“THE STUDY OF VIRECHANA KARMA AND ITS EFFECT ON   BODY FLUIDS W.S.R.T SERUM ELECTROLYTES”-               AN OBSERVATIONAL ...
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.                     DECLARATION BY THE CANDITATE        ...
CERTIFICATE BY THE GUIDE         This is to certify that the dissertation entitled “The study of VirechanaKarma and its ef...
ENDORSEMENT BY THE HOD, PRINCIPAL                        HEAD OF THE INSTITUTION       This is to certify that the dissert...
COPYRIGHT                               Declaration by the Candidate         I here by declare that the Rajiv Gandhi Unive...
ACKNOWLEDGEMENT       I express my deep sense of gratitude to his great holiness JagadguruShri Abhinava Shivananda mahaswa...
I am very much thankful to Dr. Bhajantri Medical Officer, Shirahatti, for hissuggestions and support during this study.   ...
LIST OF ABBREVIATIONS USED AS      –   Ashtanga Sangraha AH      –   Ashtanga Hridaya Aru.    –   Arunadatta A.T     –   A...
ABSTRACTBACK GROUND –        Now a day Ayurveda Chikitsa is becoming popular because of SamshodhanaChikitsa, which gives s...
Assessment Criteria –       Subjective – Samyak Virechana i.e., on Vegiki, Maniki, Antiki and Laingiki.       Objective – ...
TABLE OF CONTENTS                                                 Page No. 1.    Introduction                             ...
LIST OF TABLESSl.    Table                                                                       Page                     ...
Sl.   Table                                                                      Page                                     ...
LIST OF FIGURES AND GRAPHSSl. No                 Name of the Figure                        Page No  1.     Showing Defecat...
1                                           INTRODUCTION         Ayurveda is a science which imparts knowledge about life,...
2         Virechana karma is a specific shodhana procedure among the Panchakarmas(Biopurificatory procedures). It is speci...
3samyak Virechana on the body fluids (electrolytes) where it gives the proper knowledgeon both Ayurvedic sciences in the l...
4                               OBJECTIVES OF THE STUDY:         To evaluate the electrolytes and body fluid level after s...
5                              REVIEW OF LITERATUREHISTORICAL REVIEW:         In the text Vinayapittaka, written during th...
6SHARIRA –Anatomy and Physiology of Amashaya and Pakwashaya:         As this study deals with Virechana karma and its effe...
7indicates that kosta is made up of these two organs, actually kosta comprises of twosrotases, viz, Annavaha Srotas and Pu...
8         The Jatharagni which is situated below the Amashaya in Grahani is activated bySamana Vayu along with Pachaka pit...
9Movements of Annavaha Srotas:         All movements are caused by contractions and relaxations of muscles. Sosimilarly in...
10                   Chemical reactions involved in jatharagnipaka occur in adhoamashaya,     those implied by Dhatwagnipa...
11Stomach:                                               Table no 1                         Summary of Digestive Activitie...
121. Gastric secretion is regulated by neural, paracrine and hormonal mechanisms.    Regulation of gastric secretion occur...
13Large intestine:1. The large intestine extends from the ileocecal sphincter to the anus. It regions include    the caecu...
14Absorption of Faeces formation in the large intestine:         By the time chyme has remained in the large intestine 3-1...
15                            BODY FLUIDS (ELECTROLYTES) 26          The maintenance of a relatively constant volume and a...
16the inspired air is usually less than 47 mm Hg water is continuously lost through thelungs with respiration. In cold wea...
17            Fluid movement between the intravascular and interstitial spaces occurs thecapillary wall and is determined ...
18         Important Constituents of Intracellular Fluid:             The ICF is separated from the extra cellular fluid b...
19Clinical Abnormalities of Fluid Volume Regulation 31:                                                Table no 5         ...
20PROCEDURE OF SERUM ELECTROLYTES –1. Sodium Test:         Method – Precipitation test for Sodium         Sample – Serum  ...
213. Potassium Test:            Method – Colorimetric test for Potassium            Sample – Serum            Principle of...
22of the cells of this area causes thirst and drinking of water. These cells are stimulated byan increased osmotic pressur...
23                                  :VIRECHANA KARMA:                   The process by which the vitiated doshas are elimi...
24then reaches to Hridaya, Dhamani, macro and micro channels (srotases) of the body andreach the site where Doshas are acc...
25Virechana Yogya and Ayogya:          A number of diseases listed below along with Dosha predominance                    ...
265. Rakta Pradhana VyadhiPleeha                                            +        +         +         +         +      ...
27Udara                                             +          -       +         +         -        +        +Arocaka     ...
28Pipasita                                          +        +         -         -         +        +        +Karma Bharad...
29Urusthambha                                       -          -       -         -         +        -        -Ardita      ...
30                                      Table no 8Sl.     According to part         C.S                                   ...
31B. Virechana drugs according to their mode of action by Sharangadhara:         Acharya Sharangdhara has classified accor...
32           The drug which disintegrates the ‘Abaddha’ (unformed) or ‘Baddha’ (formed) or‘Pindita’ (dried fecal mass) for...
33a) Mridu Virechana87 –         The drugs which are Manda in Veerya or when combined with opposite Veerya orgiven in low ...
34because, they are unable to eliminate Dosha completely92. Sharangdhara recommends theuse of Madhyama Virechana in Madhya...
35D. Virechana from Ruksha and Snigdha point of view:           In many places in Ayurveda, the uses of Sneha Virechana an...
36F. Virechana drugs according to seasons105:                       Table no 9: Virechana drugs according to seasons      ...
37H. Dosage of Virechana drugs according to Matra and Kosta:         Matra of the Virechana drug should be in such a quant...
38J. Virechana Drugs According to Dosha110:                      Table no 11 showing Doshawise Virechana Dravyas      Sl. ...
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THE STUDY OF VIRECHANA KARMA AND ITS EFFECT ON BODY FLUIDS W.S.R.T SERUM ELECTROLYTES- AN OBSERVATIONAL STUDY, BY Dr. Santosh L. Yadahalli, DEPARTMENT OF PANCHAKARMA,POST GRADUATE STUDIES AND RESEARCH CENTER,SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,GADAG – 582103.

