Panchakarma in Ayurveda

Dr.Jyothi B.A.M.S

Ayurveda indeed emphasizes a holistic approach to health, considering various aspects beyond just the absence of disease. It takes into account the balance of doshas (biological energies), proper functioning of Dhatus (tissues), healthy Agni ( digestive fire) and normal Malakriya (elimination). Additionally, it acknowledges the importance of a Prasanna Atma (content soul), balanced Indriya ( sensory organs), and a tranquil Manas (mind) in achieving overall well-being. This holistic perspective is a fundamental principle of Ayurvedic medicine, which helps one to cure from the core inside.

What Is Panchakarma?

The word Panchakarma is derived from two words: Pancha, which means five, while Karma means procedure and is five treatments that include curative, preventive and promotive actions for various diseases. Some acharyas also use the word Pancha Shodana ( five purificatory), which means five purificatory therapy.

Acharya Charaka and Vagbhata consider the following  as Panchakarma’s;

  1. Vamana– Emesis
  2. Virechana– purgation therapy
  3. Niruha vasti- enema with decoction
  4. Anuvasana vasti– enema with oil
  5. Nasya– nasal instillation.

While, according to Susrutha Acharya – Father of surgery in Ayurveda, since he deals with surgery, he has given an equal importance to blood along with the Tridoshas, so he has included Raktamokshana (bloodletting procedure) to eliminate the vitiated blood as one among the Panchakarma.

Vamana – Emesis Treatment

In this treatment, the accumulated toxins are removed by means of vomiting. The person is made to vomit by giving medicines called Vamanaushada. Vamana treatment is usually indicated in Kapha dosha imbalance diseases.

Vamana is performed in two ways mainly:- 

  • Sadhyo Vamana– instant therapeutic vomiting
  • Purvakarmayukta Vamana/ Vamana– therapeutic Vomiting.

SADHYO VAMANA

Here, Sadhyo Vamana is a one-day procedure in which the patient is administered with Kashayam (Decoction) or milk in order to induce vomiting and expel the doshas and toxins from the body.

PURVAKARMAYUKTA VAMANA/ VAMANA

Classical Vamana is a collaborative effort where a patient must go through various procedure phases. Like snehapanam, svedanam, samsarjana karma etc.,

So, this procedure takes around 15 to 18 days to complete. The days depend on the disease’s condition and the patient’s digestive fire.

Generally, it takes around 15 to 18 days to complete the procedure.

Now let’s see the phases a patient undergoes while Vamana;

  • PURVA KARMA 
  • PRADHANA KARMA
  • PASCHATH KARMA

 PURVA KARMA (Pre Operative procedure)

This phase is the preparatory phase of the patient before the main procedure.

  • DEEPANA- PACHANA

           First, the patient is introduced to some appetizers and carminatives to enhance the 

           Digestive fire. This is done by taking medications internally, if it’s necessary for one.

  1. SNEHANAM

It means oleation therapy, where the oiliness (snigdhata) is attained to the body.

Bahya and Abyantara Snehana karma ( both external and internal oleation therapies) are done, and both are related to Purvakarma ( preparatory procedure).

After the Deepana-Pachana procedure, a physician can introduce ghee or oil when the patient attains enough digestive fire to digest the medicine. This phase is called the Snehapanam procedure. During the Snehapanam phase, the fat content- tailam/ ghrutha/ vasa ( oil/ ghee/ bonemarrow fat respectively) is taken without mixing in food items called Achasnehapanam.  Sometimes, the administration of Sneha dravya, orally mixed with food items such as gruel, milk, etc., is also done, and that procedure is known as Pravicharana Snehapanam. The Sneha dravya and mode of administration of sneha dravya may differ from patient to patient and is chosen by the physician by analysing a patient’s digestive fire and on the basis of Doshadikya (predominance of Dosha). 

