Detailed explanation of Virechana karma

1. Page 1
Virechanam
Concept and Practice
Dr Ananth Ram Sharma
MD Panchakarma, (PhD).
Associate Professor
Department of Panchakarma
Amrita School of Ayurveda
Presented at Institute of Management at Government, Kakkanad.
At training program in Panchakarma for medical officers of ISM on
11/06/2013

2. Page 2
Introduction
• Shodhana – Drava Shoshana.
• Procedure of Choice for PITTAJA VIKARA.
• Wide applicability and simplicity
• 40 % of patient in our hospital

3. Page 3
Virechanam
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4. Page 4
Area of Virechanam
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5. Page 5
Common Benefits
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Classification of virechana
• Mode of actionMode of action
• Intensity of actionIntensity of action
• Parts usedParts used
• Properties

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Koshtha Bheda

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Mode of Action
AnulomanaAnulomana
RechanaRechana
BhedanaBhedana
SramsanaSramsana

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Based on Intensity
Mridu VirechakaMridu Virechaka
Madhyama VirechakaMadhyama Virechaka Teekshna VirechakaTeekshna Virechaka
• BalavanBalavan
• MahavegaMahavega
• Gambheera vyadhiGambheera vyadhi
•Madhyama koshtaMadhyama koshta
•BalavanBalavan
• Mridu koshta
• Durbala

10. Page 10
Parts Used
Moola Virechaka
Phala Virechaka
Twak Virechaka
Dugdha Virechaka
Swarasa Virechaka

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Properties
• Ruksha Virechaka
• Snigdha virechaka

12. Page 12
Specific Drugs for
Virechana

13. Page 13
Ritu Anusara
VarshaVarsha SharadSharad Shishira &Shishira &
VasathaVasatha
GrishmaGrishma HemanthaHemantha All seasonsAll seasons
Yoga Trivrit,
Kuttaja
Beeja
Pippali,
Shunthi
Shyama
Trivrit,
Duralabha,
Mustha
Sharkara
Swetha
chandana
Shyama Trivrit
Pippali
Nagara
Shyam Trivrit Trivrit, Chitraka,
Patha
Ajaji, Sarala,
vacha
Trivrit, Danti,
Hapusha,
Saptala,
Katuki,
Svarnakshiri
Anupana Draksha
Rasa &
Honey
Yasti
madhu
with
Draksha
svarasa
Honey sugar Warm water Bhavana With
Cows urine

14. Page 14
Purgation and Virechana-
Karma
Virechana karmaVirechana karma PurgationPurgation
 Have systemic and local
Action
 Only local action
 Eradication of systemic
disease
 No such action
 Prior to it assessment of
Kosta, Agni and Doshas
are important
 No such assessment were
made
 Poorvakarma is essential  Poorvakarma is not done
 Have the preventive role  Not have any preventive
role

15. Page 15
Contraindication of Virechana
Asaha
• Bala
• Vriddha
• Atisthula
• Atikrisha
• Alpagni
• Upavasitha
• Pipasita
• Durbalendriya
• Garbhini
• Navaprasooth
a
Disease of rectumDisease of rectum
• Kshata guda
• Guda bhramsha
Marga virodhi vyadhiMarga virodhi vyadhi
•Adhoga rakta pitta
•Atisara
Other Conditions
•Adhmana
•Urustambha
•Rajayakshma
Manasika BhavasManasika Bhavas
• Bhayabhita
• Chintaprasakta
• Adhyayana prasakta
Vatakara ViharaVatakara Vihara
•Atirooksha
•Ratri jagarana
•Maithuna prasakta
•Vyayama prasakta

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Sadhya Vyadhi’s

17. Page 17
Procedure of Virechana
Karma
PoorvakarmaPoorvakarma
 Selection of patient
 Examination of patient
 Assessment of Koshta & Agni
 Deepana – Pachana
 Snehana – Swedana
 Vishrama kala

18. Page 18
Vamana Before
Virechana?
Decide by
• Roga bala
• Rogi bala
• Avasta of disease
• Condition of Dosha
Eg: In case of kusta if kapha is predominant
then one should go for vamana

19. Page 19
Diet Before Virechana
• Kapha avriddikara
• Snigda drava, ushna ahara
• Mamsa rasa
• Yoosha
• Amla rasa
• Laghu Bhojana

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Pradhana karma
• Samyak Snigdha Lakshana
• Nidra
• Passed natural urges
• Empty stomach
• Manasopachara
Administration of Virechana Yoga

21. Page 21
Dosage of
Virechanoushadhi
• Koshta
• Agni
• Rogi bala
• Roga bala
• Dosha: Bahudoshavasta
• Oushadha veerya

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Matra acc. Classics
• Uttama- 2 pala, Madhyama – 1 Pala, avara – ½ Pala (Bh.Si)
• 1,2,3 Tola is Mentioned for Mridu, Madhyama and Krura (Su.Chi)
Kalpana Hina for
Mridu Koshtha
Madhyama
For Madhyama
Uttama for
Krura
Kwatha 02 Tola 04 Tola 08 Tola
Kalka, Churna, Modaka 01 Tola 02 Tola 04 Tola
Swarasa 01 Tola 02 Tola 04 Tola
Ushnodaka 04 Tola 08 Tola 12 Tola

23. Page 23
Guidelines Followed After
Administration
• Ask the patient not to close the door of toilet
• Hot water gargling
• Have some fragrance
• Intake of water ? Ushna Jala/ Shita Jala
• Vega should not be induced or retained
• Time should be noted
• Keen observation of content of Vega
• Avoid sleep
• Tambula Sevana
• Avoid shitala Vihara