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  1. 1. “THE STUDY OF VIRECHANA KARMA AND ITS EFFECT ON BODY FLUIDS W.S.R.T SERUM ELECTROLYTES”- AN OBSERVATIONAL STUDY BY Dr. Santosh L. Yadahalli Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. In partial fulfillment of Regulations for award of degree of DOCTOR OF MEDICINE (AYURVEDA VACHASPATI) 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
  2. 2. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDITATE I hereby declare that this dissertation / thesis entitled “The study ofVirechana Karma and its effect on Body Fluids w.s.r.t SerumElectrolytes”- an observational study, is a bonafide and genuine researchwork 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 CandidatePlace: (Dr.Santosh L. Yadahalli)
  3. 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “The study of VirechanaKarma and its effect on Body Fluids w.s.r.t Serum Electrolytes”-an observational study, is a bonafide research work done byDr. Santosh L. Yadahalli in partial fulfillment of the requirement for thedegree of Ayurveda Vachaspati in Panchakarma. This work is applied, scientific and an original contribution in the field of researchin Ayurveda. I am fully satisfied with his original work and recommended the dissertation to beput before the adjudication.Date: Signature of the GuidePlace: Dr. Shashidhar H. Doddamani MD (Ayu) Asst Professor, Post Graduate Department of Panchakarma, D.G.M. Ayurvedic Medical College, Gadag.
  4. 4. ENDORSEMENT BY THE HOD, PRINCIPAL HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “The study of VirechanaKarma and its effect on Body Fluids w.s.r.t Serum Electrolytes”- anobservational study, is a bonafide research work done by Dr.Santosh L. Yadahalliunder the guidance of Dr. Shashidhar H. Doddamani MD (Ayu) Asst Professor, PostGraduate Department of Panchakarma, Shri D.G.M.A.M.C, Gadag and contributed goodvalues 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
  5. 5. COPYRIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation / thesis in print orelectronic format for academic / research purpose.Date: Signature of the CandidatePlace: Dr.Santosh L. Yadahalli © Rajiv Gandhi University of Health Sciences, Karnataka.
  6. 6. ACKNOWLEDGEMENT I express my deep sense of gratitude to his great holiness JagadguruShri Abhinava Shivananda mahaswamiji for their divine blessings. I bow to the “SUPREME SOUL”, who graced adi, Madhya and antya throughOM 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 andaffection through Gurus,Father,Mother,Elders,Youngers etc. I express my deep sense of gratitude to my respected ProfDr. G. Purushottamacharyulu, Head of the department, Department of PostgraduateStudies and Research in Panchakarma, D.G.M.A.M.C., Gadag. He has been very kind toguide me in research and for whose extraordinary efforts, tremendous encouragement andmost valuable advice made me to complete this work. I express my obligation to my guide, Dr. Shashidhar H. Doddamani, Asst Profin the Department of Panchakarma, P.G.A.R.C, D.G.M.A.M.C, Gadag, for tremendousencouragement 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 mypostgraduate studies. I am very much thankful to Dr. P. Shivaramudu Asst. Prof, Dept ofPanchakarma, for his valuable suggestions and support through out this study. I am very much thankful to Dr. Santosh N. Belavadi Lecturer,Dept ofPanchakarma, for his suggestions and support through out this study. I am very much thankful to Late. Dr. C. M. Sarangamath who is the root causeof 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 andDr. D.M.Patil for their valuable suggestions and timely help which made me to completethis dissertation work successfully. I am very much thankful to Dr.S.A.Patil H.O.D (Siddanta) and Dr. RadderH.O.D (Panchakarma) for encouragement and moral support during the study.
  7. 7. I am very much thankful to Dr. Bhajantri Medical Officer, Shirahatti, for hissuggestions 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. TippangoudaLaboratory technician who extended his co-operation in investigations. Special thanks to Dr. Srinivas Reddy, in spite of his busy schedule hehas given valuable suggestions and supported through out this study. I extend my gratefulness and sincere heartfelt gratitude to my colleaguesDr.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 scholarsof Kayachikitsa, Rasashastra and Dravyaguna Department for their timely supportduring the study. I am very much thankful to all UG staff and college librarianShri. V. M. Mundinmani and other library staff for their timely help and co-operationduring the study. I am very much thankful to my parents, my Brother and Bhabhi who inspiredme for higher study, rendered their valuable suggestions and encouragement throughoutthe study. I wish to thank RMO, Dr. Yerageri, physicians and other hospital staff for theirco-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 sisterVanishree for their technical support. In spite of their busy schedule they helped me inthe dissertation work in time. I wish to thank all the persons who have helped me directly and indirectly withapologies for my inability to identify them individually.Date: Signature of the CandidatePlace: Dr. Santosh L. Yadahalli
  8. 8. LIST OF ABBREVIATIONS USED AS – Ashtanga Sangraha AH – 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
  9. 9. ABSTRACTBACK GROUND – Now a day Ayurveda Chikitsa is becoming popular because of SamshodhanaChikitsa, 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 verynecessary 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 andElectrolytes 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’ – TamakaShwasa 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.
  10. 10. 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 theShodhana Chikitsa. Virechana is such a procedure which has Snehana and Swedana as Purvakarmaswhich 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 eliminatesthe 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.
