Ayurvedic Panchakarma Treatment: Introduction, Benefits, Dosha Relation

Panchakarma is the main way in which Ayurvedic treatment is carried out. The total Ayurvedic treatments can be divided into three main divisions.

• Ayurvedic Panchakarma treatments
• Ayurvedic treatments such as oil massage, steam therapy etc.
• Ayurvedic medicines prescribed according to diseases and to promote health.

Principle behind Panchkarma

The basic Ayurvedic principle behind Panchakarma:
According to Ayurveda, due to the effect of atmosphere, weather, improper diet and lifestyle habits etc, the toxins in the body accumulate. These toxins, in Ayurvedic term is called as ‘Ama’. Toxins can be of two types –

1. The toxins that enter into the body due to improper food / lifestyle – such as exposure to micro organisms through food, air etc.
2. The toxins that our body generates due to seasonal variations, improper diet etc – such as high fat consumption leading to excessive cholesterol, old age causing wear and tear in joints causing arthritis etc.

Any disease manifestation can be explained in terms of toxins and the related effect that it exhibits on Doshas, and on body  (and mind) and its function.

To re-word the term toxins, Ayurveda uses the word Tridosha. – They are Vata, Pitta and Kapha.
When they are normal, they support the body and maintain health. But when they go abnormal, they cause disease. Tridosha – in harmony with each other = health. Tridosha – imbalance, one or two or all three Doshas – they grow up hugely – disease.

Now, either we have to bring back these hyperactive Tridosha down to normal range or we throw the imbalanced Doshas out of the body. To bring the Doshas into normal levels, we use massage, oral medicines. It is helpful in minor Dosha imbalances. But if they have been vitiated to a large extent, better to get rid of them. This is done by Panchakarma treatment.

Ayurvedic treatment aims to relieve the body of these toxins by means of Panchakarma treatments.

What is Panchakarma?

The five treatments which constitute Panchakarma are –

• Vamana – therapeutic emesis
• Virechana – therapeutic purgation
• Niruha / Asthapana Vasti – decoction enemas
• Anuvasana Vasti – oil and ghee enemas, unctuous enemas
• Nasya – nasal medication

Sushruta has considered blood as fourth dosha and mentioned raktamokshana i. e. bloodletting as one among five panchakarma measures.

1. Vamana – Emesis treatment – This refers to removing the toxins by means of vomiting. The person is made to vomit by giving many medicines. The vomiting continues for a short while. Vamana treatment is given after preparation procedures called Purvakarma. After the end of the procedure, a diet plan is advised to follow for 1 – 7 days time. Vamana treatment is usually given Kapha imbalance diseases. Vamana treatment may take from 3 –  7 days.

2. Virechana – purgative treatment – This refers to removing the toxins by means of purgation. The person is made to have loose motions for a short while, by administering medicines. Virechana treatment is given after preparation procedure called Poorva Karma. After the end of the procedure, a diet plan is advised to follow for 1 – 7 days time. and post virechana procedures. Virechana treatment is usually given Pitta imbalance diseases. Virechana treatment may take from 3 –  7 days.

3 & 4 – 2 types of Basti – rectal enema – The Ayurvedic enema is quite different from the regular enema given to relieve constipation. Basti treatment is adopted in wide range of diseases, predominantly of  Vata imbalance.  There are two types of Basti – Basti with oil and Basti with a mixture of herbal decoction, honey, salt etc.

Principle behind Basti treatment – There are a few set of herbal active principles that do not undergo digestion, when given through oral route, either these herbal active components are destroyed due to acid in the stomach or due to metabolism of these components by liver (hepatic first pass effect). Thus, the Ayurvedic experts of ester-centuries found out the rectal route to administer the herbs, by which the herbal active components are directly made available for absorption at the level of intestines.

5. Nasya treatment – Instillation of powders or Ayurvedic liquids through nose is called Nasya treatment. It is usually prescribed for diseases of ear, nose, throat, headache etc.

