Virechana electrolytes pk003-gdg

“THE STUDY OF VIRECHANA KARMA AND ITS EFFECT ON

BODY FLUIDS W.S.R.T SERUM ELECTROLYTES”-

AN OBSERVATIONAL STUDY

BY

DDrr.. SSaannttoosshh LL.. YYaaddaahhaallllii

Dissertation submitted to the Rajiv Gandhi University

of Health Sciences, Karnataka, Bangalore.

In partial fulfillment of Regulations for award of degree of

DDOOCCTTOORR OOFF MMEEDDIICCIINNEE ((AAYYUURRVVEEDDAA VVAACCHHAASSPPAATTII))

IN PANCHAKARMA

Under the guidance of

DR. SHASHIDHAR H. DODDAMANI M.D. (AYU)

ASSISTANT PROFESSOR DEPARTMENT OF

P. G. A. R. Center PANCHAKARMA

POST GRADUATE DEPARTMENT OF PANCHAKARMA D.G MELMALAGI AYURVEDIC MEDICAL COLLEGE AND RESEARCH

CENTER, GADAG - 582103.

2005

Ayurmitra

TAyComprehended

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDITATE

I hereby declare that this dissertation / thesis entitled “The study of

Virechana Karma and its effect on Body Fluids w.s.r.t Serum

Electrolytes”- an observational study, is a bonafide and genuine research

work carried out by me under the guidance of Dr. Shashidhar H. Doddamani MD (Ayu),

Asst Professor, Post Graduate Department of Panchakarma, Shri D.G.M.A.M.C, Gadag.

Date: Signature of the Candidate

Place:

(Dr.Santosh L. Yadahalli)

Ayurmitra

TAyComprehended

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “The study of Virechana

Karma and its effect on Body Fluids w.s.r.t Serum Electrolytes”-

an observational study, is a bonafide research work done by

Dr. Santosh L. Yadahalli in partial fulfillment of the requirement for the

degree of Ayurveda Vachaspati in Panchakarma.

This work is applied, scientific and an original contribution in the field of research

in Ayurveda.

I am fully satisfied with his original work and recommended the dissertation to be

put before the adjudication.

Date: Signature of the Guide

Place:

Dr. Shashidhar H. Doddamani MD (Ayu)

Asst Professor, Post Graduate Department of Panchakarma, D.G.M. Ayurvedic Medical College, Gadag.

ENDORSEMENT BY THE HOD, PRINCIPAL

HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “The study of Virechana

Karma and its effect on Body Fluids w.s.r.t Serum Electrolytes”- an

observational study, is a bonafide research work done by Dr.Santosh L. Yadahalli

under the guidance of Dr. Shashidhar H. Doddamani MD (Ayu) Asst Professor, Post

Graduate Department of Panchakarma, Shri D.G.M.A.M.C, Gadag and contributed good

values to the Ayurvedic research.

We here with forward this dissertation for the evaluation and adjudication.

Seal & Signature of the HOD Seal & Signature of the Principal

Dr. G. Purushottamacharyulu Dr. G. B.Patil

COPYRIGHT

Declaration by the Candidate

I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic / research purpose.


Place:

Dr.Santosh L. Yadahalli

© Rajiv Gandhi University of Health Sciences, Karnataka.

ACKNOWLEDGEMENT

I express my deep sense of gratitude to his great holiness Jagadguru

Shri Abhinava Shivananda mahaswamiji for their divine blessings.

I bow to the “SUPREME SOUL”, who graced adi, Madhya and antya through

OM vibration to human kind. I bow to OMKARA which makes us to realize the

“SUPREME SOUL”. I bow to GOD who graces his blessings in the form of love and

affection through Gurus,Father,Mother,Elders,Youngers etc.

I express my deep sense of gratitude to my respected Prof

Dr. G. Purushottamacharyulu, Head of the department, Department of Postgraduate

Studies and Research in Panchakarma, D.G.M.A.M.C., Gadag. He has been very kind to

guide me in research and for whose extraordinary efforts, tremendous encouragement and

most valuable advice made me to complete this work.

I express my obligation to my guide, Dr. Shashidhar H. Doddamani, Asst Prof

in the Department of Panchakarma, P.G.A.R.C, D.G.M.A.M.C, Gadag, for tremendous

encouragement and thought provoking advice to complete this thesis.

With profound sense of gratitude I express my sincere thanks to Dr. G. B. Patil,

Principal, D. G. M. A. M. C, Gadag, for encouragement and facilities provided during my

postgraduate studies.

I am very much thankful to Dr. P. Shivaramudu Asst. Prof, Dept of

Panchakarma, for his valuable suggestions and support through out this study.

I am very much thankful to Dr. Santosh N. Belavadi Lecturer,Dept of

Panchakarma, for his suggestions and support through out this study.

I am very much thankful to Late. Dr. C. M. Sarangamath who is the root cause

of my entry into this Post Graduation. I remain ever great full to him.

I wish to add my warmest thanks to my PG teaching facultyDr. Varadacharyulu,

Dr. Mulagund, Dr. M. C. Patil, Dr. K. Siva Rama Prasad, Dr. Kuber Sankh,

Dr. R. V. Shetter, Dr. Danappagoudar, Dr. MulkiPatil, Dr. Mitti, Dr. Nidagundi and

Dr. D.M.Patil for their valuable suggestions and timely help which made me to complete

this dissertation work successfully.

I am very much thankful to Dr.S.A.Patil H.O.D (Siddanta) and Dr. Radder

H.O.D (Panchakarma) for encouragement and moral support during the study.

I am very much thankful to Dr. Bhajantri Medical Officer, Shirahatti, for his

suggestions and support during this study.

I am very much thankfull to Nandakumar who helped in the statistical work.

I am thankful to Dr. P S. Khona, Hans Laboratory and Sri. B S. Tippangouda

Laboratory technician who extended his co-operation in investigations.

Special thanks to Dr. Srinivas Reddy, in spite of his busy schedule he

has given valuable suggestions and supported through out this study.

I extend my gratefulness and sincere heartfelt gratitude to my colleagues

Dr.Subin, Dr.Satheesh, Dr.Febin, Dr.Jairaj, Dr.Hugar, Dr.Varsha, Dr.Shaila,

Dr.Kendadamath, Dr.Chandramouli, Dr.Suresh, Dr.Akki, Dr.Vijaykumar,

Dr.Lingareddi and Dr.Ashwinidev for their timely support during the study.

I am very much thankful to my friends Dr. Shashidhar. N, Dr. Jagadish. K,

Dr. Sharanu. R, Dr. Sanjeev, Dr. Ujwala, Dr. Samudri, Dr. V. S. Hiremath,

Dr. Pattanashetti, Dr. Koteshwara, Dr. Kalmath, Dr. Venkaraddi and other scholars

of Kayachikitsa, Rasashastra and Dravyaguna Department for their timely support

during the study.

I am very much thankful to all UG staff and college librarian

Shri. V. M. Mundinmani and other library staff for their timely help and co-operation

during the study.

I am very much thankful to my parents, my Brother and Bhabhi who inspired

me for higher study, rendered their valuable suggestions and encouragement throughout

the study.

I wish to thank RMO, Dr. Yerageri, physicians and other hospital staff for their

co-operation and all the patients who agreed to under go the treatment with trial drug.

I wish to thank Arunkumar Biradar and Aravind Yakkundi and my sister

Vanishree for their technical support. In spite of their busy schedule they helped me in

the dissertation work in time.

I wish to thank all the persons who have helped me directly and indirectly with

apologies for my inability to identify them individually.


Place: Dr. Santosh L. Yadahalli

LIST OF ABBREVIATIONS USED

A S – Ashtanga Sangraha

A H – Ashtanga Hridaya

Aru. – Arunadatta

A.T – After treatment

B.T – Before Treatment

B.P – Bhavaprakasha

B.R – Bhaishajya Ratnavali

Bh.S – Bhela Samhita

C.S – Charaka Samhita

Chi. – Chikitsa Sthana

Chak. – Chakrapani

Dal. – Dalhana

E.C.F – Extra Cellular Fluid

Gang. – Gangadhara

H.S – Highly Significant

I.C.F – Intra Cellular Fluid

K.S – Kashyap Samhita

Ka. – Kalpa Sthana

Ma.Ni – Madhav Nidana

Ni. – Nidana Sthana

N.S – Not Significant

Su.S – Sushruta Samhita

Sh.S – Sharangadhara Samhita

Sha.S – Shareera Sthana

Su. – Sutra Sthana

Si. – Siddhi Sthana

Vi. – Vimana Sthana

Y.R. – Yoga Ratnakara

ABSTRACT

BACK GROUND –

Now a day Ayurveda Chikitsa is becoming popular because of Samshodhana

Chikitsa, which gives satisfactory results in chronic diseases. Among Samshodhana,

Virechana is widely practicing treatment by Ayurvedic vaidyas through out the country.

The understanding of the procedure and its effect with modern technologies is very

necessary in this modern era. Today’s generation needs scientific proofs for every aspect.

So to understand about the Virechana Karma and its effect on Body Fluids and

Electrolytes is the study to rule out the actual loss of fluid.

OBJECTIVES –The present study was planned with the following aims and Objectives.

To evaluate the electrolytes and body fluid level after samyak Virechana

Karma.

To evaluate the effect of Virechana with Trivrit Leha on body fluids and

electrolytes.

METHODS -

This study has been designed to assess the effect of Virechana in 3 diseases,

which are Virechana arha rogas and available easily in our college hospital.

Group ‘A’ – Kitibha Kusta, Group ‘B’ – Amlapitta, Group ‘C’ – Tamaka

Shwasa

The treatment contains the following steps.

Pachana by Panchakola Churna 3-6 Gms till Nirama Lakshanas seen.

Snehapana by Murchita Ghrita in Arohana Vidhi till Samyak Snigdha

Lakshanas seen.

Abhyanga with tila Taila and Nadi Sweda by Nirgundi Patra.

Virechana by Trivrit Leha.

Samsarjana Krama for 3, 5, 7 days based on the Shuddhi.

Assessment Criteria –

Subjective – Samyak Virechana i.e., on Vegiki, Maniki, Antiki and Laingiki.

Objective – Serum Electrolytes 1. Sr. Sodium 2. Sr. Chloride 3. Sr. Potassium.

Serum Electrolytes was taken before a day of giving Trivrit Leha and one more

reading immediately after Virechana Vega stopped.

RESULTS –

Out of 30 patients, 23 patients had Madhyama Shuddhi and 7 patients had

Avara Shuddhi. No patient had Pravara Shuddhi.

After Virechana Serum Electrolyte values remained within the normal except

2 patients compared to the before readings.

In 2 patients of Tamaka Shwasa, Chloride value decreased than the normal,

but Sodium and Potassium values were within the normal.

No patients had any symptoms of fluid loss or dehydration.

After Virechana Karma many of the patients of Amlapitta and Tamaka

Shwasa were relieved from most of the symptoms.

INTERPRETATION AND CONCLUSION:

Virechana is an easiest, unfearable and most effective treatment among all the

Shodhana Chikitsa.

Virechana is such a procedure which has Snehana and Swedana as Purvakarmas

which makes the body stable and makes body ready to face the Virechana effect.

Virechana will not produce loss of body fluids and electrolytes, but it eliminates

the vitiated doshas by making liquification of doshas.

KEY WORDS –

Virechana Karma, Body Fluids, Serum Electrolytes, Sodium, Chloride,

Potassium, Trivrit Leha, Murchita Ghrita, Panchakola Churna, Cathartic.

TABLE OF CONTENTS

Page No.

1. Introduction 1-3

2. Objectives 4

3. Literary review

a). Historical review of Virechana Karma 5

b). Shareera 6-22

c). Virechana Karma 23-58

d). Disease Review 59-87

i). Kitibha Kusta 59-67

ii). Amlapitta 68-76

iii). Tamaka Shwasa 77-87

4. Methodology 88-102

5. Observations and results 103-127

6. Discussion 128-145

7. Conclusion 146-148

8. Summary

9. Bibliography

10. Annexure

LIST OF TABLES

Sl. No

Table Nos Name of the Table Page

No 1. 1 Summary of Digestive activities in the Stomach 11

2. 2 Summary of Mechanical digestion in the small intestine 12

3. 3 Digestive activities in the large intestine 13

4. 4 Osmolar substances in ECF and ICF 18

5. 5 Electrolyte Balance 19

6. 6 Virechana Yogya 25

7. 7 Virechana Ayogya 27

8. 8 Part of the Plant used for Virechana 30

9. 9 Virechana drugs according to seasons 36

10. 10 Doses of Virechana according to Sharangadhara 37

11. 11 Dosha wise Virechana Dravya 38

12. 12 Criteria for Antiki, Vegiki and Maniki Shuddhi of Virechana karma 43

13. 13a Samyak Yoga Lakshanas of Virechana Karma 43

14. 13b Ayoga Lakshanas of Virechana karma 44

15. 13c Atiyoga Lakshanas of Virechana Karma 45

16. 14 Virechana Vyapad and their treatment 46

17. 15 Samsarjana Krama (Diet) 46

18. 16 Classification and comparison of representatives Laxatives 53

19. 17 Summary effects of some Laxatives on Bowel function 54

20. 18a Aharaja Nidana of Kitibha Kusta 60

21. 18b Viharaja Nidana of Kitibha Kusta 61

22. 18c Daivapacharaja Nidana of Kitibha Kusta 61

23. 19 Purvarupas mentioned by different Acharyas of Kitibha Kusta 64

24. 20 Rupa mentioned by different Acharyas of Kitibha Kusta 65

25. 21 Comparison between Kitibha Kusta and Psoriasis 66

26. 22 Nidana of Amlapitta 70

27. 23 Samanya Rupa 73

28. 24 Nidana of Shwasa/ Tamaka Shwasa 77

29. 25 Purvarupa of Shwasa roga 82

30. 26 Rupa of Tamaka Shwasa 83

31. 27a Properties of Ingredients of Panchakola Churna 89

Sl. No

Table Nos Name of the Table Page

No 32. 27b Properties of Ingredients of Murchita Ghrita 89

33. 27c Ingredients of Murchita Ghrita 90

34. 27d Properties of Tila Taila 91

35. 27e Summarized Pharmacological profile of Trivrit 92

36. 27f Subjective Criteria for Samyak Virechana Karma 99

37. 28 Status of Patients of the present study 102

38. 29a Age wise distribution of 3 Groups 103

39. 29b Sex wise distribution of 3 Groups 104

40. 29c Distribution of 3 Groups by occupation 105

41. 29d Distribution of 3 Groups by Vyasana 106

42. 29e Distribution of 3 Groups by Prakriti 107

43. 29f Distribution of 3 Groups by Disease Symptoms 108

44. 30a Distribution of Sneha Matra of 3 Groups 109

45. 30b Sneha Jeeryamana Lakshanas of 3 Groups 110

46. 30c Distribution of Sneha Jeerna Lakshanas of 3 Groups 111

47. 31a Distribution of Samyak Snigdha Lakshanas of 3 Groups 112

48. 31b Time taken for Sneha Jeerna in Group ‘A’ 112

49. 31c Time taken for Sneha Jeerna in Group ‘B’ 113

50. 31d Time taken for Sneha Jeerna in Group ‘C’ 114

51. 32 Number of Vegas produced in 3 groups 116

52. 33 Distribution of Patients on Maniki in 3 Groups 117

53. 34 Distribution of Patients on Antiki produced in 3 Groups 118

54. 35 Distribution of Patients on Laingiki produced in 3 Groups 119

55. 36 Distribution of Patients on type of Shuddhi produced in 3 Groups 121

56. 37 Fluid loss during Virechana Karma 122

57. 38 Calculation of Fluid loss 123

58. 39a ANOVA table for the Parameter Sodium 123

59. 39b ANOVA table for the Parameter Chloride 124

60. 39c ANOVA table for the Parameter Potassium 124

61. 39d Statistical Assessment in Group ‘A’ Kitibha Kusta 124

62. 39e Statistical Assessment in Group ‘B’ Amlapitta 124

63. 39f Statistical Assessment in Group ‘C’ Tamaka Shwasa 125

LIST OF FIGURES AND GRAPHS

Sl. No Name of the Figure Page No

1. Showing Defecation Reflex 14

2. Showing Drugs used in clinical trial 89

3. Distribution of Patients by Age 103

4. Distribution of Patients by Sex 104

5. Distribution of Patients by Occupation 105

6. Distribution of Patients by Vyasana 106

7. Distribution of Patients by Prakriti 107

8. Distribution of Patients by Disease Symptoms 108

9. Distribution of Patients by Snehamatra 109

10. Distribution of Patients by Samyak Sneha Lakshana 115

11. Distribution of Patients by Number of vegas 117

12. Distribution of Patients by Fluid Loss 118

13. Distribution of Patients by Antiki Lakshana 119

14. Distribution of Patients by Samyak Virechana lakshana 120

15. Distribution of Patients by Shuddhi Observed 121

“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.

1

INTRODUCTION

Ayurveda is a science which imparts knowledge about life, with special reference

to its definition and description of happy and unhappy life, useful and harmful life.

Nowadays, total world is looking towards best disease healing methods in the

lines of holistic approach. We can find only Ayurvedic science which completely fulfills

this criterion. Ayurveda has got vivid area for the treatment of diseases like, Shodhana

and Shamana type of treatments. Among these two, shodhana (Panchakarma) chikitsa

plays a major role in treating and preventing the relapse of diseases.

The procedure which helps to eliminate the vitiated doshas from the body is

called Shodhana1 and is 5 in number. Vamana Karma, Virechana Karma, Anuvasana

basti, Niruha basti and Nasya Karma.2 Sushruta mentioned Anuvasana basti and Niruha

basti as Basti Karma only and added Raktamokshana as a fifth karma.3

Among the Panchakarmas, Virechana karma has got more importance in view of

its easy administration through oral route in a natural direction, thus helping the nature to

do its job. Though the word Virechana conveys the meaning of Rechana through either of

the way, its clinical practice is limited to only Adhobhagaharatwam. Virechana is the

only method of eliminating vitiated doshas (toxic materials) including Adhovata from

adhoamashaya more appropriately.

The Shodhana karmas should always be preceded by Purvakarma, such as

Pachana, Snehana karma, Swedana karma. These Purvakarma cause vishyandana,

doshapaka, srotomukha vishodhana and thus brings the vitiated doshas from shakhas to

kosta.


2

Virechana karma is a specific shodhana procedure among the Panchakarmas

(Biopurificatory procedures). It is specially indicated for pitta dosha, pitta predominant

rogas (diseases), pitta dosha anubandha kapha and also kapha dosha which is situated in

pitta sthana. Virechana is also useful in the elimination of vitiated vata dosha and also in

the treatment of Rakta and its disorders.

Udaka (Body fluids) plays an important role in the digestion and metabolism and

also in the procedure of Virechana karma. The nutrients will carry through ahara rasa to

their respective tissue levels (Dhatu). Rasa, Rakta and Mutra etc are composed of

jaleeyamsha which are in udaka nature. The combination of Prithwi and Aap mahabhoota

in the Virechana dravyas which are adhobhaga hara accomplishes the elimination of

doshas from Guda margaThe Purisha with pitta, kapha and vata are excreted by

Virechana respectively.

The Virechana karma can be assessed on the basis of samyak (purificatory

symptoms) Virikta lakshanas of Vegiki, Maniki, Antiki and Laingiki in pradhana,

madhyama and avara shuddhi. During this procedure some amount of fluid is lost along

with vitiated malas from the body; there is a thought of impairment in the body fluids.

In Ayurveda, no such references are found about the impairment of body fluids

after samyak Virechana karma while mentioning the shuddhi. But in Atiyoga lakshanas

of Virechana karma, some symptoms like, Kapha kshayaja vikara, Murcha, Trishna etc

are mentioned which are similar to fluid loss symptoms. So to assess the actual loss of

fluids during Virechana karma present or not is the subject of interest.

Till now no satisfactory contributions (researches) have been conducted on this

Virechana procedure. So here the work chosen was to understand the mode of action of


3

samyak Virechana on the body fluids (electrolytes) where it gives the proper knowledge

on both Ayurvedic sciences in the lines of modern science and technology.

For convenient of my study, the diseases Kitibha Kusta, Amlapitta and Tamaka

Shwasa which are Virechana arha (rogas) are selected.

In the present work part ‘A’ deals with review of literature on Virechana Karma,

Body fluids ( Electrolytes ), three diseases, Drugs used in clinical study, while the second

part ‘B’ deals with the materials and methods, observations, results, discussion with

hypothesis of the effect of Virechana karma on body fluids, summary and conclusion.


4

OBJECTIVES OF THE STUDY:

To evaluate the electrolytes and body fluid level after samyak Virechana Karma.

To evaluate the effect of Virechana with Trivrit Leha on body fluids and

electrolytes.


5

REVIEW OF LITERATURE

HISTORICAL REVIEW:

In the text Vinayapittaka, written during the period of Buddha, it is mentioned

that Virechana was given to Bhagawan Buddha by inhaling some powder spread over

Utpalapatra.

In Bhrihatrayee, Laghutrayee and other Ayurvedic texts we get elaborative

description of Virechana Karma.

In Charaka Samhita Sutrasthana Virechana dravya Sangraha, Virechana yoga’s,

procedure of Virechana is mentioned4-6, in Kalpasthana complete explanation of

Virechana Kalpas is mentioned 7, in Siddhi sthana Virechana samyak yoga, ayoga,

atiyoga, Virechana yogya, ayogya, Virechana Vyapad and chikitsa is mentioned8-10.

In Sushruta Samhita Sutrasthana Virechana dravyas, explanation of Trivrit

different preparations are mentioned11, 12, in chikitsa sthana Virechana karma vidhana,

samyak ayoga, atiyoga, Vyapad and their treatment is mentioned13, 14.

In Ashtanga Hridaya Sutrasthana Virechana Vidhi is explained15, in Kalpasthana

Virechana dravyas, Virechana Vyapad and Siddhi is explained16, 17.

In Ashtanga Sangraha Sutrasthana complete Virechana Vidhi is explained18.

Chakradatta, in Virechana adhikara complete procedure of Virechana karma is

explained19.

In Sharangadhara Uttara Khanda virechanopayogi dravyas, their Matra, Virechana

Vidhi is elaborately explained20.

Cathartics are used in modern medicine for this treatment. Different types, their

actions and drugs used for Cathartics are mentioned in Satuskar Pharmacology21.


6

SHARIRA –

Anatomy and Physiology of Amashaya and Pakwashaya:

As this study deals with Virechana karma and its effect on Body fluids, it is

necessary to explore the basic Anatomy and Physiology of Gastrointestinal tract and

Body fluids (Electrolytes).

In Ayurveda, the human body is termed as ‘Shareera’ and ‘Deha’. These two

synonyms convey two different and opposite meanings, i.e, “Sheeryate anena iti

Shareeram”-means to be rendered to pieces and therefore indicates continuous decay of

body and the term ‘Deha’ derived from the root ‘Dih Ghanj’ meaning to grow or to

develop. Thus the above two synonyms of the body indicate both catabolic and anabolic

activities going on simultaneously in the body.

The digestion of the food is the function of the jatharagni, also known as Pachaka

Pitta, which is located in Amashaya and Pakwashaya. These two organs comprise a

Srotas called ‘Annavaha Srotas’ (food conducting channel or alimentary tract) which is a

part of kosta.

Kosta according to Charaka has the synonyms-

- Mahasrotas (the great channel)

- Shareera Madhya (the mid part of the body)

- Mahanimna (the great cavity)

- Amapakwashaya ( the stomach including the small intestine and large

intestine)

- Abhyantara roga marga (internal pathway of disease).

Amapakwashaya is the combination of Amashaya and Pakwashaya and are

responsible for the digestion of the food. Even though the synonym Amapakwashaya


7

indicates that kosta is made up of these two organs, actually kosta comprises of two

srotases, viz, Annavaha Srotas and Pureeshavaha Srotas. The ingested food digested and

divided in to Sara (essence) and Kitta (waste) in this Srotas. The waste after being

transformed in to Purisha (feces) in the Pureeshavaha Srotas by the Purishadhara Kala

and it is excreted through the Guda marga.

A consistent, clear and precise anatomical description of Annavaha Srotas has

been furnished in ‘Atreya Samhita’ which has been coated by Vaidyaka Shabdasindhu as

‘Annapaka Nadi’. The description of Annapaka Nadi resembles the anatomical

description of alimentary tract of modern science. Annapaka Nadi concerns with the

digestion and metabolism of food as it is composed of Kala and Peshi and is of twenty

cubits in length. The part of this Nadi (tube) which extends from Kantha above and the

Amashaya below is known as the Anna Nadi. Amashaya is situated and appears like

bulging head.

The Sthulantra follows with Kshudrantra (small intestine) commences from the

Amashaya. The first part of the Antra is said as Grahani which is the seat of jatharagni.

The anatomical part after Grahani is Pakwashaya which restain the food that has already

been digested. The lower portion of the Sthulantra is known as Guda. Its function is to

expel the Anna-Kitta along with Malas22.

Ahara Parinamana (Paka) krama -

The function of Prana Vayu is to carry the food from mouth to the Koshta i.e.

Amashaya. Sanghatabheda of food is done by Kledaka Kapha in the Amashaya to make it

soft and mucilaginous.


8

The Jatharagni which is situated below the Amashaya in Grahani is activated by

Samana Vayu along with Pachaka pitta digests the food which has been taken in

appropriate time and quantity.

The food is acted upon by Ahara Parinamakara Bhavas, namely the Ushma, Vayu,

Kleda, Sneha, Kala and Samayoga.

The consumed food is brought into the Agnisthana by Vayu (Prana Vayu); there

the Samana Vayu stimulates the Ushmata of Pachaka Pitta which is present in Pittadhara

Kala and facilitates the Paka Karma. By the help of Kleda and Snehabhavas, the food will

get softened beginning from Amashaya. The digestion or Paka Karma depends upon the

Kala, which is responsible for the preceding of vipakas of Paka Karma. Yogaratnakara

advises not to consume food before three hours of earlier meal and not to do the

Langhana after six hours of taken food. Samayoga is the appropriate intake of food that

brings about Dhatu Samyata.

The Samana Vayu which is situated in Amashaya accomplishes rapid movement

of the food particles, which gives rise to the production of gastric juices for Paka Karma.

It also does the Vivechana Karma of Sara and Kittabhaga. Munchana Karma i.e. the

propulsion of food particle from one segment to another segment is done by Samana

Vayu throughout the Amashaya and Grahani up to Pakwashaya. The Samana Vayu by its

influence towards the rapid movement and pressure alteration helps in absorption of

Sarabhaga through the intestinal villi and Kittabhaga is propelled forwards into

Purishadhara Kala for the formation of Malabhaga.

Once the Kittabhaga enters into the Pakwashaya it gets converted into solid form

by the action of Apana Vayu and it is excreted through the Gudamarga.


9

Movements of Annavaha Srotas:

All movements are caused by contractions and relaxations of muscles. So

similarly in Annavaha Srotas muscles are present in the Amashaya and Pakwashaya i.e.,

Annavaha Srotas.

The following are the functions of these muscles.

1. Retention of food in Grahani till it is completely digested. This reaction is

possible by the action of argalas (valves) present in the Kosta.

2. Thorough admixture of food with Kledaka Kapha and Malarupa Kapha for the

physical disintegration.

3. Thorough admixture of physically disintegrated food with Pachaka Pitta and Mala

Rupa Pitta for digestion.

4. Absorption of the Anna Rasa by the action of villi.

5. Onward movement of Kitta in to the Pureeshavaha Srotas.

The peristalsis produces the onward propulsion of the food. The function of the

rhythmic contractions is to agitate the intestinal contents. This facilitates several

processes; it tends to increase the degree of sub division of food particles, to mix

food with the digestive fluids and to change constantly the layers of fluid in

contact with the mucosa, thus facilitating the absorption.

Different factors influencing the formation of Purisha23 : The factors influencing for the formation of Mala are Pittadhara Kala,

Purishadhara Kala, Pakwashaya, Agni and Vayu.

1. First ahara undergo for the jatharagnipaka i.e., intestinal digestion. The term

intestinal has been used as adhoamashaya by Chakrapanidatta.

2. The Bhutagnipaka postulates the view that the end product of jatharagnipaka.

According to Vagbhata, the separation of Sara bhaga or nutrient fraction of the food

takes place after the completion of Bhutagnipaka.


10

Chemical reactions involved in jatharagnipaka occur in adhoamashaya,

those implied by Dhatwagnipaka resemble in general the metabolic reaction that

takes place in the yakrit or liver.

3. The remaining ingredients of intestine, such as ammonia, urea, uric acid etc are seen

to be derived from the blood and they represents the outcome of metabolism or the

kitta aspect of the dhatwagnipaka.

4. The Katu bhava of avasthapaka describes the events in the Pakwashaya or large

intestine leading to the formation of faeces and gases.

As the intestinal contents reach the large intestine, the process of

absorption with the exception of water, is normally completed. In the large intestine

more of water and salts are absorbed. The material left over is converted in to faeces

which leave the body.

MODERN VIEW 24, 25:

Wall of GIT

1) Mucous layer – Has 3 layers- epithelial lining, lamina propria and muscularis

mucosa.

2) Sub mucous layer – Contents collagen fibers, elastic fibers, reticular fibers and few

cells of connective tissue. Blood vessels, Lymphatic and Nerve plexus.

