Panchakarma: What to Expect, Step by Step

Panchakarma, the five actions, is Ayurveda's shodhana, the purification that removes an aggravated dosha from the body rather than pacifying it in place, and it runs in three fixed phases: purvakarma, the preparation with internal and external oil and sweating that takes the doshas from the tissues back to the gut; pradhanakarma, the main procedure, which is one or more of vamana, virechana, basti, nasya, and raktamokshana, chosen by dosha; and paschatkarma, the graded return to food and the rasayana that follows. A full course is three to four weeks, most of it preparation and recovery. The Charaka Samhita sets out the method and the Ashtanga Hridaya's teaching on it is the one the clinics follow.

Before anything: deepana and pachana

Panchakarma is not begun on a body with ama, the residue of poor digestion, or a dull agni, the digestive fire. The first days, sometimes a week, are spent on a light diet and pungent, bitter digestives until the tongue is clean and hunger is regular. A sticky dosha does not move, and oil poured on ama feeds it.

Purvakarma: oil and sweat

Snehana, oleation, comes next. Internally, it is snehapana: medicated ghee taken on an empty stomach each morning in a measure that increases day by day, for three to seven days, until the signs of saturation appear: the skin and stool become oily, the body feels light and soft, and a dislike of fat sets in. Nothing is eaten until the ghee has digested, and the food that follows is warm, thin, and small. This stage is the heart of the work, because ghee reaches the tissues and loosens the dosha held there. Externally, it is abhyanga, the whole body massaged with warm medicated oil each day, with the oil pourings and rice-bolus rubs, pizhichil and navarakizhi, that the Kerala tradition adds.

Swedana, sudation, follows each oiling: a steam chamber, a herbal steam box with the head out, or a hot poultice, until sweat runs and the body is warm through. Oil softens the dosha, sweat liquefies it, and together they bring it to the gut. On the last day of preparation a person is oily, warm, and loose-bowelled, which is the intended state.

Pradhanakarma: the five actions

The main procedure is chosen by the dosha to be removed and is given on a single day, in the appropriate season, with rest before and after.

Vamana, therapeutic vomiting, removes Kapha from the stomach and chest. After a Kapha-provoking meal the night before, a person drinks milk or licorice decoction to fullness and then an emetic preparation, and vomits in a set number of bouts until the fluid brought up is bitter and Pitta-coloured. It is done in vasanta, spring, the Kapha season, for asthma, chronic congestion, skin disease, and Kapha-type diabetes.

Virechana, purgation, removes Pitta from the small intestine. A purgative, Trivrit, Operculina turpethum, or castor oil, is given in the morning after the days of ghee, and the bowel empties through the day in a counted number of motions until the stool is watery and Kapha-coloured. It is done in sharad, autumn, the Pitta season, for skin disease, jaundice, chronic fever, and Pitta disorders of every kind.

Basti, the enema, removes Vata from the colon and is called half of all treatment. Niruha basti is a decoction enema with honey, salt, oil, and a herbal paste; anuvasana basti is a small oil enema retained for hours. They alternate over a course of eight, sixteen, or thirty days. Basti is done in varsha, the rainy season, the Vata season, for joint disease, paralysis, constipation, low back pain, and the whole range of Vata disorders.

Nasya, medicated oil or powder through the nose, removes the doshas of the head: sinus disease, headache, hair loss, and disorders of the senses. Raktamokshana, bloodletting by leech or venesection, removes vitiated blood in skin disease and local inflammation; it is the fifth action in the Sushruta Samhita's count, while the Charaka Samhita counts the two bastis separately and leaves bloodletting aside.

Paschatkarma: the return

The cleansing quiets agni, and the days after are as controlled as the days before. Samsarjana krama is the graded diet: thin rice gruel, then thicker gruel, then soup of mung, then a light meal with rice, each for one or more meals depending on the strength of the cleansing, over three to seven days, until ordinary food is digested without heaviness. Sleep by day, exertion, sex, cold, wind, and loud speech are avoided through this period; fatigue and lightness give way to a clear mind over the following weeks. Rasayana, the rejuvenative course, is then begun on the cleared body, the point at which Chyawanprash or Ashwagandha does its full work.

What it is not

A week of oil massage and steam is purvakarma, not panchakarma, and a course that omits the light diet at the beginning, the graded diet at the end, or the season is incomplete. Panchakarma is not given to the very weak, the very old, the pregnant, the acutely ill, or a person in fever, and the strong actions are gentled or omitted for children. A person on blood-thinning drugs is not given raktamokshana. The Kerala kizhi and dhara treatments, the poultices and oil streams, are shamana, pacification, and stand on their own without the five actions.