Usually, the duration of Snehapanam takes 5- 7 days. Maximum up to 7 days.We start the Snehapanam procedure with Hruswamatra ( low dosage) of medicinal ghee/ oil, and later on, on each day, we gradually increase the dosage of ghee by analysing the patient’s digestive fire and symptoms of Samyak Snigdha Lakshanam. (signs of attaining saturation of fat in the body) like low appetite, skin becomes more lustre hydrated; stool content has the fat contents (the content of ghee or oil, whatever sneha dravyas are using).

Usually, most of people attain Samyak snigdhata ( saturated with fat contents) within 5- 7 days. However, in 7 days, the snehapanam procedure tends to stop because if we exceeds the procedure, the medicine either starts to digest by not creating snigdhatwa and becomes satmya ( ) or the patient get ati snigdha ( excessively oleated). During the Snehapanam phase, the patient is only allowed to take kanji( porridge) with no salt and that too only if the patient feels appetite. And the patients are not allowed to sleep during the daytime. And exposure to excess wind, breeze, sunlight, hotness, and excessive exercise is contraindicated. Use warm water for drinking and for body baths also.

Bahya Snehanam

After internal oleation, when the patient attains samyak snigdha lakshanam bahya snehana, i.e., external oleation therapies like Abhyangam ( body massage with oil), etc., is done and then advise svedana ( sudation) procedure is done, before the main procedure.

  • SVEDANA

This is the procedure which induces sweating for therapeutic purposes. It is usually done after Snehanam (oleation therapy).

PRADHANA KARMA (Main Procedure)

Here comes the main procedure where all Utklishta doshas ( therapeutically aggravated doshas after Snehana Svedana karma ( oleation and sudation) phases will be forcefully expelled out through the therapeutic emesis (Vamana).

Here, the patient is advised to take medicines to his/her neck level. For this, milk and decoctions made of certain medicines are given. After that, Vamanaushada dravya is given in Kapha kala ( early morning), and then the patient starts to vomit – expelling out Utklishta doshas and toxins from the body. 

Virechana – Purgation Treatment

Here, in this treatment, the accumulated toxins are removed by means of Virechana (purgation).The person is made to have loose motions for a short while by administering medicines. Virechana treatment is usually indicated in Pitta dosha vikaras ( diseases that occur by pitta dosha)

Again, Virechana is of many types, which are classified usually on the basis of mode of medication, duration, purpose, Doshadhikya ( predominance of dosha along with Pitta dosha) etc., for example, in Sukha Virechana ( mild effortless laxatives) are used, in teekshana Virechanam( strong laxatives ) are used, in Ruksha Virechanam (is usually done when Kapha dosha associates with Pitta dosha), Snigdha Virechanam ( is usually done when Vata dosha associates with Pitta Dosha), Sadhyo Virechanam is done where elimination of toxins and Pitta is needed instantly, Nitya Virechanam is done where purgation is needed on daily basis. Like this, various types of Virechana karma ( purgation therapies) are there, which are planned and chosen by the physician after analysing a patient’s body, Doshadhikya ( predominance of doshas) condition of disease and patient.

Usually, in Virechanam  (purgation procedure), the patient needs to go through the same Purvakarma ( preoperative procedures) and  Paschath karma (post-operative procedure), almost the same as Vamana( emesis therapy). 

Here also;

PURVAKARMA

  • Deepana- Pachana ( intaking of appetisers and carminatives)
  • Snehanam ( oleation treatments)
  • Svedanam ( sudation treatment)

These three steps are almost the same as in Vamana ( emesis therapy). Maybe the number of days may differ. This Vamanam and Virechanam for removing Kapha And Pitta, respectively, are like brothers as far as treatment is concerned because the deepana- pachana karma ( appetisers), the oleation phase ( snehana karma), the sudation phase and the medicine administering phase are more or less the same.

PRADHANA KARMA

After snehana and svedana karma, on the day of Virechanam, the patient is administered Virechanoushada ( purgative medicine), which helps to expel the doshas and toxins through the anal route as loose motions.

How do Vamana And Virechana Work?

