"CLINICAL ASPECTS OF VIRECHANA AND ITS MODE OF ACTION" Presented by Dr. Suraj Kumbar ,PG Scholar, Department of Panchakarma, SDMCAH Hassan

1. CLINICAL ASPECTS OF VIRECHANA
AND ITS MODE OF ACTION
By: Dr. Suraj Kumbar
PG Scholar
Department of Panchakarma
S.D.M.College of Ayurveda & Hospital, Hassan

2. INTRODUTION
Virechana (Purgation) is the second most therapy
in the sequence of Panchakarma. It is most widely
used purification procedure especially for Paittika
disease (diseases due to vitiation of Pitta) because
of its simplicity, eliminating the Doshas in more
quantity, with less stress and having lesser
complication compared to Vamana Karma. It is
also useful in the disorders of Pitta associated
with Vata or Kapha.

3. • The forcible expulsion of vitiated Pitta or Kapha
associated pitta through the anal route is called Virechana.
• After Snehana (oleation) and Swedana(sudation)Karma
the process is followed by induction of Virechana by
Virechana Kalpas (medicine for Virechana), as
described in ‘Apamargatanduliya Adhyayah’ and in
‘Kalpa Sthana’.
• The patient is advised to Samsarjana Krama
(specific dietary regimen) to reach up to normal diet and
to complete the therapy. The whole procedure including
Snehana, Swedana and Samsarjana Krama is called
Virechana Karma.

4. Nirukti
Virechana word is made by combination of main ‘Rich’
dhatu and ‘Vi’Upsarga and ‘Nich’ ‘Lyut’ Pratyayas
giving meaning ‘Visheshena Rechayateeti’.
Rechana is derived from root word ‘Ricir Dhatu and
LyutPratyaya’ (Mala Bhedana).
Acharya Charaka has mentioned Virechana word
for both Vamana and Virechana in KalpSthana. So
the word Rechana is commonly used for evacuation of
Doshas, which is done by both Vamana and Virechana.
But in general, the word Virechana denoted evacuation
of Dosha through anus.

6. • Upper gastrointestinal tract
The upper gastrointestinal tract consists of the esophagus,
stomach, and duodenum.
Some sources also include the mouth cavity and pharynx.
• Lower gastrointestinal tract
The lower gastrointestinal tract includes most of the small
intestine and all of the large intestine. According to some
sources, it also includes the anus.

7. – Small intestine, which has three parts:
• Duodenum. The digestive enzymes break down
proteins and bile emulsifies fats into micelles.
Duodenum contains Brunner's glands which produce
bicarbonate and pancreatic juice contains bicarbonate to
neutralize hydrochloric acid of stomach
• Jejunum - It is the midsection of the intestine,
connecting duodenum to ileum. Contain plicae
circulares, and villi to increase surface area.
Ileum - It has villi, where all soluble molecules are absorbed
into the blood .
– Large intestine, which has three parts:
o Cecum
• Colon.
• Rectum and Anus

8. DIGESTION AND ABSORPTION
• The gastrointestinal system is primarily involved in reducing food
for absorption into the body.
• This process occurs in 4 main phases:
i) Fragmentation
ii) Digestion
iii) Absorption
iv) Elimination of waste products
• - Initial fragmentation of food occurs along with the secretions of
the salivary glands, in the oral cavity forming a bolus.
• - Bolus of food is then carried to the esophagus by the action of the
tongue and pharynx (deglutition).

9. • - Esophagus carries food from mouth to stomach, where
fragmentation is completed and digestion initiated.(Eg: protein
to polypeptides followed by small peptides and amino-acids).
• - In the stomach food is converted into semi-digested liquid
(chyme) which passes through the pylorus, into the duodenum.
• - Unabsorbed liquid residue enters the cecum through ileo-
cecal valve where water is absorbed and become progressively
more solid as it passes into the anus

