Virechana Karma-Purgation

by **Admin** Mon 25 Oct 2010, 12:05 am

Drug induced Purgation (Virechana Karma)
Drug induced purgation is the second Principal detoxification procedure. The aim of the treatment is to stimulate vitiated doshas from the stomach, small intestine, liver and gall bladder, and bring them to the gastro intestinal tract for their eventual expulsion from the body via the rectum. Various herbs like ricinus communis, triphala – three myrobalan fruits, cassia fistula, trivrit-operculina turpethum, can be used for this purpose.

Drug induced purgation is a specific modality for the elimination of Pitta Dosha. It is indicated for the treatment of conditions involving excess Pitta, for individuals of Pitta constitution or in conditions involving Pitta mixed with Kapha, and for excess Kapha dosha which happens to be lodged in the Pitta areas of the body. Drug induced purgation is also treatment for diseases of rakta dhatu or blood.

Benefits of drug induced purgation
This process not only eradicates the diseases of Pitta and blood but it helps to rejuvenate all the tissues and organs in abdomen, it improves skin complexion, gives longevity and increases immunity also.

Indications of Drug induced purgation
Purgation is indicated in various skin diseases, chronic fevers, enlargement of liver and spleen, jaundice, erysipelas, glandular swelling due to vitiated blood, and various diseases of toxic blood due to Pitta, like stomatitis, glossitis and hyperacidity and other Pitta predominant diseases.

Contra indicatations of Drug induced purgation
It is contra indicated in children, very old and weak patients, persons who have developed fissure in anus or have disorders like bleeding peptic ulcer of the small or large intestine, fissure in anal canal, prolapse of the rectum, diarrhoea and dysentery, haemoptysis – blood in sputum due to tuberculosis or any other cause, pregnant women, immediately after delivery, and person suffering from acute heart disease, all conditions involving toxins -ama- in the body e.g. toxic fever etc.

Drug induced purgation is a simple therapy to execute, involving only the administration of an appropriate purgative substance. The single most important factor is that a proper course of preliminary procedures must be completed, prior to the procedure for the full and utmost effect of Drug induced purgation.

Drug induced purgation is usually followed after drug induced emesis. But this can be done without drug induced emesis, because it acts on Kapha dosha too along with Pitta dosha. For pitta, mild type of drug induced emesis is recommended.

Oleation
External – Abhyanga with mild massage should be done
Internal – Ghee or oil is selected according to the predominance of dosha. It is either pure cow’s ghee, sesame oil or medicated ghee or oil. Herbs used for medication are nimba, dadima, guduchi, arjun, rasna etc. Internal oleation is given in moderate dose for three to seven days. The dose is adjusted in such a way that patient is not hungry for twelve hours after consuming ghee or oil in the morning. During this procedure, patient must drink hot water throughout the day during the period. In addition the food during this period should be primarily warm, liquid and somewhat oily.

Fomentation
Whole body fomentation should be done either in sauna or the specific chamber used for this purpose. It is administered each day following external oleation. Two days gap is necessary between completion of internal oleation and drug induced purgation. During these two days, fomentation is given as before. The patient should be given light diet and he should drink hot water.

Emesis is not given in empty stomach, but purgation is given in empty stomach preferably in the morning.

Methodology
The medicine of choice in this therapy is a decoction of draksha (vitis vinifera), aragwadha (cassia fistula), haritaki (terminalia chebula), 12 gms each and katuka (picrorhiza kurroa), 6 gms. First make a decoction of these herbs in water and then take two ounces of castor oil. This is an ideal medicine for purgation. This dosage is for promoting medium type of drug induced purgation.

Useful herbs for purgation:
Charaka in Kalpasthana chapter 12 has described more than 245 different preparations for medicated purgation. He has described 110 preparations of trivrut, 11 of aragvadha, 16 of tilvaka, 20 of sudha, 39 of saptala shankhani and 48 of danti.

Sl.No. Name of Medicine Mild Moderate Maximum
dose dose dose
1. Castor Oil 10-20 ml 20-40 ml 40-60 ml.
2. Powder of trivrut, haritaki 1-3 gms. 3-6 gms. 6-10 gms.
3. Decoction of draksha,
haritaki, or triphala 10-20 ml. 20-40 ml. 40-60 ml.
or aragwadha

4. Psyllium husk 3 g. 3 – 6 gm 6 – 10 g.

5. Ecchbhedi or
ashwakanchaki etc.
which contain Jepal or
croton ½ - 1 gm. 1 – 2 gm. 2 – 4 g.

Selection of appropriate herbs for purgation

There are many medicines which can be used for this method of purification, but selection depends upon,

· the softness or hardness of the patient’s bowel movements
· the constitution of the patient.

