Panchakarma literally means five karmas or five methods of treatment in Ayurveda. Panchakarma is a set of five karmas or methods of flushing out accumulated toxic materials. The expelling of toxic materials from deep tissue is a complex thing. An Ayurvedic physician determines the type of panchakarma based on his constitution or prakriti, his physical condition and the season in which the treatment is conducted. Panch means five and karma means an action.

The five karmas in panchakarma are Vaman (vomiting), Virechan (purgation), Basti (enema), Nasya (nasal application) and Rakthamoksha (blood purification).

Purvakarma
Before the actual panchakarma, there is a purvakarma, which literally means ‘the preceding karma’. In this stage the physician gives the directions to prepare the body for the panchakarma chikitsa (treatment). Snehan and Swedan are the main two procedures. It takes up to seven days of snehan and swedan to prepare tridoshas receptive to the treatment.

Only after the purvakarma, the pachakarma starts. The panchakarma method is chosen according to the physical constitution (prakriti) and the disorder (vikriti) on the body.

Vaman
Vaman (vomiting or emesis therapy) is administered for kapha related disorders like bronchitis, colds, breathlessness, chronic asthma, diabetes, indigestion, etc. These are all due to excess mucus. The patient must go through purvakarma before administering vaman.

Virechan
Virechan (purgation therapy) is applied to relieve excess Pitta (in the form of bile) accumulated in the gall bladder, liver, small intestine etc. The result of accumulation of excess toxic materials will be rashes, inflammations, fever, nausea and jaundice.

Basti
Vata is dominant at the colon region. Basti (enema therapy) is used to flush out fallen doshas through intestinal tract. Enimas are of different kinds and they are well above 100. Basti is good for different kinds of vata disorders. Constipation, kidney stone, acidity, sexual disorders, arthritis, rheumatism etc are the diseases curable with basti.

Nasya
Nasya (nasal administration) is used to eliminate kapha related problems affecting eyes, ear, nose and throat. Migraine, sinusitis, bronchitis are the main diseases curable with nasya.

It is also regarded as treating prana (life). The life energy or prana enters our body through nose. It is also connected to brain and consciousness.

Raktha Moksha
Raktha Moksha (Blood Letting) is the technique to eliminate toxic substances accumulated in the blood stream. It is a process of purification of blood. Skin disorders like rash, acne, itching etc are due to impure blood. It regulates the action of pitta.

This treatment method is not suitable for children and elderly people and persons with anemia, general body weakness and similar problems.

Paschatkarma and Rasayana
After all the five or selected therapies of panchakarma, there is Paschatkarma. Paschatkarma or helps body re-establish its normal metabolism and immunity. Post treatment processes are essential to normalize digestion. It is only over many days that the persons can return to his normal diet through different steps of introduction of vegetables and other food items.

Rasayana chikitsa or rejuvenation therapy which includes administering of specific rasayana preparations that help bring back vitality and energy to the body.

After the Panchakarma chikitsa or panchakarma therapy, the persons need to follow a good dinacharya (daily routine) and normalize his/her daily activities according to the change of seasons (ritucharya).

Ayurveda remedies or treatment of any major kind is determined after determining the prakriti (general conditions) of a person and determining dominant dosha of the tridosha. However, Ayurvedic remedies are used for specific illnesses only. Mostly herbs – a single herb or a combination of herbs, certain spices, other plant products and minerals form the medicine.

For example, people (in Kerala) would take a few leaves of Tulsi (Ocimum tenuiflorum) or Tulasi with two or three grains of pepper as a remedy for simple cough. There are several such readily available Ayurvedic remedies for almost all common diseases.

Ayurvedic remedies or Ayurvedic treatments like panchakarma, marma chikitsa, etc requires specialized training and preparation of medicines through different processes that last for many days.

The purpose of Ayurvedic treatments is to keep tridoshas at balance. An imbalance in the balance of a dosha is a disease condition. Imbalance of any one dosha of the tridosha also causes imbalance to the other two doshas as well.

Ayurvedic treatment goes through three main stages.

1. Samsodhana (cleansing process)
2. Samsamana (palliative care)
3. Nidhanaparivarjana (treating the causes)

Panchakarma falls in Samsodhana or the cleansing process.