10. Small Intestine
Where most
nutrients are
digested and
absorbed.
Duodenum
• Jejunum
• Ileum

11. SMALL INTESTINE - ANATOMY
- connects stomach to large intestine; 15-20’ long;1” diameter; held together in
abdominal cavity by “mesentery proper”
- site for completion of chemical digestion & absorption of nutrients
- comprised of three regions:
Duodenum – 10” in length;
receives chyme from stomach,
secretions from liver,
gallbladder & pancreas
Jejunum – 8’ long; most
digestion & absorption
occurs here
Ileum – 12’ long; connects to
cecum of large intestine at
iliocecal valve (sphincter)

12. SMALL INTESTINE
Modifications in mucosa & submucosa of intestinal wall
designed to increase functional surface area:
Plicae
circulares
 Plicae circulares (circular folds) – large
transverse ridges; most abundant in
jejunum
 Villi – small finger-like projections of
mucosal folds across surface of intestine

13. ABSORBING NUTRIENTS
Figure 4.26
Villi
Tiny projections that line
the small intestine
Absorptive cells
Remove nutrients from
chyme and transfer them
into intestinal blood or
lymph

14. WATER-SOLUBLE NUTRIENTS
ENTER THE CAPILLARY OF A
VILLUS, AND TRAVEL TO THE
LIVER VIA PORTAL VEIN.
MOST FAT-SOLUBLE
COMPOUNDS ARE FORMED
INTO CHYLOMICRONS, THAT
ENTER A LACTEAL OF THE
LYMPHATIC SYSTEM AND
EVENTUALLY REACH THE
BLOODSTREAM.
 Figure 4.26

15. LARGE INTESTINE
Absorption of water
and minerals
Feces – form as
chyme becomes
semisolid
Rectum – lower part
of large intestine
where feces are stored
 Insert
figure 4.21

16. LARGE INTESTINE
- Begins at the ilium & ends at the anus; 5’ long; 3” in diameter
- main functions – H2O reabsorption; absorption of some vitamins & minerals;
formation & temporary storage of fecal material
Rectum
ileum
Ileocecal sphincter
Cecum
Vermiform appendix
Ascending
colon
Transverse
colon
Descending
colon
Sigmoid colon
Anal canal
Rectum
- 3 regions: cecum, colon, rectum
Hepatic (rt.
Colic) flexure
Splenic (lt. colic)
flexure

18. THE TRANSIT OF PHARMACEUTICALS IN THE
GASTROINTESTINAL TRACT
The transit time is long and variable and depends on
the following; type of dosage form, diet, eating pattern
and disease state.
The transit time is relatively constant, at around 3 hours. This
contrasts with the stomach as it does not discriminate between
different dosage forms or between fed or fasted state. It the main site
for absorption for most drugs. Hence, an important parameter for
drug targeting.
The transit time in the stomach is highly variable and depends
on the dosage form and the fed or fasted state of the stomach.
Once a drug is placed in the mouth it is moved down the
oesophagus by the swallowing reflex. The transit time of the
dosage form in the oesophagus is rapid usually 10-14 seconds.

20. Classification of Virechana
Mode of Action
Intensity of Action
Parts Used
Properties

21. Virechana drugs according to their
origin and parts used
Animal origin - Urine, Milk, Takra (Butter milk)
Plant origin -
Mulini drugs - The roots of the plants, which have been
recommended for Virechana are Hastidanti, Shyamatrivrita,
Adhoguda (Vidhara), Saptala, Pratyagasreni (Danti), Gavakshi,
Vishanika, Ajagandha, Pravanti, Kshirini, Shankhini, Sruk,
Svarnakshiri, Chitraka, Kinhi, Kusha and Kasha, Vacha, Hrasva
Panchamula, both Punarnava, Vastak, Shak, Shala.

22. Phalani drugs - Phalini drugs are mainly Shankhini, Vidanga,
Anupa Klitaka, Sthalaja Klitaka, Abhaya, Antahkoterpushpi,
Kampillaka and Aragwadha, Puga, Haritaki, Amalaki,
Vibhitaki, Nilini, Chaturangula, Eranda, Kampillaka, Pilu,
Priyal, Kubala, Badara, Karkandu, Kasmarya, Parusaka,
Draksha etc.
Kshirini drugs - Snuhi and Arka, Saptachhada,
Jyotishmati.
Tvak - Barks of Putika, Tilvaka, Kampillaka, Ramyaka
Patla etc.

