Panchakarma explained: what happens, and what to ask

I am a yoga teacher, not an Ayurvedic doctor, and this is written as a guide for students who ask me about panchakarma before or after a stay in Fort Kochi. For the bigger picture of how the two traditions fit together, start with our guide to Ayurveda and yoga in Kerala.

What is panchakarma?

Pancha means five and karma means action. Panchakarma is a set of five procedures that classical Ayurveda uses to remove what it calls accumulated doshas and ama, undigested waste, from the body. If the doshas are new to you, read vata, pitta and kapha explained first.

The important point is that panchakarma is not a massage holiday. In its classical form it is an active medical treatment that empties the body by vomiting, purging and enemas, under a doctor, over several weeks. A lot of what is sold to visitors as “panchakarma” is a much gentler package of oil treatments, which can be pleasant and relaxing but is a different thing.

What are the five therapies of panchakarma?

Not everyone has all five. The doctor chooses the procedures, usually one or two, after an examination. Some schools of Ayurveda count two kinds of basti separately and leave out bloodletting, which is why you will sometimes see slightly different lists.

Nasya is sometimes confused with jal neti, the yogic salt-water nasal rinse. They are different practices from different traditions, and our guide to jal neti and the shatkarmas explains the yogic cleansing methods.

What happens before and after the main therapy?

A full panchakarma has three stages, and the first and last take longer than the main event.

1. Purvakarma, preparation. Several days of snehana (oleation) and swedana (sweating). Oleation means oil inside and out: daily oil massage, and often snehapana, drinking increasing doses of medicated ghee on an empty stomach. Swedana is steam or heat treatment to loosen what the oil has gathered.
2. Pradhanakarma, the main therapy. One or more of the five procedures, timed by the doctor.
3. Paschatkarma, recovery. A graduated diet called samsarjana krama, starting with thin rice gruel and slowly building back to normal food over several days. Digestion is considered fragile after purging, and this stage is not optional.

Throughout, expect a simple vegetarian diet, early nights, no alcohol, and being asked to avoid cold drinks, strong sun and hard exercise. Our article on sattvic food describes the kind of eating most centres follow.

What are the Kerala treatments on spa menus?

Kerala has its own tradition of external therapies, sometimes called Keraleeya treatments. You will see these on every menu, often described as panchakarma. They are usually part of the preparation or stand-alone rejuvenation, not the five procedures themselves.

None of these is wrong to enjoy. Just know what you are paying for. A seven-day package of daily abhyanga and shirodhara is a rejuvenation programme, not panchakarma.

How long does panchakarma take?

A full classical course usually takes two to three weeks, sometimes four, depending on which therapies the doctor chooses and how your body responds. The preparation alone can be a week. Recovery takes several days more.

Shorter programmes of five to ten days exist and are popular with visitors. They are mostly oil treatments, sometimes with a single mild purgation or a short course of basti. Ask exactly which procedures are included.

Kerala’s traditional season for treatment is the monsoon, especially the Malayalam month of Karkidakam, roughly mid-July to mid-August. The cool, damp air is thought to open the body to oil. Our guide to the Kerala monsoon covers what that season is like to live in.

Does panchakarma work? What the evidence says

Honestly: we do not know very much. Panchakarma has been studied far less than yoga, and most of what exists is small, short and uncontrolled.

• A 2016 study in Scientific Reports, from researchers at the University of California, San Diego and others, followed 119 healthy adults at a US centre. After a six-day panchakarma-based programme of diet, meditation, yoga and oil treatments, the treatment group showed lower levels of some blood compounds linked to cholesterol and inflammation. That is a change in biomarkers after a short programme, not proof of better health.
• Indian journals publish many small studies of specific panchakarma procedures for specific conditions. Most have no control group or very small numbers.
• There are no large, well-controlled trials showing that panchakarma cures or prevents any disease.

Plenty of people find a course restful and say they feel lighter and clearer afterwards. A few weeks of rest, simple food, no alcohol, early nights and daily massage would be expected to do that. Whether the purging adds anything on top is the part that is unproven.

What are the risks of panchakarma, and who should not do it?

Panchakarma is often described as “natural” and therefore harmless. Parts of it are neither.