3) Muscular layer – Skeletal and smooth muscle fibers.

4) Serous or Fibrous layer – formed by connective tissue and meso epithelial cells.

Nervous system of GIT Intrinsic Nervous system – 2 Types: Mesenteric Nerve Plexus

Sub mucous Nerve Plexus

Extrinsic Nervous system – in the form of Autonomic Nervous system (Both

sympathetic and parasympathetic)


11

Stomach:

Table no 1

Summary of Digestive Activities in the Stomach

Structure Activity Result

Mucosa Chief cells

Secrete pepsinogen Secrete gastric lipase.

Pepsin, the activated form, breaks certain peptide bonds in proteins. Splits short-chain triglycerides into fatty acids and monoglycerides.

Parietal cells

Secrete hydrochloric acid. Secrete intrinsic factor

Kills microbes in food; denatures proteins; converts pepsinogen into pepsin. Needed for absorption of vitamin B12, which is used in red blood cells formation (erythropoiesis).

Surface mucous cells & mucous neck cells

Secrete mucous Absorption

Forms a protective barrier that prevents digestion of stomach wall. Small quantity of water, ions, short-chain fatty acids, and some drugs enter the blood stream.

G cells

Secrete gastrin

Stimulates parietal cells to secrete HCl and chief cells to secrete pepsinogen; contracts lower esophageal sphincter, increases motility of the stomach, and relaxes pyloric sphincter.

Muscularis

Mixing waves. Peristalsis.

Macerate food and mix it with gastric juice, forming chyme. Forces chyme through pyloric sphincter

Pyloric sphincter

Opens to permit passage of chyme into duodenum

Regulates passage of chyme form stomach to duodenum; prevents backflow of chyme from duodenum of stomach.


12

1. Gastric secretion is regulated by neural, paracrine and hormonal mechanisms.

Regulation of gastric secretion occurs in 3 overlapping phases – cephalic, gastric and

intestinal phases.

2. Digestive hormones – The stimuli promote the release of hormones. Among the

substance stomach can absorb water, certain ions, drugs and alcohol.

3. Within 2-4 hours after taking meal the stomach emptied its contents into the

duodenum.

Small Intestine:

Table no 2

Summary of the mechanical digestion in the Small intestine

Structure Activity

MUSCULARIS Segmentation

(Duodenum 12

times per min,

Ileum 8 times per

min)

Consists of alternating contractions of circular smooth

muscle fibers that produce segmentation and re

segmentation of sections of the small intestine; mixes

chyme with digestive juices and brings food into contract

with the mucosa for absorption.

Migrating motility

complex (MMC)

A type of peristalsis consisting of waves of contraction and

relaxation of circular and longitudinal smooth muscle fibers

passing the length of the small intestine; moves chyme

toward ileocecal sphincter.

1. Regulation of intestinal secretion and motility – The most important regulators of

small intestinal secretion motility are enteric reflexes and digestive hormones.

Parasympathetic impulses increase motility and sympathetic impulses decrease the

motility.

2. The first remnants of a meal reach the beginning of the large intestine in about 4

hours.


13

Large intestine: 1. The large intestine extends from the ileocecal sphincter to the anus. It regions include

the caecum, ascending colon, transverse colon, descending colon, sigmoid colon,

rectum, and anal canal.

2. The mucosa contains the absorptive cells (for water absorption), globet cells (secrete

mucus) and muscularis consists of teniae coli and haustra.

3. Mechanical movements of the large intestine include haustral churning, peristalsis,

and mass peristalsis.

4. The last stages of chemical digestion occur in the large intestine through bacterial

action. Substances are further broken down, and some vitamins (Vit. K, Vit. B) are

synthesized.

Table no 3

Digestive Activities in the Large Intestine

Structure Activity Functions Lumen

Bacterial activity

Breaks down undigested carbohydrates proteins, and amino acids into products that can be expelled in feces or absorbed and detoxified by liver; synthesizes certain B vitamins and Vit. K

Mucosa

Secretes mucous Absorption

Lubricates colon and protects mucosa Water absorption solidifies feces and contributes to the body’s water balance; solutes absorbed include ions and some vitamins.

Muscularis

Haustral churning Peristalsis Mass peristalsis Defecation reflex

Moves contents from haustrum to haustrum by muscular contractions. Moves contents along length of colon by contractions of circular and longitudinal muscles. Forces contents into sigmoid colon and rectum. Eliminates feces by contractions in sigmoid colon and rectum.


14

Absorption of Faeces formation in the large intestine: By the time chyme has remained in the large intestine 3-10 hours, it has become

solid or semisolid because of water absorption and is now called feces. Chemically, feces

consist of water, inorganic salts, and sloughed-off epithelial cells from the mucosa of the

gastrointestinal tract, bacteria, and products of bacterial decomposition, unabsorbed

digested materials, and indigestible parts of food.

The Defecation Reflex: The defecation reflex occurs as follows: In response to distention of the rectal

wall, the receptors send sensory nerve impulses to the sacral spinal cord. Motor impulses

from the cord travel along parasympathetic nerves back to the descending colon, sigmoid

colon, rectum, and anus. The resulting contraction of the longitudinal rectal muscles

shortens the rectum, thereby increasing the pressure within it. This pressure, along with

voluntary contractions of the diaphragm and abdominal muscles, plus parasympathetic

stimulation, opens the internal anal sphincter.


15

BODY FLUIDS (ELECTROLYTES) 26

The maintenance of a relatively constant volume and a stable composition of the

body fluids is essential for homeostasis. Some of the most common and important

problems in clinical medicine arise because of abnormalities in the control system that

maintain this constancy of the body fluids.

Water is added to the body by two major sources,

1. It is ingested in the form of liquids or water in the food (2100ml/day to body

fluids)

2. It is synthesized in the body as a result of oxidation of carbohydrates, adding

about 200ml/day.

Daily loss of body water:

Insensible water loss – Some of the water loses cannot be precisely regulated.

For ex, there is a continues loss of water by evaporation from the respiratory tract and

diffusion through the skin, which together account for about 700ml/day of water loss

under normal conditions. This is termed as insensible water loss.

The insensible water loss through the skin occurs independently of sweating and

is present even in people who are born without sweat glands- loss through skin is about

300-400ml/day. This loss is minimized by the cholesterol filled cornified layer of the

skin, which provides a barrier against excessive loss by diffusion. When the cornified

layer becomes denuded, as occurs with extensive burns, the rate of evaporation can

increase as much as 10 fold to 3-5 lit/day.

Insensible water loss through the respiratory tract averages about 300-

400ml/day. As air enters the respiratory tract, it becomes saturated with moisture, to a

vapor pressure of about 47 mm Hg, before it is expelled. Because the vapor pressure of


16

the inspired air is usually less than 47 mm Hg water is continuously lost through the

lungs with respiration. In cold weather, the atmospheric vapor pressure decreases to

nearly 0, causing an even greater loss of water from the lungs as the temperature

decreases. This explains the dry feeling in the respiratory passages in cold weather.

1. Fluid loss in Sweat – 1-2 L/hour after heavy exercise and in hot weather.

2. Water loss in feces – Amount of loss during severe Diarrhoea etc.

3. Water loss by the Kidneys – The remaining water loss from the body occurs in the

urine excreted by the Kidneys.

Body Fluid Compartment27:

Total body fluid is distributed in two major compartments- 55 to 75 % is

intracellular and 25 to 45 % is extra cellular. The ECF is further subdivided into

intravascular (Plasma water) and extra vascular (Interstitial) spaces in a ratio 1:3.

The solute or particle concentration of a fluid is known as its osmolality and is

expressed as milliosmiles / kg of water (mosmol/Kg).

The major ECF particles are Na+ and it’s accompanying anions Cl- and HCO3-,

where as K+ and organic phosphate esters (ATP, Creatine phosphate and Phospholipids)

are the predominant ICF osmoles. Na+ is largely restricted to the extra cellular

compartment; total body Na+ content is a reflection of ECF volume. Likewise, K+ and its

attendant anions are predominantly limited to the ICF and are necessary for normal cell

function. Therefore the number of intracellular particles is relatively constant and a

change in ICF water content. During chronic Hyponaetremia, brain cells loose solutes,

there by depending cell volume and diminishing neurological symptoms. The converse

occurs during Hypernaetremia.


17

Fluid movement between the intravascular and interstitial spaces occurs the

capillary wall and is determined by the Starling forces capillary hydraulic pressure and

colloid osmotic pressure. The return of fluid in to the intravascular compartment occurs

via lymphatic flow.

Intracellular Fluid Compartment28:

About 28 of the 42 liters of fluid in the body are inside the 75 trillion cells and

are collectively called the intracellular fluid. Thus the intracellular fluid constitutes about

40% of the total body weight in an average person. The composition of cell fluids is

remarkably similar even in different animals, ranging from the most primitive micro

organisms to humans. For this reason, the ICF of all the different cells together is

considered to be one large fluid compartment.

Extra cellular Fluid Compartment:

All the fluids outside the cells are collectively called as the extra cellular fluid.

Together these fluids accounts for about 20 % of the body weight or about 14 liters in a

normal 70 kg adult. These two largest compartments of the extra cellular fluid are the

interstitial fluid, which makes up over 3/4th of the extra cellular fluid, or about 3 liters.

The plasma is the non cellular part of the blood and communicates continuously with the

interstitial fluid through the pores of the capillary membranes. These pores are highly

permeable to almost all solutes in the extra cellular fluid except the proteins. Therefore,

the ECF are constantly mixing, so that the plasma and interstitial fluids gave about the

same composition except for Proteins, which have a higher concentration in the plasma.


18

Important Constituents of Intracellular Fluid:

The ICF is separated from the extra cellular fluid by a selective cell membrane

that is highly permeable to water but not to most of the electrolytes in the body.

In contrast to the ICF contains only small quantities of Sodium and Chloride

ions and almost no Calcium ions. Instead, it contains large amounts of Potassium and

Phosphate ions plus moderate quantities of Magnesium and Sulphate ions, all of which

have low concentrations in the ECF. Also, cells contain large amounts of Protein almost

four times as much as in the plasma.

Blood Volume 29, 30:

Blood contains both ECF (the fluid in the Plasma) and ICF (the fluid in the

RBC). However, Blood is considered to be a separate fluid compartment, because it is

contained in a chamber of its own, the circulatory system. The blood volume is especially

important to the control of Cardio-Vascular dynamics.

The average blood volume of adults is about 7 % of body weight or about 5

liters. About 60 5 of the blood is Plasma and 40 % is RBC, but these percentage can vary

considerably in different people, depending on sex, weight and other factors.

Table no 4 Showing Osmolar Substances in ECF and ICF:

Electrolytes Plasma Interstitial Intracellular Na+ 142 139 14 K+ 4.2 4.0 140 Ca+ 1.3 1.2 0 Mg+ 0.8 0.7 20 Cl- 108 108 4 HCO3

- 24 28.3 10 SO-

4 0.5 0.5 11 Amino acids 2 2 8 Protein 1.2 0.2 4 Urea 4 4 4 Glucose 5.6 5.6 - Creatinine 0.2 0.2 9


19

Clinical Abnormalities of Fluid Volume Regulation 31:

Table no 5

Electrolyte Balance

Ion and Normal

ECF Range (mEq/l)

Disorder Symptoms Causes Treatment

Sodium (136-142)

*Hypernaetremia (>147) *Hyponaetremia (<130)

*Thirst, dryness and wrinkling of skin, reduced blood volume and pressure. *Disturbed CNS function, confusion, hallucinations, coma; death in severe cases.

*Dehydration; loss of hypotonic fluid. *Infusion or ingestion of large volumes of hypotonic solution.

*Ingestion of water or IV infusion of hypotonic solution. *Diuretic use and infusion of hypertonic salt solution.

Potassium (3.8-5.0)

*Hyperkalemia ( >6 ) *Hypokalemia ( <3 )

*Severe cardiac arrhythmias. *Muscular weakness and paralysis.

*Renal failure, use of diuretics, chronic acidosis. *Low potassium diet; diuretics.

*Infusion of hypotonic solution, selection of different diuretics. *Increase in K+ diet IV of K+, K+ Tabs.

Chloride (96-108)

*Hyperchloremia ( >109) *Hypochloremia (<95)

*Acidosis, Hyperkalemia. *Alkalosis, anorexia, muscle cramps, apathy.

*Dietary excess, increased chloride retention. *Vomiting, Hypokalemia.

*Infusion of hypotonic solution to lower plasma concentration. *Diuretic use, hypertonic salt solution infusion.


20

PROCEDURE OF SERUM ELECTROLYTES –

1. Sodium Test:

Method – Precipitation test for Sodium

Sample – Serum

Principle for Sodium –

Sodium and Proteins are precipitated simultaneously by reagent containing

magnesium uranylacetate and alcohol. The precipitate is separated by centrifugation. The

sodium content is calculated from loss in the concentration of magnesium uranylacetate

in comparison to the standard. The residual amount of magnesium uranylacetate, which is

measured by colorimetrically.

Calculations –

Sodium (mmol/L) = ∆A Blank - ∆A Sample / ∆A Blank - ∆A Standard ×150.

Normal Value - Serum Sodium: 135- 155 mmol/L

2. Chloride Test:

Method – End Point Colorimetry

Sample – Serum

Principle for Chloride –

Chloride ions react with a solution containing ferric, mercuric, nitrate and

thiocyanate ions in equilibrium to form yellow-brown ferric thiocyanate. Absorbance

measured at 505 mm is proportional to the concentration of chloride in the specimen.

Calculations –

Serum Chloride (mEq/L) = Absorbance of Test / Absorbance of Standard × 100

Normal Value – Serum Chloride: 97-107 mEq/L


21

3. Potassium Test:

Method – Colorimetric test for Potassium

Sample – Serum

Principle of Potassium –

The turbidity of solution containing Sodium Tetraphenyl Boron Alkaline

EDTA and formaldehyde is measured after addition to sample or standard.

Calculations –

Potassium (mmol/L) = ∆A Sample / ∆A Sample × 5

Normal Value – Serum Potassium: 3.5 – 5.5 mmol / L

UDAKAVAHA SROTAS32:

The food, air and water are essential for the maintenance of life. The

Kapha, which confers dardhya (fitness, compactness) and sthiratwa (stability) to the

body, is the product of water. The fluidity of the ciculating rasa rakta complex, which has

the important vital functions of Preenana and Jevana is due to water component only.

In view of the importance of Kapha in the constitution of the body and it’s

relationship with water, it has to be summarized that the Udakavaha srotases spread

throughout the body. But Talu and Kloma have been stated to be the moolas of these

srotases. According to Chakrapani, Kloma is the pipasasthana (thirst centre) located in

Hridaya. The protoplasm which is Shleshmic and which is the essential content of the

cells. Therefore water will enter freely in to every cell and as easily come out of it.

According to Vaidyaka Shabdha Sindhu, Kloma is Puppusa, which is

pipasasthana and also masthishka.

A thirst centre has been identified as a small area located slightly anterior

to the supraoptic nuclei in the lateral preoptic area of the hypothalamus. The stimulation


22

of the cells of this area causes thirst and drinking of water. These cells are stimulated by

an increased osmotic pressure of the body fluids, which in turn is dependent on the

amount of water in the body. Any factor that will cause intracellular dehydration will in

general cause the sensation of thirst.

It may be noticed from the above information that the changes in the

quantity of both Avalambaka and Tarpaka Kapha cause stimulation of the pipasasthana

located in masthishka and generate a sensation of thirst.

Causes of vitiation of Udakavaha Srotas:

1. Ushna ahara and vihara

2. Ama accumulation

3. Bhaya

4. Madyapana

5. Trishna

6. The causes which vitiates Pitta

7. The factors which lead to disturbance of water balance in the body.

Eg: Atisara, Visuchika, Grahani, Shotha, Shwasa, Prameha etc.

Signs and Symptoms:

1. Dryness of Tongue, Palate, Lips, Throat and Kloma

2. Excessive thirst

These above are the signs and symptoms of Trishna roga and suggested

treatment for the vitiation of Udakavaha srotases is that of Trishna roga, which mainly

Pitta hara in nature is.

An injury to the Udakavaha srotases produces – Thirst and Death.


23

:VIRECHANA KARMA:

The process by which the vitiated doshas are eliminated through the guda

marga (lower out let), is called ‘Virechana’33.

Vyutpatti:

The word Virechana is derived from the Sanskrit root,

Vi – Upasarga (Prefix)

Ricir – Ric Dhatu (Root)

Lyut – Pratyaya (Suffix)

– means Mala Nissarana, i.e., elimination of malas by the body through

any route. But in Ayurveda the word Virechana is used for indicating only the

elimination of malas through the adhobhaga i.e., anus. Because there are certain specific

terminology used in Ayurvedic texts to indicate the malas eliminated through the routes

other than adhobagha i.e, anus. Eg. Mutra virechaneeya, Shiro virechaneeya etc.

According to Shabdakalpadruma,

Rechana is derived from the root word –

‘Rici Dhatu and Lyut Pratyaya’

- it means Mala Bhedana.

The word ‘Virechana’ is formed by the root Rici Dhatu, Vi – Upasarga with

‘Nich’ and ‘Lyut’ Pratyayas giving meaning ‘Visheshena Rechayateeti’. .

The root ‘Ric’ is also very important to understand the systemic action of

Virechana. According to Charaka, the Virechana drugs first get digested in Amashaya,


24

then reaches to Hridaya, Dhamani, macro and micro channels (srotases) of the body and

reach the site where Doshas are accumulated.

Virechana drugs soften the compactness (Sanghata) of the Doshas and break the

bigger molecules to smaller ones. This process occurs in a proper way by separation

(Viyojana) and combination (Samparchana) of doshas. Up to this stage the action of

Virechana is known as its systemic effect and it is obviously governed by Viyojana and

Samparchana components of Virechana dravya.

Nirukti:

The act of expelling vitiated doshas (malas) through Adhobhaga is known as

Virechana34. Here the meaning of Adhobhaga is ‘Guda’ commented by Chakrapani.35

Virechana is the procedure in which the orally administered drug acts on

internally vitiated Doshas, specifically on Pitta and expels them out through anal route.36

Virechana Karma is considered as the best treatment for evacuation of morbid

Pitta Dosha.

Paryaya:

Rechana and Praskandana is also one of the synonym.37

According to the Sanskrit – English dictionary- Purgative, Cathartic, Evacuant

and Aperient are the different meanings of Virechana (M.Monier Williams).

||


25

Virechana Yogya and Ayogya:

A number of diseases listed below along with Dosha predominance

Table no 6

VIRECHANA YOGYA38-46

Virechana Yogya C.S Su A.S A.H B.S Sh B.P Y.R

1. Pitta Pradhana Vyadhi Jwara + + + + + + + Pandu + + - - - + + Kamala + - - + - - - Halimaka + - + + - - - Asyadaha + + - - - - - Netradaha + + - - - - - Paittikavyadhi + + + - - - - 2. Vata Pradhana Vyadhi Pakshaghata + + + + + + + Pakwashaya Ruja - + + + - - - Shirahshula + - + - - - - Parshwaruja + - - - - - - Gulma + + + + - + + Vatarakta + + + + - + + 3. Kaphapradhana Vyadhi Prameha + + - - - + + Netrasrava + - - - - + + Asyasrava + - - - - + + Nasasrava + - - - - + + Shwasa + - - - - - - Kasa + - - - - - - Shwayathu + + - - - + + 4. Tridoshaja Vyadhi Kushta + + - - + + + Visarpa + + - - - - - Hridroga + + - - - + +


26

5. Rakta Pradhana Vyadhi Pleeha + + + + + + + Vyanga + - + + - - - Nilika + - - - - - - Visphotaka + + + + + + - 6. Manasa Roga Unmada + - - - - - - Apasmara + + - - - - - 7. Stree Roga Stanya Dosha + + + + - - - Yoni Dosha + + + + - + + 8. Shalya Sadhya Vyadhi Arbuda + + - - - - - Bhagandara + + + - - + + Arsha + + + + - + + Vidradhi - + + + - + + Granthi + + - - - + + Galaganda + - - - - - - Bradhna + - - - - - - Dushtavrana - + + + - - + Vriddhi - + - - - - - Apachi + - - - - - - Mutraghata + + + + - + + Shastrakshata - + - - - - - Ksaragnidagdha - + + - - - - 9. Shalakya Vyadhi Timira + + + + - - - Abhishyanda - + + + - - - Kacha - + + + - - - Akshipaka - + + - - - - 10. Annavaha Srotas Krmikoshta + + + + - + + Garavisha - + - + - + + Visucika + + - - - + + Alasaka + + - - - - -


27

Udara + - + + - + + Arocaka + + - - - + + Avipaka + + - - - + + Vibandha - + + + - - - Anaha - + - - - - - 11. Pratimarga Chikitsartha Urdhwaga Raktapitta + + + + - - - Udavarta + - + - - - - Chardi + + + + - + + Some other indications for Virechana are:

a) In Swastha47,48

b) Utkleshita Pitta

Pitta Sthanagata Alpa Kapha

Kapha Sthanagata Bahu Pitta49

Pakwashayagata Pitta or Kapha Pitta50

Pittavrita Vata

Kaphavrita Vata51

Shonita Roga52

c) As Purvakarma in Rasayana and Vajikarana53,54

Table no 7

VIRECHANA AYOGYA55-62

Virechana Ayogya C.S Su. A.S. A.H. B.S. Sa. B.P. Y.R.

1. Karma Asahanata Vilambita + - + - - - - Durbala + - - - + - - Durbalendriya + - - - - - - Upavasita + - - - - - - Subhaga + - - - - - - Alpagni + + + + - + + Khsatakshina + + + - - + + Shranta + + + - - + +


28

Pipasita + + - - + + + Karma Bharadhvahata + + - - - - - Vriddha + - - - - + + Bala + + + - + - - Atikrsha + - + - + + - Atisthula + + + - + + - Darunakoshta + - + + - - - Kshama + - - - - - - Garbhini + + - - - - - Bhakta + + - - - + - Rikta Koshta - - - - + - - Lalit - - - - + - - Sukumara - - - - + - - Navaprasuta - + - - - + + 2. Some other conditions Ratri Jagarita - - + - - - - Anupasnigdha - - - - + - - Atisnigdha + + - + - + + Atiruksha + - - - - + + Bhayabheeta - + - - - + + Chintaprasakta + - - - - + + Maithunaprasakta + - - - - - - Adhyayanaprasakta + - - - - - - Vyayamaprasakta + + + + - + + Shalyardita + - + + - - - Kamadi Vyaghra + + - - - - - Niruddha + - - - - - - 3. Samavastha Nava Pratishyaya - + - - - - - Nava Jvara + + + + - + + 4. Gudagata Vyadhi Khsataguda + + + - - - - Muktanala + - + - - - - 5. Anya Vyadhi Madatyaya + + + - - + + Adhmana + + + - - - - Talushosha - - - - + - -


29

Urusthambha - - - - + - - Ardita - - - - + - - Hanugraha - - - - + - - Hridroga - - - - + - - Kevala Vataroga - - - - + - - Rajayakshma - - + - - - - Shosha - - - - + - - 6. Marga Virodhi Vyadhi Adhoga Raktapitta + + + + - - - Atisara - - - + + - -

Classification of Virechana Drugs:

The drugs which produce Virechana (purgation) are known as Virechana dravyas

(Cathartics). They are classified in different categories according to the parts used for

Virechana and according to their action, etc.

According to references available Virechana drugs may be classified in following

6 groups:

A.Virechana drugs according to their origin and parts used:

a) Animal origin: Urine63, 64, Milk65, Takra 66.

b) Plant Origin:

c) Miscellaneous:

As Madya, Dhanyamla77, Guda, Ikshu Rasa, Payas, Krishara, Ushna Jala, some

minerals - Swarna, Kamsya, Manahsila, Gandhaka, Ratna, Uparatna, Samudraphena also

have Sara properties.


30

Table no 8

Sl. No

According to part of the plant used for Virechana

C.S Su.S Va

1 Mulini Virechana Dravya.67,68,69 (Root cathartics)

a. Hastidanti b. Shyama c. Trivrit d. Adhoguda e. Saptala f. Danti g. Gavakshi h. Vishanika i. Ajagandha j. Dravanti k. Avartaki

a. Trivrit b. Shyama c. Danti d. Dravanti e. Saptala f. Shankhini g. Vishanika h. Gavakshi i. Chitraka j. Kusha k. Kasha l. Kinahi

a. Danti b. Kumbha (Trivrit) c. Gavakshi d. Shankhini

2 Phalini Virechana Dravya.70,71,72

(Fruit Cathartics)

a. Shankhini b. Vidanga c. Anupa d. Sthalaja e. Prakeerya f. Udakeerya g. Abhaya h. Anthakotrapuspi i. Kampillaka j. Aragwada

a. Kampillaka b. Puga c. Eranda d. Haritaki e. Bibhitaki f. Amalaki g. Neelini h. Aragwada

a. Neelini b. Triphala c. Kampillak

3 Ksheera Virechana Dravya73,74

(Milk Cathartics)

a. Snuhi ksheera b. Arka

a. Mahavriksh b. Saptachala c. Swarna ksheeri

a. Snuhi b. Swarna ksheeri c. Godugdha

4 Twak Virechana Dravya 75,76

( Bark Cathartics)

a. Tilwaka

a. Tilwaka b. Patala c. Ramyaka

a. Tilwaka b. Ramyaka

5 Patra Virechana Dravya (Leaf Cathartics)

a. Swarna patri b. Aragwada

a. Putika b. Aragwada c. Karavellaka

a. Aragwada


31

B. Virechana drugs according to their mode of action by Sharangadhara:

Acharya Sharangdhara has classified according to the action of the Virechana

dravyas.

a) Anulomana78 :

Means - sending or putting in right direction

The drugs which will digest the Apakwam (undigested material) malas and bring

them to adhomarga for defecation process. That is these drugs will facilitate the

defecation process. eg: Hareetaki (Terminalia Chebula).

Sushruta considers Sara as the synonym of Anulomana. According to Dalhana

Anulomana causes expulsion of Vata and Kapha79.

According to Raja Nighantu, Bhoutika composition of Anulomana drugs is

similar to that of Virechana drugs i.e. Prithvi and Aap Mahabhuthas.

b) Sramsana80 :

Means - Sramsana is to slip or to fall down.

The drugs which expel the malas adhered to the lumen of intestines in to the

rectum without digesting (Paka) them. eg: Aragwada (Casia Fistula).

In the context of Jwara Chikitsa it has been mentioned that Sramsana eliminates

the Pitta and Kapha situated in Pakwashaya 81.

c) Bhedana82 :

Meanings of Bhedana are breaking, splitting, piercing, dividing, separations, etc.


32

The drug which disintegrates the ‘Abaddha’ (unformed) or ‘Baddha’ (formed) or

‘Pindita’ (dried fecal mass) forms of Malas by facilitating penetration into it and then

evacuating through the lower gut, is known as Bhedana. eg. Katuki.

Bhedana is a process in which Shareera Mala Nirharana is brought about83.

Charaka has described a group named as ‘Bhedaneeya’. This includes Shyama

(Trivrit), Arka, Urubuka (Eranda), Agnimukhi (Kalikari), Chitra (Danti), Chitraka,

Chirabilva, Shankhini, Sakuladani (Katuki) and Swarnaksiri84.

b) Rechana85 :

The drug which eliminates digested (Pakwam) and undigested (Apakwam) Malas

or Doshas by making them watery through the lower gut is known as ‘Rechana’ eg:

Trivrit.

The ‘Rechana’ and ‘Virechana’ words seem to be similar, but the Virechana

represents the complete therapy which includes Purvakarma, Pradhana Karma and

Samsarjana Krama; while the Rechana is the action of some types of drugs used in

Virechana.

There are certain drugs which will help in proper Virechana or which will

synergies the action of Virechana Dravyas is known as Virechanopaga. The drugs

described are Draksha, Kashmarya, Parushaka, Abhaya, Amalaka, Vibhitaka, Kuvala

Badara, Karkandhu, and Pilu86.

C. Virechana drugs according to mode of action:

According to the degree of potency of the drugs, the Virechana may be classified

into the following categories.


33

a) Mridu Virechana87 –

The drugs which are Manda in Veerya or when combined with opposite Veerya or

given in low dosage, given to the Ruksha patient and causes less purgation is known as

Mridu Virechana. Those drugs are specifically indicated in weak patients having mild

natured diseases and are not so effective in Balavan patients. These drugs may also be

given to the patients who have been Shodhita previously or having Alpa Dosha or whose

Koshta is unknown. Charaka is of the view that the physician should not hesitate to use

Mridu Virechana drugs in weak patients having more Doshas because even repeated

elimination of Doshas in small quantity may cure the disease88.

The patient who have not taken Virechana drugs in past and whose Koshta is

unknown in such persons Sushruta recommends the use of Mridu Virechana drugs in the

beginning and after knowing the Koshta required drug may be prescribed89.

Sharangdhara recommends the use of Mridu Virechana drugs in Mridu Koshta

(eg. Draksha, Milk, Caster oil, Warm water etc.)90 Drugs effective in Mridu Koshta are

Guda, Ikshu Rasa, Mastu, Ullodita Dadhi, Payas, Kshira, Sarpi, Kashamari, Triphala, Pilu

and Taruna Madya91.

b) Madhya Virechana :

The drugs which are moderate in qualities are known as Madhya Virechana drugs.