23. Virechana drugs by Charaka

24. Virechanopaga Dashamani
Sr. No. Drugs Latin Name
1 Draksha VitisviniferaLinn.
2 Gambhari GmelinaarboreaLinn.
3 Parushaka Grewia asiatica Linn.
4 Abhaya TerminaliachebulaRetz.
5 Amalaki Emblica officinarum Linn.
6 Vibhitaki TerminaliabelliricaRoxb.
7 Kuval Zizyphus sp.
8 Badar ZiziphusmauritianaLam.
9 Karkandhu Ziziphusnummularia(Burm.f.)W.&A.
10 Pilu SalvadorapersicaLinn.
There are certain drugs, which helps in proper Virechana or which
will synergic action of Virechana Dravya is known as
Virechanopaga

25. Classification of Virechana
Dravya (acc to Action)
Virechana drugs by charaka 1.Mrudu Ex:Aragvada
2.Sukha Ex:Trivrith
3.Tikshna Ex:Snuhi/Danti
Another classification given by Charaka
1.Bedaniya Ex:Arka/Eranda/Shankini
2.Anulomana Ex:Hingu/Amlavetasa
3.Sramsana Ex:Yava kshara
4.Virechanopaga Ex:Draksha/gambari/
peelu/Amalaki/haritaki/vibhitaki

26. Mrudu Virechana:
The Drugs, which are Manda in Virya, when combined with opposite Virya or
given in low dose, given to Ruksha patient and causing less purgation is known
as Mrudu Virechana. Charaka has the view that the physician should not
hesitate to use Mrudu Virechana drugs in weak patients having more Doshas
because repeated elimination of Doshas in small quantity may cure the disease.
The patient who have not taken Virechana Drugs in past and whose Kostha is
unknown in such patients Sushruta recommended the use of Mrudu Virechana
drugs in the beginning and after knowing the Kostha required drug may be
prescribed.
Sharangadhara recommended that the Mrudu Virechana drugs i.e. Draksha,
milk, warm water, castor oil etc. should be used in Mrudu Koshthi patient.
Drugs effective in Mrudu Koshta are Guda, Sugar cane juice, Mastu,
Ulloditadadhi, Payas, Kshira, Sarpi, Kashmari, Triphala, Pilu and
Tarunamadya.
Virechana drugs according to intensity of action

27. Madhya Virechana: The drugs which are moderate in
qualities are known as Madhya Virechana drugs. These
drugs are specifically indicated in the patients having Madhya
Roga (disease with moderate symptoms). The administration
of these drugs in Balavana patient is useless, because they are
unable to eliminate Dosha completely.
Sharangadhara recommended the use of Trivrut, Katuki and
Aragvadha for Madhya Kostha.
.

28. Tikshna Virechana: The drugs which cause Mahavega
(numerous motions) and eliminates the Doshas in large
quantity by Kshipra (quick) and gentle purgation causing
neither much Glani (depression) nor pain in heart area or
anus nor harmful to internal organs, is known as Tikshna
Virechana.
Acharya Charaka recommended the use of these drugs
in the Balvana Rogi, presenting all the symptoms of
the disease i.e. Tikshana Vyadhi. Snuhi Kshira is the best
Tikshana Virechana drug among those drugs

29. Acharya Sharangadhara has classified the drugs from their mode of action.
A group of drugs known as ‘Virechanopaga’ mentioned by Acharya
Charaka, which may also beaded to this classification.
Anulomana: The drugs, which move the Malas downwords after digestion
and breaking their bandha, are known as Anulomana. e.g. Haritaki
Sransana: The literary meaning of Sransana is to slip or to fall down. The
drugs, which bring the semi-digested and sticky Malas without causing their
digestion is known as Sransana. e.g. Aragvadha.
Bhedana: The Drugs which disintegrate the Abaddha (unformed) or Baddha
(formed) or Pindita (dried focal mass) forms of Malas by facilitating
penetration into it and then evacuating through the lower gut is known as
Bhedana e.g. Katuki. Acharya Charaka has described a group of drug
named as Bhedaniya. This includes Suvaha (Trivrit), Arka, Urubuka (Eranda),
Agnimukhi (Kalihari), Chitra (Danti), Chitraka, Chirabilva, Sanhini,
Shakuladani (Katuki) and Svarnakshiri.
Virechana drugs according to their mode of action

