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Virechana tirupati  2  dr.santosh bhatted
 

Virechana tirupati 2 dr.santosh bhatted

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    Virechana tirupati  2  dr.santosh bhatted Virechana tirupati 2 dr.santosh bhatted Presentation Transcript

    • Virechana KarmaDr Santoshkumar BhattedAssociate Prof, Dept of PanchakarmaNational Institute of AyurvedaJaipur5/30/2013 Presentation by Dr Santoshkumar Bhatted 1
    •  Effective Virechana OushadhiStandardization of Virechana Oushadhi on thebasis of ClassificationStandardization of dose of Virechana OushadhiAssessment of mode of action of Virechana drugsAssessment of Mridu, Madhyam & TikshnaVirechana5/30/2013 Presentation by Dr Santoshkumar Bhatted 2
    • Virechana dravya- as per potency Can be classified as Virechaka Virechanopaga5/30/2013 Presentation by Dr Santoshkumar Bhatted 3
    • Virechana DravyaTrivruta, Aragvadha, Tilvaka, Snuhi Kshira, Saptala,Shankhini, Danti, Dravanti5/30/2013 Presentation by Dr Santoshkumar Bhatted 4
    • Virechanopaga DravyaDrakshaGambhariPalasaHareetakiAmalakiBibheetakiKuvalaBadaraKarkanduPeelu.5/30/2013 Presentation by Dr Santoshkumar Bhatted 5
    • Drug wise Virechana Yoga andtheir indications Charaka has mentioned 245 Virechana YogasShyama Trivrit – All rogasAragvadha – Bala, Vriddha, Ksheena,Jwara, HridrogaTilvaka – VatavyadhiSnuhi – Pandu, DusheevishaSaptala-shankhini – Gulma, GaraDanti-Dravanti – Krimi, Bhagandara5/30/2013 Presentation by Dr Santoshkumar Bhatted 6
    • Trivruta Aragvadha Snuhi5/30/2013 Presentation by Dr Santoshkumar Bhatted 7
    • Eranda Jayapal Saptala5/30/2013 Presentation by Dr Santoshkumar Bhatted 8
    • Best Virechana dravyas as per thepart used Moolam- Shyama Twaka- Tilwaka Phala- Hareetaki Taila- Eranda Swarasa - Karavellaka Ksheera- Snuhi5/30/2013 Presentation by Dr Santoshkumar Bhatted 9
    • Characteristics of TikshnaMadhyama and Mridu Aushadhi5/30/2013 Presentation by Dr Santoshkumar Bhatted 10
    • Preference and safety of use ofMridu AushadhiUse of Mild & less quantity of Aushadha- indurbala, shodhita, alpadosha, krisha andajnyatakoshtaBetter to give repeated shodhana inbahudoshayukta durbala rogi with alpoushadhi5/30/2013 Presentation by Dr Santoshkumar Bhatted 11
    • Dose of Virechana Yoga5/30/2013 Presentation by Dr Santoshkumar Bhatted 12
    • Doses of Virechana drugs according toAushadhi Kalpana and KoshtaAushadhiKalpanaHina Matra Madhyama Matra Uttama MatraKvatha ½ Pala (2tola)1 Pala ( 4 tola) 2 Pala (8 tola)Churna Kalka etc. 1 tola 2 tola 4 tolaAccording toKoshţhaMrduKoshţhaMrdu Matra(1 tola)MadhyamaKoshţhaMadhyama Matra(2 tola )KruraKoshţhaUttama Matra(3 tola)5/30/2013 Presentation by Dr Santoshkumar Bhatted 13
    • Dose of Virechana drug as perKoshtha5/30/2013 Presentation by Dr Santoshkumar Bhatted 14
    • Qualities of Virechana dravya asper Dosha Vata – Snighdha, Ushna, Amla and LavanaEg Eranda Taila Pitta – Kashaya, Madhura,Eg Draksha Kashaya, Avipathikar Choorna Kapha – Katu Ushna and TikshnaEg Trivrut, Triphala, Gomutra5/30/2013 Presentation by Dr Santoshkumar Bhatted 15
    • Selection of Virechana Yoga as perseverity of disease and strength ofthe patient5/30/2013 Presentation by Dr Santoshkumar Bhatted 16
    • Examples of Mridu, Madhyama and TikshnaVirechana Dravya as per KoshthaMridu Koshtha- Draksha Kashaya, Kshira, AragvadhaMadhyama Koshtha- TrivrutaKrura Koshtha- Snuhi Kshira, Svarnakshiri, Danti5/30/2013 Presentation by Dr Santoshkumar Bhatted 17
    • Classification of Virechana dravyasas per their action on MalaAnulomana – HareetakiSramsana – Aragvadha5/30/2013 Presentation by Dr Santoshkumar Bhatted 18
