Panchakarma II

Understand the pradhankarma, the core step in the ayurvedic detoxification process - Panchakarma

MedicinePanchakarma involves getting ready for detoxification [purvakrama], the actual detoxification process [pradhankarma], and getting back to regular state after detoxification [pashchatkarma].

The actual detoxification process [pradhankarma] involves five methods. They are:

  1. Vamana
  2. Virechana
  3. Anuvasana basth
  4. Niruha basthi
  5. Nasya karma


Vamana means expelling doshas through the oral route. It is an emesis therapy. Before inducing vamana, the toxins and vitiated doshas are brought to amashaya or stomach with various preparatory methods like snehana and swedana. The emesis should never be induced in empty stomach. Vamana therapy is conducted in the early hours of the day, when kapha dosha is dominant. Vitiated doshas and accumulated toxins are expelled through methodically-induced emesis. The person should stay relaxed, and devoid of any mental stress throughout the therapy. After emesis, the person is gradually rehabilitated to regular diet and lifestyle.

Detoxification through vamana is suggested in diseases that mainly involve kapha dosha. Disorders such as cough, asthma, indigestion, poisoning, repeated attacks of tonsillitis, nasal discharge and tuberculosis are treated with vamana. This therapy is not recommended for children and elderly persons. The same holds true for obese and weak individuals. After undergoing vamana, the person is advised to avoid loud speech, overeating, sitting continuously for a long time, too much walking, anger, anxiety, coitus, retention of natural urges.


Virechana is expelling the vitiated doshas and toxins through purgation. This therapy can be conducted as an individual detoxification therapy or as a step after vamana to ensure complete detoxification. Virechana is a painless and easy procedure. Complications are rare. It helps to expel toxins and vitiated doshas from blood, liver and intestines. Usual panchakarma preparatory methods like snehana and swedana are completed before inducing purgation. Virechana is induced by administering herbal purgatives in the morning between 8 and 9 am, when pitta dosha is dominant. The person is made to drink warm water repeatedly during defecation. Regular diet and lifestyle can be started after the pradhankarma.

This therapy is suggested for disorders in which pitta is the prominent dosha. Skin disease, jaundice, constipation, headache, fistula, haemorrhoids, intestinal parasites, herpes, anaemia, oedema are some conditions in which virechana is chosen as the detoxifying therapy. Contraindications for virechana therapy include ulcerated rectum, obesity, diarrhoea, cardiac ailments, and tuberculosis.

Basthi Karma

Basthi Karma is expelling body toxins and vitiated doshas by introducing medicated liquids or oils through the anus, urethra or vaginal canal. Basthi means urinary bladder. In ancient times, the enema apparatus was made of the urinary bladder of animals. Hence this therapy is called Basthi karma and is mainly used in vata-dominant diseases.

Basthi karma is usually performed after the first two detoxification process namely vamana and virechana or only after virechana. After completing preparatory procedures [snehana, swedana], the patient is allowed to lie on his left side and medicated oil or herbal decoction is administered under hygienic conditions. The patient has to lie on his back for 10-15 minutes after basthi is given.

There are two types of Basthi: Anuvasana basthi and Niruha basthi

Anuvasana basthi

In anuvasana basthi, medicated oil is introduced through anus, immediately after the consumption of food. There will be no harm even if medicated oil remains inside colon for a long time. This type of basthi nourishes and strengthens the body.

Niruha basthi

In this type of basthi [also known as asthapana basthi], an enema of herbal decoction is given. Niruha basthi is administered in empty stomach. The administered decoction has to come out from the body within 45 minutes. The expelled herbal decoction brings out toxins and vitiated doshas along with it. Anuvasana basthi and Niruha basthi are given alternatively. The patient is advised to bathe after the herbal decoction is expelled. Unlike vamana and virechana, strict diet and lifestyle rehabilitation is not required after basthi karma, as basthi do not cause irritation in digestive system. But it is necessary to take light and nourishing food.

Introducing medicated liquids and oils through urethra in men or vagina in women is called uttara basthi.

Basthi karma is usually recommended in:

  • diseases involving joints such as arthritis, gout
  • Neuromuscular problems
  • Osteoporosis
  • Paralysis
  • Low back pain
  • Obesity
  • Disorders of intestines
  • Menstrual problems in women.

Benefits of basthi

Basthi improves vision, decreases weight in obese people, increases weight and nourishes emaciated persons, slows down aging and boosts health.

Nasya karma

Nasya karma means administering drops of herbal liquid preparations or medicated oils through the nose. This detoxification method is also known as Shirovirechana. Vitiated doshas and toxins accumulated in head and neck are expelled through nose and mouth, along with nasal and oral secretions. As a preparatory procedure, the head and face of the patient are massaged with medicated oil. [Administering medicated oil before nasya karma is not advised]. Steam bath is given only to the head and neck region. The patient is made to sleep on his back with feet elevated and head reclined. The medicated liquid or oil is administered in drops to both nostrils consecutively. The patient is advised to inhale the medicine slowly. After nasya karma, the patient must avoid talking loudly, getting angry and laughing.

According to the type of medicine used, nasya karma is divided into four types. They are

  • Navana Nasya: Drops of medicated oil is used
  • Avapidana Nasya: Squeezed juice of herbs is used
  • Dhmapana or pradhamana nasya: Fine powder of herbs are made to inhale through an apparatus called “nadi yantra” [a tube-like apparatus]
  • Dhuma nasya: Fumes of medicinal herbs are inhaled.

Nasya Karma is suggested in tonsillitis, stiff neck, stiff jaw, headache, sinusitis, stammering, and hoarseness of voice. Nasya Karma should not be performed when the patient has indigestion, has consumed alcohol, has taken a head bath, is tired, or is pregnant.

All panchakarma or detoxification therapies should to be conducted only under the supervision of experienced and qualified ayurvedic practitioners.

Savitha Suri, BAMS, is a Mysore-based consultant ayurvedic physician. She writes articles on ayurveda in both print and electronic media.