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EFFICICACY OF SIRAVYADHA WITH AND WITHOUT VIRECHANA IN SHARAD RUTUA COMPARATIVE STUDY, RAVIKUMAR B. PATIL, DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA GOVERNMENT AYURVEDIC MEDICAL COLLEGE …

EFFICICACY OF SIRAVYADHA WITH AND WITHOUT VIRECHANA IN SHARAD RUTUA COMPARATIVE STUDY, RAVIKUMAR B. PATIL, DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA GOVERNMENT AYURVEDIC MEDICAL COLLEGE DHANWANTARI ROAD, BANGALORE


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  • 1. “EFFICICACY OF SIRAVYADHA WITH AND WITHOUT VIRECHANA IN SHARAD RUTU- A COMPARATIVE STUDY.” BY Dr. RAVIKUMAR B. PATIL., B.A.M.S Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, for the partial fulfillment of Degree AYURVEDA VACHASPATI DOCTOR OF MEDICINE (AYURVEDA) IN PANCHAKARMA Under the guidance of Dr. SHYLAJAKUMARI R.. MD (Ayu.) Asst. Professor Department of Post Graduate Studies in Panchakarma, Government Ayurvedic Medical College Bangalore DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA GOVERNMENT AYURVEDIC MEDICAL COLLEGE DHANWANTARI ROAD, BANGALORE – 560009 2010-2011
  • 2. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled “Efficacy of Siravyadha with and without Virechana in Sharad rutu -A Comparative study” is a bonafide and genuine research work carried out by me under the guidance of Dr.Shylajakumari R., Asst. Professor, Dept of PG studies in Panchakarma, Government Ayurvedic Medical College, Bangalore. Date: Signature of the candidate Place: (Dr. Ravikumar B. Patil)
  • 3. Department of Post Graduate Studies in Panchakarma Government Ayurvedic Medical College Bangalore - 560009 CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Efficacy of Siravyadha with and without Virechana in Sharad rutu -A Comparative study” is a bonafide research work done by Dr.Ravikumar B. Patil . in partial fulfilment of the requirement for the degree of “AYURVEDA VACHASPATI” – MD (Ayurveda) in Panchakarma of the Rajiv Gandhi University of Health Sciences, Bangalore. I recommend this dissertation for the above degree to the University for Assessment and approval. Dr. Shylajakumari R.M.D (Ayu) Asst. Professor, Dept. of PG studies in Panchakarma GAMC, Bangalore - 09
  • 4. ENDORSEMENT BY HOD & PRINCIPAL This is to certify that the dissertation entitled “Efficacy of Siravyadha with and without Virechana in Sharad rutu -A Comparative study” is a bonafide research work done by Dr.Ravikumar B. Patil . In partial fulfilment of the requirement for the degree of “AYURVEDA VACHASPATI” – MD (Ayurveda) in Panchakarma under the guidance of Dr. Shylajakumari R., Asst.Prof., Dept of PG studies in Panchakarma, Government Ayurvedic Medical College, Bangalore. Dr. Shalini C. Eli, MD (Ayu.) D.N.Y. Principal Prof. & Head of the Department, Govt. Ayurvedic Medical College, Department of P.G. Studies In Panchakarma, Bangalore. Govt. Ayurvedic Medical College, Bangalore.
  • 5. COPYRIGHT DECLARATION BY THE CANDIDATE I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore, shall have the rights to preserve, use and disseminate this dissertation in print or electronic format for Academic / Research purpose. Date: Signature of the Candidate Place: ( Dr.Ravikumar B. Patil.) © Rajiv Gandhi University of Health Sciences, Karnataka.
  • 6. ACKNOWLEDGEMENT It gives me immense pleasure to offer my sincere thanks to all those who have rendered their wholehearted support, guidance and Co-operation in completing my work. I express my deep hearted reverence to that divine source. I bow my head to the lotus feet of “Lord Dhanvantri” with whose showering of blessings this task was ventured without any hindrances. It’s my great pleasure to express my deep gratitude towards my adorable guide, Dr.Shaylaja Kumari R., Asst. Professor, for her incessant and untiring guidance with all the diligence. Her benevolent teaching & critical suggestions had given me a propitious direction to accomplish this work in all aspects. I am also thankful to my H.O.D, Dr. Shalini C. Eli, for being a supporting hand in my work.I am also thankful to Dr. Shridhara B. S. former.H.O.D.for his encouragement and critical suggestions.. I am grateful to Dr. H.T.Srinivas MD (Ayu) former principal, G.A.M.C., Bangalore, for his support and guidance in carrying out this work. I express my deep gratitude to Principal of G.A.M.C, Bangalore Dr .S.G.Mangalgi. I am especially thankful to teachers of “Department of Panchakarma” Dr.Janaki, Dr.Santhosh.L.Y., Dr.V.M.Hugar, Dr.Shaila Gurappa, whose constant encouragement and useful suggestions helped me throughout the study tenure. I pay my obeisance to my all family members, my parents Shri B. S. Patil and Smt C. B. Patil being my inspiration and support in every step of my life. I also thank my grandparents Shri. S.R.Patil and Smt. M.S.Patil. and My brothers Ramesh and Rohit.
  • 7. I am especially thankful to Dr. Somnath Gore, Dr.Pooja B.A. and Dr. Manjunath Kanti for their support and cooperation. I am very much thankful to my seniors Dr.Usha,Dr.Ashwini Kulkarni, Dr.Rajani Ramesh, Dr.Divya, Dr.Salma, Dr.Smina, Dr.Sandeep, Dr.Somnath & My special thanks to my department colleagues and friends, Dr.Pooja Dr,Basavjyoti,Dr.Sumit,DrVijaya,Dr.Srinivas, and also thankful to my juniors Dr.Rashmi,Dr.Vanishri,Dr.Manjunath,Dr.Shridhar,Dr.Nandakishore,Dr.Muku nd Dr.Kamalesha and all other post graduate scholars for their needful support to fulfil this task. I thank library, hospital & office staff, R.M.O. Dr. Nagraj, Physicians, and all my patients for their kind support during my study. I take this opportunity to appreciate the generous co operation offered by volunteer by being highly obdient during my study period . I take all my effort to laud Dr. Raghavendra, Statistician, without whose help whole of my work would have looked meaningless. I am extremely grateful to my printer who has printed and bounded my work legibly and neatly. Last but not least, I express my thanks to each and every person who have helped me directly & indirectly in accomplishing this task without any blemishes, with apologies for my inability to identify them individually. Dr.Ravikumar B. Patil.
  • 8. LIST OF ABBREVIATIONS A.H. – Ashtanga Hridaya. A.S. – Ashtanga Sangraha. A.V. _ Atharvana veda Aru. – Arunadatta. B.P. – Bhavaprakasha. B.R – BhaishajyaRatnavali. B.N. – BhavaprakashNighantu. Bh.S – BhelaSamhita Ch.Dt – ChakraDatta. Ch.S. – CharakaSamhita Chi. – ChikitsaSthana Dal. – Dalhana. G.N. – GadaNigraha. Ha.Sam. – HaritaSamhita. Kal. – KalpaSthana Ka.Sam. – KashyapaSamhita. M.N – MadhavaNidana Ni. – NidanaSthana
  • 9. Pur. - Purvakhanda. Si. – SiddhiSthana Sha.S – Sharangadhara Samhita Su. S. – SushrutaSamhita Su. – SutraSthana Van.Sam. – VangasenSamhita. Vi. – VimanaSthana Utt. – Uttarkhanda. Y.R. – YogaRatnakara  
  • 10. ABSTRACT “EFFICACY OF SIRAVYADHA WITH AND WITHOUT VIRECHANANA IN SHARAD RUTU –A COMPARATIVE STUDY” Preserving the Health is one of the main endeavors of Ayurveda. For this Ayurveda describes in detail about various seasonal regimens, which harmonize the doshas disturbed by the effect of seasons. Disharmony of dosha and dushyas is the prime cause for the onset of disease Modern way of living with its inherent stress and unwholesome lifestyle such as working during night, sleeping during day, food habits and ignorance of seasonal regimen for healthy living causes doshas to become enormously vitiated and causes a number of diseases. .According to classics, both Pitta and Rakta naturally get aggravated during Sharad rutu. If this disharmony is not correct properly through seasonal regimen, it will lead to a plenty of diseases such as daha, kandu, kushta, visarpa etc. Raktmokshana has been prescribed as the principal seasonal regimen to correct the disharmony of pitta and rakta caused in Sharat rutu. Chakrapani opines that Raktamokshana should be after Virechana.Sharangdhara said that in sharad rutu rakta gets aggrevated naturally so do the raktamokshana but there is no specification regarding virechana before that. Whereas Bhavprakasha and yogratnakar stated that it should be siravyadha. So far a number of research work have been conducted on siravyadha in a variety of diseases but Rutushodhan a form of preventive treatment remains greatly ignored.In the present study an effort is being made to assess the importance of siravyadha as a form of rutushodhan and need of the virechana
  • 11. before raktamokshana with the objective of keeping diseases of modernity in check. Methods:A total of 30 subjects having the pittaprakopaka laxanas were included . As per the inclusion and exclusion criterias, the subjects who fulfill the criteria were selected and randomly divided into two groups consisting of 15 patients in each group. Group A: Jeerakadi Churna was administered till Niramavastha followed by arohana krama snehapan with Murchit goghrut until getting samyaka snigdha laxanas.Abhyanga with tila taila followed by parisheka sweda(Ushnodak) carried out for three days.On third day virechana yoga was administered.Depending upon the shuddhi the samsarjana karma was planned. After two days of completition of samsarjana karma snehapan with murchit goghrit was done for two days. On the day of siravyadha abhyanga and parisheka sweda was done. Group B: Jeerakadi Churna was administered till Niramavastha followed by snehapan with murchit goghrit for two days. On the day of siravyadha abhyanga and parisheka sweda was done. Subjective and objective parameters were assessed before and after shodhana. Result: The result was found highly significant in terms of clinically and statistically. Conclusion: Clinically and statistically this study was shown good results in subjective and objective parameter in both the groups. Siravyadha followed by virechana and siravyadha alone are beneficial to eradicate the vitiated pitta dosha . But the siravyadha followed by virechana is better than siravyadha alone. Key words: Virechana, Siravyadha, Sharad rutu, Pittaprakopa.
  • 12. CONTENTS 1. Introduction 1-3 2. Objectives 4 3. Review of Literature: 5- 109 • Procedure Review • Rutu Review • Drug Review 4. Methodology 110-121 5. Observation and Results 122-163 6. Discussion 164-182 7. Conclusion 183-184 8. Summary 185-186 9. Bibliography and References 10. Annexure
  • 13. List of Tables Sl.No. Headings PageNo. 1 Chapters and contents related to Virechana in Charaka samhita 5 2 Chapters and contents related with Virechana in Sushruta Samhita 6 3 Chapters and contens related with Virechana in Ashtang Hradaya 7 4 Factors and their function involved in Digestion. 9 5 Summary of Digestive Activities in the Stomach 12-13 6 Summary of the mechanical digestion in the Small intestine 13-14 7 Digestive Activities in the Large Intestine 15 8 Table Showing Properties of Virechana Dravya 18 9 VIRECHANA YOGYA 18-22 10 VIRECHANA AYOGYA 22-25 11 Classification of virechana dravyas based on parts used 26 12 Classification of virechana dravyas based on parts used and agraoushda. 31 13 Virechana drugs according to seasons 31 14 110 virechana kalpas according to Charaka 33 15 Virechana kalpas according to Sharangadhara 34 16 Virechana Dravyas used as per the Dosha 35 17 Formulations for virechana based on dosha involvement 35 18 Criteria for Antiki, Vegiki and Maniki Shuddhi of Virechana Karma 40 19 Samyak yoga lakshanas of Virechana karma 40-41 20 Ayoga Lakshanas of Virechana karma 41-42 21 Atiyoga lakshanas of Virechana karma 42-43 22 Showing the Diet Regimen 44 23 Showing the Ayoga and Atiyoga Lakshanas of Vyapath 46 24 Showing the Virechana Vyapath According to Acharyas 47 25 Showing the vyapath and its treatment 48-51 26 Showing Raktaradoshaja Rogas/Laxanas according to diffrent authours 60-61 27 Showing total no of siras present in the body 68 28 Showing number of Vedhya and Avedhya Sira 69 29 Showing Sthana and Sankhya of Avedhya Siras 69 30 Showing sites of Siravyadha in Various diseases 72-74 31 Table showing correlation of rutu with parts of yagna 79 32 Classification of rutus as Deva rutu and Pitru rutu 80 33 Table Showing Characteristic of all rutus in Varsha rutu. 80 34 Table Showing Characteristic of all rutus in Single day. 81 35 Table showing season and their respective months 82 36 Table showing strength during different seasons 83 37 Table showing season and their respective months 83 38 Table Showing twelvefold division of kala 84-85 39 Table showing the rutu and their respective constellation 85
  • 14. 40 Table showing the rutus with respective months 87-88 41 Table showing the contents and properties of Jeerakadi churna. 101-104 42 Table Showing the contents and properties of Murchit goghrit. 104-105 43 Table showing the properties of tila taila. 107 44 Table showing the contents and properties of Trivrutta leha 107-108 45 Table showing the study design of group A 111 46 Table showing the study design of group B 112 47 Table Showing the incidence of sex in 30 patients 122 48 Table Showing the incidence of patients who were taken under study 123 49 Table Showing age wise distribution 123 50 Table Showing education wise distribution. 124 51 Table Showing occupation of patients. 125 52 Table Showing Economic status. 125 53 Table Showing Marital status. 126 54 Table Showing Diet 127 55 Table Showing Religion wise distribution. 127 56 Table Showing the incidence of Addictions. 128 57 Table Showing the Satva of the patient. 128 58 Table Showing the status of Prakruthi. 129 59 Table showing the Sara in the patients. 130 60 Table Showing the Satmya in the patients. 130 61 Table Showing the Samhanan in the patients. 131 62 Table showingDistribution of Sneha Jeeryamana Lakshanas in group A. 132 63 Table Showing distribution of sneha Jeerna Lakshanas in group A. 132 64 Table Showing distribution of Time of initiation of Vegas in Group A. 133 65 Table Showing of vegas attained . 133 66 Table Showing Distribution of Antaki Shudhi in both the groups. 134 67 Table Showing the Laigiki lakshanas in the Group A. 134 68 Table Showing distribution of Duration of flow in both the groups. 135 69 Table Showing distribution of Nature of flow in both the groups. 135 70 Table Showing distribution of Quantity of let-out blood in both the groups. 136 71 Table Showing distribution of Sira Utthapan kala after application of torniquet in both the groups. 137 72 Table Showing distribution of Bleeding time in both the groups. 138 73 Table Showing distribution of Clotting time in both the groups. 138 74 Table Showing distribution of Subjects by pittaprakopak and raktaprakopa Symptomology in both the groups. 139
  • 15. 75 Table Showing distribution of Subjects by pittaprakopak and raktaprakopa nidan in both the groups. 140 76 Table Showing the Samyaka Viddha lakshanas in both the Groups 140 77 Table Showing Hematological Analysis. 141-149 78 Table Showing the test for normality. 153 79 Table Showing the Mann whitney for the parameter dah. 154 80 Table Showing the Mann whitney for the parameter vidah. 155 81 Table Showing the Mann whitney for the parameter kandu. 157 82 Table Showing the Mann whitney for the parameter mukhapak. 158 83 Table Showing the Mann whitney for the parameter pitika. 159 84 Table Showing the statistical analysis of duration of flow,nature of flow, and quantity. 161
  • 16. LIST OF GRAPHS Sl.No TITLE Page no. 1 Graph no.1: Showing the incidence of sex in 30 patients 122 2 Graph 2: Showing the incidence of patients who were taken under study. 123 3 Graph No. 3 Showing age wise distribution 124 4 Graph 4: showing education wise distribution. 124 5 Graph 5: Showing the occupation wise distribution of patients. 125 6 Graph 6: Showing the economic status. 126 7 Graph no.7: Showing Marital status. 126 8 Graph no.8: Showing Diet. 127 9 Graph no. 8: Showing Religion wise distribution. 127 10 Graph no.10: Showing the incidence of Addictions. 128 11 Graph no. 11: Showing the Satva of the patient. 129 12 Graph no.12: Showing the status of Prakruthi. 129 13 Graph no.13: Showing the Sara in the patients. 130 14 Graph no.14: Showing the Satmya in the patients. 131 15 Graph no.15: Showing the Samhanan in the patients. 131 16 Graph no 16.: Showing distribution of Time of initiation of Vegas in Group A . 133 17 Graph no.17: Showing of Patients by vegas attained in the groupA. 134 18 Graph no.18: Showing Distribution of Antaki Shudhi in the groupA. 134 19 Graph no.19: Showing distribution of Duration of flow in both the groups. 135 20 Graph no.20: Showing distribution of Nature of flow in both the groups. 136 21 Graph no.21: Showing distribution of Quantity of let-out blood in both the groups. 136 22 Graph no.22: Showing distribution of Sira Utthapan kala after application of torniquet in both the groups. 137 23 Graph no.23: Showing distribution of Bleeding time in both the groups. 138
  • 17. 24 Graph no.24: Showing distribution of Clotting time in both the groups. 139 25 Graph no.25: Showing the Samyaka Viddha lakshanas in both the Groups. 141 26 Graph No.26.: Showing the Mann whitney for the parameter dah. 154 27 Graph No27: Showing the Mann whitney for the parameter vidah. 156 28 Graph No.28.: Showing the Mann whitney for the parameter kandu. 157 29 Graph No.29: Showing the Mannwhitny for the parameter mukhapak. 158 30 Graph No.30: Showing the Mann whitney for the parameter pitika. 160 31 Graph No31.: Showing the statistical analysis of duration of flow,nature of flow, and quantity. 161
  • 18. Introduction   Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 1    INTRODUCTION Ayurveda an ancient Indian wisdom stands apart from the rest of medical fraternity with its holistic and encompassing approach towards the prevention of disease and disease management. Ayurveda has been in vogue since the Vedic period or even earlier. It emphasizes on the maintenance and promotion of health as well as curing of diseases. xuÉxjÉxrÉ xuÉÉxjrÉ U¤ÉhÉqÉç AÉiÉÑUxrÉ ÌuÉMüÉUmÉëzÉqÉlÉ: | This unique science is based on the fundamentals of sankya philosophy; it reflects Indian culture civilization and heritage. This science of antiquity helps in upholding the physical, mental and social health of living beings. Health of any individual depends on proper diet, way of living, personal behaviour and hygiene. Any lacuna in this routine may lead to disturbance of homeostasis and causes diseases. The health is basic need for all human being to achieve the four pursuit of life viz. Dharma artha kama and moksha.  kÉqÉÉïjÉïMüÉqÉqÉÉå¤ÉÉhÉÉÇ AÉUÉåarÉÇ qÉÑsÉÇ E¨ÉqÉqÉç| Human being is an integral part of an universe.The changes occurring in external environment affects to the body accordingly. In Ayurveda the changes occurring in external environment has been divided into six rutus which is true till to the date.These environmental variations ,affects the human being ,leading to disharmony of the doshas which are the prime cause for the manifestation of diseases.
