Panchakarma Safety: Who Should Avoid It and Warning Signs

Urgent signs: get help first

Get medical help right away if you have confusion, fainting, no urination, a fast heartbeat or fast breathing, especially after vomiting, diarrhea or heavy sweating. These can be signs of severe dehydration, which can be life-threatening. [1] In the US, call 911 for an emergency.

If you or someone else may have been poisoned (for example by an Ayurvedic herbal or mineral product), call Poison Help at 1-800-222-1222 in the US; FDA lists this number for people who used Ayurvedic products and have symptoms of possible heavy metal poisoning. [2] Other countries: Poison Help by Country. See also Poisoning: what to do first.

What this page covers

Panchakarma is the group of Ayurvedic cleansing procedures that includes induced vomiting (vamana), purgation (virechana) and enemas (basti). [3] [4] [5] In the tradition they are practitioner-supervised. This page is general and educational. It does not tell anyone how to do any procedure, and it cannot say whether a given procedure is safe for you. For the procedures themselves see Panchakarma: the five procedures, vamana, virechana and basti.

What the evidence on safety looks like

Evidence label: insufficient evidence on how often serious harm happens.

• A study of virechana measured blood salts (electrolytes) before and after in 15 patients and found them within the normal range. [3] That is a very small study with no comparison group.
• An open-label pilot of vamana with an herbal tablet in 49 people with type 2 diabetes reported no adverse event. [4] In a randomized trial of 40 people with prediabetes, no adverse effects were noted except abdominal discomfort and gas in two people who did not follow the diet chart. [6]
• Reviews warn that Ayurvedic trials often do not record harm. Only one in eight Ayush studies of spine conditions described any adverse event, and the authors said under-reporting is likely. [7] In hemiplegia trials, safety parameters were frequently not documented. [8]
• A paper on tracking side effects (pharmacovigilance) says that applying it to Ayurveda is even more difficult. [9]

So "no side effects reported" in small studies is not the same as "safe for everyone".

Why the risks exist

Vomiting, purgation and enemas cause fluid and salt loss. NCCIH says laxatives can cause diarrhea leading to dehydration and malabsorption, and that going days without food while drinking only water and tea could lead to dangerous electrolyte imbalances. [10] Fasting can cause headaches, fainting, weakness and dehydration. [10] Colon cleansing can have side effects, some serious. [10] Medicated preparations used in the process may contain metals: some Ayurvedic preparations contain lead, mercury or arsenic at toxic amounts. [11] Other risks (infection, burns, aspiration from vomiting, bleeding) are discussed on the pages for each treatment, such as raktamokshana and Swedana and steam therapies.

Who should avoid it or ask a clinician first

No single authoritative contraindication list was available to us, so we report what we could read. Do not treat any of it as a complete list.

• Pregnancy and breastfeeding. NCCIH advises consulting a health care provider because some Ayurvedic products may contain harmful ingredients. [11] A prediabetes trial and a planned trial of vamana and virechana in healthy adults both excluded pregnant and breastfeeding women. [6] [12] See Ayurveda in pregnancy.
• Children, older adults and people with chronic illness. Dehydration is more likely in older adults, infants and young children and people with chronic illnesses. [1] See Ayurveda for children and Ayurveda for older adults.
• Conditions that trials excluded. One prediabetes trial excluded people with type 1 or gestational diabetes, malignant or accelerated high blood pressure, congestive heart failure, people on steroids and people on oral diabetes drugs. [6] The planned trial (a protocol, with results pending) excluded people with eating disorders, inflammatory disorders, and those taking antidepressants or hormone replacement therapy. [12] These are research rules, not medical advice, but they show that investigators themselves screened out many groups.
• Digestive, kidney and heart disease, and severe hemorrhoids. NCCIH says harmful effects of colon cleansing are more likely in people with gastrointestinal disease, colon surgery, severe hemorrhoids, kidney disease or heart disease. [10]
• People on regular medicines. Ask your prescriber or pharmacist. Never stop medicine because a practitioner suggests it.

See Who should avoid Ayurvedic bodywork, heat treatments and cleansing.

Qualifications and oversight

In the United States, NCCIH says Ayurvedic practice is not significantly regulated and no state requires a license. [11] The World Health Organization has published benchmarks for Ayurveda practice that set minimum reference standards for safety and quality. [13] See how to check an Ayurvedic practitioner and warning signs after Ayurvedic treatment.

Reporting a problem

In the US, FDA asks people to report suspected products with heavy metals to its MedWatch program. [2] See Reporting a problem with an Ayurvedic product or treatment.