The drugs slightly exposed to water, heat or organisms, not grown in good Desha and

Kala and not having all the required properties and given comparatively in less quantity

to the patient and not properly Snehita and Swedita patient works as Madhya Virechana.

The drugs are specifically indicated in the patients having Madhya Roga (disease

with moderate symptoms). The administration of these drugs in Balavan rogi is useless


34

because, they are unable to eliminate Dosha completely92. Sharangdhara recommends the

use of Madhyama Virechana in Madhyama Koshta. eg. Trivrit, Katuki and Aragvadha93.

c) Teekshna Virechana :

The drugs, which cause numerous motions (Mahavega) and eliminates the Doshas

in large quantity by quick (Kshipra) and gentle (Sukha) purgation without causing either

much depression (Glani), is known as Teekshna Virechana.

According to Charaka, the drug which has been kept away from water, heat and

organisms, cultivated in proper Desha and Kala and which has been given Bhavana with

the drugs of same Veerya acquires the Teekshna properties. This type of drugs having all

the required properties, when given in prescribed dosage to the patient who has been well

Snehita and Swedita, then it causes Teekshna Virechana94. Sharangdhara recommends

use of Teekshna Virechana drugs in Krura Koshta persons.

Charaka recommends the use of these drugs in the strong (Balavan) patients

presenting all the symptoms of the diseases i.e. Teekshna Vyadhi95. It has been further

mentioned that the use of these drugs should be avoided in Durbala (weak), Shodhita, and

patient having Alpa Dosha and whose Koshta is unknown, otherwise it may cause

untoward effects of these patients96. Sushruta is of the view that Teekshna drugs given in

Mridu Koshta having Deeptagni passes out quickly without eliminating Doshas

properly97, Snuhi Kshira is considered as the best amongst these drugs98. More over

Sharangdhara recommend the other drugs like Hemakshiri, Danti, etc. explained in Krura

Koshta may also be included in this group.


35

D. Virechana from Ruksha and Snigdha point of view: In many places in Ayurveda, the uses of Sneha Virechana and Ruksha Virechana

have been recommended.

The drug used in the form of oil or the preparation containing Sneha is known as

Sneha Virechana, eg: Eranda Taila. Vagbhata recommends the use of Sneha Virechana in

all patients except Snigdha patients99.

The use of Sneha Virechana in the patients who have been given higher dosage of

Sneha is contraindicated because, due to this, the moving Doshas may again adhere in the

Srotas100, 101.

Sneha Virechana should be administered in Sama-Shitoshma Kala102.

The preparations, which do not contain Sneha, may be known as Ruksha

Virechana. Its use has been recommended in the Snigdha patients who have been

comparatively taken more Sneha103.

E. Based on Parts of the Dravya used:

Sushruta describes the following drugs with priority for Virechana Karma104.

i) Mula Virechana - Shyama Trivrit

ii) Phala Virechana - Hareetaki

iii) Taila Virechana - Eranda

iv) Swarasa Virechana - Karavellaka v) Paya Virechana - Snuhi.


36

F. Virechana drugs according to seasons105:

Table no 9: Virechana drugs according to seasons Varsha Sharad Shishira,

Vasanta Grishma

Hemantha (Vagbhat ) All seasons

Preparation Beeja Trivrit Kutaja Pippali Shunthi

Shyama Trivrit Duralabha Musta Sharkara Udichya Shweta Chandana

Shyama Trivrit Pippali Nagara Sindhu Aruna Trivrit

Shyama Trivrit

Trivrit Chitraka Patha Ajaji Sarala Vacha Hemakshiri churna

Trivrit Danti Hapusha Saptala Katuki Swarnaksiri

Anupana Draksha Rasa and Honey

Yasti madhu in Draksha Swarasa or Draksha Swarasa only

Honey Sugar Warm Water

Bhavana with cow urine

Adhamalla in Sharangdhara commentary mentioned that the drugs for Virechana

in Shishira, Vasanta and Hemanta Rutu are same. Kasiram Vaidya in his commentary

opined that Saindhava, Vriddhadaru, Shyama and Trivrit are to be used for Virechana in

Hemanta Rutu. Charaka mentions Trivrit Chitraka, Patha, etc. to be used for Virechana in

Hemanta Rutu.

G. According to Kalpana:

This is for maintenance of active principle for longer period and convenience of

taking drugs as – Choorna, Vartikriya, Asava, Arishta, Avaleha, Sneha, Kashaya, etc.

According to Sushruta following 8 preparations are useful.

i) Ghrita yoga ii) Taila yoga iii) Kshira yoga

iv) Madya yoga v) Mutra yoga VI) Mamsarasa yoga

vii) Bhaksanna yoga viii) Avaleha yoga

Kshira, Rasa, Kalka, Kashaya, Kwatha and Sita are respectively Laghu.


37

H. Dosage of Virechana drugs according to Matra and Kosta:

Matra of the Virechana drug should be in such a quantity, that the desired effect

of Shodhana may be achieved and may be able to avoid Atiyoga. This should be decided

according to Dosha, Atura Bala, Bheshaja, Kala, Desha, Agni, Koshta, Shareera, Ahara,

Satmya, Satwa, Prakriti, Vaya, Sama Avastha and Vikara106.

Table no 10

Doses of Virechana according to Sharangadhara107

Kalpana Heena for Mridu Koshta

Madhyama for Madhyama Koshta

Uttama for Krura Koshta

Kwatha 8 tolas 4 tolas 2 tolas Kalka, Choorna Modaka 4 tolas 2 tolas 1 tola

It is better to add honey/Ghrita if the taste is Vishavat while using this

preparation.

According to Sushruta108:

1, 2 and 3 Tolas Matra is mentioned for Mridu, Madhyama and Krura Koshta

respectively.

I. Nature of Koshta and Virechana109:

Acharya Sharangdhara opines that – for the person Mridu Kostha, Virechana

drugs must be mild and their dose should be minimum; for the Madhyama medium dose

and for Krura Kostha persons, the Virechana drugs should be Tikshna and its dose is

minimum.


38

J. Virechana Drugs According to Dosha110:

Table no 11 showing Doshawise Virechana Dravyas

Sl. No. Dosha Virechana Dravyas 1. Vataja Vikara Snigdha, Ushna VIrya with Lavana 2. Pittaja Vikara Kashaya, Madhura Rasa Pradhana 3. Kaphaja Vikara Katu Rasa Pradhana

K. Specific drugs for Virechana111:

Vata Pradhana - Trivrit + Saindhava + Shunthi + Kanji or Mamsasara

Pitta Pradhana - Trivrit Choorna + Draksha Kvatha

Kapha Pradhana - Triphala Kvatha, Gomutra, Trikatu

Children between the - Draksha Rasa + Aragvadha Phala Majja Age group of 4-12 years112.

PROCEDURE OF VIRECHANA KARMA:

Prior to Virechana Karma the patients are administered with Pachana, Snehana

and Swedana procedures as Purvakarma. PURVAKARMA:

1) Pachana :

In the patients with Agnimandya, administrations of Pachana drugs are useful for

Ama Pachana and also to increase the Agni. Ama Pachana should be done till the

appearance of Nirama Lakshanas.

2) Snehapana :

Snehapana procedure is to be followed after observing Nirama Lakshanas. The

required Sneha should be administered early in the morning at Suryodayakala after

observing Jeerna Ahara Lakshanas of the previous meal and when the patient is empty

stomach. The duration of Sneha Pana should be 3 to 7 days113, 114.


39

Regimen after Snehapana: ☻ Use of Hot water,

☻ Observing Brahmacharya,

☻ Avoid Diwa swapa,

☻ Should not suppress the natural urges like defecation, urination, flatus,thirst etc,

☻ Should not exposed to wind,

☻ Should take anabhishyandhi, liquid, hot diet mixed with slight unctuous substance.

Generally the dose of Snehapana is started from Hrisiyasi matra and gradually

increased up to Uttama matra i.e. dose of Sneha which is digested in 24 hours.

After proper Snehana, on the three gap days, Sarvanga Abhyanga and Svedana are

done daily.

Charaka mentions that by Vriddhi (increasing), Vishyandana (dissolving), Paka

(digesting), Srotomukha Vishodhana (clearing the orifice of srotas) and Vata Nirodha

(regarding the movement of Vata), the morbid material may be brought back from

Shakha to Koshta115. Here, Sneha acts in every aspect of above processes.

3) Abhyanga :

According to concept of Ayurveda, the Sneha absorbed in the body through the

minute hair follicles of skin and its effect is enhanced by Bhrajaka Pitta116. Abhyanga Guna –

☻ Jarahara – Delays the aging process by giving strength to dhatus.

☻ Shramahara – Relieves tiredness.

☻ Vatahara – It pacifies vitiated vata.

☻ Dristi prasadaka – Increases eye sight.

☻ Pustikara – Gives strength to body.

☻ Twak Dardhyakara – Brings complexion to skin.

☻ Kaphavata Nirodhana – Decreases increased Kapha and Vata dosha.


40

4) Swedana:

‘Dosha Vilayana’ takes place through the Swedana. It dilates all the channels in

the body. During the Swedana procedure the blood volume will be raised (increased). All

the bodily secretions will be increased due to stimulation of various glands. According to

Vagbhata, by the action of Snehana and Swedana, the morbid Doshas are liquefied,

dissolved and are brought to kosta117.

Dalhana also mentions that the Dosha which are lodged in Shakha are made to

move towards to Koshta by Snehana and Swedana. Vagbhata mentions that the waste

products are removed from the shakhas by these two procedures of Snehana and Swedana

in the same fashion as dirt of cloth is removed by soap and water118.

During the procedure of Abhyanga and Swedana, Snigdha, Drava, Ushna bhojana,

Mamsarasa, Odana, Amla rasa Phala is recommended120.

Before pradhana karma the diet should be such that, it does not increase ‘Kapha’

otherwise Vamana may occur121.

‘Manda Kapha’ term is used for the state of Kapha, which is desired for the

proper Virechana.

The dose of Virechana Yoga should be decided according to Vyadhibala,

Aturabala and Agnibala122. If the dose given more than Vyadhibala, may cause another

Vyadhi. If it is more than Agnibala it may cause Ajeerna, Vishtambha, and if it is more

than Aturabala then it may cause Atipravrtti or Apravrtti. So, the dose should be in Sama

Pramana only.


41

PRADHANA KARMA:

Pradhana Karma includes administration of Virechana yoga, observations

specially for Aushadha Jirnata, observations of Shuddhi Lakshanas and management of

Vyapat if occurs.

1. Administration of Virechana yoga:

Before administering the Virechana yoga, the physician must be confirmed

regarding the following.

a. The diet taken by the patient on the previous day must be digested.

b. Patient is in mentally balanced state, i.e., without any passions like angry, fear etc.

c. It should be kept in mind that whether the patient got sound sleep on the previous

night or not. Because at the time of drug administration patient must not be

drowsy/ sleepy.

After confirming the above points, patient has to offer oblations and worships

before taking the drug. Then the drug should be given to the patient to suit the kosta after

the Shleshma kala. The time is so adjusted that the Virechana should be started during

Pitta kala. The Pitta kala falls between 10 am to 2 pm. quickly acting drugs must be given

1-2 hours prior to Pitta kala; where as a drug with slow onset of action should be

administered much earlier.

If Virechana does not occur then hot water should be given and Swedana should

be done on the abdomen by the heat produced with friction of both palms ‘Pani Taptai

Cha. Jatharangani, Swedayet’123.

The Vaidya or physician must observe the signs and symptoms of Jeernoushadha,

Ajeernoushadha, Hritha Dosha, Vyapat, etc.


42

OBSERVATIONS:

a) Aushadha Jeerna Lakshana:

The following signs and symptoms of Virechana to be observed – Vatanulomana,

Swasthya, Khsudha, Trishna, Urjamanaswita, Indriya Laghuta and Udgara Shuddhi124.

b) Ajeerna Aushadha Lakshana:

If the drug is not digested it will produce some painful symptoms such as, Klama,

Daha, Angasadam, Bhrama, Murcha, Shiroruja and extreme weakness.

In this case the Virechana drug should not be repeated immediately, as the drug

may produce severe purgation. In some cases if the drug is digested but proper

elimination of doshas didn’t occurred, then next day again Virechana drug should be

given.

c). Hritadosha Lakshana:

The Virechana is considered as Kaphanta and Hritadosha, when Vata, Pitta and

Kapha come out in succession. Gatra Daurbalya and Laghuta are the associated

symptoms. If Virechana persists even after manifestation of Hritadosha lakshanas, then

vamana should be given.125

If Aushadhi Jeerna Lakshanas are manifested, but Hritadosha Lakshanas are not

found, then Virechana Yoga should be given next day. Even then Virechana does not

occur then Snehana and Swedana should be done again and thereafter Virechana drug

should be administered after 10 days126.


43

c) Shuddhi Lakshana127-131 :

Four types of Shuddhi viz. Laingiki, Antiki, Vegiki and Maniki should be

observed according to Chakrapani, but the importance should be given to Laingiki

Shuddhi.

Table no 12

Criteria for Antiki, Vegiki and Maniki Shuddhi of Virechana Karma

Shuddhi Pravara Madhyama Avara

Vegiki 30 Vegas 20 Vegas 10 Vegas

Maniki 4 Prastha 3 Prastha 2 Prastha

Antiki Kaphanta Kaphanta Kaphanta

The number of Vegas should be counted after leaving the first 2-3 Vegas, as it

contain only fecal matter. Then it should be counted till the Kapha comes out.

Laingiki Shuddhi, Lakshanas are given in tables. Thereafter the Ayoga and

Atiyoga symptoms mentioned in the texts have been presented in the tabular form. In the

last the various types of complications which may occur during Virechana are depicted.

Table no 13 (a)

Samyak Yoga Lakshanas of Virechana Karma

Lakshanas Charaka Sushruta Vagbhata

Sroto Vishuddhi + - -

Indriya Prasadana + + -

Shareera Laghuta + + -

Agnivriddhi + - -


44

Anamayatwa + + -

Kramatah Vit Pitta Kaphagamana + + -

Vatanulomana - + -

Absence of Ayoga Lakshanas - - +

Table no 13 (b)

Ayoga Lakshanas of Virechana Karma

Lakshanas Charaka Sushruta Vagbhata

Kapha Prakopa + + +

Pitta Prakopa + + +

Vata Prakopa + - -

Agnimandya + + -

Gaurava + + -

Pratishyaya + - +

Tandra + - -

Chardi + - -

Aruchi + + +

Vata Pratilomana + - Vatagraha

Daha - + +

Hridaya Ashuddhi - + +

Kukshi Ashuddhi - + +

Kandu - + +

Vit Sanga + + +

Mutrasanga - + -

Peedika - - +


45

Table no 13 (c)

Atiyoga Lakshanas of Virechana Karma

Lakshanas Charaka Sushruta Vagbhata Kapha Kshaya Vikara + + - Pitta Kshaya Vikara + - - Vata Kshaya Vikara + - - Supti + - - Angamarda + - - Klama + - - Vepathu + - - Nidra + - - Balabhava + - - Tamah Pravesha + - - Unmada + - - Hikka + - - Murcha - + - Guda Bhramsha - - - Kapha Pitta rahita Shweta Udaka Nihssarana - - + Kapha Pitta rahita Lohita Udaka Nihssarana - - + Mamsa Dhavana vat udaka srava - - + Medokhandavat Srava - - + Trishna - - + Bhrama - - + Netra praveshanam - - + Raktakshayaja Vikara + - -


46

PASCHAT KARMA135-138:

Regimens to be adopted after Virechana karma till the patient able to take

normal diet are termed as Paschat karma. As the Virechana karma eliminates dushita Pitta

dosha, the patient shouldn’t be allowed to take heavy diet, because there is derangement

in power of jatharagni. In this condition if heavy diet is given, it will only suppress only

the digestion power further and causes the vitiation of Agni. So to prevent such condition,

samsarjana karma is adopted. a) Samsarjana Krama :

As said above, this is meant for improving the digestive capacity. The patient has

to be given the following varieties of diets, from the same day evening or from the next

day morning.

After Samshodhana Karma, Agnimandya occurs because the Doshas reach the

Amashaya (Jejjata), so Peyadi Krama is recommended to increase the Agni gradually up

to the normal level.

According to Chakrapani the elimination therapy diminishes the doshas as well as

Dhatus, that’s why patient need immediate Dhatu Vardhaka Ahara in terms of Peyadi

Samsarjana karma.

Table no 15 Showing the Diet:

Day Annakala Pravara Shuddhi Madhyama Shuddhi

Avara Shuddhi

I Day Morning Evening

-- Peya

-- Peya

-- Peya

II Day Morning Evening

Peya Peya

Peya Vilepi

Vilepi Krita Yusha

III Day Morning Evening

Vilepi Vilepi

Vilepi Akrita Yusha

Krita mamsarasa SamanyaBhojana

IV Day Morning Evening

Vilepi Akrita Yusha

Krita Yusha Akrita Mamsarasa

V Day Morning Evening

Krita Yusha Krita Yusha

Krita Mamsarasa Samanya Bhojana

VI Day Morning Evening

Akrita mamsarasa Krita mamsarasa

VIIDay Morning Evening

Krita Mamsarasa Samanya Bhojana


47

Instead of Peyadi Krama, Sushruta mentions Kulatha, Aadhaki and Jangala

Mamsarasa139. Dalhana clarifies, Sushruta however agrees Peyadi Krama and he says that

incase of Ksheena Kapha, Peya should be given. Mamsarasa should be given to Vata

pradhana patients having Deeptagni. If Kapha dominance is there according to Dosha and

Prakriti, then Kulatha Yusha should be given. The Peyadi Krama ends on 7th day of

Pradhana Shuddhi patient.

b) Tarpana :

In case of ayoga of Virechana (insufficient elimination of vitiated doshas)

associated with predominance of Kapha, Pitta, if the doshas still retained in the body and

if the patient is having habit of taking alcohol, he shouldn’t be given Peyadi Samsarjana

Krama. Instead he must be given Tarpana i.e., thin or thick soup prepared with Deepana

and Pachana drugs like, Pippali, Dadima etc.

In Tarpana, Swaccha Tarpana in place of Peya and Ghana Tarpana in place of

Vilepi should be given, according to Chakrapani140. Jejjata mentions Mudga, Yusha and

Mamsarasa in place of Peya. Arunadatta recommends Laja Saktu, Jirnashalyodana and

Mamsarasa for 3 Annakalas.

c) Parihara Vishayas:

The following Ahara and Viharas are contraindicated till Prakriti Sthapana is

obtained after Virechana i.e. speaking loudly, excessive intake of diet, sitting in one

position for long time, excessive walking, anger and sorrow, sexual intercourse,

excessive use of cold diets and drinks, excessive riding on vehicles, suppression of night

vizil, day sleep, incompatible diet and with holding of natural urges.


48

Significance of Snehana karma:

• It lubricates the body.

• It brings Utklesha to the doshas so as to be eliminated easily.

• It gives strength to the body to bear the stress and stain during the drastic

Shodhana therapy.

• Sushruta said sneha is an important constituent of human body and many vital

functions are performed by sneha itself.

• It stimulates the digestive power.

• It alleviates Vata due to its Snigdha guna.

• It brings Mridutwa and oiliness to the skin.

The Role of Snehana and Swedana in Shodhana Chikitsa:

Our ancient Acharyas also has given much importance to Sneha and Sweda

karmas saying that if a person undergone for Shodhana therapy without prior Snehana

and Swedana his body will get destroyed like a dry stick which will break on bending.

The unctuous substances (Sneha) which has been administered before Swedana

Karma will enter easily in to the minute cell. There it will get attachment with the

accumulated metabolites. When hat applied by Sweda Karma the Sneha and Dosha will

get liquefied and detached from the cell. Doshas will then be carried to kosta through the

channels of the body which are already cleared. Now they get easily eliminated by

vamana, Virechana and basti karmas.

Properties of Virechana Drugs:

The properties of drugs producing Virechana Karma are – Ushna,

Teekshna, Sookshma, Vyavayi and Vikashi Gunas wholly or partly present in Virechana

Dravyas. They posses predominantly of Prithwi and Aap Mahabhoota. All the drugs

which posses the Prithwi and Aap Mahabhoota cannot produce Virechana. So the

inherent property to move downwards is especially due to Adhobhaga hara Prabhava of

the drug.


49

CATHARTICS - MODERN VIEW141, 142

The terms laxatives, cathartics, purgatives, aperients and evacuants often

are used interchangeably. However, there is distinction between Laxation and catharsis.

Laxation means – the evacuation of formed fecal material from the rectum, where

as

Catharsis means – the evacuation of unformed, usually watery fecal material from

the entire colon. Most of the commonly used agents promote Laxation but some actually

are cathartics which, at low doses, are used as laxatives.

There are three types of intestinal movements viz, Pendular movements –

are due to annular contraction of longitudinal muscles, segmental movement – due to

contraction of circular muscle and peristaltic movement. First two are mainly responsible

for mixing of food, while peristalsis also helps in propulsion. Normally the food leaves

the stomach in about half to two and half hours and it’s residue reaches the caecum by

about 5 to 6 hours. It takes approximately 18 to 24 hours before the process of evacuation

starts and the total time necessary for complete clearance of the ingested material is

approximately 5 to 6 days. The G.I tract is innervated by both Sympathetic or Adrenergic

nerves and Parasympathetic or Cholinergic nerves. Usually stimulation of adrenergic

nerves produces an inhibitory effect on the movements of the intestine, resulting the

relaxation of the gut and closure of the Sphincters. Where as if cholinergic nerves and

Vagus are stimulated, the tone and peristaltic movements of the intestines will be

increased. Emotions are known to play an important role in the physiology of

gastrointestinal secretions and movements.

Normally, most of the ingested water and fluids secreted by various gastro

intestinal glands are reabsorbed in the small intestine and caecum. And only 100 ml of


50

fluid is excreted with the fecal matter. Hence a cathartic which mainly act on small

intestine is likely to produce considerable loss of fluids, electrolytes and nutrients from

the gut. On the other hand Cathartic which act mainly on colon produce relatively less

fluid loss and don’t interfere with the absorption of food.

The rate of intestinal passage of food depends on the nature of the diet and

its fluidity. Diminished intake of both water and indigestible residue can lead to

constipation.

Classification of Cathartics:

These drugs are usually classified according to their mechanism of action. The

purgatives available for use mainly act in one of the following three ways-

• By increasing the volume of intestinal contents, thus distending the bowel

and eliciting the peristaltic reflex.

• By liquefying and lubricating the intestinal mass.

• By direct irritation of the bowel.

Hence they are classified in the following manner-

1. Stimulant or Irritant Cathartics.

2. Osmotic Cathartics.

3. Bulk laxatives.

4. Emollient laxative or Lubricant Cathartics.

1. Stimulant or irritant laxatives: In this group, mainly 3 types of drugs are identified.

i) Anthraquinone group ii) Diphenylmethane derivatives iii) Ricinoleic acid


51

Anthraquinone group: These are derivatives of plants such as aloe, cascara and senna.

These agents can produce giant migrating colonic contractions as well as induce water

and electrolyte secretion. They are poorly absorbed in the small bowel, but because they

require activation in the colon the laxative effect is not noted until 6 to 12 hours, after

ingestion.

Diphenylmethane derivatives: Examples in this group are: Bisacodyl, Phenolphthalein.

Pharmacological section is not shown clearly but drug acts as a stimulant mainly on the

large bowel after 6 hours and produces soft semi liquid stools associated with a little

gripping.

Ricinoleic acid: Important among Ricinoleic acid is caster oil. Ricinoleic acid acts as an

irritant and produces purgation. As Ricinoleic acid acts on small intestine, it produces

copious, liquid stool with associated fluid loss. The action is quicker than Anthraquinone

and is evident within 2 to 3 hours.

2. Osmotic Purgatives:

The osmotic purgative consists of salts, which though highly soluble, are

poorly absorbed from the alimentary tract. Such preparations exert an osmotic effect and,

thus retain water in sufficient amount to form an isotonic solution in the lumen of the

bowel. This distends the bowel and stimulates peristalsis, as well as liquefying the bowel

contents, making evacuation more rapid. The efficacy of the saline Cathartics is, thus

related to the osmotic activity exerted by the un absorbed fraction within the intestinal

lumen.


52

These preparations will act both on small and large intestines, and

therefore, produces watery evacuation within 3-6 hours. Because of their quick consent of

action, they are early in the morning before breakfast. Patients should be instructed to

take plenty of water along with these drugs.

Administration of a hypertonic solution may produce dehydration. A small

amount of salts may be absorbed in to the body system and renal excretion keeps pace

with absorption, but in a patient with deficient renal function, sufficient Magnesium ions

may be retained after a dose of salts to produce a depression of the C.N.S

1. Bulk forming laxatives: These are various natural or semi synthetic polysaccharide

and cellulose derivatives. eg. Bran, Psyllium preparation, methyl cellulose, Calcium

polycarbophil. These agents absorb water and swell-up, thus providing the stimulus

of mechanical distinction for evacuation. Their action is mild and is usually seen 12

to 36 hours after ingestion.

2. Stool Wetting Agents and Emollient laxatives: The best examples are liquid

paraffin, Olive oil, Docusate salts, etc. By oral administration it is not significantly

absorbed and exerts softening and lubricating effects on feces. These laxatives are

mild in action and usually seen 1 to 3 days after ingestion and itself does not initiate

peristalsis.

General mechanisms of action:

Laxatives generally have been thought to act in one of the following ways:

1. Retention of intraluminal fluid, by hydrophilic or osmotic mechanisms.

2. Decreased net absorption of fluid, by effects on small and large bowel fluid

and electrolyte transport.

3. Effects on motility by either inhibiting segmenting (non-propulsive)

contractions or stimulating propulsive contractions.


53

B. Classification according to the site of action -

a) Purgatives acting on the small intestine eg. Castor oil

b) Purgatives acting on the large intestine eg. Anthraquinone group

c) Purgatives acting on both large and small intestine eg. Saline laxatives

C. Classification according to source -

a) Vegetable purgatives. eg. Castor oil, Olive oil, Croton oil, Oleos, Senna, Cascara

sagrada, etc.

b) Mineral purgatives. eg. Saline purgatives, liquid paraffin, etc.

c) Synthetic purgatives. eg. Phenolphthalein

Table no 16

The classification and comparison of Representative Laxatives

Laxative effect and latency in usual clinical dosage

Softening of feces 1 to 3 days

Soft or semi fluid stool 6 to 8 hours

Watery evacuation 1 to 3 hours

Bulk forming laxatives Isapgol Bran Psyllium preparations Methyl cellulose Calcium polycarbophil

Surfactant laxatives Docusates Paloxamers Lactulose

Stimulant laxatives Diphenylmethene derivatives Bisecodyl

Anthraquinone derivatives

Senna Cascara Segrada

Osmotic laxatives Sodium phosphate Magnesium sulphate Milk of magnesia Magnesium citrate Castor oil


54

Table no 17

Summary Effects of some Laxatives on Bowel Function

Small Bowel Colon Agent Transit

Time Mixing

contractions Propulsive

contractions Mass action Stool water

Osmotic Laxatives Magnesium Lactulose

Decreases ↓ Decreases ↓

No effect No data available

Increased ↑ No data available

Increased ↑ No data available

Increased ↑↑ Increased ↑↑

Stimulant Laxatives Anthra-quinone Diphenyl methanes



Increased ↑ Increased ↑

Increased ↑ Increased ↑

Increased ↑↑ Increased ↑↑

MODE OF ACTION OF VIRECHANA:

Action of Virechana Karma can be understood in the following two ways.

1. Systemic – By which it brings down the morbid Doshas, particularly Pitta from

the periphery to Amashaya or Pakwashaya.

2. Local evacuant – This is concerned with the evacuation of these doshas in the form of

mala from the gut by Adhobhaghahara property.

Both the action and related factors are being described here in detail -

a) Virechana yoga gets absorbed and due to Veerya, it reaches to the Hridaya, then

the Dhamanis and thereafter it reaches to Sthula and Anu Srotas i.e. macro and

micro channels of the body.

b) The Vyavayi Guna, drug is responsible for quick absorption.


55

c) The Vikashi Guna causes softening and loosening of the bond by Dhatu

(Shaithilya Karma).

d) Due to Ushna Guna, the Dosha Sanghata (compactness) is disintegrated

(Vishyandana).

e) Action of Teekshna Guna is to break the Mala and Dosha in micro form.

According to Dalhana it is responsible for quick transmission (Dosha Sravana

Karatwa).

f) Due to Sookshma Guna by reaching in micro channels, disintegrates androgenic

toxins which are then excreted through micro channels (Anupravana Bhava).

g) Mainly due to Prabhava, Prithwi-Jala constitution and presence of Sara Guna

Virechana occurs. This is the evacuant action.

From the above description, a hypothesis can be postulated that, due to the Veerya

of the Virechana drugs softening, disintegration, liquification occurs which helps in

elimination of morbid factors in the body.

MODERN EXPLANATION OF POSSIBLE ACTION OF VIRECHANA KARMA:

In modern sciences while explaining laxatives said that they probably induce

limited low grade inflammation in the small and lower bowel to promote accumulation of

water and electrolytes and stimulate intestinal motility. From the above view we can say

that Ayurvedic shodhana are mild irritant to the stomach and the intestinal mucosa

respectively, to cause inflammation. Due to this, the permeability of the membrane

changes and those substances come out due to the changed permeability which cannot

come out in normal condition.