During the Snehapanam phase, what happens is;

  • The fat contents (oil/ ghee) that the patient takes percolate inside the body and reach every tissue across the body. This ghee/ oil ( fat contents usually have the quality to stick to things which come into contact with.
  • So when this ghee/ oil ( fat contents) enters the body, it gets stuck with these doshas and toxins.  
  • So next comes the Snehana karma with Svedana ( external oleation therapy with sudation) is done. Here, the body gets oleated again externally by doing abhyanga ( body massages) and later exposed to warm temperatures to make the patient sweat.                                 
  • Thus it helps to bring Shakhasrita doshas (Dosha accumulated in different part of body ) into Koshta, as we all know that ghee or oil will get melted easily by excess heat and liquefy and start to flow. Our body is designed in such a way that whatever flows will automatically come and be collected in the Koshta (Amashahaya and Pakwashaya) region.                                      
  • This is taken as an advantage, one medicine is given in the next phase, which helps to expel out doshas easily.

The procedure of Purvakarmayukta Vamana and Virechana is almost the same, and one difference is in Vamana Kapha dosha toxins come out with the medicine as vomiting, while in Virechana the medicine gets digested and flushed out with Pitta and toxins as loose motions

PASCHATKARMA 

In Paschatkarma, Acharyas have given more focus to diet that to follow after the main procedures which are known as Samsarjana karma. After Vamana and Virechana , digestive fire becomes very low, especially in patients who underwent through the Snehapanam phase in the Snehanam procedure, where the patient is only supposed to take the fat contents- ghee/ oil for 5 to 7 days and later undergoing the main procedure. So, what Samsarjana Karma does is to re-establish the digestive fire after these procedures. This phase will extend up to 5- 7 days. Here before planning the Samsarjana karma physician analyses the patient and plans how the diet should be. And its done according to the number of vegas by patients during the procedure( Vama and Virechana) and the strength of purification therapy. 

Vegas means the number of how many times the patient passes the motion in Virechana karma and how many times the patient vomits during Vamana karma. A patient with maximum Purification is termed as Avara Shudhi. When 8 bouts of vomiting in Vamana and 30 bowel movements during purgation in Virechana occur is said to be

 Avara Shudhi.

DAY FIRST MEAL SECOND MEAL
  1 PEYA PEYA
  2 PEYA VILEPI
  3 VILEPI VILEPI 
  4 AKRUTHA YUSHA AKRUTA YUSHA
  5 AKRUTA YUSHA KRUTHA YUSHA
  6 KRUTA YUSHA KRUTA YUSHA
  7 RASA RASA
  8 RASA NORMAL DIET

Here

  1.  PEYA – Thin gruel.
  2. VILEPI- Thick gruel
  3. AKRUTA YUSHA-  unseasoned vegetable soup
  4. KRUTA YUSHA- seasoned vegetable soup
  5. RASANNA- rice along with meat soup or protein-content food.
  6. Normal Food- get back to normal diet

A patient with Medium Purification is termed a Madhyama Shudhi. When a person is having 6 bouts of vomiting in Vamana and 20 purgations, Virechana is meant to be Madhyama Shudhi.

DAYS FIRST MEAL SECOND MEAL
  1 PEYA PEYA
  2 VILEPI VILEPI
  3 AKRUTA YUSHA AKRUTA YUSHA
  4 KRUTA YUSHA KRUTA YUSHA
  5 RASA RASA
  6 NORMAL DIET NORMAL DIET

A patient with minimum purification is termed Avara Shudhi. When a person has four bouts of vomiting in Vamana and 10 purgations in Virechana, it is meant to be Avara Shudhi. 

DAYS FIRST MEAL SECOND MEAL
  1 PEYA VILEPI
   2 AKRUTA YUSHA KRUTA YUSHA
  3 RASA NORMAL DIET

By observing Peyadikramas in Samsarjana karma after purification therapies, the digestive power which has been lowered by the therapies will gradually enhance, becomes steady and capable of digesting everything.

Basti – Enema

Two types of rectal enemas exist in Ayurveda. 

  • Niruha Vasti, Kashaya, or Ruksha Vasti ( enema with decoctions) and
  •  Anuvasana Vasti or Sneha Vasti (oil enema). 

