Panchakarma therapy, literally translated as “five actions,” is a form of detoxification and rejuvenation integral to Ayurvedic medicine. It cleanses the bodily tissues of toxins, restores balance of the tridosha, opens the subtle channels of the body and offers rejuvenation to promote sustained wellness and longevity.
In addition to offering healing from long standing imbalances, panchakarma treatment encourages individuals to make changes in diet and lifestyle practices which not only offer healing to present vikruti but promote sustainable alignment with one’s true nature, or prakrti.
According to the ancient Ayurvedic scholar Susruta, our natural state of health encompasses a balance and proper functioning of the doshas, bodily tissues, and digestive fire, in addition to the proper elimination of wastes. Health is also characterized by svastha, being situated in oneself, in order to maintain harmony in mind, senses and spirit.
As we move through the world, we fall subject to vikruti, or imbalance. The more we are exposed to stressors, toxins and other causes of disease, the more our bodily systems become debilitated and vulnerable to disease. Poor diet and lifestyle choices further remove us from our natural state of balance by vitiating the doshas and causing the formation and accumulation of ama in the GI tract and tissues. This weakening of the tissues through chronic imbalance lays the foundation for disease to take root.
Here’s what we’ll cover in this article.
Ayurveda’s Panchakarma Treatment
Purvakarma: Preparation For Panchakarma Therapy
Paschyat Karma: Post Panchakarma Treatment
Panchakarma Treatment Centers & Panchakarma Costs
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Panchakarma works by bringing excess vitiated dosha back to its homesite within the GI tract, thus reversing the disease process (samprapti), so that it may be eliminated from the body via the appropriate channel and cleansing method.
The five cleansing methods of panchakarma are vamana (therapeutic emesis), virechana (purgation), basti (medicated enema), nasya (administration of medication through the nasal passage), and rakta moksha (blood letting).
Generally speaking, Kapha dosha, in the stomach, is eliminated through vamana.Pitta dosha in the small intestine is eliminated through virechana, and Vata dosha in the colon is eliminated through basti. Rakta Moksha is mainly used in Pitta disorders to remove excess Pitta from rasa and rakta dhatu. Nasya is more tridoshic in its application and is generally used to eliminate residual dosha from majja dhatu as well as to nourish and clear the subtle channels. In addition to the five eliminatory actions, clients undergoing panchakarma are guided through purva and paschyat karma, preparatory measures and post-panchakarma rejuvenation respectively.
Panchakarma is situated within the greater context of shodhana chikitsa (cleansing measures), expounded in the classical texts as one of the two main limbs of Ayurvedic therapies, the other of which is shamana chikitsa (palliative measures). Shodhana chikitsa employs cleansing, washing and flushing techniques as a means of detoxification. It involves the application of lekhana (scraping), karshana (removal of growths of foreign bodies), and langhana (fasting) therapies, among others.
Beyond the tangible, physical aspect of cleansing the bodily tissues and GI tract, panchakarma can help clients release mental, emotional and spiritual blocks, clear the pathways of the senses, uncover heightened levels of awareness, and promote sustainable holistic wellness by healing present imbalances and preventing future dis-ease. Some of the many benefits of shodhana chikitsa and panchakarma include the following.
Restoring alignment with prakrti and finding constitutional balance
Cleansing the gross and subtle channels of the body
Healing from present imbalance and preventing future dis-ease
Bolstering immune function and resistance to dis-ease
Elimination of ama from body and mind
Improving digestion, absorption and assimilation
Greater mental clarity
Deep relaxation and situatedness in Self
Reversing the effects of stress
Supporting hormonal balance
Improve functioning of the senses
Shodhana chikitsa may be contraindicated in cases of extreme fatigue, debilitated agni, excessive ama, drug toxicity, high stress, chemotherapy, pregnancy, childhood and old age. In such cases, Ayurvedic practitioners may use the sapta shamana chikitsa (seven palliative measures) to stabilize and pacify the doshas in situ.
The seven palliative measures are generally more calming, soothing and gentle in nature and consist of deepan (to kindle agni), pachan (to burn ama), ksud nigraha (observation of hunger), trut nigraha (observation of thirst), vyayama (exercise), atapa seva (sun or moon bathing) and maruta seva (breathing practices).
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Pre-panchakarma preparation involves up to ten days of a specific dietary protocol leading up to a kitchari mono-diet during panchakarma, as well as snehana and svedana. Snehaha involves both internal and external oleation. Internal oleation generally consists of the consumption of ghee up to three times a day in increasing doses for up to a week. In addition to plain ghee, medicated ghees can be administered to target specific doshas, dhatus and srotamsi. For example, plain ghee can be taken with rock salt to pacify Vata dosha and with trikatu to pacify Kapha dosha. Tikta ghee can be used to pacify pitta dosha, while shatavari ghee can be used to support the female reproductive system and ashwagandha ghee can be used to support the male reproductive system. Brahmi ghee can be used to target majja vaha srotas and licorice ghee can be used to pacify ulceration.