By Dr Raghuram Y. S. MD (Ay) & Dr Manasa, B. A. M. S

Panchakarma for Doshas

Panchakarmas to combat vitiated doshas

All five treatments mentioned above need not be applied in all sorts of dosha vitiation. Similarly these treatments are not needed in tackling all types of dosha vitiation, especially mild dosha vitiation as happens during seasonal changes.
Read – Normal Vitiation of Doshas As Per Seasonal Variation

Quality and quantity of vitiated dosha should be analyzed before choosing a treatment. Particular treatments are effective against particular doshas. Example, emesis is best remedy for kapha but not for vata, in fact emesis may aggravate vata.

Effect on Kapha

Effective panchakarma treatment for vitiated Kapha

Therapeutic emesis is best treatment for expelling vitiated kapha out of body. Kapha is mainly located in upper portions of body. Though it is predominantly seated in throat, head, trachea, inter-phalangeal joints, stomach, lymph, fat tissue, nose and tongue, predominant seat of kapha is chest.
Read – Kapha Dosha Dominant Places in Our Body

When kapha gets vitiated, it may get vitiated in these seats and can create diseases in entire body by spreading to different parts of body.

When emesis is administered vitiated kapha is expelled through vomiting. Kapha comes to balance and diseases caused by kapha get cured.

Some kapha disorders which can be effectively treated by administering emesis

• Common cold which is chronic
• Kapha Skin diseases
• Acute fever with kapha predominance
• Cough
• Asthma and breathlessness
• Urinary disorders, diabetes
• Low digestion, loss of appetite
• Excessive salivation, nausea
• Tastelessness, indigestion
• Memory loss caused by kapha
• Insanity caused by kapha
• Body swelling
• Obesity and disorders of fat metabolism etc

Effect on Pitta

Effective panchakarma treatment for vitiated Pitta

Therapeutic purgation is best treatment to expel vitiated pitta out of body. Pitta is mainly located in middle portion of body, wherein digestive apparatus is situated.
Read –Pitta Dosha Dominance In Different Body Parts – 8 Things To Know

Though pitta is predominantly seated in navel, stomach, intestine, sweat, lymph, blood, plasma, skin and eyes, its predominant seat is navel.

When purgation is administered vitiated pitta is expelled out of body through anal route. Pitta comes to balance and diseases caused by pitta get cured.

Some pitta disorders which can be effectively treated by administering purgation

• Fever caused by vitiated pitta
• Skin disorders caused by vitiated pitta
• Diabetes and urinary disorders caused by vitiated pitta
• Fistula in anus
• Piles
• Spleen disorders
• Abdominal tumors
• Cystic disorders
• Herpes caused by vitiated pitta
• Anaemia and liver disorders caused by aggravated pitta
• Headache caused by vitiated pitta
• Jaundice
• Cough and breathlessness caused by vitiated pitta
• Memory loss and insanity with pitta predominance
• Gout
• Vaginal disorders
• Blisters and skin eruptions
• Swelling of body caused by pitta, inflammation
• Conjunctivitis
• Burning sensation in body etc

Effect on Vata

Effective panchakarma treatment for vitiated Vata

Herbal enemas in form of either decoction or oil enemas given through anal, urethral or vaginal route are best treatments to combat vitiated vata and expel it from body. Vata is mainly located in lower portion of body, in pelvis where colon and urinary apparatus is located.

Though vata is predominantly seated in colon, waist, pelvis, ears, bones and skin, its predominant seat is colon.

In vata vitiation, vata gets aggravated in one or more of above mentioned seats but can create diseases in entire body by getting spread to different parts of body.
Read – How To Balance Vata Dosha? Line Of Treatment And Reasoning

When medicated enemas are administered vitiated vata is expelled out of body. Vata comes to balance and diseases caused by it get cured. Since vata is driving force for all activities taking place in body and is also a controller of pitta and kapha, when vata gets balanced by administration of vasti, disturbed pitta and kapha too gets pacified.

All functions come back to rhythm, there is rejuvenation of tissues and organs are rehabilitated, body gains strength and endurance and immunity is established. Thus, vasti is quoted to be half treatment of all treatments available in world.