The Ayurvedic enema is quite different from the regular enema given to relieve constipation. Even though Basti treatment is adopted predominantly for Vata imbalance, it is used in a wide range of diseases because of its action. Thus, Basti plays a very important role in Panchakarma.

Basti– medicated decoctions or oil enemas given through the anal, urethral or vaginal route are the best treatment to combat vitiated vata and help to pacify it.

Vata dosha is believed to have its predominant seat in the colon, but it can affect other areas of the body as well, including the pelvis, ears, bones, and skin. Balancing Vata is essential for maintaining overall health and well-being in Ayurveda.

Basti has much importance in Ayurveda and also Panchakarma because of its benefits.

Vasti / Basti is said to be Agroushada for Vata, and it says a physician can treat any disease with Basti by using his Yukti ( logic) along with it. That’s why Basti itself is mentioned as Ardha Chikitsa – half treatment. Since its having its action from the head to the tip of the toes, it plays an important role.

As with other Pashatkarma, Basti also has Purvakarma, Pradhana karma and Paschatkarma.

ASTHAPANA BASTI/ VASTI

This vasti is also known as Ruksha vasti because if it is Ruksha guna (dry nature), also known as Kashaya Vasti because unlike Anuvasana vasti here Kashaya ( decoction) is used as the key ingredient. Other than the Kashaya, other ingredients like honey, saindava ( rock salt) etc is added to it. The Decoction will be differ from person to person and is choosed by physician according to the condition of patient.

In Purvakarma ( preparatory procedure)– usually, Snehana is done with Bahyasnehana and then svedanakarma.

In Pradhanakarma– the enema is given through the anal route, and the patient suddenly has the urge to pass the bowel after Basti.

In Paschat Karma- it is are somewhat different two types of enemas; 

In Asthapana / Kashaya Vasti the patient suddenly needs to take a bath and have food after the motion passes. 

ANUVASANA BASTI

This enema is different from the Asthapana Basti; here, oil is used instead of decoction thus, its also known as Sneha Basti because of its snigdhatha (unctuousness).

In Purvakarma ( preparatory procedure)-

The patient is supposed to have the food only after taking the food Anuvasana basti is done.

and Snehana is done with Bahyasnehana ( here abdominal massage) and later Svedanam ( sudation) is given to the patient.

In Pashchatkarma (post-operative procedure),

In Anuvasana vasti  (oil enema ), unlike Asthapana basti, the patient is supposed to stay for a while, and the motion doesn’t pass immediately after the procedure. 

There are a variety of enemas, and on the basis of the chronicity of disease and patient after analysing the doshadhikya (predominance of doshas) and strength of the patient a physician can plan it.

Nasya – Nasal Instillation

Instillation of powders or Ayurvedic liquids through the nose is called Nasya treatment. It is usually prescribed for Urdhwajatrugata Vikara (a disease that manifests above the clavicular region, Thus, it is usually prescribed for diseases of the ear, nose, throat, and head- and hence, Nasya ensure the healthy parts above the neck and enhances the healthy functioning of Indriyas.

Mainly, Nasya is of two types on the basis of dosage:

  • Marsa Nasya (higher dosage)- is to be done under medical supervision.
  • Pratimarsha Nasya (lower dosage) – which can be done on a daily basis) without much precautions as in Marsha Nasya.

While Pratimarsha Nasya can be done on a daily basis without any preparation, while Marsha Nasya can only be practised under the supervision of a physician. Here, the preparatory phase and post-operative phase are there.

  • Purvakarma ( Preparatory Procedures)
  • Pradhanakarma ( Main Procedure)
  • Pashchatkarma (Post-operative Procedures)

Purvakarma 

Bahyasnehana is given by Mukha Abhyanga ( face massage with medicated oil) and later Svedanam is given usually, Nadi Svedanam is preferred.

Pradhanakarma

Here, a prescribed amount of nasal medicine is instilled into the nasal cavity through the nostrils.The patient is asked to spit out the phlegm, whatever toxins are draining into the mouth.

