Pancha Karma: An Overview

Ayurveda, the ancient "Science of Life," is one of the oldest forms of health care in the world. It is a holistic science that places great emphasis on prevention and aims at bringing about and maintaining harmony of body, mind and consciousness. It encompasses diet and lifestyle guidelines, herbal formulas and preparations, yoga and meditation practices, as well as various therapies that support and enhance individual Ayurvedic programs.

Ayurveda defines health as the state where every aspect of our being is working properly and in harmony with all its other aspects. That is, the digestive fire (agni) is in a balanced condition; the three doshas —vata, pitta and kapha— are in equilibrium according to the individual constitution; waste products (malas) are produced and eliminated normally; and the mind, senses and consciousness are working harmoniously together. When the balance of any of these systems is disturbed, the disease process begins.
Basically, any aggravation of the doshas affects agni (the digestive fire) and produces toxins or ama. Other factors play a role in the formation of ama, as well. Some of these factors are poor digestion of food, improper food combinations and choices, poor drinking water, pollution, pesticides in food, emotional and physical stress or trauma, and so on. These toxins accumulate and spread throughout the body and eventually deposit themselves into the deeper tissues, organs or channels, creating dysfunction and disease.
One of the most unique aspects of Ayurveda is its cleansing and rejuvenation program known as panchakarma. Panch means "five" and karma means "action." Panchakarma consists of five therapeutic actions or treatments that are specific methods to safely and effectively remove ama (toxins) from different areas of the body without damaging or weakening the system.
Panchakarma is very unique in that it is tailored to meet each individual's needs according to their constitution and doshic imbalances. The therapies involved in this program work to loosen ama (toxins) from the deep tissues in order to be removed through the body's natural channels of elimination. Before one undertakes the process of panchakarma, a skilled Ayurvedic clinician must assess one's weaknesses and determine one's constitution and current state of doshas, as well as which tissues, channels and organs are involved in the imbalance and need to be addressed. Then the clinician can design a program specific to one's needs.
There are three phases of panchakarma: The preliminary therapies, called purvakarma; the five main therapies of panchakarma (vamana, nasya, virechan, raktamokshana and basti); and post-treatment procedures called paschatkarma. Both pre- and post-panchakarma therapies are essential to the success and long lasting effects of the panchakarma program.
Purvakarma therapies serve to prepare the body to get rid of stored ama (toxins). Snehana (oleation) is the first step of purvakarma and it consists of saturating the body with herbal or medicated oils: Abyantar snehana, or internal oleation with ghee or medicated oil, helps loosen ama and move it from deeper tissues into the GI tract where panchakarma's main therapies can eliminate it. External oleation is called Abhyanga (or bahya snehana) and it consists of vigorous massage over the whole body with medicated oils. The choice of oils depends on the particular needs and doshic imbalance of the individual.
Once the massage is completed, swedana (literally "sweat") is performed. The main objective of this therapy is to dilate the channels so that the removal of ama can be more easily achieved. There are several swedana treatments that can also be used as adjunct therapies during panchakarma, but the two most commonly used are nadi swedana and bashpa swedana. Nadi swedana is a localized application of steam with herbal decoctions and medicated oils. It usually focuses on specific areas of the body, such as sore joints or muscles, to improve mobility and reduce pain. Bashpa swedana applies steam evenly to the whole body (with the exception of the head) with the use of a sweatbox. This method is used to further detoxify the body after abhyanga. It is usually followed by herbal plasters and poultices called lepa to help draw toxins out of the pores of the skin.
Lastly, purvakarma uses shirodhara. It is thought in Ayurveda that deep relaxation provides an environment where deeply rooted imbalances can be overcome and where it is easier to restore the harmony and functional integrity of the doshas. Shirodhara is a subtle and profound treatment that consists in pouring warm oil in a slow, steady stream on the forehead. It pacifies vata dosha, calms and nourishes the central nervous system, promoting relaxation and tranquility, and improves mental clarity and comprehension.
The basic idea behind the function of purvakarma therapies can be understood with the following analogy. Suppose you oil a bowl thoroughly and then pour honey into it. The honey cannot stick to the bowl because the slippery quality of the oil does not allow it to. So the honey can be poured out of the bowl much more easily than if the bowl hadn't been oiled. Ama has the same sticky quality as honey, and so it moves easily after the body has been thoroughly oiled and relaxed with purvakarma therapies.
After snehana, swedana and shirodhara have been performed, ama is back in the GI tract and can be removed from it with the main panchakarma therapies: Vamana, nasya, virechan, raktamokshana and basti. Each of these therapies promote the removal of ama through the normal channels of elimination, either moving it upward, downward or through the periphery (skin). The Ayurvedic clinician will assess the imbalances and decide which therapies should be emphasized, depending on which doshas, tissues and organs are involved and where has ama lodged in the body.