Some vata disorders which can be effectively treated by administering enema

• Disorders caused in entire body or part of body
• Obstruction of feces, urine, fart and semen
• Destruction and deterioration of strength, muscles, semen
• Bloating, flatulence
• Abdominal tumors
• Colic
• Insanity and memory loss caused by vitiated vata
• Fever caused by vitiated vata
• Headache
• Pain in ear, heart, flanks, back
• Tremors,
• Pain in butts, knee, calf, thigh, hands, feet, vagina, arm, fingers and toes, breast, tooth, nails, small joints of fingers etc
• Hemiplegia, facial paralysis, joint pains and arthritis, etc

Detox for head

Effective panchakarma treatment for doshas accumulated in head and neck

Nasya or medicines administered through nasal route is best treatment to expel doshas accumulated in head and neck. Nose is said to be gateway for head. Medicines instilled in nose in form of medicinal juices, powder, decoction, processed milk and oil and fumes would expel doshas accumulated in head and neck by pulling them from their place of accumulation. By doing so, nasal medicines cure diseases related to head, neck and sense organs. This treatment also ignites mind and senses and helps in proper perception and induces proper sleep.
Read – How To Do Ayurvedic Nasya Treatment At Home? Nasal Drops For Long Life

Some disorders caused by dosha accumulation / vitiation in head which can be effectively treated by administering errhines

• Stiffness of head and neck
• Stuffed nose and cold
• Enlargement of neck due to swelling of structures therein
• Dimness of vision
• Freckles
• Headaches, Hemicrania
• Diseases of shoulder and neck, cervical spondylosis
• Diseases of mouth and tongue
• Pain in scapular region arm, ear, nose, eye, head
• Facial paralysis
• Goiter
• Tooth pain and looseness
• Voice disorders, stammer etc

Dosha Panchakarma relation

Cleansing treatments for vitiated doshas can also be given for healthy people in particular seasons wherein particular doshas tend to get aggravated. This will avoid seasonal disorders and give long standing immunity against damages caused by doshas.

Example, kapha aggravation takes place in spring season; therefore emesis can ideally be administered in this season to take control of kapha. If there is a tendency of disease being produced due to aggravated kapha, it will be aborted in earlier stages itself. In healthy person emesis would help prevent aggravation of kapha beyond limits, in expelling accumulated and vitiated doshas and for maintenance of health during this season.
Read –Shortening Panchakarma Therapy To Suit a Busy Patient – Dr CR Agnives

Therapeutic emesis should be done until pitta is seen in vomitus. Similarly therapeutic purgation should be done until kapha is seen in motion. These are indicators to tell that treatments have been done comprehensively.
Read – How To Do Panchakarma At Home?

Emesis, in spite of being a treatment of choice for kapha, also is good to combat pitta vitiation. Likewise purgation is a good remedy for both vitiated pitta and vata. Vasti is ideal to combat vata but also pacifies vitiated pitta and kapha. Errhines are good for all doshas especially to expel those vitiated in head and neck. Bloodletting is ideal treatment for diseases caused due to vitiation of blood and pitta.

If according to Sushruta if blood is taken to be 4^th dosha, raktamokshana or bloodletting which is a part of five elite treatments would become an ideal treatment of choice. Bloodletting, apart from being an ideal remedy for blood borne diseases, is also a cure for pitta disorders.

Benefits of Panchakarma

Buddhi Prasada – Clarity of the mind,
Balam Indriyanam – strength of the sense organs,
Dhatu Stiratva – stability of the tissues,
Jvalanasya Deeptim – keenness of digestive power and
Chirat cha paakam vayasaha karoti – slow and delayed ageing process
Karoti Samshodhana – all the above are benefits of purification procedures.
Samyak Upasyamanam – if the procedures are done perfectly.

Timely detox

Ayurveda recommends timely removal of toxins that build up in the body

It is done by two methods.
1. Panchakarma – Expulsion of Dosha from oral, nose and anal route, through therapeutically induced vomiting, nasal discharge, diarrhea and enema.

