Panchkarma
The techniques and methods of Panchakarma treatment are deeply rooted in the ancient Ayurvedic texts such as the Charaka Samhita and Sushruta Samhita. These therapies were described as early as 1500 B.C., nearly 5000 years ago.
Strictly speaking, Panchakarma is not a singular treatment or a fixed sequence of therapies. Rather, it refers to five therapeutic procedures designed to eliminate aggravated doshas (Vata, Pitta, Kapha) from the body, thereby restoring health. Ideally, these procedures should also be undertaken by healthy individuals during moderate seasons, avoiding times of extreme heat, cold, or heavy rainfall.
Purpose of Panchkarma
1. To eliminate aggravated doshas before they can disrupt physiological balance, thereby maintaining health.
2. To support the optimal functioning of body tissues, delaying aging and promoting active longevity.
3. To maintain the equilibrium of doshas and ensure robust physiological functioning, while also helping to treat various diseases
In short, Panchakarma therapy works as a kind of "servicing" of the body, which is constantly active and exposed to wear and tear.
Panchakarma’ is a classical therapeutic treatment, though in modern times, the term has acquired a commercial value. Popular therapies such as Shirodhara and oil massage are often mistakenly considered part of Panchakarma. In reality, such treatments are traditional Ayurvedic therapies useful for certain ailments, but they do not constitute Panchakarma.
Since Panchakarma eliminates large amounts of doshas, it is often compared to “physiological surgery.” Just like surgery, it requires strict adherence to preparatory and post-procedure regimens of diet and lifestyle. It must only be carried out under the supervision of a trained Ayurvedic physician (Vaidya).
Panchakarma can be planned for both healthy and diseased individuals after proper evaluation of constitution (Prakriti), current disease status, and strength. For a healthy person, it acts as a preventive and rejuvenative investment, while for a diseased person, it acts as a therapeutic intervention.
Before we explore the five main Panchakarma procedures, we bow at the lotus feet of Lord Dhanvantari and our Guru, seeking their blessings to present the true and pure concept of Panchakarma to society, and to stop the misrepresentation of traditional therapies as Panchakarma.
Preparatory Procedures
Before undergoing the intensive cleansing therapies of Panchakarma, the body must be prepared with a series of preliminary procedures. The two most important are:
1. Snehana – Oleation therapy
2. Swedana – Sudation (sweating) therapy
Proper application of these therapies ensures the effectiveness of the main Panchakarma procedures.
Snehana Therapy
In Snehana, unctuous substances such as ghee and oils are used to lubricate and nourish the body, both internally and externally. This loosens morbid matter, enhances resilience of tissues, and prepares the body for cleansing.
There are two types of Snehana:
1. Internal Snehana (Sneha-pana)
2. External Snehana (Abhyanga)
Internal Snehana (Sneha-pana)
Among the internal oleation methods, Shodhana Sneha-pana is specifically used to prepare the body for purification (Shodhana).
This therapy lubricates the bodily channels, allowing doshas to be dislodged and expelled. It also enhances tissue resilience so that the body can withstand the strain of cleansing procedures.
The selected ghee or oil is consumed early in the morning on an empty stomach, after the previous day’s food has been digested.
The dose is tailored to the individual’s digestive capacity and disease condition. It is gradually increased daily (e.g., 30 ml, 60 ml, 90 ml), and continued for 3–7 days until the body is sufficiently lubricated.
Completion of Sneha-pana is determined by clinical signs, assessed by a physician.
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During this period, warm food and water must be used for drinking, bathing, and cleaning, as cold substances constrict the channels and may cause complications.
Since dose adjustment is highly critical, this procedure must always be carried out under the supervision of a trained physician.
External Snehana
In Abhyanga, oil, ghee, or medicated fats are applied externally to the body. The oil penetrates through the skin pores, nourishes tissues, and pacifies Vata dosha.
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Plain sesame oil (hot in nature) is suitable for cold climates.
Coconut oil (cool in nature) is preferred in warm climates.
Daily Abhyanga is recommended for all healthy individuals, with special emphasis on head and foot massage.
A few drops of warm oil can also be instilled into the ears.
After Abhyanga, either Swedana (sudation) or a warm water bath is advised. Soap and harsh chemicals should be avoided; instead, herbal ubtan (scrub powder) may be used.
Benefits of Abhyanga -
1. Reduces fatigue and stress.
2. Pacifies Vata dosha.
3. Promotes sound sleep.
4. Improves skin tone, softness, and strength.
5. Enhances physical endurance.
6. Improves eyesight.
7. Slows down the aging process and promotes longevity.
Swedana – Sudation therapy
Swedana refers to inducing perspiration using heat. Sweating dilates body channels, dislodges doshas, and facilitates their movement toward the gastrointestinal tract for elimination.