• Vomiting and purging can cause dehydration, low blood pressure and salt imbalances. That matters a great deal for older people and anyone with heart or kidney problems.
• Drinking ghee means large amounts of fat over several days. It causes nausea in many people and may be unsuitable with gallbladder disease or high cholesterol.
• Herbal medicines can contain heavy metals. A 2008 study in JAMA tested Ayurvedic medicines bought online and found about one in five contained lead, mercury or arsenic. Among rasa shastra products, which deliberately include metals, the figure was about 40%. Ask what you are being given, and do not take preparations home without knowing what is in them.
• Interactions with prescribed medicines are possible. Never stop a prescribed medicine for a course of treatment without your own doctor’s agreement.

Classical texts themselves say the purging therapies are not for pregnant women, children, the very old, or people who are weak, recovering from illness or underweight. A responsible doctor will turn some patients away. That is a good sign, not a bad one.

How do you choose a panchakarma centre in Kerala?

Ask these questions before you book, and expect clear answers:

1. Who supervises? A qualified Ayurvedic doctor, at minimum a BAMS (Bachelor of Ayurvedic Medicine and Surgery), should examine you before treatment and see you daily.
2. Which procedures, exactly? Ask which of the five therapies are included and why. “Panchakarma package” is not an answer.
3. What is the length of each stage? Preparation, main therapy and recovery diet.
4. Is the centre classified or accredited? Kerala Tourism classifies Ayurveda centres under its Green Leaf and Olive Leaf scheme and, more recently, Ayur Silver, Gold and Diamond grades. Some hospitals hold NABH accreditation for Ayurveda.
5. What medicines will I be given, who makes them, and can I see the labels?
6. What happens if I feel unwell? Where is the nearest hospital, and who decides?
7. What does the price include? Room, food, consultations, medicines and therapies are often priced separately.

Bring a list of your medical conditions and medicines, and tell the doctor everything.

Can you practise yoga during panchakarma?

Only gently, and only with the doctor’s agreement. During oleation, purgation and the recovery diet, the body is depleted and digestion is weak. A strong asana class is the wrong thing to add.

What fits well: slow breathing such as nadi shodhana, short meditation, and long relaxation like yoga nidra. Save the full practice for the weeks after, when your appetite and energy are back. A slow return through a few traditional Hatha classes suits that moment well.

If you are planning a longer stay in Kerala around a treatment, our guide to yoga retreats in Kerala covers how to fit the two together.

This article is general information, not medical advice. Talk to your own doctor before starting panchakarma, especially if you have a health condition, are pregnant or take regular medication.

Common questions

What is panchakarma?

Panchakarma is Ayurveda’s five-part cleansing treatment: vamana (therapeutic vomiting), virechana (purgation), basti (medicated enemas), nasya (nasal medication) and raktamokshana (bloodletting). It is preceded by oil and heat treatments and followed by a graduated diet, and it should be supervised by a qualified Ayurvedic doctor.

How long does panchakarma take?

A full classical course usually takes two to three weeks, sometimes four, including preparation and the recovery diet. Shorter five- to ten-day programmes are common for visitors but are mostly oil treatments rather than the full five procedures.

Is panchakarma safe?

Oil massage and heat treatments are generally safe. The purging therapies can cause dehydration and are unsuitable for pregnant women, older or frail people, and anyone with heart or kidney problems. Some Ayurvedic medicines have been found to contain heavy metals, so ask exactly what you are given and never stop prescribed medicines without your doctor’s agreement.

Does panchakarma have scientific evidence?

Very little. Most studies are small and uncontrolled. A 2016 study of 119 adults found changes in some blood markers after a six-day programme, but no large trials show that panchakarma prevents or cures disease.

What is the best time of year for panchakarma in Kerala?

Traditionally the monsoon, especially the Malayalam month of Karkidakam, roughly mid-July to mid-August. Centres treat patients year-round.

Is shirodhara the same as panchakarma?

No. Shirodhara, the pouring of warm oil over the forehead, is a Kerala external therapy often used in preparation or rejuvenation. Panchakarma refers to the five main procedures, which shirodhara is not one of.