Vamana (therapeutic emesis) and nasya (nasal administration of medicated oils and herbal preparations) usually relate to kapha; virechan (therapeutic purgation) and raktamokshana (therapeutic withdrawal of blood) relate to pitta, and basti (therapeutic herbal enema) relates to vata. So, for example, in the case of a person with a kapha imbalance, or excess ama in a kapha site, vamana and nasya will be emphasized to remove excess kapha.
Vamana should not be associated with nausea and sickness. The preparation for vamana with the use of herbs makes it a smooth and painless process that can restore balance and help with serious kapha conditions, such as lung problems, diabetes mellitus and more. Nasya removes ama from the nasal passages, ears and eyes, and cleanses and opens the channels of the head, improving oxygenation of the brain.
Virechan is a natural, herb-induced purging process that mainly cleanses the small intestine and pitta related organs (such as the liver and gall bladder), and removes ama and excess pitta from the body, balancing all metabolic functions. Raktamokshana is used to remove excess pitta-related ama from the blood, for certain blood-related and skin conditions.
Basti is probably the most powerful of all five karmas. It consists of introducing medicated oily substances into the colon to be retained and absorbed by the whole body. Its goal is the purification and rejuvenation of the colon, because the colon is linked to all the other organs and tissues of the body. The colon is an important organ for the absorption of nutrients; it is the primary receptacle for waste elimination; and it is the seat of vata dosha, which is the mover of the other doshas and thus of all physiological activity. Therefore, since it balances and nurtures vata dosha, basti karma has a wide-ranging influence in the body and affects all the doshas, channels and tissues.
Common enemas and colonics can help cleanse the colon, but the main difference is that they do not nourish the tissues and they only remove what is present in the colon. Enemas are temporary and localized, and according to Ayurveda, repeated flushing of water with colonic therapy may weaken the mucous membrane and dry the colon, further disrupting the eliminative function of vata. When basti karma is used in conjunction with purvakarma therapies, it does more than just cleanse the colon. It helps nourish all tissues and remove toxins from the whole body. In other words, basti removes the ama from the whole body that has been brought to the colon by purvakarma.
Individual panchakarma programs can be as short as a week and as long as a month or even longer in some cases. During this time, clients are advised to put aside the usual preoccupations with work and family and devote themselves to rest as much as possible, both physically and mentally. They should surround themselves with a warm, comfortable and pleasant environment, reduce sensory input and avoid experiences that provoke strong emotions. It is also advised to meditate and do specific yoga postures, if so desired. This is an essential aspect of panchakarma, since it will help the detoxification process go deeper.
The diet prescribed during and after treatment is also a key element in this therapy. Heavy food interferes with the cleansing process, so it is advised to eat small amounts of kitchari (a nourishing and cleansing porridge made with mung beans, basmati rice, medicinal spices and clarified butter or ghee) to provide the body with enough nutrition to keep it strong, as well as to keep the digestive fire kindled throughout the process.
According to Ayurveda, it is not enough to simply abstain from food to obtain the maximum benefits of a cleansing program. In fact, Ayurveda discourages long term fasting because the sudden onslaught of ama that can flood the system from fasting for more than a few days is often too drastic and can damage the tissues, weaken the digestion and have long term health repercussions. Plus, just fasting does not necessarily insure that the toxins that are deeply deposited will be removed. This is why panchakarma lubricates and prepares the body for the removal of ama. Furthermore, it focuses on the individual doshic imbalances and uses herbs and herbal preparations to support and enhance the cleansing process.
The set of procedures that follow the main therapies of panchakarma, called paschatkarma, are aimed at assisting the body in the re-establishment of healthy metabolic system and immunity. If these post-treatment procedures are neglected, the digestion may not normalize and the production of ama would continue. So, after the program is over, it is advised to keep eating light, nourishing foods, such as mung dal soup and rice and to gradually add vegetables and other foods. It is recommended to slowly and gradually return to regular activities to avoid taxing the nervous system, because the body is in a sensitive, somewhat vulnerable state after treatment.
The lifestyle program that should be adopted at this time to support the treatment is called dinacharya, or daily routine. The Ayurvedic clinician can give specific guidelines for dinacharya as well as other seasonal guidelines and recommendations. He can also provide rasayanas, which consist of herbal and mineral preparations with specific rejuvenating effects on body and mind. Rasayanas increase the vitality and energy of the person, nourish and rejuvenate the entire organism, and thus are an important part of the paschatkarma procedures.
Finally, it is worth mentioning here that because vata dosha (the energy of movement) initiates and drives all physiological movements, including that of the other doshas, it is considered in Ayurveda to be the main player in all of the body's processes. So, managing the functioning of vata is one of the main objectives in panchakarma and is a good preventative measure in our daily life. For this reason, with the exception of internal oleation, any of the therapies mentioned here can be used individually or in combination as a vata management program.