The concept of panchakarma can be a hard one for Westerners to grasp. Those who have heard of it are often quick to assume it’s another internal cleansing regimen. But it’s more than that. Dr. John Douillard, Ayurvedic physician and author of Body, Mind and Sport (Crown, 1995), says, “Panchakarma is not a detox program. This is only its side benefit. It is a transformation in consciousnessreplacing stress with silence.”
An understanding of the principles behind the Ayurvedic view of health and disease (the event that panchakarma aims to prevent) helps put the practice in context. Ayurveda explains health as a dynamic balance, the individual living in harmony with natural law. The system takes into account an individual’s elemental, unique constitution, called prakriti, as well as how far the person has varied from that balance, the vikriti. Each person’s constitution is described in terms of doshas, three distinct energy patterns known as vata, pitta, and kapha. Though all three doshas exist in each of us in different proportion, one is generally predominant. Knowing the ways these doshas coexist in our constitutions can help guide our daily eating and lifestyle choices towards a state of balanceand better health.
When pathology does arise, Ayurveda considers it an expression of a person’s genetic predisposition, environment, habits, and understanding. Explains Dr. Marc Halpern, director of the California College of Ayurveda, disease starts in the physical body when undigested food and experience create ama, a toxic substance that accumulates in the body. Disease then develops through six distinct stages, of which only the last two are recognizable by scientific, evidence-based medicine. Because Ayurveda can identify disease patterns before there is clinical pathology, the approach allows a level of prevention unimaginable to conventional medicine. From an Ayurvedic perspective, even when physical damage is irreversible, it is still possible to minimize discomfort and arrest further deterioration.
This is where panchakarma comes in. The series of treatments helps the body release toxins and rebalances the doshas. Says Bri Maya Tiwari, Vedic monk, teacher, and author of Ayurveda, Secrets of Healing (Lotus Press, 1995), “These are not invasive therapies, but are meant to go deep within to nourish the body and cajole it into releasing its waste, its toxicity. The tissue should not feel a longing for something given up. It should not be traumatic, like candy ripped from child.”
Because Ayurvedic physicians view each individual as unique, the customizing of treatment to the patient is central. Therefore, asking physicians trained in Indian Ayurvedic schools questions about disease can be frustrating. These vaidyas, as they’re called in India, don’t treat diseases, they treat people. Invariably the response begins, “It all depends on the individual.” This is no New Age nod to holism, but rather the very foundation of this approach. (And it’s not a lack of sophistication regarding disease, either. Ayurveda recognizes not two, but 20 types of diabetes, for example.)
Indeed, panchakarmaand the broader tradition of Ayurvedaare most sophisticated systems. Dr. Vasant Lad, founder of the Ayurvedic Institute, convinced me and an audience of American cardiologists of this several years ago, when I first met him at his presentation to the Department of Cardiology at New York City’s Columbia Presbyterian Medical Center. He introduced passages from the Charak Samhita, a 5,000-year-old medical text, that outlined symptoms and complications of cardiac disease only recently discovered by Western medicine. Thousands of years before modern science, it seems, Ayurveda had gathered this knowledge, without microscope or stethoscope. The result is a deep wealth of understanding that informs the cleansing procedures used in panchakarma to this day.
One of the first things I discover after signing up for treatment is the emphasis placed on home preparation. I’m told that taking certain steps before the panchakarma treatments maximizes effectiveness, prevents complications, and prepares the body for the profound inner release the sessions will invariably bring. Ayurveda likens the body to a branch that, when dry, will snap under the stress of the various therapies. If the wood has been properly oiled first, however, it will bend beautifully.
To that end, this first phase of panchakarma starts with dietary restrictions: no meat or dairy the week before treatment. That’s easy for me. But oleationthe lubrication of the inner bodyis a bit harder to swallow. I have to eat two, four, and then six tablespoons of ghee, or clarified butter, before meditation for three consecutive mornings. It is strangely filling, and I can barely eat the rest of the day. But according to Lad, the ghee provides internal lubrication, “which is necessary so that the ama or toxins begin to come back from the deep tissue of the gastrointestinal tract for elimination.” The third night brings relief…two tablespoons of castor oil. These home therapies help liquefy the toxins at the sites where they’ve lodged in my body, loosening them and moving them out through the digestive tract.
Finally I’m set to start my five days of panchakarma. Early Sunday evening, I assemble with four others for an orientation at the Ayurvedic Institute. Besides our daily treatments, we will see Dr. Lad on Monday and Thursday, and check in daily with the panchakarma coordinator. In addition, we can attend yoga classes during the day, sit in on optional lectures, or take a cooking class in the evening. Our food is restricted to one dish, kitchari. This easily digestible, lightly spiced one-pot meal of basmati rice and mung dal can be adorned with a little ghee, fresh cilantro leaves (our only vegetable), lime, and a pinch of salt. We are advised to eat according to our hunger (which will be less than usual due to the toxins accumulating in the stomach) but not less than an hour before treatments, and preferably not after dark. Pots of herbal teas aid digestion and purification.
