Before starting the treatment each patient is assessed of his or her pathological state and the body constitution. The human body is composed of three biological units doshas, dhatus and malas that maintain the body. These three biological units are in a balanced state. Any imbalance in the units is managed through various procedures of treatment. The panchakarma therapy is the cleansing procedure that involves three stages.

Before starting the panchakarma treatment patients have to undergo preliminary procedure by which it is introduced to purify vitiated organs through the application of special processes called Purva Karma. The two procedures are snehan and swedan. Snehan is also known as oleation therapy that is the oil massage. In the snehan therapy oil is applied to the entire body with a particular type of massage that helps the toxins to move towards the gastrointestinal tract. The oil massage also makes the deep and superficial tissues soft and supple and makes the vitiated matters easily extractable. The snehan therapy makes the body smooth and oily that further removes the roughness of the body.

There are two types of oleation.

The external oleation involves the application of medicated oil on the skin. The different types of external oleation are:

It refers to the oral administration of medicated ghee. The ghee is used in three ways for:

To check whether the optimum oleation has developed or not stool, tongue and time of hunger should be noted everyday.

The other therapy in the purvakarma is fomentation therapy known as swedana. Swedana means sudation procedure. It consists of fomentation that induces sweating. Sweat or sweda is the waste product (mala) in the body. Swedana is performed after two days of snehana. It relives the stiffness, coldness and heaviness of the body. Due to fomentation therapy the Agni in the body in increased mobilizing the fatty tissues. The swedana is divided into two types:

Agni sweda – in Agni sweda heat is applied directly

Anagni sweda – the heat is applied indirectly

Pradhan karma

It is the main stage in panchakarma that consists of the five essential purificatory therapies. These therapies are also known as five basic shodhanas or the cleansing methods. These therapies are:

Emesis Therapy

It is also known as vaman karma. It is a process of therapeutic vomiting that helps in the elimination of toxic and waste matters from the stomach and thoracic cavity. When there is congestion in the lungs it causes repeated attacks of bronchitis, colds, cough and asthma, the emesis therapy helps to eliminate the kapha that is responsible for causing the excess mucus. Other kapha dominant diseases like severe skin diseases like psoriasis, urticaria, and mental disorders are selected for this treatment procedure. The emesis therapy is not suggested for expecting mothers. After the process of snehan and swedan, 3-4 glasses of licorice or salt water is administered and rubbing the tongue that triggers the vomiting center through the gag reflex stimulates vomiting. The process of therapeutic vomiting is also indicated in chronic asthma, diabetes, chronic cold, lymphatic congestion, chronic indigestion and edema.

Before administering vaman, oil massage and fomentation are recommended on the night before the day of vaman. Vaman should be given early in the morning during kapha time. The person should eat basmati rice and yogurt with high salt every morning that will aggravate kapha in the stomach. The application of heat to the chest and back will help in liquefying the kapha. After drinking the decoction of licorice the person should feel nauseated. He or she should then rub the tongue to induce vomiting and continue until bile comes out.

Indication for Emesis Therapy

Contra-indications for Emesis Therapy

The purgation therapy eliminates the toxic and waste matters from the intestine. When excess bile, pitta is secreted and accumulated in the gall bladder, liver and small intestine, it results in rashes, skin inflammation, acne, chronic attacks of fever, biliary vomiting, nausea and jaundice. A therapeutic laxative is administered in these conditions. It also cures pitta or pitta dominated diseases. A mild form if virechana without poorvakarma, is an integral part of Ayurvedic therapy. It is also used for prevention of diseases. An effective laxative for vata or pitta constitutions is a glass of hot milk to which two teaspoons of ghee is added. When taken at bedtime it helps to relieve the excess pitta causing bile disturbance in the body. The purgative therapy can cure the problem of excess pitta. A continuous diet check is required during the treatment using purgatives. The person should avoid eating foods that aggravates the predominant humor or cause the three humors to become imbalanced.

Indications for Purgation Therapy

Contra-indications for Purgation Therapy

The term basti has been derived from the fact that the Basti yantra (apparatus) used for introducing medicated materials is made up of Basti or animals' urinary bladder. Basti is among the major panchakarma procedures and is used to cure vatic disorders. The process of enema therapy is resorted to eliminate toxins from colon and strengthens the tissues.

There are eight main types of basti:

It is used for selected semen and ovulation disorders and the problems involving painful urination.

Indications for Enema Therapy

Contra-indications for Enema Therapy

This therapy should not be used of the patient is suffering from diarrhea, bleeding of the rectum, chronic indigestion, breathlessness, diabetes, fever, people in old age and for the children below seven years of age. Patients suffering from diabetes, obesity, indigestion, tuberculosis and cough should avoid the oil enemas.

It is an instillation of medicine through nose. It is an important therapy for the treatment of diseases affecting head area. It helps in cleansing the head and sinuses. The nose is the doorway to the brain and consciousness. There are six types of nasal administration:

Indications for Nasya

Contra-indications for Nasya

It is the oldest method used for purification and cleansing of the blood. The process of letting out the vitiated blood is termed as bloodletting or raktamoksha. The toxins present in the gastro-intestinal tract are absorbed into the blood and circulated throughout the body. This condition is known as toxemia and is the main cause of repeated infections. This includes repeated attacks of skin disorders such as hives, urticaria, rashes, and eczema.

Indications for Bloodletting

Contra-indications for Bloodletting

It is the post karma that includes diet, medication and lifestyle. It is the adoption of rehabilitative measures after the main treatment. It is of three types:

The restoration of digestive power by advocating specific diet after completion of sodhana therapy is known as Samsarjana karma.

Administration of various drugs after Elimination Therapy is known as Rasayanadi karma. 

Administration of medicines required to treat the particular disease after the process of elimination is called Samana Prayoga.

Panchakarma is an important Ayurvedic operation that is done individually for each person with his or her specific constitution and specific disorder in mind. It helps the person to prepare their internal environment for the current season.

Duration of Panchakarma

The panchakarma therapy is performed for a month and is broken into three cycles depending on the stages.

First cycle

Oelation, fomentation and nasal therapies are performed for seven days and on the eighth day emesis therapy is performed. There is a break for three days after eight days treatment.

Second cycle

Same oelation, fomentation and nasal therapies are performed for seven days. On the eighth day purgation therapy is performed and again there is a break of three days.

Third cycle

The three therapies are performed again for seven days and on the eighth days enema therapy is performed.

This is the end of duration of panchakarma therapy.