In general, patients with Vata constitution will have harder bowel movements and those of Pitta and Kapha constitution will have softer bowel movements.
Thus following chart is useful to select herb according to constitution—

Constitution Recommended Purgative

Vata Trivrit (Operculina turpenthum) + Ginger powder +
Salt Aragwadha (fistula) Arka (Calotropis procera), Eranda (Rocinus comunis) Snuhi (Euphorbia nerifolia) Isabgol (Plantago ovata)

Pitta Draksha (Vitus vinifera) Katuki (Picrorhiza kurroa) Puga (areca catechu)

Kapha Trivrit (Operculina turpenthum) Danti (Baliospermum montanum) Snuhi (Euforbia neriifolia) Haritaki (Terminalia chebula)

Method of administration

· As mentioned before, this medicine is always given in empty stomach.

· Mild laxatives like Haritaki, Triphala, can be given at night during bed time with hot water. They all produce one or two motions in morning in mild dose.

· All drastic purgatives can be given in morning from 3 to 4 hours after sunrise. The patient is asked to drink the medicine prepared for purgation. Soon purgation starts due to its secretion-promoting action.

· Nothing by mouth should be given after Herb induced purgation until satisfactory result.

Observations

Patient should be instructed to watch his stool for number, colour, frequency and consistency.

Watch for symptoms of excessive and negligible purification.

If patient is weak, arrange for bed pan.

Watch for complications and treat them accordingly.

Symptoms of optimum purgation

Feeling of cleanliness in the channels and sense organs, lightness in the body, and increase in the appetite (after some time) are the indications of proper elimination by Purgation. During the procedure, the patient first passes liquid faecal matter and urine, then mucus, and then yellowish coloured pitta (bile).

Symptoms of inadequate purgation

Inadequate bowel movements, frequent motions but little in quantity and with obstruction, motion with pain, heaviness in the body, or there is vomiting instead of purgation or constipation and difficulty in micturation, stupor, loss of appetite, cardiac discomfort, itching around the anus.

Treatment

Give the patient relaxing oil massage, using oil and rock salt. Then give fomentation by tube over the abdomen and repeat same or different purgative medicines, or administer a cleansing decoction enema with dashamoola or other suitable medicated enema. Afterwards, ask the patient to take soup of meat juice and then repeat medicine for purgation. In addition, the patient should be given adequate amount of hot water to drink.

Symptoms of excessive purgation
Number of bowel movements are more than our expectation, excessive quantity of faecal matter, frequent watery discharge. Due to loss of water and Kapha from the body there is weakness, tremors in hands and legs, fainting, cutting pain in the anus and mental/ emotional instability.

Treatment
First give fruit juices, lemon juice, butter milk to the patient to avoid dehydration. Then ask the patient to take complete bed rest. To control the diarrhoea, give Tab. Shankha vati 250 mg with or Kutaj Ghana vati 250 mg. after every one hour till the loose motions stop. If this is not effective then give tab. Karpur rasa 250 mg. with water every one hour till the loose motions stop. Meanwhile give the patient simple hot water, hot tea or coffee as supportive treatment.

Post Herb induced purgation regimen
After treatment the patient should rest. The samsarjan karma (dietary regimen) is the same as post – emesis. This consists of starting with a light diet like vegetable soup and then slowly increasing the diet to a heavier quality.

Patient should avoid overeating, loud talking, excessive sitting or walking, anger and sorrow, anxiety, excessive use of vehicles, sex, sleeplessness, excessive heat or cold, wind, inhibition of natural urges etc.,

by **Admin** Sat 06 Nov 2010, 8:43 pm

Introduction to Virechan Karma

Virechan Karma (Administration of Purgative)

Virechan means administration of purgative for the purpose of eradicating dosha from the body. It is mainly done to eradicate the aggravated pitta dosha in the body. It is the karma that’s should be performed only after doing Snehan and swedan. Virechan karma is to be performed on the sunny day, wind should not be blowing and day should be auspicious. Various forms of herbal preparations like churn (powders), swaras (juices) are to be administered to perform virechan karma. The kind of herb and the method of its preparation are to be considered according to the disease and the condition of dosha. As an example trivith is very beneficial in the diseases which have pitta and kapha dominance. If there is Vayu, herb containing or mixture with the herbs which have snigdh, ushan qualities and lavan rasa are to be used as medicated castor oil etc.