Monday is my first day of treatment. It begins with yoga which is followed by a meeting with Dr. Lad. I present him with a long list of complaints, primarily things I would never confess to a medical doctor, who would surely think me a hypochondriac. But in Lad’s patient presence, I spill everything that concerns me. The release alone is therapeutic. Dr. Lad is not confused by my apparently unrelated symptoms. Reading my pulses, he identifies my prakriti and vikriti, the core of Ayurvedic diagnosis. Both prakriti and vikriti are expressed by the interaction of three doshas, and a reading of all of these factors helps him tailor a program just for me. He’ll not only evaluate my current imbalances and ability to withstand panchakarma, but also monitor my condition daily through pulse and tongue diagnosis, adjusting the treatment as we go along.
That afternoon, two sunny, smiling women welcome me at the panchakarma lounge. They are the massage therapists who will give me daily warm oil massages. These massages are clearly choreographed and synchronized so that each woman mirrors the other’s movements on either side of my body. With four hands moving as one entity, warm rivers of oil soothe tender spots. Every moment is celestial. Aromatic nasal drops deepen my breathing. My mind softens. Warm oil is poured in first one ear, then the next, moving me deeply into silence. Eye drops burn intensely for a moment, then leave my eyes remarkably clear. Renouncing concern about messy sheets, I float away in a pool of warm oil.
All too soon, I’m gently ushered into the steam room to meet the therapist who will complete my treatments. She has scented the steam with sandalwood oiltherapeutic, she says, for my constitution. There are cool cloths for head, heart, and groin, and water or warm tea to drink. Twenty minutes later, she escorts me across the hall for the next treatmenta delicious-smelling concoction of warm milk, sandalwood paste, and chickpea flour which she spreads all over me. I want to eat it.
My therapist then begins shirodhara, the process of gently pouring warm oil onto the center of my forehead. The purpose is to move the nervous system into a state of deep repose. It works. Though the treatment lasts half an hour, I only last 10 minutes. I awake warm, slippery, and the consistency of an overdone noodle. “Are you ready for your shower?” she inquires. “If I must,” I reply, incapable of argument. As warm water slides over my well-greased body, I am careful not to strip the therapeutic oils with too much soap. Never have I felt so profoundly relaxed and nurtured. Can I really submit to such treatment four more times? You bet.
Back in my clothes, fatigue drops me on the sofa before I can attempt the seven-minute walk to my room. By dinner time, I’m so tired I wonder if there’s any sense going to the lecture that evening. Needless to say, early to bed is easy. The next morning I awake at 5:30 without the alarm, feeling very refreshed.
By Tuesday evening I find I’m less exhausted by the treatments. Ed Danaher, the panchakarma coordinator, assures me the immobilizing fatigue after Monday’s treatment was actually a good sign. It seems my body is releasing deep exhaustion. Now I’m ready for the second phase of panchakarma, where three consecutive days of self-administered herbal enemas (basti) are added to my treatments. Basti removes excess vata from the body. Because vata is the dosha involved in movement, it is implicated in all imbalances. Basti is not new to me. I had done it at home from the instructions in Dr. Lad’s Complete Book of Ayurvedic Home Remedies (Three Rivers Press, 1999) and found it beneficial.
On Wednesday afternoon, things take a challenging turn. The air-conditioned room where I receive my massage gives me a chill, and by the end of the session, I’m shivering. The chills intensify even in the steamer, and I start sobbing helplessly, panicked that my blissful week will be cut short by sickness. The staff is responsive, but not intrusive. Aware that I’m overreacting, unable to stop, I feel strangely reassured by a sense that they’ve seen it all before. The remaining treatments are altered to balance my current state. I’m supported until I stabilize, and Danaher offers his home number, encouraging me to call with any concerns. Tonight even the short walk home is beyond my capacity. I accept a ride and fall into bed. There were actually several times throughout the treatment that felt emotionally raw, and the skills I had learned over years of intensive meditation retreats served me well in managing my psychology. Both American and Indian experts agree that an emotional release is essential to the purification process. Dr. Smita Naram, who runs the Ayushakti Ayurved Health Center in Mumbai, India, with her husband Dr. Pankaj Naram, tells me later that the patient is never manipulated to precipitate catharsis. It just happens as a natural by-product of cleansing. The possible aggravation of emotions makes it critical that the entire process is surrounded by gentleness and nurturance, and thankfully, my therapists provide these.