    • Bhedana – KatukiRechana – Trivrut5/30/2013 Presentation by Dr Santoshkumar Bhatted 19
    • Virechana Dravya as per their GunaRooksha VirechanaSnigdha Virechana5/30/2013 Presentation by Dr Santoshkumar Bhatted 20
    • Guidelines for the preparation ofVirechana DravyaIshta Rasa, Satmya, Abeebhatsa, Sugandhi, Sudarshana,Mano-anukula5/30/2013 Presentation by Dr Santoshkumar Bhatted 21
    • Guidelines for PotentiatingVirechana Dravya Give the Bhavana of Svarasa or of the drugs havingsimilar Virya5/30/2013 Presentation by Dr Santoshkumar Bhatted 22
    • Trivrut Kalpa as per Dosha Vata- Trivruta Churna with saindhava, Shunti, with theanupana of amla dravya or Jangala Mamsarasa Pitta- Trivruta Churna with Ghrita, Madhu, Sharkaraanupana with Draksha Kashaya Kapha- Trivruta Churna with Trikatu, Panchakola andGomutra with the Anupana of Triphala Kvatha, Pilu RasaAmla Kanji
    • Trivruta Kalpa as per Dosha5/30/2013 Presentation by Dr Santoshkumar Bhatted 24
    • Virechana Yoga(Sahapana/Anupana)as per Dosha5/30/2013 Presentation by Dr Santoshkumar Bhatted 25
    • Selection of drug as per RutuVARSHA Trivrut Kutajabeeja Pippali Nagara Mridweeka rasa with Madhu5/30/2013 Presentation by Dr Santoshkumar Bhatted 26
    • SHARADTrivrutDuralabhaMusthaSharkaraUdeechya, chandanaDraksha, Yashtimadhu - sheetala Kashaya5/30/2013 Presentation by Dr Santoshkumar Bhatted 27
    • HEMANTATrivrutChithrakaPathaAjaji, Sarala, VachaSwarna ksheeri- with warm water5/30/2013 Presentation by Dr Santoshkumar Bhatted 28
    • GRISHMATrivrut with Sharkara5/30/2013 Presentation by Dr Santoshkumar Bhatted 29
    • Suitable Virechana Yoga for all seasons5/30/2013 Presentation by Dr Santoshkumar Bhatted 30
    • Virechana drugs -Mechanism of Action1. Hydrophilic or osmotic action, retaining water andelectrolytes in the intestinal lumen- increase volume ofcolonic content and make it easily expelled.2. Acting on intestinal mucosa to reduce net absorption ofwater and electrolytes, intestinal transit is enhancedindirectly by the fluid bulk.3. Increasing propulsive activity as primary actionallowing less time for absorption of salt and water as asecondary effect.5/30/2013 Presentation by Dr Santoshkumar Bhatted 31
    • Classification of Laxatives Laxatives Promote and facilitate bowel evacuation;By acting locally to stimulate intestinal peristalsis To soften bowel contents, or both. Types of LaxativesA. Bulk laxativesB. Osmotically Active LaxativesC. Irritant laxatives—purgatives, cathartics.5/30/2013 Presentation by Dr Santoshkumar Bhatted 32
    • Classification of LaxativesAcc. to laxative effect1. Slow onset- those which produce softening of stool after1-3 days of daily use- bulk laxatives, mineral oil,lactulose, dioctyl sodium succinate.2. Intermediate onset- those which lead to a soft /semisolidstool in 6-12 hrs of a single dose- saline laxatives (lowdose), phenolphthalein, bisacodyl (oral), anthraquinonegroup.3. Rapid onset- those which lead to a watery evacuation in2-6 hrs of a single dose. - Saline laxatives (high dose),castor oil, bisacodys (rectal).5/30/2013 Presentation by Dr Santoshkumar Bhatted 33
    • Bulk laxatives: Bulk-producing laxatives are not digested bythe body and therefore add bulk and water to the contentsof the intestines. The added bulk in the intestinesstimulates peristalsis, moves the products of digestionthrough the intestine, and encourages evacuation of thestool. Distention of the intestinal wall bybowel contents stimulates propulsive movements of thegut musculature (peristalsis). Activation of intramuralmechanoreceptors induces a neurally mediated ascendingreflex contraction (red ) and descending relaxation (blue)whereby the intraluminal bolus is moved in the analdirection.5/30/2013 Presentation by Dr Santoshkumar Bhatted 34
