Panchakarma explained: what happens, how long it takes, how to choose

In Ayurveda, Panchakarma is the deepest of its treatment programmes. The name means “five actions”, after the five main procedures described in the classical texts. Ayurvedic theory holds that they clear out excess doshas (the body's three functional energies) so the body can return to balance. You'll often see it sold as a “detox”, which undersells how structured and medical a proper programme is.

A doctor decides which of the five you need. Very few people have all of them, and the choice depends on your constitution (prakriti), your current state, the season and your health history.

Vamana

Induced vomiting after preparation. Used for specific conditions and only with close supervision.

Virechana

A herbal purgative taken in the morning, followed by a day of rest near your room.

Basti

A course of medicated enemas of oil or herbal decoction, often over a week or more.

Nasya

Medicated oil or drops given through the nose, usually after a head and face massage with steam.

Raktamokshana

Removal of a small amount of blood. Rarely offered at retreats.

A Panchakarma programme isn't just the five procedures. The days before and after matter as much, which is why it takes weeks rather than days.

1. Preparation (purvakarma). For several days you take small, rising amounts of medicated ghee or oil by mouth, have daily oil massages (abhyanga) and sit in a herbal steam box. Expect to feel heavy, sleepy and a little queasy.
2. The main procedures (pradhana karma). The doctor schedules the procedures chosen for you, with rest days around them. Some are done in the morning on an empty stomach; you then stay close to your room.
3. Recovery (paschat karma). Your digestion is treated as delicate, so food comes back in steps: thin rice gruel first, then thicker gruel, then simple cooked meals over several days. You're asked to rest, avoid sun, cold water and exertion, and sleep early.

Most centres set the length after the first consultation. Of the 76 Ayurveda retreats we list, 52 publish a length for their Panchakarma programme: from 3 to 56 days, most often starting at 14. Short “Panchakarma packages” of a week or less usually include only the preparation and one or two procedures; ask exactly what is included.

• Seven nights or fewer: usually rejuvenation treatments (massages, steam, shirodhara) rather than full Panchakarma.
• Fourteen nights: the common minimum for a classical programme with preparation, procedures and recovery.
• Twenty-one to twenty-eight nights: what many doctors suggest for a first full course, especially for long-standing problems.

Browse centres with their published programme lengths in Ayurveda and Panchakarma retreats in India, or narrow it to Kerala, Karnataka or Uttarakhand.

The single most important thing is the doctor. Panchakarma is a medical programme in Ayurveda, and the person planning it should be qualified to do so.

• A qualified Ayurvedic doctor. Ask who will see you and their qualification: BAMS (a five-and-a-half-year degree) at least, often with an MD (Ayurveda). Practitioners register with their state board under the National Commission for Indian System of Medicine (NCISM).
• Consultations through the stay, not just on arrival. Daily check-ins are normal at a good centre.
• Accreditation, where it exists. Some Ayurveda hospitals are accredited by NABH, India's hospital accreditation board, and Kerala's tourism department classifies Ayurveda centres that apply.
• Hospital or resort. In-patient Ayurveda hospitals are simpler, cheaper and more clinical. Resorts add comfort, pools and yoga. Both can be good; the doctor matters more than the décor.
• Same-gender therapists. This is standard at reputable centres. Ask if it isn't mentioned.

Our costs guide shows what Ayurveda retreats charge, from published prices.

1. Who is the doctor, what is their qualification, and how often will I see them?
2. Will you review my reports and medicines before I arrive?
3. Which procedures do you expect to suggest, and how many days of preparation and recovery are included?
4. Can I keep taking my regular medicines? (The answer should be yes, unless your own doctor changes them.)
5. Where are the Ayurvedic medicines made, and is the maker licensed?
6. What exactly does the price cover: room, food, consultations, treatments, medicines and taxes?
7. What happens if I feel unwell during the programme?

The US National Center for Complementary and Integrative Health notes that some Ayurvedic preparations sold internationally have contained lead, mercury or arsenic. Ask what is in anything you're given to take, and keep the labels.

Be wary of any centre that promises a set outcome, says a programme will make a disease go away, or tells you to drop your other treatment. A good doctor explains what to expect, what they can't predict and when to see your regular doctor.