Panchakarmas are specialty treatments in Ayurveda. This term Panchakarmas suggests 5 different procedures collectively. These procedures are grouped under Shodhana chikitsa (शोधन चिकित्सा detoxifying therapies) in Ayurveda wherein the excessively vitiated and doshas aggravated beyond certain level are eliminated out through the nearest external orifice of the sharira. Vamana, Virechanam, Basti, Nasyam and Raktamokshanam are these 5 procedures collective known as Panchakarmas.
परिचयः ॥ Introduction
Chikitsa in Ayurveda is classified in various types on the basis of various criteria. One of the classification classifies chikitsa in Shodhana (शोधनम्) and Shamana (शमनम्) types. Doshas are believed to be the disease pathology initiating components. When those are aggravated various methods are employed to pacify them and re-establish their equilibrium with the use of herbs, diet, lifestyle management and certain other methods. However, this is possible and beneficial only when the aggravation of doshas is mild to moderate. In certain conditions, the pathology is such that doshas are excessively vitiated and aggravated severely. In such cases, it is advisable to eliminate excessively aggravated doshas out of the body so as to get considerable relief and even prevent recurrence. In such situations, Shodhana chikitsa is considered in the form of one or more Panchakarmas. Not all 5 procedures are incorporated simultaneously.
परिभाषा ॥ Definition
The term 'Panchakarma' is composed of two parts. 'Pancha' and 'Karma'.
Pancha (पञ्च) - 5 in number
Karmas (कर्मs)- Therapeutic procedures
5 types of therapeutic procedures.
पञ्चकर्माणि ॥ Types of Panchakarmas
Five therapeutic measures are used for the elimination of vitiated Doshas, therefore Shodhana is also called as Panchakarma (five fold therapy). The five measures are Vamana (emesis therapy), Virechana (purgation therapy), Anuvasana Basti (oil enema therapy), Asthapana or Niruha Basti (decoction enema therapy) and Shirovirechana (nasal insufflation therapy). Some of the Ayurvedic authors consider Anuvasana and Asthapana Basti as one and include Raktamoksana (blood letting) in Panchakarma. In this way, in their opinion, Shodhana methods are Vamana, Virechana, Basti, Shirovirechana, and Raktamokshana (blood letting).
Vamana Karma is specific for elimination of vitiated Kapha, Virechana for vitiated Pitta and Basti is best for the elimination of vitiated Vāta.
Vamana is considered best for the elimination of morbid and increased Kapha, and thus for curing the disorders of Kapha. It eliminates the Doṣa through stomach by vomiting and should generally be given after performing Snehana and Svedana.
Purgation therapy is a specific process for elimination of pitta dosha. PT procedure involves elimination of pitta dominating dosas and toxins of the body through the rectal route.
The medicine given through enema is called Basti. It is the best treatment for the elimination of morbid Vāta. This therapy may also be used for the promotion of the health as it provides happiness, long life, strength, digestive power, intelligence, voice and colour. It is free from risks, hence it can be administered at all ages. It draws out unwanted faeces, mucus, bile, flatus and urine, imparts firmness, enriches semen and gives body strength.
Basti is of two types
- आस्थापन बस्तिः॥ Asthapana Basti - The Basti in which the preparation containing only decoction of the drug is given through Basti is known as Nirūha (Asthapana ) Basti.
- अनुवासन बस्तिः॥ Anuvasana Basti - The Basti in which the preparation containing fat is given is called Anuvasana Basti
It is also known as Shirovirachanam. This procedure is specifically employed to eliminate excessively vitiated doshas situated in head and neck. It is the procedure of giving medicine through the nose. The doshas come out through nose and mouth.
Raktmokshanam is the procedure through which vitiated blood along-with other dosha like pitta are eliminated out by puncturing a Sira (blood vessel) selected on the basis of disease and affected area. It is conducted using various tools like using leeches, various cupping tools
Steps in Panchakarmas
Two accessory measures carried out before (Purva) and after (Pashchat) performing the Panchakarma may also be considered as the part of Panchakarma therapy. The use of Snehana and Svedana before starting the Panchakarma is necessary. These two measures are collectively known as Pūrva Karma. After the Panchakarma the patient is gradually allowed to his normal routines of diet and duties and it is called as Pashchat Karma. Dietary regime prescribed after Panchakarma is also known as Samsarjana Krama.
पूर्वकर्माणि॥ Preparatory methods
- पाचनम् Pachanam or रुक्षणम् Rukshanam
- स्नेहनम् Snehanam
- स्वेदनम् Swedanam
प्रधानकर्माणि॥ Main procedures
Vamana, Virechana, Basti, Nasyam and Raktamokshanam are the main procedures known as pradhana karmas.
पश्चात्-कर्माणि॥ Post Panchakarma diet regimen
After the elimination of the dosha by any one measure the Panchakarma, for improving digestion and assimilation and also for regaining strength and vitality, pashchat-karma is indicated. Pashchat karmas include diet and activities to be followed after undergoing Panchakarmas. There are some general rules and regulations to be followed after all the 5 panchakarmas. In general, One should avoid excessive sitting, standing, talking, riding, driving etc., day-sleep, sexual intercourse, suppression of natural urges, indulgence in cold things, sun exposure, heat, worry, anger, untimely food etc.
संसर्जनक्रमः॥ Samsarjan krama
In pashchat-karma, the steps of gradual dieting have been mentioned. Sansarjan krama is a specific diet plan designed for a patient who has undergone Vamana or Virechana procedure. Following this special diet is considered extremely important in order to restore the strength and smooth functioning of Agni after undergoing complex therapeutic procedures. The significance of seriously and strictly following this dietary regime has been described in Ayurveda with a beautiful simile.
यथाऽणुरग्निस्तृणगोमयाद्यैः सन्धुक्ष्यमाणो भवति क्रमेण||१२||
महान् स्थिरः सर्वपचस्तथैव शुद्धस्य पेयादिभिरन्तरग्निः||१३|| 
For taking the patient to his normal diet, various foods with their recipes have been described. The diet should begin with Peya (Rice water), then Vilepi, Krta Yusha (green gram soup), Akruta Yusha, Mamsa-Rasa (meat soup) with the increase in quantity and quality gradually, this process is known as Samsarjana Krama.
It is to be worth mentioning here that Panchakarma described in Ayurveda is not merely emesis, purgation or enema but it is a complete therapy for the various disorders. It is an important line of treatment in which the diseases are cured by elimination of doshas from the body. However for the success of the therapy the contraindications of each Karma should be borne in mind so that complications or side effects may not occur.
- Charaka Samhita (Siddhisthanam Adhyaya 1 Sutram 12-13)