    • 5/30/2013 Presentation by Dr Santoshkumar Bhatted 35
    • Osmotically Active Laxatives: They are soluble but nonabsorbable particles that retainwater in the bowel by virtue of their osmotic action. The osmotic pressure (particleconcentration) of bowel contents always corresponds to that ofthe extracellular space. The intestinal mucosa is unable tomaintain a higher or lower osmotic pressure of the luminalcontents. Therefore, absorption of molecules (e.g.,glucose, NaCl) occurs isoosmotically, i.e., solute molecules arefollowed by a corresponding amount of water.5/30/2013 Presentation by Dr Santoshkumar Bhatted 36
    •  Conversely, water remains in the bowel when molecules cannot beabsorbed. With Epsom and Glauber’s salts (MgSO4 and Na2SO4, respectively),the SO4-2 anion is nonabsorbable and retains cations to maintainelectroneutrality. Mg2+ ions are also believed to promote release from the duodenalmucosa of cholecystokinin/pancreozymin, a polypeptide that alsostimulates peristalsis. These so-called saline cathartics elicit a watery bowel discharge1–3 h after administration (preferably in isotonic solution). They are used to purge the bowel (e.g., before bowel surgery) orto hasten the elimination of ingested poisons.5/30/2013 Presentation by Dr Santoshkumar Bhatted 37
    • 5/30/2013 Presentation by Dr Santoshkumar Bhatted 38
    •  Osmotic laxative effects are also produced by the polyhydricalcohols, mannitol and sorbitol, which unlike glucose cannotbe transported through the intestinal mucosa, as well as by thenonhydrolyzable disaccharide, lactulose. Lactulose is used in hepatic failure in order to prevent bacterialproduction of ammonia and its subsequent absorption(absorbable NH3 ! Nonabsorbable NH4 +), so as to forestallhepatic coma. Glauber’s salt (high Na+ content) is contraindicated inhypertension, congestive heart failure, and edema. Epsom salt is contraindicated in renal failure (risk of Mg2+intoxication).5/30/2013 Presentation by Dr Santoshkumar Bhatted 39
    • Irritant laxatives—purgatives, cathartics. Laxatives in this group exert an irritant actionon the enteric mucosa. Consequently, less fluid is absorbedthan is secreted. The increased filling of the bowel promotesperistalsis; Excitation of sensory nerve endings elicitsenteral hypermotility. According to the site of irritation, onedistinguishes the small bowel irritant castor oil from the large bowel irritants anthraquinone and diphenolmethanederivatives .5/30/2013 Presentation by Dr Santoshkumar Bhatted 40
    • Small Bowel Irritant Purgative e.g. Ricinoleic Acid (Castor oil ) Ricinoleic acid, but not the oil itself, is active. It arises asa result of the regular processes involved in fat digestion. Oral administration of 10–30 mL of castor oil is followedwithin 0.5 to 3 h by discharge of a watery stool. Because of its massive effect, castor oil is hardly suitablefor the treatment of ordinary constipation.5/30/2013 Presentation by Dr Santoshkumar Bhatted 41
    • It can be employed after oral ingestion of a toxin in order to hasten elimination andto reduce absorption of toxin from the gut.Castor oil is not indicated after the ingestion of lipophilic toxins likely to depend onbile acids for their absorption.5/30/2013 Presentation by Dr Santoshkumar Bhatted 42It can be employed after oral ingestion of a toxin in order to hasten eliminationand to reduce absorption of toxin from the gut.Castor oil is not indicated after the ingestion of lipophilic toxins likely to dependon bile acids for their absorption.
