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Line 93: − Administration of virechana dravya- It is essential to administer drug or dravya after kapha kala has passed, thus the dravya should be given around 9am till 11 am in the morning on empty stomach. − + + + + + + − The purification might occur in varying number of vega(bout) which are influenced by few factors like age, strength of patient, strength of disease etc.+ − + − There are certain features stated by acharyas to assess whether the procedure has been done appropriately and if the doshas have been eradicated completely indicating samyak yoga (appropriate), ayoga (insufficient elimination) and atiyoga (excess elimination). Kaphanta virechana is the samyak lakshana (appropriate symptom) of virechana karma, which precisely means that when there is mucous like substance is seen the virechana bouts is stopped. − − Further patient is assessed for any kind of complications like, Adhmana (Distension of abdomen), parikartika (cutting like pain in anal region), hridgraha (cardiac spasms or ache), sraava (excessive discharge of any kind), jivadana(blood discharge), graha (rigidity and spasms) etc. these complications can arise if the vamana karma is done inappropriately. Further treatment is given immediately in any such case. (char. sidd.6.29). − === Pashchata Karma ===+ − After vega(bouts) of purgation are stopped, paschat karma begins.+ + + + + + + − Paschat karma remains same as that of vamana karma. Which are dhumapana (therapeutic smoke), rest, dietic regimen, and few lifestyles advises and restrictions.+
→Pradhana Karma
=== Pradhana Karma ===
=== Pradhana Karma ===
Observation and advises – patient must gargle with hot water to avoid initial nausea due to drug. Patient is advised to take rest, not get exposed to cold winds or air conditioners. Hot water is given at repeated intervals for easy and unhindered vega(bouts) of purgation. The vega(bouts) of virechana take time to start compared to vamana vega(bout), thus patient must wait and be attentive. Patient is told to observe colour, quantity, odour, sound etc of the each vega and inform to Vaidya.
# On the day of Virechana karma, the patient is advised to remain empty stomach. After the daily morning routine like brushing, bowel movement and bathing the patient is advised to reach the panchakarma clinic in the morning.
# Once again in the morning [[Abhyanga (अभ्यङ्गम् )|Abhyanga]] and swedana (whole body oil massage and steam bath) of the patient is done.
# Administration of virechana dravya- After these procedures and offering prayers to god, the patient is made to sit on a comfortable and relaxed chair. It is essential to administer drug or virechaka dravya after kapha kala has passed (early morning period with cold in the atmosphere is known as kapha dominant time) thus the medicine is given around 9am till 11am in the morning on empty stomach.
# Observation and advises – Patient must gargle with hot water to avoid initial nausea due to drug. Patient is advised to take rest, not get exposed to cold winds or air conditioners. Hot water is given at repeated intervals for easy and unhindered vegas (bouts) of purgation. Hot water bag for abdominal fomentation might be given. The vegas (bouts) of virechana take time to start compared to vamana vegas (bout), thus patient must wait and be attentive. Patient is told to observe color, quantity, odor etc of the each vega and inform to Vaidya. This helps to understand the elimination of morbid doshas and extent of purificaiton. The purification might occur in varying number of vega (bout) which are influenced by few factors like strength of medicine, age of patient, strength of patient, strength of disease etc.
# There are certain features stated by acharyas to assess whether the procedure has been done appropriately and if the doshas have been eradicated completely indicating samyak yoga (appropriate elimination), ayoga (insufficient elimination) and atiyoga (excess elimination). Vaidya observes these features and accordingly takes a call to continue or stop the process of virechanam.
# Once the virechanam karma is completed patient is assessed for presence any kind of complications like, Adhmana (Distension of abdomen), parikartika (cutting like pain in anal region), hridgraha (cardiac spasms or ache), srava (excessive discharge of any kind), jivadana (blood discharge), graha (rigidity and spasms) etc. these complications can arise if the virechana karma is done inappropriately. Further treatment is given immediately in any such case.<ref>Charaka Samhita (Siddhisthanam Adhyaya 6 Sutra 29)</ref>
=== Pashchata Karma ===
Once the vaidya decides to stop virechana karma, the post virechana procedures are considered and these are known as Pashchat (post) karmas. Pashchata karma of virechanam include Mouth cleansing, rest, diet plan and some lifestyle related advices. These post procedures are similar to the post procedures of vaman karma except the therapeutic smoking part which is not done after virechanam.
# After appropriate virechana karma patient is made to wash mouth clean with warm water and must rest in a room where there is not direct exposure to cold air or fan or AC.
# There are certain behavioral instructions stated to avoid further complications. Patient should avoid sitting or standing in one position for too long, long walks must be avoided, speaking loudly, anger, grief, exposure to excessive cold, sunlight, winds etc. sexual indulgence, sleeping during daytime, staying awake late at night are few restrictions imposed on patient after virechana karma.
# '''Samsarjana krama''': (संसर्जन क्रमम्) It refers to the specific diet plan after virechana karma (rehabilitation diet) which is given for at least 3 to 7 days depending on the grade of shuddhi (purification) happened by virechanam. It is to be started from the same day (evening) of the procedure or on the next day morning if there is any vitiation of doshas observed and remaining doshas are yet to be eradicated.
# On the first day or as a first meal, “manda” (मण्डम्) is given. It is ideally made with red variety of rice which is a gruel like food preparation which is given for three consecutive meals. This kind of preparation is liquid in nature and supports the weak digestive state which is present after the virechana karma.
# For the next 1 or 2 consecutive meals “vilepi” (विलेपी) which is again a kind of gruel, made with red type of rice is given. This is semisolid in consistency.
# After this,” odanam” (ओदनम्) which is a well cooked rice made with red rice along with mudga yusha (मुद्ग यूषम् soup from green gram) is given for next one or three meals.
# Warm water is consumed during samsarjana krama.
# For the next one or three meals meat soup is given or for vegetarians simple regular diet is started. Later, the patient is expected to have a normal diet.
In this way gradual shift in diet from rice water to normal diet helps one to regain his digestive strength which is significantly hampered in the process of virechana. Thus if one follows all the diet and other guidelines carefully can recover from illness quickly, even permanently and also prevent adverse effects of the therapy.
== Mode of action ==
== Mode of action ==