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Practically Encountered
Problem• Chardi soon after giving medicine?
• Chardi after 2-3 hours of administration?
• If virechana won’t happen ?
• If only 2-3 vega observed?
•Aushadha Jeerna Lakshana
•Aushadha Ajeerna Lakshana
•Samyak Shuddhi
•Bala traividyam
•Vyapat
•Shesha Dina
Any intervention only on the following observation

25. Page 25
Shuddhi Prakara
Shuddhi Classics Observed by research studies
Vaigiki Pravara-30
Madyama-20
Avara-10
Haritaki 13-15
Aragvadha 13-17
Katuki 15-25
Trivrit 15-27
Maniki 4 prasta
3 prasta
2 prasta
Haritaki 700-1000ml
Aragvadha 700-100ml
Katuki 800-1500ml
Trivrit 1200-1650ml
Antiki Kaphanta Haritaki P-60%,K-40%,
Aragvadha P-50% K-40%, V – 10%
Katuki K-60% P-30% , V – 10%
Trivrit K-100%

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27. Page 27
Ayoga And Atiyoga of
Virechana
Ayoga
• Agnimandya
• Kandu
• Pidaka
• Vata sanga
• Vit sanga
Atiyoga
• Angamarda
• Vepatu
• Balabava
• Klama
• Trishna
• Brama
• Tama pravesha
• Netra pravesha

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Paschat Karma
• Same as that of Vamana Karma except
Dhumapana
• Samsarjana Krama

29. Page 29
Samsarjana Krama
Day Annakala Pravara Madhyama Avara
1st Morning - - -
Aft. Noon - - -
Evening Peya Peya Peya
2nd Morning Peya Peya Vilepi
Aft. Noon Peya Vilepi Kruta yusha
Evening Vilepi Vilepi Akrutmamsa rasa
3rd Morning Vilepi Akruta yusha Krita mamsa rasa
Aft. Noon Vilepi Kruta yusha Normal diet
Evening Akruta yusha Akrita mamsa ras or
akrita masha yusha
4th Morning Akrut yusha Krita mamsa rasa
Aft. Noon krut yusha
Evening Akrita Mamsa rasa or Krita yusha
5th Morning AKrita Mamsa rasa or Akrita yush ras
Aft. Noon krita mamsa rasa or krita masha
yusha
Evening Normal diet

30. Page 30
Nutritive Values
K.
Cal
Prot Fat Carb Phos Fe Cal Thim N.
acid
Rib Vit C
Peya
100 gms
94 2.7
gm
2.2
gm
15.8
gm
0.07
gm
0.25
mg
0.11
gm
0.04
gm
0.11
mg
0.12
gm
3.3
mg
Yusha
100 gms
158 5.5
gm
3.6
gm
25.6
gm
- 3.4
mg
0.05
gm
0.04
gm
0.04
mg
0.28
gm
-

31. Page 31
Benefits of Samsarjana
Krama
• Immediate supply of Calories and
Nutrition
• Restoration of digestive power through
specific dietary schedule.
• Absorption and assimilation function of
GIT get increase.

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Pariharya Vishaya
• Speaking loudly.
• Excessive meal.
• Excessive walking.
• Anger and sorrow.
• Sleeplessness.
• Day sleep.
• Incompatible diet.
• With holding natural
urges.
• All these causes GI
upset, further it
will lead to
formation of Ama,
hence aim of
Virechana will fail.

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Nitya Virechana
• Elimination of excessive fluid
• Reliving the constipation
• Acts as diuretic
• Increase of appetite
What may be the scientific reason?

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Virechana as preventive
measure
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• Disease deterrent
• Delay the process of ageing
• Bio purifier

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Virechana as curative
measure
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• Removes the morbid Doshas
• Multiple therapeutic benefit
• Effect on specific disease

36. Page 36
Virechana as Rasayana & Vajikarana Poorva
karma.
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Enhance the drug absorption -
Removing interfering molecules or ions.
Enhancing mucosal blood supply
Altering secretary function
?

37. Page 37
Diminished activity of GI tract
Intestinal villi blunted by many GI disorders due to
ischemic condition
Irritant activity of virechana drug
Re dilate arteriole and correct the blood supply
Increase the parasympathetic activity
Enhances absorption and removes the morbid Doshas
and waste products
Bioavailability of Rasayana and Vajikarana drugs increases

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Mode of Action of Virechana.Mode of Action of Virechana.

39. Page 39
Causes physician induced inflammation
Increased propulsive movement and
irritant properties of virechana Dravya
Increases permeability of the capillaries
Then patient gets Virechana Vega

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Role of inflammation
Hyperemia
Arteriolar
dilatation
Exudation Dilution of
the toxins

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Chemical factors
Vasoactive
amines
Mast cells
Platelets
Histamine
Serotonin
Increase
permeability
Dilatation

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Elimination of
Pitta
Relaxation of sphincter of oddi
Increase uptake of fatty food
Polyunsaturated fatty acid stimulate
oxidation of cholesterol into bile
Cholycytokinin hormone is released
Stimulate gallbladder to contract

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Elimination of Kapha
• Elimination of kapha
•Large intestine chiefly secretes mucous
•Extreme parasympathetic stimulation
secretes large amount of mucous

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Elimination of Waste
Product
1.Interchange of ECF & ICF
2. Some hormones excreted by liver
3. Liver eliminate it through bile

45. Page 45
Summary
• VirechanaVirechana therapy can be used as
Preventive, Curative and Conservative line
of management
• Virechana hold the supremacy over the Pitta
• Careful assessment of Roga – Rogi – Koshta
– Agni — Oushda is essential
• Importance should be given to Samsarjana
Krama that we usually ignore

46. Page 46
For Your
Attention
Dr. Sharma’s Panchakarma Concepts
“Na Matra Matramapyatra Kinchit Agama Varjitam”