  • 19. Introduction   Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 2    Maintaining the health in healthy is one of the main endeavour of Ayurveda. Preservation of health and prevention of diseases is an essential thing for human being. As well said” prevention is better than cure”. For this Ayurveda describes in detail about various seasonal regimens as per the season,which hormoize the doshas disturbed due to seasonal variations. In classics it has been told that on regular interval ;purification of body by purificatory measures keeps person healthy ,delays ageing and avoid obesity,diabetes,skin diseases, anaemia,digestive disorders,which are the burning problem of present era. According to classics both pitta and rakta gets aggravated during sharad rutu. If this is not corrected properly through seasonal regimen, it will lead to plenty of pitta and rakta induced diseases such as daha ,kandu, kushtha, visarpa, kandu, mukhapak etc. In present era modern way of living with its inherent stress and unwholesome life style such as working during night, sleeping during day, wrong food habits and ignorance of seasonal regimen of person causes doshas to become enormously vitiated and manifestation of various diseases. Health has become secondary to money until disease strikes, once health is disturbed people are forced to spend both money and time in an effort to regain the lost health. Panchashodhanas are the integral parts of Ayurveda.These therapies are comprehensive method of internal purification of body. These are designed to eradicate the vitiated doshas and to maintain the normalcy and equilibrium of the dosha dhatu mala.
  • 20. Introduction   Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 3    Virechana is one of the prime purificatory measure; for the elimination of vitiated pitta dosha  ÌuÉUåcÉlÉÇ ÌmɨÉWûUÉlÉÉqÉç There are different measures for elimination of vitiated rakta such as shrunga, jalouka, alabu which eliminate the dushit rakta from limited area. But siravyadha is the unique procedure to let out the vitiated blood from whole body. ÍxÉUÉ xÉuÉÉÇïaÉzÉÉåÍkÉÌlÉ | So far many research works has been carried out regarding the role of purificatory procedures in curative aspects. But purificatory measures as a preventive method remained greatly ignored; even though their importance had been underlined by Ayurvedic classics. Doshas which are the prime cause for the disturbance of health, if maintained in equilibrium state, through purification on regular interval, will be helpful for the preservation of health. In the present study an effort is being made to assess the importance of siravyadha as a form of rutushodhan and need of virechana before raktamokshana. So with this view the work has been carried out under the heading “EFFICACY OF SIRAVYADHA WITH AND WITHOUT VIRECHANA IN SHARAD RUTU-A COMPARATIVE STUDY.”      
  • 21. Objectives of study.    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 4    OBJECTIVES OF STUDY: 1) To study the effect of siravyadha with virechana in sharad rutu. 2) To study the effect of siravyadha without virechana in sharad rutu. 3) To compare the efficacy of siravyadha with and without virechana in sharad rutu.
  • 22. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 5  PROCEDURE REVIEW VIRECHANA KARMA: Historical review of virechana karma: Purana kala: In Manu smrithi, it is stated that bath is done after the completion of vamana and virechana. In the text Vinaya pittaka, mentioned that virechana was given to Bhagwan Buddha by inhaling some powdered medicine sprinkled over uthplapatra. In Agni purana it is told that virechana as best treatment for the diseases caused due to Pitta.Trivrutta as best virechaka dravya. It is indicated in urdhwaga rakta pitta, jwara, hridroga.1,2 Samhita and Sangraha kala: Charaka samhitha: Virechana dravyas, virechanaopaga dravyas, sangraha vidhi and virechana procedure is explained in sutrasthana.3,4,5 Different types of virechana kalpas are explained in kalpa sthana6 . Yogyas-ayogyas, samyak, heena and atiyogas of virechana karma 7 , samsarjana krama8 , vyapath and its treatment are explained in siddhisthana9 . Table No.1: Chapters and contents related to Virechana in Charaka samhita. Sthana Ch. No. Name of chapter Content Sutrasthana 2 Apamargatanduliya Virechana dravya 4 Shadvirechanashateeya Shadvirechanaashraya Virechanopaga 15 Upakalpaniya Virechana procedure Siddhisthana 2 Panchakarmiyasiddhi Virechana
  • 23. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 6  yogya-ayogya 6 Vamanavirechan vyapatasiddhi Virechana vyapat and chikitsa kalpasthana 7,8,9,10,11,12 Shyama trivruttakalpa Chaturangulakalpa Tilwakkalpa Sudhakalpa Saptalashankhinikalpa Dantidravantikalpa Different formulations of virechana drugs Sushrutha samhitha: Ideal place for cultivation of virechana dravyas, dose of virechana dravyas according to disease, strength of person have been explained. Trivrutta and Danti are explained in sutra sthana.10, 11 In chikitsa sthana, procedure of Virechana karma, samyak, ayoga, atiyoga, vyapath and their management are told12, 13 Table No.2:Chapters and contents related with Virechana in Sushruta Samhita Sthana Ch. No. Name of chapter Content Sutrasthana 44 Virechanadravyavikalpa vignaneeya Virechana dravya Different formulations of virechan drugs. Chikitsasthana 33 Vamanvirechanasadhyopdrava chikitsitopakrama Procedure of Virechana
  • 24. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 7  karma , samyak, ayoga, atiyoga, vyapath and their management In Ashtanga sangraha14 and Ashtanga hriday, virechana vidhi, yogya and ayogya are explained in sutra sthana15 .Virechaka dravyas, its matra, vyapath and treatments are told in kalpa sthanam16, 17 . Table No.3: Chapters and contens related with Virechana in Ashtanga Hradaya Sthana Ch. No. Name of chapter Content Sutrasthana 18 VamanVirechanavidhi Virechana vidhi, yogya and ayogya Kalpasthana 2 Virechanakalpa Virechaka dravyas, its matra 3 Vamanvirechana vyapatsiddhi vyapath and their management Chakradatta, in chapter virechanaadhikara describes complete procedure of virechana karma 18 . Acharya Sharangadhara has explained virechanakala, dravyas, its matra, and preparations in uttarakhanda19 . Even other Acharyas such as Madhavakara, Vangasena, Bhavamishra, and Yogaratnakara has explained about virechana. In modern pharmacology also, detailed description is available about purgatives, its definition, types, action and their uses20 .
  • 25. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 8  SHAREERA – Anatomy and Physiology in relation with virechana: Srotas The function of the jatharagni is to digest the food. it is situated in between Amashaya and Pakwashaya. Amashaya is Mula of Annavaha srotas (food conducting channel),. . Pakwashaya and sthula guda are Mula of Purishavaha srotas. According to Charaka, Koshta has the following 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). Here the Amapakwashaya indicate the combination of Amashaya and Pakwashaya which is responsible for the complete process of digestion.By this we can understand koshta comprises of two srotases, viz, Annavaha Srotas and Pureeshavaha Srotas. The digestion, assimilation, and separation of ingested food into Sara (essence) and Kitta (waste) occurs in these Srotas. The Kitta portion further get divides into purish and mutra as per its composition.Formation of purisha takes place in the Pureeshavaha Srotas by the Purishadhara Kala and it is excreted through the Guda marga. Anatomical structures • Aamashaya
  • 26. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 9  • Grahani • Kshudrantra • Sthulantra • Pakwashaya • Guda 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 restrain 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 Malas. 21 Ahara Parinamana (Paka) krama – Table No.4:Factors and their function involved in Digestion. Factor Function Pran vayu Carry food from mouth to aamashaya Kledaka kapha Ann sanghat and kledan Jatharagni Paka Saman vayu Stimulation of agni and movement of food Ahara Parinamakara Bhavas, viz., the Ushma, Vayu, Kleda, Sneha, Kala and Samyoga plays important role in digestion of ingested food.
  • 27. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 10  The consumed food is brought into the Aamashaya by Vayu (Prana Vayu), there the Samana Vayu stimulates the jatharagni and helpful for the proper movement of food which 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. The Samana Vayu which is situated in koshta accomplishes movement of the food particles.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 SamanaVayu 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 intestines 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. Different factors influencing the formation of Purisha 22 : The factors influencing for the formation of purisha are Pittadhara Kala, Purishadhara Kala, Pakwashaya, Agni and Vayu. 1. First ahara undergo for the jatharagnipaka i.e., intestinal digestion. The term has been used as adhoamashaya by Chakrapanidatta. 2. The Bhutagnipaka postulates the view that the end product of jatharagnipaka.
  • 28. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 11  According to Vagbhata, the separation of Sara bhaga or nutrient fraction of the food takes place after the completion of Bhutagnipaka. 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 23, 24 Wall of GIT: 1) Mucous layer – Has 3 layers- epithelial lining, lamina propria and muscularis mucosa. 2) Sub mucous layer – Consists of 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
  • 29. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 12  Sub mucous Nerve Plexus Extrinsic Nervous system – in the form of Autonomic Nervous system (Both sympathetic and parasympathetic) Stomach: Table no 5: 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
  • 30. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 13  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 from stomach to Duodenum prevents backflow of chyme from duodenum to stomach. 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 6: Summary of the mechanical digestion in the Small intestine Structure Activity MUSCULARIS Segmentation Consists of alternating contractions of circular smooth muscle fibers that produce segmentation and re segmentation of sections
  • 31. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 14  (Duodenum 12 times per min, Ileum 8 times per min) of the small intestine; mixes chyme with digestive juices and brings food into contact 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 is 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. 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.
  • 32. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 15  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 7: 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. Absorption of Faeces formation in the large intestine:
  • 33. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 16  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, and parasympathetic stimulation, opens the internal anal sphincter. VIRECHANA The process by which the vitiated doshas are eliminated through the adhomarga, guda marga (lower out let), is called ‘Virechana..Virechana in broader term denotes both vamana and virechana.25 . Vyutpatti: The derivation of the word Virechana is as follows, Vi – Upasarga (Prefix)
  • 34. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 17  Richir – Rich Dhatu (Root) – samparka viyogayo (kavikalpadruma) Lyut – Pratyaya (Suffix) – means Mala Nissarana, i.e., elimination of malas by the body through any route.Hence widely used in elimination of doshas e.g mutra virechana, shirovirechana .As it gives meaning of elimination of malas commonly used for both vaman and virechana. According to Shabdakalpadruma, Rechana is derived from the root word – ‘ ËUcÉç kÉÉiÉÑ and srÉÑOèû mÉëirÉrÉ’ - 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 ‘Rich’ is also very important to understand the systemic action of Virechana. According to Charaka, the Virechana drugs first get digested in Amashaya, then reaches to Hridaya, Dhamani, macro and micro channels (srotases) of the body and reach the site where Doshas are accumulated.26 Nirukti: The act of expelling vitiated doshas (malas) through Adhobhaga is known as Virechana.27 . Here the meaning of Adhobhaga is ‘Guda’ commented by Chakrapani28 . ÌuÉUåMüÉå qÉÑZÉmÉÏiÉÇ aÉÑSqÉÉaÉëåhÉÉliÉÈ ÎxjÉiÉxiÉ SÉåwÉxrÉ ÌlÉxxÉÉUhÉÇ ÌmɨÉxrÉ mÉUqÉÉãwÉkÉqÉç|| 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. iÉ§É SÉåwÉWûUhÉÇ AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç |
  • 35. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 18  Virechana Karma is considered as the best treatment for evacuation of morbid Pitta Dosha.29 Virechana dravya guna karma: Table No.8:Table Showing Properties of Virechana Dravya. Guna Karma (prabhav) Mahabhoot Ushna ,Teekshna Sukshma Vyavayi, Vikasi Adhobhaghara Pruthvi and Jala The guna of virechana dravya are ushna, teekshna, sukshma, vyavayi, vikashi, these qualities are common in vamana aoushadam, but virechana dravya has adhobagahara prabhavam. Virechana dravya has jala and prithwi mahabootha predominance.30 Paryaya: Rechana, Praskandana,Reka,Virechana.31 According to the Sanskrit – English dictionary the different meanings are- Purgative, Cathartic, Evacuant and Aperient (M.Monier Williams). Virechana Yogya and Ayogya: A number of diseases listed below along with Dosha predominance. Table no 9: VIRECHANA YOGYA 32-39 Virechana Yogya C.S Su A.S A.H B.S Sh B.P Y.R 1. Pitta Pradhana Vyadhi Jwara + + + + + + +
  • 36. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 19  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 + + - - - + +
  • 37. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 20  4. Tridoshaja Vyadhi Kushta + + - - + + + Visarpa + + - - - - - Hridroga + + - - - + + 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 + + - - - + +
  • 38. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 21  Galaganda + - - - - - - Bradhna + - - - - - - Dushtavrana - + + + - - + Vriddhi - + - - - - - Apachi + - - - - - - Mutraghata + + + + - + + Shastrakshata - + - - - - - Ksaragnidagdha - + + - - - - 9. Shalakya Vyadhi Timira + + + + - - - Abhishyanda - + + + - - - Kacha - + + + - - - Akshipaka - + + - - - - 10. Annavaha Srotas Krmikoshta + + + + - + + Garavisha - + - + - + + Visucika + + - - - + + Alasaka + + - - - - - Udara + - + + - + + Arochaka + + - - - + + Avipaka + + - - - + +
  • 39. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 22  Vibandha - + + + - - - Anaha - + - - - - - 11. Pratimarga Chikitsartha Urdhwaga Raktapitta + + + + - - - Udavarta + - + - - - - Chardi + + + + - + + Some other indications for Virechana are: a) In Swastha40,41 It is indicated in sharad rutu. b) Utkleshita Pitta Pitta Sthanagata Alpa Kapha Kapha Sthanagata Bahu Pitta42 Pakwashayagata Pitta or Kapha Pitta43 Pittavrita Vata Kaphavrita Vata44 Shonita Roga45 c) As Purvakarma in Rasayana and Vajikarana46,47 Table no 10: VIRECHANA AYOGYA 48 – 55 Virechana Ayogya C.S Su. A.S. A.H. B.S. Sa. B.P. Y.R. 1. Karma Asahanata Vilambita + - + - - - -
  • 40. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 23  Durbala + - - - + - - Durbalendriya + - - - - - - Upavasita + - - - - - - Subhaga + - - - - - - Alpagni + + + + - + + Khsatakshina + + + - - + + Shranta + + + - - + + Pipasita + + - - + + + Karma Bharadhvahata + + - - - - - Vriddha + - - - - + + Bala + + + - + - - Atikrsha + - + - + + - Atisthula + + + - + + - Darunakoshta + - + + - - - Kshama + - - - - - - Garbhini + + - - - - - Bhakta + + - - - + - Rikta Koshta - - - - + - - Lalit - - - - + - - Sukumara - - - - + - - Navaprasuta - + - - - + + 2. Some other conditions
  • 41. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 24  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 - - - - + - -
  • 42. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 25  Urusthambha - - - - + - - Ardita - - - - + - - Hanugraha - - - - + - - Hridroga - - - - + - - Kevala Vataroga - - - - + - - Rajayakshma - - + - - - - Shosha - - - - + - - 6. Marga Virodhi Vyadhi Adhoga Raktapitta + + + + - - - Atisara - - - + + - - Classification of Virechana Drugs: A. Virechana drugs according to their origin and parts used: a) Animal origin: rÉÑ£üqÉÉxjÉÉmÉlÉå qÉÔ§ÉÇ rÉÑ£Çü cÉÉÌmÉ ÌuÉUåcÉlÉå| Urine.56,57 ÌuÉUåcÉlÉå xlÉåWûlÉå cÉ mÉrÉ: xÉuÉï§É rÉÑerÉiÉå|Milk 58 Takra 59 b) Plant Origin c) Miscellaneous: As Madya, Dhanyamla60 , Guda, Ikshu Rasa, Payas, Krishara, Ushna Jala, some minerals - Swarna, Kamsya, Manahsila, Gandhaka, Ratna, Uparatna, Samudraphena also have Sara properties. Table no 11: Classification of virechana dravyas based on parts used
  • 43. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 26  Sl.No Parts used Charaka 61 Sushruta 62 Vagbhata 63 1 Mulini 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 a. Shankhini b. Vidanga c. Anupa d. Sthalaja e. Prakeerya f. Udakeerya g. Abhaya h. Anthakotrapuspi i. Kampillaka a. Kampillaka b. Puga c. Eranda d. Haritaki e. Bibhitaki f. Amalaki g. Neelini h. Aragwada a. Neelini b. Triphala c. Kampillak
  • 44. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 27  B. Virechana drugs according to their mode of action by Sharangadhara: Acharya Sharangdhara has classified according to the action of the Virechana dravyas. a) Anulomana 64 : These drugs will digest the Apakwa (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 Kapha65 . According to Raja Nighantu, Bhoutika composition of Anulomana drugs is similar to that of Virechana drugs i.e. Prithvi and Aap Mahabhuthas. b) Sramsana 66 :The drugs which expel the malas adhered to the lumen of intestines in to the rectum without digesting (Paka) them. eg: Aragwada (Casia Fistula). j. Aragwada 3 Ksheera a. Snuhi ksheera b. Arka a. Mahavriksh b. Saptachala c. Swarna ksheeri a. Snuhi b. Swarna ksheeric. Godugdha 4 Twak a. Tilwaka a. Tilwaka b. Patala c. Ramyaka a. Tilwaka b. Ramyaka 5 Patra a. Swarna patri b. Aragwada a. Putika b. Aragwada c. Karavellaka a. Aragwada
  • 45. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 28  In the context of Jwara Chikitsa it has been mentioned that Sramsana eliminates the Pitta and Kapha situated in Pakwashaya 67 . c) Bhedana 68 :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 about 69 . 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 Swarnaksiri 70 . c) Rechana 71 : 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 the drugs used in Virechana. There are certain drugs which help in enhancing the action of Virechana Dravyas is known as Virechanopaga. The drugs described are Draksha, Gambari, Parushaka, Abhaya, Amalaka, Vibhitaka, Kuvala Badara, Karkandhu, and Pilu72 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. a) Mridu Virechana73 – The drugs which are Mridu in Veerya or when combined with opposite Veerya or given in low dosage, given to the Ruksha patient and causes less purgation is
  • 46. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 29  known as Mridu Virechana. Those drugs are specifically indicated in weak patients having mild natured diseases. 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 disease74 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 prescribed 75 Sharangdhara recommends the use of Mridu Virechana drugs in Mridu Koshta (eg. Draksha, Milk, Caster oil, Warm water etc.) 76 Drugs effective in Mridu Koshta are Guda, Ikshu Rasa, Mastu, Ullodita Dadhi, Payas, Kshira, Sarpi, Kashamari, Triphala, Pilu and Taruna Madya . 77 b) Madhya Virechana : The drugs which are moderate in qualities are known as Madhya Virechana drugs. The drugs are specifically indicated in the patients having Madhya Roga (disease with moderate symptoms). The administration of these drugs in Balava rogi is useless because, they are unable to eliminate Dosha completely 78 . Sharangdhara recommends the use of Madhyama Virechana in Madhyama Koshta. eg. Trivrit, Katuki and Aragvadha79 c)Teekshna Virechana : The drugs, which cause severe 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.
