It is interesting to note that a few elements of Panchakarma were prevalent during the vedic period itself though the word Panchakarma appears only in Ayurvedic literature. There are references to virechana and vamanadravyas (materials for emesis or purgation) in the vedic and post-vedic literature. Dhanvanthari, the lord of Ayurveda holds a jalooka (leech) in one hand symbolizing surgical procedure. It is understood that different forms of blood letting as a purifying method were prevalent even during ancient period. Similarly one can see references to nasya (nasal medication) in pumsavana (eugencies) in vedic literature. For example, to achieve conception by an infertile woman, nasya is done with root juice of white flowered Brihati (Solanum anguivi) collected on Pushya nakshatra (Tewari 1992:72). Even though some of these techniques have been described in vedic period itself, Panchakarma as a comprehensive system of therapy took shape in Carakasamhita period.

Panchakarma is a unique contribution of Ayurveda. One can see extensive references to Panchakarma in the earliest classical texts available on Ayurveda. Caraka samhita, Susruta samhita and Vaghbhata is AshtangaHrdayam known as Brihathrayi. As a living tradition, Panchakarma is widely prevalent in the Ayurvedic practice of Kerala.

Not only in Ayurveda but in other different medical cultures as well, one could see treatment such as Panchakarma used for purification purposes. Techniques like Panchakarma are mentioned in the other systems of medicines as well. For instance, catharsis in the Greek medicine is a method of purgation or purification. Till recently, in Western Bio-medicine there was practice of medicated enemas for conditions like arthritis, asthma described in the form of high rectal or low rectal enema. Even recent pharmacological books had explanations on how these get absorbed into the body through lymphatic or systemic circulation and their effects. Drug administration methods like nasal medications for conditions like diabetes insipidus were also mentioned.

Even in other medical traditions Unani, Tibetan, Sidhya, Chinese, Kampo in Japan in Indonesia or the different African healing traditions, some of these techniques are used for purification purposes. 

Techniques like emesis or purgation are techniques that support or activate body’s natural processes. One can see techniques like induced vomiting being used by animals as well. Cats or dogs when sick eat grass and induce vomitting. Even in the local community specific oral traditions of India, one can find some of these treatments widely prevalent . For instance, a common treatment of mental disorders in these traditions is based on vamana (emesis). E.g. Thiruvizha chardi. This is a practice of emesis followed in a Siva temple of Southern Kerala for treating mental disorders. A paste made of specific herbs is given along with milk to the devotees suffering from mental disease to induce vomiting. A milk pudding is also given which would facilitate emesis. Apart from inducing emesis, these medicines would also cause bouts of purgation, which would last for two to three hours. Following this a specific type of rice gruel is given to strengthen the body without any other diet restrictions. This practice is commonly done in artificial poisoning. There are number of such practices of emesis, purgation, bloodletting or enemas in these local health traditions.

If these methods are widely described in various traditions, one wonders what is exceptional about Panchakarma in Ayurveda. Panchakarma has a systematic approach that includes pre-Panchakarma techniques, a sequential approach of five methods and post Panchakarma procedures in the form of a complete package. Persons who are suitable and not suitable for each of these techniques, how to do Panchakarma, symptoms of effective medication, complications of Panchakarma, treatment of these complications, benefits of doing each of these techniques, variations to be followed in the method based on the strength of the patient, seasons etc, different materials used, conditions in which each technique has to be administered are discussed in detail in Ayurvedic classical texts. In the context of vasti (medicated enema), it is mentioned "Etat chikitsardham iti pratishtha…." which means that vasti is considered half of treatment in Ayurveda. Thus, one could aver that Panchakarma forms a major part of the treatment in Ayurveda  

THEORETICAL BACKGROUND

According to Ayurveda, body is made of 7 different types of tissues called dhatu. These body tissues are nourished through food materials that get digested by action of digestive fire (agni) . The digested materials are carried to different tissues through srotas (body channels). At each tissue level, there is a digestive fire that works on the food material to activate absorption of nutrients into the corresponding tissue.

As a by-product of this process, mala (waste materials) are formed which are eventually eliminated. Nourishment of body tissues results in the indigestion of food in the body. This undigested material or waste material (ama) clog the body channels and manifests in different disease conditions. Management of these conditions has to be done by removing of these clogged materials in the body channels when they become pakva (digested and disintegrated), and they then move into the kostha (main channel). During Panchakarma, these are expelled through natural orifices. As it is a mechanism to eliminate the waste materials from the body, Pancharkarma is not only used as curative treatment but also as preventive and promotive.

"Seetodbhavam dosacayam vasante visodhayam greesmajam abhrakale
ghanatyaye varsikamaasu samyak prapnoti rogaan rtujaan na jaatuch"
                                                 [Astanga samgraha, Roganutpadaniya]

Astanga samgraha, one of the classical texts, says that Panchakarma has to be applied to remove the waste materials accumulated in the body in different seasons for preventing diseases caused by seasonal changes. It is mentioned that waste materials accumulated in the body during winter would be eliminated in spring, those accumulated in summer should be eliminated in rainy season and that accumulated in rainy season should be cleared in autumn. In Kerala, during the month of Karkataka (July-August) oil treatments is very popular. This is to alleviate the vata accumulated in the body during summer and aggravated in rainy season.

There is a general thinking that Panchakarma removes the toxic materials. But it has to be understood that Ayurveda does not mention these materials as visha (toxins) but they are considered as ama. Ama refers to the material that is a drop out of body’s metabolic process i.e. the undigested materials. Panchhakarma activates body’s natural processes and eliminates mala (waste) from the body.