Definition - Virechan or administration of purgatives is one of the series of panchkarma procedures. This is a Shodhana karma (cleansing procedure) or purifying operation with regards to pitta dosha. The aim and administration of virechan karma are different from and more comprehensive than those of administration of purgatives in modern sciences.

Benefits of virechan
• Properties of herbs that are used in virechan karma
• Virechan is indicated in following diseases.
• Action of virechan dravya (purgative) dravya (substance)
• Importance of performing purva karma before performing Vaman
• Mode of administration
• Different types of bowels (koshth)
• Purva karmas of Virechan karma
• Pradhan karma (main procedure)
• Complication of improper virechan karma

Panchakarma: Types of Bowels, Mild Bowel, Severe Bowel, Medium Bowel

• There are three of koshth or the bowel
• Mridu koshth (mild bowel)
• Karoor koshth (severe bowel)

Madhya koshth (medium bowel)

If a person has a Mridu koshth he ahs to administered by mild laxative like warm milk, which has the potency to evacuate bowel. Karoor koshth or the habitual constipated bowel is administered by using drastic purgatives. This type of koshth is to handles by first administrating it with the Snehan (lubrication) at least for six days and then the swedan karma (sweating) is to done. Madhayama or the medium koshth can be administered by any purgative of normal potency. Karoor koshth is the result of vata. Mridu koshth is the result of pitta and madhayama koshth is due to homeostasis of the all the doshas. After the purgative has been administered person should not obstruct the urge of evacuation of the bowel.

Panchakarma: Purva Karmas of Virechan Karma

In this process, we prepare our selves to perform the major process i.e. the virechan karma. Following are the points which are to be taken care of before the procedure has to start.
(a) Samagri or the collection
Before performing virechan one must do Snehan, swedan and Vaman karma. It is very important to perform these karmas before the virechan karma otherwise complications may arise.

(b) Rogi pariksha or the investigation of the patient
It should be first adjudged that does patient require virechan karma. If he requires this karma then he should be care fully investigated and his health should be judged on the criteria of desh (place), kaal (time and season), bal (strength), sharir (body), prakruti (nature). Depending on all these conditions it should be decided, that to what degree of and what type of virechan is to be given.

(c) Preparation of the Rogi
If the patient has also to be administered with Vaman karma prior to the virechan karma, then after performing Vaman karma, Snehan and swedan is to be performed again.

After performing Vaman karma sansarjan karma is to be performed in sequence and on the ninth, tenth, eleventh day and twelth day snehpaan (internal lubrication of body) is to be done.

After performing this one should take rest and then the procedure of virechan is to be performed.

The person who has to be given virechan must be given fatty stuff like ghee butter etc mixed with meat; rice etc prior 2 to 3 days before virechan karma and then he should be given purgatives.

Virechan should be performed empty stomach only.

Person who is to treated should be given psychological encouragement that he will be fine after the procedure is over.

(d) Preparing medicine

A person who is week, lean and sensitive should be given Mridu virechak (mild purgative)

If a person has the Mridu koshth (mild bowel) he can be given sugarcane juice, milk, ghee, triphala and warm water for performing virechan karma.

If a person has Karoor koshth, he has vata dominance in his grehni (first part of intestine).

It should be determined earlier the condition of koshth (bowel) of the person.

Panchakarma: Introduction to Pradhan Karma (Main Procedure)

After careful examination patient should be administered with the purgatives when he is empty stomach. According to Maharishi Sharanghdhar following are the doses that are to be administered in the following doses. Type of purgative Maximum dose Medium dose Least dose
Kashaya (decoction)2 pal (100 ml)1 pal (50 ml)½ pal (12 ml)
kalk50 gram25gram12 gram
Churan (powder)50 gram25 gram12 gram
Modak (laddu like sweet)50 gram25 gram12 gram

Some of the doses of commonly used purgatives Serial number purgative Doses in Karoor koshth 2waDoses in madhayama koshth Doses in Mridu koshth
1Ichabhedi rasa500 mg250 mg125 mg
2erand tail120 gram60 gram30 gram
3Isabgol15 gram8 gram4gram
4Trivritt churan15 gram8 gram4 gram
5Panchaskar churan15 gram8 gram4 gram
6Amaltas kwath120 ml60ml30 ml

After the purgative has been given he should be kept under careful observation.