  • 47. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 30  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 Virechana 80 . 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 Vyadhi81 . 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 patients. Sushruta is of the view that Teekshna drugs given in Mridu Koshta having Deeptagni, passes out quickly without eliminating Doshas properly82 , Snuhi Kshira is considered as the best amongst these drugs83 . More over Sharangdhara recommend the other drugs like Hemakshiri, Danti, etc. explained in Krura Koshta may also be included in this group. D. Classification based on guna of drug: 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 patients 84 . 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 Srotas85 . Sneha Virechana should be administered in Sama-Shitoshma Kala 86 .
  • 48. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 31  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 Sneha 87 . E. Based on Parts of the Dravya used: Sushruta describes the following drugs with priority for Virechana Karma88 . Table no. 12: Classification of virechana dravyas based on parts used and agraoushda. Mula Virechana Shyama Trivrith Phala Virechana Haritaki Twak Virechana Tilwaka Swarasa Virechana Karvellaka Dugdha Virechana Snuhi Taila Erandam F. Virechana drugs according to seasons 89 Table no 13: Virechana drugs according to seasons Varsha Sharad Shishira /Vasanta Greeshma Hemanta All seasons Preparation Beeja Trivrit Kutaja Pippali Shunthi Shyama Trivrit Duralabha Musta Sharkara Udichya Shyama Trivrit Pippali Nagara Sindhu Aruna Shyama Trivrit Trivrit Chitraka Patha Ajaji Sarala Vacha Trivrit Danti Hapusha Saptala Katuki Swarnaksiri
  • 49. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 32  Shweta Chandana Trivrit Hemakshi ri churna Anupana Draksha Rasa and madhu Yasti madhu in Draksha Swarasa or Draksha Swarasa only Honey Sugar Warm Water Bhavana with cow ‘s 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: Different forms of yogas are prepared to help in enhancing the potency, shelflife and convenience. 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. Table no.14: 110 virechana kalpas according to Charaka90
  • 50. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 33  Kalpana Trivrth Argvada Tilvaka Sudha Saptala Shankini Danti Dravanti Amla kanji 2 1 1 1 1 1 Mutra 22 - 1 - - - Tushodaka 2 - - 1 1 1 Maireya 2 - - - 1 - Yusha 2 - - 1 - 2 Kwatha 1 2 1 - 11 - Churna 32 - - 1 1 6 Tarpana 8 - - 1 - - Ksheera 2 - - - - - Mamsa ras 2 - - 4 - 6 Ikshu ras 1 - - - - 1 Swarasa 6 2 1 2 - - Leha 1 1 3 1 3 6 Modhaka 7 - - - - - Raga shadava 4 - - - - - Sura Madhya 3 1 2 2 5 4 Souvira 2 1 1 1 1 1 Sidhu - 1 1 - 1 1 Uthkarika 1 - - - - 1 Gritha 4 2 4 4 8 6
  • 51. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 34  Taila - - - - 6 2 Chatusneha - - - - - 1 Asavarishta - 1 1 - - 5 Greya - - - 1 - - Yavagu - - - - - 1 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 Vikara 91. Table no. 15 : Virechana kalpas according to Sharangadhara 92 Kalpana Heena Madhyama Uttama Kwatha 2 tolas 4 tolas 8 tolas Kalka, Choorna Modaka 1 tolas 2 tolas 4 tola According to Sushruta93 : 1, 2 and 3 Tolas Matra is mentioned for Mridu, Madhyama and Krura Koshta respectively. I. Nature of Koshta and Virechana94 : qÉ×²Ï qÉɧÉÉ qÉ×SÒMüÉå¸å qÉkrÉMüÉå¸å cÉ qÉkrÉqÉÉ | ¢ÔüUå iÉϤhÉÉ qÉiÉÉ SìurÉæqÉ×ïSÒqÉkrÉqÉiÉϤhÉMæü: || Acharya Sharangdhara opines that – for the person Mridu Kostha, Virechana drugs must be mild and their dose should be minimum; for the Madhyama medium
  • 52. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 35  dose and for Krura Kostha persons, the Virechana drugs should be Tikshna and its dose is minimum. J. Virechana Drugs According to Dosha 95 : Table no.16: Virechana Dravyas used as per the Dosha 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 formulations for Virechana96 : Tabe no. 17: Formulations for virechana based on dosha involvement Vata Pradhana Trivrit + Saindhava + Shunthi + Kanji or Mamsasara Pitta Pradhana Trivrit Choorna + Draksha Kvatha Kapha Pradhana Triphala Kvatha, Gomutra, Trikatu Children between the Age group of 4-12 years97 Draksha rasa+ Aragvadha phala majja 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.
  • 53. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 36  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 days98, 99 . 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 expose to vata, atapa. • Should take anabhishyandhi, liquid, hot diet mixed with slight unctuous substance100 . 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 Koshta101 . Here, Sneha acts in every aspect of above processes. In sneha satmya patient, first rukshana is carried out after that virechana is planned.Patients who have ruksha shareera,krura koshta,vata pradhana, who is
  • 54. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 37  habituated of doing exercise daily, having good appetite should be given sneha basti prior to virechana, if this is not done,then virechana aoushadi gets digested instead of causing virechana102 . 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 Pitta103 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 koshta104 . 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 water105 . During the procedure of Abhyanga and Swedana, Snigdha, Drava, Ushna bhojana, Mamsarasa, Odana, Amla rasa Phala is recommended106 . Before pradhana karma the diet should be such that, it does not increase ‘Kapha’ otherwise Vamana may occur107 . ‘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 Agnibala108 . If the dose given more than Vyadhibala, may cause another Vyadhi. If it is more than Agnibala it may cause Ajeerna, Vishtambha, and if
  • 55. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 38  it is more than Aturabala then it may cause Atipravrtti or Apravrtti. So, the dose should be in Sama Pramana only. PRADHANA KARMA: Pradhana Karma includes administration of Virechana yoga, observations for Aushadha Jirnata and 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, Swedayet109
  • 56. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 39  The Vaidya or physician must observe the signs and symptoms of Jeernoushadha, Ajeernoushadha, Hritha Dosha, Vyapat, etc. OBSERVATIONS: a) Aushadha Jeerna Lakshana: The following signs and symptoms of Virechana are to be observed – Vatanulomana, Swasthya, Khsudha, Trishna, Urjamanaswita, Indriya Laghuta and Udgara Shuddhi110 . 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.111 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 days112 .
  • 57. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 40  c) Shuddhi Lakshana113-117 : 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 18: 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 19: Samyak Yoga Lakshanas of Virechana Karma Lakshanas C.S S.S Va Sroto Vishuddhi + - - Indriya Prasadana + + -
  • 58. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 41  Shareera Laghuta + + - Agnivriddhi + - - Anamayatwa + + - Kramataha Vit Pitta Kaphagamana + + - Vatanulomana - + - Absence of Ayoga Lakshanas - - + Table no 20: Ayoga Lakshanas of Virechana karma Lakshanas C.S S.S Va Kapha Prakopa + + + Pitta Prakopa + + + Vata Prakopa + - - Agnimandya + + - Gaurava + + - Pratishyaya + - + Tandra + - - Chardi + - - Aruchi + + + Vata Pratilomana + - Vatagraha Daha - + + Hridaya Ashuddhi - + + Kukshi Ashuddhi - + +
  • 59. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 42  Kandu - + + Vit Sanga + + + Mutrasanga - + - Peedika - - + Table no 21: 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 - - +
  • 60. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 43  Mamsa Dhavana vat udaka srava - - + Medokhandavat Srava - - + Trishna - - + Bhrama - - + Netra praveshanam - - + Raktakshayaja Vikara + - - PASCHAT KARMA118-121 : 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, to restore the strength of agni.The patient has to be given the following varieties of diets, from the same day evening or from the next day morning122 . 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.
  • 61. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 44  Acharya Charaka gives beautiful example to explain this, just as the agni flares up by the fuel like dry grass,cow dung,etc.The person who has undergone shodana karma ,agni will gradually gets improved by following samsarjana krama.123,124 .Hence it is decided according to shudhi. i.e. for pravara shuddhi, madhyama shuddhi, avara shuddhi, samsarjana krama is done for 3,5,7 days respectively125 Table no 22: Showing the Diet Regimen Annakala Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi I II -- Peya -- Peya -- Peya III IV Peya Peya Peya Vilepi Vilepi Krita Yusha V VI Vilepi Vilepi Vilepi Akrita Yusha Krita mamsarasa SamanyaBhojana VII VIII Vilepi Akrita Yusha Krita Yusha Akrita Mamsarasa XI X Krita Yusha Krita Yusha Krita Mamsarasa Samanya Bhojana XI XII Akrita mamsarasa Krita mamsarasa XIII XIV Krita Mamsarasa Samanya Bhojana Instead of Peyadi Krama, Sushruta mentions Kulatha, Aadhaki and Jangala Mamsarasa126 . Dalhana clarifies, Sushruta however agrees Peyadi Krama and he says
  • 62. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 45  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.Acharya Sushrutha has opined samsarjana krama in respect to bala of the patient127 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 Chakrapani128 . Jejjata mentions Mudga, Yusha and Mamsarasa in place of Peya. Arunadatta recommends Laja Saktu, Jirnashalyodana and Mamsarasa for 3 Annakalas. Rasa samsarjana krama: Acharya Charaka and Sushrutha has given a special sequence of rasa intake in samsarjana krama to be followed to avoid the chances of vitiation of doshas129 . Acharya Charaka has advised to take madhura, amla and hridhya ,snigdha ahara to pacify vata.Amla lavana to increase agni,Madhura and tikta rasa to pacify pitta dosha,kashaya and katu rasa to pacify kapha dosha130 . Acharya Sushrutha opined that rasa should be started with Madhura and Tiktha to increase the agni and to pacify vata pitta. Then snigda,amla,lavana and katu rasa to reduce vata,kapha dosha followed by madhura tikta rasa to pacify vata pitta
  • 63. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 46  dosha,thereafter kashaya katu rasa to pacify kapha pitta.131 .This is followed to do sarva rasa abyasa for the patient during samsarjana krama. 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 urges132 . VYAPATH 133-135 : Vyapath are the complications occurring due to improper handling of shodana karma.Acharaya Charaka has explained 10 vyapath, Chakrapani has divided this 10 Vyapada in two groups i.e. Ayoga and Atiyoga. AÉkqÉÉlÉÇ mÉËUMüÌiÉï¶É xÉëÉuÉÉå ¾ûªÉ§ÉrÉÉåaÉëïWû:| eÉÏuÉSÉlÉÇ xÉÌuÉpÉëÇzÉ: xiÉqpÉ:xÉÉåmÉSìuÉ: YsÉqÉ|| Table No. 23: Showing the Ayoga and Atiyoga Lakshanas of Vyapath Ayoga Atiyoga Adhamana Hritgraha Gatragraha Kandvadi Vibhramsha Sthambha Upadrava Klama Srava Jivadana Parikartika Gudabramsha Sanjnabhramsha
  • 64. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 47  Table No. 24 Showing the Virechana Vyapath According to Acharyas Vyapath Charaka Sushrutha Vagbhatta Adhmana + + + Parikartika + + + Parisrava + + + Hrdgraha + - + Gatragraha + - Sarvangagraha Jivadana + + + Vibhramsha + - Guda Vibhramsha Stambha + - - Klama + - - Upadrava + - - Vamana - + + Savashesha Aushadhitva - + + Jirna Aushadhitva - + + Hina Aushadhitva - + - Vata Shula - + Vedana Ayoga - + + Atiyoga - + + Hridaya-Upasarana - + - Vibandha - + - Pravahika - + + Visamjnata - - +
  • 65. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 48  Table No.25 showing the vyapath and its treatment S.N o. Vyapat h Causes Signs and symptoms Treatment 1 Adman a Virechaka aoushdi in low dose with low potency given in ruksha patient or in bahudosha or in agnimandhya. Prishta parshva shiro ruja,shwasa vinmutravatanam sangam Abyanga,sweda,varti, Bastiand udavarta chikitsa. 2 Parikar tika Teekshna virehana aoushada given in snigda patient having guru ama &mridu koshta/durbala and shrantha/durbal a,mridu koshti,manda agni patient given aoushda Teevra shulam in guda pradesha and pichila rakta mala pravrithi Langana, pachana,rukshana,ushna drugs, picha basti.