Swedana can be done through methods such as steam chambers, herbal boluses (Pinda Sweda), localized fomentation (Nadi Sweda), or full-body steam (Bashpa Sweda).
Duration is usually 10–15 minutes, until sweating is achieved.
It is typically combined with Snehana for best results.
Dry fomentation is sometimes used in conditions where oil application is contraindicated.
Benefits of sweating -
1. Pacifies Vata.
2. Improves appetite.
3. Makes skin soft and supple.
4. Reduces heaviness, lethargy, and excess fat.
5. Improves joint mobility.
6. Relieves bloating by facilitating expulsion of gas.
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Excessive Swedana can cause weakness, dizziness, or skin rashes. Hence, it should not be practiced regularly without medical advice.
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Vamana – Emetic Therapy
The term Vamana literally means "vomiting." In Ayurveda, it refers to a therapeutic procedure in which vomiting is deliberately induced using specific medicinal substances to expel aggravated doshas (primarily Kapha, and to some extent Pitta) from the body.
Unlike simple vomiting caused by salt water or throat stimulation, Ayurvedic Vamana is a well-planned and guided therapeutic intervention.
Indications:
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Vamana is especially beneficial for Kapha and Pitta disorders, such as:
Allergic rhinitis, asthma, and chronic cough
Skin diseases
Indigestion and fevers
Nodular swellings
Chronic allergies
Preparatory Phase
Since Vamana is an intensive purification therapy, the body must be properly prepared:
Oleation (Snehana) and Sudation (Swedana) are carried out for 3–7 days.
On the evening prior to Vamana, a Kapha-promoting diet such as curd rice or Khichadi made with black gram (Udad dal) is given to loosen the doshas.
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The Procedure
On the day of Vamana:
1. The patient undergoes Snehana and Swedana in the morning.
2. They are then given a specially prepared Vamana decoction in large quantities.
Usually 5–8 liters of liquid (e.g., sugarcane juice, herbal decoctions, medicated water, or milk) are consumed.
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3. After a few glasses, medicinal vomiting is induced.
4. The sequence of expulsion is typically Kapha first, followed by Pitta.
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The whole process usually takes 70–90 minutes.
The signs of successful Vamana include:
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Lightness in the chest, abdomen, and body
Clarity of senses
Relief of congestion
Gentle fatigue
After the procedure, Dhumapana (medicated smoking) is done to clear residual Kapha, followed by Gandusha (herbal gargles).
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Post-Therapy Care
The patient should rest but not sleep during the day.
A special post-procedure diet (Samsarjana Krama) is followed for 4–5 days to restore digestive strength (Agni).
Preventive Vamana is often recommended once a year during spring, when Kapha accumulation is highest
Note: Patient cooperation is crucial for success, as Vamana requires disciplined participation.
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Virechana – Purgation Therapy
Virechana is the therapeutic induction of controlled purgation to expel aggravated doshas (mainly Pitta, and secondarily Kapha) through the downward route of the gastrointestinal tract.
Unlike ordinary laxatives, Virechana has a deeper purpose: to eliminate not only waste products but also the root cause of disease lodged in tissues.
Indications:
Pitta disorders such as jaundice, skin diseases, and blood disorders
Hemorrhoids and piles
Digestive and metabolic disorders
Asthma and chronic fevers
Genital and urinary disorders
Chronic toxicity
Contraindications:
Pregnancy, childhood, advanced age, and certain heart diseases.
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Preparatory Phase
Similar to Vamana, the body is prepared with 5–7 days of Snehana and Swedana. Once the doshas are sufficiently loosened and collected in the GI tract, Virechana can be administered.
The Procedure
1. The day before Virechana, internal oleation is stopped.
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2. On the morning of Virechana:
A light breakfast (usually Moong dal) is given soon after sunrise.
After partial digestion of this meal (about 2–2.5 hours later), the patient receives Abhyanga and Swedana.
Then, the purgative medicine (selected according to constitution, strength, age, and disease) is administered.
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3. The patient drinks only warm water and remains indoors.
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4. Elimination usually begins within 2–3 hours, producing 5–20 bowel evacuations.
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Signs of proper Virechana:
Expulsion of fecal matter, followed by Pitta and Kapha
Feeling of lightness, enthusiasm, clarity, and freshness
Mild fatigue
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Post-Therapy Care
Food and sleep are avoided until elimination is complete.
Only warm water should be used for drinking and external purposes.
A special post-procedure diet (Samsarjana Krama) is followed for 3–5 days to rekindle digestive fire (Agni).