    • 5/30/2013 Presentation by Dr Santoshkumar Bhatted 43
    • Large Bowel Irritant Purgatives:Anthraquinone derivatives They occur in the leaves (folia sennae) or fruits (fructus sennae) of the senna plant, the bark of Rhamnus frangulae and Rh.purshiana, (cortex frangulae, cascara sagrada), the roots of rhubarb(rhizoma rhei), or the leaf extract from Aloe species . Among other substituents, the anthraquinone nucleus containshydroxyl groups, one of which is bound to a sugar(glucose,rhamnose). Following ingestion of galenical preparations or of theanthraquinone glycosides, discharge of soft stool occurs after alatency of 6 to 8h. The anthraquinone glycosides themselves are inactive but areconverted by colon bacteria to the active free aglycones.5/30/2013 Presentation by Dr Santoshkumar Bhatted 44
    • 5/30/2013 Presentation by Dr Santoshkumar Bhatted 45
    • Emollient laxatives: They lubricate the intestinal walls and soften thestool, there by enhancing passage of fecal material. Mineral oilis an emollient laxative. Fecal softeners promote water retention in the fecal mass andsoften the stool. One difference between emollient laxatives andfecal softeners is that the emollient laxatives do not promotethe retention of water in the stool.5/30/2013 Presentation by Dr Santoshkumar Bhatted 46
    •  Examples of fecal softeners include docusate sodium(Colace) and docusate calcium (Surfak). Saline laxatives: attract or pull water into theintestine, thereby increasing pressure in the intestine,followed by an increase in peristalsis. Magnesium hydroxide (Milk of Magnesia) is a salinelaxative.5/30/2013 Presentation by Dr Santoshkumar Bhatted 47
    • Virechana Dravya KarmukataUshna, Teekshna, Sookshma, Vyavayi, Vikashioushadhi reach Hridaya by their veerya movesthrough dhamanis into sarvashareeraOushnya- vishyandana of doshasanghataTaikshnya- vicchindana of doshasanghataReach amashaya & propelled out because of prithvi,jala mahabhootas and adhobhaga prabhava5/30/2013 Presentation by Dr Santoshkumar Bhatted 48
    • PROBABLE MODE OF ACTIONOF VIRECHANA The Ayurvedic Sodhana Karmas are "Physician induced mildinflammation". Mainly Virechana drugs are quite irritant to the intestinal mucosa , to causeinflammation. Due to this, the permeability of the membrane changes and those substancescome out due to the changed permeability which can not come out innormal condition. The gross signs of inflammation are redness, heat, swelling, pain and loss offunctions. These signs occur due to three following changes at microscopic level.5/30/2013 Presentation by Dr Santoshkumar Bhatted 49
    • Hyperemia - It occurs due to capillary dilatation and arteriolardilatation mechanisms.Exudation - Exudation is the increased passage of protein rich fluidthrough the vessel wall, in the intestinal tissue. The advantageousresult of fluid increases is dilution of toxins.Increase Permeability: Some chemical factors are also responsiblewhich increase the permeability in response to acute inflammation.A.Vasoactive amines:b.Vaso active polypeptides: These causesvasodilatation.c.Miscellaneous agents: like Prostaglandins5/30/2013 Presentation by Dr Santoshkumar Bhatted 50
    • Thank You5/30/2013 Presentation by Dr Santoshkumar Bhatted 51