VIRECHANA KARMA - A BRIEF DESCRIPTION OF PURGATION THERAPY PROCEDURE

 

VIRECHANA KARMA (PURGATION THERAPY)

Virechana is a procedure in which Prakupita Doshas are expelled through Adhomarga by the administration of medicine through oral route.

Medicines are used in different form like Churna, Kwath, Sneha, Lehya etc. depending on the condition of the patient.

Indications of Virechana (According Astanga Hridaya Sutra Sthana)

Jeerna jwara	Kustha	Prameha
Urdwagata raktapitta	Bhagandara	Arsha
Vriddhi	Pliha dosha	Gulma
Grandhi	Mutraghata	Krimikostha
Sirah shul	Chardi	Visphota
Vata rakta	Arbuda	Visuchika
Alasaka	Pandu	Netradaha
Asyadaha	Hridroga	Vyanga
Aruchi	Haleemaka	Swasa
Kasa	Kamala	Apachi
Unmada	Parswasula	Udavarta
Neelika	Nasika srava	Netra srava
Udara	Timira	Kacham

 

Contra Indications of Virechana (According Astanga Hridaya Sutra Sthana)

Kshataguda	Muktanala	Adhogata raktapitta
Langhana	Durbalendriya	Alpagni
Person treatedbyniruha vasti	Ajirna	Navajwara
Madatyaya	Adhimana	Abhigata
Atiruksha	Atibhubuksha	Krura kostha (hard bowel)
Kshata kshina	Bala	Vridha
Sosha	Atisar

 

Virechana Yogas (preparation) for Various Doshas

Doshas	Yoga (Preparation)	Qty.
Vata disorders	Eranda taila	20-40 ml
Pitta disorders	Trivrith churna	5-10 gm
Vata kapha disorders	Hingu triguna taila	10-20 ml
Vata, Vriddhi	Mishraka sneha	2-5 ml
Vata dosha	Gandharva hasta eranda	15-30 ml
Katishula	Sindhuvar eranda	15-30 ml
Vata sonita	Nimbamritadi eranda	15-30 ml
Pitta dosha	Avipattikar churna	10-20 gm
Twak roga	Manibhadra modak/gutika	20-40 gm
Sthoulya/Twak roga	Ichhabhedi rasa	1-2 tablet
Stree roga	Kalyanaka gutika	10-15 gm
Pitta rogas	Trivrith lehya	10-15 gm

 

Infrastructure Required

Manpower: - One Panchakarma Specialist, One Attendant and One Nurse

Room facilities: - Room with attached latrine

 

Equipments & Materials

Bed, Measuring jar, Commode with graduated scale, Virechana aushadha of sufficient qty.

 

Preparation of patient for Virechana

Poorva Karma:

Proper snehapana followed by Abhyanga & swedana should be carried out as Poorva karma.

Preparatory guidelines:

On the day of virechana, the following things should be ensured before administering the medicine. Proper sleep in the previous night, proper digestion of previous day’s food, proper elimination of natural urges.

After the subsidence of vegas, patient is advised to take bath in luke warm water followed by samsarjana karma.

 

Examination of patient before Virechana Drug Administration

ASHTA STHANA PARIKSHA (Nadi- Pulse, Mootram – Urine, Malam – Faeces, Jihwa – Tongue, Shabda – Voice, Sparsa – Examination by palpation, Drik – Eyes, Akriti – Dimensions of body) is to be carried out prior to virechana. Physical condition like hypertension, dehydration, weakness etc. has to be taken into account before administering virechana drugs.

Season, Time (Kala-Samay) of Drug Administration

Sarad ritu is the best season for virechana. It is better to perform virechana by all during sarad ritu. It will keep away from epidemic diseases (Ritujanya roga). Virechana can be done in any season according to indication. In practice usually virechana aushadha is given at 6 am, so that virechana occurs in pitta kala.

 

Procedure

The prescribed quantity of medicine is to be given in prescribed time along with suitable adjuvant. Patient has to take rest and to drink hot water to stimulate virechana vega. The patient is advised to drink luke warm water after each vega to avoid dehydration.

