Historical Background of Panchakarma

It is interesting to note that a few elements of Panchakarma were prevalent during the vedic period itself though the word Panchakarma appears only in Ayurvedic literature. There are references tovirechana and vamanadravyas (materials for emesis or purgation) in the vedic and post-vedic literature.Dhanvanthari, the lord of Ayurveda holds a jalooka (leech) in one hands symbolizing surgical procedure. It is understood that different forms of blood letting as a purifying method were prevalent even during ancient period. Similarly one can see references to nasya (nasal medication) in pumsavana(eugencies) in vedic literature. For example, to achieve conception by an infertile woman, nasya is done with root juice of white flowered Brihati (Solanum anguivi) collected on Pushya nakshatra (Tewari 1992:72). Even though some of these techniques have been described in vedic period itself,Panchakarma as a comprehensive system of therapy took shape in Carakasamhita period.

Panchakarma is a unique contribution of Ayurveda. One can see extensive references to Panchakarma in the earliest classical texts available on Ayurveda. Caraka samhita, Susruta samhita and AshtangaHrdayam of Vagbhata known as Brihathrayi. As a living tradition, Panchakarma is widely prevalent in theAyurvedic practice of Kerala.

Not only in Ayurveda, but in other different medical cultures as well, one could see treatment such asPanchakarma used for purification purposes. Techniques like Panchakarma are mentioned in the other systems of medicines as well. For instance, catharsis in the Greek medicine is a method of purgation or purification. Till recently, in Western Bio-medicine there was practice of medicated enemas for conditions like arthritis, asthma described in the form of high rectal or low rectal enema. Even recent pharmacological books had explanations on how these get absorbed into the body through lymphatic or systemic circulation and their effects. Drug administration methods like nasal medications for conditions like diabetes insipidus were also mentioned.

Even in other medical traditions like Unani, Tibetan, Siddha, Chinese, Kampo in Japan and Indonesia, or the different African healing traditions, some of these techniques are used for purification purposes.

Treatments like emesis or purgation are techniques that support or activate body's natural processes. One can see techniques like induced vomiting being used by animals as well. when sick Cats or dogs eat grass and induce vomiting. Even in the local community specific oral traditions of India, one can find some of these treatments widely prevalent . For instance, a common treatment of mental disorders in these traditions is based on vamana (emesis). E.g. Thiruvizha chardi. This is a practice of emesis followed in a Siva temple of Southern Kerala for treating mental disorders. A paste made of specific herbs is given along with milk to the devotees suffering from mental disease to induce vomiting. A milk pudding is also given which would facilitate emesis. Apart from inducing emesis, these medicines would also cause bouts of purgation, which would last for two to three hours. Following this a specific type of rice gruel is given to strengthen the body without any other diet restrictions. This practice is commonly done in artificial poisoning. There are number of such practices of emesis, purgation, bloodletting or enemas in these local health traditions.

If these methods are widely described in various traditions, one wonders what is exceptional aboutPanchakarma in Ayurveda. Panchakarma has a systematic approach that includes pre-Panchakarmatechniques, a sequential approach of five methods and post Panchakarma procedures in the form of a complete package. Persons who are suitable and not suitable for each of these techniques, how to doPanchakarma, symptoms of effective medication, complications of Panchakarma, treatment of these complications, benefits of doing each of these techniques, variations to be followed in the method based on the strength of the patient, seasons etc, different materials used, conditions in which each technique has to be administered are discussed in detail in Ayurvedic classical texts. In the context ofvasti (medicated enema), it is mentioned "Etat chikitsardham iti pratishtha…." which means that vasti is considered half of treatment in Ayurveda. Thus, one could aware that Panchakarma forms a major part of the treatment in Ayurveda.


According to Ayurveda, body is made of 7 different types of tissues called dhatu. These body tissues are nourished through food materials that get digested by action of digestive fire (agni) . The digested materials are carried to different tissues through srotas (body channels). At each tissue level, there is a digestive fire that works on the food material to activate absorption of nutrients into the corresponding tissue.