Purva karma (or poorva karma or pre-karma) refers to the preparation of body for Ayurvedic panchakarma therapy. There are two different methods in purvakarma – snehan and swedan. Purva karma is necessary for the body to achieve the complete benefits of panchakarma. Purvakarma can complete in one day or over many days.

Snehan — is oil therapy or olation therapy. It has two different parts.

The first part includes taking medicated ghee (ghruta) or medicated edible oil. It reduces the dryness of the body and open the srotas (channels) of body by working on all the dhatus of sapta dhatu. This is important to drive the ama and mala out of the body with panchakarma. This step frees, and mobilizes the waste matters accumulated over different parts of the body. This step adds to the efficiency of panchakarma. A poorly administered purvakarma can hinder the effectiveness of panchakarma therapy.

The second part includes medicated oil massages. The skin absorbs the medicinal parts of the oils to the blood.

Swedan
Swedan is given after snehan. It includes steam bathing or heating the body to facilitate sweating. There can be different types of fomentation, like heating the specific area or whole body below neck according to the specific requirements.

The choice of snehan and swedan depends on the specific conditions of the patient and his/her requirements.

Virechan is the second among the five karmas of Pancha karma. Virechan karma is to address pitta induced diseases. Excess bile (pitta) accumulated in liver, small intestine, can cause skin problems, nausea, jaundice, fever, vomiting etc…  Virechan is the method of flushing out accumulated pitta dosha elements from the body to create a healthy state.

The person is given snehan (oil massage) and/or swedan (fomentation) early in the morning before virechan. The person shall not eat any food that can aggravate pitta. The person is given lot of coconut water in the daytime.

There is a range of purgatives, and the effectiveness varies from mild to strong. Warm milk, raising, mango juice etc are mild purgatives. Prune flax, dandelion root etc are moderate purgatives. It can be made powerful by a heavy dose. Senna leaves, prune, bran, flax seed, root of dandelion, milk with ghee, castor oil, ginger, triphala, etc can act as virechan substances. The physician chooses a combination based on the physical conditions of the person.

Virechan is given at the bed time and the results will be visible the next day in the form of loose motion one or two times. There is however nothing to worry about loose bowels, as it is part of the cleaning procedure to expel excess pitta from the system.

Persons suffering from dehydration due to diarrhea or vomiting, fever, etc shall not take this therapy.

The success of virechan also shows more positive mental conditioning. Positive thoughts and will feel light and confident.

Vaman is the method to purify lungs and breathing system to address diseases like bronchitis, asthma, cough, cold, etc caused due to congestion of lungs and respiratory track.

Vaman is therapeutic vomiting administered to expel excess kapha dosha that causes mucus.

In the night before vaman, Snehan (oil massage) and Swedan (fomentation) is given to the person. The man is given three-four glassed of salt water. Rubbing the base of tongue also stimulate vomiting. Gag reflex at work here. Other substances that can induce vomiting are vep (neem) leaves, cedrus deodar, etc.

Many times you can see released of suppressed emotions that were forcefully held back. The person feels relieved after vomiting, because of the expelling of excess kapha that accumulated in the body as mucus.

The person also shall take certain medication two-three days before vaman, until the stool becomes loose, or until he feels overly nauseated. The main aim for the purvakarma is to aggravate kapha, hence the proposal of kaphagenic food. Vaman is also given in the kapha muhurtha or kapha time, which is early in the morning.

Vaman is administered for all disorders associated with Kapha. Dizziness, headache, nausea, are also treated with vaman therapy. Administered carefully, vaman is the best treatment for all respiratory problems. Only an experienced Ayurvedic practitioner can recommend the type of vaman karma of panchakarma to a person.

The person will feel instant relief from chest congestion, and will be able to breathe freely. After vaman, the person has to observe fast until evening, when he is given boiled rice with ghee. Honey, lime tea, etc are also given in small quantities.

After vaman, the person shall not suppress any natural urges – like urination, defecation, sneezing, belching, etc.

Vaman is not for everyone. Children below age 12 and persons aged 65 or more are not fit for this kind of therapy. Persons with anxiety, fear, grief, etc too are not fit. Persons with vata diseases are also not given vaman therapy. Diarrhea, heart diseases, obesity, etc too prevent the physician from administering vaman.

