Pañcakarma includes specially designed five procedures of internal purification. Āyurveda treatment comprises of two major treatment principles i.e., Samśodhana and Samśamana cikitsā. Pañcakarma is basically a bio purificatory method intended to eliminate the toxic elements from the body and thereby maintains equilibrium of doṣas.The word Pañcakarma is made out of two words, Pañca and Karma.

• Pañca – Five
• Karma – कर्मलक्षणं बह्वितिकर्तव्यतायोगिदोषनिर्हरणशक्तिज्यायस्त्वम् (Cha. Su. 2/15 Ṭīkā)

Here Pañca is saṅkhyā prādhānya and Karma refers to the procedure which has multiple and broad-spectrum action and having the capacity to eliminate the vitiated doṣas.

स्नेहस्वेदादि द्वार शरीरस्य उत्क्लिष्ट दोषाणां यथा आसन्न मार्गेण बहिर्निर्हरण कर्त्रुत्वं संशमनं कर्त्रुत्वं पञ्चकर्मत्वं॥ (Mu. Dvi)

Pañcakarma is a procedure in which the Utkliṣṭa Doṣas are expelled out through the nearest route after Snehana and Svedana. It is followed by Śamana therapy.

The term Pañcakarma has been used for the first time in Caraka Samhita Sūtrasthāna Apamārga Taṇḍulīyam Adhyāya.

तान्युपस्थितदोषाणांस्नेहस्वेदोपपादनैः|

पञ्चकर्माणि कुर्वीत मात्राकालौ विचारयन्||१५||

(Cha. Su. 2/15)

After attainingupasthita doṣavasthā by Snehana and Svedana, a physician should administer the Pañcakarma paying due regard to the dose and time.

Here Chakrapani explains the meaning of upasthita doṣas.

उपस्थितदोषाणामिति शाखां त्यक्त्वा कोष्ठगमनेन तथा लीनत्वपरित्यागेन प्रधानावस्थाप्राप्तदोषाणाम्

(Cha. Su. 2/15 Ṭīkā)

Doṣas which have left the periphery (śākhā) and moving towards koṣṭha, which have lost līnatva (deep seated or adherence) and attained pradhāna avasthā (attained the qualities to be expelled) are known as upasthita doṣas namely,

1. Vamana
2. Virecana
3. Nirūha basti
4. Anuvāsana basti
5. Nasya

Pañcakarma is useful in all the Aṣṭāṅgas of Āyurveda. Pañcakarma is not only meant for śodhana, but also a measure for laṅghana, bṛṃhaṇa, lekhana and śamana. Even though a person stays healthy, there is a seasonal deposition of some amount of doṣas which may lead to disease in future. Season wise Pañcakarma is effective in preventing these diseases. In the present era where people are more affected with stress, anxiety, allergies, improper digestion, lifestyle diseases. By clearing the body from toxins, Pañcakarma is effective in revitalizing body as well as mind. Thus, pañcakarma procedures are widely used in a preventive, promotive and curative aspect.

Śārṅgadhara explains Pañcakarma as[i]

• Vamana
• Recana
• Nasya
• Nirooha Vasti
• Anuvāsana Vasti

Pañcakarma can act both as Laṅghana and Bṛṃhaṇa. Anuvāsana Basti acts as Bṛṃhaṇa. Nirooha Vasti and Nasya has Bṛṃhaṇa type also.

According to Aṣṭaṅga Hṛdaya Pañcaśodhana is explained as

यदीरयेद्वहिर्दोषान् पञ्चधा शोधनं च तत्|

निरूहो वमनं कायशिरोरेकोऽस्रविस्रुतिः||५||[ii]

Śodhana is the procedure by which vitiated doṣas are expelled out from the body. There are 5 types of Śodhana – Nirooha Vasti, Vamana, Kāyareka or Virecana, Śiroreka or Nasya and Raktamokṣa. Śodhana comes under Laṅghana Cikitsā.

The word “Patra Poṭṭali” is derived from two words, Patra means leaves and Poṭṭali means bundle. Patra Poṭṭali Sveda refers to the sudation performed by specially prepared bundle of medicinal leaves (generally Vātakaphāhāra). It is a form of Ūṣma Sveda.

Materials required:

1. Vātāhāra   Patras – Arka, Eraṇḍa, Nirgundi, Agnimantha, Dhattura, Vātaghni, Ciñca,

Śigru, Vasa, Karanja etc (any six types) – 50 gms each chopped into pieces

2. Grated coconut – 100g (half piece grated)                                

3. Sliced lemon – 2              

4. Cotton cloth (45 cm X 45cm): 4 pieces                    

5. Tags – 4                              

6. Vessels (for frying leaves and for heating poṭṭali s) – 2                                              

7. Oil

  For frying leaves – 50 ml Apakva Taila;

  For heating Poṭṭalis – 120ml                                        

  For Abhyaṅga – 80 ml         

  For Talaṃ – 10 ml                                                                

8. Cūrṇa

  Saindhava – 20gms

  Śatapuṣpa – 10 gms

  Haridra – 10 gms

  Methika – 10 gms

  Rāsnā – 10 gms

9. Towels – 2                                                                              

10. Masseurs – 2                                                                     

11. Attendant – 1                                                                                                                                                       

Preparation of Poṭṭali:

The fresh leaves should be washed in water and chopped into small pieces. The leaves, grated coconut & sliced lemon should be mixed thoroughly and fried together in 80 ml of appropriate oil till coconut scrapings attain a brown tinge. It should be divided in to four equal parts and made into Poṭṭalis. (Average weight of a standard Poṭṭali is 300- 350 gm).

