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Demonstrating the effectiveness of Panchakarma requires evidence that is credible to clinicians, regulators and patients. This article examines the nature and quality of the clinical evidence for Panchakarma, the methodological challenges that complicate randomised controlled trials (RCTs) of individualised, multi-component and procedural interventions, and the tools used to appraise evidence, including CONSORT, PRISMA, Cochrane risk-of-bias and GRADE. Available studies include observational programme evaluations, metabolomic work in healthy participants and RCTs of Ayurvedic treatment approaches in conditions such as osteoarthritis. Overall, the evidence is promising but limited by small sample sizes, heterogeneity, inadequate blinding and incomplete reporting. A structured agenda for improving trial design is proposed.