  11. 11. 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. Bibliography10. Annexure
  12. 12. LIST OF TABLESSl. Table Page Name of the TableNo Nos 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 3610. 10 Doses of Virechana according to Sharangadhara 3711. 11 Dosha wise Virechana Dravya 3812. 12 Criteria for Antiki, Vegiki and Maniki Shuddhi of Virechana karma 4313. 13a Samyak Yoga Lakshanas of Virechana Karma 4314. 13b Ayoga Lakshanas of Virechana karma 4415. 13c Atiyoga Lakshanas of Virechana Karma 4516. 14 Virechana Vyapad and their treatment 4617. 15 Samsarjana Krama (Diet) 4618. 16 Classification and comparison of representatives Laxatives 5319. 17 Summary effects of some Laxatives on Bowel function 5420. 18a Aharaja Nidana of Kitibha Kusta 6021. 18b Viharaja Nidana of Kitibha Kusta 6122. 18c Daivapacharaja Nidana of Kitibha Kusta 6123. 19 Purvarupas mentioned by different Acharyas of Kitibha Kusta 6424. 20 Rupa mentioned by different Acharyas of Kitibha Kusta 6525. 21 Comparison between Kitibha Kusta and Psoriasis 6626. 22 Nidana of Amlapitta 7027. 23 Samanya Rupa 7328. 24 Nidana of Shwasa/ Tamaka Shwasa 7729. 25 Purvarupa of Shwasa roga 8230. 26 Rupa of Tamaka Shwasa 8331. 27a Properties of Ingredients of Panchakola Churna 89
  13. 13. Sl. Table Page Name of the TableNo Nos No32. 27b Properties of Ingredients of Murchita Ghrita 8933. 27c Ingredients of Murchita Ghrita 9034. 27d Properties of Tila Taila 9135. 27e Summarized Pharmacological profile of Trivrit 9236. 27f Subjective Criteria for Samyak Virechana Karma 9937. 28 Status of Patients of the present study 10238. 29a Age wise distribution of 3 Groups 10339. 29b Sex wise distribution of 3 Groups 10440. 29c Distribution of 3 Groups by occupation 10541. 29d Distribution of 3 Groups by Vyasana 10642. 29e Distribution of 3 Groups by Prakriti 10743. 29f Distribution of 3 Groups by Disease Symptoms 10844. 30a Distribution of Sneha Matra of 3 Groups 10945. 30b Sneha Jeeryamana Lakshanas of 3 Groups 11046. 30c Distribution of Sneha Jeerna Lakshanas of 3 Groups 11147. 31a Distribution of Samyak Snigdha Lakshanas of 3 Groups 11248. 31b Time taken for Sneha Jeerna in Group ‘A’ 11249. 31c Time taken for Sneha Jeerna in Group ‘B’ 11350. 31d Time taken for Sneha Jeerna in Group ‘C’ 11451. 32 Number of Vegas produced in 3 groups 11652. 33 Distribution of Patients on Maniki in 3 Groups 11753. 34 Distribution of Patients on Antiki produced in 3 Groups 11854. 35 Distribution of Patients on Laingiki produced in 3 Groups 11955. 36 Distribution of Patients on type of Shuddhi produced in 3 Groups 12156. 37 Fluid loss during Virechana Karma 12257. 38 Calculation of Fluid loss 12358. 39a ANOVA table for the Parameter Sodium 12359. 39b ANOVA table for the Parameter Chloride 12460. 39c ANOVA table for the Parameter Potassium 12461. 39d Statistical Assessment in Group ‘A’ Kitibha Kusta 12462. 39e Statistical Assessment in Group ‘B’ Amlapitta 12463. 39f Statistical Assessment in Group ‘C’ Tamaka Shwasa 125
  14. 14. LIST OF FIGURES AND GRAPHSSl. 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
  15. 15. 1 INTRODUCTION Ayurveda is a science which imparts knowledge about life, with special referenceto its definition and description of happy and unhappy life, useful and harmful life. Nowadays, total world is looking towards best disease healing methods in thelines of holistic approach. We can find only Ayurvedic science which completely fulfillsthis criterion. Ayurveda has got vivid area for the treatment of diseases like, Shodhanaand Shamana type of treatments. Among these two, shodhana (Panchakarma) chikitsaplays a major role in treating and preventing the relapse of diseases. The procedure which helps to eliminate the vitiated doshas from the body iscalled Shodhana1 and is 5 in number. Vamana Karma, Virechana Karma, Anuvasanabasti, Niruha basti and Nasya Karma.2 Sushruta mentioned Anuvasana basti and Niruhabasti as Basti Karma only and added Raktamokshana as a fifth karma.3 Among the Panchakarmas, Virechana karma has got more importance in view ofits easy administration through oral route in a natural direction, thus helping the nature todo its job. Though the word Virechana conveys the meaning of Rechana through either ofthe way, its clinical practice is limited to only Adhobhagaharatwam. Virechana is theonly method of eliminating vitiated doshas (toxic materials) including Adhovata fromadhoamashaya more appropriately. The Shodhana karmas should always be preceded by Purvakarma, such asPachana, Snehana karma, Swedana karma. These Purvakarma cause vishyandana,doshapaka, srotomukha vishodhana and thus brings the vitiated doshas from shakhas tokosta.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  16. 16. 2 Virechana karma is a specific shodhana procedure among the Panchakarmas(Biopurificatory procedures). It is specially indicated for pitta dosha, pitta predominantrogas (diseases), pitta dosha anubandha kapha and also kapha dosha which is situated inpitta sthana. Virechana is also useful in the elimination of vitiated vata dosha and also inthe treatment of Rakta and its disorders. Udaka (Body fluids) plays an important role in the digestion and metabolism andalso in the procedure of Virechana karma. The nutrients will carry through ahara rasa totheir respective tissue levels (Dhatu). Rasa, Rakta and Mutra etc are composed ofjaleeyamsha which are in udaka nature. The combination of Prithwi and Aap mahabhootain the Virechana dravyas which are adhobhaga hara accomplishes the elimination ofdoshas from Guda margaThe Purisha with pitta, kapha and vata are excreted byVirechana respectively. The Virechana karma can be assessed on the basis of samyak (purificatorysymptoms) Virikta lakshanas of Vegiki, Maniki, Antiki and Laingiki in pradhana,madhyama and avara shuddhi. During this procedure some amount of fluid is lost alongwith 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 fluidsafter samyak Virechana karma while mentioning the shuddhi. But in Atiyoga lakshanasof Virechana karma, some symptoms like, Kapha kshayaja vikara, Murcha, Trishna etcare mentioned which are similar to fluid loss symptoms. So to assess the actual loss offluids during Virechana karma present or not is the subject of interest. Till now no satisfactory contributions (researches) have been conducted on thisVirechana procedure. So here the work chosen was to understand the mode of action of“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  17. 17. 3samyak Virechana on the body fluids (electrolytes) where it gives the proper knowledgeon both Ayurvedic sciences in the lines of modern science and technology. For convenient of my study, the diseases Kitibha Kusta, Amlapitta and TamakaShwasa 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 secondpart ‘B’ deals with the materials and methods, observations, results, discussion withhypothesis of the effect of Virechana karma on body fluids, summary and conclusion.