Changes

== Definition ==

== Definition ==

Virechana karma is defined as below,  

Virechana karma is defined as below, <blockquote>तत्र दोषहरणमूर्ध्वभागं वमनसञ्ज्ञकम्, अधोभागं विरेचनसञ्ज्ञकम्; उभयं वा शरीरमलविरेचनाद्विरेचनसञ्ज्ञां लभते  (Char. Samh. 1.4)<ref>Charaka Samhita (Kalpasthanam Adhyaya 1 Sutram 4)</ref></blockquote>Meaning: The procedure in which the morbid doshas are expelled out from body through mouth is called as vamanam, Iwhere these doshas are expelled out via) anal route by (controlled and therapeutic) purgation is called as virechana karma. Since by any route the morbid doshas in body are eliminated or evacuated both of these karmas can be called as virechana.  

 

तत्र दोषहरणमूर्ध्वभागं वमनसञ्ज्ञकम्, अधोभागं विरेचनसञ्ज्ञकम्; उभयं वा शरीरमलविरेचनाद्विरेचनसञ्ज्ञां लभते  (Char. Samh. 1.4)<ref>Charaka Samhita (Kalpasthanam Adhyaya 1 Sutram 4)</ref>

 

Meaning: The procedure in which the morbid doshas are expelled out from body through mouth is called as vamanam, Iwhere these doshas are expelled out via) anal route by (controlled and therapeutic) purgation is called as virechana karma. Since by any route the morbid doshas in body are eliminated or evacuated both of these karmas can be called as virechana.  

However virechana refers to theraputic purgation as a general rule.  

However virechana refers to theraputic purgation as a general rule.  

== Contraindications for Virechana Karma ==

== Contraindications for Virechana Karma ==

Virechana is not advised in Kapha dosha predominant diseases. In such cases virechana may not be carried out successfully due to excess kapha dosha hampering the action of virechaka dravyas (Purgative drugs). Inappropriately conducted virechana then can lead to complications. Also in individuals who have very weak digestive strength (agni) and overall strength (Balam), virechana is not recommended.  

Virechana is not advised in Kapha dosha predominant diseases. In such cases virechana may not be carried out successfully due to excess kapha dosha hampering the action of virechaka dravyas (Purgative drugs). Inappropriately conducted virechana then can lead to complications. Also in individuals who have very weak digestive strength (agni) and overall strength (Balam), virechana is not recommended.  

There are certain conditions listed in the classical treatises wherein Virechana karma is not advised by Ayurveda acharyas,

There are certain conditions listed in the classical treatises wherein Virechana karma is not advised by Ayurveda acharyas,

=== 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.

# 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.

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.

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.

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.

# 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.

# 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.

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).

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.

=== Pashchata Karma ===

== Mode of action ==

After vega(bouts) of purgation are stopped, paschat karma begins.

Virechana karma can be closely related to inducing laxation, purgation, evacuants in modern texts. Laxatives induce mild inflammation in the lower bowel to promote water and electrolyte accumulation and stimulation of intestinal motility. From this view, virechaka dravyas (purgative substances) are mild irritant to stomach and intestinal mucosa to cause inflammation. Thus, permeability of the membrane changes. This mechanism allows quick initial absorption of virechaka dravyas and later leads to excretion of morbid substances due to the active principle present in the drug. Precisely, virechana karma is a whole systemic cleansing procedure rather than induced purgation. The advantages are wide spread and not organ specific.<ref>Principles and practice of panchakarma, Dr. Vasant C. Patil , Chaukhamba publications 5^th edition chap 11^th pg </ref>

 

Paschat karma remains same as that of vamana karma. Which are dhumapana (therapeutic smoke), rest, dietic regimen, and few lifestyles advises and restrictions.