30. Rechana: The drugs which eliminates Pakvam (digested) and
Apakvam (undigested) Malas or Doshas by making them
watery through the lower gut is known as Rechana. e.g. Trivrut.
Virechanopaga: The Virechanopaga Gana described in Charaka
Samhita has been considered as helping in inducing Virechana.
These are Draksha, Kasmarya, Parusaka, Abhaya, Amalaki,
Bibhitaki, Badara, Karkandu and Pilu.

31. Virechana from Ruksha and Snigdha
Properties
 The drugs which are used in the form of oil or the
preparation containing Sneha is known as Sneha Virechana
e.g. Castor oil. Vagbhatta recommended the use of Sneha
Virechana in all patients except Snigdha patient.
 The use of Sneha Virechana in the patients who have taken
higher dosage of Sneha is contraindicated because due to
this the movable Doshas may again adhere in the Srotas.
 The preparations, which do not contain Sneha, can be
used as Ruksha Virechana. It has been recommended on
the Snigdha patients who have comparatively taken
more Sneha.

32. Classification of Laxative :
These drugs are sometimes classified according to the intensity of action
as mild, moderate, severe laxative effect suggest the eliminations of soft,
formed stool without griping and without much loss of water. In large doses,
many laxatives promote catharsis which means purgation and the passage
more fluid stools.
of
(1) Drugs which accelerates the passage of food.
a. Bulk purgatifve : These work by one or more of the following actions.
I. Non metabolizing
II. Retaining water
III.Promoting peristalsis e.g.plant gums like sterculina, isabgole, etc.
b. Faecal softners : As dioctyl sodium sulphosuccinate.

33. c. Osmotic purgatives
i. Poorly absorbed solutes, which maintains an increased fluid volume.
ii. Accelerate transfer to gut contents through small intestine to
iii. Large volume in colon results in purgation.
colon.
iv. Saline purgative e.g. MgSO4 doubles the volume of faeces.
d. Stimulant purgative
i. Stimulates the mucosa of gut.
ii. Irritate local reflexes e.g. castor oil.
Castor oil is hydrolyzed in small intestine by lipase to give ricinoleic
irritates and requires bile for hydrolysis.
acid which

34. (2) Drugs which increases GI motility
Local stimulant effect on motility
Acceleration of gastric emptying,
secretion.
but no effect on gastric-
Thought to activate cholinergic neurons.

35. they may also be classified according to the pattern of laxative effect following
the therapeutic doses into :
(1)Slow Onset :Those which produce softening of the stool after one to three
days of daily use bulk laxatives, mineral oil, Dioctyl Sodium Sulphosuccinate,
lactulose.
(2) Intermediate Onset : Those which lead to soft or semisolid stool in 6 - 12
hours of a single dose Saline laxative (low dose), phenolphthalein, bisacodyl
(oral) anthraquinone group.
(3) Rapid Onset : Those which leads to watery evacuation in 2 -6 hours of a
single dose saline laxative (high dose), castor oil, bisacodyl.
Out of these, certain drugs increase the motility of intestine certain modify the
fluid dynamics of the mucosal wall and may cause fluid accumulation in lumen.

36.  Pitta alone. e.g. Amlapitta
 Pitta in association with Kapha. e.g. Vicharchika
 When Kapha is situated in the seat of Pitta. e.g. Kamala
 When Pitta is situated abundantly in the seat of Kapha.
e.g. Ardhavbhedaka
AREA OF VIRECHANA KARMA

37. Durbala, Durbalendriya,
Adhoga-Raktapitta, Alpagni,
Garbhini, Navaprasuta,
Madatyaya, Navajvara,
Navapratishyaya, Adhmana,
Atisthula, Atikrisha, Atisnigdha,
Atiruksha
Contraindications of Virechana

38. Svastha
Kushta, Visarpa
Sthula Madhumehi, Pandu
Shvasa, Kasa
Gulma, Amlapitta, Udararoga,
Grahani
Vatavyadhi, Vatarakta, Udavarta,
Yonivyapad
Common Indications

39. The mode of action of Virechana dravyas
• Acharya Charaka’s described a very unique
and conceptual mechanism of Vamana and
Virecana Karma.
• The mechanism of Vamana as well as
Virechana is almost the same because they
have more or less the same properties.
• The difference between both mechanisms is in
the Pancha-Mahābhaūtik composition of
Kalpas(medicine) thereby eliminating route.