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  18. 18. 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.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  19. 19. 5 REVIEW OF LITERATUREHISTORICAL REVIEW: In the text Vinayapittaka, written during the period of Buddha, it is mentionedthat Virechana was given to Bhagawan Buddha by inhaling some powder spread overUtpalapatra. In Bhrihatrayee, Laghutrayee and other Ayurvedic texts we get elaborativedescription of Virechana Karma. In Charaka Samhita Sutrasthana Virechana dravya Sangraha, Virechana yoga’s,procedure of Virechana is mentioned4-6, in Kalpasthana complete explanation ofVirechana 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 Trivritdifferent 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 KalpasthanaVirechana 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 isexplained19. In Sharangadhara Uttara Khanda virechanopayogi dravyas, their Matra, VirechanaVidhi is elaborately explained20. Cathartics are used in modern medicine for this treatment. Different types, theiractions and drugs used for Cathartics are mentioned in Satuskar Pharmacology21.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  20. 20. 6SHARIRA –Anatomy and Physiology of Amashaya and Pakwashaya: As this study deals with Virechana karma and its effect on Body fluids, it isnecessary to explore the basic Anatomy and Physiology of Gastrointestinal tract andBody fluids (Electrolytes). In Ayurveda, the human body is termed as ‘Shareera’ and ‘Deha’. These twosynonyms convey two different and opposite meanings, i.e, “Sheeryate anena itiShareeram”-means to be rendered to pieces and therefore indicates continuous decay ofbody and the term ‘Deha’ derived from the root ‘Dih Ghanj’ meaning to grow or todevelop. Thus the above two synonyms of the body indicate both catabolic and anabolicactivities going on simultaneously in the body. The digestion of the food is the function of the jatharagni, also known as PachakaPitta, which is located in Amashaya and Pakwashaya. These two organs comprise aSrotas called ‘Annavaha Srotas’ (food conducting channel or alimentary tract) which is apart 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 areresponsible for the digestion of the food. Even though the synonym Amapakwashaya“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  21. 21. 7indicates that kosta is made up of these two organs, actually kosta comprises of twosrotases, viz, Annavaha Srotas and Pureeshavaha Srotas. The ingested food digested anddivided in to Sara (essence) and Kitta (waste) in this Srotas. The waste after beingtransformed in to Purisha (feces) in the Pureeshavaha Srotas by the Purishadhara Kalaand it is excreted through the Guda marga. A consistent, clear and precise anatomical description of Annavaha Srotas hasbeen furnished in ‘Atreya Samhita’ which has been coated by Vaidyaka Shabdasindhu as‘Annapaka Nadi’. The description of Annapaka Nadi resembles the anatomicaldescription of alimentary tract of modern science. Annapaka Nadi concerns with thedigestion and metabolism of food as it is composed of Kala and Peshi and is of twentycubits in length. The part of this Nadi (tube) which extends from Kantha above and theAmashaya below is known as the Anna Nadi. Amashaya is situated and appears likebulging head. The Sthulantra follows with Kshudrantra (small intestine) commences from theAmashaya. 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 alreadybeen digested. The lower portion of the Sthulantra is known as Guda. Its function is toexpel 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 itsoft and mucilaginous.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  22. 22. 8 The Jatharagni which is situated below the Amashaya in Grahani is activated bySamana Vayu along with Pachaka pitta digests the food which has been taken inappropriate 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); therethe Samana Vayu stimulates the Ushmata of Pachaka Pitta which is present in PittadharaKala and facilitates the Paka Karma. By the help of Kleda and Snehabhavas, the food willget softened beginning from Amashaya. The digestion or Paka Karma depends upon theKala, which is responsible for the preceding of vipakas of Paka Karma. Yogaratnakaraadvises not to consume food before three hours of earlier meal and not to do theLanghana after six hours of taken food. Samayoga is the appropriate intake of food thatbrings about Dhatu Samyata. The Samana Vayu which is situated in Amashaya accomplishes rapid movementof 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. thepropulsion of food particle from one segment to another segment is done by SamanaVayu throughout the Amashaya and Grahani up to Pakwashaya. The Samana Vayu by itsinfluence towards the rapid movement and pressure alteration helps in absorption ofSarabhaga through the intestinal villi and Kittabhaga is propelled forwards intoPurishadhara Kala for the formation of Malabhaga. Once the Kittabhaga enters into the Pakwashaya it gets converted into solid formby the action of Apana Vayu and it is excreted through the Gudamarga.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  23. 23. 9Movements of Annavaha Srotas: All movements are caused by contractions and relaxations of muscles. Sosimilarly 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.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  24. 24. 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 GIT1) 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 GITIntrinsic Nervous system – 2 Types: Mesenteric Nerve Plexus Sub mucous Nerve Plexus Extrinsic Nervous system – in the form of Autonomic Nervous system (Bothsympathetic and parasympathetic)“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  25. 25. 11Stomach: Table no 1 Summary of Digestive Activities in the Stomach Structure Activity ResultMucosaChief cells Secrete pepsinogen Pepsin, the activated form, breaks certain peptide bonds in proteins. Secrete gastric Splits short-chain triglycerides into fatty acids lipase. and monoglycerides.Parietal cells Secrete Kills microbes in food; denatures proteins; hydrochloric acid. converts pepsinogen into pepsin. Secrete intrinsic Needed for absorption of vitamin B12, which factor is used in red blood cells formation (erythropoiesis).Surface Secrete mucous Forms a protective barrier that preventsmucous cells & digestion of stomach wall.mucous neck Absorption Small quantity of water, ions, short-chain fattycells 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. Macerate food and mix it with gastric juice, forming chyme. Peristalsis. Forces chyme through pyloric sphincterPyloric Opens to permit Regulates passage of chyme form stomach tosphincter passage of chyme duodenum; prevents backflow of chyme from into duodenum duodenum of stomach.