Pre-operative measures:

The patient should be seated with leg extended over the Droṇi facing to the East. Abhyaṅga should be performed with prescribed medicated oil all over the body for about 10 minutes. Talaṃ with suitable oil/Cūrṇa should be applied.

Procedure:

The prepared Poṭṭali should be heated with suitable oil in a hot iron pan up to 42- 46⁰ C. After checking the temperature, Poṭṭali should be applied throughout the body with mild pressure in seven prescribed positions by two attendants standing on both sides of the Droṇi.

The process should be carried out in seven positions as follows.

1. Sitting                                                                                                                                               

2. Supine                                                                                                                                                   

3. Right lateral                                                                                                                                             

4. Supine                                                                                                                                                    

5. Left lateral                                                                                                                                           

6. Supine                                                                                                                                                    

7. Sitting

Care should be taken to maintain the temperature throughout the procedure by reheating the poṭṭali s.

Post-operative procedure:

Give Gandharvahastādi Kaṣāya (Pathi Kaṣāya) after procedure. Wipe off the oil from the body using clean dry towel. Body is covered with thin blanket for 10-15minutes. Remove Talaṃ & apply Rāsnādi  Cūrṇa . Patient should be advised to take hot water bath after half an hour depending on disease.

Duration: 45 minutes to 1 hour.

Precautions:

1. Care should be taken to prevent charring while frying leaves and also while reheating the Poṭṭali.
2. Every time the therapist should ensure the temperature of the Poṭṭali by placing it over their own dorsum of hand. Also enquire the patient whether the temperature is bearable.
3. If the patient feels any discomfort or attains good perspiration at any time during the treatment the therapy should be stopped.   
4. Preferably done in morning hours in moderate climate.

Complications:

1. Burns

2. Fainting

Suitable measures should be taken.

Indications:

SarvangaVāta, Pakṣāghāta, Kaṭī Graha, Pārśvasula, Gr̥dhrasī

The Jambīra Piṇḍa Sveda is performed with the bolus of Jambīra fruit pieces. This is mainly applied in Vātakapha predominant condition. It is usually done in frozen shoulder, plantar fascitis and traumatic conditions. It is Śophahara, Rūkṣa and Tīkṣaṇa.

Materials required:

1. Jambīra (chopped into pieces)         – 750g
2. Saindhava powder                            – 30 g
3. Turmeric powder                              – 60g
4. Cotton cloth (45 cm X 45 cm)           – 4
5. Threads                                             – 4
6. Vessels for heating                            – 2
7. Suitable oil for Talaṃ                        – 10 ml
8. Suitable oil for Abhyaṅga                 -100ml
9. Oil for reheating Poṭṭali                    -Q.S
10. Rāsnādi  Cūrṇa                                 – 5g
11. Soft towels                                       – 2
12. Masseurs                                          – 2
13. Attendant                                         – 1

Preparation of Poṭṭali:

Ingredients are fried in appropriate quantity of oil and are divided into four equal parts and Poṭṭalis are made accordingly (coconut & egg yolk can be added according to condition).

Pre- operative procedure:

The patient should be seated with leg extended over the Droṇi and Talaṃ is applied with suitable oil /Cūrṇa.

Procedure:

Abhyaṅga should be performed with suitable medicated oil. Out of the four Poṭṭalis, the two Poṭṭalis should be heated upto 40^oC- 45⁰C by keeping on the hot pan containing suitable oil. This Poṭṭali should be applied to the patient as per the general procedure for about 30-45 minutes.

Post- operative procedures:

After the procedure body should be wiped with clean towel, Talaṃ should be removed and Rāsnādi Cūrṇa should be applied. The patient should be advised to take complete rest for half to one hour.

Precautions:

1. While preparing the medicine care should be taken to prevent charring.
2. Tie the Poṭṭalis firmly to avoid leaking of the contents during the procedure.
3. The therapists on either side should apply the bolus simultaneously in a synchronized manner.

Complication and management:

Fainting – Sprinkle cold water on face, put talaṃ with suitable oil and medicated cūrṇas.       Drākṣādi Kaṣāya can be given internally.

Burns – Apply Madhu and Ghṛta, preferably Śatadhaḥuta Ghṛta.

Indications:

It is usually done in frozen shoulder, plantar fascitis, Kaṭīśūla, traumatic conditions. It is Śophahara, Rūkṣa and Tīkṣṇa.

Done in Very painful conditions