Authentic Pancha Karma Treatment in Kerala

In the heavily touristed areas of southern Kerala, the insincere and exaggerated claims put forth by many less scrupulous practitioners can be an exhausting distraction when looking for authentic Ayurvedic care. Everywhere one turns, it seems, there spas and billboards claiming to be able to cure all diseases, extend mortality, and restore youth. As I began again in my search for an authentic practitioner, I was becoming skeptical that I would ever find “real Ayurveda.”

While my sneha paana treatment with Dr. Raj had been authentic in that he didn’t cater to tourists looking for massages rather than medicine, all that time spent suffering the strict diet and ghee drinking failed to pass the simple test of alleviating any of my symptoms. Still, I felt I needed to give a full course of pancha karma a chance before going home, if for no other reason than thoroughness; it was what I set out to do when I started this blog, and I didn’t feel I could make a fair judgment about Ayurveda without the experience.

In my search for a provider, I returned to scour industry-related Facebook groups, AYUSH recognized hospitals, Green Leaf certified clinics, and traveler review websites. I cannot overstate how difficult it is to find a good pancha karma clinic that is both authentic and provides treatments at a reasonable price. Those two criteria immediately eliminated all the fancy spas and resorts from my list, but there were still dozens of choices to sift through. After many emails and phone calls with several top treatment centers, each of which had a price tag averaging in the $100+/day range, I finally found Dr. Bina through her high ratings on a travel website.

While most Ayurvedic centers I corresponded with recommended 21-28 days treatment in order to reach a “cure” (sometimes even before I explained my symptoms), Dr. Bina told me that two and a half weeks should be plenty for my “mild” conditions, and that, while she thought we could see some good effects, she was was not making any false claims she could provide a cure. Her honesty in setting my expectations about results was the main reason I chose her center for treatment, but there was also the price, which was about half of what I was quoted everywhere else: only 70,000 rs ($1087) for the treatments, room, and board for 19 days.

When I arrived at the center around noon on the first day, Dr. Bina was there to greet me and chatted with me as I ate the delicious homemade vegetarian lunch they provided. She then left me to unpack in one of two guestrooms upstairs where there was also a treatment room, cook’s quarters, living room, and dining area. She and her husband, a government Ayurvedic doctor who also consulted on treatments, lived with their young daughter in the lower unit of the spacious residential duplex, so she was never more than an instant message away when I needed anything.

My first treatment, an abhyanga massage, was administered expertly by the only therapist at the center, a woman in her late 50s named Anna. When I remarked later how strong Anna’s hands were, Dr. Bina told me that she had worked hard as a laborer while raising her daughter alone after her husband died tragically during her pregnancy. After years of odd jobs, Anna had come to be a PK therapist after Ayurveda cured her from a serious disease. Dr. Bina spoke of how difficult it was to find a committed therapist who had both “the hands and the heart,” but Anna had both. Unlike many of the massages I had experienced, she seemed completely present and aware during her treatments, and I felt something like love coming from her hands: for me and for the practice.

The chief complaints I presented with were the recurring insomnia, although I’d largely gotten it under control with help from daily meditation; constipation with any change in diet or routine, which was a bothersome issue while traveling; emotional excesses such as anger, impatience, and anxiety; both dryness and inflammation of the skin, which my dermatologists had shrugged off as rosacea; and pain in my fingers and hands, usually after typing, that felt like the beginning of joint issues or maybe carpal tunnel. In short, I was middle aged.

Despite well-groomed case of hypochondria, Dr. Bina told me I was pretty healthy, but that I had some vata (one of the three main doshas, or energies) imbalances that led to the dryness, insomnia, anxiety, and joint pain. She also noted a healthy dose of pitta in my doshic makeup that tended toward its own set of disorders, such as the inflammation of my skin, the pre-hypertension, the anger, and the impatience.

For these imbalances, she suggested the following plan, with modifications to come as we saw how I progressed.

The Treatment Plan

Abhyanga: whole body massage with oil. Six days.
This massage technique consists of long, vigorous strokes up and down the body in an effort to stimulate the internal organs and improve circulation. There are copious amounts of oil used, which softens the skin and is part of the “sneha” (oleation) process preceding PK. Abhyanga is thought to help with sleep and to aid in longevity.