  • 66. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 49  with ushna lavana guna 3 Srava In bahudosha avastha and krura koshti rogi, alpa virya aoushada is given Kandu,shotah,kushta, Gouravam,agnimandh yam Sthaimithyam,pandu, Dourbalya,udara. After snehana teekshna virechana is given, asava arishta, asthapana basthi is given. 4. Hrithgr aha Patient when tries to do vega dharanam after taking aoushada, causes vata prakopa Hikka swasa parshva arthi,dainya,lalakshi vibrama. Pachana,abyaanga,dhany a sweda,shiro virechana.chardana with yshtimadhu sddha tandulambu. 5 Angagr aha Peeta aoushdasya veganam nigrham Sthamba,vepathu,thod a Vataharam ,snehanam and swedana is done 6 Jeeva dhana m Teekshna aoushada given in mridu koshta and alpa doshavastha Heavy discharge of blood Pitta hara chikitsa,rakta basti, piccha basti,ghrita manda. 7 Vibram Guda Guda bhramsha Kashya rasa pradana
  • 67. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 50  sha vibramsha,kand u ahara,udumbara rasa,lodhra choorna with jatyadhi taila 8 Sthamb a When snigda virechana is given for snigda patients Guda sthamba,passes mala in small quantity with pain. Langana,pachana,tikshna basti,virechana. 9 Upadra va Ruksha virechana given in ruksha patient Sthamba,shoola,gatrag raha Murcha Snehana,swedana and vatahara aoushada. 10 Klama Snigda, mrudu koshta patient is given mrudu aoushada causes vitiation of kapha pitta And vata retension Tandra,gaurava,klama, dourbalya Pain Langana,pachana,snehan a’ Tikshna shodana 11 Savase sha Aousha di vyapat h Dosha vigrathita drug is given in small dose Trushna,parshwa vedana,chardi, Sandhi vedana and aruchi Vamana
  • 68. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 51  12 Jirna aousha di vyapat h Virechana aoushadi of mridu virya given in small doses to patient with krura koshta and Tikshna agni Aoushadi gets digested, vyadhi, bala bramsha Snehana followed by tikshna shodana. 13 Viband ha Patient when gets exposed to vata, atapa after taking virechana aoushadhi,cause s vata vit mutrasanga. Atopa,daha,jwara Vamana,virechana,basthi ,anuvasana Basti. 14 Pratilo ma gati vyapat h Virechana aoushadhi is given before digestion of previous meal / kapha is aggravated/drug has offensive smell Chardi Snehana ,swedana followed by virechana.
  • 69. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 52  MODE OF ACTION OF VIRECHANA: ÌuÉUåcÉlÉÇ iÉÑ xÉuÉÉåïmÉ¢üqÉåprÉ: ÌmɨÉå mÉëkÉÉlÉiÉqÉÇ qÉlrÉliÉå ÍpÉwÉeÉ:, iÉk±ÉÌSiÉ LuÉÉqÉÉzÉrÉqÉlÉÑmÉëÌuÉzrÉ MåüuÉsÉÇ uÉæMüÉËUMÇü ÌmɨÉqÉÔsÉqÉmÉMüwÉïÌiÉ,|136 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. 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).
  • 70. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 53  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. PURGATIVES Drugs that promote evacuation of bowels. Purgation: - (Pur-ga shun), Latin word, - An agent that will stimulate the production of bowel movements. Purge- (purj), [Latin word-Purgare, to cleanse], A drug that causes evacuation of the bowels. Purgative – [Lat-Purgatius] 1) Cleansing 2) An agent that will stimulate the production of bowel movements. P-Cholagogue – P. - that stimulste the flow of bile, producing green stools. P-Drastic – P- that produces violent bowel movements. P-Saline – P- that produces copious watery discharges. SYNONYMS: Aperients, Cathartics , Laxatives, Purgatives. Apereient- (a-pere-ent), [Lat, aperiens,opening]. A very mild laxatives. Cathartic- (ka-thartic), [Greek word-kathartikosis,purging] An active purgative, producing bowel movements.
  • 71. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 54  Laxative-Lax (laks), [Lat-laxus,slack] 1. Without tension. 2. Loose & not easily controlled, said of bowel movements. Laxation (lak-sa-shun), [Lat-laxare, to loosen], Bowel movement Laxative (lak-sa-tiv), [Lat-laxare, to loosen], A food or chemical substances that acts loosen the bowels (i.e. fecilitate passages of bowels contents at time of defecation). Therefore, to prevent or treat constipation. Laxator(lak-sa-tor),[Lat-laxare, to loosen], that which has a relaxing effect. A distinction is sometimes made according to the intensity of action. a). Laxative or Aperient – milder action, elimination of soft but formed stools. b). Purgative or Cathartic – stronger action resulting in more fluid evacuation. Many drugs in low doses act as laxative and in larger doses as purgatives. CATHARTICS - MODERN VIEW137, 138 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, whereas 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.
  • 72. Review of literature Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 55  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 its 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 in 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 gastrointestinal glands are reabsorbed in the small intestine and caecum. And only 100 ml of 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.
  • 73. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 79    RUTU Vedic Period: Yajurveda: There is description of six rutus and their respective months1 . • Madhu Madhav –Vasant rutu • Shukra Shuchi-Greeshma rutu • Nabha nabhasya- Varsha • Isha Urja –Sharad • Saha Sahasya-Hemant • Tapa Tapasya-Shishira Jaiminiya Brahman: As per the agnishomiya siddhant, there are three major rutus, viz., Grishma Varsha Hemant whereas the three rest are depends upon them.2 Shathapatha Brahman: There are six rutus in one year. Here the whole year is considered as yagna and six rutus are part of it.3 Table No.31:Table showing correlation of rutu with parts of yagna Vasant Samidha Greeshma Agni Varsha Ida Sharad Barhi Hemant Swaha
  • 74. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 80    The rutus are classified as, Dev rutu and Pitru rutu Table No.32:Classification of rutus as Deva rutu and Pitru rutu. Deva rutu Pitru rutu Vasant Sharad Grishma Hemant Varsha Shishir Yagna should be performed in varsha rutu, as it shows the characteristics of all the rutus.4 Table No.33:Table Showing Characteristic of all rutus in Varsha rutu. Rutu Characteristic Vasant Breeze flows Greeshma Sound Varsha Rainfall Hemant Coldness Sharad Lightning All the rutus are incorporated in single day5
  • 75. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 81    Table No.34:Table Showing Characteristic of all rutus in Single day. Rutu Characteristic Vasant Early Morning Greeshma Mid Day Varsha Afternoon Hemant At the time of End of day Sharad Evening In Sahitya In Panini Ashthadhyayi the word sharad has been used to denote Rog and Aatap. Sharad shabda thay pratyaya (4/2/13) It will give two forms, shardiko rogah, shardo rogah6 Shriharsha There is elaboration of administration of nimba patra in vasant rutu.7 In samhita Period Charaka samhita The year is divided into six parts according to seasons. The northward movement of the sun and its act of dehydration bring about three seasons beginning
  • 76. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 82    from late winter to summer.The southward movement of sun and its act of hydration give rise to other three seasons beginning with the rainy to early winter.8 Table No.35:Table showing season and their respective months. Season Months Hindu calendar Months English calendar Shishir(late winter) Magha-falguna Jan-Mar Vasant(spring) Chaitra-vaishakha Mar-May Greeshma(Summer) Jeshtha-aashadha May-Jul Varsha(rainy) Shravan-bhadrapada Jul-Sept Sharad(autumn) Ashwin-kartik Sept-Nov Hemant(early winter) Margshirsha-pousha Nov-Jan In the period of visarg, winds are not very dry as they are during period of Aadan.The period of visarg predominantly shares the qualities of moon and during this period the moon with the unstrained cooling property continuosly delight the world with its soothing rays. On the other hand the period of Aadan is dominated by qualities of Agni.9 During the period of Aadan not only sun with its rays but also wind with its sharp velocity and dryness absorb the moisture from the earth. Winds progressively brings about dryness in the atmosphere during the three seasons of this period,viz., shishir,vasant,grishma, which enhances the bitter, astringent, and pungent tastes respectively.All having drying effects and as a result human being also become weak.10
  • 77. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 83    During the varsha, sharad, and hemant rutus the sun moves towards the south and its power is slackened by various factors viz., time,course,storm and rain but the moon is not affected.The earth is relieved of its heat by the rain water.Sour, salty, sweet tastes which causes unctuousness in the body grows during the varsha sharad hemant respectively.11 As a result of all these , human beings also progressively grow in strength. Strength during different seasons12 Table No.36:Table showing strength during different seasons Season Strength Greeshma, Varsha Alpa Vasant, Sharad Madhyama Hemant, Shishir Uttama Sushrut Samhita Magha etc. Are the twelve months. Two months make one rutu, which are six in number such as shishir, vasant greeshma, varsha, sharad, hemant13 . Table No.37: Table showing season and their respective months. Months Rutu Tapa, tapasya Shishir Madhu,madhava Vasant Shuchi,shukra Greeshma Nabha,nabhasya Varsha Isha,urja Sharad Saha,sahasya Hemant
  • 78. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 84    Six rutus are divided on the basis of predominance of effect of the sun and moon and characterized by cold, heat, and rain respectively. Become divided into two ayan viz., dakshin and uttar.Varsha,sharad and hemant form dakshina ayan.shishir vasant and greeshma form uttarayan.14 During forenoon the features of vasant rutu should be expected in the body, during mid day those of greeshma,during afternoon those of pravrut during evening those of varsha during midnight those of sharad and during morning those of hemant.15 In this manner the qualities of the seasons such as cold heat and rain should be understood as happening during every day, as happening in year. Astang samgraha: Kala is divided into the following twelve parts.16 Table No.38:Table Showing twelvefold division of kala Matra Time required for blinking the eyelid Kashtha 15 matra Kala 30 kashtha Nadika 10 kashtha+20 kala Muhurta 2 nadika Yama 3 hours Ahoratra 8 yama Paksha 15 ahoratra Masa 2 paksha Rutu 2 masa
  • 79. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 85    Ayana 3 rutu Varsha 2 ayana He followed sushruta to describe the effect of ayana and strength of human being in different rutus. Astang Hradaya: With every two months commencing with magha are the six rutus shishir, vasant, greeshma, varsha, sharad, hemant successively. Shishir, vasant, greeshma form the uttarayan also known as aadan kala because the sun takes away the strength of the people daily. Varsha, sharad, hemant form the dakshinayan also known as visarga kala because the moon gives the strength to the people daily.17 Sharangdhara: Movement of the sun from one stellar constellation to the other makes for the six rutus 18 . Table No.39:Table showing the rutu and their respective constellation. Rutu Constellation Greeshma Mesha, vrishabha Pravrut Mithuna, karka Varsha Simha, kanya Sharad Tula, vrischik Hemant Dhanu,grahi Vasant Kumbha,meen Yogaratnakar: Magha etc. Are the twelve months.Two monts make one rutu, which are six in number such as shishir, vasant greeshma, varsha, sharad, hemant.19
  • 80. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 86    MEASURES TO BE ADOPTED AS PER RUTUS: Vedic period: Gopatha Brahman:The diseases are going to manifest during rutusandhi,hence yagnya has to be perform during this period.20 Jaiminiya Brahman:During sandhikala there is elaboration of ashwini ukth.21 Shathapatha Brahman:the Brahman has to perform yagnya during vasant rutu,kshatriya during greeshma,and vaishya during varsha rutu.22 Aapastambha kshoutrasutra: The yagnya has been told as per the rutus,23 • Vasant-vaishwadev yagnya • Pravrut-varunpraghas yagnya • Sharad-shakmedha yagnya. Charak samhita: Having the administration of purification therapies in view ,seasons are thus divided into six.There are three rutus pravrut sharad and vasant which are of moderate nature.24 Purificatory therapies viz., vaman etc.,should be administered only in seasons of moderate nature.In other seasons having extreme cold ,heat, or rain such therapies should not be administered .If needed administered with utmost care.25 The disease in its early stage appears to be insignificant but it grows and grows thereafter and after gaining a strong hold in the body it takes away the strength and life of fool.26
  • 81. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 87    In case of a poor man in the event of emergency necessitating the administration of the purification therapy should take the prescribed drugs available without caring for collecting all the rare medicaments in advance.All the prescribed medicaments are not available to all human beings.At the same time diseases can attack even poor.So in these circumstances whatever drugs, cloths, diets are easily available should be used by patients according to their capacity.27 The person who undergo purificatory measures at regular interval will live free of diseases. Doshas accumulated in hemant be eliminated in vasant,those accumulated in greeshma be eliminated in abhrakal and those accumulated in varsha be eliminated in sharad.28 Sushrut samhita: In ayurveda varsha, sharad, hemant, vasant, greeshma, and pravrut are the six rutus, which are the causes for upachaya,prakopa and upashama of doshas. These happens in every two month commencing from bhadrapada.29 Table No.40:Table showing the rutus with respective months. Month Season Bhadrapada,ashwayuja Varsha Kartik,margasheersha Sharad Pousha,magha Hemant Falgun,chaitra Vasant Vaishakha,jeshtha Greeshma Aashadha,shravan Pravrut
  • 82. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 88    The accumulated pitta undergoes prakopa in sharad rutu,in which the sky has scattered clouds,sun’s rays dries up the slush(moisture of the earth) and produces diseases caused by pitta.30 Doshas which have accumulated in varsha hemant and greeshma should be eliminated out during sharad vasant and pravrut.31 Astang samgraha: Just as slit develops surely ,in course of time, even in pure water kept undisturbed in a earthen pot ,so also dirt accumulates inside the body hence it should be removed from the body at appropriate times.32 The doshas undergoing increase slowly in the body of such persons, who are negligent of taking purificatory measures, produce many diseases which might even deafly treatment. Doshas which have been mitigated by fasting and use of digestive drugs are likely to increase ones again but those conquered by purificatory measures will never increase again.33 In varsha pitta undergo only chaya because the food substances that are used then, posses more moisture and become sour at the end of digestion and similar condition exists inside the body also. It does not undergo prakopa because of the cold of season.34 The ideal time for administration of therapies like emesis and purgation is the day time of the ordinary seasons; whereas the day time of other seasons are unsuitable because of the risk of inadequate or excessive bouts. Ordinary seasons are ideal because of mild degrees of cold heat and rain during these seasons and so are easy and harmless. Opposite will be condition in other seasons.35 The rules and
  • 83. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 89    regimen so far described for each season is meant only for persons who are healthy; for others(sick person) separate regimen will be described later while elaborating diseases.36 Astang hradaya: All our efforts should be made to clear out the malas(doshas and waste products) at appropriate time ,their accumulation may become life threating.Hence the doshas should be removed out of the body as per their shodhana kala.37 The doshas which are get aggravated followed by chaya those should be removed out by purificatory measures and which are aggravated without chaya ,in such cases shaman should be adopted.38 The accumulation of doshas arising from cold season should be expelled out during vasant, that arising from grishma should be expelled during abhrakala ,that arising from varsha be expelled during ghanatyaya expeditiously and effectively.By this people will not become victims of diseases born by the effect of the seasons.39 Vayu and other two doshas which have undergone chaya in greeshma varsha and hemant should be removed out in the sadharan months.40 BHEL: One should take honey in rainy season, ghee in sharad, varuni mixed with gandak in shishira, grape juice in vasant and milk in greeshma rutu. Whenever earth becomes satisfied with water and gets endowed with flowers,in tha season purificatory measures should be adopted.When sun starts travelling mid way in the sky and stretches upward grass and other element then when spring arrives then emesis to be given.Purificatory measures should be adopted in the season in which cool and hot nature present moderately.41
  • 84. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 90    Sharangdhara: Doshas which are mitigated by shaman therapies are likely to get aggravated again but those which are expelled out of the body by shodhanas do not reccur at all.42 SHODHANA IN SHARADA RUTU: ÌiÉ£üxrÉ xÉÌmÉïwÉÉmÉÉlÉÇ ÌuÉUåMüÉå U£üqÉÉåYzÉlÉqÉ|| cÉUMü Pitta which has been accumulated in varsha rutu gets aggravated in sharad rutu.In order to check the pitta prakopa one should undergo virechana and raktamokshana-charak43 ÌiÉ£üxrÉ xÉÌmÉïwÉ: mÉÉlÉæUxÉëÑYxÉëÉuÉæ¶É rÉÑÌ£üiÉ:|| uÉwÉÉïxÉÑmÉÍcÉiÉÇ ÌmɨÉÇ WûUåŠÌmÉ ÌuÉUåcÉlÉæ:|| xÉÑ´ÉÑiÉ Pitta accumulated in rainy season should be eliminated properly with blood letting and purgation.-sushruta44 zÉxiÉÇ ÌiÉ£üWûÌuÉ:mÉÉlÉÇ ÌuÉUåMüÉå xÉëxÉëÑÌiÉ: xÉSÉ| A¹ÉÇaÉ xÉaÉëÇWû45 iÉ‹rÉÉrÉ bÉëÑiÉÇ ÌiÉ£Çü ÌuÉUåMüÉå U£üqÉÉåYzÉlÉqÉ| A¹ÉÇaÉ ¾ûSrÉ46 zÉUiMüÉsÉå xuÉpÉÉuÉålÉ MÑürÉÉïS U£üxÉëÑÌiÉÇ lÉU:| zÉÉUÇaÉkÉU47 In sharad rutu rakta gets aggravated naturally hence one should undergo raktamokshana.sharangadhara ÌmɨÉÉlÉÉÇcÉ ÌuÉUåcÉlÉÇ oÉsÉuÉiÉÉårÉÑ£Çü ÍxÉUÉqÉÉåYzÉlÉqÉ| pÉÉuÉÍqÉ´É 48 ÌmɨÉÉlÉÉÇcÉ ÌuÉUåcÉlÉÇ oÉsÉuÉiÉÉårÉÑ£Çü ÍxÉUÉqÉÉåYzÉlÉqÉ| rÉÉåaÉU¦ÉÉMüU49
  • 85. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 91    In sharad rutu one should undergo siravyadha. SHARAD RUTU CHARYA: Charaka: In this season sweet, light, cold and bitter foods and drinks which have potentialities to alleviate pitta are to be taken in proper quantity when there is good appetite.The meat of common quail,grey partridge, antelope, sheep, wapiti, rabbit, rice, barley, and wheat are prescribed during this season.One should avoid taking sun bath ,vasa(fat), oil and meat of aquatic and marshy animals,alkaline salt preparations and curd in food.One should not sleep during day time and should not expose himself to frost and facing wind.Use of garlands made of autumnal flowers and clean apparel and also the rays of the moon are exceedingly beneficial in this season.50 Sushruta: In autumn season one should be careful to take substances with astringent sweet and bitter tastes,milk, sugarcane products, honey, shali, green gram etc. And meat of wild animals.He should enjoy moon light wearing white garlands in the early night the dress should be light and fine.All water is beneficial because of being clear. One may swim in tanks decorated with lotus and lily and apply paste of sandal One should avoid irritant, sour , hot, alkaline items in food ,day sleep, sun rays, night awaking.51 Astang samgraha:The foods and drinks should be cold easy to digest, less in quantity with sweet bitter and astringent tastes, rice, wheat, barley, green gram, sugar, honey, patola, aamalaka, draksha and meat of animals of desert like regions are good for those who have very good hunger. Day time should be spent in sailing in lakes which are full of swans, rows of humming bees, and blossomed lotus flowers, wearing light
  • 86. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 92    and clean dress, garlands, anointing the body with the paste of ushira which is coolant, nights should be spent on a terrace having good moonlight. Over satiation, curds, sunlight, alkaline substances, muscle fat ,oils, eastern breeze, strong alcoholic drinks, sleeping during day time should be avoided.52 ASTANGA HRADAYA: When hungry the person should take foods which are of bitter sweet and astringent tastes and easily digestable such as Sali, mudga, sita dhatri patola, madhu and meat of animals of desert like lands.Evening should be spent on the terraces of houses by anointing the body with the paste of chandana, ushira, and karpura wearing garlands of pearls enjoying the moonlight.Exposure of mist, indulgence in alkaline substances, satiation with hearty meal, use of curd ,oil, muscle fat, exposure to sun light, strong liquors, sleeping at day time and the eastern breeze should be avoided.53 BHEL In autumnal season cooling measures should be adopted to counteract the aggrevated pitta such as bathing, anointing.Person should fan himself with the large stalk of Palmyra leaves roam around the lakes.He should drink laja saktu along with water containing sugar or honey.Person should eat old rice specially the one that matures in sixty days along with a soup of mudga.Person should consume sweet taste and the juice of vidari, ikshu, and draksha.Person should drink ghee.54 HARITA:Person should consume the boiled milk, sugar candy, receive the moon light in early night.Person should adopt the cooling measures,roaming around lakes.anointing the body with cooling drugs such as chandana.55
  • 87. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 93    YOGARATNAKAR: Substances having sweet, astringent, bitter tastes ,light to digest, meat of desert animals, godhuma, yava, mudga, shali should be used. For drinking milk, sugarcane juice are useful.exposure to moonlight by wearing clean light cloths by anointing the body with chandana. Person should avoid the curd, exercise, sour, pungent substances, day sleep, exposure to sun light.56 GADANIGRAHA: Person should consume the substances having cooling properties, for drinking usage of milk, grape juice, sugarcane juice. Person should avoid the irritant, alkaline, hot substances, day sleep, oil, heavy substances.57 HAMSODAK: The water is exposed to the heat of the sun during the day time and to the cooling rays of moon during night and is detoxicated by star canopus(agastya) this is known as hamsodaka and is a beneficial as nectar for the purpose of bathing and drinking.58 Season59 A season is a division of the year, marked by changes in weather, ecology, and hours of daylight.Seasons result from the yearly revolution of the Earth around the Sun and the tilt of the Earth's axis relative to the plane of revolution. In temperate and polar regions, the seasons are marked by changes in the intensity of sunlight that reaches the Earth's surface, variations of which may cause animals to go into hibernation or to migrate, and plants to be dormant.