2. Daily expulsion of toxins: From all possible openings of the body.
there is Panchakarma , at a massive scale. But there are mini therapies that do this kind of expulsion happening in minor forms as well. These minor expulsions are planned right throughout the day, as part of Dinacharya.
For example, Tooth brushing – Especially with herbal tooth powders.  Read related: Ayurvedic tooth brushing and tongue cleaning
Once a week, Rasanjana – applying aqueous extract of Daru Haridra – Berberis aristata – is used for applying to induce secretions – Sravanartha.

Oil pulling – It is done till there is secretion through eyes and nose. It is also done after face oil massage and mild steam. Read related: Oil pulling as per Ayurveda

Avoid Doing These in Panchakarm

Ashta mahadosha karas are those eight factors which tend to contaminate the body and cause serious problems if not avoided in the post-operative care of panchakarma. The word maha indicates that they are great troublemakers.

Ashta = eight, Maha = great
Dosha = contaminants, Kara = which tend to cause

They are also called as Pariharyas i.e. avoidable things.

Reference

This concept has been explained in the 12^th chapter i.e. Uttarabastisiddhi of Siddhisthana of Charaka Samhita. Though this concept has been explained in relation to enema treatment, it can be applicable for all five therapies of panchakarma.

In the post-operative care of emesis and purgation therapies, samsarjana krama i.e. graduated dietetic protocol has been mentioned. This comprises of a time period from 3-7 days depending on the type of cleansing. It is not only about the diet, many things have to be avoided in order to reestablish the strength of the digestive fire which has become weak after these therapies. Only when the fire recovers, the digestion of food takes place properly. This leads to proper nutrition of the body and quick recovery of health. Along with graduated diet, the eight avoidable factors too should be taken into concern in the follow up period of emesis and purgation therapies.
Read – Shortening Panchakarma Therapy To Suit a Busy Patient – Dr CR Agnives

Similarly, after the course of enema therapies, parihara kala i.e. gap time or refractory / recovery period has been explained. This is double the number of days of enema therapy. During this time period, one should follow strict diet and lifestyle regimen to regain total health. Even here, the eight factors which would be explained below shall be avoided.

These eight factors should also be avoided in the post-operative care of errhine therapy and bloodletting therapies. Though these avoidable factors are not emphasized to be followed post emesis, purgation, errhine or bloodletting therapies in classical references, they need to be followed strictly to obtain optimum results of the cleansing treatments.
Read – Vamana Virechana – Emesis and Purgation – Ashtanga Hridayam Sutrasthana 18

Eight avoidable things in the post-operative care of panchakarma

1. Uchchaihi Bhashyam – Speaking loud

One should avoid speaking loudly. Below mentioned are the consequences of speaking loudly –

• Increased heat in the head
• Throbbing pain in the temples
• Feeling as if the ears are clogged with some material
• Dryness of throat and palate,
• Darkness before the eyes
• Thirst
• Fever
• Stiffness of the jaws
• Stiffness in the neck
• Excessive expectoration
• Chest pain
• Pain in the flanks
• Hoarseness of the voice
• Hiccough
• Dyspnea etc
  Read – Reasons Why Fat Is Good For You

Treatment

Herbal oil massages

• Sudation
• Medicinal poultices
• Medicated smoking
• Errhine
• Oral consumption of medicated fats
• Consumption of meat juice and milk
• Vata mitigating measures
• Silence
  Read – Snehana – Oils and Fats Treatment – Ashtanga Hrudayam Sutrasthana 16

2. Rathakshobha – Excess travelling

Too much travelling in the chariots and other vehicles. Excessive travelling in this context includes methods of commuting of modern day i.e. riding bicycles and two wheeler, driving cars, traveling in flights and trains etc. The effects of excessive travelling are as listed below –

• Laxity of bony joints
• Laxity of small joints of hands and feet
• Pain in the jaws, nose, ear and headache
• Throbbing pain in the body
• Colic
• Sounds in the abdomen
• Flatulence
• Distension of abdomen
• Catches in the region of heart
• Discomfort / gripping feel in the sense organs
• Pain in butts, groin, flanks and pelvis
• Weakness in the sides of the neck
• Weakness of shoulders
• Raised heat in the body parts
• Numbness in the hands and feet
• Tingling in the hands and feet etc

Treatment

• Oleation
• Sudation
• Vata mitigating measures
• Avoidance of travelling
  Read – How To Balance Vata Dosha? Line Of Treatment And Reasoning

3. Ati Chankramana – excessive walking

Below mentioned are the effects of excessive walking.