As someone used to having massages in the US, I was surprised and unabashedly delighted to discover that traditional Indian massage includes massaging the breast area, usually with long strokes that include the arms and go down to the belly or ankles. It’s healthy for the breast and surrounding lymphatic tissue to be massaged regularly, and it’s a good addition for women to include in their daily practice of abhyanga self-massage.

Jambeera Pinda Swedam: application of poultice with medicinal powders, lemon—jambeera—and coconut. Three days.
I thought I was going to miss the abhyanga, but the poultice treatment was a lovely substitute. Each morning, Anna cooked up a batch of herbs in oil with lemons and crushed coconut, which she wrapped in a tight muslin poultice. During the treatment, she dipped the poultice in oil before rubbing it over my body with deep strokes that felt like a cross between a massage and an exfoliation treatment. The smell is heavenly, and the slightly coarse texture of the muslin left my skin feeling silky soft.

Patra Potala Swedam: application of poultice with medicinal leaves—patra—lemon, and coconut. Four days.
This treatment is the same as the one above but incorporates the addition of medicinal leaves as the primary ingredient. These “swedam,” or heat treatments, use hot oil to prepare the body for PK. As Dr. Bina explained, the body must be both lubricated (“sneha”), either internally, externally, or both and steamed with warm oil or water (swedam). When it comes time for the actual treatment, the body will be pliable enough to fully receive the medications.

Nasyam: instilling liquid medication through nostrils. Six days.
Anna gave me this treatment in the morning a couple of hours before the abhyanga. After she massaged my face, chest, and back with a mentholated substance, I would deeply inhale from a steamer to open up the sinuses and bronchial areas. Then she would tilt back my head back to drop up to six drops of medicated ghee into my nose, which she would have me sniff deeply to draw in but not swallow, which was a difficult reflex to suppress. Instead I had to spit it out into a container until my saliva no longer tasted of ghee, which usually lasted only a few minutes.

Sirodhara: pouring warm oil on the forehead continuously for 45 mins. Seven days.
The poster child of Ayurvedic massages for good reason. This technique involves a stream of warmed oil pouring over the forehead for 45 minutes, which is exactly as hypnotic as it sounds. I was not supposed to go to sleep during the session, but a few times I couldn’t help dozing off as my body and mind reached total relaxation.

Vasthi: a combination of five oil enemas and three decoction enemas where a special medicated liquid will be inserted through the anus. Four days.
This treatment and the virechana (below) are the main PK treatments which all others have been leading up to and will begin shortly after this blog post goes live.

Virechana: purgation therapy aimed at eliminating excess pitta dosha from the small intestine, liver, and gall bladder. One day.
Not originally part of the treatment regimen, she added a mild virechana PK treatment after I arrived as I had more pitta imbalance than she originally thought.

The Medications

I started on all three medications immediately, and all were provided free of charge. In addition to the diet and massage, these were used to prepare the body for the PK (Vasthi).

Gandharvahastadi Kashayam: used to treat digestive issues and bring vata dosha under control. After 5 days, we switched to Guloochiaddi Kashayam, which is indicated to clear liver heat in case of high pitta dosha.
Ashwagandharishtam: used to soothe neurological disorders (anxiety).
Gandharvahasta Tailam: a castor-oil based liquid used to treat vata digestive and neurological disorders.
Medicated ghee starting on the 4th day with 20 ml, increasing to 50 ml by day 10, which was the day before virechana. Post virechana treatment, we returned to 20 ml.

The Diet

I knew the diet was going to be vegetarian as non-veg foods are too heavy for any PK diet, and I also expected it to be a little bland and pretty restricted. I could not have been more wrong. Each meal was a south Indian specialty, and the subtle flavors and complex but mild spices did not leave me missing the spicy, salty, and oily diet I had become accustomed to while eating in restaurants since my last treatment. Dr. Bina even let me have raw fruit, although raw vegetables were not part of the plan. South Indians just don’t do salads, she told me, and besides raw vegetables were hard to digest, which was not allowed during treatment.

She also dealt me the blow of no more coffee—not ever—due to its heating and drying properties and how much it increased stress and blood pressure, which were two things of the issues I was battling. I think she noticed how saddened I was by this news because she relented to giving me a nice thermos of chai early each morning to ease my SBS (shy bowel syndrome). When she first started the clinic, she had her patients follow a stricter diet, but then noticed they were becoming even more stressed out by the deprivation. She now allows for some small joys, such as oil, some spice, some fruit, and a little caffeine as long as the patient’s condition is not too severe.

