Once the Poorvakarma are completed, the Pradhankarma commences. The procedures of Pradhankarma are given here in the order that they are typically performed. However, every patient may not need to undergo each of the procedures listed here.
The Herbal Purification (Vamana), is the process of controlled vomiting induced by herbs or drugs. It is the first main purification therapy and is of functional importance to the entire scheme of Panchakarma. The patient is given warm milk, licorice tea, sugar water or butter milk to drink, after which an emetic is administered to induce vomiting. Vamana purges excess mucus (Kapha) from the body, purifies the body fluids and helps to cure asthma, bronchitis, sinusitis, skin diseases, and obesity.
The Drug Induced Purgation (Virechana), is the controlled process of excreting solid wastes from the body. Bowel movements are induced by a herbal or drug laxative. Virechana eradicates disease of the blood, rejuvenates the tissues and organs of the abdomen, improves skin condition and increases immunity.
The Medicated Enema (Basti), is universally regarded as the most important Panchakarma procedure.The liquid used for the Basti is either water-based (Niruha and Asthapan Bastis) or oil-based (Anuvasana and Sneha Bastis). Additional elements include herbs, salts, wines, yogurt, and honey. Enemas are applied to the rectum, vagina, uretha, or to the cavity of a wound. Basti serves to lubricate the system and alleviate dryness caused by an excess of Vata (air).
The Nasal Cleansing (Nasya Karma), involves the cleansing of the nasal passage by the administration of oils, pastes, powders, plant juices, infusions or smoke. In case of liquids, the head is tilted back and the liquid is put into the nostrils. Powders and pastes are applied by hand or with a special apparatus, while smoke is inhaled. Nasya can prevent diseases of the ear, nose, throat, and head, as well as strengthen hair and improve mental functions.
Blood Letting (Rakta Mokshana), must be performed and controlled by a licensed physician. Blood-letting stimulates the production of anti-oxidants and pro-immune substances that deactivate or destroy toxins. Blood-letting can assuage eye diseases, headaches, tumors, depression, tremors, gout, and other ailments.