As a by-product of this process, mala (waste materials) are formed which are eventually eliminated. Nourishment of body tissues results in the indigestion of food in the body. This undigested material or waste material (ama) clog the body channels and manifests in different disease conditions. Management of these conditions has to be done by removing of these clogged materials in the body channels when they become pakva (digested and disintegrated), and they then move into the kostha(main channel). During Panchakarma, these are expelled through natural orifices. As it is a mechanism to eliminate the waste materials from the body, Pancharkarma is not only used as curative treatment but also as preventive and promotive.

"Seetodbhavam dosacayam vasante visodhayam greesmajam abhrakale
ghanatyaye varsikamaasu samyak prapnoti rogaan rtujaan na jaatuch"
[Astanga samgraha, Roganutpadaniya]

Astanga samgraha, one of the classical texts, says that Panchakarma has to be applied to remove the waste materials accumulated in the body in different seasons for preventing diseases caused by seasonal changes. It is mentioned that waste materials accumulated in the body during winter would be eliminated in spring, those accumulated in summer should be eliminated in rainy season and that accumulated in rainy season should be cleared in autumn. In Kerala, during the month of Karkataka (July-August) oil treatments is very popular. This is to alleviate the vata accumulated in the body during summer and aggravated in rainy season.

There is a general thinking that Panchakarma removes the toxic materials. But it has to be understood that Ayurveda does not mention these materials as visha (toxins) but they are considered as ama. Ama refers to the material that is a drop out of body's metabolic process i.e. the undigested materials. Panchakarma activates body's natural processes and eliminates mala (waste) from the body.


Modern India has experienced an unusual yet perfect blend of the traditional and the modern in both domestic as well as in the international arena. On one hand, Indian Information Technology is being hailed as a power to reckon with, and on the other, the traditional Indian knowledge systems likeAyurveda, Yoga, etc. are being considered seriously. More and more people from all over the world are flocking to India to get Ayurvedic opinion on their health issues. Panchakarma clinics can now be found everywhere, including star hotels and holiday resorts. It is important, at this juncture, to know whatPanchakama is. As this write-up is mainly for the common reader, only minimum information has been imparted. For a more detailed study, one has to get in touch with an Ayurvedic physician or refer to the reference books on this topic. This material must not be expected to serve the purpose of a user's manual.

The objective of Ayurveda is "Svasthasya svasthya rakshanam athurasya vikaraprasamanam" which means to protect the health of the healthy and to relieve the suffering of the sufferer. To achieve this objective, Ayurveda advises different methods of treatment. One of the classifications is as follows.

Treatment (Upakrama)

Here are two types of treatment (upakrama) mentioned in Ayurveda - These are also known as

Santharpana or Brimhana (nourinshing) and Apatharpana or Langhana respectively.

Langhana or apatharpana (depleting) is divided into further two categories. They are Sodhana (elimination) and Samana (pacifying).

Sodhana is the elimination of waste materials accumulated in the body through a series of treatment processes and samana is pacifying of the condition. Sodhana is done when there is prabhoota dosa(excessive accumulation of waste materials) where as, samana is done when there is alpadosa (less waste materials). In today's Ayurvedic treatment most of the practices like taking medicines or massages and steam baths fall into the category of samana.

Langhana (depleting)
Sodhana (purification) - 5 kinds Samana (pacifying) - 7 kinds
1) Vamana (emesis) 1) Pachana (using digestives)
2) Virechana (purgation) 2) Deepana (increasing digestive fire)
3) Vasti (enema) 3) Kshut (hunger)
4) Nasya (nasal medication) 4) Thrit (thirst)
5) Rakta moksha (blood letting) 5) Vyayama (exercise)
  6) Athapa (Sunlight)
  7) Marutha (Wind)

"Nirooha vamana kaya sirorekosravisrutaya iti panchakarmani" [Astanga hrdaya, sutrasthana, 14/5]

Panchakarma literally means five actions or techniques. They are vamana (induced vomiting/emesis)virechana (purgation), kashaya vasti and sneha vasti (two kinds of medicated enemas with decoction and unctuous material), nasya (nasal medication) and raktamoksha (blood letting).

