The main seat of dosas is the alimentary canal in the upper, middle and lower third of the tract. When dosas accumulate, they are susceptible to perturbation by numerous factors such as dietary indiscretion, suppression of natural urges and emotional upheavals. The accumulated dosas then enter the body compartment through the openings of countless channels that criss cross through the body. When this perturbation is severe, Panchakarma becomes very effective to eliminate the dosas.
It is not difficult to eliminate by emisis and purgation whatever dosas has collected in the alimentary canal, but these two procedures on their own would fail to remove the perturbed dosas present in the vast network of body channels. Therefore, Panchakarma applies two preparatory steps – lubricant therapy and fomentation to loosen and mobilize the dosas from the body channels into the alimentary canal and deliver them into its lumen. The role of these preparatory steps is identical to the application of lubrication and steam for unclogging of a network of pipes. The loosened dosas from the body channels return to the alimentary canal through openings, which also would have been unblocked by the preparatory measures.
Panchakarma or the five evacuative therapies is then applied to eliminate the dislodged dosas – emesis (vamana), purgation (virejana), nasal evacuation (nasya), non – lubricant enema (kasaya vasti) and lubricant enema (sneha basti).
It is impossible to exaggerate the importance of panchakarma in Ayurvedic practice.