Note: Improperly administered Virechana may lead to complications, hence it must always be performed under the supervision of an experienced physician.
Nasya Therapy
In Ayurveda, the nose is considered the gateway to the head and brain. Nasya is a therapeutic procedure in which medicinal substances are administered through the nostrils to eliminate doshas accumulated in the head, neck, and face.
Depending on the medicine used, Nasya can be either nourishing or purifying.
Procedure
1. The face, head, and neck are massaged with oil (Abhyanga)
2. Local Swedana (fomentation) is given to open the channels.
3. The medicine (oil, ghee, herbal decoction, powder, or medicated smoke) is warmed to lukewarm temperature.
4. With the patient lying down, head tilted back, the medicine is instilled drop by drop into each nostril.
5. Gentle massage is given to encourage absorption
6. Finally, the patient spits out the discharge instead of swallowing, as it contains morbid doshas.
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Indications
Nasya is beneficial in conditions such as:
Headache and migraine
Neck stiffness and cervical spondylosis
Hoarseness of voice
Eye and ear disorders
Tonsillitis, sinusitis, rhinitis
Facial paralysis and TMJ disorders
Contraindications
It should not be performed:
After meals or alcohol consumption
During indigestion or fever
In extreme fatigue
During pregnancy or immediately postpartum
After coitus or exercise
Immediately after other Panchakarma therapies like Vamana or Virechana
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Types of Nasya
Classical Nasya – intensive, used in specific disorders under physician’s supervision.
Pratimarsha Nasya – mild, preventive practice in which 2 drops of oil or ghee are instilled into each nostril daily. This can be done at any age, in any season.
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Benefits of Nasya
Strengthens the head, neck, and sensory organs
Enhances cognitive function and memory
Improves immunity against respiratory conditions
Relieves stress and tension
Improves voice, vision, and facial vitality
Basti – Medicated Enema Therapy
Long before the advent of intravenous fluids, the Physicians of Ayurveda administered numerous herbal preparations directly into the anal canal to reach the deep tissues of the body and to manage different acute disorders. This form of treatment is known as Basti in Ayurveda. Though commonly referred to simply as "Enema Therapy," Basti Therapy far exceeds the Western understanding and application of enemas. Basti Therapy utilizes a wide range of medicinal substances to treat very specific disorders.
The word Basti literally means "bladder."
In ancient times, prior to the invention of catheters and syringes, physicians used the cleaned and fashioned urinary bladders of animals to administer herbal preparations. Today, of course, physicians use enema bags, pots with catheters, or syringes.
The concept of Basti Therapy also extends to the administration of herbal preparations through the vagina and urethra. These applications are specifically called Uttar Basti.
Basti Therapy is most commonly used for disorders of Vata Dosha. Through Basti Therapy, herbal preparations are absorbed through the large intestine and thereby spread throughout the body into the deepest tissues, pulling aggravated Doshas back into the large intestine. Since the large intestine is the main seat of Vata, Basti is especially effective for Vata disorders. Nevertheless, it can also be employed in the treatment of Pitta and Kapha disorders by modifying the herbal preparations. For Kapha Dosha, for example, Bastis are given with Kapha-reducing (scraping) substances such as ghee and milk.
The classical texts of Ayurveda state that "Basti Therapy is half of the treatment in all diseases." On one side are all the herbal medicines and therapies of Ayurveda, and on the other side stands Basti Therapy alone — illustrating its unparalleled importance and utility.
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Types of Basti Therapy
Basti Therapy is divided into two main categories:
1. Niruha Basti (Decoction Enemas)
2. Anuvasana Basti (Oil Enemas)
Niruha Basti (Decoction Enema):
A strong herbal decoction is first prepared, to which honey, salts, herbal powders, and different oils or animal fats are added, sometimes with a small amount of black salt or specific herbs.
Anuvasana Basti (Oil Enema):
Primarily contains oil or ghee. Niruha Basti expels aggravated Vata and accumulated wastes from the body, whereas Anuvasana Basti pacifies Vata within the system.
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Preparatory Measures
Before administering Basti Therapy, the body is prepared through Snehana (oleation) and Swedana (sudation). These procedures strengthen tissues, widen internal channels, and encourage the Doshas to move into the gastrointestinal tract. Often, external Snehana and Swedana are applied only to the back, abdomen, and thighs, depending on the disorder.
After Abhyanga and Swedana, the patient lies prone with the left leg extended and the right knee bent. A small amount of oil is applied to the anus, and then a well-lubricated catheter is gently inserted in the direction of the vertebral column. The Basti fluid is administered gradually with uniform pressure. Afterwards, the patient lies supine with hips elevated on a pillow until the urge to evacuate arises.