  • 88. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 94    In temperate and subpolar regions generally four calendar-based seasons are recognized: spring (adj. vernal), summer (adj. estival), autumn (adj. autumnal), and winter (adj. hibernal). However, ecologists are increasingly using a six-season model for temperate climate regions that includes pre-spring (adj. prevernal) and late summer (adj. seritonal) as distinct seasons along with the traditional four. Chinese seasons are traditionally based on 24 periods known as solar terms, and begin at the midpoint of solstices and equinoxes. Causes and effects: Illumination of the earth during various seasons This is a diagram of the seasons, regardless of the time of day (i.e. the Earth's rotation on its axis), the North Pole will be dark, and the South Pole will be illuminated. In addition to the density of incident light, the dissipation of light in the atmosphere is greater when it falls at a shallow angle. Effect of sun angle on climate: The seasons result from the Earth's axis being tilted to its orbital plane; it deviates by an angle of approximately 23.5 degrees. Thus, at any given time during summer or winter, one part of the planet is more directly exposed to the rays of the Sun ( Fig. 1). This exposure alternates as the Earth revolves in its orbit. Therefore, at any
  • 89. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 95    given time, regardless of season, the northern and southern hemispheres experience opposite seasons. The effect of axis tilt is observable from the change in day length, and altitude of the Sun at noon (the culmination of the Sun), during a year. Seasonal weather differences between hemispheres are further caused by the elliptical orbit of Earth. Earth reaches perihelion (the point in its orbit closest to the Sun) in January, and it reaches aphelion (farthest point from the Sun) in July. Even though the effect this has on Earth's seasons is minor, it does noticeably soften the northern hemisphere's winters and summers. In the southern hemisphere, the opposite effect is observed. Seasonal weather fluctuations (changes) also depend on factors such as proximity to oceans or other large bodies of water.In the temperate and polar regions, seasons are marked by changes in the amount of sunlight, which in turn often causes cycles of dormancy in plants and hibernation in animals. These effects vary with latitude and with proximity to bodies of water. For example, the South Pole is in the middle of the continent of Antarctica and therefore a considerable distance from the moderating influence of the southern oceans. The North Pole is in the Arctic Ocean, and thus its temperature extremes are buffered by the water. The result is that the South Pole is consistently colder during the southern winter than the North Pole during the northern winter. The cycle of seasons in the polar and temperate zones of one hemisphere is opposite to that in the other. When it is summer in the Northern Hemisphere, it is winter in the Southern Hemisphere, and vice versa.
  • 90. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 96    In the tropics, there is no noticeable change in the amount of sunlight. However, many regions (such as the northern Indian Ocean) are subject to monsoon rain and wind cycles. A study of temperature records over the past 300 years shows that the climatic seasons, and thus the seasonal year, are governed by the anomalistic year rather than the tropical year. In meteorological terms, the summer solstice and winter solstice (or the maximum and minimum isolation, respectively) do not fall in the middles of summer and winter. The heights of these seasons occur up to seven weeks later because of seasonal lag. Seasons, though, are not always defined in meteorological terms. Compared to axial tilt, other factors contribute little to seasonal temperature changes. The seasons are not the result of the variation in Earth’s distance to the sun because of its elliptical orbit. Orbital eccentricity can influence temperatures, but on Earth, this effect is small and is more than counteracted by other factors; research shows that the Earth as a whole is actually slightly warmer when farther from the sun. This is because the northern hemisphere has more land than the southern, and land warms more readily than sea.http://en.wikipedia.org/wiki/Season ‐ cite_note‐2#cite_note‐2 Mars however experiences wide temperature variations and violent dust storms every year at perihelion.[ Meteorological: Meteorological seasons are reckoned by temperature, with summer being the hottest quarter of the year and winter the coldest quarter of the year. Using this reckoning, the Roman calendar began the year and the spring season on the first of March, with each season occupying three months. In 1780 the Societas Meteorologica Palatina, an early international organization for meteorology, defined
  • 91. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 97    seasons as groupings of three whole months. Ever since, professional meteorologists all over the world have used this definition. So, in meteorology for the Northern hemisphere: spring begins on 1 March, summer on 1 June, autumn on 1 September, and winter on 1 December. In Sweden and Finland, meteorologists use a different definition for the seasons, based on the temperature: spring begins when the daily averaged temperature permanently rises above 0° C, summer begins when the temperature permanently rises above +10° C, summer ends when the temperature permanently falls below +10° C and winter begins when the temperature permanently falls below 0° C. "Permanently" here means that the daily averaged temperature has remained above or below the limit for seven consecutive days. This implies two things: first, the seasons do not begin at fixed dates but must be determined by observation and are known only after the fact; and second, a new season begins at different dates in different parts of the country. Astronomical: The following diagram shows the relation between the line of solstice and the line of apsides of Earth's elliptical orbit. The orbital ellipse (with eccentricity exaggerated for effect) goes through each of the six Earth images, which are sequentially the perihelion (periapsis—nearest point to the sun) on anywhere from 2 January to 5 January, the point of March equinox on 20 or 21 March, the point of June solstice on 20 or 21 June, the aphelion (apoapsis—farthest point from the sun) on anywhere from 4 July to 7 July, the September equinox on 22 or 23 September, and the December solstice on 21 or 22 December.
  • 92. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 98      In astronomical reckoning, the solstices and equinoxes ought to be the middle of the respective seasons, but, because of thermal lag, regions with a continental climate often consider these four dates to be the start of the seasons as in the diagram, with the cross-quarter days considered seasonal midpoints. The length of these seasons is not uniform because of the elliptical orbit of the earth and its different speeds along that orbit. From the March equinox it takes 92.75 days until the June solstice, then 93.65 days until the September equinox, 89.85 days until the December solstice and finally 88.99 days until the March equinox. In Canada and the United States, the mass media consider the astronomical seasons "official" over all other reckonings, but no legal basis exists for this designation. Because of the differences in the Northern and Southern Hemispheres, it is no longer considered appropriate to use the northern-seasonal designations for the astronomical quarter days. The modern convention for them is: March Equinox, June Solstice, September Equinox and December Solstice. The oceanic climate of the Southern
  • 93. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 99    Hemisphere produces a shorter temperature lag, so the start of each season is usually considered to be several weeks before the respective solstice or equinox in this hemisphere, in other countries with oceanic climates, and in cultures with Celtic roots. Ecological seasons: Ecologically speaking, a season is a period of the year in which only certain types of floral and animal events happen (e.g.: flowers bloom—spring; hedgehogs hibernate—winter). So, if we can observe a change in daily floral/animal events, the season is changing. The temperate areas:Six seasons can be distinguished. Mild temperate regions tend to experience the beginning of the hibernal season up to a month later than cool temperate areas, while the prevernal and vernal seasons begin up to a month earlier. For example, prevernal crocus blooms typically appear as early as February in mild coastal areas of British Columbia, the British Isles, and western and southern Europe. The actual dates for each season vary by climate region and can shift from one year to the next. Average dates listed here are for cool temperate climate zones in the Northern Hemisphere: • Prevernal (ca.1 March–1 May) • Vernal (ca.1 May–15 June) • Estival (ca.15 June–15 August) • Serotinal (ca.15 August–15 September) • Autumnal (ca.15 September–1 November) • Hibernal (ca.1 November–1 March) Traditional season divisions:Traditional seasons are reckoned by insolation, with summer being the quarter of the year with the greatest insolation and winter the
  • 94. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 100    quarter with the least. These seasons begin about four weeks earlier than the meteorological seasons and 7 weeks earlier than the astronomical seasons. In traditional reckoning, the seasons begin at the cross-quarter days. The solstices and equinoxes are the midpoints of these seasons. For example, the days of greatest and least insolation are considered the "midsummer" and "midwinter" respectively. So, according to traditional reckoning, winter begins between 5 November and 10 November, spring between 2 February and 7 February, summer between 4 May and 10 May, and autumn between 3 August and 10 August. The middle of each season is considered Mid-winter, between 20 December and 23 December, Mid-spring, between 19 March and 22 March, Mid-summer, between 19 June and 23 June, and Mid-autumn, between 21 September and 24 September. India:In India, and in the Hindu calendar, there are six seasons or Ritu: Hemant (pre- winter), Shishir (Winter), Vasanta (Spring), Greeshma (Summer), Varsha (Rainy) and Sharad (Autumn).