40. Properties of Virechana Dravyas
• Guna: Virechana Dravyas have all the properties of
Vamana Dravya i.e. Ushna, Tikshana, Sukshma, Vyavayi
and Vikasi.
• Panchabhautika Sanghathana : These drugs consist of
Prithvi and Jala Mahabhutas.
Virechana drugs have a specific property of removing the Doshas
from the lower part of the body (Adhobhaga).
• Virya :Virechana drugs possess an inherent Virya.
• Prabhava: Inherent Prabhava on virtue of which, they can
induce Virechana.
The main action of Virechana Dravyas is on Adhobhaga of the
individual.
The vitiated Pitta Dosha present in entire body is alleviated and
expelled out through the mechanism of Virechana and the
disease process is arrested.

41. Mode of Action

43. The Virechana Dravya spreads throughout the body of cellular
level due to its pharmacological properties.
 Vyavayi property of Virechana Dravya is responsible for
quick absorption, while
Vikasi Guna causes softening and loosening of the bond by Dhatu
Saithilya Karma.
 Due to Ushna Guna, the Dosha Sanghata (compeactness) is
liquefied (Vishyandana).
 Tikshna properties of Virechana drugs produce Chedana of
the Doshas, which are already softened due to oleation
therapy or able to disintegrate the Sanghata of the Doshas.
According to Dalhana this action is due to quick excretion
(Dosha Sravana- Karatvam )Thus, liquefied Doshas are dragged
towards the Koshtha.

44.  Due to Sukshma property by reaching in micro channels, disintegrates
endogenic toxins, which are then excreted through micro channels.
 Due to dominance of Prithivi and Jala Mahabhutas in the
Virechana drugs and their potent Adhobhaga Hara Prabhava, the
vitiated Doshas are made to pass through anal route and are expelled
out of the body.
 The Vamaka and Virechaka Dravya induce emesis and purgation
respectively due to their specific Prabhava.
For example, Danti (Baliospermum montanum Muell.-Arg.) and
Chitraka (Plumbago zeylanica Linn.) both have same rasa and Virya, but
Danti on administration internally produces Virechana Karma, but
Ciktraka does not produce Virechana. This is
called selective action of the drug i.e. Prabhava.
When there is similarity in two drugs in relation to their taste (Rasa) and
potency (Vipaka and Virya), their pharmacological actions may be
different due to Prabhava of these drugs.

45. Virechana drug possessing the above properties reaches the Hridaya
by virtue of its Virya and then following the Dhamani.
It pervades the whole body through large and small Srotas. On virtue
of its Agney properties, it causes Vishyandana i.e. oozing of the
Doshas and by its Tikshana Guna, it is able to disintegrate the
accumulated Dosha. Due to Snehana, Dosha smear easily without
any hurdle and easily come to Amashaya from where Virechana
evacuates them.
Here the word Hridaya can be understood in two ways. Firstly, as
center of local nerve plexus upon which the drug may act i.e.
Ghreya Yoga in which Virechana Dravyas are administered by nasal
route.
It is possible that such medicine has some effect over brain or local
plexus of abdomen through which it causes Virechana.
On the other hand, Hridaya can be taken for circulation .i.e. Drug like
phenolphthalein used for purgation, is partly absorbed after which it
enter in circulation and then comes in intestine exerting its purgative
effect.