56

This medically produced mild inflammation facilitates quick absorption of the

active principles (Veerya) of the drug in initial stage. Later on it facilitate the excretion of

the morbid matters, which generally are not supposed to be excreted out through the

mucosa of gut. It is possible only because inflammation increases the permeability of the

capillaries which in turn allow the absorption as well as excretion of such substances

which are not allowed in normal condition.

The gross signs of inflammation are redness, heat, swelling, pain and loss of

functions. These signs occur due to three following changes at microscopic level.

1) Hyperemia – It occurs due to capillary dilatation and arteriolar dilatation

mechanisms.

2) Exudation – Exudation is the increased passage of protein rich fluid through the

vessel wall, in the intestinal tissue. The advantages result of fluid increases is dilution

of toxins.

Some chemical factors are also responsible which increases the permeability in

response to acute inflammation.

a) Vasoactive amines :

Mast Cells Histamine Increase permeability

Inflammation

Platelets Serotonin Dilatation

b) Vaso active Polypeptides: These causes vasodilatation.

Some of the above factors may be responsible for the increased permeability of

the intestinal mucosa, in response to the inflammation caused by irritant Virechana Yoga.


57

To further understand the action, we should go through the mode of action of

certain modern purgative drugs. In the modern medicine, the purgative are classified into

the following groups:

1) Drugs which accelerates the passage of food

A) Bulk purgatives – These work by one or more of following actions

a) Non metabolising

b) Retaining water

c) Promoting peristalsis eg. : Plant gums like Sterculina, Isabgol, etc.

B) Fecal softeners – As dioctyl sodium sulphosuccinate

C) Osmotic purgatives –

a) Poorly absorbed solutes which maintain an increased fluid volume.

b) Accelerate transfer to gut contents through small intestine to colon.

c) Large volume in colon results in purgation.

d) Saline purgatives – eg: MgSO4 doubles the volume of feces.

D) Stimulant purgatives –

a) Stimulate the mucosa of gut

b) Irritate local reflexes eg: Castor oil

Hydrolyzed in small intestine by lipase to give ricinoleic acid which is irritant. It

requires bile for hydrolysis.

2) Drugs which increase GI motility :

• Local stimulant effect on motility

• Acceleration of gastric emptying, but no effect on gastric secretions.

• Thought to activate cholinergic neurons.


58

Out of these, certain drugs increase the mobility of intestine; certain modify the

fluid dynamics of the mucosal wall and may cause fluid accumulation in lumen.

Following mechanisms may be responsible for fluid accumulation and gastro

intestinal motility in the lumen.

1) Inhibition of Na+ K+ cyclase in crypt cell, hence increase the secretion of water and

electrolytes.

2) PAF a Phospholid pro-inflammatory mediator and it produces significant stimulation

of colonic secretion and gastro-intestinal motility.

3) Nitric Oxide (NO) also involved in stimulation of intestinal secretion via

prostaglandin and cyclic-Gmp-dependent mechanisms, in addition, NO may inhibit

segmenting contraction in the colon, promoting Laxation.

A variety of laxatives both osmotic and stimulant have been found increased the

activity of NO synthesis and to increase the biosynthesis of PAF in the gut.


59

DISEASE REVIEW

Here Kitibha Kusta, Amlapitta and Tamaka Shwasa, these three diseases were

taken for the clinical study as they are indicated for Virechana Karma. So these three

disease literature will be reviewed briefly.

KITIBHA KUSTA

Nirukti and Paribhasha of Kitibha Kusta:

The term Kitibha is constituted by the combination of “Kiti” and “Bha”. The word

kiti refers to a variety of insect, which is black in colour and stays in kesha pradesha or in

hair143.The term “Bha” refers to the resembalence or similarity. So the term Kitibha,

which is constituted by suffixing “Bha” to “Kiti”, suggests something, which resembles

louse.

So the definition of Kitibha Kusta is “A pathological skin condition where the

colour of skin is black like “Kiti” i.e, louse. Sushruta has also given one more meaning to

Kitibha; it is an upadrava caused as a result of the bite of poisonous varieties of insects .

NIDANA

Specific Nidana of Kitibha Kusta is not described in Ayurvedic classics, as

Kitibha Kusta is one among the 18 types of Kusta. Some of the Nidana mentioned in the

context of Kusta holds good for Kitibha Kusta also.

The Nidana mentioned for the causation of Kusta can be broadly classified under

the following headings.

1. Aharaja 3. Karmaja 5. Sankramika

2. Viharaja 4. Chikitsa Sambandhi


60

Table no 18 (a) Showing the Aharaja Nidana144-150

Sl.No Nidana Ch Su A.S B.S Ha.S

1 Viruddhahara + + + + +

2 Ajeerna, Adhyashana + + - + -

3 Matsyadi Sevana + + - + -

4 Dugdhati Sevana + - - - +

5 Amlati Sevana + - - - +

6 Guru Ahara + - - - +

7 Gramodaka with Anupamamsa Sevana - + - + -

8 Dadhi Sevana + - - + -

9 Sneha ati Sevana + - - + -

10 Matsya with Payasa + - - + -

11 Ahitashana - + - - -

12 Drava, Snigdha ahara Sevana + - - - -

13 Navanna, Yavaka, Kulatha + - - - -

14 Moolaka, Satata madhu Sevana + - - - -

15 Tila pista, Guda Sevana + - - - -

16 Madyamladravya with milk - - - + -

17 Guda with milk - - - + -

18 Matsya, Nimba with milk - - - + -

19 Mamsa with madhu - - - + -

20 Dusta jala - - - - +

21 Pippali, Harita shakha,Vidagdhahara - - - + -


61

Table no 18 (b) Showing Viharaja Nidana

Sl.No Nidana Ch Su A.H B.S Ha.S

1 Chardi Nigraha + + - + -

2 Vegavarodha + + - + -

3 Sheetambu Snana after Atapa Sevana + + - + -

4 Diwa Swapna + - - + +

5 Mithyavihara - + + - -

6 Vyayama,Atisantapa Bhuktopa Sevana + - - - -

7 Shrama, Bhayarta Sheetambu Sevanam + - - - -

8 Ratri Jagarana - - - - +

9 Ajeernepi Vyayamama + - - - -

10 Sneha Peetasya Vantasyeva Vyayamam - + - - -

11 Vyavaya after Vidahi ahara Sevana - - - + -

12 Gramya Dharma Sevanam - + - - -

Table no 18 (c) Showing Daivapacharaja Nidana

Sl.No Nidana Ch Su A.S B.S Ha.S

1 Papakarma + + + - -

2 Viprama Garshayatana + + + - -

3 Purvakrita Akarma + + + - -

4 Gohatya - - - - +

5 Money or material through theft - + + - -

6 Sadhu, Apamana and Ninda - + + - -


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4. Chikitsa Sambandhi Nidana:

The hetu listed under chikitsa sambandha are Vyadhi hetus. Panchakarma

mityapachara is considered as a nidana for Kusta in Brihatrayee. The vyapat of shodhana

is a cause for Kusta. That too, ayogya of Vamana and Virechana is a stronger cause for

Kusta than atiyoga of these procedures.

5. Sankramika Nidana151 :

Sushrutacharya is an only author who has mentioned the category nature of Kusta,

even though he had not mentioned these in the context of explaining the causative factors

of Kusta. The diseases manifesting due to Sankramika hetu can be as bhootabhishangaja,

here bhoota refers to krimi.

In krimi prakarana whole explaining about the raktaja krimi has been told, which

clearly justifies the role of krimi in Kusta.


63

SAMPRAPTI

The nidana vitiates all the three doshas and these doshas moves through the

tiryag siras. These cause dooshana and shithilata of twak, rakta, laseeka and mamsa dhatu

and lodge them in the udakadhara, raktadhara and mamsadhara twak. Along with three

doshas kleda plays an important role in the pathogenesis of any of the variety of Pitta

including Kitibha Kusta.

NidanaSevana

Agnimandya Amotpatti

Vata Kapha Dosha Pradhana Tridosha Prakopa

Prakupita doshas moves through tiryagata siras

Dooshana and Shithilata of Twak,Rakta,Laseeka,Mamsa

Prakupita dosha get lodged in Twagadi Dhatu

Kitibha Kusta


64

PURVARUPA There is no mentioning of specific Purvarupas, general Purvarupas explained in

the context of Kusta can be considered here.

Table no 19 showing all Purvarupas mentioned by different acharyas152-154:

Sl.No Name of Purvarupa Ch Su A.H K.S B.P

1 Aswedanam + + - + +

2 Atiswedanam + + - + +

3 Parushyam + + - - +

4 Atishlakshna + - - + +

5 Vaivarnyata + - + + +

6 Kandu + + + - +

7 Supta + + + - +

8 Nistoda + - + - +

9 Lomaharsha + + + + +

10 Kharatwam + - + + +

11 Gouravam + - + + +

12 Swaydhu + - - + -

13 Rukshata + + + + +

14 Pipasa + + - + +

15 Saraga - - - + -

16 Daurbalya + - - + +

17 Pidaka - - - + +

18 Daha - - - + -


65

RUPA

The Lakshanas of Kitibha Kusta explained by acharyas have variations among

which majorities of acharyas opine that Kitibha Kusta is Vata Kaphatmaka, while some

acharyas considered it as Pittadhikya.

Table no 20 Showing all Rupa mentioned by different acharyas155-161 :

Sl.No Name of the Rupa Ch,B.P,Y.R,M.N Su A.H B.S K.S

1 Shyava + - + + -

2 Kinakhara Sparsha + - + + -

3 Khara Sparsha + - + + -

4 Parusha + - + + -

5 Kandu - + + + -

6 Ahitam - - + + -

7 Sravi - + - - -

8 Vrittam - + - - -

9 Ghanam - + - - -

10 Snigdham - + - - -

11 Krishnam - + - - -

12 Drudham - - - - -

13 Punaha Prasravati - - - + -

14 Roodhanvitam cha - - - + -

15 Vardatechasamutpannam - - - + +

16 Aruna - - - - +

17 Vriddhimanthi - - - - +

18 Garuni - - - - +

19 Prashanicha Punarutpadyante - - - - +


66

Table no 21 Showing Comparisons between Kitibha Kusta and Psoriasis.

Sl.No Kitibha Kusta Psoriasis

1 Ruksha Dry

2 Kina Ruda vrana- site of healing wound

3 Khara Rough

4 Kandu Itching

5 Parusha Hard

6 Prashantanicha Punar Utpadyante Subsides and Relapses

7 Vriddhimanthi Spreading in nature

8 Vrittam Round or coin shape lesions

9 Ghanam Well defined borders

10 Snigdham Sticky, Unctuous

11 Krishnam Black

12 Shyava Bluish Black

13 Aruna Reddish Brown

SADHYASADHYATA

As there are no specific Sadhyasadhyata for Kitibha, general Sadhyasadhyata

mentioned for Kusta are to be considering for Kitibha also.

In a condition when the three doshas and Krimi intensify their activity and cause

certain definite complication in a patient of Kusta like prasrava, vranas in lesions,

Trishna, Jwara, Atisara, Daurbalya, Arochaka and Avipakam, the diseases should be

considered as Asadhya.162


67

UPADRAVA

The common upadravas possible in Kusta are as follows,

1. Prasravanam- Excessive exudation 7. Angabedha - Ulceration of organs

2. Trishna - Thirst 8. Jwara - Fever

3. Atisara - Diarrhoea 9. Daha - Burning sensation

4. Dourbalya - Weakness 10. Arochaka - Anorexia

5. Avipaka - Indigestion

6. Patanani Angavayavanam – Sequestration of the organs of the body.

CHIKITSA

The general line of treatment explained (in classics) by Charaka is, Ghritapana in

vata pradhana Kusta, vamana karma in kapha pradhana Kusta and in pitta pradhana

Kusta, first Raktamokshana then Virechana should be performed163

Samshodhana chikitsa should be followed by keeping in mind that the bala of the

patient shouldn’t be lost164.

Sushruta considered Kitibha Kusta as Pittadhikya. The general line of treatment

explained by Sushruta is, vamana should be performed monthly twice i.e., 15 days once,

Virechana monthly once, Nasyakarma 3 days once and Raktamokshana once in 6

months165. As Kusta is of bahudoshajanya, repeated shodhana is also very necessary. By

following the above order of the treatment the bala of the patient also will maintain and

elimination of vitiated doshas also is in large quantity. As Rakta is one among the

dooshyas, the elimination of vitiated Rakta dhatu is essential. So among the shodhana,

Virechana and Raktamokshana helps in the elimination of this vitiated Rakta dhatu and

does the prasadana of Rakta dhatu which gives complexion to twacha.


68

AMLAPITTA

NIRUKTI, PARIBHASHA AND PARYAYA OF AMLAPITTA–

NIRUKTI:

Etymologically the word “Amlapitta” comprises of two components ‘Amla’ and

‘Pitta’.

Amla is derived as ‘Amyatya amlaha’. From the dhatu ‘Am’ meaning to be ill or

be afflicted or diseased.

The word amla has commonly been used to express one of the six kinds of taste.

In this present context the meaning of amla can be taken as one of the properties of

pitta.166

In this present context, if from the word amla we take its meaning as diseased,

then etymologically Amlapitta may be diseased state of pitta.

PARIBHASHA:

Srikantadatta in his Madhukosha vyakya defines

“ Vidahadhyamla gunoudrikta pittam amlapittam” 167

That is, the pitta becomes augmented or vidagdha because of excessive increase

of amla guna of pitta.

“Amlam vidagdam cha tat pittam amlapittam” 168

The pitta, which attains amla guna and vidagdhata, is called as Amlapitta.

Apart from the above there are some definitions of Amlapitta, they are:

• Kashyapa explains in Kashyapa Samhita khila sthana that the vidagdha anna rasa

terns to Shukta, this Shukta Anna Rasa is retained in Amashaya and produces

Amlapitta.169


69

• Another by Madhava Nidana, the Amlapitta is that condition where the pitta

which has previously accumulated from the self aggravating causes gets vidagdha

due to virudha, dustha, amla, vidahi and pitta provocating foods and drinks.170

These two definitions to a certain extent would speak of Nidana and Samprapti of

the disease.

PARYAYA:

1. Prameelaka 2. Amlapitta 3. Pittamla 4. Shuktaka 5. Amlaka

As stated above these synonyms would refer to the different aspects of the

abnormal state of pitta.

NIDANA

Here the term Nidana refers to the causative factors, which play an important role

in the manifestation of a disease. Nidana parivarjana forms the first and foremost step in

the treatment of any disease in general and specifically in Amlapitta. It is a practically

observed fact that, many of the patients can be managed only by Nidana parivarjana.

In classics a large number of Nidana have been explained in the context of

Amlapitta. Opinions of different authors are listed in the table under two headings.

1. Ahara sambandhi.

2. Vihara sambandhi.

Etiological factors of Amlapitta related to the food articles and intake are

considered in the ahara sambandhi factors and the others regarding the non-congenial

activities vegadharana etc. are mentioned under the second heading.


70

Table no 22- Showing the Nidana of Amlapitta -

Sl. No. Ahara sambandhi Vihara sambandhi

1 Abhojana Buktebukte snana

2 Atibhojana Buktebukte avagha

3 Ajeerana Buktebukte divaswapna

4 Amapurana Vegadharana

5 Vishamashana

6 Adhyashana

7 Gurubhojana

8 Gorasa atisevena

9 Apakva atisevana

10 Abhishyandi atisevana

11 Phanita atisevana

12 Pishta atisevana

13 Ikshuvikara atisevana

14 Prutuka atisevana

15 Ushna atisevana

16 Katurasa atisevana

17 Amla atisevana

18 Lavana atisevana

19 Drava atisevana

20 Kulatha atisevana

21 Madya atisevana

22 Ruksha atisevana

23 Bhristadhanya atisevana


71

SAMPRAPTI

Madhavakara in his Madhava Nidana explains samprapti as; pitta, which is

already sanchita due to its self-aggravating factors, further, attains vidagdha due to

virudha ahara (in compatible diet), dusta (spoiled diet), amla (sour), vidahi (fried) and

pitta provocating food and drinks.171

Samprapti of Amlapitta:

Pitta prakopa Nidana vata & kapha or vata kapha, Prakopa Nidana with pitta Prakopa Nidana. Amla guna vriddhi in pitta Vata or kapha or vata kapha Vriddhi Vidagdha pitta Agni mandya Vidagdha Anna

Shuktha paka Amlapitta

Samprapti ghataka of Urdhvaga Amlapitta:

1. Dosha : Pitta pradhana kapha.

2. Dushya : Rasa dhatu.

3. Agni : Jatharagni.

4. Ama : Jatharagnijanya ama.

5. Srotas : Annavaha and rasavaha.

6. Srotodusti prakara : Sanga, vimarga gamana.


72

7. Udbhava sthana : Amashaya.

8. Adhisthana : Amashaya.

9. Vyakta sthana : Amashaya.

10. Rogamarga : Abhyantara.

11. Sadhyasadhyata : Sadhya vyadhi.

In modern science the pathogenesis of Functional dyspepsia is poorly understood;

Most of the patients have normal gastric acid secretion and a relation between Functional

dyspepsia (Non-ulcer dyspepsia) and duodenitis or duodenal ulcer has not been

demonstrated. Similarly a role of Helicobacter pylori and associated chronic gastritis in

causing dyspepsia ulcer is improven. Disordered gastro duodenal and small intestinal

motility appears to account for some cases of Functional dyspepsia (Non-ulcer

dyspepsia).172

PURVARUPA

In Amlapitta, Purvarupa are not evident as they probably belong to the latter

category. Even if they are present, it is not possible to recognize them, as minor

fluctuations of doshas are common events. Hence no Purvarupa have been mentioned for

Amlapitta in classics.


73

RUPA The urdhwaga Amlapitta has been separately mentioned in the classics. These

features along with Samanya Rupa that are applicable for both urdhwaga and adhoga

Amlapitta mentioned by different authors are listed in table. .

Table No 23 Showing the Samanya Rupa

Sl. No. Lakshanas K.A. M.N. B.M Y.R. V.S.

1 Amlodgara - + + + +

2 Tiktodgara - + + + +

3 Kantavidaha + + + + +

4 Urovidaha + - - - -

5 Kukshidaha - + + + +

6 Utklesha - + + + +

7 Amla utklesha + - - - -

8 Avipaka - + + + +

9 Hritdaha - + + + +

10 Guru koshtata + - - - -

11 Udaradhmana + - - - -

12 Antrakujana + - - - -

13 Vidbheda + - - - -

14 Aruchi - + + + +

15 Klama - + + + +

16 Gourava - + + + +

17 Angasada + - - - -

18 Romaharsha + - - - -


74

Bhedas of Amlapitta:

According to Madhavakara: 173

1) Urdhvaga Amlapitta. 2) Adhoga Amlapitta.

This is mainly based on location of doshas, their subsequent Urdhvaga and

Adhoga pravritti.

According to Kasyapa: 174

Classified on the basis of dosha,

a) Vataja b) Pittaja c) Kaphaja

UPADRAVA

The occurrence of another disease in the wake of primary disease, as a

complication or is termed as Upadrava.175

Kashyapa Samhita khila sthana describes176 Upadrava of Amlapitta as

1) Jwara 2) Atisara 3) Pandutva 4) Shula

5) Shotha 6) Aruchi 7) Bhrama

The occurrence of these in Amlapitta made the latter asadhya or incurable.


75

SADHYASADHYATA

Charaka says “A disease when in its early stage is easily curable but when

advanced is cured with quite difficulty or even becomes incurable.”177

This principle is applicable to Amlapitta also. If Amlapitta is in early stage it is

curable with efforts. If it becomes continuous or chronic it becomes Yapya or curable

with difficulty (Krichchra sadhya).178 In a person who adopts wholesome diet and habits

on controlling the self. If Amlapitta is accompanied with above-mentioned complications,

then becomes Yapya or Asdhya.Thus the early diagnosis and prompt treatment is very

necessary in newly originated Amlapitta.

UPASHAYANUPASHAYA . According to Charaka, an unmanifested or obscure disease may be investigated

by upashaya and anupashaya.179Here in Amlapitta, Kashyapa explains about upashaya of

vataja, pittaja, and kaphaja variety. In vataja snigdha ahara, in pittaja swadu sheeta ahara

and ruksha ushna ahara in kapha variety are considered as upashaya.180

The Anupashaya of Amlapitta is not mentioned in classics. But however the

causative factors themselves may be taken as Anupashaya.


76

CHIKITSA

Different measures have been explained by many authors of our

classics for the purpose of the samprapti vighatana. Kashyapa, Bhavamishra

and Yogarathnakara have mentioned the line of treatment of Amlapitta as

vamana, Virechana and shamana therapy. In Bhaishajya Ratnavali and

Chakradatta there is a mention of vamana, Virechana, Anuvasana basti and

Asthapana in the context of treatment of Amlapitta. Vamana is mainly useful

in urdhwaga Amlapitta and Virechana is helpful in adhoga Amlapitta. Other

than this Raktamokshana is mentioned by Vangasena. The individual role of

these measures in the management of Amlapitta is described below.

The necessity of Raktamokshana arises when the doshas do not subside

by other measures. Vangasena observes this as a last measure restored to

cleanse the unabated dosha by other measures. This is beneficial in Amlapitta

associated with Kota etc. synchronizing with raktadusti.181


77

TAMAKA SHWASA

NIRUKTI:

“Tamakascha Asou Shwasascha Tamaka Shwasa” this line explains

manifestation of the difficulty in breathing, which occurs mainly during the night time,

this is called as Tamaka Shwasa. Difficulty in breathing is the cardinal symptom of

Tamaka Shwasa and in extreame cases it may be associated with darkness infront of the

eyes. Also the attacks of Tamaka are considered to be worst during the night. These

natures of the illness are unrevealed in the above said etymological derivation.

PARIBHASHA:

Sushruta – defines Tamaka Shwasa as “Vischesta Durdine Tamayati Shwasaha”. It

means the attack of Shwasa with Tama pravesha which occurs especiaaly during

‘Durdina’.

Vijayarakshita explains Tamaka Shwasa as, “Shwasastu Basthrikadmana

Samavathordhwa Gamani” it means it is a disease where in the expiration of air

produces a sound similar to the sound of blow of blacksmith.

NIDANA Table no 24 – Showing Nidana Of Shwasa / Tamaka Shwasa:

Factors C. S182 S.S183 A.H184 A.S185 M.N186

Vata-Prakopa Ahara

Rukshanna - Ununctuous food + + - - +

Visamashana - Irregular food habit + + - - +

Adhyashana - Habit of eating frequently - + - - -

Anasana - Observation of fast for long - + - - +


78

Dvandvatiyoga - Mutually contradicting

foods

+ - - - -

Sheetashana - Cold foods - + - - +

Visha – Poison + + - - +

Sheetapana - Cold drinks - + - - +

Pitta-Prakopa Ahara

Tilataila - Sesamum oil + - - - -

Vidahi - Food causing burning sensation + + - - +

Katu -Spicy food - - - + -

Usna - Hot food - - - + -

Amla - Sour - - + - -

Lavana - Salt - - + + -

Kapha-Prakopa Ahara

Nishpava - Dolichos lablab + - - - -

Masa - Vigna radiatus + - - - -

Pistanna – Pastries + - - - -

Shaluka - Rhizome of lotus + - - - -

Guru dravyas - Heavy food + + - - +

Jalajamamsa - Meat of aquatic animals + - - - -

Anupa mamsa - Meat of marshy animals + - - - -

Dadhi – Curds + - - - -

Amaksira - Unboiled milk + - - - -

Utkleda - Kaphakara food + + - - +

Vistambhi + + - - +

Vata-Prakopa Vihara

Rajas - Dust / Pollen + + + + +

Dhuma - Smoke + + + + +

Vata - Cold breeze + + + + +

Sheeta Sthana - Cold places + + - - +

Sheeta ambu - Cold water + + + + +


79

Ativyayama - Excessive exercises + + - - +

Gramya dharma - Excessive sexual

intercourses

+ - - - +

Apatarpana - Emaciating techniques + - + - +

Shuddhi Atiyoga - Excessive purification + + - - +

Kantha/Urah pratighata - Injury to

throat/chest

+ - - - +

Bharakarshita - Emaciation due to lifting

heavy weights

+ + - - +

Adhwahata - Excessive walking + + - - +

Karmahata - Excessive-work + + - - +

Veganirodha - Suppression of urges - - - + -

Abhighata - Injury - + + + -

Marmabhighata–Injury to vital structures + - - - +

Pitta-Prakopa Vihara

Usna – Hot - - - + -

Vata-Prakopa Vihara

Abhishyandi Upacara - Administration of

substances which obstruct the channels

+ - - - +

Divasvapna - Day sleeping - - - - -

Vataja-Vyadhi / Avastha Sambandhi Nidana

Anaha + - - - -

Dourbalya + - - - -

Atisara + - - - +

Kshaya - + - - -

Ksataksaya + - - - -

Udavarta + - - - -

Visucika + - - - -

Panduroga + + + + -


80

Visa Sevana + + + + -

Vibandha + - - - -

Pittaja

Rakta pitta + - - - -

Jwara + - - - +

Kaphaja

Kasa - - + + -

Amapradosa - + - - -

Chardi + - + + -

Pratisyaya + - - - -

Amatisara - - + + -

SAMPRAPTI

Charaka opines that, the vitiated kapha along with vitiated vata obstructs the

srotas, the obstructs vayu tries to over come the obstruction and moves in all the direction

resulting in Shwasa.187

Sushruta says, the Prana vayu goes against it’s individually (Prakriti) all the

direction resulting in Shwasa.188

Bhavamishra189 and Yogaratnakara190 opinion regarding Samprapti coincides

with Charaka, Madhavakaras191 coincides with Sushruta.

Vagbhata further emphasized that, the Annavaha Srotas is also involved and

hence the production of Kapha in Amashaya is affected. Thus Shwasa roga is regarded as

Amashaya samudbhava.192


81

Nidana Sevana Agnimandya Shleshma Vriddhi

(Vatakara Nidana)

Vata Dusti Amotpatti Rasa dusti

Prana,Udana Dusti KaphaDusti

(Kledaka,Avalambaka)

Udaka, Annavaha Srotodusti

& Pranavaha Sroto Avrodha

Sroto Sanga due to

Kapha + Amadosha

Srotosanga of Pranavaha srotas due to Kapha, Amadosha

Dosha Dooshya Sammurchana

Pranavayu Vimargagamana

Tamaka Shwasa

Samprapti Ghataka :

Dosha: : Pranavayu, Udanavayu, Avalambaka Kapha.

Dushya : Rasa Dhatu

Agni : Jataragni and Rasadhatwagni

Ama : Jataragni and Dhatwagnimandya

Srotas : Pranavaha Srotas,Udakavaha Srotas, Annavaha Srotas

Dusti Prakara : Sanga, Vimargagamana


82

Udbhavastana : Amashaya

Adhistana : Uras

Sancharacharastana : Pranavaha Srotas

Vyakta Stana : Uras, Shwasana Kriya marga

Roga Marga : Madhyama

PURVARUPA Specific purvarupa has been explained for Tamaka Shwasa, but the purva

rupa explained in the context of Shwasa holds good for Tamaka Shwasa.

Table no. Table no 25 - Showing Purvarupa Of Shwasa Roga:

Symptoms C.S19

3

S.S194 A.H195 M.N196

Anaha – distension of abdomen + + + +

Adhmana – fullness of the

abdomen - - - +

Arati – restlessness - + - -

Bhaktadwesa – aversion to take

food - + - -

Vadanasya vairasya – abnormal

taste in the mouth - + - -

Parshwa shoola – pain in the sides

of the chest + + + +

Peedanam hridayasya – tightness of

the chest + + + +

Pranasya vilomata – obstruction to

expiration + - + +

Shankha nistod–temporal headache - - + +


83

RUPA -

Vata as well as Kapha dosha, Rasa dhatu and Pranavaha Srotas are the

predominant factors involved in the pathogenesis of Tamaka Shwasa and for apparent

reasons; these factors determine the course and clinical manifestation of the disease.

Table no 26- Showing theRupa of Tamaka Shwasa

Sl.No Symptoms C.S197 S.S198 A.S199 A.H200

1 Pinasa – running nose, sneezing, stuffiness of the nose

+ + + +

2 Shwasa – dyspnoea + + + + 3 Tivravega Shwasa – rapidity of

breathing + + + +

4 Amuchyamane Tu Bhrisham – severe breathlessness if sputum is not expectorated out.

+ + + +

5 Vimokshante Sukham – slight relief in breathlessness on spitting out the sputum.

+ + + +

6 Anidra – breathlessness disturbs sleep. + - - - 7 Sayanah Shwasa Piditaha – discomfort

worsens on lying. + + + +

8 Aseeno Labhate Soukhyam – feels easy to breathe in sitting position.

+ + + +

9 Pratamyati Ati Vegat – deterioration of conciousness

+ - + +

10 Kasa – Cough + + + + 11 Pramoham Kasamanascha – frequent

deterioration of consciousness during paroxysm of cough

+ - + +

12 Kanta Ghurghuraka – rattling + - - - 13 Kantodhwamsa – soreness of the throat + - - - 14 Utshoonaksa –oedema around the eyes. + - + + 15 Vishuskasya – dryness of mouth + - + + 16 Lalata Sweda – sweating in the forehead + + + + 17 Meghaihi Abhivardhate – cloudy

weather worsens the attack + - + +

18 Sheeta Ambu – cold water + - + + 19 Pragvata – breeze + - + + 20 Sleshmala – Kaphakara + - + + 21 Usnabhinandate – likes hot thing + - + + 22 Aruchi – anorexia - + + + 23 Trishna – excessive thirst - + + + 24 Vepathu – tremors - - + + 25 Vamathu – expectoration - + - -


84

BEDHA201 : 1. Pratamaka 2. Santamaka

If a patient suffering from Tamaka Shwasa gets afflicted with fever and murcha,

then the condition is called Pratamaka.