== Mode of action ==

According to Ayurveda, pitta dosha in body is of  'sara' [[Gunas or Qualities : An Ayurvedic perspective (आयुर्वेदे गुणाः)|guna]].<ref>Charaka Samhita (Sutrasthanam Adhyaya 20 Sutram 15)</ref> Sara refers to the instability or precisely outgoing downward movement due to fluid state.<ref>Chakrapani commentary on Charaka Samhita ([https://niimh.nic.in/ebooks/ecaraka/?mod=read&h=saratva Chikitsasthanam Adhyaya 2.4 Sutra 48])</ref> Thus the natural way of removing accumulated morbid pitta on daily basis is smooth bowel movements.<ref>Chakrapani Commentary on Charaka Samhita ([https://niimh.nic.in/ebooks/ecaraka/?mod=read&h=saratva Sutrasthanam Adhyaya 13 Sutras 65-69])</ref> Naturally when pitta is in excess  there should be more bowel movements than normal to excrete it or eliminate it. Thus virechana is believed to be the the best method to eliminate accumulated excess pitta out of the body. According to Charka Samhita the medicines used to carry out virechanam are dominant in prthvi and Jala [[Panchamahabhutas (पञ्चमहाभूतानि)|mahabhutas]]. Inherently these mahabhutas have downward movement due to heaviness. Thus they tend to expel the doshas by creating the downward movement known an virechanam.<ref>Charaka Samhita (Kalpasthanam Adhyaya 1 Sutra 5)</ref>

Virechana karma can be closely related to inducing laxation, purgation, evacuants in modern texts. Laxatives induce mild inflammation in the lower bowel to promote water and electrolyte accumulation and stimulation of intestinal motility. From this view, virechana dravya are mild irritant to stomach and intestinal mucosa to cause inflammation. Thus, permeability of the membrane changes. This mechanism allows quick initial absorption of virechana dravya and later leads to excretion of morbid substances due to the active principal present in the drug. Precisely, virechana karma is a whole systemic cleansing procedure rather than induced purgation. The advantages are wide spread and not organ specific.

== Other therapeutic considerations ==

== Other therapeutic considerations ==

After the intake of virechana dravya vega initiation will take around 60 to 120 mins. Since virechana yoga or medicine needs to be digested before the bouts start. This mechanism depends on the digestive ability of the individual and dose of the medicine which are decided by a Vaidya.

After the intake of virechana dravyas vega initiation will take around 60 to 120 mins. Since virechana yoga or medicine needs to be digested before and only then the bouts start. This mechanism depends on the digestive ability of the individual known as agni and dose of the medicine decided by a Vaidya.

In some conditions of bahu kapha (excessive kapha dosha), bouts of purgation start in the evening after the liquefication of kapha dosha. Patient is kept under observation in such conditions. (char.kalpa.12)

In some conditions of bahu kapha (excessive kapha dosha), bouts of purgation start in the evening after the liquefication of kapha dosha. Patient is kept under observation in such conditions. <ref>Charaka Samhita (Kalpasthanam Adhyaya 12)</ref>

Virechana medicine is given again on the same day if there are no vega(bouts) or dosha elimination seen. This is decided by the Vaidya. (char. Kalp. 12.63)

In some cases, it might happen that the virechaka drug may not work and the bouts of virechana might not start at all. Then the vaidya would reassess the patient and plan the next course of action. May a times virechaka medicine is given again on the same day if there are no vegas (bouts) or dosha elimination seen. <ref name=":3">Charaka Samhita (Kalpasthanam Adhyaya 12 Sutra 63-67)</ref>

Patient must acknowlwdge vaidya about number, colour, sound, texture and the gap between the vega(bouts) as well.

Patient must properly update vaidya about number, color, other features of eliminated wastes and the gap between the vega (bouts) as well.

in few cases vamana(vomiting) occurs after the intake of virechana medicine due to initial nausea. In such conditions Vaidya asks patient to wash mouth clean and fasting is done on that day and virechana karma is conducted again on the next day. (char.kalp.12.67)

In few cases vamanam (vomiting) occurs after the intake of virechaka medicine due to initial nausea. In such conditions Vaidya asks patient to wash mouth clean and fasting is done on that day and virechana karma is conducted again on the next day.<ref name=":3" />

Virechana karma is carried out prophylactically in sharad rutu of hindu calender which is mid-august till mid- September under the supervision of a Vaidya. Virechana being the front line shodhana treatment in pitta dosha related disorders and pitta dosha is elevated during sharad rutu the process is at ease and prevents seasonal diseases.

Virechana karma is carried out prophylactically in sharad rtu of hindu lunar calander (At the beginning of Ashvin masa mostly) which is mid-august till mid- September under the supervision of a Vaidya. Virechana being the front line shodhana treatment in pitta dosha related disorders and pitta dosha being naturally elevated during sharad rtu the virechana process happens at ease and prevents seasonal diseases due to pitta aggravation.

== References ==

== References ==