Pashchatkarma

Here, after instilling the medicine, the patient’s soles, neck, palms, ears, etc., should give a mild massage administered with svedana and Dhoomapanam ( smoke inhalation- prepared with medicine), then advised to take Kavalam ( gargle) with medicated lukewarm water.

Patients who underwent the Nasya are not supposed to wash their heads and can’t use cold water to wash their bodies. Patients are not supposed to go to wind exposure or heat exposure, are not supposed to sweat and heavy exercises are contraindicated. And Nasya procedure can’t be done soon after the food, and a patient can’t intake food soon after Nasya.

Right Time For Nasya

Nasal medication should be administered in;

  • Morning – if Kapha is increased
  • Mid day – if Pitta is increased.
  • Evening – if Vata is increased.

It should be given in the forenoon during the Sharath ( autumn) and Vasanta ( spring) seasons. During Winter, Nasya can be done at midday if it’s too cold.

And in the summer in the evening. However, the time of medicine installation and type and dosage of medicine for Nasya will differ from person to person and is chosen by the physician after analysing the condition of the disease.

Who Needs Panchakarma Treatment?

Panchakarma is a therapeutic procedure aiming to cleanse and rejuvenate the body. While it can benefit many people, its suitability should be assessed individually, taking into account factors like one’s health, age, and specific conditions.

Benefits of Panchakarma Treatments

  • Ayurveda is a traditional system of medicine that emphasises a balanced body’s doshas, which are Vata, Pitta, and Kapha. When these doshas become imbalanced, it can lead to various health issues. Ayurvedic treatment aims to restore the equilibrium of these doshas.

    Panchakarma, as mentioned, is a key component of Ayurvedic Therapy. It involves a series of five therapeutic procedures which give benefits of:

    • Detoxifying – toxins are eliminated from the body.
    • Regain the balance of Tridoshas– These procedures help remove accumulated toxins and restore the body to a state of balance. 
    • Rejuvenation of the body– slows the ageing process and increases the lifespan.
    • Relaxation for the body– stress is reduced, and the body gets relaxed.
    • Energy level increases- helps to boost the immunity and body energy level.
    • Increases mental power– enhances strength, energy, vitality and mental clarity.
    • Enhances skin glow– Increases the glow and lustre of skin.

  • Helps to implement a healthy diet and lifestyle.

    Thus, Panchakarma can be used to manage various health conditions for preventive, curative and promotive purposes.

Ayurvedic Panchakarma Treatment

Lifestyle And Diet Changes During Panchakarma Treatments

One must follow the Diet and lifestyle while undergoing the Panchakarma procedures.

Here are some important common rules to be followed during Panchakarma procedures:

  • One must use only warm water for drinking, baths (except the head) and other activities.
  • A person who is undergoing Panchakarma therapy can not indulge in sex.
  • Sleeping in the daytime is contraindicated.
  • Natural urges should not be controlled.
  • Exposures to extreme temperatures or weather conditions have to be avoided.
  • Ratri jagaranam (keeping awake at night) is not advisable.
  • Foods that cause Amam (indigestion) can not be consumed.
  • Mental stress and heavy exercise have to be avoided.

Even though these are the common regimens to follow while undergoing the Panchakarma procedure, each procedure of Panchakarma has its own Purva karma (preparational procedures) and Paschat karma (post-procedure), diets and regimens to follow and avoid while undergoing Panchakarma procedures.

Steps and Procedures In Panchakarma

Usually, Panchakarma is performed in three steps:

  • Purvakarma– Preparatory procedures
  • PradhanakarmaMain procedures
  • Paschathkarma Post-operative procedures.

for every procedure, a patient needs to go through these phases, which will be different for each procedure. Why are these Purvakarma (pre-operative measures) so important to follow before Panchakarma? Can any Panchakarma procedures be done without Purvakarma? is the same way of steps and procedures to be followed before every Panchakarma. Is it necessary for everyone to undergo Purvakarma before Panchakarmas?