• Pain in the feet, legs, calves, knee, groin, back and pelvis
• Immobility and weakness in the thighs / lower limb (feeling of heaviness of the limbs)
• Loss of sensation
• Cramps in the calves / legs
• Pain in the body parts wherein the person feels that he is beaten all over
• Raised heat in the body parts
• Excessive pulsation in the blood vessels
• Dyspnoea
• Cough etc

Treatment

• Same as in excessive travelling
• Avoidance of excessive walking

4. Ati Asana – excessive sitting

Sitting in the same place for long durations should be avoided. If done the same symptoms i.e. pain in the butts, flanks, groin etc explained in the context of ‘excessive travelling’ will manifest.

Treatment

• Same as in excessive travelling
• Avoidance of excessive sitting

5. Ajirna-Adhyashana – indigestion, repeated eating

When one consumes excessive food when the digestion capacity is less, it leads to indigestion. When one consumes food repeatedly before the previous food is digested, it will lead to digestive errors. Both these should be avoided. If these are not followed with discipline, the below mentioned complications can arise –

• Dryness of the oral cavity
• Distension of the abdomen
• Colic
• Throbbing pain in the belly
• Thirst
• Weakness in the body parts
• Fainting / loss of consciousness
• Vomiting
• Diarrhea
• Fever
• Dysentery
• Toxicity due to ama etc

Treatment

• Thorough emesis to expel the morbid doshas in totality
• Dry sudation
• Lightening measures
• Medicines and measures which cause digestion of ama and increase appetite

6. Vishama Ahitashana – incompatible foods

One should not consume imbalanced or incompatible foods. If consumed it gives raise to the below mentioned conditions –

• Tastelessness / anorexia
• Weakness
• Discoloration
• Itching
• Eczema
• Debility of body parts
• Aggravation of vata
• Irritable bowel
• Piles etc

Treatment

• Interventions should be in accordance to the symptoms or complications developing in the process
• Avoidance of causative factors

 7. Divaswapna – day sleeping

The ill effects of day sleeping are as below enlisted –

• Anorexia
• Indigestion
• Sluggish digestion
• Feeling as if the body has been enveloped with wet cloth
• Anemia / pallor
• Scabies / eczema
• Itching
• Burning sensation
• Vomiting
• Beating pain in the body
• Stiffness in the chest / heart region
• Stiffness of the body / immobility
• Stupor / drowsiness
• Excessive sleep
• Cysts
• Weakness
• Blood in urine
• Rush of blood (high blood pressure)
• Feel of coating in the palate
• Thirst etc
  Read – Day Sleep – Sleeping In The Day: Rules, Benefits, Contra Indications

Treatment

• Medicated smoking
• Fasting / lightening measures
• Emesis
• Exercise
• Dry foods
• Consumption of asava and arishta
• Medicines which increase appetite and digest ama
• Rubbing of the body with medicinal powders
• Compression of the body
• Sprinkling / showering medicinal fluids
• Kapha mitigating measures
  Read – Activities And Diet For Kapha Balance

8. Vyavaya – indulgence in sex

Below mentioned are the complications arising from indulgence in sex post-panchakarma.

• Immediate loss of strength
• Weakness in the thighs
• Pain in head, region of urinary bladder, anus / rectum, penis, thigh, knee, calves / leg and feet
• Increased palpitation
• Pain in eyes
• Laxity in body parts
• Bleeding along with ejaculation
• Cough
• Dyspnoea
• Spitting of blood
• Weakness of voice
• Weakness in the pelvis
• Diseases pertaining to any one part of the body
• Diseases pertaining to the whole body
• Swelling of scrotum
• Obstruction to fart and urine
• Difficulty in ejaculation
• Tremors in the body
• Deafness
• Depression / grief
• Cutting pain in the rectum
• Squeezing / twisting pain in the penis
• Discomfort of mind
• Feel of tremors in the region of heart
• Joint pains
• Feel of darkness in front of the eyes
  Read – Ghee Home Remedy For Dry Cough