It should be check that patient due do bad taste of the purgative should not vomit out the medicine. To prevent all this he should be kept in well fragmented place with calm ness all around.

He should also gargle his mouth with the warm water. Wash his face with cold water to make him feel fresh.

He should be kept in a place which is undisturbed by people.

He should be made to drink warm water in small small amount.

He should evacuate on bed in bed pan in lying down condition.

In the process of virechan first of all mal (faeces), then pitta (bile juices) and at last kapha (mucous) comes out. After it patient feels weakness and lightness in the body. If the medicines has digested and there is no out flow of faeces then the patient is given food that day and virechan karma is administered next day. If still virechan is in effected then after ten days again Snehan and swedan are done and with the strong purgatives.

Amount of evacuation in virechan karma. One should not count the first 2 to 3 Vegas (times) of the faeces and then it should be counted that how many times the patient has evacuated. The degrees up to which the virechan is done is classified into three categories i.e. pravar (most), Madhya (medium) and avar (least).

Serial number Degree of shuddhi Vegas (time) Maan (quantity) Dosha which comes out the last 1Pravar304 prasthKapha2Madhya203 prasthKapha 3Avar102 prasthkapha. It is advised that after every evacuation the bed pan should be changed so as the analysis of the last passed stool could be done.

Panchakarma: Importance of performing Purva Karma before performing Vaman

Importance of performing purva karma before performing Vaman Purva karma is very essential before performing the virechan karma. Other wise many complications can arise.

Snehan (lubrication) and swedan (sweating) are very important procedures are very critical before the virechan karma is initiated.

Snehan (lubrication) checks the Vayu, softens the tissues (deham) and separates the debris (mala) from the healthy tissue.

Sweating, if it is conducted after proper lubrication, liquefies the debris which is entangled in the tiny channels. In order to enhance the effect of Snehan and swedan, pitta or heat should be increased by the previous administration of In a chronic disease, such as prameha (urine disorder), kushth (skin disease), apasmaara (epilepsy), etc which is caused principally by kapha dosha and pitta or by any other dosha located in amashya (stomach) along with kapha, the preliminary process of Snehan karma and swedan karma has to be sufficiently executed before Virechan karma is administered, carefully regulating the diet and other habits all the while. Such processes were described by charaka and sushurut in the following manner

The patient is to undergo Snehan karma along with proper diet. Usually three to six days relapse in such a course. Swedan karma suited to constitution and the dosha vitiation of the patient in the next administered. If the patient is in the habit of taking hot potency foods, he may have swedan karma administers on the next day following Snehan karma. He has to take pitta producing food on the night of the next day. This act of eating such food increases pitta and this increased pitta makes the old stationary pitta somewhat mobile. If the static dosha is thus made mobile; it may easily be removed by administration of proper emetic.

Panchakarma: Mode of Administration of Panchakarma

If there is presence of kapha in the amashya (stomach) then one should. First go for Vaman karma and then after again going Snehan and swedan karma he should go for virechan of removing predominance of pitta. Most important of all the things is to properly handle the diet. If there is any kapha, the vairechanika dravya or the purgative is to be administered properly only serves to bring the kapha to the grehni (first part of the
intestine) and creating imbalance in jatharagni (digestive fire).hence it must be noted that virechan should not be given without overcoming kapha by following the suitable diet regimen and doing lahghan karma. It is advised that the person should take laghu aahar (light food), ushanodak (warm water) and juice liker that of orange Etc. on seeing in the next morning weather the previous meals had been digested. If yes then one should perform virechan karma.

Panchakarma: Diseases where Virechan is Indicated and Contraindicated

Virechan is indicated in following diseases.
Serial no. Disease charak sushurut Vagabhatta
1 Jwar + + +
2 Kushth + + +
3 Prameha + + +
4 Udharvagata rakta pitta + + +
5 Bhagandar + + +
6 Arsh + + +
7 Pliha dosha + + +
8 Gulm + + +
9 Arburd + + -
10 Galgand + + +
11 Granthi + + +
12 Visuchika + + -
13 Alsak + + -
14 Mutra ghaat + + +
15 Krimi koshth + + +
16 Visarpa + + +
17 Pandu + + -
18 Shirr shool + + +
19 Parshav shool + - -
20 Netra dah + + -
21 Hridya roga + + -
22 Aruchi + + -
23 Netra sraav + - -
24 Halimak + - +
25 Shwas + - +
26 Kaas + - +
27 Kamala + - +
28 Apchi + - +
29 Apasmaara + + -
30 Unnmad + - -
31 Vatarakt + + +
32 Yoni dosha + + +
33 Rakta dosha + - +
34 Timir + + +
35 Chardi + + +
36 Visphot + + +
37 Vibhandh - + -
38 Vidradhi - + +
39 Shavthu + + +
40 Dagdh - + -
41 Akshi paak - + -
42 Abhishayad - + -
43 Guda dah - + -
44 medh dah-+- - + -
45 Nasika dah - + -
46 Anah - + +
47 Shlipada - - +
48 Stabnnya dosha - - +

Virechan contraindicated in following diseases.