Administration Guidelines
Niruha Basti is administered on an empty stomach, immediately after Abhyanga and Swedana. It is usually expelled quickly due to the potency of the preparation and rarely retained beyond 45 minutes. The patient may eat immediately afterward and should drink only hot water.
Anuvasana Basti is administered after a light meal. It is retained for longer — often 3 to 4 hours, sometimes overnight. The patient should not eat again until expulsion occurs and genuine hunger is felt.
For therapeutic purposes, Niruha and Anuvasana Bastis are often alternated in a planned sequence, sometimes for extended periods up to a month.
During the therapy, traveling, excessive talking, day sleeping, strenuous exercise, and sexual activity should be avoided. Food should be light, fresh, and easily digestible.
Indications
Niruha Basti is useful in abdominal disorders, distension, gout, splenic disorders, recurrent fever, respiratory complaints, male and gynecological disorders, infertility, obstructed stools or urine, scrotal enlargement, urinary stones, amenorrhea, and neurological disorders such as tremors, paralysis, and sensory dysfunctions.
Anuvasana Basti is indicated in conditions of wasting, debility, dryness, fatigue, fractures, anxiety, excessive thinking, and during convalescence. It is also advised for pregnant women in the ninth month to facilitate easy and comfortable labor.
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Uttar Basti
As mentioned earlier, Uttar Basti refers to therapeutic enemas administered through the vaginal or urethral passages. Special medicated oils and Snehas are used depending on the disorder.
It is indicated in urinary problems such as dysuria, burning, delayed or obstructed urination, stones, seminal disorders (e.g., poor motility, oligospermia), reproductive disorders, menstrual difficulties, and infertility.
Preparatory cleansing (Snehana and Swedana) enhances the efficacy of Uttar Basti. Vaginal douching with specific herbal decoctions, known as Yoni Dhavana, is also performed prior to therapy.
The procedure is usually carried out immediately after menstruation, by inserting a catheter through the cervical passage. Following Uttar Basti, medicated tampons, called Picchus, are placed inside. All procedures must be performed by a qualified physician under strict hygiene. Properly administered, Uttar Basti is highly effective in improving uterine health and treating female reproductive disorders such as ovarian cysts.
Rakta Mokshana : Therapeutic Bleeding
Raktamokshana literally means "release of blood." It is the process of removing vitiated blood from the body and has parallels in many ancient and modern medical traditions.
In Ayurveda, Raktamokshana is performed either surgically (venesection) or para-surgically (leeches, cupping, scratching, suction). It is considered a Shodhana (purification) therapy, indicated when the blood itself is vitiated and carries Doshas throughout the body.
Where Vamana is best for Kapha, Virechana for Pitta, and Basti for Vata — Raktamokshana is prescribed when the blood itself is corrupted.
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Causes of Vitiated Blood
Blood becomes impure due to regular intake of hot, spicy foods, excessive salt, fermented foods, alcohol, day sleeping, overexertion in hot climates, and negative emotions such as anger, sadness, and fear.
As the body attempts to eliminate this vitiation, toxins rise toward the surface. During Raktamokshana, this impure blood is removed first, stimulating fresh and healthy blood production.
Venesection: 100–120 ml of blood is withdrawn.
Leech therapy or suction: 10–20 ml is removed.
The body replenishes this blood within 48 hours.
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Seasonal Considerations
Autumn is the ideal season for Raktamokshana, as the weather is balanced and clear. If needed, it may also be performed in cooler seasons during midday, or in summer during early mornings.
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Indications
Raktamokshana is beneficial in skin diseases, splenomegaly, jaundice, piles, acne, ocular disorders, hypertension, abscesses, liver conditions, headaches, epistaxis, blood in urine or stool, and joint disorders. It can bring almost instantaneous relief in some cases.
It is contraindicated during pregnancy, chronic fatigue, or generalized swelling.
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Methods
Venesection: For systemic blood vitiation.
Scratching: Useful in local Kapha disorders.
Cupping (suction): For Vata and deeper impurities.
Leeches: For Pitta and localized conditions.
Leech therapy is especially gentle and painless, suitable even for children and the elderly. Leeches secrete Hirudin, which prevents clotting and allows effective blood withdrawal. In Ayurveda, leeches are preserved and reused after purification with turmeric, oil, and rock salt.
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Aftercare
After Raktamokshana, patients should consume light, soupy, easily digestible foods until digestion strengthens. Excessively hot, cold, heavy, or stale foods must be avoided, along with anger, daytime sleep, and heat exposure.
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Conclusion
Raktamokshana, though simple, is a profoundly effective therapy. Like Basti, Ayurveda regards it as half the treatment in many diseases due to its deep purifying action.