In Santamaka patient feels as if he is in darkness (Tama).

ARISTA LAKSHANA :

The patient presenting Deergha uchwasa, Nishwasa, patient passing grathita

mutra, purisha associated with Agnimandya, the Shwasa complicated with Atisara, Jwara,

Hikka, Chardi, Medhrashopha and Andashopha.202

SADHYASADHYATA :

In Charaka Samhita, Tamaka Shwasa becomes sadhya, if it is treated in early

stages, even though it is stated that Yapya vyadhi.203 Along with this Dalhana mentions

that it also becomes asadhya,204 if it is associated with Jwara and Murcha. According to

Vagbhata it is Yapya,205 but can be Sadhya, if it is treated in the beginning and if it occurs

in a strong person.

UPASHAYA AND ANUPASHAYA :

Ushna ahara and Ushna vihara are the upashaya of Tamaka Shwasa206.

Sheetambu, Sheeta vayu, Pragvata and Shleshmala aharas are Anupashaya207.


85

CHIKITSA

According to ayurvedc principles, the treatment of Tamaka Shwasa consists of

nidana parivarjana, shodhana and ahamana which does the samprapti vighatana.

Chikitsa of tamaka Shwasa depends on doshic and physical states of the patients.

The patients can be classified as follows208.

i. Kaphadhika and Vatadhika ii. Balawan and Durbala

Principle of management based on doshic status. Tamaka Shwasa is caused by

Vata Kapha dosha. If both doshas aggrevated in equal form or vitiated in samana rupa,

then therapy will alleviates both doshas should be used, because just by increasing vata,

kapha will automatically subsides and allows vata to move freely. When vata is much

aggrevated and kapha is in it’s rupavastha, then treatment to increase kapha eill correct

the vata.

Different Therapies in the Management of Tamaka Shwasa –

All the different therapies of Tamaka Shwasa described in different texts

are based on the above said principles. The details will be given below.

1. Snehana and Swedana: All most all Ayurvedic classics have mentioned snehana

and swedana by Nadi, Prasthara or by Sankara method209. This is very effective

when kapha prakopa is more i.e, acute condition.

2. Langhana and Ruksha Sweda: If a patient of Tamaka Shwasa suffers from

Navajwara and Amadosha, then patients should be administered ruksha sweda

and langhana.

3. Vamana Karma: The Clinical presentation in patients suffering from Tamaka

Shwasa is not uniform. Some patients present with symptoms suggestive of dominant


86

Vata Dosha and are characterized mostly by dry cough and prominent wheezing. In

such patients, Vamana Karma is not the ideal choice. Yet, other patients present with

symptoms suggestive of dominance of Kapha Dosha, which is characterized by

paroxysmal productive cough, where the sputum is tenaecious, bouts of distressing

paroxysmal cough brings out small amounts of sticky sputum and this is associated

with breathlessness. In such patients, with the predominant vitiation of Kapha Dosha,

Vamana Karma is most ideal. This renders clarity of the Pranavaha srotas and thereby

allowing free passage of the Prana Vayu.

The procedure of Vamana Karma is advisable only in patients who are physically

strong and can tolerate the strain of Vamana Karma. The mild form of Vamana is

always advisable in all patients of Tamaka Shwasa and it can be repeated during

every attack.

In children, spontaneous vomiting is a natural defence mechanism that clears the

passage of respiratory tract. Here, act of vomiting along with emptying the stomach,

also includes forced expiration that clears the respiratory passage.

After subjecting the patient to Abhyanga and Nadi Sweda over the chest, in the

evening, the patient is allowed to take the food that provocates the Kapha Dosha - like

meals with curds or fish. This Kaphotkleshana procedure renders easy elimination of

the Kapha Dosha by the Vamana procedure, which is carried out on the immediate

next day, in the morning hours210.

4. Dhoomapana: This is another procedure also aimed at eliminating the Kapha

Dosha from the srotas. Dhoomapana is advised after the Vamana karma and it

eliminates some amount of Kapha Dosha that is still left out after the Vamana karma.

Or else, if the Kapha Dosha in the srotas is minimum, as in Vata dominant cases or in

cases of milder attacks, Dhoomapana may be performed alone without prior Vamana

karma. Further, in debilitated patients, where purificatory procedure is not possible,

Dhoomapana alone helps in the elimination of Kapha Dosha. Added to this, the drugs


87

used in Dhoomapana also reduces spasm or stiffness of Pranavaha srotas bringing

about Srotomardavata that ensures free passage of Vata Dosha.

Improvement from the respiratory distress can be spontaneously seen, as

expectoration is improved and made easy. Also, it produces bronchodilatation,

bringing maximum relief to the patient. Here, the medicines are directly delivered

into the system and hence response is prompt and immediate. The procedure is

akin to the inhalers prescribed by the modern counterparts. Procedure can be

repeated regularly depending upon the requirement .

Occasionally, due to irritant cough, breathlessness may worsen in some

patient. This is mostly seen if the patient cannot smoke smoothly, and is especially

true in females and children.

5. Virechana: ‘Tamaketu Virechana’ can be justified like this.

a). According to srotas involvement – Pranavaha, Udakavaha and Annavaha srotas are

involved. The importance of moolasthana is that, if moolasthana is affected, then it

affects entire srotas. In Tamaka Shwasa sanga and vimargagamana type of srotodusti

occurs. In pranavaha srotas sanga occurs due to kapha, which causes vimargagamana

of vata. By virechana, removal of sanga takes place and virechana causes

vatanulomana, there by relief in Tamaka Shwasa.

b). According to Udbhava Sthana – The udbhava sthana of Tamaka Shwasa is amashaya

and is seat of pitta mainly and kapha. Even though kapha is main dosha in this

disease, but sthanika dosha and udbhava sthana should be treated first. So Virechana

helps in sthanika dosha chikitsa as well as normalizing amashaya.


88

METHODOLOGY

DRUG REVIEW

The Present study has been carried out to evaluate the effect of Virechana on

Body Fluids.

Drugs used in clinical study was grouped as -

1. Drug used in Purva Karma of Virechana :

PANCHAKOLA CHURNA: Ingredients are, Pippali, Pippali Mula, Chavya, Chitraka,

Nagara211.

MURCHITA GHRITA : For Murchana of Ghrita Kalka of Hareetaki, Amalaki,

Bhibhitaki, Musta, Rajani, Matulunga, Swarasa and Jala were used and Ghrita was

prepared212.

TILA TAILA : For Abhyanga.

2. Drug used in pradhana karma of Virechana:

Trivrit Leha : For The Preparation, Krishna Nishottara Moola Kwatha, Krishna

Nishottara Moola Kalka, Sharkara Was Used213.


89

Table no 27 (a) Showing the Properties of Ingredients of Panchakola Churna Dravya Rasa Guna Veerya Vipaka Doshaghnata Karma Pippali

and Pippali Mula Piper

longum

Katu

Laghu Snigdha

Teekshna Pippali Mula is Ruksha

Anushna Sheeta Pippali Mula is Ushna

Madhura Pippali Mula is

Katu

Kapha Vata

Hara

Medhya Deepana Mutrala

Kasahara

Chavya Piperretro fractum

Katu

Laghu Ruksha

Ushna

Katu

Kapha Vata

Hara

Triptigna Deepana Pachana Krimigna

Chitraka Plumbago Zeylanica

Katu

Laghu Ruksha

Teekshna

Ushna

Katu

Kapha Vata

Hara

Deepana Pachana

Grahi Krimigna

Nagara Zingiber officinale

Katu

Laghu Snigdha

Ushna

Madhura

Kapha Vata

Hara

Deepana Pachana Vrushya

Anulomana Table no 27 (b) Showing the Properties of Ingredients of Murchita Ghrita -

Dravya Rasa Guna Veerya Vipaka Doshaghnata Karma Prayojya Anga

Pathya (Hareetaki)

Lavana Varjita Kashaya Pradhana Pancharasa

Laghu, Ruksha

Ushna Madhura Tridoshahara Deepana, Pachana, Anulomana, Rochana

Phala

Dhatri (Amalaki)

Lavana Varjita Amla, Pradhana Pancharasa

Guru, Ruksha Sheeta

Sheeta Madhura Tridoshahara Rochana, Deepana, Anulomana, Rasayana

Phala

Vibhitaki Kashaya Rasa

Laghu, Ruksha

Ushna Madhura Tridoshahara, especially Kapha hara

Deepana, Anulomana

Phala

Jaladha (Musta)

Tikta, Katu, Kashaya

Laghu, Ruksha

Sheeta Katu Kapha, Pitta Shamaka

Pachana, Deepana, Grahi, Rochana, Mutrala

Kanda

Rajani (Haridra)

Tikta, Katu

Laghu, Ruksha

Ushna Katu Tridoshahara Ruchya, Anulomana, Pitta Rechaka

Kanda

Matulung Amla Teekshna

Ushna Amla Kaphahara, VataShamaka

Rochana, Deepana, Anulomana

Phala


90

Ghrita:

Ghee is obtained from the milk of class Mammalian of the animal Kingdom

especially cow, goat, sheep etc. Though the Ghrita of these animals posses many

common features, Ayurveda differentiates their particular features also and recommends

the Go ghrita as best. The Ghrita is used for both, food and medicinal purposes. In this

study Cow Ghee was used so its properties are being described here under.

Clarified milk fat (or) butter fat is known as Ghee. It is prepared by heating butter

or cream to just over 100˙c to remove water content by evaporation. The residue is

filtered out as pure ghee. The melting point of ghee is 33 – 37˙ C that is less than the

normal human temperature of the body. Its digestibility coefficient or rate of absorption

is 96%, which is highest of all oils and fats. It contains more oxygen than other oils. The

Lipophilic nature of ghee facilitates entry of the formulation into the cell and its delivery

to the mitochondria and nuclear membrane.

Method of Preparation of Murchita Ghrita 214:

Table no 27 (c) showing Ingredients of Murchita Ghrita

Ingredients Quantity

Pathya 4 Toga

Dhatri 4 Toga

Vibhitaki 4 Toga

Jaladha 4 Toga

Rajani 4 Toga

Matulunga Swarasa 4 Toga

Ghrita 64 Toga

Jala 256 Toga


91

Procedure:

Heat the ghrita on low flame till it stops foaming and allow it to cool down. Then

drugs in Table from 1to 5 are taken and they were made into Kalka form by mixing with

Matulunga Swarasa. Kalka and water in prescribed quantity to ghrita were added. Heat

was given till the appearance of Ghrita Siddha Lakshanas, after that vessel was taken out

from the fire and Ghrita was filtered.

Importance of Ghrita Murchana:

It is a process adopted for enhancing the potency (Veeryavan Soukhyadayi) of

ghee. There by, bad odour (Gandham Vinihanti) and Amadosha (Amadosham harati) are

removed from the Ghrita. The Sneha substances are rendered chemically stable. They

also attain a pleasing colour and flavor.

Table no 27 (d) - Showing the Properties of Tila Taila-

Sankrit

name

Latin

name

Family Rasa Guna Veerya Vipak

a

Dosha

ghnata

Karma

Tila

taila

Sesamu

indicum

Pedaliacee Madhur,

Kashay

a ,Tikta

Sookshma,

Vyavayi,

Vikashi,

Vishada,

Guru, Sara,

Teekshna,

Hima

sparsha

Ushna Madhu

ra

Tridos

haghna

Deepana,

Pachana,

Pramehahara,

Vrinahara,

Mamsadhatu

Pushtikara,

keshya,

Netrya.


92

TRIVRIT -Table no 27 (e) - Summarized Pharmacological profile of Trivrit215

Drug Parts used Pharmacological

properties

Chemical

Composition

Name : Trivrit

Latin name:

Operculina turpethum

Family :

Convolvulacae

Mula Twak

Rasa – Kashaya

Madhura

Tikta, Katu

Guna– Ruksha, Tikshna

Veerya – Ushna

Vipaka – Katu

Karma – Rechana,

KaphaShamana,

Pitta Shamana

The root contains an

active principle in

Glycoside resin. This

substance has been

named Turpethin.

Root also contains 2

more Glycoside α-

turpethine and β-

turpethine.

TRIVRIT MULA: Sharangdhara explained Trivrit in Rechana group of Virechana Dravya. The

action of Trivrit attributed here was 216-

“e®d§d™®da SdQ§d™®da ®dd «d¬ddeQ Q„®d£dd ¦dSdy£dŠ | TyŸdSd£Sde§d £d¡¡dySda TyŸd¦da eÎd®dm£dd Sd¤dd ||”

Drug Trivrit eliminates digested (Pakwam) and Undigested (Apakwam) Malas or

Doshas by making them watery through the lower gut.

Adhamalla, while commenting on this verse mentions that Trivrit not only

liquefies the Mala but also eliminates it quickly (Rechayati).

4) Drugs used in Paschat Karma of Virechana:

Rice, Green gram, Refined Sunflower oil, Saindhava Lavana, Sarshapa, Jeeraka

was used.

The clinical study is based on the classical explanations with scientific well

designed research protocols.


93

METHOD OF COLLECTION OF DATA –

1. RESEARCH DESIGN: Prospective clinical trial was conducted. The patients were

assigned in to three groups. Group ‘A’, Group ‘B’, Group ‘C’.

Group ‘A’ – 10 patients suffering from Kitibha kusta, who were fit for Virechana

karma.

Group ‘B’ – 10 patients suffering from Amlapitta, who were fit for Virechana karma.

Group ‘C’ – 10 patients suffering from Tamaka Shwasa, who were fit for Virechana

karma.

2. SOURCE OF DATA :

Patients suffering from Kitibha Kusta, Amlapitta and Tamaka Shwasa were selected

from OPD and IPD of D.G.M.Ayurvedic Medical College and Hospital, Gadag.

a. Literary – Literary aspect of the study was collected from classical Ayurvedic

texts and contemporary texts updated with recent medical journals.

b. Therapy – Virechana Karma : Classical procedure was followed.

Drugs used for Clinical trial and their Preparation –

i). Panchakola Churna for Deepana and Pachana.

Preparation -

Contents: 1. Pippali 2. Pippali Mula 3. Chavya 4. Chitraka 5. Shunti were taken

in equal quantity in fine powder form and mixed well.


94

ii). Murchita Ghrita for Snehapana.

Preparation –

Ingredients Quantity

1. Pathya (Hareetaki) 4 Tola

2. Dhatri (Amalaki) 4 Tola

3. Bibhitaki 4 Tola

4. Jaladha (Musta) 4 Tola

5. Rajani (Haridra) 4 Tola

6. Matulunga Swarasa 4Tola

7. Ghrita 64 Tola

8. Jala 256 Tola

Procedure: Ghrita was heated in low flame till it stops foaming and allowed it to cool

dow. Then the above mentioned drugs from 1-5 were taken and made in to kalka form

by mixing with matulunga swarasa. Kalka and jala in prescribed quantity to

Ghrita were added. Heat was given till the appearance of ghrita siddha lakshanas, after

that vessel was taken out from the fire and ghrita was filtered.

iii) Tila taila for Abhyanga.

iv) Trivrit Leha for Virechana.

Preparation – Ingredients:

1. Krishna Nishottara Mula Kwatha

2. Krishna Nishottara Mula Kalka

3. Sharkara

Procedure: The above said drugs were mixed together and boiled well. When this

attained to tantu paka, then removed from the fire, cooled it and used.


95

3. SAMPLE SIZE :

A minimum of 30 patients were taken for study. All the patients received classical

Virechana karma.

4. DIAGNOSTIC CRITERIA :

The diagnosis of Kitibha Kusta, Amlapitta and tamaka Shwasa were made

according to the signs and symptoms mentioned in classical Ayurvedic texts.

5. INCLUSION CRITERIA:

The selection of the patients for the study was done with following criteria-

a. The patients fit for Virechana Karma.

b. The patients who had Samyak Virechana.

c. Patients who fall in the age group of 18-60 years.

d. Patients of both sexes.

e. Patients diagnosed as Kitibha Kusta, Amlapitta and Tamaka Shwasa

according to classical symptoms.

6. EXCLUSION CRITERIA:

Following were the criteria to exclude the patients from the clinical study-

a. Below 16 years and above 60 years.

b. Patients who were unfit for Virechana Karma.

c. Severe form of systemic disorders like, diabetes mellitus, hypertension etc.

d. Patients who had ayoga and atiyoga symptoms of Virechana.


96

7. LABORATORY INVESTIGATIONS:

- Serum Electrolytes

The following routine investigations were carried out in all the patients.

- Hb %

- TC, DC

- ESR

- Other necessary investigations were also done.

8. PLAN OF THE STUDY:

All the three group patients have received classical Virechana Karma with above

mentioned preparations.

Purvakarma –

Pachana: Here, Panchakola Churna was chosen for Ama Pachana. The patients

withAmadosha were administered till Nirama lakshanas were seen.

Snehapana: Murchita Ghrita was selected for Snehapana. First day started with٭

hrisiyasi matra of 30 ml in all patients of three groups. Depending on digestion of sneha

and Agni bala second day onwards 30 ml was increased each day and given up to samyak

snigdha lakshanas observed in all patients of three groups. The (uttama) Matra up to 150

ml of murchita ghrita with pinch of Saindhava lavana was administered. Ushna jala and

laghu ahara was advised during this process.

Abhyanga: Abhyanga was performed for 45 minutes in seven postures with sukhoshna٭

tila taila up to 4 days in morning 7.30 to 8.30 am.

Swedana : Nadi Sweda with Nirgundi Patra was given in group ‘B’ Amlapitta, and٭

group ‘C’ Tamaka Shwasa patients. But in group ‘A’ of Kitibha Kusta patients ushna jala

snana was advised for 4 days. Patients were advised to take pathya ahara, vihara in these

days.


97

Pradhana Karma –

The patients were asked about the digestion of previous day meal, sleep and

observing his mental condition, abhyanga and sweda was done. In the morning around

7.30 am to 8.30 am Virechana dravya i.e, Trivrit leha 25 -35 Gms was given along with

ushna jala as a anupana. The dosage of Trivrit Leha was fixed according to rogi bala and

roga bala.

Nireekshana – Observation of the patient was made for assessing the number of Vegas,

samyak Virikta lakshanas and Kaphanta of Virechana Vega.

Paschat Karma – After Virechana Vega stopped, by observing the avara, madhyama and

pravara shuddhi 3-7 days samsarjana karma was advised to bring balance in the Agni.

Thin rice ganji, thick rice ganji, Rice, Rice with oil and salt and then normal diet

was advised.

After samsarjana karma, according to the disease shamanoushadhi’s were

advised.

STUDY DURATION:

Prospective clinical trial was done for 21 days, i.e, the observational study

was conducted. The effect of Virechana Karma was analyzed on body fluids by the

parameter Serum Electrolyte test before and after the Virechana Karma in all the three

groups of patients.

The classical symptoms of the three diseases were also observed before to after

the Virechana karma.


98

9. CRITERIA FOR ASSESSMENT:

The assessment of the result for this present study was made with Serum

Electrolyte value before and after Virechana karma and with Samyak Virikta lakshanas

and also disease symptoms were considered.

Group ‘A’ – Kitibha Kusta - Group ‘B’ - Amlapitta

Group ‘C’ – Tamaka Shwasa

Symptooms BT AT

Amlodgara

Tiktodgara

Kanta Vidaha

Urividaha

Kukshidaha

Utklesha

Amlotklesha

Udaradmana

Symptooms BT AT

Ruksha

Khara Sparsha

Kandu

Parusha

Vriddhimanthi

Ghanam

Shyava

Aruna

Symptooms BT AT

Peenasa

Shwasa

Vimokshamane

Sukham

Anidra

Shayana

Shwasa Peedita

Kasa

Kanta

Ghurghuraka


99

10. SUBJECTIVE PARAMETERS:

Signs and Symptoms of Samyak Virechana Karma.

i) Vegiki ii) Maniki iii) Antiki iv) Laingiki

27 (f) –Showing the Samyak Virechana Karma

Shuddhi Pravara Madhyama Avara

Vegiki 30 Vegas 20 Vegas 10 Vegas

Maniki 4 Prastha 3 Prastha 2 Prastha

Antiki Kaphanta Kaphanta Kaphanta

11. OBJECTIVE PARAMETERS:

Serum Electrolytes

i. Sodium (135 – 155 U/Lit)

ii. Chloride (98 – 108 U/Lit)

iii. Potassium (3.5 – 5.5 U/Lit)

Before Virechana Karma, i.e, day before giving Trivrit Leha for Virechana and

immediately after Virechana Vega shamana, two readings of Serum Electrolyte was taken

in all cases and assessed.

This test was carried out with the help of Dr. P.S.Khona in Hans Laboratory,

Gadag.

12. CRITERIA FOR ASSESSMENT OF RESULTS:

Finally overall assessments of results were made with the help of above

mentioned subjective and objective parameters.


100

Subjective Assessment:

1. Number of Vegas: (Calculation of Vegas was done leaving first Mala Vega)

Numbers of Vegas of each patient were recorded.

2. Time of administration of drug and time of onset of first Virechana Vega were noted.

Latency was calculated by subtracting time of onset of first Vega from the time of

administration of drug.

3. Time of last Vega was noted and duration of Virechana was calculated by subtracting

the time of last Vega from the time of onset of Vega.

4. Laingiki Shuddhi: The Laingiki Lakshanas were observed which were Vit Pitta

Kapha Vata Kramataha, Vatanulomana, Udara Laghuta, Shareera Laghuta, Indriya

Prasada, Sroto Shuddhi, absence of Ayoga Lakshanas, and Agni Deepti.

5. Antiki Lakshanas : Antiki Lakshanas were assessed based on the features exhibited at

the end of all Vegas i.e. Malanta, Pittanta, Kaphanta and Vatanta.

6. Maniki Lakshanas : Total approximate quantity of the feces was measured by asking

the patients.

Grouping of the results of objective criteria were made as follows –

a. Serum Electrolyte values remained same.

b. Serum Electrolyte values increased within normal range.

c. Serum Electrolyte values decreased within normal range.

d. Serum Electrolyte values increased.

e. Serum Electrolyte values decreased.

a. Serum Electrolyte values remained same:

The values of Sodium, Chloride and Potassium shouldn’t change, i.e., remained as

it is after samyak Virechana compared with before Virechana karma values.


101

b. Serum Electrolyte values increased within normal range:

Any of the values among Sodium, Chloride and Potassium increased

within normal range after the samyak Virechana as compared with before Virechana

karma values.

c. Serum Electrolyte values decreased within normal range:

Any of the values among Sodium, Chloride and Potassium decreased within

normal range after the samyak Virechana as compared with before Virechana karma

values.

d. Serum Electrolyte values increased:

Any of the values among Sodium, Chloride and Potassium increased than the


values.

e. Serum Electrolyte values decreased:

Any of the values among Sodium, Chloride and Potassium decreased than the


values.

13. STATISTICAL ANALYSIS:

Only net effect i.e., base line data’s with day before Virechana Karma and

immediately after Virechana Vega stopped. Serum Electrolyte values were considered for

statistical analysis.

As this clinical trial is of 3 groups, ANOVA test was used for analysis.


102

OBSERVATIONS AND RESULTS:

In this clinical study, totally 42 cases were reported. Among 42 cases 40 cases

were came under the 3 groups. 12 cases of Kitibha Kusta, 15 cases of Amlapitta and 13

cases of Tamaka Shwasa were diagnosed. Finally 10 patients in each group were taken

for the clinical study and 10 cases were dropout due to so many factors during treatment.

Some patients dropped the therapy due to inconvenience in timing, some patients due to

inability to take high dose of murchita ghrita. 10 patients in each group were completed

the Virechana Karma.

The observed data’s were recorded in well designed proforma before and after

Virechana Karma.

Table no 28 Showing the Status of Patients of the Present Study

Group Total

Registered

Discontinued Completed

Group ‘A’ 12 02 10

Group ‘B’ 15 05 10

Group ‘C’ 13 03 10

Total 40 10 30

Total observed data’s divided in to three sections for better understanding.

A) Demographic Data

B) Data Related to Virechana Karma

C) Data Related to Objective Criteria.


103

A) Demographic Data:

1. Distribution of Patients in Different Age Groups –

Table no 29 (a) - Age wise distribution of 3 groups.

Age (in Yrs)

Group ‘A’

% Group ‘B’

% Group ‘C’ % Total %

18-24 02 20 05 50 01 10 08 26.66 24-30 02 20 02 20 01 10 05 16.66 30-36 01 10 02 20 02 20 05 16.66 36-42 02 20 00 00 02 20 04 13.33 42-48 01 10 01 10 01 10 03 10.00 48-54 01 10 00 00 00 00 01 03.33 54-60 01 10 00 00 03 30 04 13.33

Group ‘A’ have 2 patients each (i.e., 20%) in the age group of 18-24 yrs, 24-30 yrs

and 36-42 yrs.

Group ‘B’ have maximum number of patients i.e., 5 (50%) in the age group of 18-24

yrs.

Group ‘C’ had 3 patients (i.e., 30%) in the age group of 54-60 yrs.

Out of 30 patients in 3 groups, majority of the patients i.e., 8 in the age group of 18-

24 yrs.

Fig: 3

Distribution of Pt.'s by Age

2 2

1

2

1 1 1

5

2 2

0

1

0 0

1 1

2 2

1

0

3

0

1

2

3

4

5

6

18-24 24-30 30-36 36-42 42-48 48-54 54-60

Age groups

No. o

f Pt.'

s

A B C


104

2. Distribution of Patients by Sex –

Table no 29(b) - Sexwise distribution of 3 groups

Sex Group ‘A’ % Group ‘B’ % Group‘C’ % Total %

Male 06 60 08 80 09 90 23 76.66

Female 04 40 02 20 01 10 07 23.33

In Group ‘A’, 6 patients (60%) were males and 4 patients (40%) were females.

In Group ‘B’, 8 patients (80%) were males and 2 patients (20%) were females.

In Group ‘C’, 9 patients (90%) were males and 1 patient (10%) was female.

So out of 30 patients maximum number of patients i.e., 23 ( %) were males and

females were only 7 ( %).

Fig: 4

A B C

6

4

8

2

9

10

2

4

6

8

10

Distribution of Pt.'s by Sex

Male Female


105

3. Distribution of Patients by Occupation:

Table no 29(c) – Distribution of 3 groups by occupation

Occupation Group ‘A’ % Group ‘B’ % Group‘C’ % Total %

Student 02 20 05 50 01 10 08 26.66

Labour 02 20 00 00 02 20 04 13.33

Sedentary 00 00 00 00 03 30 03 10.00

Active 04 40 03 30 03 30 10 33.33

Housewives 02 20 02 20 01 10 05 16.66

In Group ‘A’ 4 patients (40%) were active and 2 patients (20%) each in student,

labour and housewives. No patients in sedentary.

In Group ‘B’ 5 patients (50%) were of student, 3 patients (30%) active and 2

patients (20%) of housewives. No patients in labour and sedentary.

In Group ‘C’ 3 patients (30%) each in sedentary and active, 2 patients (20%) in

labours and 1 patient (10%) each in student and house wives.

So out of 30 patients, maximum number of patients i.e, 10 (33.3%) were active.

Below depicted graph describes the above statement.

Fig: 5

Distribution of pt.'s by Occupation

2 2

0

4

2

5

0 0

32

12

3 3

1

0

1

2

3

4

5

6

Std Lab Sed Act HW

Occuaption

No. o

f Pt's

.

A B C

Std – Student, Lab – Labour, Sed – Sedentary, Act – Active, HW – House Wife.


106

4. Distribution of Patients by addiction:

Table no 29(d)- Distribution of 3 groups by Vyasana

Vyasana Group‘A’ % Group ‘B’ % Group C’ % Total %

Smoking 01 10 04 40 06 60 11 36.66

Alcohol 00 00 03 30 00 00 03 10

Tobacco 02 20 02 20 02 20 06 20

No habit 08 80 04 40 04 40 16 53.33

In Group ‘A’ 1 patient (10%) addicted to smoking, 2 patients (20%) to tobacco

and 8 patients (80%) were not addicted to any bad habits.

In Group ‘B’ 4 patients (40%) were addicted to smoking, 3 patients (30%) to

alcohol, 2 patients (20%) to tobacco and 4 patients (40%) were not addicted to any bad

habits.

In Group ‘C’ 6 patients (60%) were addicted to smoking, 2 patients (20%) to

tobacco and 4 patients (40%) were not addicted to any bad habits.

So, out of 30 patients maximum number of patients i.e, 16 (53.33%) had no

addictions. Fig: 6

Distribution of pt.'s by Vyasana

1 02

8

4 3 24

6

02

4

02468

10

Smk Alc Tob NHVyasana

No. o

f Pt.'

s

A B C

Smk – Smoking, Alc – Alcohol, Tob – Tobacco, NH – No Habit.


