The science of Ayurveda has five broad strategies of intervention: avoidance of cause, palliation or balancing (shamana) of doshas, purification or cleansing of the body (shodhana), rejuvenation  (rasayana) and surgery. Technically, the first four of these are medical interventions and the fifth--surgery is non-medical (surgical). Panchakarma is a medical strategy for fighting disease and maintaining health and is a shodhana type therapy. It's the concept of elimination, extraction, or cleansing of doshic factors that interfere with physiology. Pancakarma (PK) means five actions or therapies. It is formally described as having 3 discreet elements: purva karma (preparatory actions), pradhana karma (the principle actions), pashcat karma (follow-up actions).

The preliminary or preparatory techniques to elimination are oleation and sudation (snehana and svedana).  Oil is used internally and externally to soften the body and to bind up “the undesirables” (mainly doshic substances) in cells and clinging to their membranes. This affects tissues and organs by promoting the removal of substances interfering with processes at microscopic and macroscopic levels. The heat, applied following oleation, further softens, dilates, and “energizes” the circulatory system to pick up and remove the undesirable doshic components and to bring them to the purifying organs and tissues—mainly the liver, but also the kidneys, skin, and lungs. 

Ayurveda regards Pancakarma (PK) as one of its primary treatment strategies. In the most technical sense this is a series of protocols aimed at treating the body, although mental aberrations are sometimes amenable through treating the body. The 5 principle actions are eliminative: vomiting (vamana) for kapha, purgation (virecana) for pitta, enema (basti) for vata, nasal (nasya) administration for vata and kapha, and blood letting (rakta moksha) for pitta. PK works with herbalized Materia Medica, which operate on the basis of their chemical constituents.  It aims at removing interfering substances, the absence of which permits of normal, balanced functioning.

The follow up therapies are--rejuvenation  and virilization--and include (predominantly) herbal preparations, but also behavioral guidelines (some regarded as rejuvenative in their own right).

The Extraction techniques of vamana, virecana, basti, rakta moksha, and nasya follow in this sequence in order to complete the removal of the doshic substances. Caraka and others write extensively on the many techniques, and countless drugs and drug formulations for accomplishing and successfully managing these practices. In nearly all, drugs are utilized to facilitate the movement of things; the body reacts to their presence and starts moving things. In vomiting (vamana) salt water, calamus root, and licorice are convenient substances long noted for their ability to promote emesis.  Castor oil is a popular purgative (virecana), while for some only milk or raisins are necessary. Enemas (basti) are of several types but their use helps the colon function better—peristalsis, secretory action, and absorption improve by cleansing—and the drugs administered in the enemata are absorbed and circulate systemically. These absorbed drugs change physiology for the better. Caraka has declared that basti may comprise 50% or more of the total treatment of vata disorders. Nasal administration (nasya) is a way to move dosha out of the head. Generally, the substances are irritant to the mucus membrane; this causes a secretory reaction that eliminates things out through the nasal passage. Included is snuffing or inhaling of smoke of burning herbs. Blood letting (rakta moksha) may be accomplished with leeches, scalpel, aspiration, etc. Sushruta declares: “an act of venesection, properly performed, gives more speedy relief than that derived from the application of medicated oil, etc. and or of plaster as well. Venesection (bleeding) properly performed is half of the treatment described in surgery as the application of basti karmas in therapeutics.” Su Sa. VIII.55

Bhela (Si. I.2-4) gives an accounting of the protocol for emesis (and purgation) for a person on an empty stomach: Therefore, the patient should drink liquid gruel and nicely unctuous scum of boiled rice on an mild tithi, muhurta, and auspicious karana. The physician giving the emetic should be wearing white garments, having bathed, and having worshipped the Brahmins and great physicians. The patient should be given the drink while facing east but not into strong winds in a karana that is auspicious. He should not be subjected or exposed to any tiresome act....

(C) Copyright 2006 Michael Dick All Rights Reserved Dhanvantari Ayurveda Center / Ayurveda Education Programs