Panchakarma and Allied Treatments in the Management of Sthaulya (Obesity): A Narrative Review

In Ayurveda, Sthaulya (obesity) is categorised as a Santarpanottha Vyadhi (diseases caused by over-nutrition) and is characterised by an excess of Meda and Kapha, impaired Agni, and obstruction of the Srotas. The management of sthaulya focuses on Shodhana (purification) that also exerts Apatarpana (depleting) effects, with Panchakarma as the core therapy. A review of clinical studies on Vamana (Therapeutic emesis), Virechana (Therapeutic purgation), Basti (Medicated enema), such as Lekhaniya Kashaya Basti and Bhadradi Asthapana Basti, Nasya (Nasal administration of medicated oils or powders) was conducted. Bhadradi Asthapana Basti effectively reduced Body Mass Index (BMI) and addressed Kapha-Meda pathology. Lekhaniya Kashaya Basti targeted Meda, Kapha, and Vata at the cellular level. Udvartana (Powder massage) and Rookshana are supportive treatments, whereas Abhyanga is a Purva karma. Udvartana reduced localised Meda more effectively than Abhyanga. Vamana and Virechana, combined with Rookshana Karma, were found to be effective in regulating vitiated doshas, correcting Agni, and clearing the Srotas. Panchakarma is a dosha-specific strategy for managing obesity. As obesity is a chronic, multifactorial, and difficult condition to address, a blend of systemic and local therapies offers a practical and effective approach to its management. However, standardised methods and long-term follow-up are required for widespread clinical implementation. Therefore, this review aims to evaluate the effectiveness of Panchakarma in reducing BMI, Waist-Hip Ratio (WHR), circumference of various body parts (chest, abdomen, hip, mid-arm and mid-thigh) and symptoms of Sthaulya.