As the name suggest, Panchkarma means Pancha Karma i.e. Five Methods or Five Operation in Ayurvedic Medicinal System. These are:

Administration of the Vamaka Dravya

If the patient is a delicate one or weak or very much afraid of the emetic or a boy or an old man, he should be give yavagu (conjee) or milk or butter milk or curds to the fullest and then the emetic dose is to be given to vomit it out along with the dosha. After taking the dose of the emetic, the patient has to rest for a muhurat. To have his body fomented with heated hands all the while. If sweat appears, it should be known that dosha is being melting and liquefying, if horripilation occurs, it should be known that the dosha has begun to move from its location, if the distension of the abdomen appears, it should be known that the dosha has come to kukshi (koshtha). When nausea (hrillaasa) and the watering of the mouth (aasyasravanam) occur, it should be known that the dosha is coming out. The patient should sit on a cushioned chair about eighteen inches in height, so as to enable him to stoop forward and vomit easily and to rest in the interval. He should be held by the attendants. These parts should be also massaged by them. If the patient does not feel sufficiently nauseous, he should tickle his face with finger or with his fingers or with the stem of errand nalaa (stem of castor plant), or with the stalk of the water lily flower, so that he may easily vomit out the contents.

The patient is thus induced to vomit when he gets the nauseous sensation; he should not be made to vomit when he gets the nauseous sensation, he should not be made to vomit sufficient nausea. In this way, he may vomit four to six times or eight times according to his strength. Four vomits are considered to be due to an inferior action of medicine. Six vomits are considered to be due to medium action of the medicine and eight vomits are due to drastic action of the medicine.

There are four ways of knowing that the dose of the emetics has produced its results in a satisfactory manner. The four ways of such knowledge are named by the commentators.

1. laingikee: the patient should experience a feeling of relief as he vomits out the dosha, and he feels lightness of heart region, sides, heads, senses and upper koshta and a feeling of relief their in . This sort of feeling demotes the laingikee way of knowing that the emetic has acted in the desirable manner.
   
   
2. Maanikee: the total volume of the vomited matter is measured and one prastha (2 seers= about 48 fluid ozs.) of the matter is considered as madhayama (medium) suddhi (purification) and four prastha are considered as uttam (best) suddhi (purification). This consideration of suddhi is according to manna or measurement and hence it is called maanikee
   
   
3. Vaigikee: the number of vegaas or urges to vomit is another consideration. It is noted already that four vegaas or urges or vomits are considered as madhayama suddhi and eight vegaas are considered uttam suddhi (pradhaana suddhi). As the consideration of suddhi rests on the number of vegaas of the patient, it is called vaigikee.
   
   
4. Aantikee: the patient who has taken an emetic should first vomit the medicine and gradually kapha in the succeeding vomits and pitta in the last vomit. Thus pitta is the last to be vomited and hence it is said “pittaanam isstam vamanam” i.e. pitta should be the last to be vomited. The appearance of pitta (bile) in the concluding vomit is desired and this kind of suddhi is called aantikee (pertaining to conclusion). Or Vayu is also, however, said to be the last or concluding dosha.

But the discharge of the Vayu is only inferred by the empty urges (to vomit) in the end and it is not attended with any matter. If there is matter, however little, it should be pitta. Hence pitta is practically the last dosha to appear concretely. This consideration of suddhi is called aantikee. The commentators (Chakarpani and Dalhan etc) say that there may be fallacies in concluding that the doshas have been expelled by any one or two of these consideration and hence all these points should be considered in deciding weather the patient had a thorough suddhi or not.

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