Treatment

• Administration of ghee and milk processed with jivaniya group of herbs
• Vata mitigating measures
• Sudation
• Massage with herbal oils
• Poultices
• Foods having aphrodisiac properties (eggs, meat, meat soup, milk, ghee etc)
• Unctuous enemas
• Strengthening enemas
• Enema through urethra / vagina should be administered with oils processed with Vidarigandhadi group and Jivaniya group of herbs (in case of problems related to urinary bladder, like pain and in urinary disorders)

Sanskrit Verses

Overall impact –
The overall impact of not avoiding the above said eight factors will be dreadful. Panchakarma therapies cause cleansing of body and the body will get weak after the procedures. In such condition if the above said eight avoidable things are partaken, they will cause more weakness of the body and cause serious complications. Therefore these should be compulsorily avoided.
Read – Which Panchakarma Ayurvedic Treatment Suits You?

How long these things should be avoided?

The physician should carefully observe if the patient has gained normal health and is keeping good after the follow up of panchakrama therapies. The wellbeing of the patient during or after the post-operative care of panchakarma is identified by the presence of prakrutastha purusha lakshanas i.e. signs of a person who has gained back health and is keeping normal.

Signs of Prakrutastha

• Capable of consuming foods of all tastes
• Voiding urine, feces and other reflexes properly
• Shows interest in various things
• The sense organs, motor organs and mind are stable, normal and functioning in a good way
• Soul is pleasant
• Has gained strength so as to do and tolerate activities of various kinds
  Read – How To Do Panchakarma At Home?

The above said avoidable things should be kept away until these signs of establishment of total health are obtained.

If the person does not keep away these things, various diseases caused by vitiated kapha, ama, depletion of tissues, vata etc are manifested and create serious complications in the body. These conditions will be manifested in the upper, middle and lower portions i.e. all over the body.

Number of days for Panchakarmam

Should all these treatments be done at a time?

No, the choice of treatments depends on lot of factors. On most of the occasions one or two therapies are selected. The number of therapies depends on

• the doshas involved – as in emesis for kapha aggravation, purgation in pitta and enema for vata, bloodletting for blood disorders and errhine for diseases located in the head and neck
• the quantity and number of doshas aggravated in a given disease, severity,
• acute or chronic nature of the disease,
• strength and tolerance of the patient,
• whether it is implemented to combat seasonal aggravation of doshas, like emesis in spring and purgation in autumn
• whether it is being implemented with preventive, curative or immunity enhancing perspective or
• for administration of rasayana i.e. rejuvenating therapies or vajikarana i.e. aphrodisiacs
  Read – 13 Important Benefits Of Rasayana Treatment

Here I will be using the below mentioned terms throughout the article –

• Oleation – for snehana
• Sudation – for swedana
• Herbal oil massage – for abhyanga
• Graduated special diet protocol – samsarjana krama
• Gap days / refractory period / reserve days / exemption days – for parihara kala

Snehana and Swedana are the pre-operative procedures for Panchakarma therapies.

A. In Pravara Shuddhi – optimum cleansing – 138 days

1. Vamana: 9 days

• Oleation – for 7 days
• Herbal oil massage and sudation – on 8^th day
• Emesis – on 9^th day

2. Virechana: 15 days, falls on 15^th day after emesis i.e. from the day of emesis

• Graduated special diet protocol – 7 days (10^th to 16^th day)
• Oleation – for 3 days (18^th, 19^th day & 20^th day)
• Sudation or diet comprising of liquid, hot, soups, meat soup and foods which doesn’t cause aggravation of kapha – for 3 days (21^st, 22^nd & 23^rd days)
• Purgation – 24^th day

Note: emesis + purgation days = 9 days + 15 days = 24 days

3. Vasti – 98 days excluding emesis and purgation days

We need to understand the classification of standard courses of enema before discussing the scheduling.

Karma vasti enema is given for 30 days. Kala vasti is administered for 16 days duration and Yoga vasti for 8 days. Each of these types will have both decoction and unctuous enemas given on alternative days.