46. Pharmacodynamic of Virechanopaga Dravyas
 The overall pharmacodynamic of Virechanopaga Dasemanidrugs is
based on Guna concept.
 Most of the drugs are having property of Madhura Rasa and Snigdha
Guna. These are based on Prithvi and Jala Mahabhauta (one of the five
elements of the universe) in composition.
 Acharya Charaka has mentioned only the role of Gunas in the
pharmacodynamic of Virechana Karma. In fact Guna is the thing which
represents a drug. So, the selection of a drug should be on the basis of
Gunas for Virechana karma.
 Acharya Charaka has mentioned predominance of Prithavi and Jala
mahabhuta drugs for Virechana Karma. Rasas (taste) of Virechano-
paga Dravyas are chiefly Madhura(sweet), Kashaya(Astringent)and
Amla(sour) Rasa which are composition of the same Mahabhutas.
 Most of drugs are Madhura Vipaka having similar Bhautik constitution.
Other drugs are supportive to the therapy or to avoid complications
during Virechana Karma.

47. As an example;
• Draksha which is mentioned in Virechano-paga Dashemaniis used with
Virechna drugs for increasing the palatability and giving soothing effect.
Draksha is said to be Srista-virna Mutra(increases amount of excreta),
and due to Snigdha, Sheeta, Madhura Guna(properties), it may be
used in complications of Virechana like thirst, burning sensation, fever,
bleeding disorders. So with the addition of Draksha, in Virechana Karma
the procedure becomes comfortable and smooth.
• In common practice decoction of Triphala is used as Anupana of
Virechana Yoga like Trivruta , Danti Yogas etc. for induction of better
Vega in Virechana Karma. As per the Ayurvedic pharmacology it is a
good Pitta-kapha-hrit , Sara, safe in nature so helps in Virechana Karma
for eliminating the Dosha through anal route. That’s why Triphala does
not only increase the potency of Virechana Dravyas but also soothing
effect of the irritation and decreases the complications of Virechana
procedure.

49. PARASYMPATHETIC DEFECATION REFLEX

50. • Mass peristaltic movements push fecal material from the sigmoid
colon into the rectum.
• The resulting distension of the rectal wall stimulates stretch
receptors, which initiates a defecation reflex that empties the
rectum.
• The defecation reflex occurs as follows: In response to distension of
the rectal wall, the receptors send sensory nerve impulses to the
sacral spinal cord. Motor impulses from the cord travel along
parasympathetic nerves back to the descending colon, sigmoid colon,
rectum and anus.
• The resulting contraction of the longitudinal rectal muscles shortens
the rectum, thereby increasing the pressure within it.
• This pressure, along with voluntary contractions of the
diaphragm and abdominal muscles, plus parasympathetic
stimulation, opens the internal anal sphincter and defecation occurs
and the feces are expelled through the anus.
Physiology of Virechana(The defecation reflex)

51. All purgatives increase the water content of faeces by:
 Ahydrophilic or osmotic action, retaining water and
electrolytes in the intestinal lumen – increase volume of
colonic content and make it easily propelled.
 Acting on intestinal mucosa, decrease net absorption of
water and electrolyte; intestinal transit is enhanced
indirectly by the fluid bulk.
 Increase propulsive activity as primary action, allowing
less time for absorption of salt and water as a secondary
effect.
Mechanism of Purgation

52. For some of the drugs, controversy continues as to whether they
increase water content of stools as the primary action or it is a
consequence of increased motility. However, certain purgatives
do increase motility through an action on the mesenteric
plexuses. Laxatives modify the fluid dynamics of the mucosal
cell and may cause fluid accumulation in gut lumen by one or
more of following mechanism :
a) Inhibiting Na+ K+ ATPase of cells – Impairing electrolyte
and water absorption.
b) Stimulating adenylyl cylase in crypt cell – Increasing water
and electrolyte secretion.
c) Enhancing PG synthesis in mucosa which increase secretion.
d) Structural injury to the absorbing intestinal mucosal cells.