Serial no. Disease charak sushurut Vagabhatta
1 Shat guda + - +
2 Adhog rakta pitta + + +
3 Durbal + - -
4 AlpglanI + + +
5 Ajirn + + +
6 Nav jwar + - +
7 Ati snigdh + + +
8 Ati ruksh + + +
9 Ati sthool + + +
10 Ati krish + + +
11 Balak + + +
12 Vridh + + +
13 Shrant + + -
14 Pipasit + + -
15 Upvasit + + -
16 Methun Prasakt + - -
17 Garbhini + + +
18 Rajyakshma - - +
19 Atisaar - - +
20 Shudhit - - +
21 Hridya Rogi - - +
22 Bhyabhiitgt - - +
23 Subhag (child) + - -

Panchakarma: Benefits of Virechan

Virechan karma is the wonderful remedy in disorders caused by pitta dosha
• It helps in reducing jwar (fever).
• Helps in normalizing blood pressure
• Helps in relieving constipation
• It helps in normalizing the menstrual problems
• It is very helpful in gouty arthritis (vatarakt)
• It is help ful in conditions like jalodar (ascitis)
• It remove oedema from the body
• It makes our genital organs strong.
• By performing virechan karma our sense organs also gains strength
• It provides overall strength to the body.

Panchakarma: Properties of Herbs Used in Virechan Karma

Properties of herbs that are used in Virechan Karma

Ushan (hot): due to this ushan gunn (hot property) virechak dravya (purgative herbs) makes doshas vishyand i.e. it melts the doshas and then makes it to reach amashya (stomach) and mahastrota (gastro intestinal tract) thus doshas enters in koshth (body trunk), which are easier to eliminate from the body.

Tikshan (sharpness) ): it is an agneye (fire) in dominance thus helps in melting the doshas which get stick to the body parts due to this property it easily penetrate Vyavyahi: it is property in which the herb enters body and digested in the whole body. It has dominance of Aakash and Vayu mahabhoot. Vikashi: it helps in separating the doshas which are stuck to the dhatus (tissues) so as to make the movement in the body trunk so as to get it removed by the action of purgatives. Suksham (fineness): due to Aakash mahabhoot, vyavyahi and tejas gunna it gets the property of penetrating power which helps it to penetrating into the small strotas (channels)

Adhomargharan: due to this property the downward movement is obtained and the dosha re carried in the downward direction and hence acts as purgative.

Panchakarma: Action of Virechan Dravya

Action of Virechan Dravya (purgative) Dravya (substance)
Action of virechan dravya (purgative) dravya (substance)

It generally acts in four ways.Some or the purgative herbs stimulates the mucous membrane of our gastrointestinal tract which makes it to secrete more secretions. E.g. indravaruni.
Some of the herbs increase the peristaltic movements in the gastro intestinal tract especially in the intestines. It also increases the bile secretions which are involved in producing the purgation.] Some herbs get absorbed in the blood and perform there function. E.g. sanai leaves.

Panchakarma: Complication of Improper Virechan Karma

Complication of improper virechan karma. If the procedure of virechan is not properly carried out then following complications occur.

Heaviness in body
Piercing pain in chest region
Burning sensation
Itching over the body
Retention of stools
Vertigo
Unconsciousness
anal prolepses
pain in the body

Diet
If the patient has no appetite or hunger for food, do not force him to take any thing and let him fast instead of giving him peya. If the patient feels weak and thirsty then he may be given with the warm kanji.

Paschat karma
After completion of Virechan karma one should administer Sansarjan karma: It is the sequence of easily digestible food.

Tarpan Aushadh: these are the medicines that provide strength to the patient weekend after the vairechanika procedure

Sayam Niyam: it means disciplined life.

Virechana Karma-Purgation

Virechana Karma-Purgation

Virechan Karma-full details