Since we are discussing time duration needed for optimum cleansing in this instance, we will prefer including karma vasti in this schedule.

• Graduated special diet protocol – 7 days (25^th to 31^st day)
• Fat enema – on 9^th day of diet (33^rd day)
• Other 29 enemas (leaving out the first fat enema) – on the next 29 days (34^th to 62^nd day)
• Gap days wherein no treatment is done, regulated diet and lifestyle are practiced, comprises of double the days of enema – 60 days (63^rd to 122^nd day)

Note: emesis + purgation + enema days = 9 days + 15 days + 98 days = 122 days

4. Nasya – errhine therapy, 7 days

In the sequence, errhine should be done after enema course. The number of days of administration of nasal medication has not been mentioned in the Ayurveda classics. On an average 7 days will be taken for a course of errhine therapy. Oleation and sudation before errhine too has not been mentioned in the classics. Therefore local oleation and sudation in the form of oil massage and steaming is given to the head, face and neck.

• Nasal medication – for 7 days, starting from the next day of the last day of enema (123^rd to 129^th day)

Note: emesis + purgation + enema days + errhine days = 9 days + 15 days + 98 days + 7 days = 129 days
Read – How To Do Ayurvedic Nasya Treatment At Home? Nasal Drops For Long Life

5. Raktamokshana – 1 or 9 days

There is a controversy if oleation and sudation needs to be administered prior to bloodletting therapy. The number of days to complete the schedule differs by considering or not considering oleation and sudation.

1. If bloodletting is administered without giving oleation and sudation – 1 day, i.e. it shall be administered on the next day of errhine therapy i.e. on the 130^th day.
2. If oleation and sudation are given before bloodletting – 9 days, i.e. 7 days oleation (from 130^th – 136^th day) + 1 day massage and sudation (137^th day) + 1 day for bloodletting (138^th day)
   Read – Sweating Treatment – Swedana Types And Methods – Charaka Samhita 14

Final calculations –
So, the number of days needed to complete a course of panchakarma which causes optimum cleansing of doshas is either 130 or 138 days.

Emesis days + purgation days + enema days + errhine days + bloodletting days = 9 days + 15 days + 98 days + 7 days + 1 or 9 days = 130 or 138 days

B. In Madhyama Shuddhi – medium / moderate cleansing – 87 days

1. Vamana: 7 days

• Oleation – for 5 days
• Herbal oil massage and sudation – on 6^th day
• Emesis – on 7^th day

2. Virechana:

• Graduated special diet protocol – 5 days (8^th to 12^th day)
• Oleation – for 3 days (14^th, 15^th day & 16^th day)
• Sudation or diet comprising of liquid, hot, soups, meat soup and foods which doesn’t cause aggravation of kapha – for 3 days (17^th, 18^th & 19^th days)
• Purgation – 20^th day

3. Vasti –

Since we are discussing time duration needed for moderate cleansing in this instance, we will prefer including kala vasti in this schedule.

• Graduated special diet protocol – 5 days (21^st to 25^th day)
• Fat enema – on 7^th day of diet (27^th day)
• Other 15 enemas (leaving out the first fat enema) – on the next 15 days (28^th to 42^nd day)
• Gap days wherein no treatment is done, regulated diet and lifestyle are practiced, comprises of double the days of enema – 32 days (43^rd to 74^th day)

4. Nasya –

• Nasal medication – for 5 days, starting from the next day of the last day of enema (75^th to 79^th day)

5. Raktamokshana –

1. If bloodletting is administered without giving oleation and sudation – 1 day, i.e. it shall be administered on the 80^th day
2. If oleation and sudation are given before bloodletting – 7 days, i.e. 5 days oleation (from 81^st – 85^th day) + 1 day massage and sudation (86^th day) + 1 day for bloodletting (87^th day)

Final calculations –

So, the number of days needed to complete a course of panchakarma which causes moderate cleansing of doshas is either 80 or 87 days.