External oleation generally consists of a morning abhyanga practice with a doshically appropriate oil. Both of these forms of snehana serve to lubricate the deep tissues and push vitiated dosha back to the GI tract, making them ready for elimination.
Svedana is the other preparatory measure for panchakarma. Svedana therapy helps to liquefy Pitta and Kapha and calm Vata dosha, promote optimum perspiration, lightness in the body, relieve stiffness, pain and muscle spasms, restore the proper vector of the Vayus, and regulate bowel movements and appetite. There are a number of forms of svedana, including the following.
AGNI Direct exposure to heat (eg. hot water, steam, bath, sweatbox, sauna, pichili)
ANAGNI Stimulation of body heat through exercise, blankets, hunger, etc.
FOMENTATION Local application of heat
BHASPA SVEDA Herbal steams (eg with nirgundi, eucalyptus or sandalwood)
DHARA SVEDA Hot shower after abhyanga
SURYA SEVA Sunbathing
INFRARED LIGHT For local joint and muscle pain
Vamana: Therapeutic Emesis
Vamana takes the action of urdhva bhaga roga haraman – the elimination of dosha through the upper pathway. It acts on kledaka kapha, as well as udana and prana vayu. Substances used to induce vomiting often include the three elements of water (to promote salivation), air (which moves upwards) and fire (which is emetic). Examples of vamak substances include the following.
Bitter melon juice
Vamana is most commonly indicated for kapha constitutions and disorders including but not limited to sinus infections, high cholesterol, hypothyroidism, asthma, lymphedema, fatty liver, diabetes, sluggish metabolism and kapha-type depression.
Virechana: Therapeutic Purgation
Virechana removes fecal toxicity, stimulates agni, enhances intelligence and concentration, and brings stability to the dhatus. This treatment has a downward moving action (apana kshetra) and works on samana vayu, apana vayu, kledaka kapha and pachaka pitta. Examples of virechana substances are as follows.
ANULOMAN Laxatives which digest ama in the feces, such as haritaki
SAMSRANA Drastic purgatives
BHEDANA Purgatives such as kutki and castor oil
RECHAN Mild laxatives such as triphala, aloe gel and nishottar
Basti: Therapeutic Enema
Basti has a very wide field of action. It is said to work on all seven dhatus, the upadhatus, and the srotamsi, in addition to the main sites of Vata (colon, thighs, pelvis, bones, nerves, ears). There are many different types of bastis.
Anuvasan: Oil (lubricating)
Bruhana: Building, nutritive
Lekhana: Scraping, detoxifying
Ghee + Honey: To support ojas
Bitter Ghee: To support tejas
Sesame Oil + Honey: To support prana
Brahmi + Jatamansi: Neurological support
Shatavari + Guduchi: Anti-inflammatory
Vidanga For krumi
Enemas are also customized according to the doshas. Please note that basti should only be performed under the guidance of a qualified practitioner.
Vata: Sesame oil, dashamoola, devadar, bala, vidari, lodhra, salt, gomutra
Pitta: Coconut oil, sunflower oil, shatavari tea, guduchi, ghee, milk
Kapha: Sesame oil, punarnava, gokshura, gomutra, madanaphala, bibhitaki
Nasya: Nasal Administration
Even after purvakarma and vamana, virechana or basti, some doshas may linger in the nervous system, or majja dhatu. Nasya is used to support the release of dosha in this deep tissue by working on prana vayu, tarpaka kapha and sadhaka pitta. There are three general types of nasya.
VIRECHANA “cleansing” for example with vaccha powder for Kapha dosha
BRUHANA “building, nourishing, nutritive” with medicated milk or oil for Vata dosha
SHAMANA “palliative” with ghee or medicated milk for Pitta dosha
Rakta Moksha: Bloodletting
Rakta moksha, literally means to liberate blood from the body. While this technique is rarely practiced by Ayurvedic practitioners in the west, traditional texts explain the therapeutic use of bloodletting to release excess Pitta dosha from rasa and rakta dhatus, particularly in cases of chronic skin conditions, eczema, psoriasis, hemorrhoids, vitiligo, in podiatry conditions, stroke paralysis, thrombosis, embolisms, hematomas and others. Susruta emphasized the importance of the blood, giving rakta the standing as the fourth dosha alongside Vata, Pitta and Kapha and by suggesting that most diseases arise from toxemia.
