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The word panchakarma is composed of two words, ‘pancha’ and ‘karma’. Pancha means five and karma means ‘action’.<ref>Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Karman, Page 258</ref>  In this context karma represents therapeutic procedure or treatment given by a physician. Thus, Panchakarma means the five kinds of therapeutic procedures or treatments. This includes therapeutic emesis ([[vamana]]), therapeutic purgation ([[virechana]]), therapeutic enema with decoction (niruha), therapeutic enema with unctuous substances (anuvasana) and trans-nasal drug administration ([[nasya]]). These procedures are intended to maintain equilibrium in body by expelling the excessively aggravated [[dosha]] outside through nearest external route. [Chakrapani on [[Sutra Sthana]] 2/15] [Su.Sa.Chi.33/3]. These are indicated as seasonal regimen for preservation of health and prevention of diseases. [Cha.Sa.[[Sutra Sthana]] 7/45-50]

The word panchakarma is composed of two words, ‘pancha’ and ‘karma’. Pancha means five and karma means ‘action’.<ref>Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Karman, Page 258</ref>  In this context karma represents therapeutic procedure or treatment given by a physician. Thus, Panchakarma means the five kinds of therapeutic procedures or treatments. This includes therapeutic emesis ([[vamana]]), therapeutic purgation ([[virechana]]), therapeutic enema ([[basti]]) with decoction ([[niruha]]), enema with unctuous substances ([[anuvasana]]) and trans-nasal drug administration ([[nasya]]). These procedures are intended to maintain equilibrium in body by expelling the excessively aggravated [[dosha]] outside through nearest external route. [Chakrapani on Cha.Sa.[[Sutra Sthana]] 2/15] [Su.Sa.Chikitsa Sthana 33/3]. These are indicated as seasonal regimen for preservation of health and prevention of diseases. [Cha.Sa.[[Sutra Sthana]] 7/45-50]

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==Synonyms==

==Synonyms==

*Shodhana: It literally means purification. It is the procedure by which excessively aggravated [[dosha]] are expelled out from the body [AH.Su.14/5]

*Shodhana: It literally means purification. It is the procedure by which excessively aggravated [[dosha]] are expelled out from the body. [A.H.Sutra Sthana 14/5]

   

   

*Virechana: It literally means specifically dragging outside. At some places, this term is applied to denote evacuation of [[dosha]] through upward (mouth) and downward (anus) directions. [Cha.Sa.[[Kalpa Sthana 1/4]. Mostly this term is used to denote therapeutic purgation only.  

*Virechana: It literally means specifically dragging outside. At some places, this term is applied to denote evacuation of [[dosha]] through upward (mouth) and downward (anus) directions. [Cha.Sa.[[Kalpa Sthana 1/4]. Mostly this term is used to denote therapeutic purgation only.  

#Bloodletting ([[Raktamoksha]])

#Bloodletting ([[Raktamoksha]])

==Inclusion of bloodletting ([[raktamoksha]]) in panchakarma==

==Inclusion of bloodletting ([[raktamokshana]]) in panchakarma==

There are differences in opinions about inclusion of bloodletting ([[raktamokshana]]) in five purification procedures. The total number remains five only as they combine two types of enema (unctuous and non-unctuous) in single procedure [A.H.Su.14/5]. However, this inclusion is not supported by Charak as it does not fulfill the inclusion criteria with fundamental principles of purification. The reasons are as below:  

There are differences in opinions about inclusion of bloodletting ([[raktamokshana]]) in five purification procedures. The total number remains five only as they combine two types of enema (unctuous and non-unctuous) in single procedure. [A.H.Sutra Sthana 14/5] However, this inclusion is not supported by Charak as it does not fulfill the inclusion criteria with fundamental principles of purification. The reasons are as below:  

#Panchakarma are intended to expel out [[dosha]] only. Blood ([[rakta]]) is a body component under category of [[dhatu]], not [[dosha]].

#Panchakarma are intended to expel out [[dosha]] only. Blood ([[rakta]]) is a body component under category of [[dhatu]], not [[dosha]].