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  26. 26. 121. 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 Consists of alternating contractions of circular smooth (Duodenum 12 muscle fibers that produce segmentation and re times per min, segmentation of sections of the small intestine; mixes Ileum 8 times per chyme with digestive juices and brings food into contract min) with the mucosa for absorption. Migrating motility A type of peristalsis consisting of waves of contraction and complex (MMC) 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.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  27. 27. 13Large 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 Breaks down undigested carbohydrates proteins, activity 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 Lubricates colon and protects mucosa mucous Water absorption solidifies feces and contributes Absorption to the body’s water balance; solutes absorbed include ions and some vitamins. Muscularis Haustral Moves contents from haustrum to haustrum by churning muscular contractions. Peristalsis Moves contents along length of colon by contractions of circular and longitudinal muscles. Mass peristalsis Forces contents into sigmoid colon and rectum. Defecation Eliminates feces by contractions in sigmoid colon reflex and rectum.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  28. 28. 14Absorption of Faeces formation in the large intestine: By the time chyme has remained in the large intestine 3-10 hours, it has becomesolid or semisolid because of water absorption and is now called feces. Chemically, fecesconsist of water, inorganic salts, and sloughed-off epithelial cells from the mucosa of thegastrointestinal tract, bacteria, and products of bacterial decomposition, unabsorbeddigested materials, and indigestible parts of food.The Defecation Reflex: The defecation reflex occurs as follows: In response to distention of the rectalwall, the receptors send sensory nerve impulses to the sacral spinal cord. Motor impulsesfrom the cord travel along parasympathetic nerves back to the descending colon, sigmoidcolon, rectum, and anus. The resulting contraction of the longitudinal rectal musclesshortens the rectum, thereby increasing the pressure within it. This pressure, along withvoluntary contractions of the diaphragm and abdominal muscles, plus parasympatheticstimulation, opens the internal anal sphincter.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  29. 29. 15 BODY FLUIDS (ELECTROLYTES) 26 The maintenance of a relatively constant volume and a stable composition of thebody fluids is essential for homeostasis. Some of the most common and importantproblems in clinical medicine arise because of abnormalities in the control system thatmaintain 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 anddiffusion through the skin, which together account for about 700ml/day of water lossunder normal conditions. This is termed as insensible water loss. The insensible water loss through the skin occurs independently of sweating andis present even in people who are born without sweat glands- loss through skin is about300-400ml/day. This loss is minimized by the cholesterol filled cornified layer of theskin, which provides a barrier against excessive loss by diffusion. When the cornifiedlayer becomes denuded, as occurs with extensive burns, the rate of evaporation canincrease 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 avapor pressure of about 47 mm Hg, before it is expelled. Because the vapor pressure of“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  30. 30. 16the inspired air is usually less than 47 mm Hg water is continuously lost through thelungs with respiration. In cold weather, the atmospheric vapor pressure decreases tonearly 0, causing an even greater loss of water from the lungs as the temperaturedecreases. 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 % isintracellular and 25 to 45 % is extra cellular. The ECF is further subdivided intointravascular (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 isexpressed 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 cellularcompartment; total body Na+ content is a reflection of ECF volume. Likewise, K+ and itsattendant anions are predominantly limited to the ICF and are necessary for normal cellfunction. Therefore the number of intracellular particles is relatively constant and achange in ICF water content. During chronic Hyponaetremia, brain cells loose solutes,there by depending cell volume and diminishing neurological symptoms. The converseoccurs during Hypernaetremia.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  31. 31. 17 Fluid movement between the intravascular and interstitial spaces occurs thecapillary wall and is determined by the Starling forces capillary hydraulic pressure andcolloid osmotic pressure. The return of fluid in to the intravascular compartment occursvia lymphatic flow. Intracellular Fluid Compartment28: About 28 of the 42 liters of fluid in the body are inside the 75 trillion cells andare collectively called the intracellular fluid. Thus the intracellular fluid constitutes about40% of the total body weight in an average person. The composition of cell fluids isremarkably similar even in different animals, ranging from the most primitive microorganisms to humans. For this reason, the ICF of all the different cells together isconsidered 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 anormal 70 kg adult. These two largest compartments of the extra cellular fluid are theinterstitial 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 theinterstitial fluid through the pores of the capillary membranes. These pores are highlypermeable 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 thesame composition except for Proteins, which have a higher concentration in the plasma.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  32. 32. 18 Important Constituents of Intracellular Fluid: The ICF is separated from the extra cellular fluid by a selective cell membranethat 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 Chlorideions and almost no Calcium ions. Instead, it contains large amounts of Potassium andPhosphate ions plus moderate quantities of Magnesium and Sulphate ions, all of whichhave low concentrations in the ECF. Also, cells contain large amounts of Protein almostfour 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 theRBC). However, Blood is considered to be a separate fluid compartment, because it iscontained in a chamber of its own, the circulatory system. The blood volume is especiallyimportant to the control of Cardio-Vascular dynamics. The average blood volume of adults is about 7 % of body weight or about 5liters. About 60 5 of the blood is Plasma and 40 % is RBC, but these percentage can varyconsiderably 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“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  33. 