Panchakarma overview: the five procedures and safety questions

Panchakarma is one of the best-known parts of Ayurveda. The Ministry of Ayush describes it as a cleansing and rejuvenating treatment for body and mind ^[1]. This article explains how the Ministry of Ayush describes Panchakarma, what the stages of a programme are, who delivers the therapies and what questions to ask before you take part. It does not claim that Panchakarma helps with or prevents any disease. It uses information from the Ministry of Ayush, a national skills standard hosted by the Central Council for Research in Ayurvedic Sciences (CCRAS), and the US National Center for Complementary and Integrative Health (NCCIH).

1. Introduction

The name Panchakarma means "five actions". The Ministry of Ayush describes it as five purification procedures, also called Pancha Shodhana, which in Ayurvedic theory remove "vitiated" doshas from the body ^[1]. The doshas (Vata, Pitta and Kapha) are the three functional forces that Ayurveda uses to describe health, and vitiated means disturbed or out of balance in the traditional sense. These are traditional concepts, not findings from modern laboratory tests.

NCCIH, a US government centre, explains that Ayurvedic care can combine products, diet, exercise and lifestyle ^[4]. Panchakarma is one form of that care, and NCCIH reports that there are few well-designed trials of Ayurvedic treatments overall ^[4].

2. The five procedures

The Ministry of Ayush lists these five procedures and the dosha that each one is traditionally aimed at ^[1].

1. Vamana: medicine-induced vomiting, mainly directed at Kapha and secondarily at Pitta.
2. Virechana: medicine-induced purging (a strong clearing of the bowel), mainly directed at Pitta.
3. Basti: a medicated enema, directed at Vata. An enema is liquid placed in the lower bowel through the rectum.
4. Nasya: putting medicated oil, powder or juice into the nose. The Ministry links it with Kapha and Vata in the region above the collarbones.
5. Raktamokshana: bloodletting, which means letting out a small amount of blood. The Ministry links it with conditions of "impure blood" in the traditional sense.

These descriptions come from the Ministry's own account of the theory. They are not statements that the procedures are proven to help any illness.

3. How a programme is staged

Each Panchakarma procedure is described as having three stages: preparation, the main procedure and follow-up care ^[1].

• Preparation: starts with oleation, which means applying or taking oily substances, and sudation, which means inducing sweating with heat ^[1].
• Main procedure: the chosen procedure is carried out. In theory, the preparation loosens the doshas and moves them into the gut so that they can leave by the nearest route ^[1].
• Follow-up: care after the procedure, which the Ministry describes as a separate stage of the programme ^[1].

4. Related therapies and who delivers them

Many spa-style "Ayurveda treatments" are not among the five procedures themselves. A national skills standard for Panchakarma technicians, published by the Healthcare Sector Skill Council and hosted by CCRAS, lists related therapies such as abhyanga (oil massage), shirodhara (a flow of liquid over the forehead), pizhichil (pouring warm oil), udwartana (dry powder massage), several types of swedana (sudation, or heat therapy), and different kinds of basti ^[2]. The same standard also lists Vamana, Virechana, Nasya and Raktamokshana ^[2].

The standard says that a technician prepares the therapy unit and the patient, supports the patient during the session and keeps records, and gives the therapy as per the prescription ^[2]. Technicians are expected to check and record the patient's vital signs, report any deviation from normal to the therapist or doctor, confirm the patient's identity, check that the patient has obtained consent from the therapist or doctor, check the expiry dates of formulations and materials, wear clean attire, follow hand hygiene before and after patient contact, and take appropriate steps if an emergency arises during the procedure ^[2]. You can use this list as a guide to what good practice looks like.

5. Safety and questions to ask

NCCIH advises that "natural" does not necessarily mean safe, and that you should think about the practitioner's training, skill and experience when choosing a practice ^[3]. Before you book a programme, consider asking these questions.

• Who will examine me first, and who is the supervising doctor or therapist?
• Are the practitioners registered, and can I see their registration?
• What will happen at each stage, and how will my safety be monitored?
• Are any medicines, oils or powders used that contain metals or minerals? NCCIH reports that some Ayurvedic preparations may contain lead, mercury or arsenic in amounts that can be toxic, and that the US Food and Drug Administration warns that metals in some products may be harmful ^[4].
• Will the practitioner speak to my own doctor?

NCCIH suggests choosing a complementary practitioner as carefully as you would choose a primary care provider, and checking that the practitioner is willing to work with your other health care providers ^[3]. It also says that some Ayurvedic products may be harmful in pregnancy or while nursing, so people in those situations should consult their own provider first ^[4]. Because the procedures involve vomiting, purging, enemas or the removal of blood, it is sensible to ask your own doctor whether they are suitable for you, especially if you are unwell, pregnant, elderly or take regular medicines. The doctor decides.

6. When to see a doctor

Speak to your doctor before starting Panchakarma if you have a long-term health condition, take regular medicines, are pregnant or breastfeeding, or are planning surgery. NCCIH advises that you should not use an unproven approach to delay seeing your health care provider about a medical problem ^[3]. See a doctor promptly if you feel unwell during or after a programme, for example with ongoing vomiting, dizziness, weakness or abdominal pain, or if a symptom you started with becomes worse.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

7. Conclusion

Panchakarma is described by the Ministry of Ayush as five procedures, Vamana, Virechana, Basti, Nasya and Raktamokshana, each with preparation, main and follow-up stages. Related therapies are carried out by trained technicians who give them as per the prescription. Evidence for most Ayurvedic treatments is limited, so treat any promise of results with caution. Choose a registered practitioner, ask the safety questions above, and tell all your doctors about every approach you use.