When blood is removed from the body, blood is squeezed out of the spleen, which stores about one pint of blood rich in T lymphocytes. Thus, when used correctly, rakta moksha can stimulate immune function. Rakta moksha can also stimulate red bone marrow for erythropoietic functioning.
Rakta moksha is contraindicated in cases of anemia, dehydration, edema, ascites, low platelet count, acute pyrexia, generalized swelling, as well as in the elderly and children.
Following panchakarma, clients are guided through a period of rasayana and vajikarana (rejuvenation and virilization therapies). Examples of herbs used in rasayana therapy include ashwagandha, bala and haritaki for Vata, shatavariand amalaki for Pitta and punarnava and bibhitaki for Kapha. Proper post-panchakarma rasayana ensures that the body is replenished following the cleanse and can also help to strengthen khavaigunyas (weak tissues or organs within the body) to prevent the recurrence of dis-ease.
During this time, clients also follow an incremental diet to break the mono-diet kitchari fast of the panchakarma period. Specific fruits, grains, vegetables, oils and spices are systematically reintroduced into the diet with the intention of rekindling agni for sustained digestive health.
According to the classics, the best time for panchakarma is during rtu sandhi, the junction between seasons. This is further specified in terms of the doshic imbalance. For constitutions prone to Pitta imbalance or for presently manifested Pitta disorders, it is best to administer panchakarma in the transition between spring and summer. Similarly, for Vata disorders, it is best to cleanse in the transition from summer to autumn. For Kapha, it is best to administer panchakarma in the transition from winter to spring. While this is the ideal, panchakarma can be done at any time.
What is most important is that the individual can commit to taking time away from their regular schedule to turn their awareness within, to rest, and to devote their energy to the process of panchakarma without disturbance or distraction.
Here are some of the most well established and widely recognized panchakarma centers in the United States.
The Ayurvedic Institute, Albuquerque, NM
“Our five-day program, designed by Vasant Lad, BAM&S, MASc, and based on his 30 years of clinical Ayurvedic and allopathic experience, is custom-tailored to your current state of health, wellness and constitution. It is the starting point to pro-actively manage and improve your own health and wellness. Personal attention is given to each client’s specific needs.”
Panchakarma Cost: $2,690 for a 5-day program
The Ayurvedic Center of Vermont, Wilmington, VT
“Panchakarma (PK) therapy is a detoxifying and cleansing program based on ancient purification and rejuvenation techniques from India. This treatment must be performed by a knowledgeable and well-trained therapist. PK is designed to ripen the bodily tissues and expunge them of impurities/toxins so the body can heal itself and function at optimal levels. It is a scientific approach that involves a specific series of Ayurvedic treatments designed to meet your individual needs. This deeply cleansing process will give you a fresh start as you leave behind toxins and fatigue, as well as physical, emotional, and mental stress. We offer our panchakarma retreats as a 1-day Sampler, a 3-day Rejuvenation, and a 5-, 7- or 10-day Deep Cleanse and Restoration.”
Panchakarma Cost: $2,495 for a 5-day program
The Raj, Fairfield, IA
“Panchakarma or PK is the most comprehensive program offered at The Raj. Also known as our Rejuvenation Therapy Program, Panchakarma is the umbrella program to address a wide-variety of health concerns, ranging from chronic disorders and anti-aging to weight loss and rejuvenation. Panchakarma is tremendously powerful and uplifting with its ability to detoxify the body and reduce stress, while nurturing both the body and well-being. Panchakarma is a customized program tailored to your health needs and is experienced in three phases: starting at home, moving to in-residence, and ending at home. It’s not just a 3-day stay or a week visit, Panchakarma is a two or three month program designed to enhance your health, digestion, routine, and well-being.”
Panchakarma Cost: $3,500 for a 5-day program
The California College Of Ayurveda, Nevada City, CA
“Retreats at CCA follow a traditional method of Ayurveda and take place in a clinical yet comfortable Ayurvedic setting. Our goal is to provide a highest level of Ayurvedic care to our clients for healing to take place. We offer both personalized Panchakarma and Rejuvenation Retreats, as well as a full Ayurvedic Therapy menu in our Day Spa. Panchakarma may last anywhere between 5-30 days and takes one through all three phases including pre and post care. Our retreats are designed to provide support and coaching as clients move through each phase. Whether clients come in for a specific health concern or preventative care they will have a full Ayurvedic consultation with our managing practitioner to ensure that they receive the care that is best for them.”
Panchakarma Cost: all inclusive at $640 per day, length of program varies
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