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Virechana concept and practice

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Virechana concept and practice

  1. 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. 2. Page 2 Introduction • Shodhana – Drava Shoshana. • Procedure of Choice for PITTAJA VIKARA. • Wide applicability and simplicity • 40 % of patient in our hospital
  3. 3. Page 3 Virechanam SÉåwÉ WûUhÉÇ FkuÉï pÉÉaÉÇ uÉqÉlÉ xÉÇ¥ÉMÇü AkÉÉå pÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMÇü | EpÉrÉÇ uÉÉ zÉUÏU qÉsÉ ÌlÉWïûUhÉÉiÉç ÌuÉUåcÉlÉ xÉÇ¥ÉÉ sÉpÉiÉå || cÉ.Mü.1/4
  4. 4. Page 4 Area of Virechanam MüTåü ÌuÉS±É²qÉlÉÇ xÉÇrÉÉåaÉã uÉÉ MüTüÉåsoÉhÉã | iɲ̲UåcÉlÉÇ|| ÌmɨÉå iÉÑ ÌuÉUåMÇü zsÉåwqÉxÉÇxÉ×¹å uÉÉ iÉixjÉÉlÉaÉiÉå uÉÉ zsÉåwqÉÍhÉ CÌiÉ | A.xÉÇ xÉÔ.27/4 ÌuÉUåcÉlÉÇ ÌmɨÉWûUÉhÉÉÇ || cÉ.xÉÔ. 25 (Indu A.S. Su. 1/39) ÌuÉUåMüÉå qÉÑZÉmÉÏiÉÇ aÉÑSqÉÉaÉåïhÉÉliÉÈ | ÎxjÉiÉxiÉ SÉåwÉxrÉ ÌlÉxxÉÉUhÉÇ ÌmɨÉxrÉ mÉUqÉÉæwÉkÉqÉç ||
  5. 5. Page 5 Common Benefits ÌuÉUåcÉlÉålÉ zÉÑSèkrÉÎliÉ mÉëxÉÏSliÉÏÎlSìrÉÉÍhÉ kÉÉiÉuÉ¶É ÌuÉzÉÑSèkrÉliÉå oÉÏeÉÇ pÉuÉÌiÉ MüÉqÉÑïMüqÉç || MüÉ. xÉÇ rÉSÉæSMüÉlÉÉqÉÑSMåüÅmÉlÉÏiÉå cÉUÎxjÉUÉhÉÉÇ pÉuÉÌiÉ mÉëhÉÉzÉÈ ÌmɨÉå WØûiÉåiuÉåuÉqÉÑmÉSìuÉÉhÉÉÇ
  6. 6. Page 6 Classification of virechana • Mode of actionMode of action • Intensity of actionIntensity of action • Parts usedParts used • Properties
  7. 7. Page 7 Koshtha Bheda
  8. 8. Page 8 Mode of Action AnulomanaAnulomana RechanaRechana BhedanaBhedana SramsanaSramsana
  9. 9. Page 9 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. 10. Page 10 Parts Used Moola Virechaka Phala Virechaka Twak Virechaka Dugdha Virechaka Swarasa Virechaka
  11. 11. Page 11 Properties • Ruksha Virechaka • Snigdha virechaka
  12. 12. Page 12 Specific Drugs for Virechana
  13. 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. 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. 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
  16. 16. Page 16 Sadhya Vyadhi’s
  17. 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. 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. 19. Page 19 Diet Before Virechana • Kapha avriddikara • Snigda drava, ushna ahara • Mamsa rasa • Yoosha • Amla rasa • Laghu Bhojana
  20. 20. Page 20 Pradhana karma • Samyak Snigdha Lakshana • Nidra • Passed natural urges • Empty stomach • Manasopachara Administration of Virechana Yoga
  21. 21. Page 21 Dosage of Virechanoushadhi • Koshta • Agni • Rogi bala • Roga bala • Dosha: Bahudoshavasta • Oushadha veerya
  22. 22. Page 22 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. 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
  24. 24. Page 24 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. 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%
  26. 26. Page 26
  27. 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
  28. 28. Page 28 Paschat Karma • Same as that of Vamana Karma except Dhumapana • Samsarjana Krama
  29. 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. 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. 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.
  32. 32. Page 32 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.
  33. 33. Page 33 Nitya Virechana • Elimination of excessive fluid • Reliving the constipation • Acts as diuretic • Increase of appetite What may be the scientific reason?
  34. 34. Page 34 Virechana as preventive measure oÉÑ®åÈ mÉëxÉÉSÇ oÉsÉÇ CÎlSìrÉÉhÉÉÇ kÉÉiÉÑ ÎxjÉUiuÉÇ oÉsÉÇ AÎalÉ SÏÎmiÉÈ | ÍcÉUÉccÉ mÉÉMüÇ uÉrÉxÉÈ MüUÉåÌiÉ ÌuÉUåcÉlÉÇ xÉqrÉaÉç EmÉÉxrÉqÉÉlÉqÉç || xÉÑ. ÍcÉ 33/27 • Disease deterrent • Delay the process of ageing • Bio purifier
  35. 35. Page 35 Virechana as curative measure qÉsÉÉmÉWûÇ UÉåaÉWûUÇ oÉsÉ uÉhÉï mÉëxÉÉSlÉqÉç | mÉÏiuÉÉ xÉÇvÉÉåkÉlÉÇ xÉqrÉaÉç AÉrÉÑwÉÉ rÉÑerÉiÉå ÍcÉUqÉç || cÉ. xÉÔ 15/22 • Removes the morbid Doshas • Multiple therapeutic benefit • Effect on specific disease
  36. 36. Page 36 Virechana as Rasayana & Vajikarana Poorva karma. ÍcÉUÉccÉ mÉÉMüÇ uÉrÉxÉÈ MüUÉåÌiÉ ÌuÉUåcÉlÉÇ xÉqrÉaÉç EmÉÉxrÉqÉÉlÉqÉç || xÉÑ. ÍcÉ 33/27. ÌuÉUåcÉlÉålÉ vÉÑ®rÉçÇÌiÉ mÉëxÉÏSÇiÉÏ CÎlSìrÉÉÍhÉ cÉ | kÉÉiÉuÉ¶É ÌuÉvÉÑkrÉÇÌiÉ oÉÏeÉÇ pÉuÉÌiÉ MüÉqÉÑïMüqÉç || MüÉ. ÍxÉÌ®. Enhance the drug absorption - Removing interfering molecules or ions. Enhancing mucosal blood supply Altering secretary function ?
  37. 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
  38. 38. Page 38 Mode of Action of Virechana.Mode of Action of Virechana.
  39. 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
  40. 40. Page 40 Role of inflammation Hyperemia Arteriolar dilatation Exudation Dilution of the toxins
  41. 41. Page 41 Chemical factors Vasoactive amines Mast cells Platelets Histamine Serotonin Increase permeability Dilatation
  42. 42. Page 42 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
  43. 43. Page 43 Elimination of Kapha • Elimination of kapha •Large intestine chiefly secretes mucous •Extreme parasympathetic stimulation secretes large amount of mucous
  44. 44. Page 44 Elimination of Waste Product 1.Interchange of ECF & ICF 2. Some hormones excreted by liver 3. Liver eliminate it through bile
  45. 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. 46. Page 46 For Your Attention Dr. Sharma’s Panchakarma Concepts “Na Matra Matramapyatra Kinchit Agama Varjitam”

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