INTRODUCTION TO PANCHAKARMA
Elimination happens naturally in every living being. Human body is a complex type of machine, which has millions of functions: – majority of them are voluntarily controlled and some involuntary.  Millions of cells in the body are working throughout the day to produce energy and to maintain life. In this process lots of wastes are produced at the level of cells.

It is natural that some toxins accumulate in the body as a result of various metabolic activities, which the body performs involuntarily. There are certain toxins that still remain in the body causing many diseases, when their quantity increases beyond a certain limit. Unless these wastes are expelled from the body they tend to stick into minute channels known as ‘srotas’ and start producing diseases. Hence to be healthy, it is necessary to eliminate wastes from these channels.

To bring about equilibrium in the body Ayurveda prescribes Panchakarma- a curative line of treatment that works in the principles of sodhana chikilsa (purification procedure)

THE TREATMENT PROCESS:
The Panchakarma therapy of Ayurveda comprises of five types of advanced treatment for elimination of vitiated Dosha (toxic materials) from the body.

Charakas Classification:

1. Vamana Karma (Emesis Therapy)
2. Virechana Karma (Purification Therapy)
3. Anuvasana Vasthi (Unctous enema Therapy)
4. Nirooha Vasthi (Decoction Enema Therapy)
5. Nasya Karma (Errhine Therapy)

Sushrutha clubbed the vasthikarmas mentioned separately above together as enema therapy and in the vacant place adds Rakthamoksha or Blood letting as the fifth measure of eliminative or purificatory procedures.

Before doing Panchakarma therapies, pre-operative procedures like Snehana (oleation) and Sweda (sudation) therapy must be done.

The administration of oleation therapy is a must to the patient otherwise the patient’s body will be subjected to discomfort like dry stick if it is bent by force it will break. So without the application of oil to the wooden stick it cannot bend. In the same way the sodhana or eliminatory procedure cannot be conducted without proper oleation.

External and internal administration of oil is necessary in Panchakarma therapy. The external application is done in many ways like massage, pizhichil, after heating oil to an optimum temperature.

The advantage of massage are: –
relieves weakness, strengthens the body, Induces sleep, Improves the colour and complexion of the skin, Relieves vata in the body and Tones up the tissues of the body

Sudation is administered after oleation. It brings vata under control and helps in facilitating the easy elimination of bowel and urine.

In Sudation Therapy (fomentation therapy) the sweat or perspiration is triggered from the body. Sweat is the internal excreta of the body and Medas (fat). It cures stiffness, heaviness and coldness of the body.

VAMANA
Vamana is the induced vomiting procedure after sneha sweda kriyas. Vamana dravya (drug) is given followed by large quantities of milk. It is indicated in kaphaja vikaras like asthma, skin ailments etc

VIRECHANA
Virechana is the induced purgation. After sneha sweda kriyas virechana dravya (drug) is given in the early morning. It is indicated in pitha vikaras like rheumatic complaints.

VASTHI
The work vasthi is named because the urinary balder of animals is used to inject the contents of either unctuous drugs or eliminatory drugs into the rectum of the body to produce immediate effect. It has a very important role in treatment of rheumatoid arthritis, hemiplegia, facial paralysis, gout, diseases of lower abdomen, constipation, obstruction and loss of seamen, amenorrhoea and eliminate worms of elementary tract. Vitamin B, increased after vasthi controls diseases of the eye, skin and give complexion to the skin.

Vasthi is of two types: – 1) Using unctuous oil (Anuvasana). 2) Using medicated oil (Nirooha). Nirooha vasthi is given using decoction of certain drugs. Anuvasana vasthi is done using mainly the medicated oil

NASYA KARMA (ERRHINE THERAPY)
In Nasya therapy medicated thaila (oil) or choorna (powder) will be made to pass through the nostrils.

Nasya is very useful in the diseases of the upper part of the neck. For the head the nose is the channel. The medicines applied through the nose will reach the head and it helps to clean the doshas from the head.

Nasya therapy will prevent the diseases related to head, prevents premature greying of hair and enhances hair growth, give strength to veins, arteries, nerve, joints, ligaments and tendons of the head and the face of the individual will be cheerful and voice becomes sweet and stabilised.

RAKTHAMOKSHA (BLOOD LETTING THERAPY)
Blood letting is considered to be one of the panchakarmas by Sushrutha.

The main and the best chikilsa of the pitha rogas is rakthamoksha. This can be done through different methods 1. By using the instruments 2. By prachana (by pricking or by making cuts with surgical blades) 3. By siravedha (by cutting the veins)

Rakthamoksha also can be done using the leeches; application of cow’s horn etc. Sushrutha has advocated its use in the treatment of skin diseases, glandular enlargement and diseases produced due to vitiation of blood. When blood is purified the colour of the skin will be bright and the sense organs will act powerfully and quickly.