===State of [[dosha]]===

===State of [[dosha]]===

*[[Dosha]] should be in excessive aggravated state [Cha.Sa.[[Sutra Sthana 16/13-16]]

*[[Dosha]] should be in excessive aggravated state. [Cha.Sa.[[Sutra Sthana]] 16/13-16]

*Excessive vitiation of either [[kapha]], [[pitta]],[[rakta]] and wastes (mala).  

*Excessive vitiation of either [[kapha]], [[pitta]],[[rakta]] and wastes (mala).  

*Affliction and obstruction of [[Vata]][[dosha]]. [Cha.Sa.[[Sutra Sthana]] 22/19]

*Affliction and obstruction of [[Vata]][[dosha]]. [Cha.Sa.[[Sutra Sthana]] 22/19]

===Person===

===Person===

The person should have good strength in order to withstand the purificatory procedures [Cha.Sa[[Sutra Sthana 22/19].

The person should have good strength in order to withstand the purificatory procedures. [Cha.Sa.[[Sutra Sthana]] 22/19]

==Contraindications==

==Contraindications==

==Importance of Panchakarma==

==Importance of Panchakarma==

*Panchakarma are indicated for purification of body, mind and senses. It helps to maintain equilibrium of body components. It is an important part in seasonal regimen for preservation of health. It eradicates diseases from their roots. Therefore, prevention of disease occurrence and recurrence is possible through panchakarma. These are preferred over pacification therapies ([[shamana]]) where recurrence is possible [Cha.Sa.[[Sutra Sthana]] 16/20].   

*Panchakarma are indicated for purification of body, mind and senses. It helps to maintain equilibrium of body components. It is an important part in seasonal regimen for preservation of health. It eradicates diseases from their roots. Therefore, prevention of disease occurrence and recurrence is possible through panchakarma. These are preferred over pacification therapies ([[shamana]]) where recurrence is possible. [Cha.Sa.[[Sutra Sthana]] 16/20]  

*Purification results in improvement in functioning of agni (factors responsible for digestion and metabolism), clarity of sense organs, mind, intellect, strength and virility. [Cha.Sa.[[Sutra Sthana]] 16/17-19].

*Purification results in improvement in functioning of agni (factors responsible for digestion and metabolism), clarity of sense organs, mind, intellect, strength and virility [Cha.Sa.[[Sutra Sthana]] 16/17-19]

*Panchakarma are pre-requisite for rejuvenation ([[rasayana]) therapy. In order to get the complete benefit of rejuvenation, purification is essential [Su.Sa.Chi.27/3].

*Panchakarma are pre-requisite for rejuvenation ([[rasayana]) therapy. In order to get the complete benefit of rejuvenation, purification is essential. [Su.Sa.Chikitsa Sthana 27/3]

===Importance in preservation of health and prevention of disease===

===Importance in preservation of health and prevention of disease===

The [[dosha]] have a natural tendency to get aggravated in specific seasons due to environmental conditions. If the aggravated [[dosha]] are removed properly by following seasonal regimen, then diseases can be prevented and equilibrium of health can be maintained [Cha.Sa.[[Sutra Sthana]] 07/46]. For example, [[vata]] [[dosha]] is aggravated in early rainy season. If it is managed through administration of therapeutic enema ([[basti]]) in that season, then diseases due to [[vata]] [[dosha]] can be prevented. It is the best treatment to normalize [[vata]] [Cha.Sa.[[Siddhi Sthana]] 1/40].

The [[dosha]] have a natural tendency to get aggravated in specific seasons due to environmental conditions. If the aggravated [[dosha]] are removed properly by following seasonal regimen, then diseases can be prevented and equilibrium of health can be maintained. [Cha.Sa.[[Sutra Sthana]] 7/46] For example, [[vata]] [[dosha]] is aggravated in early rainy season. If it is managed through administration of therapeutic enema ([[basti]]) in that season, then diseases due to [[vata]] [[dosha]] can be prevented. It is the best treatment to normalize [[vata]]. [Cha.Sa.[[Siddhi Sthana]] 1/40]

===Suitable seasons for purification therapy in healthy individuals===

===Suitable seasons for purification therapy in healthy individuals===

   

   

Following panchakarma procedures are indicated in seasonal regimen to preserve health [Cha.Sa.[[Sutra Sthana]]]7/46] [Cha.Sa.[[Siddhi Sthana]] 6/5-6].