Most often, many people have these questions and doubts about procedures, and When we step into the description of these questions, we should know about some basic concepts that we follow in Ayurvedic treatments, like concepts about doshas,  bahudoshavastha, Leena dosha avastha, upasthita doshas etc;

Bahudoshavasta – is the phase in which vitiated Doshas are in excess quantity and where Shodhana can be indicated. 

Leena Doshavastha– is the dosha that is stick on to a specific area. In this stage usually one doesn’t prefer Shodhana directly because it will be like the extraction of juice from unriped fruit. So it will be very difficult for the doshas in this phase.

Upasthitha Doshas– here, the accumulated dosha from shakha (extremities) to koshta  ( can be correlated with stomach/ intestine) and have changed from their fors from Leenavastha to Utklishta avasta ( aggravated) can be said as Upasthitha Doshavastha.

Purvakarma  Pre-operative Procedures

Purvakarma gives the body a gentle introduction to more intensive treatments that follow in Panchkarma. Without preparatory measures, the body may react adversely to the abrupt detoxification process in Panchakarma. By doing Purvakarma procedures, if doshas are Bahudoshavastha, by Snehana and svedana by making it Utkleshavastha, which helps to expel the doshas easily. And if the doshas are in leena avastha, then by Purvakarma, we bring the leena dosha to Upasthitha dosha and then expel it through shodhana karma (purification process).

Pradhanakarma 

Pradhana karma expels toxins and Utklishta doshas (aggravated doshas) from the body through any of Panchakarma.

Pashchatkarma

Pashchatkarma helps the body regain normalcy, like digestive fire, appetite, etc., by following Samsarjanakarma ( diet and regimens) as mentioned according to the Panchakarma practised .

What Happens to Your Body After Panchakarma?

Panchakarma improves health and promotes the body’s self-healing power. After the five purification procedures of  Panchakarma, once the dosha gets back to normalcy, a healthy body with a healthy mind will be regained. The whole body is cleansed in the Panchakarma treatment. During the Panchakarma itself, after one or two phases, you will notice both mental and emotional changes to your body. For some, it’s common to experience a healing crisis in the initial phases, which is usually seen as a beneficial step.

A healing crisis is- when toxins are expelled through purification procedures; expelling of unwanted toxins may cause insomnia, a feverish-like feel, tiredness, general discomfort, heaviness and achy feel. Up to an extent, it’s necessary and is experienced as a part of the natural process of tissue cleaning. Thus after Panchakarma therapies as aggravated doshas get expelled and thus by regaining the normalcy of Tridoshas and digestive fire, both body and mind get healthy and calm, feel fresh and get rid of Disease condition

Panchakarma Treatment at Dheemahi Ayurveda

Dheemahi Ayurveda is an authentic ayurvedic hospital having a team of expert doctors for patient care with the knowledge of the past five generations and thus we follows the traditional way of healing methods as per Ayurveda. Thus we ensure the quality of treatments that we provide for healing too.Dheemahi Ayurveda village provides a calm and peaceful atmosphere which also has a major role in curing the disease. Mind serves equal importance as the body in attaining a healthy life. The spacious Garden and living rooms support your peaceful stay and healing process.

While privileged resorts give calm and beautiful surroundings for your stay. Dheemahi facilitates the same with a professional approach of doctors and treatments. We have our own pharmacy and medicine manufacturing unit – through this, we can provide you with authentic medicines and assure you to get cures. Our team of professionals help you achieve a complete state of health and vitality by giving you a daily food and lifestyle routine.

Conclusion

Panchakarma treatments are a very important part Of Ayurveda. But often, people who are new to Ayurvedic treatments  always mislead or confuse Panchakarma treatments with other treatments like Massages, kizhi, etc., and sadly, some people often misuse it too. Always remember you are supposed to undergo any Panchakarma treatments only under a certified physician and in a place where authentic treatments are provided. The mode of steps or procedures followed during the Panchakarma procedures may have slight changes, as planned by the physician by analysing the dosha avastha, stage of disease and condition of the patient.

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