33. 19Clinical Abnormalities of Fluid Volume Regulation 31: Table no 5 Electrolyte Balance Ion and Normal Disorder Symptoms Causes Treatment ECF Range (mEq/l) Sodium *Hypernaetremia *Thirst, dryness *Dehydration; *Ingestion of (136-142) (>147) and wrinkling loss of water or IV of skin, reduced hypotonic infusion of blood volume fluid. hypotonic *Hyponaetremia and pressure. solution. (<130) *Disturbed CNS function, *Infusion or *Diuretic use confusion, ingestion of and infusion hallucinations, large volumes of hypertonic coma; death in of hypotonic salt solution. severe cases. solution. Potassium *Hyperkalemia *Severe cardiac *Renal *Infusion of (3.8-5.0) ( >6 ) arrhythmias. failure, use of hypotonic diuretics, solution, chronic selection of *Hypokalemia *Muscular acidosis. different ( <3 ) weakness and diuretics. paralysis. *Low *Increase in potassium K+ diet IV of diet; diuretics. K+, K+ Tabs. Chloride *Hyperchloremia *Acidosis, *Dietary *Infusion of (96-108) ( >109) Hyperkalemia. excess, hypotonic increased solution to chloride lower plasma *Hypochloremia *Alkalosis, retention. concentration. (<95) anorexia, *Diuretic use, muscle cramps, *Vomiting, hypertonic apathy. Hypokalemia. salt solution infusion.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  34. 34. 20PROCEDURE OF SERUM ELECTROLYTES –1. Sodium Test: Method – Precipitation test for Sodium Sample – Serum Principle for Sodium – Sodium and Proteins are precipitated simultaneously by reagent containingmagnesium uranylacetate and alcohol. The precipitate is separated by centrifugation. Thesodium content is calculated from loss in the concentration of magnesium uranylacetatein comparison to the standard. The residual amount of magnesium uranylacetate, which ismeasured by colorimetrically.Calculations –Sodium (mmol/L) = ∆A Blank - ∆A Sample / ∆A Blank - ∆A Standard ×150.Normal Value - Serum Sodium: 135- 155 mmol/L2. Chloride Test: Method – End Point Colorimetry Sample – Serum Principle for Chloride – Chloride ions react with a solution containing ferric, mercuric, nitrate andthiocyanate ions in equilibrium to form yellow-brown ferric thiocyanate. Absorbancemeasured at 505 mm is proportional to the concentration of chloride in the specimen.Calculations –Serum Chloride (mEq/L) = Absorbance of Test / Absorbance of Standard × 100Normal Value – Serum Chloride: 97-107 mEq/L“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  35. 35. 213. Potassium Test: Method – Colorimetric test for Potassium Sample – Serum Principle of Potassium – The turbidity of solution containing Sodium Tetraphenyl Boron AlkalineEDTA and formaldehyde is measured after addition to sample or standard.Calculations –Potassium (mmol/L) = ∆A Sample / ∆A Sample × 5Normal Value – Serum Potassium: 3.5 – 5.5 mmol / LUDAKAVAHA SROTAS32: The food, air and water are essential for the maintenance of life. TheKapha, which confers dardhya (fitness, compactness) and sthiratwa (stability) to thebody, is the product of water. The fluidity of the ciculating rasa rakta complex, which hasthe 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’srelationship with water, it has to be summarized that the Udakavaha srotases spreadthroughout the body. But Talu and Kloma have been stated to be the moolas of thesesrotases. According to Chakrapani, Kloma is the pipasasthana (thirst centre) located inHridaya. The protoplasm which is Shleshmic and which is the essential content of thecells. 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 ispipasasthana and also masthishka. A thirst centre has been identified as a small area located slightly anteriorto the supraoptic nuclei in the lateral preoptic area of the hypothalamus. The stimulation“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  36. 36. 22of the cells of this area causes thirst and drinking of water. These cells are stimulated byan increased osmotic pressure of the body fluids, which in turn is dependent on theamount of water in the body. Any factor that will cause intracellular dehydration will ingeneral cause the sensation of thirst. It may be noticed from the above information that the changes in thequantity of both Avalambaka and Tarpaka Kapha cause stimulation of the pipasasthanalocated in masthishka and generate a sensation of thirst.Causes of vitiation of Udakavaha Srotas:1. Ushna ahara and vihara2. Ama accumulation3. Bhaya4. Madyapana5. Trishna6. The causes which vitiates Pitta7. 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 Kloma2. Excessive thirst These above are the signs and symptoms of Trishna roga and suggestedtreatment for the vitiation of Udakavaha srotases is that of Trishna roga, which mainlyPitta hara in nature is. An injury to the Udakavaha srotases produces – Thirst and Death.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  37. 37. 23 :VIRECHANA KARMA: The process by which the vitiated doshas are eliminated through the gudamarga (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 throughany route. But in Ayurveda the word Virechana is used for indicating only theelimination of malas through the adhobhaga i.e., anus. Because there are certain specificterminology used in Ayurvedic texts to indicate the malas eliminated through the routesother 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 ofVirechana. According to Charaka, the Virechana drugs first get digested in Amashaya,“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  38. 38. 24then reaches to Hridaya, Dhamani, macro and micro channels (srotases) of the body andreach the site where Doshas are accumulated. Virechana drugs soften the compactness (Sanghata) of the Doshas and break thebigger 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 ofVirechana is known as its systemic effect and it is obviously governed by Viyojana andSamparchana components of Virechana dravya.Nirukti: The act of expelling vitiated doshas (malas) through Adhobhaga is known asVirechana34. Here the meaning of Adhobhaga is ‘Guda’ commented by Chakrapani.35 || Virechana is the procedure in which the orally administered drug acts oninternally vitiated Doshas, specifically on Pitta and expels them out through anal route.36 Virechana Karma is considered as the best treatment for evacuation of morbidPitta Dosha.Paryaya: Rechana and Praskandana is also one of the synonym.37 According to the Sanskrit – English dictionary- Purgative, Cathartic, Evacuantand Aperient are the different meanings of Virechana (M.Monier Williams).“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  39. 39. 