Following panchakarma procedures are indicated in seasonal regimen to preserve health. [Cha.Sa.[[Sutra Sthana]]]7/46] [Cha.Sa.[[Siddhi Sthana]] 6/5-6]

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Trans-nasal administration in low dose (pratimarsha [[nasya]]) is advised as a part of daily regimen to preserve health. It has preventive and protective effect against the diseases of head and neck region [Su.Sa.Chi.40/52]. The time of trans-nasal administration varies according to season.  

Trans-nasal administration in low dose (pratimarsha [[nasya]]) is advised as a part of daily regimen to preserve health. It has preventive and protective effect against the diseases of head and neck region. [Su.Sa.Chikitsa Sthana 40/52] The time of trans-nasal administration varies according to season.  

===Importance in management of disease===

===Importance in management of disease===

Panchakarma are indicated in management of all diseases in which the [[dosha]] are excessively aggravated and need to be removed from body [Cha.Sa.[[Vimana Sthana]] 3/44].

Panchakarma are indicated in management of all diseases in which the [[dosha]] are excessively aggravated and need to be removed from body. [Cha.Sa.[[Vimana Sthana]] 3/44]  

Panchakarma are administered in acute exacerbated conditions of diseases like skin diseases (kushtha) [Cha.Sa.[[Chikitsa Sthana]] 7], erysipelas(visarpa)[Cha.Sa.[[Chikitsa Sthana]] 21], diseases of three vital organs -heart, brain and kidney (tri [[marma]])[Cha.Sa.[[Chikitsa Sthana]] 26].  

Panchakarma are administered in acute exacerbated conditions of diseases like skin diseases (kushtha) [Cha.Sa.[[Chikitsa Sthana]] 7], erysipelas(visarpa)[Cha.Sa.[[Chikitsa Sthana]] 21], diseases of three vital organs -heart, brain and kidney (tri [[marma]])[Cha.Sa.[[Chikitsa Sthana]] 26].  

These therapies are effective in management of chronic diseases by removing toxins like [[ama]]. Panchakarma therapies like unctuous enema (anuvasana) are utilized for restoration of health.  Panchakarma is helpful in the prevention of diseases, preservation and promotion of health<ref>Sharma H., Chandola H.M., Singh G., Basisht G. Utilization of Ayurveda in health care: an approach for prevention, health promotion, and treatment of disease. Part 1 – Ayurveda in primary health care. J Altern Complement Med. 2007;13(9):1011–1019.</ref>.

These therapies are effective in management of chronic diseases by removing toxins like [[ama]]. Panchakarma therapies like unctuous enema (anuvasana) are utilized for restoration of health.  Panchakarma is helpful in the prevention of diseases, preservation and promotion of health.<ref>Sharma H., Chandola H.M., Singh G., Basisht G. Utilization of Ayurveda in health care: an approach for prevention, health promotion, and treatment of disease. Part 1 – Ayurveda in primary health care. J Altern Complement Med. 2007;13(9):1011–1019.</ref>

    

    

==Cautions in administration of panchakarma==

==Cautions in administration of panchakarma==

The only contra-indication for panchakarma is urustambha (diseases of thigh) [Cha.Sa.[[Chikitsa Sthana]] 27/20-22]. In this condition, only drying therapies ([[rukshana]]) are indicated.   

The only contra-indication for panchakarma is urustambha (diseases of thigh). [Cha.Sa.[[Chikitsa Sthana]] 27/20-22] In this condition, only drying therapies ([[rukshana]]) are indicated.   

Improper administration of panchakarma procedures can lead to diseases like skin disorders [Cha.Sa.[[Chikitsa Sthana]] 7/6], diseases of digestion (grahani) [Cha.Sa.[[Chikitsa Sthana]] 15/43], disease due to [[vata]] vitiation [Cha.Sa.[[Chikitsa Sthana]] 28/15]. Excessive or inadequate administration of panchakarma also leads to complications [Cha.Sa.[[Siddhi Sthana]]. Therefore, the panchakarma shall be administered cautiously after considering all suitable factors. Otherwise it may fail to give expected results and cause complications [Cha.Sa.[[Siddhi Sthana]] 1/59].