Emesis days + purgation days + enema days + errhine days + bloodletting days = 7 days + 13 days + 54 days + 5 days + 1 or 7 days = 80 or 87 days
Read – External Treatments To Keep Doshas In Balance

C. In Avara Shuddhi – minimum cleansing – 87 days

1. Vamana:

• Oleation – for 3 days
• Herbal oil massage and sudation – on 4^th day
• Emesis – on 5^th day

2. Virechana:

• Graduated special diet protocol – 3 days (6^th to 8^th day)
• Oleation – for 3 days (10^th, 11^th day & 12^th day)
• Sudation or diet comprising of liquid, hot, soups, meat soup and foods which doesn’t cause aggravation of kapha – for 3 days (13^th, 14^th & 15^th days)
• Purgation – 16^th day

3. Vasti –

Since we are discussing time duration needed for minimum cleansing in this instance, we will prefer including karma vasti in this schedule.

• Graduated special diet protocol – 3 days (17^st to 19^th day)
• Fat enema – on 5^th day of diet (21^st day)
• Other 7 enemas (leaving out the first fat enema) – on the next 7 days (22^nd to 28^thday)
• Gap days wherein no treatment is done, regulated diet and lifestyle are practiced, comprises of double the days of enema – 16 days (29^th to 44^th day)

4. Nasya –

• Nasal medication – for 3 days, starting from the next day of the last day of enema (45^th to 47^th day)

5. Raktamokshana –

1. If bloodletting is administered without giving oleation and sudation – 1 day, i.e. it shall be administered on the 48^th day
2. If oleation and sudation are given before bloodletting – 5 days, i.e. 3 days oleation (from 48^th to 50^th day) + 1 day massage and sudation (51^stday) + 1 day for bloodletting (52^ndday)
   Read – Raktamokshana Benefits, Types, Procedure, Indications

Final calculations –

So, the number of days needed to complete a course of panchakarma which causes mild / minimum cleansing of doshas is either 48 or 52 days.

Emesis days + purgation days + enema days + errhine days + bloodletting days = 5 days + 11 days + 28 days + 3 days + 1 or 5 days = 48 or 52 days

Views of Master Kasture – author of Ayurveda Panchakarma Vijnana

85 days needed for Moderate cleansing –

• Oleation for 5 days, sudation 6^th day and emesis on 7^th day
• Purgation – on 15^th day of emesis i.e. on 22^nd day
• Enema commenced on the 9^th day of purgation = 9+22 = 31^st day, Kala vasti should be given i.e. 16 enemas, i.e. 15 enemas (excluding that given on 31^st day) = up to 46^th day + 32 gap days = up to 78^th day
• Errhine therapy = 5 days i.e. 78+5 = 83^rd day
• Bloodletting on 7^th day of gap days = 85 days

I have an objection to this format because purgation is given on 15^th day of emesis as in optimum cleansing. But here graduated diet will be for 5 days, 3 days oleation and 3 days for massage and steaming and 1 day for purgation as a rule. This makes purgation to be administered on 12^th day and not 15^th day of emesis. Similarly enema should as a rule fall on 7^th day of purgation and not on 9^th day. The author has taken 7; days graduated diet everywhere which isn’t as per rules. This has created 5-7 days difference from my explanation of the panchakarma schedule.

57 days needed for minimum cleansing –

• Oleation for 3 days, sudation 4^th day and emesis on 5^th day
• Purgation – on 15^th day of emesis i.e. on 20^th day
• Enema commenced on the 9^th day of purgation = 9+20 = 29^th day, Karma vasti should be given i.e. 8 enemas, i.e. 7 enemas (excluding that given on 29^th day) = up to 36^th day + 16 gap days = up to 52^nd day
• Errhine therapy = 3 days i.e. 52+3 = 55^th day
• Bloodletting on 5^th day of gap days = 57 days

Here too purgation is given on 15^th day of emesis as in optimum cleansing. But here graduated diet will be for 3 days, 3 days oleation and 3 days for massage and steaming and 1 day for purgation as a rule. This makes purgation to be administered on 10^th day and not 15^th day of emesis. Similarly enema should as a rule fall on 5^th day of purgation and not on 9^th day. The author has taken 7 days graduated diet everywhere which isn’t as per rules.
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