A major therapeutic use of panchakarma is purification (sodhana) of the body. Though sodhana(purification) forms a major part of Panchakama. But Panchakama is not a purificatory technique (sodhana chikitsa) alone; The purificatory treatment in the form of Panchakama is quite unique to Ayurveda. According to Caraka samhita, one of the earliest writings on Ayurveda, if a disease is treated with sodhana, it does not recur. Thus Panchakama becomes an important part of Ayurvedic treatment modality.

There is a difference of opinion among classical authors on the techniques that come underPanchakama. Some include vamana (emesis), virechana (purgation), two types of vastis (enemas) andnasya (nasal medication). Here it is to be noted that even though there is a difference of opinion, most of the classical authors like Susruta and Vagbhata include raktamoksha (blood letting) inPanchakama apart from the other four techniques.

Panchakama is commonly used in treating broad categories of conditions – arthritic, rheumatic, neurological, neuromuscular, musculo-skeletal disorders, other degenerative conditions, mental disorders, insomnia, depression, menstrual irregularities, infertility, obesity, asthma and other respiratory conditions, irritable bowel syndrome, gastro-intestinal conditions, other chronic conditions, etc. Thus Panchakama has preventive, curative and promotive functions.

In Ayurveda, there are three methods of treatment. They are Hetu vipareetha (against cause),vyadhivipareetha (against disease) or ubhayarthakari (both the above). Panchakama includes all the three types of treatments.


Panchakama includes preparatory technique, five main techniques and a few post techniques. Click on the following links to know about them.


Following diseases have poor prognosis i.e., they are incurable diseases (based on our experience)

  • Motor Neuron Disease (MND)
  • Myopathy
  • Duchenne Muscular Dystrophy (DMD)
  • Down syndrome
  • Parkinson plus
  • Progressive supranuclear palsy
  • Cerebellar ataxia
Instruction to Foreign Patients / NRI Patients / North Indian Patients.
  1. Our hospital is not a spa. We treat complicated cases. We cannot offer abhyanga, or oil massage based on the patient demand.
  2. We give simple south Indian vegetarian food only. We will give kanji (yavagu) with green gram. If needed Chappati can be prepared. No kitchadi or Prakruti based food is given. We do not have facilities to do the same. For people who studied Ayurveda in western countries and for rich people.
  3. We give mineral water. We change beds spread once in 3 days only. The water available for bath here is very very hard water, so we have difficulties to clean.
  4. Dr. L. Mahadevan cannot come for rounds every day. Senior experienced doctor with 15 years experience who are with Dr. L. Mahadevan are given responsibility to take rounds.
  5. They will discuss with Dr. L. Mahadevan and treat. First prescription and diagnosis will be made by Dr. L. Mahadevan.
Special Notes
  • Ayurveda also have certain side effects. Many of the raw drugs are purchased. Fresh herbs are collected. In Patients with auto immune disorders some of the drugs trigger, the disease. For example manifestations of auto immune hepatitis in RA patients, etc. This was documented in our hospital, but it is rare phenomena. In order not to miss this we take regular blood tests.
  • Those who want pure Ayurveda, we will give pure Ayurveda. Those who are interested to do modern blood test and investigations we will do so. If you give the freedom to us, we would like to do integrated approach only, so that we do not miss anything. This style is based on my experience in last 22 years, after treating 6 to 7 Lakh cases.
  • The hospital runs by quality of diagnosis, medicines and medical services. Our inpatient service is not as great as star hotels or spas or any other ayurvedic tourist centres. Our main customer is sick people only.

Dr. L. Mahadevan's Speech about Ayurveda