Improper administration of panchakarma procedures can lead to diseases like skin disorders [Cha.Sa.[[Chikitsa Sthana]] 7/6], diseases of digestion (grahani) [Cha.Sa.[[Chikitsa Sthana]] 15/43], disease due to [[vata]] vitiation [Cha.Sa.[[Chikitsa Sthana]] 28/15]. Excessive or inadequate administration of panchakarma also leads to complications. [Cha.Sa.[[Siddhi Sthana]] Therefore, the panchakarma shall be administered cautiously after considering all suitable factors. Otherwise it may fail to give expected results and cause complications. [Cha.Sa.[[Siddhi Sthana]] 1/59]

==Contemporary approach==

==Contemporary approach==

1. Classical panchakarma therapies are followed as described in classics.

1. Classical panchakarma therapies are followed as described in classics.

2. Traditional panchakarma therapies are modified and sophisticated external oleation and sudation therapies based on classics. These are widely publicized as Keraliya panchakarma. Some practitioners consider pouring medicated liquid on head (shiraseka), whole body (kaya seka), application of processed rice in bolus (shashtikashalipindasweda), as paste on body (anna lepa), application of herbal paste on head (shirolepa) as keraliya panchakarma. These therapies gained global recognition due to their efficacy and practices in resorts and spas<ref>Patil Vasant. Principles and Practice of Panchakarma.Ilkal, India: Atreya Ayurveda publications,2011.pg.7.</ref>.

2. Traditional panchakarma therapies are modified and sophisticated external oleation and sudation therapies based on classics. These are widely publicized as Keraliya panchakarma. Some practitioners consider pouring medicated liquid on head (shiraseka), whole body (kaya seka), application of processed rice in bolus (shashtikashalipindasweda), as paste on body (anna lepa), application of herbal paste on head (shirolepa) as keraliya panchakarma. These therapies gained global recognition due to their efficacy and practices in resorts and spas.<ref>Patil Vasant. Principles and Practice of Panchakarma.Ilkal, India: Atreya Ayurveda publications,2011.pg.7.</ref>

However, the fundamental principles of panchakarma therapies shall always be followed to achieve maximum benefit.  

However, the fundamental principles of panchakarma therapies shall always be followed to achieve maximum benefit.  

Research studies show efficacy of panchakarma therapies in management of diseases.

Research studies show efficacy of panchakarma therapies in management of diseases.

   

   

*Research has shown that it reduces risk factors for heart disease <ref>Sharma HM, Nidich SI, Sands D, Smith DE. Improvement in cardiovascular risk factors through Panchakarma purification procedures. J Res Educ Indian Med 1993;12:2–13.</ref> and decreases blood levels of fat-soluble toxins such as polychlorinated biphenyls and agrochemicals by about 50%<ref>Herron RE, Fagan JB. Lipophil-mediated reduction of toxicants in humans: An evaluation of an Ayurvedic detoxification procedure. Altern Ther Health Med 2002;8:40–51.</ref>  

*Research has shown that it reduces risk factors for heart disease <ref>Sharma HM, Nidich SI, Sands D, Smith DE. Improvement in cardiovascular risk factors through Panchakarma purification procedures. J Res Educ Indian Med 1993;12:2–13.</ref> and decreases blood levels of fat-soluble toxins such as polychlorinated biphenyls and agrochemicals by about 50%.<ref>Herron RE, Fagan JB. Lipophil-mediated reduction of toxicants in humans: An evaluation of an Ayurvedic detoxification procedure. Altern Ther Health Med 2002;8:40–51.</ref>  

*External and internal purification therapy is found to be effective in reducing the symptoms of blistering skin disease (visphotakushtha) within a short duration with a long lasting effect.<ref>Aiswarya IV, Parameswaran Namboothiri K, Anandaraman PV. Effect of multi-modality Ayurvedic treatment in a case of Visphota kushta. J Ayurveda Integr Med. 2019 Jul - Sep;10(3):207-213. doi: 10.1016/j.jaim.2018.06.005.</ref>   

*External and internal purification therapy is found to be effective in reducing the symptoms of blistering skin disease (visphotakushtha) within a short duration with a long lasting effect.<ref>Aiswarya IV, Parameswaran Namboothiri K, Anandaraman PV. Effect of multi-modality Ayurvedic treatment in a case of Visphota kushta. J Ayurveda Integr Med. 2019 Jul - Sep;10(3):207-213. doi: 10.1016/j.jaim.2018.06.005.</ref>   

