeutic purification process that removes metabolic waste (mala) with the intent to restore normal function to the dosas. The word panchakarma comes from two sanskrit words, pancha and karma, and translates as “the five actions.”
There are five therapeutic procedures that aim to return the dosas back to their normal state (prakriti). The procedures intentionally aggravate and move the accumulated metabolic waste, which is deeply seated within the cellular level, through the nearest external opening. (Ca. Su. 16/, Ah. Su. 14/)
Metabolic waste accumulates overtime from improperly digested foods caused by improper daily and seasonal habits, food, drink, exercise, and mental stress. Ayurveda believes this metabolic waste accumulates primarily because of low digestive fire (agnimandhya).
Panchakarma is an important part of yearly and seasonal regimen as it removes the aggravated dosa before it can fully manifest as a disease. The principals and process of panchakarma was first introduced in the Caraka Samhita (earliest Ayurvedic text). The main principal with Caraka’s panchakarma is to move the aggravated dosa with the help of preparatory procedures from the periphery (sakha) to the gut (kostha) and expel it through the nearest natural opening.
Caraka’s five therapies of panchakarma
- Therapeutic vomiting: vamana
- Therapeutic purgation: virecana
- Therapeutic medicated enema: niruha basti (evacuative enema)
- Therapeutic medicated enema: anuvasana basti (restorative enema)
- Nasal drops: nasya
The inclusion of bloodletting or raktamokshana, was later introduced as one of the five therapies in the Susruta Samhita. Susruta was a surgeon and introduced bloodletting or raktamokshana as one of the five therapies. This process also removes the aggravated dosa but it’s still in the periphery (sakha) and removed through a surgical opening created by the Ayurvedic doctor.
Susruta’s five therapies of panchakarma with raktamokshana
- Therapeutic vomiting: vamana
- Therapeutic purgation: virecana
- Therapeutic enema: niruha basti (evacuative enema)
- Therapeutic bloodletting: raktamokshana
- Nasal drops: nasya
More About Panchakarma
Panchakarma, also known as shodhana or purification therapy, is preferred over shamana, also known as palliation or pacification therapy. Shamana reduces the aggravated dosas but does not remove them from the body. Shodana is superior because it removes toxins or aggravated doshas from its root, improves the function of agni (digestion and metabolism), brings clarity to the sense organs, mind, intellect, and restores strength and virility. Panchakarma is a required pre-requisite before rasayana therapy or rejuvenation therapy.
The process for panchakarma has been discussed in all of the ancient Ayurvedic texts. The Caraka Samhita, which is the most important text on internal medicine, gives great detail on the wide use of panchakarma therapy for almost all the major diseases. There are two sections: Kalpa Sthana is the study of formulations used in the therapeutic purification procedures and Siddhi Sthana is the standardization and successful administration of various therapeutic purification procedures.
Purva karma (preparation):
The purva karma stage includes four therapies before the main panchakarma procedures. These therapies start the process of moving metabolic waste from their sites of vitiation by liquefying and expediting them toward the gut for expulsion. Theses therapies remove obstructions and pacify vata dosa to move in its normal direction. The medicines and time frame for purva karma differ according to the procedure and the condition of each patient.- Dipana: stimulating digestion and metabolism with herbal preparations.
- Pacana: digesting the undigested and poorly metabolized waste or mala.
- Snehana: internal and external oleation with unctuous herbal preparations.
- Swedana: fomentation or steam heat to induce the body to sweat.
Pradhan karma (main treatments):
This stage is the main procedure and is prescribed based upon the disease, site of dosa vitiation and nearest route to expel it. When a healthy person undergoes panchakarma for maintaining good health, the therapies are given in order of vamana, virechana, unctuous basti, decoction basti, and nasya nasal cleansing. For disease management usually one or more procedures are performed until the morbid dosa/s are brought back to a normal state.
Vamana – therapeutic vomiting
When there is congestion in the lungs and symptoms such as chronic bronchitis, colds, coughs or asthma, the Ayurvedic treatment prescribed is typically therapeutic vomiting. This therapy is useful for eliminating excess kapha dosa from its main site the stomach. Vamana is usually administered with three to four glasses of different ingredient such as salt water, milk, sugarcane juice, yashtimadhu phanta and herbal paste to stimulate vomiting.
Virechana – therapeutic purgation
When excess bile (pitta dosa) accumulates in the gall bladder, liver and small intestine, it tends to produce rashes, acne, chronic fever, nausea, burning sensation, and disorders with inflammation. virechana is generally administered with avipattikar powder, trivrit lehyam, castor oil or triphala in a combination that is appropriate for each person.
Basti – two types of therapeutic enema
The colon is the site for vata dosa and herbal ingredients are prepared in sesame oil and administered into the colon and held for a period of time depending on the recommendations for each person. Basti is one of the most effective healing therapies for vata disorders and usually a series of bastis over a period of time is recommended. Basti’s are useful for constipation, bloating, sexual disorders, backache, sciatica, arthritis, rheumatism, gout, muscle spasms and chronic headaches. Two types of bastis are given during panchakarma, niruha basti is an herbal decoction used as an evacuative enema and anuvasana basti is an herbal oil used as a restorative enema.
Nasya – therapeutic nasal cleansing
The nose is the doorway to the brain and consciousness and the site where prana enters the body. Prana governs sensory and motor functions, memory, concentration, and all intellectual activities. Imbalanced prana creates headaches, convulsions, loss of memory, and reduced sensory perception. The herbal preparations are warmed to body temperature and the eyes are covered with cloth. The tip of the nose is raised and the herbal medicine is administered to each nostril. When the preparation comes to throat, the patient should hold for 10 seconds then spit the contents till the entire medicine is expelled. Nasya therapy brings clarity to the mind, sense organs and restores proper sleep.
Pascat karma (post-therapy):
There is a specific regimen to follow once the main panchakarma procedures are complete, this stage is called samsarjana krama. Digestive strength is weakened due to the expulsion of dosa and to regain the correct digestive strength there are certain guidelines for foods and lifestyle habits that must be followed. In total there are 28 types of gruels that may be recommended after the main therapies are given. Each gruel has the intention of slowly building up the digestive strength to its normal state and are made from rice or barley with herbs like amalaki, bilva, and ginger. Dhumapana (medicinal herbal smoke) is also administered to help the dosas regain their normal state.
Shamana is a process of pacification where the aggravated dosas are slowly pacified over time. This therapy involves kindling the digestive fire to digest some of the accumulated toxins which helps to bring balance to the dosas and dhatus. Shamana differs from panchakarma in that the therapies slowly pacify the accumulated metabolic waste or mala rather than expelling them all at once. There are seven classical therapies for shamana therapy- Dipana: the process of stimulating digestion and metabolism with herbal preparations.
- Pacana: the process of digesting the undigested and poorly metabolized waste or mala.
- Ksut: the process of withstanding hunger
- Trt: the process of withstanding thirst
- Maruta – the process of exposing to wind
- Atapa – the process of exposing to sunlight
- Vyayama – the process of performing exercise
Shamana is a good temporary solution if the person is unable to take time off from work or other responsibilities. Shamana can be utilized to help the person feel better until they are able or ready for panchakarma. The best possible solution is to consult an Ayurvedic doctor for the best panchakarma treatment plan for each person’s vikruti, age, climate, season and available time.
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