Panchakarma
It is stated that, "Brahma remembered the Veda of Ayu -the Ayurveda - and transmitted it to Prajapathi". Underlying in this statement is the belief that Ayurveda existed even before Brahma or creation. Although such a thought may not be acceptable to everyone, even the written history of Ayurveda is very old; for example, Caraka Samhita is dated to fourth century BC. One of the established texts of Ayurveda is Ashtanga Hrudayam, written by Vagbhata or Vahata. There are two texts attributed to him, the second being Ashtanga Samhita. Hrudayam is the principal text taught in the Keraleeya system of Ayurveda and the tradition is several centuries old. One of the reasons for the widespread use of Hrudayam is that Vagbhata spent considerable portion of his life teaching Ayurveda in Kerala and is believed to have died in central Kerala. The segregation of Ayurvedic families in this part of Kerala may have something to do with this.

Ayurveda has eight branches called Ashtangas. They are Kaya (general medicine), baala (paediatrics), graha (astrological), urdwanga (above neck), shalya (surgery), dhamshtra (toxicology), jara (longevity) and vrusha (infertility). The physician who is well versed in all these eight branched is called an Ashtavaidyan. There are eighteen families of Ashtavaidyas in Kerala who are believed to be the torchbearers of the Vahata tradition. Ayurveda is an integral system of health, which does not separate body from nature. This integral relation extends to medicine too. The purity of nature, to a large extent, still exists in Kerala, which is probably one of the reasons for Ayurveda to be preserved in the traditional form in Kerala. It is still possible to find a few herbs for a Kashayam in a typical Kerala household whereas almost nothing is obtainable in the residential areas of other regions of the country.

Ayurveda emphasises on prevention and not on management of diseases. From the chapters of daily routines and hygiene, Hrudayam moves to methods for the prevention of diseases. It is advised not to pollute body and mind with sins to be healthy. Use of proper foods and food combinations, giving due consideration to natural instincts, etc. are described next. In a similar vein, Charaka Samhita dwells on activities destroying janapathams (communities). It is important to recall that even environmental protection is recognised as an important aspect of health. In today's world, cleaning of pollutants accumulated in the body due to the modern life style is even more important. Ayurveda suggests this through Panchakarma.

In the treatment of diseases, Ayurveda adopts two distinct modalities. Shamana is the one used to manage the symptoms of the disease whereas shodhana is the one used to eliminate the cause of the disease. Shamana methodology keeps the doshas at their places but gradually bring down their negative influences by the application of medicines. Shodhana removes ama (toxins) and mala (waste) from the body and restores the balance of the doshas. Panchakarma is the most important shodhana chikitsa. Panchakarma constitutes pancha (five) karmas (actions) for purifying the body, mind and consciousness. However, in its application, Panchakarma is not just the use of all of these methods alone. It also includes a set of purvakarmas which prepares the body to remove the toxins and paschatkarma which makes sure that the person regains the digestive Agni and a thorough rejuvenation of the body is achieved.

The five procedures of Panchakarma are: Vaman, Virechan, Vasti, Nasya and Raktamoksha. Vamana is therapeutic vomiting or emesis; Virechana is a purgation therapy with herbal laxatives; Vasti is the term used for therapeutic enema with Ayurvedic preparations; Nasya refers to the nasal administration of Ayurvedic preparations and the cleansing procedure through nose and Raktamoksha refers to the removal of doshas from blood with blood-letting. There are several forms of Raktamoksha such as sucking with leaches, incision on the skin, piercing into the flesh and lastly cutting the vein. The kind of panchakarma advised depends on the physiological condition of the person. Normally not all of the five procedures are used to remove the toxins.

Panchakarma starts with selected purvakarmas which includes Snehana and Swedana. Snehana refers to internal and external oleation. Oil massages are done to cause superficial and deep tissues to supple. This process nourishes the nervous system. This can also be deeply relaxing. Swedana is therapeutic application of steam to cause sweating. This process loosens the toxins and the process can be accelerated by the addition of herbal preparations to the steam. After a few (generally three to seven) days of purvakarmas, the doshas are ready to be flushed out of the system by one or more of the panchakarma procedures.

Panchakarma programme varies slightly from school to school. A typical Panchakarma session begins with an Abhyanga procedure. Abhyanga is an Ayurvedic oil massage whereby one/two practitioners apply warm oil on the entire body. This helps to loosen and facilitate the removal of accumulated doshas (vata, pitta or kapha; the thridoshas of Ayurveda) and amas from the body. Following this nurturing and relaxing treatment, the person rests briefly and then receives swedana in a steam cabinet. Herbalized steam dilates the srotas or channels of circulation, further loosening and removing impurities through the skin and gastrointestinal tract. After swedana, a herbal powder such as sandalwood, rose or vaca powder is rubbed briskly on the skin. This helps circulation, removes toxins from the skin and helps to pacify the imbalanced doshas.

For some, Shirodhara is suggested after swedana. Shirodhara is the continuous pouring of warm oil to the forehead for approximately 25 minutes. This calms the mind and expands consciousness thereby relaxing the entire body. Lastly, Nasya drops are administered to the nasal passages. These medicated oil drops help remove residual doshas and toxins from the head and neck area. They balance prana and thus promote clarity of perception. At the completion of the session, patient may shower and rest. Other procedures may be recommended depending on the body condition. Rejuvenative herbal preparations are suggested subsequently which can be had as food supplement. The purpose of these treatments is to relax the body and mind, improve the flow of energy by opening the srotas and to prepare the body to eliminate excess doshas and toxins. After a few days of these treatments, the doshas have usually ripened in their sites of origin in the gastrointestinal tract and are ready to be flushed from the system.