 

Criteria to be followed to asses Jaghanya, Madhyama, Pravara Suddhi

10, 20, 30 are the desirable number of vegas of virechana for Jaghanya, Madhyama & Pravara Suddhi. In terms of quantity they are 1, 2 & 4 prasthas respectively.

 

Signs & Symptoms of proper Virechana

Purgation may be allowed till kapha is expelled. Purification of Hrit and Kukshi will occur.

 

Ayoga, Atiyoga Lakshana

Ayoga:- Hrit kukshi asiddhi (impurities of epigastrium), aruchi (anorexia), dislodgement of kapha and pitta, kandu (pruritus), vidaha (internal burning sensation), pitaka (skin eruptions), pinasa (rhinitis), flatulence and constipation are the features of Ayoga (inadequate purgation therapy), opposite of these are the features of proper therapy.

 

Atiyoga:- In case atiyoga (excessive purgation), after the elimination of feces, pitta, kapha and vata in succeeding order, there will be expulsion of watery material which does not contain kapha or pitta which is either colourless, black or blood stained. There may also prolapsed of the rectum, trishna (thirst), bhrama (giddiness), sunken eyes and the clinical presentation of excess emesis therapy i.e. excessive weakness, burning sensation, dryness of throat, black outs (timira darsana) etc. Powerful disease of vata origin and even death due to loss of life blood also may occur.

 

Paschat Karma of Virechana

The person who has underwent proper purgation therapy should be administered all other therapies except dhumapana (inhalation of herbal smoke), which are prescribed in emesis therapy. Then he should adhere to the special dietary regimen, in the same way as in emesis and resume his normal diet.

Fasting should be prescribed to a patient who has consumed medicines for purgation, if he has weak digestive power, poor response to purification therapy, if not emaciated, is not weak by vitiated Doshas and has not shown features of proper digestion. By this, the patient will not be harmed (by the discomfort caused) by the obstruction due to utklestia (provoked) Doshas, precipitated by the league of unction and sudation therapies and medicines for purgation. Hence in the patient, whose digestive power becomes dull by purification therapies peyadikarma (special dietary regimen) should be observed. Peya (thin gruel) should not be given when only little quantities of pitta and kapha are expelled out, to persons who are addicted to liquor and in whom vata and pitta are predominant Tarpanadi karma is suitable for them.

 

Samsarjan Karma

Persons who have had the maximum, medium and minimum purification therapies should consume PEYA (Thin gruel), VILEPI (Thick gruel), AKRITA YUSANNA (Rice along with unseasoned vegetable soup), KRITA YUSANNA (Rice with seasoned vegetable soup) and RASANNA (Rice along with meat soup) in successive order, for the two and one ANNAKALA (Time of meal) respectively. It can be started in the same day if appetite appears properly. Otherwise Peyadi karma should be started in the next day morning onwards.

·        In present day practice 3 (three) time KANJI is given for 7 days as Samsarjana at hospital

Minimum Purificatory Therapy
Day	1st Meal	2nd Meal
1	Peya	Vilepi
2	Akrita yusha	Krita yusha
3	Rasa	Prakriti bhojanam

 

Minimum Purificatory Therapy
Day	1st Meal	2nd Meal
1	Peya	Peya
2	Vilepi	Vilepi
3	Akrita yusha	Akrita yusha
4	Krita yusha	Krita yusha
5	Rasa	Rasa
6	Prakriti bhojanam	Prakriti bhojanam

 

Minimum Purificatory Therapy
Day	1st Meal	2nd Meal
1	Peya	Peya
2	Peya	Vilepi
3	Vilepi	Vilepi
4	Akrita yusha	Akrita yusha
5	Akrita yusha	Krita yusha
6	Krita yusha	Krita yusha
7	Rasa	Rasa
8	Rasa	Prakriti bhojanam

 

Dietary & Other lifestyle

Described in ‘PASCHAT KARMA OF VIRECHANA’

 

Clinical vital data recording

Sodium, potassium level of the blood of the patient is to be estimated before and after the procedure. General pathological and biochemical investigations are to be carried out during the treatment. It is necessary to check pulse rate, blood pressure etc frequently during procedure.

 

Follow up therapy

Suitable Samana therapy has to be done according to diseases.