53. MODERN EXPLANTION ON POSSIBLE ACTION OF VIRECHANA KARMA:
From the modern point of view we can say that the
Ayurvedic shodhana karma are physician induced mild
inflammation mainly vamana and virechana drugs are
quite irritant to the stomach and the intestinal mucosa
respectivley, which cause inflammation. Due to this the
permeability of the membrane changes and those
substances come out due to the changed permeability
condition.which can not come out in normal

54. The gross sign of inflammation are redness, heat, swelling and
pain and loss of functions. These sign occurs due to the following
changes at microscopic level.
Hyperemia:
It occurs
and mechanism.
due to capillary dilatation and arteriolar dilatation
Exudation:
Exudation is the increased passage of protein rich fluid
through the vessel wall, in the intestinal tissue. The advantageous
result of fluid increase is dilution of toxins.

55. Some chemical factors are also responsible which increase
the permeability in response to acute inflammation.
Vaso active amines:
Inflammation
Mast-Cells: - Histamine - Increase permeability.
Platelets - Serotonin – Dilatation
Vasoactive Polypeptide:
These causes vasodilatation.

56. MiscellaneousAgents:
The other agents influencing
permeability are
vascular dilatation and increasing
• Lysosomal enzymes from polymorphs
•
•
Prostaglandins.
Globulin permeability factor
•
•
•
Lymphnode permeability factor
Degradation products of DNA and RNA.
Antigen antibody complexes.

57. Assessment
• Vaigiki- 30,20,10
• Antiki- kaphanta
• Maniki- 1,2,4 prastha
• Laingiki- sarva, madhya, alpa
lakshana

58. Samyak yoga
Samanya lakshana
• (Vata)Mootra, purisha, pitta, oushdha, kapha
(Vata)
• Hrit sudhi
• Kukshilaghava
• Anulomabhava
Avara
Madhyama
Pravara

59. Samyak yoga
Characteristic Pravara Madhyama Avara
1 Vega 30 20 10
2 Mana (prasta) 4 3 2
3 Doshantha Kapha Kapha Kapha
4 Lakshana Dosha expulsion, lightness of
umbilicus, wellbeing etc

60. Ayoga lakshana
• Immediate signs
– Hritkukshi asudhi
– Sleshmapitta utlklesha
– Aruchi, Chardhi, gourava
• Late Signs
– Kandu, kushtha, pitaka, kotha
– Peenasa
– Agnimandhya
– Vathavitmootrarodha

61. • Treatment:
• Sutasekara ras 2 ratti+Shankha basma 4 ratti +
Pravala pisti 2 Ratti 3 times with
honey.
• Drink luke warm water

62. Atiyoga laxana
• Moorcha, Bhrama, Netrapraveshana
• Jeevaadana
• Gudabhramsa
• Thrishna
• Vatavriddha laxana

63. Treatment for Atiyoga:
• Vamana
• Parisheka
• Avagaha
• Rakapitta Treatment
• Amlapitta treatment
• Jwara treatment
Drugs:
Sanjivani vati 2 ratti
Shankodara ras 1 ratti
Nagakesara chu 2 ratti
Chandra kala ras 2 ratti
Jatiphaladi chu 4 ratti
Indrayava chu 4 ratti give it for 3 to
4 times with dadimavalehya.
• Kutajaghana vati 4 ratti to 1
masha 3 to 4 times.

64. Ajirna/ Jirna oushada lakshanas
Ajirna oushada
• Klama
• Daha
• Angamarda
• Bhrama
• Murcha
• Shirah shula
• Arati
• Dourbalya
Jirna oushada
• Vatanulomana
• Swastha anubhava
• Thrist/appetite
• Sharira utsaha
• Manah prasannata
• Indriya laghava
• Shudda
dakara(eructation)

65. Virechana Vyapada
Due to Ayoga
• Adhmana
• Parisrava
• Hrid-graha
• Gatra-graha
• Kand’vaadi Vibhramsha
• Upadrava
• Klama
Due to Atiyoga
• Parikartika
• Jivadana
• Vibhramsha
• Gudabhramsha
• Sanjnaa Bhramsha

66. Emergency drugs
• Sugar
• Kutaj ghana vati
• Karpur rasa
• Ahiphena vati
• Mahashankha vati
• Ajmodadi vati
• Hingu karpur vati
• Sanjivini vati
• Bol parpati, Bolabadda
rasa
• Shonitarangal rasa
• ORS
• Jatyadi gritha
• Jatyadi Tail
• Phala varti
• Drugs for piccha basti….
Some medicines are to be kept ready, to combat various types of
complications