  • 95. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 56    RAKTA Vyutpatti: UgeÉiÉå AXçaÉqÉlÉålÉåÌiÉ U£üqÉç ||  The word Rakta is derived from the root ‘Ranj’ means to give colour.1 Paryaya of Rakta: Raktam, Rudhiram, Asruk, Shonitam, Lohitam, Rohatam, Asram, Kshatajam.2 Utpatti of Rakta: xÉ ZÉsuÉÉmrÉÉå UxÉÉå rÉM×üimsÉÏWûÉlÉÉã mÉëÉmrÉ UÉaÉqÉÑmÉæÌiÉ | UÎgeÉiÉÉxiÉåeÉxÉÉ iuÉÉmÉ: vÉUÏUxrÉåuÉ SåÌWûlÉÉqÉç | AurÉÉmɳÉÉ: mÉëxɳÉålÉ U£üÍqÉirÉÍpÉkÉÏrÉiÉå ||  The apya rasa after getting red colour of the tejas present in the Yakrit and pleeha, remaining unvitiated and clear, come to be called as Rakta. Here the word ‘Tejas’ refers to Ranjaka pitta.3 Panchabhautika of Rakta: ÌuÉxÉëiÉÉ SìuÉiÉÉ UÉaÉ: xmÉlSlÉÇ sÉbÉÑiÉÉ iÉjÉÉ | pÉÔqrÉÉSÏlÉÉÇ aÉÑhÉÉ ½åiÉå SØvrÉliÉå cÉÉ§É vÉÉåÍhÉiÉå ||  Visrata, Dravata, Raga, Spandana and Laghuta, are the qualities of Prithvyadi Panchamahabhutas respectively found in Rakta. 4
  • 96. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 57    Importance of Rakta: SåWûxrÉ ÂÍkÉUÇ qÉÔsÉÇ ÂÍkÉUåhÉæuÉ kÉÉrÉïiÉå | iÉxqÉÉiÉç rɦÉålÉ xÉÇU¤rÉÇ U£üÇ eÉÏuÉ CÌiÉ ÎxjÉÌiÉ: || Rakta is the moola of the Deha, body is supported or maintained by Rakta itself. So it should be protected by all efforts and Rakta itself is considered as Jeeva (life).5 Shuddha Rakta Lakshana: ClSìaÉÉåmÉmÉëiÉÏMüÉvÉqÉxÉÇWûiÉqÉÌuÉuÉhÉïÇ cÉ mÉëM×üÌiÉxjÉÇ eÉÉlÉÏrÉÉiÉç || Rakta which resembles Indragopa (cochineal insect which is bright red in colour), not thick and not discoloured should be considered as Shuddha. 6 iÉmÉlÉÏrÉålSìaÉÉåmÉÉpÉÇmɲÉsÉ£ü xÉ̳ÉpÉqÉç |aÉÑgeÉÉTüsÉuÉhÉïÇ cÉ ÌuÉvÉÑkSÇ ÌuÉÎkS vÉÉåÍhÉiÉqÉç || Shuddha Rakta can be like heated gold, Indragopa (fire fly), red lotus, lac, and fruit of Gunja in colour depending upon the individual constitution.7 Rakta Sthana: vÉÉåÍhÉiÉxrÉ xjÉÉlÉÇ rÉM×üimsÉÏWûÉlÉÉæ |  Sthana of Rakta dhatu are Yakrut and pleeha. 8 Rakta guna: AlÉÑwhÉ vÉÏiÉqÉç qÉkÉÑUÇ ÎxlÉakÉÇ U£üÇ cÉ uÉhÉïiÉÈ | vÉÉåÍhÉiÉÇ aÉÑ ÌuÉxÉëÇ xrÉÉ̲SÉWû¶ÉÉxrÉ ÌmɨÉqÉç || 
  • 97. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 58    Rakta is anushna sheeta, madhura, snigdha, rakta in varna, guru, having visragandha and vidaha like that of pitta.9 Prakruta Rakta Karma: U£üÇ uÉhÉïmÉëxÉÉSÇ qÉÉÇxÉmÉÑÌ·Ç eÉÏuÉrÉÌiÉ cÉ |  Rakta dhatu bestows colour, nourishes the Mamsa and is the sign of life10 . Raktaprakopaka Karana: Rakta get vitiated either by Raktaprakopaka Ahara, Vihar and Kala.11 Ahara Hetu: Excessive intake of Ushna, teekshna, laghu, vidahi, drava, snigdha, lavana, kshara, amla and katu rasayukta dravya. Excessive intake of Kulattha, Masha, Nishpava, Tila, Pinyaka, Sarshapa, Atasi, Haritshaka. Excessive intake of mamsa of Jalaja, anupa, prasaha and bileshaya animals. Excessive intake of dadhi, takra, kurchika, masthu, sauveeraka, suravikara, amlaphala like Katvara etc. Intake of ajeernahara, viruddhahara, adhyashana etc. Vihara Hetu: • Diwaswapna, excessive exposure to atapa, shrama, abhighata, maithuna, ayasa. Manasika Hetu:
  • 98. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 59    • Excessive bhaya, krodha, shoka. Kala: • Ushnakala,and Sharad rutu, madhyahna, ardharatri, during the digestion of the food. Dushta Rakta Lakshana: The Rakta thus getting vitiated exhibits various features depending on the predominance of Dosha.12 • The Rakta which is frothy, slightly reddish, black, nonslimy, thin, flowing quickly and not clotting are the features of the blood vitiated by Vata. • Neela, peeta, harita, shyava, visragandhi, not liked by ants and flies and askandhi rae features of rakta vitiated by Pitta. • Colour similar to gairikodaka, snigdha, sheetala, bahala, picchila, chirasravi (flowing slowly), mamsapeshiprabha are features of Kapha dusta rakta. • Raktha exhibits all the above said features resembliing Kanjika and having very bad smell (durgandhi) are features of tridosha dushta rakta and exhibiting features of any two doshas is dwidoshaja dusta Rakta. Raktapradoshaja Vikara: Irrespective of doshic involvement, Dustarakta produses certain laxanas/vyadhis Table No.26: Showing Raktaradoshaja Rogas/Laxanas according to diffrennt authours:
  • 99. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 60    Sl No. Vikara Nama Charaka Sushruta Vagbhata 1 Kushta + + + 2 Visarpa + + + 3 Pidaka + + - 4 Raktapitta + + + 5 Asrugdhara + + - 6 Gudapaka + + - 7 Medrapaka + + - 8 Mukhapaka + + + 9 Pleeha(doshavruddhi) + + + 10 Gulma + + + 11 Vidradhi + + + 12 Nilika + + + 13 Kamala + - + 14 Vyanga + + + 15 Piplu + - - 16 Tilakalaka + + + 17 Dadru + - - 18 Charmadala + - - 19 Shwitra + - - 20 Pama + - - 21 Asramandala + - - 22 Akshiroga + - + 23 Puti asyagandhita + - - 24 Upakusha + - + 25 Prameelika + - - 26 Raktameha + - - 27 Vatarakta + - + 28 Vaivarnya + + - 29 Agnimandhya + - - 30 Pipasa + + + 31 Gurugatrata + - -
  • 100. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 61    32 Santapa + - + 33 Atidaurbalya + - - 34 Aruchi + - - 35 Shiroroga + - - 36 Annapana vidaha + - - 37 Tiktodgara + - - 38 Amlodgara + - + 39 Katu udgara + - + 40 Klama + - - 41 Krodhadikya + - - 42 Buddhi sammoha + - + 43 Lavanasyata + - + 44 Sweda + - 45 Shareera daurgandhya + - + 46 Mada + - - 47 Kampa + - - 48 Svarakshaya + - - 49 Atinidra + - - 50 Atitamodarshana + - - 51 Kandu + + - 52 Kota + - - 53 Mashaka + - - 54 Nyaccha - - - 55 Indralupta - - - 56 Arbuda - - - 57 Angamarda - - - 58 Upajihvika - - - 59 Raktatvak - + + 60 Raktanetrata - - + 61 Raktamutrata - - + 62 Bhrama - - +
  • 101. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 62    63 Arsha - - - • Signs & Symptoms: Agnisada, Pipasa, Gurugatrata, Santapa, Atidaurbalya, Aruchi, Shiroruk, Vidaha annapanasya, Tiktamlodgara, Klama, Kroda prachuta, Buddi Sammoha, Lavanasyata, Sweda, Shareera dourgandya, Mada, Kamapa, Swarakshaya, Tandra, Nidratiyoga, Tamschatidarshanam. • ENT disorders: Mukhapaka, Akshiroga, Puthigrana, Putiasya gandhita. • Systemic disorders: Gulma, Upkusha, Raktapitta, Prameelaka, Vidradi, Raktameha, Pradara, Vatashonita. • Skin disorders: Vaivarnya, Kandu, Kota, Pidaka, Kusta, Charmadala, Visarpa. RAKTAMOKSHANA Raktamokshana is one among the shodhanakarma according to Acharya Sushruta and Vagbhata. Charaka has also mentioned the procedure Raktamokshana but not consider it under Panchakarma. The word ‘Raktamokshana’ consists of two words ‘Rakta’ and ‘Mokshana’. Rakta Vyutpatti: UgeÉiÉå AXçaÉqÉlÉålÉåÌiÉ U£üqÉç ||  The word Rakta is derived from the root ‘Ranj’ means to give colour .1 Mokshana: Vyutpatti:
  • 102. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 63    qÉÉå¤ÉhÉ; ‘mÉÑ’, qÉÉå¤ÉiÉå SÒZÉqÉlÉålÉ CÌiÉ |  The word ‘Mokshana’ is derived from the root ‘Moksh’ means ‘to relieve’ or ‘to let out’13 . Thus letting out of rakta from the body is Raktamokshana. Historical review:As far as Ayurveda is concerned, we get the first record of the systemic knowledge from Vedas. So it is hard to expect any prevedic references regarding indigenous, medical practices of any kind, so also Raktamokshana. Vedic Period: • In the Kaushika Sutra of Atharvaveda, a reference of Raktamokshana from Jalauka application is found.14 • During the period of Buddha, this procedure was in regular practice, in Pilindivaccha, Raktamokshan by Shringa for Paravata.14 Samhita period: Acharya Sushruta and Vagbhata focused on Raktamokshana in detail. In Sushruta Samhita and Astanga Samgraha we get separate chapters on Siravyadha. Charakacharya also gives brief description on this topic. Sangrahakaras period:
  • 103. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 64    • Siravyadha vidhi is also described by Bhavamishra and Sharangadhara, in the management of various diseases.15 • In the period of 1200 AD extensive practice of blood letting in many skin diseases were carried out by unani practitioners.16 • During 1300 AD in Europe there is evidence of raktamokshana are available.17 • King jahangeer was also having the habit of blood letting once in a year.18 • During 18th century blood letting was done to whom it was understood that all other said treatments were helpless19 . • Recently in modern medical science blood letting by venesection(phlebotomy) advised in the conditions like acute pulmonary oedema, thrombosis of the cerebral arteries, right heart failure indicated by orthopnoea with distended jugular veins, cyanosis, venous congestion, in acute pericarditis.20 • In Iron over load states blood letting is the choice of treatment such as in haemochromatosis, transferrin deficiency,erythropiotic sederosis, porphyria.21 Types of Raktamokshana: Raktamokshana can be achieved mainly by 2 ways. 1. Shastravisravana and 2. Ashastravisravana. iÉ§É vÉx§ÉÌuÉxÉëÉuÉhÉÇ Ì²ÌuÉkÉÇ mÉëcNû³ÉÇ ÍxÉUÉurÉkÉlÉqÉç cÉ ||  Shastravisravana is done by either of the ways.22 1. Pracchanna and 2. Siravyadha ............... vÉ×XçaÉeÉsÉÉæMüÉåÅsÉÉoÉÑÍpÉUuÉxÉåcÉrÉåiÉç | 
  • 104. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 65    Ashastra visravana can be carried out by the way of23 1. Shringa 2. Jalauka 3. Alabu and 4. Ghatiyantra, an addition by Vagbhata.   aÉ׺ûÉÌiÉ vÉÉåÍhÉiÉÇ vÉ×XçaÉÇ SvÉÉXçaÉÑsÉÍqÉiÉÇ oÉsÉÉiÉç | eÉsÉÉãMüÉ WûxiÉqÉɧÉÇ iÉÑ iÉÑqoÉÏ cÉ ²ÉSvÉÉXçaÉÑsÉqÉç | mÉSqÉXçaÉÑsÉqÉɧÉxrÉ ÍxÉUÉ xÉuÉÉïXçaÉvÉÉåÍkÉlÉÏ || Application of Shringa can bring out blood from an area of Ten angulis around, Jalauka can suck from an area of one hasta, Alabu from an area of twelve anguli, Pracchanna from an area of one anguli, while Siravyadha can purify entire body.24
  • 105. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 66    SIRAVYADHA It is a type of Shastrakruta Raktamokshana, in which Shastra is being used to do Vyadhana of the Sira (the vessel) to let out the blood. SIRAVARNANA: Nirukti of Sira: xÉUhÉÉiÉç ÍxÉUÉ: |25 The srotas which carry substances from one place to another is called Sira. Siras are called so as it does transport of rasadi dhatus which flows within it. Sira Utpatti: The Vayu, utilizing the snehamsha of medas transforms them into Sira and Snayu. The Siras arise because of Mrudupaka and Snayu arise from Kharapaka.26 Moola of Sira: rÉÉuÉirÉxiÉÑ ÍxÉUÉ: xÉqpÉuÉÎliÉ vÉUÏËUhÉÉqÉç | lÉÉprÉÉÇ xÉuÉÉï ÌlÉoÉÑkSÉxiÉÉ: mÉëiÉuÉÎliÉ xÉqÉliÉiÉ: ||  Those Siras that are found in the Shareera, originate from the nabhi and thence they spread all over.27 Sira sankhya and Prakara: xÉmiÉÍxÉUÉ vÉiÉÉÌlÉ pÉuÉÎliÉ | 
  • 106. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 67    There are Seven hundred Siras in the entire body.28 These 700 siras originate from 40 principle siras. These 40 siras are divided into 4 types as • Vatavaha Siras: 10 • Pittavaha Siras: 10 • Kaphavaha Siras: 10 • Raktavaha Siras: 10 Of these the Vatavaha Siras, situated in its prime seat ie. Pakwashaya, are again found to branch out into one hundred and seventy five smaller branches. Similarly each of the remaining pitta, kapha and rakta vahana siras are found to branch out in as many numbers as one hundred and seventy five from their prime seat, thus making 700 in all. Total Siras in the body: Vata, Pitta, Kapha and Raktavaha Siras have their branches in Extremities, Thorax and abdomen and Head and neck in the following fashion. Siras in Extremeties: These are twenty five Vatavaha Siras in one extremity and same count applies to other three extremities, thus making the total of 100. The same is with Pitta, Kapha and Raktavaha Siras. Siras in Koshta: • Guda, Medra Shroni: 8 • Parshwa: 4 • Prushta: 6 • Udara: 6
  • 107. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 68    • Vaksha: 10
  • 108. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 69    Siras in Urdhwajatru: • Greeva: 14 • Karna: 4 • Jihwa: 9 • Nasika: 6 • Netra: 8 Thus total numbers of Vatavaha Siras are 175, similarly with Pittavaha, Kaphavaha and Raktavaha Siras, with an exception where the Pittavaha in Netra are 10 each and in karna 2 each. Table No.27: Showing total no of siras present in the body: Number of Siras in Shakhas 400 Number of Siras in Koshta 136 Number of Siras in Urdhwajatru 164 Total Siras in Shareera 700 Do’s & Don’t of Siravyadha: a) Vedhya and Avedhya Siras: Out of the enumerated Siras in the body, for therapeutic purposes, specific Sira are not to be touched as they result in death or bodily deformity A total of 16 Sira out of 400 in the extremities, 32 Sira out of 136 in the Koshta and 50 out of 164 Siras in the Urdhwajatrugata region should not be taken for Siravyadha purpose.29
  • 109. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 70    Table No.28: Showing number of Vedhya and Avedhya Sira: Anga pratyanga Vedhya Siras Avedhya Siras Total Shakhagata 384 16 400 Koshta 104 32 136 Urdhwajatrugata 114 50 164 Total 602 98 700 Table No.29: Showing Sthana and Sankhya of Avedhya Siras: Site & Number Avedhya Sira Sankhya Modern equivalent Adhoshakha 200 Jaladhara Urvi Lohitaksha 2 4 2 Great Saphenous Vein Femoral Artery & Vein Femoral artery & vein Urdhwashakha 200 Jaladhara Urvi Lohitaksha 2 4 2 Cephalic Vein Brachial plexus Axillary vessels Shroni 32 Vitapa Katikataruna 4 4 Spermatic Vessels Gluteal vessels Parshwa 16 Urdhwaga Parshwasandhigata 2 2 --- Prishta 24 Bruhati Urdhwaga 2 2 Subscapular Artery Udara 24 Over Medhram on both sides 4 Inferior epigastric vessels Vaksha 40 In Hridaya Stanamoola Stanarohita Apalapa Apastambha 2 4 4 2 2 Heart Internal mammary Intercostals and lateral thoracic vessels Greeva 56 Matruka Neela Manya 12 Internal & External carotid arteries and jugular vessels Hanu 16 Haunsandhigata 2 Internal Maxillary vessels Jihwa 36 Rasavaha 2 Deep lingual vessels Nasa 24 Oupanasikya Talu 4 1 Angular vessels
  • 110. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 71    b) Siravyadha Anarhas: AjÉÉÌuÉxÉëÉurÉÉ: - xÉuÉÉïXçaÉvÉÉåTü: ¤ÉÏhÉxrÉ cÉÉqsÉpÉÉåeÉlÉÌlÉÍqɨÉ: mÉÉhQÒûUÉåÌaÉ AvÉïxÉÉåSËUvÉÉåÌwÉaÉÍpÉïhÉÏlÉÉqÉç cÉ μÉrÉjÉuÉ: |   In the following cases, Siravyadha is contraindicated – generalized swelling, swelling in debilitated persons caused by amla ahara and that in those suffering from Pandu, Arshas, Udara, Shoshi and Garbhini.30 In extremes of age, a person who is ruksha, bheeru, ksheena, shranta, krusha, a person emaciated due to madya, adhva and sthree, patient who has undergone Panchakarma procedure and a person afflicted with kasa, shwasa, jwara, kshata, trushna, akshepaka, pakshaghata, should not undergo Siravyadha karma.31 Vyadhana should not be made into those Siras which are avedhya, those which are vedhya but invisible. Though visible but can not be fixed and those sira which doesn’t became prominent even after yantrana karma. c) Siravyadha Arhas: xÉëÉurÉÉ ÌuÉSìkÉrÉ: mÉgcÉ pÉuÉårÉÑ: xÉuÉïeÉÉSØiÉå | MÑü¸ÉÌlÉ uÉÉrÉÑ: xÉÂeÉ: vÉÉåTüÉå rɶÉæMüSåvÉeÉ: || mÉÉsrÉÉqÉrÉÉ: vsÉÏmÉSÉÌlÉ ÌuÉwÉeÉÑ·¶É vÉÉåÍhÉiÉqÉç | AoÉÑïSÉÌlÉ ÌuÉxÉmÉï¶É aÉëljÉrɶÉÉÌSiÉxiÉÑ rÉå || §ÉrÉx§ÉrÉÉåmÉSÇvÉÉ: xiÉlÉUÉåaÉÉ ÌuÉSÉËUMüÉ |  xÉÑÌwÉUÉå aÉsÉvÉÉsÉÔMüÇ MühOûMüÉ: M×üÍqÉSliÉMü: || SliÉuÉå·: xÉÉåmÉMÑüvÉ: vÉÏiÉÉSÉå SliÉmÉÑmmÉÑOû: |
  • 111. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 72    ÌmɨÉÉxÉ×YMüTüeÉɶÉÉæwOèrÉÉ: ¤ÉÑSìUÉåaÉÉ¶É pÉÔrÉvÉ: || Diseases like Vidradhi except tridoshaja, kushta, ekadoshaja shopha, shleepada, visha, arbuda, visarpa, granthi, stanaroga, krimidanta, dantaveshta, upakusha, sheetada, dantapupputa, kshudraroga are indicated for Siravyadha.32 Siravyadha Vidhi:   iÉ§É ÎxlÉakÉÎxuɳÉqÉÉiÉÑUÇ rÉjÉÉSÉåwÉmÉëirÉlÉÏMüÇ SìuÉmÉëÉrÉqÉç A³ÉqÉç pÉÑ£üuÉliÉÇ rÉuÉÉaÉÔÇ mÉÏiÉuÉliÉÇ uÉÉ rÉjÉÉMüÉsÉqÉÑuÉxjÉÉsrÉ AÉxÉÏlÉÇ ÎxjÉiÉÇ uÉÉ mÉëÉhÉÉlÉoÉÉkÉqÉÉlÉÉå uÉx§ÉmÉOèOûcÉqÉÉïl§ÉuÉïsMüsÉ sÉiÉÉqÉlrÉiÉqÉålÉç rÉl§ÉÌrÉiuÉÉ, lÉÉÌiÉaÉÉRûÇ lÉÉÌiÉvÉÏiÉsÉÇ vÉUÏUmÉëSåvÉqÉç AÉxÉɱ rÉjÉÉå£üÇ vÉx§ÉÇ aÉ×WûÏiuÉÉ ÍxÉUÉÇ ÌuÉkrÉåiÉç ||  The patient, after snehana, swedana should be given ahara contrary to the respective dosha, mainly consists of yavagu, at appropriate time, and should be asked to sit or stand comfortably. Selecting the area, the Sira are made prominent with the help of either vastra, patta, charma, antharvalkala, latha tied neither too hard nor too loose. Such uttita Sira are taken for vyadhana karma with the shastras mentioned.33 Instruments used for Siravyadha: MÑüPûÉËUMüÉuÉëÏÌWûqÉÑZÉÉUÉuÉåiÉxÉmɧÉMüÉÍhÉ urÉkÉlÉå xÉÔcÉÏ cÉ |  Shastras like Kutarika, Vrihimukha, Ara, Vetasapatra and Suchi are indicated for Siravyadha karma. Size and depth of Incision: qÉÉÇxÉsÉåwuÉuÉMüÉvÉåwÉÑ rÉuÉqÉɧÉÇ vÉx§ÉÇ ÌlÉSkrÉÉiÉç, AiÉÉåÅlrÉjÉÉÅkÉïrÉuÉqÉɧÉÇ uÉëÏÌWûqÉɧÉÇ uÉÉ uÉëÏÌWûqÉÑZÉålÉ AxjlÉÉqÉÑmÉËU MÑüPûÉËUMürÉÉ ÌuÉkrÉåSkÉïrÉuÉqÉɧÉqÉç |