*Panchakarma followed by internal medications showed amelioration of motor, sensory and sphincter deficits in case of Guillain Barre syndrome.<ref>Basavaraj R Tubaki, Shruti Tarapure. Ayurveda management of Gullian Barre syndrome: A case report. J Ayurveda Integr Med. 2020 Jan - Mar;11(1):73-77. doi: 10.1016/j.jaim.2018.08.004. Epub 2019 Jan 18</ref>  

*Panchakarma followed by internal medications showed amelioration of motor, sensory and sphincter deficits in case of Guillain Barre syndrome.<ref>Basavaraj R Tubaki, Shruti Tarapure. Ayurveda management of Gullian Barre syndrome: A case report. J Ayurveda Integr Med. 2020 Jan - Mar;11(1):73-77. doi: 10.1016/j.jaim.2018.08.004. Epub 2019 Jan 18</ref>  

==List of theses done==

==List of theses done==

There are total 99 research works done on various procedures of panchakarma in last 17 years since 2001 to 2018.  

There are total 121 research works done on various procedures of panchakarma in last 17 years since 2001 to 2018 at Institute for post graduate teaching and research in Ayurveda, Jamnagar.  

 

The following table shows number of research works done on each procedure:

The following table shows number of research works done on each procedure:

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Following list shows theses works done on the general aspects of panchakarma.  

Following list shows theses works done with emphasis on general aspects of panchakarma.  

#Chaturvedi GN (1959): A study of panchakarma therapy vis-à-vis its physio-pathological basis.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Chaturvedi GN (1959): A study of panchakarma therapy vis-a-vis its physio-pathological basis.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Vasant Sohanlal (1960): Panchakarma shastram.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Vasant Sohanlal (1960): Panchakarma shastram. Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Parashar BN (1965): Sodhanamdoshanirghatanam.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Parashar BN (1965): Sodhanam dosha nirghatanam. Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Selote SB (1962): Elimination therapy.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Selote SB (1962): Elimination therapy.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Ramu MG (1966): Diseases of raktavahasrotasa and shodhana therapy.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Ramu MG (1966): Diseases of raktavaha srotasa and shodhana therapy.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Arunachalam S (1969): Sanshodhanasanshamanachikitsa in agnimandya.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Arunachalam S (1969): Sanshodhana sanshamana chikitsa in agnimandya. Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Pilapitiya U (1969): Sanshodhana and sanshamanachikitsa in amlapitta.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Pilapitiya U (1969): Sanshodhana and sanshamanachikitsa in amlapitta.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Vidya Shekar MS (1971): Shodhanaupakrama for tridosha.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Vidya Shekar MS (1971): Shodhanaupakrama for tridosha.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Misha SK (1988): A clinical study on the role of shodhana in the management of vicharchika.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Misha SK (1988): A clinical study on the role of shodhana in the management of vicharchika.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Moradia Ghanshyam (1990): A comparative study on the role of shodhana and shaman therapies of gridhrasi (sciatica).Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Moradia Ghanshyam (1990): A comparative study on the role of shodhana and shaman therapies of gridhrasi (sciatica).Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#ManoranjanSahu (2002): A critical study on aetiopathogenesis of Gridhrasi and its management with RasnaGuggulu along with Shodhana therapy.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#ManoranjanSahu (2002): A critical study on aetiopathogenesis of Gridhrasi and its management with Rasna Guggulu along with shodhana therapy.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Nakum Sudha K (2003): Comparative study of the roleofShamana (Rasayana) andShodhana therapy inVicharchika.Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

#Nakum Sudha K (2003): Comparative study of the role of Shamana (Rasayana) and Shodhana therapy in Vicharchika. Department of Kayachikitsa, I.P.G.T. & R.A.  Jamnagar

==More information==

==More information==

The list of references for Panchakarma in Charak Samhita can be seen [[Media:References_of_word_Panchakarma_in_Charak_Samhita.pdf|here]]

The list of references for Panchakarma in Charak Samhita can be seen [[Media:References_of_word_Panchakarma_in_Charak_Samhita.pdf|here]]

==References==

==References==