Typical meals were as follows:

Breakfast: a south Indian specialty like rice noodles (Iddyapam) with coconut milk, puttu (steamed rice and coconut rolls) with curry, or rice pancake rolls stuffed with shredded coconut. Rice and coconut are common and beloved staples in this part of India, and they provide sweetness in a diet that does not include refined sugar. If these dishes sound bland or boring, I can assure you they are not, despite their simplicity.

Lunch: the largest meal of the day, as the digestive strength (or agni, fire) is considered highest at this time in Ayurveda. At first they were serving me white rice until I requested brown, which puzzled them as brown rice is considered inferior and is often fed to animals, and they proudly had been serving me the best white rice available. I explained that I wanted the extra nutrients and fiber with brown rice, so they accommodated my eccentricity with good humor. In addition to the rice, they usually served a soupy coconut-based curry along with a couple of vegetable masalas, and fresh fruit for dessert.

Dinner: whole wheat chapatis with a simple vegetable curry. Whole fruit dessert along with fruit juice, although I cancelled the juice later because I wanted to reduce my calorie intake.

The Results

Each day I have kept a journal, and, looking back, it was on day five that I started to feel really relaxed and at peace. My skin, oiled each day during treatment, has taken on a lustrous quality, and my hands looked younger. It will doubtless return to a drier state once I stop the daily oleation treatments, but for now I’m enjoying it. The inflammation has lessened but still remains.

My sleep, pretty good before I arrived, has deepened to a level I haven’t felt since I was in my 20s. It’s so good, I don’t even want to tell my other friends in their 40s who almost all complain of having lost the ability to sleep through the night.

Of course, my main issue is stress, and there is none of that here. The house sits back from the main road over a quarter mile and backs up to wetlands framed by palm trees in the far distance, so there is no noise other than bird song, the bleating of goats as a herd wanders by, and children playing in the adjacent field. All my meals are prepared, my room cleaned daily, my clothing washed, and my body manipulated into relaxation every day by someone else’s hands, so I have nothing to do aside from read, write, do yoga, and take gentle walks. The test will come when I return to the real world, and Dr. Bina has warned me that conditions that got better often worsen again after her patients go back to their old environments and perhaps old habits, so it will take discipline to maintain a lifestyle that will allow me maximum benefits from the treatment.

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After a week on the prescribed diet, it was time for the main treatment: Sneha Paana, or ingestion of medicated ghee.

Typically, ghee drinking is a form of oleation therapy undertaken in preparation for panchakarma, but at times it is used as the treatment in itself. Philosophically, Dr. Rajah believed in treating his patients with the minimal amount of medicine needed to bring about a cure while incurring minimal cost, which made sense to me from the standpoint of logic and economy: why take two pills when one would do the trick, and why pay for more treatment than you needed. According to him, only about 5% of all patients actually needed panchakarma, and I was not one of them.

His philosophy flies in the face of almost everything I have read about detoxing with panchakarma, which is universally prescribed for practically every medical complaint. I found only one source that spoke of treating with ghee alone, while everything else I read explained that ghee was meant to loosen the toxins from the cells so that the panchakarma treatment could finish the job by flushing them out of the body from one of its exit paths, be that the mouth (vamana), anus (virechana and basti), nose (nasya), or through the skin (rakta mokshana) aided by the use of leeches (yikes!).

When I asked Dr. Raj what happened to the toxins if they were not expelled using panchakarma, he said that toxins cannot be simply pushed out—they must be neutralized. As cow ghee has an affinity for human cells since the time of birth, according to Ayurveda, it neutralizes the toxins and makes the cells receptive once again. He said the 5% of cases where panchakarma was recommended were when people had the sickness lodged deep in their viscera, whether that was the stomach, the small intestine, or the large intestine, and he did not think I had that.

He explained that the lack of receptivity in the cells in my body was what had led to my hypertension. While my systolic (when the valve closes) readings were usually fine, my diastolic (when the valve opened) pressure was high. What happened when my heart tried to circulate fresh, healthy blood into my cells was that it was not fully accepted due to the principal of “like attracts like,” and all the cells in my body were a bunch of Brie-eating, Cabernet-swilling, Nicorette-popping rock stars who stubbornly refused to take in any salubrious substances. Like the naughty teenagers I imagined them to be, they had to be lovingly reconditioned to learn to like the annoyingly clean blood circulating in my body all the time now. According to this rationale, my issues with chronic dryness were due to the same root cause: my bratty, party animal cells were on strike until I consumed something toxic they could relate to.