  • 112. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 73    In mamsala pradesha, Vrihimukha Shastra is used for vyadhana karma as deep as yava, where as in other places it should be ardha Yava or Vrihimatra pramana.If Siravyadha to be done above boney prominence, the depth should be equal to ardha Yava matra with Kutarika Shastra.34 Kala Maryada for Siravyadha: Siravyadha should not be performed when the season is too cold or too hot and when there is excess breeze and on cloudy day.35 Siravyadha should be employed in Varsha rutu when the sky is clear, when it is cool during Grishma rutu and in Hemanta rutu during afternoon.36 Site of Siravyadha: Table No.30: Showing sites of Siravyadha in Various diseases: Sl. No. Diseases Sushrutokta Vagbhatokta 1 Padadari, Padadaha, Avabahuka Chippa, Visarpa, Vatakantaka, Vicharchika 2 Angula above the Kshipra marma 2 Angula above the Kshipra marma 2 Krostukashirsha, Khanja, Pangu, Vatavedana 4 Angula above Gulpha sandhi 4 Angula above Gulpha sandhi 3 Gridhrasi 4 Angula either above or below Janu sandhi 4 Angula either above or below Janu sandhi 4 Vishwachi Angula either above or below Koorpara sandhi Angula either above or below Koorpara sandhi 5 Apachi 2 Angula below Basthi marma 2 Angula below Basthi marma 6 Galaganda Urumoola Sira Urumoola Sira 7 Pliharoga Sira present near vama koorpara sandhi between kanishta and anamika Sira present near vama koorpara sandhi between kanishta and anamika
  • 113. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 74    8 Yakrutdalyudara, Kaphodara, Shwasa Dakshina koorpara sandhigata sira or sira between dakshina anamika and kanishta Dakshina koorpara sandhigata sira or sira between dakshina anamika and kanishta 9 Pravahika, Shoola Sira present 2 Angulas around the shroni Sira present 2 Angulas around the shroni 10 Parivartika, Upadamsha, Shukra roga, Shukra dosha Medhramadhya Sira Medhramadhya Sira 11 Mootravruddhi Siras behind the medhra Siras behind the medhra 12 Jalodara 4 Angula below and to left of nabhi 4 Angula below and to left of nabhi 13 Antarvidradhi, Parshwashoola Between kaksha and sthana Between kaksha and sthana 14 Bahushosha, Avabahuka Siras between Amsa Siras between Amsa 15 Tritiyaka Jwara Trika sandhi Madhya Trika sandhi Madhya 16 Chaturthaka Jwara Below amsa sandhi in either of the parshwa Below amsa sandhi in either of the parshwa 17 Apasmara Sira in hanusandhi Madhya bhaga Anywhere near hanu or bhru Madhya sira 18 Unmada Shankha Madhya and keshanta or urahapradesha or in lalata pradesha or apanga sira Urah, apanga and lalata sira 19 Jihwa and danta roga Jihwa adhobhaga sira -- 20 Taluroga Talugata sira Talugata sira 21 karna roga Karna urdhwagata sira Karna urdhwagata sira 22 Mukharoga - Siras near talu,oshta, hanu, jihwa 23 Nasaroga & gandhagrahanahani Nasagra sira Nasagra sira 24 Peenasa - Sira between nasa and lalata
  • 114. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 75    25 Timira, Akshepaka, adhimanta, shiroroga Upanasika sira or lalata sira or apanga sira Upanasika sira or lalata sira or apanga sira 26 Jatrudhwa granthi - Greeva, karna, shankha and shirastita sira 27 Vataja Shleepada 4 Angula above Gulpha sandhi - 28 Pittaja Shleepada Below gulpha sandhi - 29 Kaphaja Shleepada 4 Angula above kshipra marma - If the Sira specified are not visible, then the visible Sira near that area,avoiding marma sthana, should be taken for vyadhana karma.37 Raktamokshana pramana: oÉÍsÉlÉÉå oÉWÒûSÉåwÉ¶É uÉrÉxjÉ¶É vÉUÏËUhÉ: | mÉUÇ mÉëqÉÉhÉÍqÉcNûÎliÉ mÉëxjÉÇ vÉÉåÍhÉiÉqÉÉå¤ÉhÉå ||  The bloodletting up to the quantity of one prastha measure is advised for a rogi who is balavan, vayastha and with bahudosha.38 Acharya Dalhana is of the opinion that the blood can be let out in the order of one prastha, half prastha and one kudava in case of Uttama, Madhyama and Adhama matras respectively. Samyak Viddha Lakshana: Following features are indicative of properly performed Siravyadha xÉqrÉaaÉiuÉÉ rÉSÉ U£üÇ xuÉrÉqÉåuÉÉuÉÌiɸiÉå |
  • 115. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 76    vÉÑkSÇ iÉSÉ ÌuÉeÉÉlÉÏrÉÉiÉç xÉqrÉÎauÉxÉëÉÌuÉiÉÇ cÉ iÉiÉç ||  During Raktamokshana, when the blood which is flowing freely stops on its own, it has to be known that shodhana has taken place and is indicative of Samyak visravana.39 xÉqrÉMçü vÉx§ÉÌlÉmÉÉiÉålÉç kÉÉUrÉÉ rÉÉ xÉëuÉåSxÉ×Mçü | qÉÑWÕûiÉïÇ ÂkuÉÉÌiɸåccÉ xÉÑÌuÉkSÉ iÉÉÇ ÌuÉÌlÉÌSïvÉåiÉç ||  A well and successfully viddha sira, bleeds in stream and spontaneously stops after a muhurta.40 rÉjÉÉ MÑüxÉÑÇpÉ mÉÑwmÉåprÉ: mÉÔuÉïxÉëuÉÌiÉ mÉÏÌiÉMüÉ| iÉjÉÉ ÍxÉUÉxÉÑÌuÉkSÉxÉÑ SÒ¹qÉaÉëå mÉëuÉiÉïiÉå|| The vitiated blood is seen first to flow out of an opened sira, like the drop of yellow pigment first coming out of a Kusumbha flower.41 sÉÉbÉuÉÇ uÉåSlÉÉvÉÉÎliÉ urÉÉÍkÉuÉåïaÉmÉËU¤ÉrÉ: | xÉqrÉÎauÉxÉëÉÌuÉiÉå ÍsÉXçaÉqÉç mÉëxÉÉSÉå qÉlÉxÉxiÉjÉÉ ||  Lightness, cessation of pain, decrease in the intensity of vyadhi and cheerfulness of mind are symptoms of proper blood letting.42 Heena Viddha Karana:   Siravyadha, if done on a cloudy day, if vyadhana is improper, if affected with cold and breeze, if swedana is not done earlier, and if done after meals, then the blood having become thick, doesn’t flow out as much as required or flows out in little quantity. In person suffering from mada, murcha and shrama, who have suppressed
  • 116. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 77    the urges of vata, vit and mutra, who are in the grip of sleep and fear, rakta doesn’t flow out.43 Heena Viddha Lakshana: The vitiated blood if not let out properly, leads to shopha, kandu, raga, daha paka and vedana.44 Atiraktasrava Karana and Lakshana: If ignorant person perform Siravyadha, during hot season, after excessive sudation in excessive measures, blood flows out excessively which gives rise to Shiroabhitapa, aandhya, adhimantha, timira, dhatukshaya, akshepaka, daha, pakshaghata, ekangavikara, hikka, shwasa, kasa, panduroga and marana.45  Dushtyavyadha prakara: There are 20 types of defectively done Siravyadha procedure. They are- Durviddha, Atividdha, Kunchita, Picchita, Kuttita, Apasruta, Atyudeerna, Anteviddha, Parishushka, Kunita, Vepita, Anuttitaviddha, Shastrahata, Thiryakviddha, Viddha apaviddha, Avyadhya, Vidrutha, Dhenuka, Punarviddha, Mamsasirasnayu asthi sandhi marma viddha.46 Asamyak Siravyadha Chikitsa: 1) Rakta apravrtamana chikitsa; If blood does not flow out, properly during the procedure, then Sukshma churna of ela, sheetashiva, kushta, patha, bhadradaru, vidanga, chitraka, trikatu, agaradhuma, haridra, arkankura, naktamala phala, of these either signally or in combination mixed lavana and taila, should be rubbed on vyadha sthana, by which blood flows out properly.47
  • 117. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 78    2) Atiraktasrava Chikitsa: cÉiÉÑÌuÉïkÉÇ rÉSåiÉÎkS ÂÍkÉUxrÉ ÌlÉuÉÉUhÉqÉç | xÉlkÉÉlÉÇ xMülkÉlÉÇ cÉæuÉ mÉÉcÉlÉÇ SWûlÉÇ iÉjÉÉ || uÉëhÉÇ MüwÉÉrÉ: xÉlkɨÉå U£üÇ xMülSrÉiÉå ÌWûqÉqÉç | iÉjÉÉ xÉqmÉÉcÉrÉå°xqÉ SÉWû: xÉXçMüÉåcÉrÉåiÉç ÍxÉUÉ ||  There are 4 methods of preventing excess bleeding:  1) Sandhana 2) Skandana 3) Pachana 4) Dahana Under Sandhana, use of either Kashaya or Shastra unites the edge of the wound, hima makes blood to clot, in skandana, Bhasma does Pachana (adheres there and closes the wound) and thermal cauterization constricts the vessel, thus haemostasis is attained.48 Importance of Siravyadha: xlÉåWûÉÌSÍpÉ: Ì¢ürÉÉrÉÉåaÉælÉï iÉjÉÉ sÉåmÉlÉæUÌmÉ | rÉÉlirÉÉvÉÑ urÉÉkÉrÉ: vÉÉÎliÉ rÉjÉÉ xÉqrÉMçü ÍxÉUÉurÉkÉqÉç || The treatment like Snehana and Lepana karma do not cure the disease so quickly as properly performed act of Siravyadha does.49 iuÉaSÉåwÉÉ aÉëljÉrÉ: vÉÉåTüÉ UÉåaÉÉ: vÉÉåÍhÉiÉeÉÉ¶É rÉå |
  • 118. Review of literature    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 79    U£üqÉÉå¤ÉhÉvÉÏsÉÉlÉÉÇ lÉ pÉuÉÎliÉ MüSÉcÉlÉ || Diseases of Twak, Granthi, Shopha and diseases of Rakta will never occur in persons who undergo Raktamokshana.50
  • 119. Drug Review    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 101      DRUG REVIEW JEERAKADI CHURNA: Table No.41:Table showing the contents and properties of Jeerakadi churna.         Sl. No. Sanskrit Latin Family Rasa Guna 1 Jeeraka Cuminum Cyminum umbelliferae katu Laghu ruksh 2 Tankan Sodium pyroborate Katu Ruksha tikshna 3 mustak Cyperus Rotundus cyperaceae Tikta katu Laghu ruksha 4 patha Cissampelos pariera menispermacea Tikta Laghu tikshna 5 bilva Aegeal marmelos rutaceae Kashay tikta Laghu ruksha 6 dhanyaka Coriandrum sativum umbelliferae Kashay tikta Laghu snigdha 7 hriber Vetiveria zizanoides graminae Tikta madhur Ruksha laghu 8 shatpushpa Anethum sowa umbelliferae Katu tikta Laghu tikshna 9 dadim Punica granatum punicaceae Kashay madhur aamla Laghu snigdha 10 kutaj Holarrhena antidycentrica apocynaceae Tikta kashay Laghu ruksha 11 samnga Mimosa pudica mimosaoeae Kashay tikta Laghu ruksha 12 dhataki Woodfordia fruticosa lytharaceae Kashay Laghu ruksha
  • 120. Drug Review    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 102      13 shunthi Zinziber officinale scitamine Katu Guru ruksha tikshna 14 pippali Piper longum piperaceae Katu Laghu snigdha 15 maricha Piper nigrum piperacea Katu Laghu tikshna 16 Twak Cinnamomum zeylanica lauracea Katu tikta madhur Laghu ruksha tikshna 17 ela Elettaria cardamomum scitaminae Katu madhur Laghu ruksha 18 tejapatra Cinnamomum tamal lauraceae Madhura katu Tikshna laghu pichchil 19 mocharasa Salmalia malabarica bombacaceae kashay Laghu snigdha 20 kalinga Holarrhena antidycentrica apocynaceae Tikta Laghu ruksha 21 parad hydragyrum Shada rasa Guru snigdha 22 vyom Muscovite Madhura Snigdha 23 gandhak sulphur Kashay katu Ushna 24 jatiphala Myristica myristicaceae Tikta katu Laghu tikshna  
  • 121. Drug Review    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 103        Sl. No. Sanskrit Veerya Vipaka Dosha Karma 1 Jeeraka ushna katu Kapha vata Dipan pachana grahi 2 Tankan Ushna Katu Vatakapha Agnikrut balya 3 mustak sheet Katu Kapha vata Dipan pachan lekhan 4 patha ushna Katu Vata kapha Grahi vishaghna 5 bilva ushna Katu Vata kapha Dipan pachan grahi 6 dhanyaka ushna madhur Tridosh Dipan pachan grahi 7 hriber sheet Katu Kapha pitta Pachan stambhan 8 shatpushpa ushna Katu Vata kapha Dipan 9 dadim ushna Madhur/aamla Tridosha Hradya grahi 10 kutaj sheet Katu Kapha pitta Dipan grahi 11 samnga sheet Katu Kapha pitta Sandhaniya purishasangrahaniya 12 dhataki sheet Katu kaphapitta madakari 13 shunthi ushna madhur Vata kapha Dipan bhedan 14 pippali ushna madhur Kapha vata Dipan pachan vrushya 15 maricha ushna Katu Kapha vata Dipan pramathi 16 Twak ushna Katu Vata pitta Varnya grahi 17 ela sheet Katu Kapha vata Hradya dipak 18 tejapatra ushna Madhur Kapha vata ruchya 19 mocharasa sheet Madhur Pitta vata Grahi rasayan 20 kalinga sheet Katu Kapha pitta Dipan grahi 21 parad ushna madhur tridosha Yogvahi 22 vyom Sheet Madhur Vatakapha Dipan Pachana Yogvahi 23 gandhak ushna katu Kapha vata Dipan pachana
  • 122. Drug Review    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 104    24 jatiphala ushna Katu Kapha vata Dipan rochana grahi   DRUG Chem. Const. DRUG Chem. Const. DRUG Chem.const. Jeeraka Cuminin diacyl glycerol dadim Tannin estrone malvidine ela Bornneol camphene Tankan Na2B4O7 kutaj Holarrhennine conkurchine holacetine tejapatra Eugenol cinnamic aldehyde mustak Cineol copaene cyperene I & II samnga Mimosine orientin mocharasa Gallic acid tannic acid patha Menismine cissamine dhataki Inositol woodferdin A B C kalinga Holarrhennine conkurchine holacetine bilva Xanthotoxol marmesin skimming shunthi Curcumene d- borneal citral parad Hg dhanyaka Carotene eugenol bergapten pippali Piperine b- sitosterol vyom M2KAI3(SiO4)3 hriber Allokhusiol benzoic acid maricha Piperene piperonal gandhak Sulphur shatpushpa Carvone limonene Twak Cinnamaldehyde eugenol cymene jatiphala Safrole methyleugenol   MURCHIT GOGHRIT Table No.42:Table Showing the contents and properties of Murchit goghrit. Sl no. Sanskrit Latin Family Rasa Guna 1 Aamalaki Emblica officinalis euphorbiaceae Pancharasa (amla) snigdha 2 haritaki Terminalia chebula combretaceae Pancharasa (kashaya) Laghu ruksha 3 bibhitaki Terminalia combretaceae Kashay Ruksha
  • 123. Drug Review    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 105    bellerica laghu 4 mustak Cyperus Rotundus cyperaceae Tikta katu Laghu ruksha 5 haridra Curcuma longa zingeberceae Tikta katu Ruksha laghu 6 matulung Citrus medica rutaceae Aamla madhura Laghu tikshna 7 ghrit Madhur snigdha     Sl no. Sanskrit Virya Vipak Dosha Karma Chemical Const 1 Aamalaki sheet Madhura tridosha Chakshushya rasayan Ellogic acid lupeol vit c 2 haritaki ushna Madhura tridosha Anuloma rasayan Chebulinic acid tannic acid 3 bibhitaki ushna Madhur Kapha pitta Keshya chakshushya Galactose mannitol sitosterol 4 mustak sheet Katu Kapha vata Dipan pachan lekhan Cineol copaene cyperene I & II 5 haridra ushna katu Kapha pitta Lekhan vishaghna Curcumene curcone 6 matulung ushna aamla Vata kapha Dipan pachan chakshushya Auxin limonin vit c absciscis acid 7 ghrit sheet Madhur Vata pitta rasayan Fat VitA VitE GHRITA English name : Ghee Synonyms : Ghrita, Aajya, Sarpi Gana : Gorasa varga
  • 124. Drug Review    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 106    Rasa : Madhura and sarvarasa Guna : Guru Virya : Sheeta Vipaka : Madhura Doshaghnata : Tridosha shamaka Chemical Composition Cow’s ghee which is an animal fat is abundant in saturated fatty acid, ghee contains approximately 8% of lower saturated fatty acids which make it easily digestible. The digestibility co-efficient or rate of absorption is 96%, which is better than other animal and vegetable fats. Chemical composition of cow’s ghee (per 100gm edible portion.) Moisture (g) : 0.5 Fat (g) : 99.5 Vitamin A : 2000 Energy : 900 K.Cal The composition of fat content of ghee is as follows-triglycerides, diglycerides, monoglycerides, ketoacid, glycerides, glyceryl esters, free fatty acids, phospholipids sterol. Ghee contains beta carotene (600 mg) and Vitamin E both of which are known as antioxidant. Actions and uses:
  • 125. Drug Review    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 107    It is considered as a chakshushya, vridhya, agnikrita, medhya, kantivardhaka, lavanya kara, ojavardhaka, tejavardhaka, vayasthapaka, balya and rasayana. It is useful in udavarta, Jvara, Unmada, Shula, Anaha, Vrana, Visarpa and Raktavikara Tila Taila: Table No.43:Table showing the properties of tila taila.  Sl no. Sanskrit Latin Family Rasa Guna 1 Tila Sesamum indicum pedaliaceae Madhur kashay tikta Guru snigdha   Sl no. Sanskrit Virya Vipak Dosha Karma Chemical const 1 Tila ushna madhur Kapha vata Brumhan lekhana twachya keshya Neutral lipids glycolipids phospholipids Trivrutta Leha: Table No.44:Table showing the contents and properties of Trivrutta leha Sl no. Sanskrit Latin Family Rasa Guna 1 Trivrutta Operculina turpethum convalvulaceae Tikta katu Laghu ruksha tikshna 2 Sita Saccharum officinarium Gramineae madhur Snigdha 3 madhu Madhur kashay Laghu tikshna 4 Twak Cinnamomum zeylanica lauracea Katu tikta madhur Laghu ruksha tikshna 5 ela Elettaria cardamomum scitaminae Katu madhur Laghu ruksha 6 tejapatra Cinnamomum tamal lauraceae Madhur katu Tikshna picchila laghu   Sl no. Sanskrit Virya Vipak Dosha Karma Chemical const
  • 126. Drug Review    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 108    1 Trivrutta ushna katu Kapha pitta Rechana Turpethins scopoletin coumarin 2 Sita sheet madhur Vata pitta Brumhan vrushya Snigdha 3 madhu ushna madhur kaphavata Sukshmamarganusarini yogavahi Maltose levulose vitB C copper calcium 4 Twak ushna Katu Vata pitta Varnya grahi Cinnamaldehyde eugenol cymene 5 ela sheet Katu Kapha vata Hradya dipak Bornneol camphene 6 tejapatra ushna madhur Kapha vata ruchya Eugenol cinnamic aldehyde   Trivrutta: Botanical name: Operculina turpethum Family: Convolvulaceae Gana: Charaka: Bhedaniy Sushruta:Shyamadi Adhobhagahara Vagbhata: Shyamadi Distribution: Common in waste places and thickest throughout India ascending upto 1000m. Botanical Description: A stout twinner with quadrangular stem, winged, compressed or nearly round. Leaves: Ovate or oblong, base cardate or obtuse. Flower: Often pinkish, Sepals ovate(much enlarged in fruits) softly pubscents,petals white,tubular campanulate. Fruit: four seeded globose capsule ,seeds smooth black.
