• Abhyanga ; Massaging whole body    
• Lepa – Smearing medicated oil and herbs   
• Mardana – Kneading the body parts with fingers and fists.  
• Padaghata – Tampling the body with foot. 
• Gandusha - The mouth is filled with oil and is retained for a longer period of time. 
• Parisheka (Pizhichil ) - The warm medicated oil is poured continuously over the entire body for an extended period of time.

Soon after oil massage the body or body part is exposed to heat through steam bath or other heating methods according to the physician’s choice. This process of exposing body to heat is called as swedana or sweating. Both snehana and swedana help to soften the channels and toxin clogs. Elimination of toxins becomes easy when channels are soft and toxins are loose.

Pradhana Karma

This is the main detoxifying process. The softened and loosened toxins are expelled from body by five methods. Considering these five major detoxifying methods the whole process is named as “Panchakarma” (Pancha = 5, Karma = process ) .

• Vamana (through Emesis), 
• Virechana (Purgation), 
• Niruha basthi Basthi (enema with herbal concoctions),
• Anuvasana basthi (enema with medicated oil) 
• Nasya (nasal drops) and
• Raktamokshana (Blood letting).

Physician can chose any of these detoxifying methods according to disease and prevalence of doshas.

Vamana

Vamana means expelling doshas through oral route. It is 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 early hours of day, when kapha dosha is dominant. Vitiated doshas and accumulated toxins are expelled through methodically induced emesis. Patient is required to be relaxed calm and devoid of any mental stress through out the therapy. After emesis therapy, patient is gradually rehabilitated to regular diet and lifestyle.

Detoxification through vamana is suggested in diseases which mainly involve kapha dosha. The disorders like cough, asthama, indigestion, poisoning, repeated attacks of tonsillitis, nasal discharge, tuberculosis, etc are treated with vamana therapy. Children and elderly are not to be subjected to this therapy. The same holds good for obese and weak persons. After vamana the loud speech, overeating, continued sitting, too much walking, anger, anxiety, coitus, retention of natural urges have to be avoided.

Virechana

Virechana is expelling the vitiated doshas and toxins through purgation. This therapy can be conducted as an individual detoxification therapy or as a follow up therapy next to vamana to ensure complete detoxification. Virechana is a non painful and easiest procedure. Complications are usually very rare in this therapy. This detoxification method 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 morning between 8 am to 9 am, when pitta dosha is dominant. Patient is made to drink warm water repeatedly as he passes stools. Patient is later rehabilitated to his regular diet and lifestyle.

This therapy is suggested for disorders in which pitta is prominent dosha. Skin diseases, jaundice, constipation, headache, fistula, hemorrhoids, intestinal parasites, herpes, anemia, edema are few of many diseases in which Virechana is the chosen as detoxifying therapy. Contraindications for virechana therapy are ulcerated rectum, pregnancy, obesity, diarrhea, cardiac ailments, tuberculosis, children and elderly

Basthi Karma

Basthi karma is expelling body toxins and vitiated doshas by introduce medicated liquids or oils through anus, urethra or vaginal canal. Basthi means urinary bladder. In ancient times the enema apparatus used to be made up of urinary bladder of animals. Hence this detoxification process is called Basthi karma.

Basthi karma 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), patient is allowed to lie on his left side and medicated oil or herbal decoction is administered under hygienic conditions. 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 body within 45 minutes. The expelled herbal decoction brings out toxins and vitiated doshas along with it. Anuvasana basthi and Niruhabasthi are given alternatively . Patient is advised to take bath after 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 through vagina in women, is called uttara basthi.

Basthi karma is usually recommended in

1. Diseases involving joints like arthritis, gout etc,
2. Neuro muscular problems
3. Osteoporosis
4. paralysis
5. Low back pain
6. Obesity
7. Disorders of intestines
8. Menstrual problems of women

Benefits of basthi

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

Nasya karma

Nasya karma means administering drops of herbal liquid preparations or medicated oils through nose. This detoxification method is also known as Shirovirechana. Vitiated doshas and toxins which are 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 patient is massaged with medicated oil (Administering medicated oil before nasya karma is not advised) and steam bath is given only to head and neck region. Patient is made to sleep on his back with foot end elevated and head reclined. The medicated liquid or oil is administered in drops to both nostrils consecutively. 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, the nasya karma is divided into four types. They are:

1. Navana Nasya : In this type drops of medicated oil is used.

2. Avapidana Nasya: Here squeezed juice of herbs is used.

3. Dhmapana or pradhamana nasya : Fine powder of herbs are made to inhale through an apparatus called “nadi yantra” ( a tube like apparatus)

4. Dhuma nasya : Fumes of medicinal herbs are inhaled in this type of nasya.

Nasya Karma is indicated in tonsillitis, stiff neck, stiff jaw, headache, sinusitis, stammering, hoarseness of voice etc. Nasya Karma should not be performed when patient has indigestion, consumed alcohol, taken head bath, and tiered, pregnancy.

All panchakarma or detoxification therapies have to be conducted strictly under the supervision of well experienced qualified Ayurvedic doctors.

Pashchat Karma

A strict diet and lifestyle procedure has to be followed through out Panchakarma treatment. The rehabilitative procedures to bring back the diet and lifestyle to normal are considered as “paschat Karma”. In this stage the digestion power is brought back to normalcy. Medicines are administered to rejuvenate the body or to treat the disease.

During Panchakarma treatment the following rules have to be strictly followed.

• One has to use only warm water to drink, bathe and for other activities. 
• Person who is undergoing Panchakarma therapy cannot indulge in sex.
• Sleeping in daytime is contraindicated.
• Natural urges should not be controlled.  
• Exposures to extreme temperatures or weather conditions have to be avoided.
• Keeping awake at night is not advisable.
• Foods which cause indigestion can not be consumed.
• Exercise and mental stress have to be avoided.

The Panchakarma therapy is not advisable for persons in whom the following conditions exist:

• Menses
• Lactation
• Cancer of the Lungs or Testicles
• Melanoma
• HIV or AIDS
• Extreme Obesity
• Lympho-Sarcoma
• Hypertension
• Congestive Heart Failure
• Emaciation
• Any Active Infectious Disease
• Pregnancy
• Angina Pectoris

The benefits of Panchakarma are as follows:

• Toxins are eliminated from body.
• Doshas get Balanced.
• Stress is reduced and body gets relaxed.
• Slows ageing process and increases the lifespan.
• Increases glow and luster of skin.
• Boosts body immunity and body energy level.
• Enhances strength, energy, vitality and mental clarity.
• Reduces dependence on alcohol, tobacco and drugs.
• Help to implement healthy diet and lifestyle.