Virechana Karma – Medicines, Indications, Procedure & More

Abstract

In purificatory procedures Acharya Vagbhatta has described five varieties:- Vamana (therapeutic emesis), Virechana (therapeutic purgation), Basti (enema), Nasya (medicine administered through nose), and Raktamokshan (bloodletting). Virechana is a specific treatment for pitta dosha, and pitta samsarga (Combination) doshas. Kapha, that resides in pitta place and stomach, which is the seat of kapha as well as pitta. In the process of virechana the person will not have the same amount of trouble and exhautions as in normal purgation, as he has been subjected to snehana (Oleation) and swedana (Sudation), etc. We can conclude that virechana is the treatment of pitta, kapha and samana vayu. So today we will read about virechana karma (therapeutic purgation) in detail in this article.

Introduction

तत्र दोषहरणम अधोभागं विरेचनसंज्ञकम। (C.kalpa.1/4)

Virechana (purgation) is a process by which doshas are made to pass through adhomarga (downward direction) that is anus. It is said to be an important therapy for evacuation of pitta dosha. By virechana the pitta dosha and malas are cleared not only from the colons and rectum but also from the whole body that is from cellular level. In virechana the doshas even from the stomach are taken to the large intestine and they are removed from the anus opening. It maintains the health of a healthy individual. It plays an important role in preventing diseases by enhancing the non-specific immunity against all diseases.

Indications

• Jvara (fever)
• Kustha (skin diseases)
• Prameha (diabetes)
• Arsha (haemorrhoids)
• Pleeha vriddhi (splenomegaly)
• Bhagandar (fistula in ano)
• Gulma (tumor)
• Granthi (lump)
• Shira shoola (headache)
• Pandu (anemia)
• Aruchi (anorexia)
• Swasa (difficulty in breathing)
• Kasa (cough)
• Kamala (jaundice)
• Apasmara (epilepsy)
• Vatarakta (gout)
• Unmada (insanity)
• Sleepada (elephantiasis)
• Vibandha (constipation)
• Nausea 
• Discharge from eyes, nose
• E.N.T. diseases

Contraindications

• Alpa agni (weak digestive fire)
• Ajeerna (indigestion)
• Navajwara (first stage of fever)
• Excessive alcohol intake
• Excessive dryness
• Pregnancy 
• Old peoples
• Children
• Weak people
• Heart diseases
• Diarrhea 
• Tuberculosis 
• People with fear
• Thirsty person

Investigations

• Random blood sugar
• Lipid profile
• SGPT
• SGOT
• Blood urea
• CT and BT
• Hb%, ESR, TLC, DLC
• Urine examination
• Stool examination
• LFT test
• Chest X-ray
• ECG

Collection Of Material

The physician, who wants to administer purgative to the patient has to arrange the necessary equipment before-hand, in order to provide pleasure in case of the drug being favorable and counter-action in that of complications arising keeping in view the nature of complications. Because it is not possible to arrange for the proper drugs easily and immediately, in spite of the arrangement of sale and import, in case an emergency occurs, when there is no time.

Virechana Medication

• Nishotha (operculina turpethum)
• Aragwadha (cassia fistula)
• Lodhra (symplocos racemosa)
• Snuhi (euphorbia neriifolia)
• Saptala (acacia concinna)
• Shankhini (andrographis paniculata)
• Dravanti (croton tiglium)
• Dantibeej (baliospermum montanum)
• Eranda (ricinus communis)
• Haritaki (terminalia chebula)
• Kampillak (mallotus philippinensis)

Materials And Medicines

1. Ghrita 500 gm or medicated ghrita that is mahatiktaka ghrita 500 gm. Pipplalyadi ghrita 500 mg.
2. Milk 200 ml/day during snehapana.
3. Virechana drugs:-
   1. Eranda tail (castor oil) 50 ml
   2. Ichhabhedi Ras 500 mg
   3. Trivrut churna 50 gm (operculina turpethum)
   4. Katuka churna 50 gm (picrorhiza kurroa)
   5. Sonamukhi churna 50 gm (cassia angustifolia)
4. Anti-diarrheal drugs:-
   1. Sanjeevani vati
   2. Kutajghan vati
   3. Karpooradi ras
5. Deepana (stimulate the digestive fire)
   1. Shankha vati
   2. Hingvastak churna
   3. Sutshekhar ras
6. Emergency drugs:- Basti dravyas (enema medications), piccha basti drugs, mocharas (bombax malabaricum), milk, kutaja churna (holarrhena antidysenterica), etc.