IMPORTANT SNEHA SWEDA KRIYAS (OLEATION AND SUDATION)
OIL MASSAGE
Massage is the oldest of all techniques for relieving pain, regenerating tissues, and correcting almost all internal malfunctions. Massage is necessary for every creature, animal or human. A unique factor of nature is that even grass, plants and trees get massaged every time the wind blows through them. Everybody, either knowingly or unknowingly, definitely practices massage. In order to keep ones health, awareness and longevity, massage is very essential. With massage, the physical appearance of the body is enhanced to a very great extent. The complexion and quality of the skin undergoes a transformation. Massage helps to cure various ailments ranging from paralysis to insomnia. Daily massage strengthens the muscles and restores strength and vitality. Massage is very essential for being more youthful and for minimizing the effect of age.

Massage can help us to restore the body to its normal condition of health, vitality, youth, stamina and awareness. Massage benefits all parts of the human body. It aids in digestion, absorption and assimilation. It stimulates the nutrition of the body by the circulation of fresh blood and causing an interchange of fluids within the tissues. It also removes inflammation, swelling and disperses congestion.

MEDICATED STEAM BATH
The medicated fumes are passed into the steam chamber. The duration of the sweat therapy depend upon the prakriti of the individual. Drugs like dasamoolam, milk etc can be used for making fumes. When milk is used its called as ksheera dhoomam practiced in facial paralysis, hemiplegia etc. Steam bath helps to purify the body and relieves the body pain.

NAVARAKKIZHI
This is the treatment that includes the sweda kriya (sweat therapy). The Kizzhi (pouch) is prepared by cooking Navara rice in Bala decoction (sida cordifolia) and milk. When the rice assumes the form of a semisolid paste or pudding it is made into four bolus bags. After doing the massage of the patient with suitable oil the bolus bags are applied on the body after dipping into the boiling bala decoction and milk. Both sides of the patient should be done at the same time. Strict care is to be taken to ensure uniformity of temperature and pressure on all parts of the body. When the massage is finished all the bolus are opened and the pudding remnants are applied to the body of the patient and rubbed by the hands acting as in the massaging process. The pudding from the body is removed scrapping with some suitable materials such as the edge of the leaves of the coconut palms. Generally the course of the treatment lasts for 7,9,11 or 14 days.

Great restrictions are to be observed during these days of actual treatment as well as an equal number of days thereafter in respect of diet as well as physical and mental exertions of every type.

The effect of treatment if properly done is many. It confers all the benefits of the sweda kriya (steam bath and consequent diaphoresis). If done in the correct manner sweda makes the body supple removes stiffness of joints due to diseases of vitiated vata types, cleanses the strotas (channels) of the body and brings about better blood circulation. It improves complexion, increases appetite, improves digestion and restores relish for food. It is a good rejuvenative therapy.

PIZHICHIL (KAYASEKAM)
Of various kinds of specific treatments for vata born diseases, Pizhichil is one of the most important. This is generally resorted of in cases of paralysis, hemeplegia, londosis and such other nervous disorders.

Pizhichil is the process by which the body is made to perspire by means of application of warm medicated oils in a specific manner. The actual pouring of the warm oil on the body of the patient is done by dipping the pieces of clean cloth in the warm oil and squeezing the clothe over the body with the hands. Small vessels call ‘kindy’ may also be used for pouring the warm oil over the body. The oil is poured at a distance of 4 ‘anjulas’ from the body. After due consideration of the aggrevation of the dosas, dushyas, body strength of the patient, one should apply dhara on each day using fresh oil. The oil should be very hot in vatha disorders, lukewarm in pitta and just hot enough to be liquefied in cases of kapha.

SIRODHARA
Sirodhara is carried out by continuously flowing warm medium over the forehead using special apparatus. Dhara therapies is suggested to prevents premature greying of hair, exhaustion, for relieves headache, to alleviates the vitiated doshas, for preventing loss of ojus (energy) from the body, urinary disorders, diseases of eye, ear etc., Sirodhara also promotes sound sleep, increase memory and retaining power, and also nourishes the semen and blood.

The various type of Dhara is:
Thakradhara: Pouring of medicated buttermilk over the forehead.

Thailadhara: Pouring of medicated oil over the forehead.

SIROVASTHI
In Sirovasthi external application of oil is kept over the head in specially prepared tanks, which is beneficial in: Loss of sensation of the skin, treating cases of facial paralysis, insomnia and also indicated in diseases of the head

UDWARTHANA
This is of two types – Dry and Unctous. This refers to massage of the body with oil or powder from below upwards by using required pressure on the body. The dry type is used in obesity. The advantages are: It helps to eliminate bad odour, cures heaviness and drowsiness, removes toxins from body, gives good complexion to body and promotes reduction of body fat.

HEAD MASSAGE
Various medicated oils are used as per the individual constitution of the patient. It makes the hair grow luxuriously and imparts thickness, softness and makes them dark and glossy and also it soothes and invigorates the head and sense organs and removes the wrinkles of the face