Early Thursday morning I awake clear, refreshed, and ready for basti. The rest of the treatments go wonderfully, and by Friday, I’m done. But lifestyle and self-care in the weeks following panchakarma will demand my attention. To make sure everything continues well, the panchakarma coordinator carefully reviews my dietary guidance, suggests lifestyle modifications (which include sexual abstinence for the length of time one goes through treatmentone week in my case), and gives directions for continuing basti every Saturday for a month. I marvel at his patience educating clients rendered blissfully spaced out by five days of treatments. By now, I am so heavily invested in this processand so enamored of my new comfort foodthat continuing the kitchari fast another two weeks seems a desirable inconvenience. Aside from the actual treatment time, which is borderline ecstatic, panchakarma feels a bit like early pregnancy. You’re not really sick, but you don’t feel well, the stomach’s uncertain, and you’re tired all the time. This is not like lolling about a spa. This rest is hard work, so all-consuming I could barely do anything else. In this fatigue, even keeping a journal seemed a gargantuan feat. But given the depth of the changes engineered, the amount of rest the treatment requires seems a reasonable cost. Naram explains that “rest makes panchakarma more effective. Many times, activity can disturb vata, thus blocking the process of panchakarma.”
Five days of treatment is common fare in stateside panchakarma clinics, but after five days, it felt like I was just beginning. Dr. Ramkumar, director of the Ayurvedic Trust in Coimbatore, India, tells me that a careful reading of Ayurvedic scripture points to longer time frames, perhaps four to six months (no wonder it’s known as the health care of royals) and very precise protocols. Every winter, Americans and Europeans fill half of his 100-bed hospital, where, Ramkumar says, “a course of Kerala oil treatments lasts a minimum of five weeks.”
Undergoing treatment in India actually has many perksnamely, longer treatments and lower fees. In America, programs and lodging run between $1,500 and $3,000 per week. Many people will need to travel as well. One month of panchakarma in India commonly costs $1,000. Flights from New York average $1,200. Even with airfare, India is a bargain. And Indian clinics offer many more therapies than are available in the United States. But if details like planks on the floor instead of padded massage tables, and therapists chatting during treatment put you off, then it’s best to try panchakarma closer to home. Dr. Robert Svoboda, author of Prakruti, Your Ayurvedic Constitution (Lotus Press, 1989), is the only American who has graduated from an Indian Ayurvedic college and is licensed to practice in India. Svoboda rarely recommends going to India for your first panchakarma experience unless you have lived there before.
To those considering panchakarma in India, Ramkumar offers the following suggestions: “Be ready for Indian hygiene. The standards are much lower than in America, although that is not important for this particular process, where we are looking at internal cleansing.” He further advises that one “come prepared for total rest. Don’t expect to even take walks, but you can bring a tape player to listen to soothing music.” To this, Svoboda adds the desirability of bringing your own enema bag or syringe for basti, or using disposable bags, as “there is considerable HIV and hepatitis C in India.”
Whether looking for an Ayurvedic practitioner in the United States or India, Svoboda advises caution. “If you have an inexpert doctor,” he cautions, “your life is in danger.” He explains that the procedures might “aggravate the doshas without getting them to move, or move the doshas in the wrong direction, deeper into the tissues.” Scott Gerson, M.D., medical director of the National Institute of Ayurvedic Medicine, underscores the importance of accurately assessing which stage of disease the patient is experiencing. He warns that if the practitioner “erroneously applies radical cure measures to someone who can only be palliated, you risk injuring the patient, pushing disease deeper into the physiology and accelerating disease progression.” Dr. Marc Halpern adds that panchakarma is “the single most profound and deepest treatment offered through the science of Ayurveda. Because of that, the potential for healing is greater and so is the potential for causing imbalance.”
That said, many people find qualified practitioners that provide profoundly healing treatments. My own experience was that the aftermath lasted much longer than anticipated. There was an immediate shift towards feeling more present. The increased self-awareness put me more in touch with my deep fatigue, which lingered two long months. For better or worse, that New York City edge that enabled me to function against all odds didn’t survive Albuquerque. It took a while to acclimate to my new just-can’t-quite-force-myself-against-my-needs M.O., but somehow life gets done, and I’m not done-in by the process.
Those interested in panchakarma but looking for some lower-octane care can try some simple home treatments. It’s not technically panchakarmathat is strictly a clinical process that must be monitored by an experienced Ayurvedic physician. But outside the clinic, Ayurveda’s strong point is the education of the client into a life of ongoing self-care. More than a health care system, Ayurveda is a lifestyle. Halpern asserts that “the best at-home care is to create a lifestyle that is in harmony with your environment through the principles and practices of Ayurveda,” such as daily oil massage, meditation, yoga, and healthy eating habits. He stresses the value of simply resting 15 minutes after eating. Remember, Ayurveda sees indigestion as the beginning of disease.
Reflecting on my experience, I hear Bri Maya Tiwari’s softly resonant voice: “The intention of panchakarma is to bring us into harmony with who we are.” The shifts in my well-being are both subtle and very real. I’m distinctly more present, more patient with my kids and myself, more appreciative and respectful of both friends and adversaries, more satisfied with life. Blood sugar is stable, digestion strong, and sleep refreshing. When stress is unavoidable, I have deeper resilience and simple, effective tools. But am I satisfied? Not totally. One week has done all this. What could six weeks do? I’ll see you in India.
Pamela Miles has written on the humanization of medicine and on natural supports in HIV treatment in Healthy Living and the New York Daily News.