25Virechana Yogya and Ayogya: A number of diseases listed below along with Dosha predominance Table no 6 VIRECHANA YOGYA38-46 B.P Virechana Yogya C.S Su A.S A.H B.S Sh Y.R1. Pitta Pradhana VyadhiJwara + + + + + + +Pandu + + - - - + +Kamala + - - + - - -Halimaka + - + + - - -Asyadaha + + - - - - -Netradaha + + - - - - -Paittikavyadhi + + + - - - -2. Vata Pradhana VyadhiPakshaghata + + + + + + +Pakwashaya Ruja - + + + - - -Shirahshula + - + - - - -Parshwaruja + - - - - - -Gulma + + + + - + +Vatarakta + + + + - + +3. Kaphapradhana VyadhiPrameha + + - - - + +Netrasrava + - - - - + +Asyasrava + - - - - + +Nasasrava + - - - - + +Shwasa + - - - - - -Kasa + - - - - - -Shwayathu + + - - - + +4. Tridoshaja VyadhiKushta + + - - + + +Visarpa + + - - - - -Hridroga + + - - - + +“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  40. 40. 265. Rakta Pradhana VyadhiPleeha + + + + + + +Vyanga + - + + - - -Nilika + - - - - - -Visphotaka + + + + + + -6. Manasa RogaUnmada + - - - - - -Apasmara + + - - - - -7. Stree RogaStanya Dosha + + + + - - -Yoni Dosha + + + + - + +8. Shalya Sadhya VyadhiArbuda + + - - - - -Bhagandara + + + - - + +Arsha + + + + - + +Vidradhi - + + + - + +Granthi + + - - - + +Galaganda + - - - - - -Bradhna + - - - - - -Dushtavrana - + + + - - +Vriddhi - + - - - - -Apachi + - - - - - -Mutraghata + + + + - + +Shastrakshata - + - - - - -Ksaragnidagdha - + + - - - -9. Shalakya VyadhiTimira + + + + - - -Abhishyanda - + + + - - -Kacha - + + + - - -Akshipaka - + + - - - -10. Annavaha SrotasKrmikoshta + + + + - + +Garavisha - + - + - + +Visucika + + - - - + +Alasaka + + - - - - -“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  41. 41. 27Udara + - + + - + +Arocaka + + - - - + +Avipaka + + - - - + +Vibandha - + + + - - -Anaha - + - - - - -11. Pratimarga ChikitsarthaUrdhwaga Raktapitta + + + + - - -Udavarta + - + - - - -Chardi + + + + - + +Some other indications for Virechana are:a) In Swastha47,48b) Utkleshita Pitta Pitta Sthanagata Alpa Kapha Kapha Sthanagata Bahu Pitta49 Pakwashayagata Pitta or Kapha Pitta50 Pittavrita Vata Kaphavrita Vata51 Shonita Roga52c) As Purvakarma in Rasayana and Vajikarana53,54 Table no 7 VIRECHANA AYOGYA55-62 B.P. Virechana Ayogya C.S Su. A.S. A.H. B.S. Sa. Y.R.1. Karma AsahanataVilambita + - + - - - -Durbala + - - - + - -Durbalendriya + - - - - - -Upavasita + - - - - - -Subhaga + - - - - - -Alpagni + + + + - + +Khsatakshina + + + - - + +Shranta + + + - - + +“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  42. 42. 28Pipasita + + - - + + +Karma Bharadhvahata + + - - - - -Vriddha + - - - - + +Bala + + + - + - -Atikrsha + - + - + + -Atisthula + + + - + + -Darunakoshta + - + + - - -Kshama + - - - - - -Garbhini + + - - - - -Bhakta + + - - - + -Rikta Koshta - - - - + - -Lalit - - - - + - -Sukumara - - - - + - -Navaprasuta - + - - - + +2. Some other conditionsRatri Jagarita - - + - - - -Anupasnigdha - - - - + - -Atisnigdha + + - + - + +Atiruksha + - - - - + +Bhayabheeta - + - - - + +Chintaprasakta + - - - - + +Maithunaprasakta + - - - - - -Adhyayanaprasakta + - - - - - -Vyayamaprasakta + + + + - + +Shalyardita + - + + - - -Kamadi Vyaghra + + - - - - -Niruddha + - - - - - -3. SamavasthaNava Pratishyaya - + - - - - -Nava Jvara + + + + - + +4. Gudagata VyadhiKhsataguda + + + - - - -Muktanala + - + - - - -5. Anya VyadhiMadatyaya + + + - - + +Adhmana + + + - - - -Talushosha - - - - + - -“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  43. 43. 29Urusthambha - - - - + - -Ardita - - - - + - -Hanugraha - - - - + - -Hridroga - - - - + - -Kevala Vataroga - - - - + - -Rajayakshma - - + - - - -Shosha - - - - + - -6. Marga Virodhi VyadhiAdhoga 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 forVirechana and according to their action, etc. According to references available Virechana drugs may be classified in following6 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, someminerals - Swarna, Kamsya, Manahsila, Gandhaka, Ratna, Uparatna, Samudraphena alsohave Sara properties.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  44. 44. 30 Table no 8Sl. According to part C.S Su.S VaNo of the plant used for Virechana 1 Mulini Virechana a. Hastidanti a. Trivrit a. Danti Dravya.67,68,69 b. Shyama b. Shyama b. Kumbha (Trivrit) (Root cathartics) c. Trivrit c. Danti c. Gavakshi d. Adhoguda d. Dravanti d. Shankhini e. Saptala e. Saptala f. Danti f. Shankhini g. Gavakshi g. Vishanika h. Vishanika h. Gavakshi i. Ajagandha i. Chitraka j. Dravanti j. Kusha k. Avartaki k. Kasha l. Kinahi 2 Phalini Virechana a. Shankhini a. Kampillaka a. Neelini Dravya.70,71,72 b. Vidanga b. Puga b. Triphala (Fruit Cathartics) c. Anupa c. Eranda c. Kampillak d. Sthalaja d. Haritaki e. Prakeerya e. Bibhitaki f. Udakeerya f. Amalaki g. Abhaya g. Neelini h. Anthakotrapuspi h. Aragwada i. Kampillaka j. Aragwada 3 Ksheera Virechana a. Snuhi ksheera a. Mahavriksh a. Snuhi Dravya73,74 b. Arka b. Saptachala b. Swarna ksheeri (Milk Cathartics) c. Swarna ksheeri c. Godugdha 4 Twak Virechana a. Tilwaka a. Tilwaka a. Tilwaka Dravya 75,76 b. Patala b. Ramyaka ( Bark Cathartics) c. Ramyaka 5 Patra Virechana a. Swarna patri a. Putika a. Aragwada Dravya b. Aragwada b. Aragwada (Leaf Cathartics) c. Karavellaka“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  45. 45. 31B. Virechana drugs according to their mode of action by Sharangadhara: Acharya Sharangdhara has classified according to the action of the Virechanadravyas.a) Anulomana78 : Means - sending or putting in right direction The drugs which will digest the Apakwam (undigested material) malas and bringthem to adhomarga for defecation process. That is these drugs will facilitate thedefecation process. eg: Hareetaki (Terminalia Chebula). Sushruta considers Sara as the synonym of Anulomana. According to DalhanaAnulomana causes expulsion of Vata and Kapha79. According to Raja Nighantu, Bhoutika composition of Anulomana drugs issimilar 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 therectum without digesting (Paka) them. eg: Aragwada (Casia Fistula). In the context of Jwara Chikitsa it has been mentioned that Sramsana eliminatesthe Pitta and Kapha situated in Pakwashaya 81.c) Bhedana82 : Meanings of Bhedana are breaking, splitting, piercing, dividing, separations, etc.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  46. 46. 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 thenevacuating 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) Malasor 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 Virechanarepresents the complete therapy which includes Purvakarma, Pradhana Karma andSamsarjana Krama; while the Rechana is the action of some types of drugs used inVirechana. There are certain drugs which will help in proper Virechana or which willsynergies the action of Virechana Dravyas is known as Virechanopaga. The drugsdescribed are Draksha, Kashmarya, Parushaka, Abhaya, Amalaka, Vibhitaka, KuvalaBadara, Karkandhu, and Pilu86.C. Virechana drugs according to mode of action: According to the degree of potency of the drugs, the Virechana may be classifiedinto the following categories.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  47. 47. 