Pancha + karma = 5 procedures of treatment used in Ayurveda, especially for detoxification or elimination of aggravated and vitiated doshas.

  1. Vamana = Induced Emesis
  2. Virechana = Medicinal Purgation
  3. Nasya = Nasal Administration
  4. Basti (Anuvasan) = Medicinal Enema (oil base)
  5. Basti (Niruha) = Medicinal Enema (decoction base)
  6. Raktamokshana = Blood Letting.

This therapy works on the premise of eliminating the undesirable from the body, thereby purifying the body resulting in the rejuvenation of the subject. Thus, there is an alternate use of the words elimination therapy, purification therapy and rejuvenation therapy for this branch of medicine.

Blood Letting – Use of Leech

Atha jalaukosvasekasadhyavyadhitamupavesya

sarnvesya va viruksya casya tamavakasam

mrdgornayacurnairyadyarujah syat I

Grhitasca tal) saraparajanIkalkodakapradigdhagatIiJ:!

salilasarakamadhye rnuhurttasthita vigataklarna

jiiatva tabhl rogam grahayet I


mukhamapavrnuyat I

Agrhrnantyai ksirabindurn sonitabindurnva

dadyacchastrapadani va kurvita I

Yadyevamapi na grhnryattadasnyarngrahayet I

Translated as – Then, making the patient treatable with leeches sit or lie down; if he does not have a wound, roughen an opening, with the powder of mud and cow dung.

  • Paste the selected ones (leeches) with the water of mustard, turmeric and incense
  • let them soak in a pot full of water for 48 minutes
  • confirm that they are rid of their tiredness and
  • then have the wound gripped by them.

Covering (the leech) with smooth wet white cotton, leave the mouth alone uncovered. If she does not bite, give her a drop of milk or blood or cut (the wound). Even then if she does not bite, then, pick another.


Susruta-samhita, Sutra-sthanam, Adhyayah 13, Para- graph 19 (6th Century BCE)

Western Reference

Therapeutic use of leech finds mention in Greek and Egyptian medical literature also in addition to Ayurveda.

Current Relevance

In 2003, in a paper by Dr. Andreas Michalsen and colleagues from Essen, Germany, titled Effectiveness of Leech Therapy in Osteoarthritis, of the Knee, published in a recent issue of Annals of Internal Medicine, 24 patients with osteoarthritis, caused by wear and tear of the ageing knee, were given a one-shot leech therapy. Four to six leeches were allowed to attach themselves to each knee and drink blood for about an hour. 27 others with the same ailment were given twice daily doses of the painkiller Diclofenac for a month. Conclusion: leech therapy was better than drug therapy.

While the ancient Hindus, Greeks and Egyptians knew what to do, today’s scientists have identified why the leech therapy works. Nature has endowed the leech saliva with some purpose-specific chemicals:

  • Vasodilator, a histamine that increases the diameter of the blood vessel
  • An enzyme called hyaluronidase, which breaks down hyaluronic, the material that bonds connective tissues and
  • Hirudin (named after the specie of leech that is commonly used for bloodletting), which inhibits blood-clotting.

The combined result of these chemicals is increased blood flow. In addition, the bite instantaneously anesthetizes the bitten spot giving the leech the time to take its fill.

This combination of action is precisely what provides the patient relief from arthritic pain. To combine all the above attributes in a chemical substance or a combination is challenge enough. The delivery is in fact considered a bigger challenge. There are doctors who believe that modern chemistry and gadgetry cannot improve upon what the leech can do. The leech, tiny as it is, absorbs blood at an extremely slow pace. The leech would also let go as soon as it has its fill. This combination virtually eliminates the risk of excessive extraction of blood. Achieving a similar result would call for delicate instruments and continuous attention from a nurse with attendant risks of human error.

Leech treatment is more main stream than what is commonly understood. In 1985, a Boston surgeon who had learnt the usage of leeches in surgery in Vietnam used the procedure on a five year old boy whose ear had been bitten off by a dog. The fact that there are at least 2 companies in the United States of America – Leeches U.S.A Ltd., Long Island, New York and Biopharm of Charleston, South Carolina – whose business is supplying leeches for medical purposes, vouches for this practice gaining ground and acceptance in USA.

This is a classic example of how a study of history (of medicine, in this instance) helps. The ‘why’ behind the solutions of yore can be figured out and alternative more convenient vehicles for delivery of the solutions can be synthesized to suit the modern times.

Note: Recently leeches are approved as ‘medical equipment’ by U.S.F.D.A.

Elimination Therapy – Panchakarma Benefits

Evam visuddhakosthasya kayagnirabhivardhate

Vyadhayascopasamyanti prakrtiscanuvartate II

Translated as – For the person whose abdomen is thus cleansed, the metabolism increases, diseases subside and normalcy come back.

Indriyani manobuddhirvarnascasya prasidati I

Balam pustirapatyam ca vrsata casya jayate II

Translated as – Sense faculties, mind, intellect and color (of the skin) of the person become happy. He gets nourishment, strength, virility and offspring.

Jararn krcchrena labhate ciram jlvatyanamayah I

Tasmat sarnsodhanam kale yuktiyuktam

pibennarah II

Translated as – He does not age easily; live long disease-free. Therefore, people should undertake cleansing when appropriate.

Dosah kadacit kupyanti jita langhanapacanaih I

Jital:J sarnsodhanairye tu na tesam

punarudbhavah II

Translated as – The humors (body elements) subdued by (the combination of) fasting and digestive drugs may sometime aggravate. (But) when conquered by the ‘purification therapy’, there is never their recurrence.

Dosanarn ca drurnanam ca mulesnupahate sati I

Roganarn prasavanam ca gatanamagatirdhruva II

For humors (body elements) and trees, when their root is not destroyed, the reoccurrence of the disease and the flowers is a certainty.


Charaka-samhita, Sutra-sthanarn, Adhyayah 16, Paragraph 17-21 [11Century BCE]


1. Kaya + agnih = Body + fire -> Metabolism

2. Pacati -> Pachanam = Cooks -> Digestive drugs

3. Sam + sodhanam = Complete + purification = Purification therapy.


The focus on removing a problem at its root, as against quick fixes, is at the heart of the Purification stream of treatment in Ayurveda.