107

5. Distribution of Patients by Prakriti

Table no 29(e) – Distribution of 3 groups by Prakriti

Prakriti Group‘A’ % Group‘B’ % Group‘C’ % Total %

VataPitta 01 10 03 30 01 10 05 16.66

VataKapha 03 30 01 10 05 50 09 30.00

PittaKapha 06 60 06 60 04 40 16 53.33

In Group ‘A’ 1 patient (10%) was Vata Pitta Prakriti, 3 patients (30%) Vata

Kapha Prakriti and 6 patients (60%) were Pitta Kapha Prakriti.

In Group ‘B’ 3 patients (30%) were Vata Pitta Prakriti, 1 patient (10%) was Vata

Kapha Prakriti and 6 patients (60%) were Pitta Kapha Prakriti.

In Group ‘C’ 1 patient (10%) was Vata Pitta Prakriti, 5 patients (50%) were Vata

Kapha and 4 patients (40%) were Pitta kapha Prakriti.

So, out of 30 patients maximum number of patients i.e, 16(%) were Pitta Kapha

Prakriti.

Fig: 7

Distribution of the Pt.'s by Prakriti

1

3

1

3

1

56 6

4

0

2

4

6

8

A B CPrakriti

No. o

f Pt.'

s

VP VK PK

VP – Vata Pitta, VK – Vata Kapha, PK – Pitta Kapha


108

6. Distribution of patients by Disease symptoms:

Common Symptoms where considered in all three groups and assessed on general

signs and symptoms.

Table no 29(f) – Distribution of 3 groups by Disease symptoms

Symptoms Group‘A’ % Group‘B’ % Group‘C’ % Total %

Decreased 08 80 09 90 09 90 26 86.66

Increased 00 00 00 00 00 00 00 00.00

Remained

same

02 20 01 10 01 10 04 13.33

In group ‘A’ 8 patients (80%) signs and symptoms were decreased by seeing the

before complaints and 2 patients (20%) symptoms remained same.

In group ‘B’ 9 patients (90%) signs and symptoms were decreased by seeing the

before complaints and 1 patient (10%) remain same.

In group ‘C’ 9 patients (90%) signs and symptoms were decreased by seeing the

before complaints and 1 patient (10%) remain same.

So, out of 30 patients 26 patients signs and symptoms decreased by seeing before

complaints after samyak Virechana karma.

Fig: 8

Distribution of Pt.'s

89 9

0 0 02

1 10

2

4

6

8

10

A B CGroups

No. o

f Pt.'

s

De In RS

De – Decreased, In – Increased, RS – Remained Same.


109

B) Data related to Virechana karma.

1) Distribution of Snehamatra.

Table No. 30(a)- Distribution of Snehamatra of 3 groups

Matra Group‘A’ % Group‘B’ % Group‘C’ % Total %

30 ml 10 100 10 100 10 100 30 100

60 ml 10 100 10 100 10 100 30 100

90 ml 10 100 10 100 10 100 30 100

120 ml 5 50 5 50 5 50 15 50

150 ml 0 0 2 20 0 0 2 6.66

In Group ‘A’, 5 patients (50%) received maximum quantity of Sneha (Murchita

Ghrita) i.e., 120 ml and 5 patients received up to 90 ml.

In Group ‘B’, 2 patients (20%) received maximum quantity of Sneha (Murchita

Ghrita) i.e., 150 ml and 3 patients received up to 120 ml. and 5 patients (50%) received

up to 90 ml.

In Group ‘C’, 5 patients (50%) received maximum quantity of Sneha (Murchita

Ghrita) i.e., 120 ml and 5 patients received up to 90 ml.

So, out of 30 patients, 2 patients received up to 150 ml, 13 patients received up to

120 ml and 15 patients received up to 90 ml of Murchita Ghrita for Snehapana.

Fig: 9

Distribution of Pt.'s by Snehamatra10 10 10

5

0

10 10 10

5

2

10 10 10

5

002468

1012

30 ml 60 ml 90 ml 120 ml 150 ml

Matra

No. o

f Pt.'

s

A B C


110

2) Distribution of Sneha Jeeryamana Lakshanas.

Table No. 30(b)- Distribution of Sneha Jeeryamana Lakshanas of 3 groups

Lakshanas Group

‘A’

% Group

‘B’

% Group

‘C’

% Total %

Shiroruja 10 100 10 100 8 80 28 93.33

Bhrama 3 30 7 70 8 80 18 60.00

Lala srava 10 100 10 100 7 70 27 90.00

Murcha 0 0 1 10 4 40 5 16.66

Angasada 9 90 9 90 10 100 28 93.33

Klama 0 0 3 30 6 60 9 30.00

Trishna 8 80 10 100 8 80 26 86.66

Daha 0 0 0 0 0 0 0 0

Arati 0 0 0 0 0 0 0 0

In Group ‘A’, 10 patients (100%) each got Shiroruja and Lalasrava, 9 patients

(90%) got Angasada, 8 patients (80%) got Trishna and 3 patients (30%) got Bhrama.

In Group ‘B’, 10 patients (100%) each got Shiroruja and Lalasrava and Trishna, 9

patients ( 90%) got Angasada, 7 patients (70%) got Bhrama, 3 patients (30%) got Klama

and 1 patient (10%) got Murcha.

In Group ‘C’, 10 patients (100%) got Angasada, 8 patients (80%) each got

Shiroruja, Bhrama and Trishna, 7 patients (70%) got Lalasrava, 6 patients (60%) got

Klama and 4 patients (40%) got Murcha.

So, out of 30 patients, maximum number of patients i.e., 28 each got Shiroruja,

Angasada and 27 patients got Lalasrava in Jeeryamana Lakshanas


111

3) Distribution of Sneha Jeerna Lakshanas.

Table No. 30(c) - Distribution of Sneha Jeerna Lakshanas of 3 groups

Lakshanas Group‘A’ % Group‘B’ % Group‘C’ % Total %

Jeeryamana

Lakshanas

Prashama

10 100 10 100 10 100 30 100.00

Shariralaghuta 5 50 6 60 9 90 20 66.66

Vatanulomana 9 90 8 80 10 100 27 90.00

Kshudha

Pravritti

10 100 10 100 10 100 30 100.00

Trishna

Pravritti

7 70 5 50 8 80 20 66.66

Udgara

Shuddhi

6 60 7 70 8 80 21 70.00

In all the three group patients Jeeryamana Lakshanas Prashama and Kshudha

Pravritti was observed.

In Group ‘A’, 9 patients (90%) got Vatanulomana, 7 patients (70%) got Trishna

Pravritti, 6 patients (60%) got Udgara Shuddhi and 5 patients (50%) got Shariralaghuta.

In Group ‘B’, 8 patients (80%) got Vatanulomana, 7 patients (70%) got Udgara

Shuddhi, 6 patients (60%) got Shariralaghuta and 5 patients (50%) got Trishna Pravritti.

In Group ‘C’, 10 patients (100%) got Vatanulomana, 9 patients (90%) got

Shareera Laghuta, 8 patients (80%) each got Trishna Pravritti, Udgara Shuddhi.

So, out of 30 patients, maximum number of patients i.e., 30 got Jeeryamana

Lakshanas Prashama and Kshudha Pravritti, 27 patients got Vatanulomana in Sneha

Jeerna Kala


112

5) Distribution of Time taken for Sneha Jeerna.

Table No. 31(a) - showing Time taken for Sneha Jeerna in Group ‘A’.

Duration

(in min)

Day I

(%)

Day II

(%)

Day II

(%)

Day IV

(%)

Day V

(%)

0-180 50 - - - -

181-360 50 - - - -

361-540 - 100 - - -

541-720 - - 100 - -

721-900 - - - 50 -

In Group ‘A’- Sneha jeerna occurred within 0-180 min in 50% of patients and

180- 360 min in 50% of patients on day I.

On Day II, 100% patients got sneha jeerna in 361-540 min.

On Day III, 100% patients got sneha jeerna in 540-720min.

On Day I 100% patients got sneha jeerna in 721-900min.

Table No. 31(b) - showing Time taken for Sneha Jeerna in Group ‘B’.

Duration

(in min)

Day I

(%)

Day II

(%)

Day III

(%)

Day IV

(%)

Day V

(%)

0-180 50 - - - -

181-360 50 - - - -

361-540 - 100 10 - -

541-720 - - 90 10 -

721-900 - - - 40 20

In Group ‘B’,

On Day I, 50% patients got sneha jeerna in 0-180 min.

50% patients got sneha jeerna in 181-360 min.


113


On Day III, 10% patients got sneha jeerna in 361-540 min.


On Day IV, 10% patients got sneha jeerna in 541-720 min.


On Day V, 20% patients got sneha jeerna in 721-900 min.

Table No. 31(c) showing Time taken for Sneha Jeerna in Group ‘C’.

Duration

(in min)

Day I

(%)

Day II

(%)

Day III

(%)

Day IV

(%)

Day V

(%)

0-180 50 - - - -

181-360 50 10 - - -

361-540 - 90 20 - -

541-720 - - 80 - -

721-900 - - - 50 -

In Group ‘C’,

On Day I, 50% patients got sneha jeerna in 0-180 min.



90% patients got sneha jeerna in 361-540 min

On Day III, 20% patients got sneha jeerna in 361-540 min.


On Day IV, 50% patients got sneha jeerna in 721-900 min.


114

4) Distribution of Samyak Snigdha Lakshanas.

Table No. 30(d) - Distribution of Samyak Snigdha Lakshanas of 3 groups

Lakshanas Group

‘A’

% Group

‘B’

% Group

‘C’

% Total %

Vatanulomana 9 90 8 80 10 100 27 90.00

Agnideepti 10 100 10 100 10 100 30 100.00

Purisha

Snigdhata

10 100 10 100 10 100 30 100.00

Asamhata

Varchas

10 100 10 100 10 100 30 100.00

Twak

Snigdhata

5 50 6 60 6 60 17 56.66

Angalaghava 7 70 10 100 10 100 27 90.00

Gatra

Mardavata

6 60 6 60 8 80 20 66.66

Snehodwega 8 80 8 80 8 80 24 80.00

Klama 1 10 2 20 2 20 5 16.60

Shaithilya 0 0 0 0 0 0 0 00.00

In all the three group patients Agnideepti, Purisha Snigdhata and Asamhata

Varchas were observed.

In Group ‘A’, 9 patients (90%) got Vatanulomana, 8 patients (80%) got

Snehodwega, 7 patients (70%) got Angalaghava, 6 patients (60%) got Gatramardava, 5

patients got Twak Snigdhata and 1 patient got Klama.

In Group ‘B’, 10 patients (100%) got Angalaghava, 8 patients (80%) each got

Vatanulomana and Snehodwega, 6 patients (60%) each got Gatramardava and Twak

Snigdhata, 2 patients (20%) got Klama.


115

In Group ‘C’, 10 patients (100%) got Vatanulomana and Angalaghava, 8 patients

(80%) each got Gatramardava and Snehodwega, 6 patients (60%) got Twak Snigdhata, 2

patients (20%) got Klama.

So, out of 30 patients, maximum number of patients i.e., 30 got Agnideepti,

Purisha Snigdhata and Asamhata Varchas and 27 patients each got Vatanulomana and

Angalaghava.

Fig: 10

Distribution of Pt.'s by Sneha Samyak Lakshana

910 10 10

5

76

8

10

8

10 10 10

6

10

6

8

2

0

10 10 10 10

6

10

8 8

2

00

2

4

6

8

10

12

VA AD PS AV TS AL GM SD Kl Sh

Lakshanas observed

No. o

f Pt.'

s

A B C

VA – Vatanulomana, AD – Agni Deepti, PS – Purisha Snigdhata, AV – Asamhata

Varchas, TS – Twak Snigdhata, AL – Anga Laghava, GM – Gatra mardava, Kl – Klama,

Sh – Shaithilya.

6. ABHYANGA AND SWEDANA:

Sarvanga Abhyanga was done for 45 minutes in all the 3 groups, followed by

Nadi Sweda in Group ‘B’ and ‘C’ till the appearance of Samyak swinna lakshanas like

Shitoporama, Sthambha Nigraha, Gaurava Nigraha, Shareera Mardavata and Sweda

Pradurbhava. In Group ‘A’, ushna jala snana was advised.


116

7. Distribution of number of Vegas produced by Trivrit Leha:

Table No. 32 – showing number of Vegas produced in 3 Groups

No. of vegas Group‘A’ Group ‘B” Group‘C’ Total %

07 02 (20%) 01 (10%) 00 03 10.00

08 00 00 01 (10%) 02 03.33

09 01 (10%) 00 02 (20%) 03 10.00

10 00 01 (10%) 00 00 03.33

11 01 (10%) 02 (20%) 01 (10%) 04 13.33

12 03 (30%) 02 (20%) 02 (20%) 07 23.33

13 01 (10%) 02 (20%) 01 (10%) 04 13.33

14 01 (10%) 02 (20%) 02 (20%) 05 16.66

15 01 (10%) 00 00 01 03.33

16 00 00 01 (10%) 01 03.33

In Group ‘A’, 3 patients had 12 Vegas, 2 patients had7 Vegas, 1 patient each had

9, 11, 13, 14, 15 Vegas.

In Group ‘B’, 2patients each had 11, 12, 13, 14 Vegas and 1 patient each had 7 and

10 Vegas.

In Group ‘C’, 2 patients had 9, 12 and 14 Vegas, 1 patient each had 8, 11, 13, 16

Vegas.

So out of 30 patient’s maximum number of patients i.e., 7 (23.33%) had 12 Vegas

and 5 (16.66%) patients had 14 Vegas.

The mean number of Vegas is going to be 11.569 i.e., approximately 12 Vegas

occurred with 20 mg/ kg body wt with variance 5.79, i.e., 6 Vegas. Assume that the

probability of Vegas occurred is equal to 0.5 which follows Binomial distribution, which

is not equal to 0.5 in this study.

This study can be made better, if you study in different doses of Trivrit Leha, say

20, 30, 40 mg/kg body wt by using factorial design.


117

Fig: 11

Distribution of pt.'s by no. of vegas

78 9 10

11 12 1314 15 16

20 1 0 1

31 1 1 01 0 0 1

2 2 2 20 00 1

21 1

21

20 1

02468

1012141618

1 2 3 4 5 6 7 8 9 10

Number of vega obtained

No. o

f Pts

.s

No. of vegas A B C

8. Quantity of stools:

Table No. 33 – Distribution of Patients on Maniki in 3 Groups

Fluid loss

(ml)

Group‘A’ Group ‘B’ Group ‘C’ Total

1600-1700 02 (20%) 02 (20%) 01 (10%) 05 (16.66%)

1700-1800 02 (20%) 02 (20%) 00 04 (13.33%)

1800-1900 02 (20%) 03 (30%) 05 (50%) 10 (33.33%)

1900-2000 04 (40%) 02 (20%) 02 (20%) 08 (26.66%)

2000-2100 00 01 (10%) 02 (20%) 03 (10.00%)

The mean quantity of stool is 1850 ml.


118

Fig: 12

Distribution of Pt.'s by Fluid loss̀

2 2 2

4

0

2 23

211

0

5

2 2

0123456

1600-1700 1700-1800 1800-1900 1900-2000 2000-2100

fluid loss

No. o

f Pt.'

s

A B C

9. Effect of Trivrit Leha in Antiki Shuddhi:

At the end of Vegas, if the colour of the stool was yellowish with slight burning

sensation in anal region and having visra Gandhi Mala, it was considered as Pittanta,

Mala of whitish colour with frothy (mucous stool) were considered as Kaphanta, if the

stools were frothy along with flatus was considered as Vatanta.

Table No. 34 – Distribution of patients on Antiki produced in 3 Groups

Antiki

Lakshanas

Group‘A’ % Group‘B’ % Group‘C’ % Total %

Malanta 00 00 00 00 00 00 00 00

Pittanta 00 00 00 00 00 00 00 00

Kaphanta 10 100 10 100 10 100 30 100

Vatanta 00 00 00 00 00 00 00 00

All the patients of 3 groups (100%) had Kaphanta.


119

Fig: 13

Distribution of pt.'s by Antiki lakshana

0 0

10

00 0

10

00 0

10

00

2

4

6

8

10

12

Malanta Pittanta Kaphanta Vatanta

Antiki lakshana

No. o

f pt.'

s

A B C

10. Laingiki Shuddhi produced by Trivrit Leha:

The main symptoms considered for assessment of Laingiki shuddhi were Mala

pitta kapha vata kramataha, Vatanulomana, Shareera Laghuta, Indriya prasadana, Sroto

shuddhi, absence of ayoga lakshanas and agnideepti. All these lakshanas assessed from

the day of Virechana till the day of completion of samsarjana karma.

Table No. 35 – Distribution of patients on Laingiki produced in 3 Groups Lakshanas Group

A

% Group

B

% Group

C

% Total %

Srotoshuddhi 04 40 03 30 05 50 12 40.00

Indriya Prasada 08 80 09 90 10 100 27 90.00

Shareera

Laghuta

09 90 09 90 07 70 25 83.33

Agnideepti 10 100 10 100 10 100 30 100

Anamayatwa 10 100 10 100 10 100 30 100

Vatanulomana 06 60 06 60 04 40 16 53.33


120

In group ‘A’- 9 patients (90%) got shareera laghuta, 8 patients (80%) got Indriya

prasada, 6 patients (60%) got vatanulomana and 4 patients (40%) got srotoshuddhi.

In group ‘B’- 9 patients (90%) got Indriya prasada and shareera laghuta, 6 patients

(60%) got vatanulomana and 3 patients (30%) got srotoshuddhi.

In group ‘C’- 10 patients (100%) got Indriya prasada, 7 patients (70%) got

shareera laghuta, 5 patients (50%) got srotoshuddhi and 4 patients (40%) got

vatanulomana.

So out of 30 patients, all patients (100%) got agnideepti and anamayatwa, 27

patients (90%) got Indriya prasada and 25 patients (83.33%) got shareera laghuta.

Fig: 14

Distribution of Pt.'s by samyka virechana lakshana

4

89

10 10

6

3

9 910 10

65

10

7

10 10

4

0

2

4

6

8

10

12

SS IP SL AD AA VL

Samyak Virechana lakshanas

No. o

f Pt.'

s

A B C

SS – Sroto Shuddhi, IP – Indriya Prasada, SL – Shareera Laghuta,

AD – Agni Deepti, AA – Anamayatwa, VL – Vatanulomana.

11. Pravara, Madhyama and Avara Shuddhi:

Pravara, Madhyama and Avara shuddhi was considered by seeing vegiki

response. Hence <10 vegas are considered as Avara shuddhi, 11-20 vegas are considered

as Madhyama shuddhi and 21-30 vegas are considered as Pravara shuddhi.


121

Table No. 36 – Distribution of patients on Type of Shuddhi produced in 3 Groups

Shuddhi GroupA % GroupB % GroupC % Total %

Pravara 00 00 00 00 00 00 00 00

Madhyama 07 70 08 80 08 80 23 76.66

Avara 03 30 02 20 02 20 07 23.33

In group ‘A’ – 7 patients (70%) had Madhyama shuddhi and 3 patients (30%) had

Avara shuddhi.

In group ‘B’ – 8 patients (80%) had Madhyama shuddhi and 2 patients (20%) had

Avara shuddhi

In group ‘C’ – 8 patients (80%) had Madhyama shuddhi and 2 patients (20%) had

Avara shuddhi.

So, out of 30 patients maximum number of patients i.e., 23 (76.66%) had

Madhyama Shuddhi.

Fig: 15

Distrubution of Pt.'s by Shuddhi observed

0 0 0

78 8

32 2

0123456789

A B C

Groups

No. o

f Pt.'

s

Pravara Madhyama Avara


122

12. Calculation of Fluid loss –

Table No. 37– Showing Fluid loss during Virechana Karma

Sl. No Maniki (ml) – Fluid Gain (ml) = Net loss / Wt (ml) → ml / kg body wt

GROUP ‘A’

01 1700 – 900 = 800/62 → 12.90

02 1950 – 1100 = 850/42 → 20.23

03 1900 – 1100 = 800/47 → 17.02

04 1600 – 650 = 950/59 → 16.10

05 1850 – 1000 = 850/62 → 13.70

06 1650 – 1100 = 550/58 → 09.48

07 1850 – 1100 = 750/56 → 13.39

08 1900 – 1000 = 900/47 → 19.41

09 1900 – 1200 = 700/53 → 13.20

10 1700 – 1000 = 700/54 → 12.96

Sl.

No

Maniki (ml) – Fluid Gain (ml) = Net loss / Wt (ml) → ml / kg

body wt

GROUP ‘B’

01 1650 – 950 = 650/64 → 10.15

02 1800 – 1500 = 300/42 → 07.14

03 1800 – 1100 = 700/59 → 11.86

04 1700 – 1000 = 800/52 → 15.38

05 1650 – 850 = 750/56 → 13.39

06 1850 – 1100 = 750/54 → 13.88

07 1950 – 950 = 1000/51 → 19.60

08 1750 – 1200 = 550/56 → 09.82

09 2000 – 1300 = 700/58 → 12.06

10 1950 – 900 = 1050/48 → 21.87


123

GROUP ‘C’

01 1950 – 1350 = 600/53 → 11032

02 1800 – 1200 = 600/63 → 09.52

03 1850 – 1000 = 850/64 → 13.28

04 1650 – 700 = 950/57 → 16.66

05 2050 – 1450 = 600/59 → 10.16

06 1850 – 1200 = 650/48 → 13.54

07 1800 – 900 = 900/57 → 15.78

08 1900 – 1050 = 850/58 → 14.65

09 2000 – 1300 = 700/64 → 10.93

10 1800 – 900 = 850/49 → 17.34

Table 38 – Showing the calculation of Fluid loss.

C - I Tally f x

7.14-10.14 | | | | 4 8.64

10.14-13.14 | | | | | | | | 8 11.64

13.14-16.14 | | | | | | | | | | | 11 14.64

16.14-19.14 | | | 3 17.64

19.14-22.14 | | | | 4 20.64

The mean fluid loss is approximately 14 ml / kg body wt with S.D = ±78. 59

STATISTICAL ANALYSIS OF ASSESSMENT PARAMETERS IN 3 GROUPS:

Table No. 39 (a): ANOVA – Table for the Parameter Sodium (I)

Source of

Variation

D f Sum of

Squares

Mean

sum of

Squares

F-

value

F-

table

value

R

value

Remarks

Group 2 11.2626 5.6313 0.383 3.35 > 0.05 N S

Error 27 396.099 14.670 - - -

Total 29 407.366 - - - -


124

Table No. 39 (b): ANOVA – Table for the Parameter Chloride (II)

Source

of

Variation

D f Sum of

Squares

Mean

sum of

Squares

F-

value

F-

table

value

R

value

Remarks

Group 2 3.466 1.733 0.294 3.35 > 0.05 N S

Error 27 158.7 5.877 - - -

Total 29 162.166 - - - -

Table No. 39 (c): ANOVA – Table for the Parameter Potassium (III)

Source

of

Variation

D f Sum of

Squares

Mean

sum of

Squares

F-

value

F-

table

value

R

value

Remarks

Group 2 0.122 0.061 1.69 3.35 > 0.05 N S

Error 27 0.978 0.036 - - -

Total 29 1.1 - - - -

Table No. 39 (d): Statistical Assessment in Group ‘A’ Kitibha Kusta (IV)

Parameters Mean S.D S.E t- value P- value Remarks C.V

Sodium 2.8 2.097 0.663 4.22 < 0.001 H.S 71.07

Chloride 1.4 0.966 0.3055 4.582 < 0.001 H.S 65.46

Potassium 0.2 0.163 0.051 3.92 < 0.001 H.S 77.45

Table No. 39 (e): Statistical Assessment in Group ‘B’ Amlapitta (V)

Parameters Mean S.D S.E t- value P-

value

Remarks C.V

Sodium 2.1 0.875 0.276 7.61 < 0.001 H.S 39.55

Chloride 2.4 1.173 0.371 6.46 < 0.001 H.S 46.39

Potassium 0.2 0.094 0.029 6.896 < 0.001 H.S 44.72


125

Table No. 39 (f): Statistical Assessment in Group ‘C’ Tamaka Shwasa (VI)

Parameters Mean S.D S.E t- value P-

value

Remarks C.V

Sodium 2.6 1.349 0.426 6.103 < 0.001 H.S 49.25

Chloride 2.3 2.263 0.715 3.216 < 0.001 H.S 93.35

Potassium 0.23 0.163 0.051 4.509 < 0.001 H.S 67.49

Statistical Conclusion:

The 3 groups show not significant in all the 3 parameters. It means that, the mean

effect of treatment is same in the 3 groups (as P > 0.05 from table I, II, III).

The parameter Sodium in the Group ‘A’ is having uniform effect in the patients

after the treatment and also means effect is more than the other group.

The mean effect of Serum Electrolyte in Group ‘B’ and ‘C’ is same, but there is a

much variation in Group ‘B’.

The parameter Chloride in the Group ‘B’ is having uniform effect in the patients

after the treatment and also means effect is more than the other group. There is a much

variation in Group ‘B’ and Group ‘A’ shows no uniform effect on the patients (by

comparing co-efficient of variations CV).

The parameter in the Group ‘A’ having stable effect on the patients and the mean

effect is also more than the other group. There is a more variation in Group ‘B’ and it

shows not stable effect on the patients.

Individually, all the parameters shows highly significant in all the 3 groups,

assume that he Virechana does not responsible for the changes of electrolyte values. For

this we use Paired‘t’ test. All the parameters reading in 3 different groups follow within

the normal range.


126

In the Group ‘A’ (Kitibha Kusta), Chloride shows highly significant than the

other parameters.

The mean effect on the Sodium is more and there is a much variation. (From table

IV as P < 0.001 and by comparing variance).

In the Group ‘B’ (Amlapitta), the parameter Sodium shows highly significant than

the other parameters.

The mean effect on Chloride is more and there is a much variation. (From table V

as P < 0.001 and by comparing variance).

In the group ‘C’ (Tamaka Shwasa), the parameter Sodium shows highly

significant.

The mean effect is also more and there is more variation in the parameter

Chloride. (From the table VI as P < 0.001 by comparing variance).


127

SERUM ELECTROLYTE VALUES BEFORE AND AFTER VIRECHANA KARMA:

Master chart II

SODIUM (135-155 U/Lit) CHLORIDE (98-108 U/Lit) POTASSIUM (3.5-5.5 U/ Lit) SL. NO

OPD NO BF AF S N N BF AF S N N BF AF S N N

No.of Vegas

GROUP ‘A’ 01 3571 148 140 - - + - - 101 99 - - + - - 5.00 4.50 - - + - - 09

02 3942 140 138 - - + - - 99 99 + - - - - 4.30 4.40 - + - - - 14

03 3372 148 145 - - + - - 99 98 - - + - - 4.40 4.10 - - + - - 12

04 4044 144 141 - - + - - 101 98 - - + - - 4.40 4.20 - - + - - 07

05 4497 146 143 - - + - - 102 101 - - + - - 4.70 4.50 - - + - - 11

06 338 145 142 - - + - - 103 101 - - + - - 4.40 4.40 + - - - - 07

07 392 144 143 - - + - - 100 98 - - + - - 4.30 4.30 + - - - - 12

08 1225 149 145 - - + - - 100 100 + - - - - 4.60 4.20 - - + - - 13

09 1227 147 145 - - + - - 101 100 - - + - - 4.70 4.60 - - + - - 15

10 2310 150 149 - - + - - 101 99 - - + - - 4.50 4.30 - - + - - 12

GROUP ‘B’

01 4009 138 136 - + - - 100 98 - - + - - 4.00 4.10 - + - - - 11

02 4114 142 140 - + - - 100 98 - - + - - 4.40 4.10 - - + - - 13

03 4143 140 141 + - - - 100 98 - - + - - 4.20 4.00 - - + - - 12

04 4367 143 141 - + - - 100 99 - - + - - 4.40 4.30 - - + - - 11

05 1605 150 148 - + - - 102 99 - - + - - 4.80 4.70 - - + - - 07

06 2163 146 142 - + - - 99 98 - - + - - 4.40 4.20 - - + - - 12

07 2315 154 152 - + - - 100 102 - + - - 4.80 4.40 - - + - - 14

08 4224 143 141 - + - - 103 100 - - + - - 4.30 4.10 - - + - - 10

09 1982 140 138 - + - - 107 105 - - + - - 4.40 4.20 - - + - - 13

10 2334 142 139 - + - - 103 98 - - + - - 4.20 4.00 - - + - - 14

GROUP ‘C’

01 3243 140 140 + - - - - 98 96 - - - - + 4.00 4.50 - + - - - 14

02 3258 140 136 - - + - - 99 99 + - - - - 4.50 4.20 - + - - 13

03 4046 142 139 - - + - - 101 99 - - + - - 4.50 4.40 - - + - - 11

04 3929 145 141 - - + - - 99 91 - - - - + 4.20 4.00 - - + - - 08

05 860 145 142 - - + - - 104 102 - - + - - 4.40 4.20 - - + - - 16

06 1310 150 148 - - + - - 106 103 - - + - - 5.00 4.60 - - + - - 12

07 2137 145 141 - - + - - 100 100 + - - - - 4.60 4.20 - - + - - 09

08 1934 143 141 - - + - - 100 99 - - + - - 4.40 4.30 - - + - - 12

09 2216 148 145 - - + - - 102 99 - - + - - 4.60 4.60 + - - - - 14

10 2400 146 145 - - + - - 101 99 - - + - - 4.50 4.40 - - + - - 09

BF – BEFORE TREATMENT, AF – AFTER TREATMENT, S – REMAINED SAME,

N - INCREASED WITHIN NORMAL LIMITS,

N - DECREASED WITHIN NORMAL LIMITS, - INCREASED ABOVE THE NORMAL LIMITS,

– DECREASED BELOW THE NORMAL LIMITS


128

: DISCUSSION:

I) On Review of Literature –

In Ayurvedic general practice, most of the ayurvedist using the Virechana Karma

as shodhana chikitsa more commonly.Virechana means elimination of vitiated dosha,

mainly Pitta. These drugs are formed by Prithwi and Aap mahabhoota pradhanata and are

adhobhaga hara prabhavi dravyas. These drugs soften the compactness of the doshas and

break the bigger molecules to smaller once. This process occurs in proper way by

Samyojana and Viyojana of doshas.

