Within Tantric philosophy, there are two paths that interpret the panchamakara differently.
Observers of the “left-handed path” practice the panchamakara literally by consuming alcohol, meat and fish, parched grain, and sexual intercourse with orgasm restraint in order to build up kundalini energy in the top chakras.
Observers of the “right-handed path” interpret the panchamakara symbolically. Under this symbolic interpretation, madya represents divine nectar (amrita) or immortality; mamsa represents controlling one’s speech; matsya refers to both the ida and pingala nadi controlled through pranayama practice; mudra represents keeping spiritual companionship and avoiding negative or destructive companionship; and maithuna is about raising kundalini.
In the practice of panchamakara, mudra does not refer to incorporating ritualistic yogic gestures. Historically, it refers to the use of drugs within this Tantric practice as all five of the substances were used by some groups to experience bliss.