Procedure

Poorva Karma (Preoperative Procedure)

After careful examination the patient should be kept under snehapana for 3 to 7 days as per the prakriti (type of body) and severity of the disease.

Snehana Dravyas

1. Tila oil (sesame oil)
2. Ghrita (ghee)
3. Milk

Time

Time for snehapana is 7 am to 10 am.

• 1st Day:- 150 ml. Milk + 50 to 100 ml. Ghrita
• 2nd Day:- 150 ml. Milk + 100 to 150 ml. Ghrita
• 3rd Day:- 150 ml. Milk + 150 to 200 ml. Ghrita

If the patient does not get proper and samyak snigdha lakshanas (proper symptoms of internal oleation) after three days, snehapana should be continued for 5 to 7 days. Maximum patients will get samyak snehana lakshanas after 3 days of snehana. During snehapana, jeeryamana and jeerna (assessment of internal oleation) lakshanas should be observed in every patient. After samyak snigdha lakshanas are found in the patient for the next 2 to 3 days he should be advised to take hot and fresh diet in morning and night. During these days the patient should be kept on abhyanga (massage) with tila oil (sesame oil) and bashpa swedana (box like steamer) in the morning and evening.

Pradhana Karma (Operative Procedure)

The person who had undergone the complete procedure of poorva karma thereafter, when he is cheerful, seated comfortably, has food well digested, has done oblation, offering, auspicious and expiratory rites, after recitation of mantras wishing well-being by brahmanas, on a day having auspicious date and time should be administered the virechana drug in the morning. According to the patient’s age, take 30 to 50 ml of Eranda tail (castor oil) and add 500 mg of Ichhabhedi ras in powder form and mix well and ask the patient to take. Lukewarm water should be given for anupana or take 50 gm of trivrut churna or katukarohini or sonamukhi add 200 ml of water and prepare 1/4 decoction that is 50 ml, and add 500 mg of Ichhabhedi mix well and administer. For ladies and delicate persons give only castor oil or decoction without Ichhabhedi ras.

Observation Of Patient

As soon as the drug is administered in some sensitive patients there will be a sensation of nausea or vomiting. It will be due to bad taste. Hence these patients should be given lavang (clove) or shatapuspa (anethum graveolens). The patient must take complete rest within one hour and the patient will start passing motions. The pulse, heart rate, blood pressure, respiration rate should be observed during the motions. After getting the samyak virechana lakshanas the patient is asked to take complete rest. The following clinical symptoms will be assessed for samyak virechana.

a). Laingiki

• Lightness of the body
• Indriya prasannata (cheerful)
• Alleviation of vitiated doshas
• Passing of flatus
• Increase in appetite
• Feeling happy

b). Vegiki

• Pravara shuddhi (proper)- 30 vegas
• Madhyama shuddhi (moderate)- 20 vegas
• Avara shuddhi (mild)- 10 vegas

Note:- Assessment of vegas can be done on the basis of each time when the patient goes to the toilet how many times he passes the bowels should be calculated.

c). Maniki

• Pradhan – 4 prastha (2160ml)
• Madhyama – 3 prastha (1620 ml)
• Avara – 2 prastha (1080)

d). Antiki

• “Kaphantam virechanam”

In virechana the kapha should come out at last.

Paschat Karma (Post-Operative Procedure)

After samyak virechana the patient should be advised to take complete rest physically and mentally, he should not be allowed to take normal diet. Digestive powder becomes weak after sanshodhana (detoxification) treatment. When he feels happy he should be advised to take a hot water bath.

Samsarjana Karma

• 1st Day:- If the patient gets a good appetite he should be given yusha (moong dal water) after-noon and as well as at night.
• 2nd Day:- If the patient gets a good appetite he should be kept on moong dal khichdi with moong dal water. If there is no good appetite, moong dal water should be continued.
• 3rd Day:- If the patient gets a good appetite he should be kept on khichdi with ghee otherwise should be kept on moong dal water.