67. Vyapada Treatment Yoga
Adhmana Abhyanga ,Swedana,
Varti, Niruha &
Anuvasana Basti
Hingvadi churna,
Agnitundi vati,
Chitrakadi vati
Parikartika Langhana, Pachana,
Rukshana, Ushna
dravyas
Kamadudha rasa, Jatyadi
Gritha, Shatdhouta
Gritha
Srava Tikshna virechana after
Snehana, Asava &
arishata prayoga,
Asthapana basti
Hingvadi churna,
Agnitundi vati,
Chitrakadi vati,
Pippalyasava
Hritgraha Vamana, Pachana,
Abhyanaga, Swedana
with Dhanya & Tikshna
Nasya
Snigdha & Lavana
Dravya sevana
Sutashekhar rasa, Malla
sindhura, Shvasa kuthar
rasa, Hemagarbha pottali
rasa.
Gatra griha Vatahara sneha & Sweda Vatavidwamsaka rasa

68. Vyapada Treatment Yoga
Jivadana Pittahara chikitsa, Rakta
basti, Piccha basti, Ghrita
manda, Anuvasana
Kamdudha rasa with
mukta, Pravala Pishti
Vibhramsha Prolapse should be
corrected applying
saurashtri
powder,udumbar churna,
Lodhra churna with jatyadi
taila
Changeri gritha
Sthamba Langhana, Pachana,
Tikshna basti & Virechana
Hingvadi Churna, Agnitundi
vati, Chitrakadi Vati
Upadrava Snehana & swedana,
Vatahara Dravayas
Sutashekhar Rasa &
Hemagarbha pottali rasa
Klama Langhana, Pachana,
Snehana & Tikshna
Shodhana dravyas

69. Complication and management:
• Nausea and vomiting
It may occur at the time of intake of medicine
and during the procedure. To avoid the
feeling of nausea, the patient is advised to
smell lemon.
• Feeble pulse, Giddiness, Collapse.
Sidhamakaradhwajam with honey and betel
juice, Drakshadi kashaya, Dhanwantharam
gulika can be given in this condition.

70. • Adhmanam- Swedana should be done locally at
abdominal region.
• Apravruthi of Vega- Ushnajalapana,Swedana.
• Kandu- Thrikatu with sitha is given
• Udarasoola- Ushnajalapana, swedana.
Hinguvachadi Choorna can be given if necessary.
• Dehydration: Tender coconut water.

71. • If No vega occurs
Second dose
Leave the day with fasting
Administer Vamana or Basthi as the
condition demands

72. • Virechana means to expel out Doshas through Adhobhaga (anal
route),by this route the Doshas can be eliminated by means of
Niruha Basti also but Niruha Basti has no power of
Adhobhagaharana.
• Therefore, Niruha Basti cannot be included under Virechana
karma. Virechana expels out the Amashayadi Doshas dragging
them towards the Adhobhaga through the anus. Similarly the
Niruha Basti removes the Doshas from Pakwashaya.
• Another point of differentiation between Virechana karma and
Niruha Basti is that the Virechana is a specific treatment for
Pitta Dosha while Basti is recommended for treating Vata-
Dosha.
• Virechana aims at the elimination of Doshas, which cannot be
removed by Vamana or through kidney, stomach, lungs or sweat
glands. This process is meant for elimination of Doshas through
Purisha-Dhara Kala(lower intestine)and Yakrita(liver).
Discussion

73. Virechana karma & Purgation
Virechana Karma
• Have systemic & local
Action
• Eradication of Systemic
Disease
• Prior to it assessment of
Koshta, Agni & Doshas are
important
• Poorvakarma is Essential
• Have the preventive role
Purgation
• Only local action
• No such action
• No such assessment were
made
• Poorvakarma is not done
• Not have any preventive
role

74. Conclusion
• Virechana is a Treatment choice in Pittaja
Vikara.
• Take care while selecting the patients in
consideration of indications & contra
indications of Virechana.
• Virechana karma can be used as Preventive,
Curative & Conservative line of Management.