As Virechana can be done in Pitta pradhana vyadhis i.e., Jwara, Pandu, Kamala

etc, Vata associated, Kapha associated, Tridoshaja, Rakta pradhana vyadhi and other

types of vyadhis. It was widely used by the acharyas. It mainly gives good effect in

rasavaha and raktavaha srotodusti. This Virechana can be performed in Swastha also in

Sharad rutu, because Pitta prakopa occurs in Sharad rutu. So in Swastha also there is a

chance of increase of Pitta dosha.

Pancha shodhanas are to be done before Rasayana and Vajeekarana for longevity

of life, to stop aging process, to get healthy child. But pancha shodhana is not possible

now a days due to long duration. So Virechana is the shortest root to over come the

pancha shodhanas.

Virechana is contraindicated mainly in those persons whose bala is Alpa, e.g.,

bala, vriddha, garbhini, krisha etc. In Kapha utklesha if Virechana is administered, then

the drug causes vamana instead of Virechana. In samavastha also Virechana is

contraindicated.


129

Classification of Drugs:

The drugs which produce Virechana are classified in to many types based on their

origin, mode of action, parts of dravya used, according to seasons and kalpana. Most of

the acharyas classified these above said classifications. Sharangadhara’s classification is

very useful for the administration of drugs pertaining to the situation. He classified in to 4

types, Anulomana, Sramsana, Bhedana and Rechana. This classification was done on the

basis of action of drugs and the duration in which these types of drugs can be used.

Anuloma – These drugs are having the action of digestion of undigested food and

bringing them for the defecation process. Sushruta considered it as Sara. The moving of

undigested food and feces from colon to outside the body is the function of Sara, eg-

Hareetaki in Amatisara.

Sramsana – The drugs which expel the malas adhered to the lumen of intestines without

digesting, eg- Aragwada. It is having mridu, guru, snigdha guna and helps in slippery

action of the feces.

Bhedana – The drugs act as Bhedana are mainly Kapha and Pitta hara, so they

disintegrates the pindita (dried fecal mass) mala and then evacuates through the lower

gut.

Gangadhara opines Bhedana as Shareera mala nirharana, it means here not only

evacuation or elimination of mala (feces), but also the action will be systemic and expel

the shareeragata vikrita malas, eg- Arka,Swarna Ksheeri, Chitraka etc comes under this

category.

Rechana – This has the similarity with Osmotic Purgatives. It eliminates digested and

undigested malas by making them watery through lower gut, eg- Trivrit. Daily usage of


130

Rechana drugs cause mal absorption of food leads to elimination of food also. This may

leads to Anemia etc, so it is contraindicated for daily usage.

There are some drugs which helps in the action of Virechana are called

Virechanopaga. These drugs increase the action of virechaka dravyas. Eg- Draksha,

Amalaki, Badara etc.

Some drugs are having snigdha guna and are used in ruksha rogi and ruksha

gunayukta drugs are used in snigdha rogi. Eranda taila is a best snigdha virechaka used

mainly in ruksha persons.

According to seasons, Sharangadhara mentioned the usage of drugs, it means the

veerya of the drugs rich in that particular season eg- Kutaja in Varsha, Musta in Sharad,

Nagara in Shishira and Vasanta, Shyama Trivrit in Grishma, Chitraka in Hemantha.

Some drugs can be used in all the seasons, means they are having good potency in all

seasons, eg- Trivrit, Danti etc.

These Virechaka yogas can be prepared in many forms like Ghrita, Taila, Avaleha

etc. For better palatability and action these above said kalpanas can be used.

Depending on the kosta of the patient dosage can be fixed. Sharangadhara has

given dosage of kwatha, kalka and churna. But the dose mentioned in those days is not

sufficient or it is more in these days. Because the environment in which they grow in

those days are having good potency, but nowadays environment the potency of the drugs

are decreasing, so dose is not sufficient.

In other hand the cause for less dose comparing to the Samhitas may be, the body

constituent, kosta, Agni and other factors are good in olden days, so they withhold the

dosage. But nowadays these all are weak, so dosage must be reduced.


131

Procedure:

Virechana Karma has got 3 steps, Purvakarma, Pradhanakarma and Paschatkarma.

These are having significance, in Purvakarma Pachana, Snehana, Swedana are to be done.

These increases the vitiated doshas in the body (shakhas), does the vishyandana and paka,

then does the cleansing of srotases, by this vititated doshas come to kosta. In long

standing or chronic diseases some toxins release in the body. These toxins soluble in fat

media, Here medicated ghrita or taila reaches the cellular level and does the shithilata of

vitiated doshas and brings them for elimination. This is the function of Purvakarma.

In the Pradhana karma, we are giving virechaka yoga, it has to be digested and

enters the systemic circulation and it also brings some remained doshas, then increases

the peristalsis and eliminates the vitiated doshas (malas).

By this process, the Agni may be suppressed i.e., the agnideepti occurs but the

quality of Agni increases not the quantity. So it is not in the position to digest the heavy

food. So samsarjana krama has to be done as Paschat karma. Here Peya, vilepi etc are

advised. They contain rich in carbohydrates, proteins and are laghu for digestion. So

these not only help in agnideepti but also give strength to body.

During Pradhana karma observation of the patient has to be made. We have to

observe the kaphantha, number of Vegas and quantity of expelled mala. Kaphantha

shows samyak vireka, because first purisha will come, then vitiated pitta dosha comes out

and lastly if any vitiation in kapha dosha is there means it will come out and then the

phenayukta drava shows the complete elimination of vitiated doshas. As kapha is

phenayukta, kaphantha should be considered.

Numbers of Vegas according to shuddhi are 10, 20 and 30. How many Vegas

passes by the patient, it is depend on his body constitution. After Vega shamana patient


132

feels shareera laghuta and other symptoms like vatanulomana, agnideepti, kshudha

pravritti etc. These symptoms show samyak shuddhi.

If the quantity of mala nirharana and Vegas increases, then patient will get atiyoga

lakshanas which may cause many complications. Here some reasons like fixation of

dosage improper following of the Purvakarma may leads to atiyoga

If Purvakarma not done properly and Virechana dose is also low, then ayoga

symptoms will see. So fixation of dose according to bala and kosta of the patient, proper

follow up of diet during sneha, Swedana is very important.

By these factors vyapads may occur. The patient having dosha bahulata, shareera

rukshata and agnimandya will cause Adhmana by giving less dose also.

In case of teekshna and adhika oushadha prayoga, atiyoga occurs and this

frequency causes wound in the mucous membrane of rectum leads the parikartika.

If after taking virechanoushadhi due to vegavarodha vata prakopa takes place and

causes Hridgraha.

In mridu kosta and alpa doshayukta rogi if ati teekshna oushadha was given,

blood will come through the guda is called jeevadana.

Some other vyapads also occurs during this Virechana. So physician should

mainly observe the patients by kosta, dosha bala and dosage of virechaka yoga to prevent

the vyapads.

II) Discussion on Materials and Methods:

1. Research design – It is a prospective clinical study. Three groups were made,

because, there are so many diseases which are fit for Virechana Karma, among those

diseases, Kitibha Kusta, Amlapitta and Tamaka Shwasa diseases were selected. These


133

three diseases are most common in this area and easily available in O.P.D of our hospital,

D.G.M.A.M.C, Gadag.

By above reasons, this study was assigned disease wise in to three groups and all

groups included 10 patients each, Group ‘A’- 10 patients of Kitibha Kusta, Group ‘B’ –

10 patients of Amlapitta and Group ‘C’ – 10 patients of Tamaka Shwasa.

These three diseases were diagnosed basing on lakshanasamuchaya mainly signs

and symptoms mentioned in the Ayurvedic texts.

The topic Virechana Karma on Body Fluids was selected to assess whether

excessive fluid loss is resulting or not after the Virechana karma and to disprove the

misconcept by assessing the electrolyte values by serum electrolyte test in three different

diseases. For this study, the Virechana drugs were chosen which are common for all these

three diseases which helps in assessing the results uniformly.

2. Drugs used in Virechana Karma –

a. Panchakola Churna for Pachana: This drug was chosen because; it is both

Agni Deepak, Ama Pachaka and also ruchikaraka. It digests the shareeragata ama. This

Churna was given 3-6 Gms three times in a day before meals with hot water till Nirama

lakshanas seen.

b. Murchita Ghrita for Snehapana : As this study involves three groups of

patients, universal fat Murchita Ghrita was selected for Snehapana instead of different

snehas which are indicated in the concerned diseases because concerned snehas indicated

in particular diseases may not produce vishyandana of vitiated doshas. Murchita Ghrita is

also devoid of Tikta Rasa, which makes palatable to the patients to take comfortably


134

c. Tila Taila for Abhyanga : Abhyanga for 4 days was performed in all three

groups of patients by sukhoshna tila taila. Tila is contraindicated in Kusta as it is

mentioned as one of the nidana. But intake of seed of tila is an etiological factor for

Kusta, but external application can be done.

d. Nirgundi Patra for Nadi Swedana : Nirgundi Patra and Nadi Sweda was

selected in Group ‘B’ and ‘C’ patients, as Nirgundi Patra is Amadosha hara, Shwasa hara

and used in Ajeerna. In Group ‘A’, Kitibha Kusta, as it is rakta dooshita vyadhi having

the qualities of pitta, Sweda is contraindicated, so ushna jala snana was advised.

e. Trivrit leha for Virechana: Trivrit is a sukha virechaka and commonly using

for virechana by most of the physicians. So this drug was chosen. Leha form was made

because, it’s absorption starts from the mucous membrane in the mouth and action starts

within 1-3 hours of administration. In Charaka Kalpasthana, Trivrit Leha was explained

and advised to give 1 Karsha pramana which comes around 12 Gms, which is

appropriately 20 mg/kg.wt. Before starting the clinical trial, pilot study was tried with 12

Gms in two patients. But one patient passed only 3 Vegas and another patient not passed

a single Vega. So the dose was increased for the purpose of proper assessment of fluid

loss.

In the olden days, the dose advised in classics was 12 Gms and

observed to get pravara shuddhi of Virechana. But after giving 35 Gms also observed

only madhyama shuddhi. The cause may be mostly collection of Trivrit was not done in

the proper rutu or Veerya of the drug is decreasing now a day, bhusara is also decreasing

day by day.


135

So collection of drug in the proper rutu, proper preservation and

proper preparation is needed.

3. Inclusion and exclusion criteria -

* For convenient of the study, age factor was fixed between 18-60 years. Below

18 years and above 60 years patients are unable to withstand the procedure of Virechana,

because bala, vriddha etc comes under this age group.

* Samyak Virikta lakshanas were observed and subjected for the study, because to

justify or to understand the electrolyte mechanism in the normal Virikta patient.

* Other than samyak yoga, ayoga and atiyoga lakshanayukta patients were

excluded.

4. on laboratory investigations –

i. Serum Electrolyte test i.e., Sodium, Chloride and Potassium was done to assess

the electrolyte level before and after the Virechana karma.

ii. Routine Hb%, TC, DC, E.S.R was carried out to see the associated infection,

anemia etc.

iii. Other investigations made to rule out chronic systemic disorders like,

Diabetes, Hypertension etc, and A.E.C carried out for differential diagnosis of Tamaka

Shwasa from Tropical Esinophelia. [ 5. Study Duration:

Study was done for 21 days. By considering 3 days for Pachana, 7 days for

Snehapana, 3 days for Abhyanga and Sweda, 4th day morning Abhyanga and Sweda then

Viechanoushadha prayoga, 7 days for samsarjana krama. (3 + 7 + 3 + 1 + 7 = 21 days)

After samsarjana karma all the patients were advised shamanoushadhi’s according

to the disease for the follow up treatment.


136

6. Criteria for Assessment:

As this study mainly deals with the study of Virechana and it’s effect on body

fluids, assessment criteria was made with the samyak Virikta lakshanas i.e., Vegiki,

Maniki, Antiki and Laingiki for considering the patients for inclusion and serum

electrolyte values i.e., Sodium, Chloride and Potassium before and after the Virechana

karma. Serum electrolyte shows the values of Sodium, Chloride and Potassium present in

the body serum. So before the day of giving Virechana yoga and after Vega shamana of

Virechana, two readings were taken and assessed the results.

7. Subjective and Objective Parameters:

Subjective parameters were Vegiki, Antiki, Maniki and Laingiki of Virechana

karma. By these 4 we can assess the samyak Virechana. Vegiki, Antiki and Laingiki can

be assessed by observing and asking the patient, but Maniki was measured approximately

by asking the patients how much amount approximately passed during one Vega. Then it

was noted and finally total quantity of Mala (Vitiated doshas) was calculated.

Objective parameters were, Serum Sodium, Chloride and Potassium. It was the

main parameter for the present study to rule out whether the loss of electrolytes was there

or not after samyak Virechana karma. This was done in Hans Laboratory, Gadag by using

precipitation test for Sodium and Colorimetry for Chloride and Potassium.

8. Overall Assessment of Results:

Overall assessment of result was made with the subjective and objective

parameters. Grouping of the results were made to assess the difference of electrolytes

after samyak Virechana to the before Virechana karma.

This was done by recording the before and after serum electrolyte values, whether

they remained same, decreased within the normal range, increased within the normal


137

range, decreased below the normal range, increased above the normal range. These

above observations are the key points to be used for complete assessment of the study.

III) Discussion on Observations and Results –

As this study was mainly aimed at the assessment of body fluids and electrolytes

due to effects of Virechana, observation and results of the process of diseases which were

taken for clinical study was given secondary importance and based on

lakshanasamuchaya as described in Ayurvedic classics.

a. Demographic Data :

i. Age wise Observation –

In group ‘A’ and ‘C’ patients, the age factor was not played any role, because

majority of cases were not noted.

But in group ‘B’ Amlapitta, majority of cases (7) were found in the age group of

18-24 years and 24-30 years. In this age group more number of the students were

registered. It was found that all patients of these two age groups were having habit of

drinking tea frequently, they use to sleep very late in night and wake up early, their food

intake was also in irregular time and further observed that tension towards their study or

work is the cause of diseased (Amlapitta).

ii. Vyasana – In group ‘A’, out of 10, 8 patients were observed with no bad

habits. It shows, there is no association of Vyasana directly in the manifestation of

Kitibha Kusta.

In group ‘B’, 6 patients were observed with different habits like smoking, alcohol,

tobacco chewing etc, which leads to hyper secretion of HCl causing hyperchlorhydria.


138

It was observed in group ‘C’ patients that 6 patients had cigar and beedi smoking

habits which will aggravate the symptoms of Tamaka Shwasa.

b. Vrechana Karma :

i. Pachana – The three groups of patients taken for the study were not of

prabhoota amadoshajanya. So, Panchakola Churna was given 3-6 Gms of before meals

thrice daily i.e., breakfast, lunch and dinner for 2-3 days.

It was observed that all the patients in three groups got Ama Pachana within 2-3

days without any complications except in 3 patients of Amlapitta who showed mild

burning and irritation in the chest region after 10-15 minutes of consuming the Churna. In

such condition instead of Churna, ushnodaka was advised to take regularly till Nirama

lakshanas seen.

ii. Snehamatra – Murchita Ghrita was prepared and given within 7 am to 8.30 am

to all the patients of three groups.

In group ‘A’, 5 patients got samyak snigdha lakshanas by taking Murchita Ghrita

up to 90 ml and 5 patients got by taking up to 120 ml. All the patients took Murchita

Ghrita without any complications.

In group ‘B’, 2 patients got samyak snigdha lakshanas on 5th day by taking150 ml,

3 patients up to 120 ml and 5 patients up to 90 ml. In this group 2 patients took more

quantity of Murchita Ghrita than the other groups.

In group ‘C’, 5 patients got samyak snigdha lakshanas by taking up to 90 ml, 5

patients up to 120 ml. As Tamaka Shwasa is a Kapha dosha pradhana vyadhi, Snehapana

was started in between the attacks i.e., after relief from the attack. 9 patients had no

Kapha vriddhikara complications, but only1 patient got mild asthmatic attack on 4th day

(120 ml). In such condition, ushna jala was given and advised for back rest for few


139

minutes. Then patient was relieved from the attack and further no complications were

found.

iii. Sneha Jeeryamana – In group ‘A’, patients got most of the symptoms of

Jeeryamana except Daha, Arati and Klama. In group ‘B’, patients got most of the

symptoms of Jeeryamana except Murcha and Klama after taking 150 ml of Murchita

Ghrita. In group ‘C’, patients got most of the symptoms of Jeeryamana except Murcha

and Klama.

The symptoms which occur during Jeeryamana of sneha may be, after consuming

sneha it obstructs the Srotas during digestion, there by patient feels symptoms like,

Shiroruja, Bhrama, Murcha, Angasada etc up to complete digestion of sneha.

iv. Sneha jeerna – It was observed that 30 ml of Murchita Ghrita was digested

within 180 minutes in 5 patients each in 3 groups and in another 5 patients in each group

has taken time for digestion within 180 – 360 minutes. 60 ml of Murchita Ghrita was

digested within 360-540 minutes in group ‘A’ and ‘B’, but in group ‘C’, 1 patient had

digestion within 180-360 minutes as his Agni was Teekshna. 9 patients had digestion

within 360-540 minutes.

90 ml of Murchita Ghrita was digested within 360-540 minutes in group ‘C’ in all

patients. In group ‘B’, 1 patient had digestion within 360-540 minutes and 9 patients had

digestion within 540-720 minutes. In group ‘C’, 2 patients had digestion within 360-540

minutes and 8 patients had digestion within 540- 720 minutes.

120 ml of Murchita Ghrita was digested within 720-900 minutes in group ‘A’ in 5

patients. In group ‘B’, 1 patient had digestion in 540-720 minutes and 9 patients had in

720-900 minutes. In group ‘C’, 5 patients had digestion of Murchita Ghrita in 720-900

minutes.


140

150 ml of Murchita Ghrita was digested within 720-900 minutes in 2 patients of

group ‘B’.

After giving Ghrita, hot water was advised. This hot water is Kaphanashaka,

deepaka, Ama Pachaka, vatanulomaka, so helps in getting the proper jeerna lakshanas.

v. Samyak Snigdha – After giving the sneha for number of days, it was observed that,

the effect of Snehana causes the stability of the body, dosha vishyandana and mardavata

and Purisha Snigdhata. Due to snigdha guna of Murchita Ghrita results in to

vatanulomana, Angalaghava.

In all the three group patients, most of the samyak snigdha lakshanas seen.

vi. Abhyanga – Sukhoshna tila taila was used for Abhyanga for 4 days up to 45 minutes

daily. The Abhyanga accelerates the movement of lymph, which also carries out some

waste products. It helps to increase the circulation of blood which carries nutritional

products.

Tila taila was chosen for Abhyanga in all the three groups of patients. 2 patient’s

patches of Kitibha Kusta were reduced and in 1 patient itching sensation was increased.

So in that condition Abhyanga with Tila taila was replaced by Manjistadi taila.

In other 2 groups ‘B’ and ‘C’, no significant effect was observed, Twak

mardavata, Shramahara and Anga laghava symptoms were seen.

vii. Swedana – Nirgundi Patra was used for Nadi Sweda in Amlapitta and Tamaka

Shwasa patients. Ushnajala snana was advised in patients of Kitibha Kusta. Twak

mardavata and Shramahara lakshanas were observed in most of the patients. In group

‘A’, as Swedana is contraindicated, ushna jala snana was advised. In group ‘B’ and ‘C’,

Nadi Sweda was given using Nirgundi Patra. Most of the patients in group ‘C’ of Tamaka


141

Shwasa had relief in their Shwasa symptoms after Swedana. It may be because, Nirgundi

Patra is a Shwasa hara and Sweda does the relief of sthambana and liquiies the Kapha.

viii. Virechana with Trivrit Leha – Trivrit Leha was given in all the 3 groups of

patients by seeing the kosta and bala of the patient by keeping 25-35 gms. For facilitating

the Vega, ushnodaka was advised to take.

The Vegas started between 1-3 hours of administration. This fast action may be

because of Trivrit in Leha form. The Leha absorption starts in the mucous membrane of

the oral cavity and digests and enters the circulation.

Ushnodaka was advised to take little quantity after passing the Vega. This

ushnodaka increases the peristalsis and helps to motivate the vega.

Laingiki – Vayu, Purisha, Pitta and Kapha kramataha nissarana, shareera karshya,

Dourbalya, shareera laghuta are the samyak Virikta lakshanas, along with these some

others symptoms like srotoshuddhi, vatanulomana etc can be considered. Shareera

karshya was observed by the weight loss after Virechana comparing to before Virechana

and dourbalya, shareera laghuta were asked to the patients and noted. Most of the other

symptoms also observed after samyak Virechana.

Vegiki – It was observed that 23 patients had above 10 Vegas and 7 patients had below

10 Vegas. But these are madhyama and avara shuddhi respectively. These Vegas may be

dependent on the body constituents presents in each person. The percentage of water and

electrolytes depends on the weight of the body.

Maniki – It was observed that, the quantity of Vegas was measured by asking the

patients about the approximate quantity of a single Vega. Approximately 2050 ml of


142

maximum amount of fluid was measured in a patient who passed 16 Vegas and 1600 ml

of minimum fluid was measured in a patient who passed 7 Vegas.

Antiki – All the patients had manifested the features of Kaphanta in between 5.30-8.30

hours after administration of Virechana dravya. 1 patient of Kitibha Kusta and 1 patient

of Tamaka Shwasa got Kaphanta within 5.30 hours and 1 patient of Tamaka Shwasa got

Kaphanta within 8.30 hours.

ix. Samsarjana Krama – After samyak Virechana patients were advised to follow the

samsarjana krama for 3-5 days depending on the shuddhi. In the present study 23 patients

followed 5 days and 7 patients followed 3 days. The diet advised was such that it can be

prepared easily in their home. First day in the evening thin rice ganji (supernatant portion

of rice) was advised, then thick portion of rice ganji, then soft rice, then rice prepared

with oil and salt and lastly normal diet was continued. It was observed in this study that

all patients restored the Agni to normal level.


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DISCUSSION ON THE EFFECT OF VIRECHANA WITH TRIVRIT

LEHA ON BODY FLUIDS AND ELECTROLYTES:

Among the Shodhana karmas, Virechana karma is widely used by almost all

Ayurvedic physicians in general practice due to less complications and unfearable

procedure. Here it is very essential to see the levels of electrolytes during and after the

procedure. The loss of electrolytes will make much difference in the condition of the

patient. Virechana procedure involves Pachana, Snehana, Abhyanga, Swedana,

Virechana drug administration and then Samsarjana Krama. Mainly this Snehapana

makes the body stable for that condition.

Body fluids and electrolytes play an important role in the formation of body.

Percentage of fluid is depends on the weight of the person. If pathology occurs related

with the body fluids, then hyper or hypo of the electrolytes occur and leads to some other

diseases. For example, in Diarrhoea due to some pathology electrolytes and body fluid

loss will occur and patient needs infusion of fluids. But Virechana procedure not only

contains the administration of the drug to expel the doshas in the form of fluids, it has

Purvakarma, such as Snehana, Swedana which makes the body stable to face the

procedure. Charaka describes 245 Virechana yoga’s, among them Trivrit is a sukha

virechaka, which is a common choice of most of the physicians in India.

Above three statements are the main contents of this study. So it is very essential

to discuss the relation of Virechana with Trivrit.

Now there is necessary to bring some of the important aspects to substantiate the

result of the study.


144

☺ In the procedure of Virechana, patient passes watery discharge along with vitiated

doshas. In the present study we observed that highest 16 Vegas of approximately about

2050 ml of watery discharge was passed by the patient of 56 kg body weight. In such

condition we won’t found any electrolyte loss which may leads to hypo condition and

producing dehydration symptoms. But in Diarrhoea condition 500ml-1000ml of water

loss in an adult leads to hypo condition of the electrolytes. Diarrhoea is a pathological

condition, but Virechana is a procedure which involves Snehana and Swedana procedures

and used to treat the pathological condition (diseases).

☺ The drugs which act mainly on colon produce relatively less fluid loss. Here, modern

people are using these cathartics for evacuation of feces. But ayurvedist use these for

therapeutic purpose followed by Snehana and Swedana procedures. Castor oil is a irritant

purgative, but we are using medicated castor oil which won’t irritate much and won’t

cause for fluid loss and we are not using it in Virechana procedure i.e., after Snehana and

Swedana procedures.

☺ In Indian medicinal plant, there is a description of Trivrit as a hydrogogue and its

action is on intestine. But for this no evidence and researches have done. So it is must to

know the action by evidence.

☺ Body mechanism is such that, whenever fluid loss from the body is there due to any

cause, eg – Diarrhoea, Vomiting, Excessive sweat etc, intracellular and extra cellular

fluid exchange takes place and compensate certain amount of fluid to the loss. So here

also during Virechana karma, some amount of fluid will compensate by the body.


145

HYPOTHETIC EFFECT OF VIRECHANA KARMA WITH TRIVRIT

LEHA ON BODY FLUIDS AND ELECTROLYTES: By Snehana and Swedana, intracellular changes occur and make the body ready to

face the burden of the balancing of dosha, dhatu samyata and electrolyte balance.

Trivrit (Operculina Turpethin) after ingestion, it mixes with HCl in stomach and

forms as Turpethic acid and glucose. To neutralize the Turpethic acid, some

amount of Chloride will release from interstitial compartment and mixes with it.

Then enters in to circulation and then comes to stomach, again it mixes with acid

and Chloride will release to neutralize it. Then it increase the peristalsis leads to

purgation. It means after ingestion it won’t acts directly on intestine and which

may not leads loss of fluids.

During the procedure of Virechana, hot water is advised which increases the

peristalsis and helps to occur Vega.

The loss of fluid during Virechana karma to certain amount will compensate by

the compensatory mechanism of the body.

The above reasons prevent the body fluid and electrolyte loss or gain below or

above the normal. But in some patients, little amount of fluid will lost which is

within the normal range after samyak Virechana.

Basing on results observed in the present study can be undoubtedly

concluded that, “Virechana Karma will not produce any loss of body fluid and

electrolytes”.


146

SUGGESTIONS FOR THE FUTURE STUDY –

Study on large sample.

Study with stool examination, and Serum electrolyte values before Snehapana,

after Snehapana, immediately after Virechana and after Samsarjana Krama.

Study on Swastha persons or in which electrolyte values are raised.


147

CONCLUSION -

Virechana is an easiest, un fearable and most effective treatment among all the

Samshodhana Chikitsa.

Statistically this study was not Significant that means there will not be any

marked changes in the electrolytes after Virechana karma.

After Samyak Virechana there will not be any disturbance in the body fluids.

Complete evaluation of loose stools produced during Virechana karma with the

help of modern technologies can give some wider knowledge about this present

study.


148

SUMMARY:

The thesis entitled – “The Study of Virechana Karma and its effect on Body

Fluids” consists of -

01. Introductory part regarding the present work and the objectives.

02. Historical aspect of Virechana, Body fluids and Electrolytes.

03. Virechana karma in detail along with its modern concepts, anatomical and

physiological aspects and also physiology of Electrolytes.

04. Nidana Panchakas and Chikitsa of Kitibha Kusta, Amlapitta and Tamaka Shwasa.

05. Review of Drugs used in Virechana Karma.

06. Description regarding the materials and methods used in the present study.

07. Observations of the present study, results and discussion, summary, conclusion

and finally bibliography.

The study was conducted over three diseases i.e., Kitibha Kusta, Amlapitta and

Tamaka Shwasa having 10 patients each and all the patients received classical Virechana.

First part designated as Review of Literature at the outset presents historical

background of Virechana. After giving the brief description of related Anatomy and

Physiology of Gastro-intestinal tract and physiology of Electrolytes, the detailed

etymology derivation with definition, indication and contra-indication, classification,

procedure and mode of action of various types of Virechana are dealt with. Thereafter the

modern concept of purgatives has been given due consideration.

Three diseases of the clinical trial were diagnosed on the basis of lakshana

samuchaya explained in the Ayurvedic classics.


149

The drugs selected for the study were, Panchakola Churna for Pachana, Murchita

Ghrita for Snehapana, Tila taila for Abhyanga, Nirgundi Patra for Nadi Sweda and Trivrit

Leha for Virechana have been explained under the heading of drug review in second part

of the thesis.

