Panchakarma

Overview

Panchakarma means the five actions, from pancha, five, and karma, action. It is the classical Ayurvedic programme of cleansing, built around five purifying procedures and meant to clear from the body the doshas and the ama that have built up beyond their proper measure. It is the most thorough of the Ayurvedic treatments, and Charaka gives it a whole section of his work, the Siddhisthana, setting out the procedures, the cases for them, the cases against and the care they require.

It is important to read panchakarma as a full course and not as a set of isolated treatments. Each of the five actions sits between a phase of preparation and a phase of recovery, and the texts treat those surrounding phases as no less important than the purifying step at the centre.

The five actions

Charaka counts the five actions as follows:

• Vamana, a guided clearing through the upward route, used chiefly for excess kapha seated in the chest and stomach.
• Virechana, a guided clearing through the downward route, used chiefly for excess pitta seated in the liver and small intestine.
• Asthapana basti, a herbal-decoction enema, the principal means of managing vata.
• Anuvasana basti, an oil enema, nourishing and lubricating, given in alternation with the decoction enema.
• Nasya, treatment given through the nose, for conditions of the region above the collarbone.

Sushruta orders the list a little differently. He counts the two forms of basti as one and adds raktamokshana, the letting of a measure of blood, as the fifth action, so that his five are vamana, virechana, basti, nasya and raktamokshana.

The three phases

The texts set panchakarma out in three stages, and the purifying actions belong only to the middle one.

The first is purvakarma, the preparation. Its work is to loosen the doshas and ama from where they have lodged and to draw them toward the digestive tract, where they can be cleared. It has two parts: snehana, oleation, both inward by taking measured amounts of medicated ghee over several days and outward by abhyanga with medicated oils; and swedana, therapeutic sweating, by steam or by warm applications, which opens the channels and helps the loosened matter move.

The second is pradhanakarma, the main procedure, the chosen one or more of the five actions, selected and ordered by the person’s constitution, the dosha in excess, their strength and the season.

The third is paschatkarma, the recovery. At its centre is samsarjana krama, a graded return to ordinary food, beginning with thin rice water and moving step by step through gruels back to a full diet over several days. The texts count this measured return as fully as important as the cleansing itself. They also describe the period after panchakarma as the right time for rasayana, the nourishing and renewing preparations, the body being then well made to receive them.

The standing of Basti

Charaka singles out basti above the rest, saying that it is half of the whole treatment, and that some hold it to be the whole of it. The texts explain this by basti’s role as the chief means of managing vata; and because vata is held to be the mover of the other two doshas, settling it through basti is said to bring benefit that reaches through the whole system.

Matching action to condition, season and person

The classical authors match each action to the dosha it best addresses: vamana for kapha states, virechana for pitta states, basti for vata states, nasya for conditions of the head and raktamokshana for certain conditions of the blood. They also tie the actions to the seasons, placing vamana in spring when kapha gathers, virechana in autumn when pitta gathers, and basti in the rains when vata is most easily disturbed.

The texts are equally careful about who should not undergo the course, or only under modified terms: the very young and the very old, those in pregnancy, those much weakened, and those with acute fever or acute illness. Each single action carries its own further cautions in the classical accounts. For all these reasons panchakarma is described throughout as work to be carried out only by, or under the close direction of, a qualified physician.

Frequently asked

What are the five actions of Panchakarma? In Charaka’s account they are vamana (clearing by the upward route), virechana (clearing by the downward route), asthapana basti (decoction enema) and anuvasana basti (oil enema), counted together as basti, and nasya (treatment through the nose). Sushruta counts the two enemas as one and adds raktamokshana, the letting of blood, as the fifth.

Is Panchakarma just the cleansing procedures? No. The classical texts describe it as three phases: purvakarma, the preparation by oleation and sweating; pradhanakarma, the chosen purifying actions; and paschatkarma, the graded recovery and return to ordinary food. The texts treat the preparation and recovery as just as important as the cleansing at the centre, and the whole course is meant to be undertaken under qualified supervision.