Rakthamoksha or blood letting is the last, but most complex form of body purification therapies in Ayurvedic panchakarma. Toxins from the gastro-intestinal track accumulate in the blood and reach every tissue and cell of the body. This toxins cause different problems like infections, skin diseases, and diseases that affect heart, liver, spleen, etc.

Excess pitta can be transferred to raktha (blood). Pitta is originally produced from the red blood cells disintegrated at the liver. Thus pitta and rakta are closely related. Excess pitta converts to toxins of the blood.

Blood letting automatically stops after some time. It is as if the body knows how much blood it needs to throw out to attain swastya or healthy condition.

Conditions like acne, rashes, eczema, chronic itching, enlarged liver or spleen etc are the conditions for which blood letting is advocated.

Persons with anemia, edema, body weakness, etc are not advised to take rakta moksha. Children, elderly people, pregnant woman, etc are also not allowed to take this therapy.

Nasya or nasal administration of medicines is an important treatment in panchakarma method of Ayurvedic treatment. According to Ayurveda concepts, nose is the doorway to brain and consciousness.

According to yoga and Ayurveda, Prana, the life force enters our system through our nose. The doshas of the body accumulated in sinus, throat, nose or head can block the movement of prana. Nasya therapy is a method of eliminating the accumulation of such doshas from sensitive areas. Prana is responsible for healthy functioning of nervous system, memory, and intellectual qualities of humans.

Nasya also address problems like sinus congestion, migraine, certain eye and ear problems, etc. Improvement of breathing is another application of nasya.

There are six main types of nasya, they are:

Pradhama or virechan nasya characterized by blowing of dry powders to the nose. Headaches, heaviness in head, cold, sinusitis, epilepsy, drowsiness, etc are the conditions that attract the use of prahamana nasya. It also will eliminate negative emotions like greediness.

Bruhana Nasya (nutrition nasya) involves the use of nutritional ghee, oils, salts, shatavari extracts, ashwagandha, milk, etc. It is to normalize vata imbalances like headaches, nervousness, fear, dizziness, negative emotions, dry sinus, etc.

Shaman Nasya (sedative nasya) is for pitta dosha disorders.

Navana Nasya (decoction nasya) is used for problems associated with vata-pitta or kapha-pitta combination disorders. Medicated oils are applied to the nostrils.

Marshya Nasya (ghee-oil nasya)

Prati Marshya (daily oil nasya) – dip the clean little finger in medicated oil or ghee and insert into each nostril to lubricate the nasal passage. Care should be taken not to harm the sensitive lining tissue.

Basti or Vasti is the third karma of Panchakarma. It is administered to lower conditions occurred due to the aggravation of vata or vata dosha. Basti or enema therapy involves introduction of medicated oils or medicinal preparation to the rectum. Basti is administered for almost all kinds of vata disorders. It is also used to treat constipation, chest pain, back ache, arthritis, sexual disorders, muscle cramps, headaches, etc.

Basti is further divided into eight types, they are:
Anuvasana (oil enema) used to treat pure vata disorders.

Niruha Ashthapana (decoction enema) is used to address conditions like nervous diseases, fever, certain urinary problems, acidity, etc.

Uttara Basti (basti through the upper side or sexual organs) is to treat sexual disorders. Semen, ovulation disorders are treated. This therapy is not for persons with diabetes.

Matra Basti (daily oil enema) is for persons continuing too much physical exertion like walking too much, lifting heavy objects, indulgence in sexual activities, and for persons with chronic vata aggravation related disorders. It gives the person strength and helps in elimination of waste products quickly.

Karma Basti is a schedule of 30 bastis.

Kala Basti – 15 bastis; 10 oil bastis and 5 decoction bastis

Yoga Basti  – schedule of 8 bastis; 5 oil and 3 decoction

Enema is administered in both kalabasti and yogabasti as a combination of both oil enema and decoction.

Bruhana Basti (nurtritional enema) is for nourishment to body. Highly nutritive substances like bone marrow soup, shatavari, ashwagandha etc are used.

Oil enema is not directed for persons with diabetes, obesity, digestion problems, cough, etc.  Nutritional enemas are not persons with diabetes, obesity and lymphatic obstruction.