The same type of food must be continued till he gets a good appetite and then he should be kept on a normal diet. Throughout the treatment period he should be advised to take lukewarm water.

Virechana Vyapat

If we are not following the proper procedures mentioned in the texts the Panchakarma therapy may create many complications and side effects. Hence one should be careful while practicing this therapy. Panchakarma vyapats (complications) may arise due to four reasons as mentioned by Acharya Charaka.

• Physician:- Not taking proper decisions regarding the selection of patient, preparation of the patient, selection of the drug and dose.
• Drug:- The drug with less potency, old, atirukasa (excessive dry) may produce complications.
• Paricharak (attendant):- Not performing proper duties while preparing the drug and preparation of the patients. 
• Rogi (patient):- Non cooperation with physicians may lead to complications.

Virechana Samyak Yoga Lakshana (Proper Purgation Symptoms)

• Lightness in the body
• Recession of diseases
• Detoxification of heart
• Clear skin with good skin complexion
• Increase of hunger and thirst
• Vata movement in right direction
• Proper metabolic and digestion
• Clear the intellect, sense organ and manas (mind)
• Slimness

Virechana Ayoga (Improper Purgation)

The virechana drugs administered to the patient who is having poor appetite and predominance of shleshma (kapha) will get:-

• Bloating
• Distension
• Chest discomfort
• Nausea
• Spitting
• Weakness
• Vomiting
• Lack of lightness in the body
• Tiredness of sense organ
• Anorexia
• Stiffness
• Vata obstruction
• Running nose

The person who is without snehan (oleation), asweda (without sudation), dry body receives old and low potency purgative drug may get dizziness, edema, giddiness and pain in calf muscles.

Management

1. Once again fresh and good quality purgative dravyas should be administered after oil massage and sankara sweda (sudation).
2. Niruha basti with Gomutra (cow urine) should be administered then the patient should be given mamsa rasa (mutton soup) for diet. Afterwards milk can be given for virechana.
3. In virechana ayoga the following management should be given
   • Oil massage
     • Swedan (sudation)
     • Phalavarti (suppository)
     • Niruha basti
     • Anuvasana basti
     • Deepan pachana drugs (carminative and digestive medicines)
     • Shankha vati, hingwastak churna, lavana bhaskar churna etc.
     • Diet, i) laghu ahara (light diet) ii) madhura rasa (sweet taste) iii) mamsa rasa (meat soup)

Pharmacokinetics Of Virechana Drugs

Virechana dravyas have the characters of vyavahi (diffuse) and vikashi (spreading nature) by virtue of veerya (potency) they get quickly circulated into large and small capillaries of the body. It pervades all over the body. By virtue of its ushna (hot) and tikshna (acute) qualities the accumulated doshas get liquified and break up into small pieces at cellular level. Doshas start melting in the body due to ushna guna then we can observe the perspiration (sweda pradurbhava) on a patient’s forehead or sometimes the whole body. Because of its vikashi guna it detaches the malas from dhatus. At this stage we can observe horripilation (lomaharsha) in the patient. Owing to the presence of sukshma guna (minute property) and anupravana properties the malas or doshas float because already body has got smayak snigdhata (proper internal oleation) and pass through smallest capillaries and ultimately reaches to pakwashaya (intestine). Detached malas won’t obstruct even in the smallest capillaries. When a patient feels adhamana (bloating, distension) it indicates that doshas are shifted to pakwashaya (intestine). Virechana dravyas are predominant of prithwi (earth) and ap (water) mahabhutas. When a patient feels a purgative urge it indicates that doshas are adhogami (downward direction) and he may get virechana vega at any time.

Conclusion

Virechana therapy is the process in which the toxins of the body are removed through anus. It is the process which declines the adipose tissue and fatty acid. It is very effective in the controlling of obesity because it corrects the gut flora. It is indicated in various conditions like fever, skin diseases, haemorrhoids, tumor, fistula in ano, cough, anorexia, etc. It is a detoxifying process that enhances age, relieves from weakness, induces sleep, increases immunity, etc. If the channels of the body are washed and purified periodically one can easily prevent many diseases.