The Protocol

The saying about how nothing worse will happen to you in the day if you eat a frog first thing in the morning is something I kept remembering as I drank ghee on an empty stomach before sunrise.

As much as the taste disgusted me, I was ready to get the treatment over with so I could get back to a regular diet. At that point, I had been eating my own cooking for a week, and while usually I do not mind that, the struggle of trying to cook Indian food without oil, a full repertoire of spices, or decent cookery was starting to be a drag.

Adding to my eagerness to start the treatment were the promises from Dr. Rajah that it would address all my ailments: the hypertension, my dry skin, and—can we talk?—the constipation that was came with following a diet devoid of insoluble fiber. I had been suffering pretty much the entire week before we started the treatment on October 6, so I happily chugged down the 50 ml of ghee (that’s almost a 1/4 cup) on the first morning.

This ghee was not just ordinary ghee, nutty and golden, like the kind you spoon onto your dal for extra flavor. This was Mahathikthakam Ghrutham, which, if you Google it, is supposed to be good for skin and heart conditions, among other things. In addition to the ghee used a base, there are about twenty different herbs that are infused into the fat, which renders it a greenish color and gives it a terrible smell. And while it was pretty easy to slam the initial 50 ml, Dr. Rajah kept ratcheting up the dosage until by day 4, we were up to 150 ml.

Dr. Rajah had told me that the treatment would probably last five days but could go up to seven. On the fourth day as I stood in front of the sink with the last 50 ml of ghee in my glass, I seriously wondered if I was going to be able to get it down. One of the signs of successful oleation is the inability to think about the ghee without becoming nauseated, and I was there by that morning. I finally was able to finish it by imagining that my daughter had been kidnapped and all I had to do was finish this final shot to get her released. I still almost puked.

As the day wore on, I started to get some of the relief that Dr. Rajah had promised me, and by my fifth bathroom report (it’s flattering in a weird way when your doctor wants to hear about your every “move”), he messaged me back to tell me that the treatment had concluded and that I was to scale back to 25 ml the next morning. Pshaw, 25 ml? Piece of cake.

The Results

For the first few days after the treatment, my skin was absolutely glowing, and much of the dryness has disappeared. My hair also felt moisturized despite not using any conditioner, but there’s also a lot of humidity in the air here, and having recently ingested a pound of butter also may have contributed.

As for my blood pressure, I had my first normal reading (diastolic under 90) in a doctor’s office before we began the medicated ghee therapy, so simply changing my diet was enough to bring it down to acceptable readings. In the days that followed the therapy, my diastolic stayed in the low to mid-80’s, although there was one morning when I woke up with anxiety and got a reading of 120/92. That’s nowhere near the 160/110 I had back in Bombay at the doctor’s, but I’m shooting for optimal blood pressure without the use of drugs that only mask the symptoms. Only time will tell if my diastolic will stay low once I return to enjoying some of my favorite foods in moderation, which was not what I was doing when I arrived in Bombay.

I also had issues with constipation again, and that didn’t clear up until I was back to eating insoluble fiber, mostly from raw apples as they were one of the few sources of high insoluble fiber I could find readily in the small north Keralan town where I was doing the treatment.

Nor has my insomnia abated. Although I typically feel rested when I arise at 3 am as long as I am in bed by 9 pm the night before, it’s sub-optimal to keep that schedule. I have the sort of insomnia that will wake me at 3 am regardless of whether I’ve gone to bed at 9 or 10:30 pm, so I conform to its schedule rather than trying to make it go away by staying up later.

I really wanted for this treatment to work. Dr. Rajah and his wife are committed to giving the best care they can for a minimal price, and they focus on treating people first before asking for their nominal fee. Committed to the cause of updating Ayurveda with modern understanding of metabolic processes, they are warriors against solutions proposed by so many healers, either here in India or abroad, that include over medicating and charging outrageous prices.

The only problem was that the treatment did not have the results I was promised. The doctor has asked me to return for a second treatment in December to instill the benefits, which he assured me would build with time. But I need a better response before I do this again—my no-oil cooking is just not good enough to sustain me for another round.

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Panchakarma