The clinical study in the beginning describes the selection criteria of the three

diseases, detailed treatment and the criteria of the assessment adopted for assessing the

effect of Virechana on Body fluids and Electrolytes. Thereafter the general observations

pertaining to 3 group patients of this study were presented in tabular form with brief

comments on each finding. Later the results obtained in 3 groups of treatment of

Virechana with Trivrit Leha on Body Fluids were presented. The effect of Virechana over

Vegiki, Maniki, Antiki and Laingiki and Serum Sodium, Chloride and Potassium on each

groups were statistically analyzed and systematically presented in tables with brief

comparison also.

The observations pertaining to the review of literature on Virechana, Materials

and Methods, Observations and Results and hypothesis of effect of Virechana on Body

Fluids were discussed to draw the logical conclusions in the fourth part of the thesis.

The points observed in this study were –

☻ Trivrit Leha 25-35 Gms may capable to produce only Madhyama Shuddhi Vega.

☻ Body Fluids and Electrolytes will not deplete after samyak Virechana.

☻ There will not be much variation of the electrolytes in these three diseases, i.e.,

Kitibha Kusta, Amlapitta and Tamaka Shwasa after samyak Virechana.

The conclusions were drawn on the basis of the results of this clinical study.

Table – 14132-134 Virechana Vyapad with their treatment

Vyapad Dosha Agni Koshta Avasth

a Sharira Atura Bala

Aushada Guna/ Virya

Vihara Ausha

da Matra

Lakshanas Chikitsa

Adhmana Bahu Manda - - Ruksha - - - Alpa Adhmana, Udavarta, Nabhi, Pristha, Parshva, Shiroruja, Shvasa, Vit Mutra Vata Sanga

Abhyanga, Sveda, Phalavatri, Niruha, Anuvasana, Udavartavat Cikitsa

Parikartika I II III

- Alpa -

- - Manda

Guru Mridu -

Sama - -

Snigdha - -

- Durbala

Tikshana - Atjushna Lavana Ruksha

- -

- - -

Guda Parikartana Tivrashula, Piccha, Rakta, Mala Pravrit

Langhana, Pacana Ruksha, Ushna, Bhojana Yashtimadhu Snehabasti

Parisrava Bahu - Krura - - - Alpaveerya

- - Alpa Mala Pravriti, Kandu Shopha, Kushta, Gaurava, Agnimandya, Staimitya, Aruci, Panduta

Alpa – Samana Vamana, Virechana, Grahani, Chikitsa Asava, Arista

Hridgraha

- - - - - - - Vegavarodha after Aushada

- Hikka, Shwasa, Kasa, Parshvashula, Lalasrava,

Snigdha Lavana Sveda, Yasti Taila Anuvasana, Tikshna Nasya,

Pana Akshivibhrama, Shula, Dantakitkitayana, Sanjnanash

Vamana, Basti

Angograha

- - - - - - - Vegava rodha

- Stambha, Vepathu, Toda Pindikodvestana, Manthanavat pida

Vatahara, Snehana, Swedana

Vyapad Dosha Agni Koshta Avasth

a Sharira Atura Bala

Aushada Guna/ Virya

Vihara Aushada Matra Lakshanas Chikitsa

Jivadana Alpa - Mridu - - - Ati tikshna

- - Rakta chandrika, Udakasrava, Guda bhramsha, Trishna, Murca, Mada

Pittahara, Raktapana, Raktabasti, Piccha Basti, Ghrita Manda, Anuvasana Basti

Vibramsa - Guda - Sanjya Vibramsa associated with kandu

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

Only mala excerted not Doshas, Shodhana occurs Guda Bhramsa Sanjya Bhramsa Kandu, Pidika, Kushta Roga

Kashaya Lepa, Snehana Mridu Sweda Mano Anukula Cikitsa, Tikshna Shodhana after Snehapana

Sthambha - - - - Snigdha

- Snigdha - - Vatavarodha, Gudastambha, Gudshula, Alpalpa mala Pravrit

Langhana, Pacana, Tikshna Basti, Virechana

Upadrava - - - - Ruksha - Ruksha - - Sthambha, Shula, Gatragraha, Sarvanga, Vedana

Snehana, Svedana, Vathana Chikitsa

Klama - - Mridu - Snigdha

- Mridu - - Tandra, Gaurava, Klama, Daurbalya, Angasada

Langhana, Pachana, Snehana, Tikshna, Shodhana

Vamana by Virechana Yoga

Kapha Utklesha

Ajirna Avastha

- - - - Durgandhi Aruci

Vamana Snehana, Svedana, Virechana

Ayoga - - - - Ruksha - Gata virya

- - Vibhramsa Hikka, Pindikodvestana, Kandu, Urusada, Vaivarnyata

Roganusara Chikitsa Gomutra Niruha Basti

Atiyoga - - Mridu - - - Tikshna - - Ati Virechana Mridu Vamana Raktapittavat Chikitsa

Master chart I

LAINGIKI

SHUDDHI SL. NO

OPD NO

AGE

SEX

Sroto shuddhi

Indriya prasada

Shareera laghuta

Agnideepti

Anamayatwa

Vatanulomana

VEGIKI

ANTIKI

MANIKI (ml) PR MD AV

GROUP ‘A’ 01 3571 35 M - + + + + - 09 Kaphantya 1700 - - + 02 3942 22 F - + + + + + 14 Kaphantya 1950 - + - 03 3372 41 F - - + + + + 07 Kaphantya 1900 - + - 04 4044 40 M + + + + + - 12 Kaphantya 1600 - - + 05 4497 29 F - + + + + + 11 Kaphantya 1850 - + - 06 338 58 M + + - + + - 07 Kaphantya 1650 - - + 07 392 25 M - - + + + - 12 Kaphantya 1850 - + - 08 1225 20 M + + + + + + 13 Kaphantya 1900 - + - 09 1227 50 F - + + + + + 15 Kaphantya 1900 - + - 10 2310 46 F + + + + + + 12 Kaphantya 1700 - + -

GROUP ‘B’ 01 4009 18 M + + + + + - 11 Kaphantya 1800 - + - 02 4114 22 M - + + + + + 13 Kaphantya 1800 - + - 03 4143 28 F - + + + + + 12 Kaphantya 1700 - + - 04 4367 21 M + - - + + - 11 Kaphantya 1650 - + - 05 1605 45 F - + + + + - 07 Kaphantya 1850 - - + 06 2163 23 M + + + + + + 12 Kaphantya 1950 - + - 07 2315 24 M - + + + + + 14 Kaphantya 1750 - + - 08 4224 27 M - + + + + + 11 Kaphantya 1650 - + - 09 1982 30 M - + + + + + 13 Kaphantya 2000 - + - 10 2334 30 M - + + + + - 14 Kaphantya 1950 - + -

GROUP ‘C’ 01 3243 33 M + + + + + + 14 Kaphantya 1950 - + - 02 3258 28 M - + + + + + 13 Kaphantya 1800 - + - 03 4046 22 M - + + + + + 11 Kaphantya 1850 - + - 04 3929 58 M - + - + + - 08 Kaphantya 1650 - - + 05 860 35 M + + + + + - 16 Kaphantya 2050 - + - 06 1310 37 M - + + + + - 12 Kaphantya 1850 - + - 07 2137 40 M + + - + + - 09 Kaphantya 1800 - + - 08 1934 44 F + + + + + + 12 Kaphantya 1900 - + - 09 2216 55 M - + + + + - 14 Kaphantya 2000 - + - 10 2400 59 M + + - + + - 09 Kaphantya 1800 - - + PR – PRAVARA, MD – MADHYAMA, AV – AVARA, M – MALE, F – FEMALE, + PRESENT, – ABSENT

:BIBLIOGRAPHY:

1. Vagbhata, Ashtanga Hridaya Sutrasthana chapter 14 sloka 5. 9th ed.

Varanasi:Chaukhambha orientalia; 2002. p.223.

2. Sharangdhara, Sharangdhara Samhita Uttara khanda Goodartha Deepika Vyakhya,

chapter 8, sloka 63. Chaukhambha Sanskrit Series. (Jaikrishnadas 53). p. 35-36.

3. Sushruta, Sushruta Samhita Sutrasthana chapter5 sloka 3. 7th ed. Varanasi:

Chaukhambha orientalia; 2002. p. 18.

4. Agnivesa, Charaka Samhita Sutrasthana chapter 2 sloka 9, 10. 1st ed. Varanasi:


5. 4. Ibid p. 30.

6. 15. Ibid p. 95,96.

7. Agnivesa, Charaka Samhita Kalpasthana chapter 7 -12, 1st ed. Varanasi:

Chaukhambha orientalia; 2004. p. 662-76.

8. Agnivesa, Charaka Samhita Siddhisthana chapter 1 sloka 17,18,19. 1st ed. Varanasi:


9. Agnivesa, Charaka Samhita Siddhisthana chapter 2 sloka 1-13. 1st ed. Varanasi:


10. Agnivesa, Charaka Samhita Siddhisthana chapter 6. 1st ed. Varanasi:


11. Sushruta, Sushruta Samhita Sutrasthana chapter 39 sloka 4. 7th ed. Varanasi:


12. Sushruta, Sushruta Samhita Sutrasthana chapter 44 sloka 1-91. 7th ed. Varanasi:


13. Sushruta, Sushruta Samhita Chikitsasthana chapter 33. 7th ed. Varanasi:




15. Vagbhata, Ashtanga Hridaya Sutrasthana chapter 18. 9th ed. Varanasi: Chaukhambha

orientalia; 2002. p.260- 70.

16. Vagbhata, Ashtanga Hridaya KalpaSiddhi sthana chapter 2. 9th ed. Varanasi:

Chaukhambha orientalia; 2002. p.741-8.

17. Vagbhata, Ashtanga Hridaya KalpaSiddhi sthana chapter 3. 9th ed. Varanasi:


18. Y.T.Acharya, Ashtanga Sangraha Sutrasthana chapter 27. 11th ed. Varanasi:


19. J.P.Tripathi, Chakradatta chapter 71. 4th ed. Varanasi: Chaukhambha orientalia;

1976. P.589-92.


chapter 4, sloka 1-48. Chaukhambha Sanskrit Series. (Jaikrishnadas 53). p. 477-86.

21. Satuskar RS, Bhandarkar SD, Ainapure SS. Pharmocology and

Pharmacotherapeutics chapter 33. 16th ed. Mumbai: Popular Prakashan

Publications.1999.

22. C. Dwarakanath, Digestion and Metabolism in Ayurveda, 2nded. Krishnadasa

Academy; 1997. p.4, 5.

23. C. Dwarakanath, Digestion and Metabolism in Ayurveda, 2nded. Krishnadasa

Academy; 1997. p.32.

24. Torotora, J. Gerard, Graboski Reynolds Sandra. Principles of Anatomy and

Physiology 8th ed. Harper Collins Publications, Inc, New York.

25. Martini, fundamentals of Anatomy and physiology 4th ed. Fluid, Electrolyte and Acid

Base Balance. P. 1008-20.

26. Guyton & Hall, Text book of Medical Physiology chapter 25. 10th ed. India: Harcourt

Publishers International Company; 2001. p. 264.

27. Harrison’s, Principles of Internal Medicine vol I. 14th ed. Fluid and Electrolyte

Balance.


Publishers International Company; 2001. p. 265-7.

29. Martini, fundamentals of Anatomy and physiology 4th ed. Fluid, Electrolyte and Acid

Base Balance.


Publishers International Company; 2001. p. 267.

31. Davidson principles and practice of medicine chapter 10. Edwards CRW, Bouchier

IAD,Haslett C, Chilvers ER. 18th ed. London: ELBS; 2001. p. 586.

32. Prof. V.V.S. Shastry, Essentials of Basic Ayurvedic Concepts chapter 8 Udakavaha

Srotas. P. 142-5.

34. Agnivesa, Charaka Samhita Kalpasthana chapter 1 sloka 4. 1st ed. Varanasi:

Chaukhambha orientalia; 2004. p.651.

35. Ibid chakrapani commentary

36. Y.T.Acharya, Ashtanga Sangraha Sutrasthana chapter 1 sloka 39. 11th ed. Varanasi:

Chaukhambha orientalia; 1996.

37. Agnivesa, Charaka Samhita Sutrasthana chapter 13 sloka 80. 1st ed. Varanasi:


38. Agnivesa, Charaka Samhita Siddhisthana chapter 2 sloka 13. 1st ed. Varanasi:


39. Sushruta, Sushruta Samhita Chikitsasthana chapter 33 sloka 25-32. 7th ed. Varanasi:


40. Sushruta, Sushruta Samhita Uttara sthana chapter 4 sloka 7-11. 7th ed. Varanasi:




42. Vagbhata, Ashtanga Hridaya Sutrasthana chapter 18 sloka 8,9. 9th ed. Varanasi:


43. Bhela, Bhela Samhita with English Translation by Krishnamurthy K.H., 1st ed.

Chaukhambha Vishwabharati, Varanasi; 2000.


chapter4, sloka 8-11. Chaukhambha Sanskrit Series. (Jaikrishnadas 53). p. 478-9.

45. Bhavamishra, Bhavaprakasha Purvakhanda. 5th ed. Varanasi: Chaukhambha Sanskrit

series 130; 1988.

46. Bhisagratna Brahmasankar Shastri, Yogarathnakara, Vidyotini Hindi commentary,

chapter Virechanam sloka 8-11. Chaukhambha Sanskrit Sansthan; p. 138-9.

47. Agnivesa, Charaka Samhita Sutrasthana chapter6 sloka 44. 1st ed. Varanasi:


48. Vagbhata, Ashtanga Hridaya Sutrasthana chapter 4 sloka 35. 9th ed. Varanasi:




50. Vagbhata, Ashtanga Hridaya Chikitsasthana chapter 1. 9th ed. Varanasi:


51. Agnivesa, Charaka Samhita Chikitsasthana chapter 28 sloka 188. 1st ed. Varanasi:






54. Vagbhata, Ashtanga Hridaya Uttara sthana chapter 39 sloka 11. 9th ed. Varanasi:






57. Y.T.Acharya, Ashtanga Sangraha Sutrasthana chapter 27 sloka 5. 11th ed.

Varanasi: Chaukhambha orientalia; 1996. p. 238-9.

58. Vagbhata, Ashtanga Hridaya Uttara sthana chapter 39 sloka 10, 11. 9th ed. Varanasi:


59. Bhela, Bhela Samhita with English Translation by Krishnamurthy K.H., 1st ed.

Chaukhambha Vishwabharati, Varanasi; 2000.


chapter 4, sloka 6,7. Chaukhambha Sanskrit Series. (Jaikrishnadas 53). p. 478.

61. Bhavamishra, Bhavaprakasha Purvakhanda. 5th ed. Varanasi: Chaukhambha Sanskrit

series 130; 1988.


chapter Virechanam sloka 6, 7. Chaukhambha Sanskrit Sansthan; p. 138.

63. Agnivesa, Charaka Samhita Sutrasthana chapter 1 sloka 94-7. 1st ed. Varanasi:
























75. Agnivesa, Charaka Samhita Sutrasthana chapter 1 sloka 117-8 1st ed. Varanasi:






78. Sharangdhara, Sharangdhara Samhita Purva khanda Goodartha Deepika Vyakhya,

chapter 4, sloka 3. Chaukhambha Sanskrit Series. (Jaikrishnadas 53). p. 44.

79. Sushruta, Dalhana commentary on Sushruta Samhita Sutrasthana chapter 46 sloka

259. 7th ed. Varanasi: Chaukhambha orientalia; 2002. p. 233.



81. Agnivesa, Charaka Samhita Chikitsasthana chapter 3 sloka 171 1st ed. Varanasi:






84. Ibid.







88. Ibid 56-58, 67-69.

89. Sushruta, Sushruta Samhita Chikitsasthana chapter 33 sloka 44. 7th ed. Varanasi:






92. Agnivesa, Charaka Samhita Kalpasthana chapter 12 sloka 55-8. 1st ed. Varanasi:




94. Agnivesa, Charaka Samhita Kalpasthana chapter 12 sloka 51-4. 1st ed. Varanasi:


95. Ibid 58.

96. Ibid 68.





99. Vagbhata, Ashtanga Hridaya Sutrasthana chapter 18 sloka 53-5. 9th ed. Varanasi:






102. Bhela, Bhela Samhita Sutrasthana with English Translation by Krishnamurthy K.H.

chapter 25 sloka 8. 1st ed. Chaukhambha Vishwabharati, Varanasi; 2000.



104. Sushruta, Sushruta Samhita Sutrasthana chapter 44 sloka 3-4. 7th ed. Varanasi:




106. Agnivesa, Charaka Samhita Sutrasthana chapter 16. 1st ed. Varanasi: Chaukhambha

orientalia; 2004. p. 93.






chapter 4, sloka 13. Chaukhambha Sanskrit Series. (Jaikrishnadas 53). p. 479-80.




chapter 4, sloka 18-9. Chaukhambha Sanskrit Series. (Jaikrishnadas 53). p. 481.







115. 28 Ibid 33. p. 180.











121. Ibid 9.



123. Y.T.Acharya, Ashtanga Sangraha Sutrasthana chapter 27. 11th ed. Varanasi:




125. Ibid 21.







129. Sushruta, Sushruta Samhita Chikitsasthana chapter 33 sloka 24-7. 7th ed. Varanasi:


130. Ibid.

131. Y.T.Acharya, Ashtanga Sangraha Kalpasthana chapter 3 sloka 6. 11th ed. Varanasi:






134. 34 Ibid 521-5.





137. Agnivesa, Chakrapani commentary on Charaka Samhita Sutrasthana chapter 16

sloka 2. 1st ed. Varanasi: Chaukhambha orientalia; 2004. p. 97.





140. Agnivesa, Chakrapani commentary on Charaka Samhita Siddhisthana chapter 6 sloka

25. 1st ed. Varanasi: Chaukhambha orientalia; 2004. p. 705.

141. Satuskar RS, Bhandarkar SD, Ainapure SS. Pharmocology and

Pharmacotherapeutics chapter 33. 16th ed. Mumbai: Popular Prakashan

Publications.1999.

142. Joel G Hardman and Lee E Limbird, Goodman and Gilman, The pharmacological

basis of therapeutics, , 10th ed, Mc. Graw Hill Book Company, Hamberg: 2001.

143. Agnivesa, Charaka Samhita Nidanasthana chapter 5 sloka 6. 1st ed. Varanasi:


144. Agnivesa, Charaka Samhita Chikitsasthana chapter 7 sloka 4-8. 1st ed. Varanasi:


145. Sushruta, Sushruta Samhita Nidanasthana chapter 5 sloka 32-3. 7th ed. Varanasi:


146. Y.T.Acharya, Ashtanga Sangraha Nidanasthana chapter 14 sloka 2-3. 11th ed.

Varanasi: Chaukhambha orientalia; 1996. p. 235.

148. K.H.Krishnamurthy, Bhela Samhita Nidanasthana with English Translation. chapter

5 sloka 16. 1st ed. Chaukhambha Vishwabharati, Varanasi; 2000.

149. 4 Ibid 6-7.



151. Sushruta, Sushruta Samhita Nidanasthana chapter 5 sloka 6. 7th ed. Varanasi:


152. Y.T.Acharya, Ashtanga Sangraha Nidanasthana chapter 14 sloka 12-13. 11th ed.

Varanasi: Chaukhambha orientalia; 1996. p. 236.



154. Sushruta, Sushruta Samhita Nidanasthana chapter 5 sloka 13. 7th ed. Varanasi:


155. K.H.Krishnamurthy, Bhela Samhita Chikitsasthana with English Translation. chapter

6 sloka 25. 1st ed. Chaukhambha Vishwabharati, Varanasi: 2000.

156. Vriidha Jeevaka, Kashyap Samhita. Varanasi: Chaukhambha orientalia; 2002. p.160

157. Vagbhata, Ashtanga Hridaya Nidanasthana chapter 14 sloka 20. 9th ed. Varanasi:

haukhambha orientalia; 2002. p.525.

158. Dr. Indradev Tripathi and Dr. Dayashankar Tripathi, Yoga Ratnakara Kustadhyaya.

1st ed. Varanasi: Chaukhambha orientalia; 1998.

159. Madhavakara, Madhavanidana (Vol II) chapter 49.Varanasi: Chaukambha Ayur

vigyana Grantha mala 46; 1998. p. 167.



161. Ibid 10.

162. Ibid 11.



164. Ibid 41.





167. Madhavakara, Madhavanidana (Vol II) chapter 51 sloka1.Varanasi: Chaukambha

Ayur vigyana Grantha mala 46; 1998. p. 167.

168. Ibid

169. Kashyap, Kashyap Samhita Khilasthana chapter 16 sloka 9.



171. Ibid.

172. Harrison’s Principles of Internal Medicine vol II, Mc Grow-Hill, 14th

ed. Health

Professions Division. 1998. p.233.



174. Vriidha Jeevaka, Kashyap Samhita Khilasthana chapter 16 sloka 16-7.Varanasi:




176. Vriidha Jeevaka, Kashyap Samhita Khilasthana chapter 16 sloka 49.Varanasi:






179. Agnivesa, Charaka Samhita Vimanasthana chapter 4 sloka 8. 1st ed. Varanasi:


180. Vriidha Jeevaka, Kashyap Samhita Khilasthana chapter 16 sloka 16-7.Varanasi:


181. Vangasena, Vangasena samhita Amlapitta Chikitsa sloka 22, Mumbai: Khemnath

Publications, Krishnadas publishers, 1996.



183. Sushruta, Sushruta Samhita Uttara sthana chapter 51 sloka 3. 7th ed. Varanasi:




185. Y.T.Acharya, Ashtanga Sangraha Nidanasthana chapter 4 sloka 8. 11th ed. Varanasi:


186. Madhavakara, Madhavanidana chapter12 sloka 15.Varanasi: Chaukambha Ayur

vigyana Grantha mala 46; 1998.





189. Bhavamishra, Bhavaprakasha Purvakhanda. Chapter 14 sloka 4. 5th ed. Varanasi:

Chaukhambha Sanskrit series 130; 1988.


chapter 12 sloka 13. Chaukhambha Sanskrit Sansthan















198. Sushruta, Sushruta Samhita Uttara sthana chapter 51 sloka 8-10. 7th ed. Varanasi:


199. Y.T.Acharya, Ashtanga Sangraha Nidanasthana chapter 4 sloka 12. 11th ed. Varanasi:






203. Ibid 62.



205. Vagbhata, Ashtanga Hridaya Nidanasthana chapter 4. 9th ed. Varanasi: Chaukhambha

orientalia; 2002. p.473.



207. Ibid 62.

208. Ibid 88.

209. Ibid 71.

210. Ibid 75.

211. Sharangdhara, Sharangdhara Samhita Madhyama khanda Goodartha Deepika

Vyakhya, chapter 6, sloka 13. Chaukhambha Sanskrit Series. (Jaikrishnadas 53). p.

250.

212. Bhaishajya Ratnavali chapter 5 sloka 1285 ed. Varanasi: Chaukhambha orientalia;

p.130.



214. Bhaishajya Ratnavali chapter 5 sloka 1285 ed. Varanasi: Chaukhambha orientalia;

p.130.

215. K.R.Kirtikar and B.D. Basu, Indian Medicinal Plants vol III. 2nd ed. Dehradun:Valley

offset printer and pubishers. P.1731.


chapter 4, sloka 6. Chaukhambha Sanskrit Series. (Jaikrishnadas 53).

ANNEXURE DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA “The study of Virechana Karma & its effect on body fluids with special

reference to Serum Electrolytes”- an observational study. _____________________________________________________________ Guide: Dr.S.H.Doddamani M.D (Ayu) P.G. Scholar: Santosh L. Yadahalli ________________________________________________________________________ 01. Name of the Patient: Sl.No : 02. Fathers/ Husband’s Name: O.P.D.No : 03. Age : yrs I.P.D.No : 04. Sex : Bed. No : Male Female 05. Religion : Hindu Muslim Christian Others 06. Occupation: Sedentary Active Labour 07. Economical Status: Poor Middle Class Higher Class 08. Diet : Vegetarian Mixed

09. Address: __________________________ Date of Initiation

__________________________ Date of Completion

_____________________. Tel. no: _____________

Pin:

10. Result : S.E

remained same

S.E Increased within normal

limits

S.E Decreased within normal

limits

S.E Increased

S.E Decreased

CONSENT I am fully educated with the disease and treatment, there by I got satisfied whole heartedly, I accept for the medicinal trial over me.

Signature of Investigator Signature of the Patient

1. Pradhana Vedana: Avadhi (Chief Complaint) 2. Anubandhi Vedana: (Associated Complaints) 3. Vyadhi Vrittanta: 4. Vayaktika Vrittanta : 5. Purva Vyadhi Vrittanta :

6. Kula, Kautumbika Vrittanta : 7. Personal History:

Vegetarian Mixed Viruddha Snigdha a) Ahara : b) Jatharagni : Manda Teekshna Vishama Sama c) Nidra : Sukha Alpa Ati Vaishamya

Smoking Alcohol Tobacco No Habit d) Vyasana : *SAMANYA PAREEKSHA: Bhara

Dairghya Rakta Chapa Dehoshma Varna

* ASHTA STHANA PAREEKSHA: Nadi

Mutra Mala Jihwa

Shabdha Sparsha Drik Akriti

* PRAKRITYADI PAREEKSHA:

Shareerika 1. Prakriti Manasika

2. Sara Pravara Madhyama Avara 3. Samhanana Susamhata Madhyasamhata Asamhata 4. Satmya Ekarasa Sarvarasa Vyamishra5. Satwa Pravara Madhyama Avara 6. Pramana Sama Heena Adhika 7. AharaShakti Pravara Madhyama Avara 8. VyayamaShakti Pravara Madhyama Avara 9. Vaya Balya Yuva Vriddha

10.Vikriti :

Hetu :

Linga :

Dosha :

Dushya:

Bala :

Kala :

* SYSTEMIC EXAMINATION:

1) Shiras (Head & Neck) :

2) Madhyamanga (Uraha Pradesh):

a. Cardio Vascular System (Hridaya) :

b. Respiratory System (Puppusa) :

c. Urinary System (Mutravaha) : d. Digestive System (Annavaha) : *INVESTIGATIONS:

Blood:

1) Hb% ---

2) TC ---

DC ---

3) ESR ---

4) Serum Electrolytes --- Sodium -

Chloride -

Potassium -

Necessary Investigations :

Vyadhi Vinishchaya :

CHIKITSA

VIRECHANA KARMA

Purva Karma: Deepana – Pachana with Panchakola Churna 3 -6 Gms till niramavastha seen. (3-5) days. Snehapana in Arohana vidhi with Murchita Ghrita till samyak snigdha lakshanas seen. (3-7) days. Day & Date I II III IV V VI VII

Sneha Matra Pana Kala Agnipradurbhava Kala Sneha Pachana Samaya

• Observation of Jeeryamana lakshanas :

Lakshanas

I II III IV V VI VII

Shiroruja Bhrama Lalasrava Murcha Angasada Klama Trishna Daha Arati

● Sneha Jeerna Lakshanas:

Lakshanas І II III IV V VI VII

Jeeryamana Lakshanas Prashama

Shareera Laghuta

Vatanulomana

Kshudha Pravritti

Trishna Pravritti

Udgara Shuddhi

Anya

*Observation of Samyak Snigdha Lakshanas:

Lakshanas Ι II III IV V VI VII

Vatanulomana Agnideepti Purisha snigdhata Asamhata varchas Twak snigdhata Anga laghava Gatra mardava Snehodwega Klama Shaithilya

* Abhyanga and Sarvanga Swedana for 3 days.

Types of Sweda Abhyanga (Samyak Snigdha Lakshanas)

Swedana (Samyak Swinna Lakshanas)

Twak mardavata Sheeta Vayu prama Shramahara Sthambha Nigraha Samjata Mardavata Gaurava Nigraha

Nadi Sweda

Samjata Sweda

* Pradhana Karma: Virechana Karma with Trivrit Leha

Date: Time: Matra Anupana Vega Prarambha Vega Shamana

* Observation: Degree of Virechana having Vegiki, Maniki, Antiki and Laingiki Shodhana Lakshanas.

Laingiki Vegiki Antiki Maniki Degree of

Virechana

Srotoshuddhi

Indriya Prasadana

Shareera Laghuta

Agnideepti

Anamayatwa

Vatanulomana

Date/ Time

Dose Mala Pravritti

Colour AppQty Vega BP/Pulse Anupana

* Samsarjana Krama:

Days Annakala

I Mor-

Eve -

II Mor –

Eve -

III Mor –

Eve -

IV Mor –

Eve –

V Mor –

Eve -

VI Mor –

Eve -

VII Mor –

Eve -

• ASSESSMENT CRITERIA :

Subjective Parameters

Procedure Symptoms Before Symptoms After

Deepana-Pachana

Snehana

Abhyanga, Sweda

Virechana

Samsarjana Krama

Objective Parameters

Diff in Both Serum Electrolytes

Before Virechana

Serum Electrolytes

After Virechana

Increase Decrease

Sodium - Sodium -

Potassium- Potassium-

Chloride - Chloride - Investigators Note: Signature of the Guide

Documents

Virechana electrolytes pk003-gdg