33a) Mridu Virechana87 – The drugs which are Manda in Veerya or when combined with opposite Veerya orgiven in low dosage, given to the Ruksha patient and causes less purgation is known asMridu Virechana. Those drugs are specifically indicated in weak patients having mildnatured diseases and are not so effective in Balavan patients. These drugs may also begiven to the patients who have been Shodhita previously or having Alpa Dosha or whoseKoshta is unknown. Charaka is of the view that the physician should not hesitate to useMridu Virechana drugs in weak patients having more Doshas because even repeatedelimination of Doshas in small quantity may cure the disease88. The patient who have not taken Virechana drugs in past and whose Koshta isunknown in such persons Sushruta recommends the use of Mridu Virechana drugs in thebeginning 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 areGuda, Ikshu Rasa, Mastu, Ullodita Dadhi, Payas, Kshira, Sarpi, Kashamari, Triphala, Piluand 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 andKala and not having all the required properties and given comparatively in less quantityto the patient and not properly Snehita and Swedita patient works as Madhya Virechana. The drugs are specifically indicated in the patients having Madhya Roga (diseasewith moderate symptoms). The administration of these drugs in Balavan rogi is useless“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  48. 48. 34because, they are unable to eliminate Dosha completely92. Sharangdhara recommends theuse of Madhyama Virechana in Madhyama Koshta. eg. Trivrit, Katuki and Aragvadha93.c) Teekshna Virechana : The drugs, which cause numerous motions (Mahavega) and eliminates the Doshasin large quantity by quick (Kshipra) and gentle (Sukha) purgation without causing eithermuch depression (Glani), is known as Teekshna Virechana. According to Charaka, the drug which has been kept away from water, heat andorganisms, cultivated in proper Desha and Kala and which has been given Bhavana withthe drugs of same Veerya acquires the Teekshna properties. This type of drugs having allthe required properties, when given in prescribed dosage to the patient who has been wellSnehita and Swedita, then it causes Teekshna Virechana94. Sharangdhara recommendsuse of Teekshna Virechana drugs in Krura Koshta persons. Charaka recommends the use of these drugs in the strong (Balavan) patientspresenting all the symptoms of the diseases i.e. Teekshna Vyadhi95. It has been furthermentioned that the use of these drugs should be avoided in Durbala (weak), Shodhita, andpatient having Alpa Dosha and whose Koshta is unknown, otherwise it may causeuntoward effects of these patients96. Sushruta is of the view that Teekshna drugs given inMridu Koshta having Deeptagni passes out quickly without eliminating Doshasproperly97, Snuhi Kshira is considered as the best amongst these drugs98. More overSharangdhara recommend the other drugs like Hemakshiri, Danti, etc. explained in KruraKoshta may also be included in this group.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  49. 49. 35D. Virechana from Ruksha and Snigdha point of view: In many places in Ayurveda, the uses of Sneha Virechana and Ruksha Virechanahave been recommended. The drug used in the form of oil or the preparation containing Sneha is known asSneha Virechana, eg: Eranda Taila. Vagbhata recommends the use of Sneha Virechana inall patients except Snigdha patients99. The use of Sneha Virechana in the patients who have been given higher dosage ofSneha is contraindicated because, due to this, the moving Doshas may again adhere in theSrotas100, 101. Sneha Virechana should be administered in Sama-Shitoshma Kala102. The preparations, which do not contain Sneha, may be known as RukshaVirechana. Its use has been recommended in the Snigdha patients who have beencomparatively 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.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  50. 50. 36F. Virechana drugs according to seasons105: Table no 9: Virechana drugs according to seasons Shishira, Grish Hemantha Varsha Sharad All seasons Vasanta ma (Vagbhat )Preparation Beeja Shyama Shyama Shyam Trivrit Trivrit Trivrit Trivrit Trivrit a Chitraka Danti Kutaja Duralabha Pippali Trivrit Patha Hapusha Pippali Musta Nagara Ajaji Saptala Shunthi Sharkara Sindhu Sarala Katuki Udichya Aruna Vacha Swarnaksiri Shweta Trivrit Hemakshiri Chandana churnaAnupana Draksha Yasti Honey Sugar Warm Bhavana Rasa madhu in Water with cow and Draksha urine Honey Swarasa or Draksha Swarasa only Adhamalla in Sharangdhara commentary mentioned that the drugs for Virechanain Shishira, Vasanta and Hemanta Rutu are same. Kasiram Vaidya in his commentaryopined that Saindhava, Vriddhadaru, Shyama and Trivrit are to be used for Virechana inHemanta Rutu. Charaka mentions Trivrit Chitraka, Patha, etc. to be used for Virechana inHemanta Rutu.G. According to Kalpana: This is for maintenance of active principle for longer period and convenience oftaking 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.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  51. 51. 37H. Dosage of Virechana drugs according to Matra and Kosta: Matra of the Virechana drug should be in such a quantity, that the desired effectof Shodhana may be achieved and may be able to avoid Atiyoga. This should be decidedaccording 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 Heena for Madhyama for Uttama for Kalpana Mridu Koshta Madhyama Koshta Krura KoshtaKwatha 8 tolas 4 tolas 2 tolasKalka, Choorna Modaka 4 tolas 2 tolas 1 tola It is better to add honey/Ghrita if the taste is Vishavat while using thispreparation.According to Sushruta108: 1, 2 and 3 Tolas Matra is mentioned for Mridu, Madhyama and Krura Koshtarespectively.I. Nature of Koshta and Virechana109: Acharya Sharangdhara opines that – for the person Mridu Kostha, Virechanadrugs must be mild and their dose should be minimum; for the Madhyama medium doseand for Krura Kostha persons, the Virechana drugs should be Tikshna and its dose isminimum.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.
  52. 52. 38J. 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 PradhanaK. 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, Snehanaand Swedana procedures as Purvakarma.PURVAKARMA:1) Pachana : In the patients with Agnimandya, administrations of Pachana drugs are useful forAma Pachana and also to increase the Agni. Ama Pachana should be done till theappearance of Nirama Lakshanas.2) Snehapana : Snehapana procedure is to be followed after observing Nirama Lakshanas. Therequired Sneha should be administered early in the morning at Suryodayakala afterobserving Jeerna Ahara Lakshanas of the previous meal and when the patient is emptystomach. The duration of Sneha Pana should be 3 to 7 days113, 114.“The Study of Virechana Karma and its effect on Body Fluids WSRT Serum Electrolytes”- an observational study.

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