  • 127. Drug Review    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 109    Charaka emphasized trivrutta as the best herb for sukha virechana. He described elaborately the different formulations of trivrutta for virechana.He further explained that it is of two kinds viz., aruna and shyama.Bhavamishra also quoted two varieties as shweta and shyama. Chemical constituent: alpha and beta turpethins, scopoletin, turpethinic acid A, turpethin,coumarin.
  • 128. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 110      CLINICAL STUDY The clinical study plays a pivotal role in the field of research. So here is a clinical study entitled “EFFICACY OF SIRAVYADHA WITH AND WITHOUT VIRECHANA IN SHARAD RUTU-A COMPARATIVE STUDY.”Which is under taken with following Objectives” 1) To study the effect of siravyadha with virechana in sharad rutu. 2) To study the effect of siravyadha without virechana in sharad rutu. 3) To compare the efficacy of siravyadha with and without virechana in sharad rutu. Source of data: The present study is a clinical trial which will be conducted on volunteers who fulfills the inclusion criteria from the G.A.M.C. campus. Method of collection of data:- 30 volunteers presenting with the pitta and rakta prakopaka laxanas are selected irrespective of sex, religion, age, and economic status. Inclusion criteria: • Volunteers between the age group of 16 to 70 years. • Volunteers having pitta and rakta prakopaka laxanas. • Volunteers having normal values of clotting and bleeding time. • Virechana yogya • Raktamokshana yogya
  • 129. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 111      Exclusion criteria: • Volunteers having abnormal clotting and bleeding time. • Volunteers suffering from infectious diseases. • Volunteers having systemic disorder like Diabetes Mellitus,Hypertension. • Virechana Ayogya • Raktamokshana Ayogya Sample size and grouping : 30 volunteers who fulfilled the inclusion criteria were randomly divided into both group. Study Design: Group A Table No.45: Showing the study design of group A Procedure Duration Poorva Karma Pachana and Deepan Snehana Abhyanga and Swedana Virechana Samsarjana karma Snehan Abhyang and swedana Till Niramavastha Till Samyaka snigdha For 3 days Once Depending upon shuddhi For 2 days For 1 day Pradhana Karma Siravyaha Once
  • 130. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 112      Group B Table No.46: Showing the study design of group B Procedure Duration Poorva Karma Pachana and Deepan Snehana Abhyang and Sweda Till Niramavastha For 2 days For 1 day Pradhana Karma Siravyaha Once Paschat Karma : The Volunteers were asked to take rest for 10-15 minutes and fluid (lemon water) was given to drink. Then they will be adviced for Laghu and Deepaniya Aahara. Materials required for the study: Drugs Jeerakadi churna Murchit ghrit Tila taila Trivrutta leha Yavagu
  • 131. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 113      Instrumens Disposable Scalp vein sets of 18 gauze Tourniquet Sterile glove- No7 Sterile Cotton Swabs Sterile Cotton Pads Surgical Spirit Sterile bandage cloth Fiber measuring jar Vessels Assessment Criteria: The symptoms will be assessed before and after the treatment. Subjective parameters: DAHA: (As per presence in the netra, nasa, hasta, pada, ura, udara, payu, upastha.) Absent-0 Presence in any of two-1 Presence in any two to four-2 Presence in more than four-3 VIDAHA: (Depending upon the sour belching and sourness of mouth) Absent :0 Occasional:1 Present after sometime of taking food :2
  • 132. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 114      Present throughout day : 3 KANDU: (As per the six parts of the body i.e. Shadang, trunk, head, neck,two upper extremities, two lower extremities) Absent-0 Presence in any of two-1 Presence in any two to four-2 Presence in more than four-3 Objective parameters: PITIKA: (Depending upon the number of Pitikas) Absent-0 0 to 5 in number-1 5to 10 in number-2 More than 10 in number-3 MUKHAPAKA: (As per the involvement of the Buccal mucosa, Tounge, Palate) Absent-0 Anyone-1 Any two-2
  • 133. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 115      All-3 Jeerakadi Churna : All the contents of jeerakadi churna were collected from the shop “Amrut kesari depot” Avenue road, near K.R. Market and Bangalore medicals dhanwantri road,bangalore. Then jeerakadi churna was prepared according to classics and used for the purpose of Nirameekarana and Agni deepana. Murchit Ghrita :- Ghrita is obtained from market and processed with the drugs explained in ghrit murchana vidhi. Tila taila : Market sample of taila was used for Sarvanga abhyanga. Trivrth leha:For the purpose of the study Trivrth leha obtained from The Arya vaidhya Pharmacy Ltd was used. Reference from Ashtanga Hridayam. PLAN OF STUDY Group A: Poorvakarma: All necessary equipments should be arranged. All necessary drugs as Deepana Pachana drugs, Virechana yoga, Drugs for emergency such as Karpur rasa, Sutashekhar, Kutajaghana vati etc. should be collected in sufficient quantity according to Atura and Roga. Prior to procedure the detailed examination of the patient is done according to Dosha, Desha, Kala, Bala, Shareera, Ahara, Satmya, Satva, Prakruti and Vaya.
  • 134. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 116      Amapachana: Here jeerakadi churna was chosen, The churna was administered as long as Nirama lakshanas are seen. Snehapana: After appearance of Nirama lakshana murchita Ghrita was administered for the purpose of Sneha Pana. Sneha Pana was done in between 6.30 -7 am and Ushna Jala Anupana was given. The Sneha Pana was started with Hrisiyasi Matra i.e 30 ml .Then according to the symptoms presenting in the individual, the duration taken to digest the given dose of Sneha, the time of appearance of appetite in the patient , the next day dose was decided. In this pattern Arohana karma Snehapana was followed until the appearance of Samyak Snigdha Laxanas. Patients were advised to avoid exposure to wind , sunlight, emotional upsets, heavy work, excessive talking, laughing , standing for long time , journey , intake of heavy meals, night waking , day sleep, cold comforts. Patients were properly educated about the Laxanas which may appear during digestion of Sneha, after digestion. Patients were advised to take only hot water in little quantity till Sneha Jeerna Laxanas appears. When patient noticed strong sensation of hunger advised to take the gruel Rice, Ragi, or Rava according to their food habit. When the samyak snigdha laxanas were observed, the intake of ghee was stopped.
  • 135. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 117      Assesment of Samyak Snighdha Laxanas Vatanulomana- assessed by the normal expulsion of the flatus, feces. Deeptagni- Based on the time taken for digestion of sneha Asamhata varchas- based on the consistency of the feces .i e stool will be loose in consistency Snigdha varcha- confirmed based on nature of stool. Stool will be sticky or pasty , floating of feces over water, Sense of oiliness over the fingers on washing after defecation Twak snigdhata- it is assessed by comparing the texture of the skin, before and after Sneha pana. Glani- assessed by presence of exhaustion or weakness Angalaghava- By enquiring with the patient about lightness of the body. Snehodhvega- Confirmed by the aversion of the patient towards Sneha Adastath sneha darshana-Appearance of sneha in stool without digestion Swedana: Whole body Abhyanga with lukewarm Tila Taila was done for 30 mins. in 7 positions . Then patients made to under go parisheka Sweda till the appearance of perspiration. Abhyanga and Swedana were administered on the gap day, and also on the day of Virechana just prior to the procedure. Virechana: The Trivrutta leha was given in dose of 40 gm to volunteer with Sukoshana Jala Anupana. • The volunteer are asked about the digestion of previous day meal, sleep and observing his mental condition, After assessing the psychological condition of the patient.
  • 136. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 118      • Trivrutta leha was given in empty stomach. In the morning around 8.30 a.m to 9.00 a.m Virechana yoga was given. • Just after administration of Virechana yoga cold water was sprinkled on the face to prevent vomiting. • The patient was asked to gargle with hot water. • Patients were protected from direct cold wind. • Patients were advised to avoid Pravahana. • Hot water was given frequently. 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 is stopped, by observing the avara, madhyama and pravara shuddhi, samsarjana karma was adviced to bring agni to its normalcy. Thin rice ganji,thick rice ganji,rice, rice with oil and salt and then normal diet was advised.when volunteers reached to normal diet then gap of one day was given. Next day onwards snehapan started for siravyadha. Snehapana: Murchita Ghrita was administered for the purpose of Sneha Pana. Sneha Pana was done in between 6.30 -7 am and Ushna Jala Anupana was given. Sneha was administered for two days , first day 30 ml and second day 60 ml. Swedana: Whole body Abhyanga with lukewarm Tila Taila was done for 30 mins. in 7 positions . Then patients made to under go parisheka Sweda till the appearance of perspiration, on the day of siravyadha.
  • 137. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 119      Pradhana Karma:Yavagupana was done before doing the siravyadha. The patient was made to sit comfortably over the examination table. With their both hands firmly kept sideway of body. Then the part was cleaned with surgical spirit. A tourniquet was tied, neither too tight nor too loose, above the right elbow joint to make the Sira prominent and if essential, mild blow was given over the Sira. The sterile Scalp vein set of 18 gauze was taken and needle was introduced into the Sira (vein). When the needle of the Scalp vein set was in situ, the other end of the set was kept in the kidney tray for collection and to assess the quantity let out, which ranged between 30ml-120ml. Careful observation of patient was made during the procedure for vital parameters. Paschat Karma: After letting out sufficient quantity of blood, the needle was taken out, sterile cotton pad was kept and bandaged. The patient was asked to take rest for 10-15 minutes and fluid (lemon water) was given to drink. Group B: Amapachana: Here jeerakadi churna was chosen, The churna was administered as long as Nirama lakshanas are seen. Snehapana:
  • 138. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 120      After appearance of Nirama lakshana murchita Ghrita was administered for the purpose of Sneha Pana. Sneha Pana was done in between 6.30 -7 am and Ushna Jala Anupana was given. Sneha was administered for two days , first day 30 ml and second day 60 ml. Swedana: Whole body Abhyanga with lukewarm Tila Taila was done for 30 mins. in 7 positions . Then patients made to undergo parisheka Sweda till the appearance of perspiration, on the day of siravyadha. Pradhana Karma: Yavagupana was done before doing the siravyadha. The patient was made to sit comfortably over the examination table. With their both hands firmly kept sidewise of body. Then the part was cleaned with surgical spirit. A tourniquet was tied, neither too tight nor too loose, above the right elbow joint to make the Sira prominent and if essential, mild blow was given over the Sira. The sterile Scalp vein set of 18 gauze was taken and needle was introduced into the Sira (vein). When the needle of the Scalp vein set was in situ, the other end of the set was kept in the kidney tray for collection and to assess the quantity let out, which ranged between 30ml-120ml.
  • 139. Materials and Methods     Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 121      Careful observation of patient was made during the procedure for vital parameters. Paschat Karma: After letting out sufficient quantity of blood, the needle was taken out; sterile cotton pad was kept and bandaged. The patient was asked to take rest for 10-15 minutes and fluid (lemon water) was given to drink.
  • 140. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 122  OBSERVATIONS A total of 45 subjects were screened for the study, out of which 38 met the inclusion criteria. A total of 38 subjects were registered for the present study. 18 were registered in group A, 3 dropped out in the middle, while 20 were registered in Group B, and 5 dropped out in the middle All the subjects were examined before and after the Shodhana according to the case sheet format given in the appendix. Changes in both the subjective and objective parameters were recorded. INCIDENCE OF SEX: Table No47. Showing the incidence of sex in 30 subjects Sex Group A Group B Total % Male 11  12  23  77  Female 4  3  7  33  Graph no.1: Showing the incidence of sex in 30 subjects SEX: It has been observed that among 30 subjects, 23(77%) were males and 7(33%) were females.
  • 141. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 123  Table No48. Showing the incidence of subjects who were taken under study SL.No Taken Dropouts Group A 18 3 Group B 20 5 Graph 2: Showing the incidence of subjects who were taken under study Drop Out: In this study 38 subjects were registered. All the patients were randomly grouped into 2 groups. Out of these 38 subjects, 6 discontinued and 2 were not include because of complication. Table No49. Showing age wise distribution. Age Group A Group B Total % 16 - 19 1 0 1 3% 20 – 29 12 5 17 57% 30 – 39 1 6 7 24% 40 – 49 1 2 3 10% 50 – 59 1 1 3% 60 – 70 1 1 3%
  • 142. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 124  Graph No. 3 Showing age wise distribution. AGE: Maximum of subjects belonged to middle aged people.1(3%)out of 30 subjects were in 16-19, 17(57%) in 20-29. 7(24%) out of 30 subjects belonged to 30-39, 3(10%) in 40-49 ,1(3%) in 50-59and1(3%) in 60-70 age group. Table No.50 : Showing education wise distribution. Education Group A Group B Total % Primary 2 5 7 24 Higher secondary 6 5 11 36.5 Graduate 7 4 11 36.5 Illiterate 0 1 1 3 Graph 4: showing education wise distribution. EDUCATION: Among the 30 subjects 7(24%) had primary education,11(36.5%) had higher secondary,11(36.5%) had graduation and 1(3%) was illiterate.
  • 143. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 125  Table no. 51: Showing occupation of subjects Occupation Group A Group B Total % Student 6 1 7 24 Labour 2 5 7 24 House wife 0 3 3 10 Service 7 4 11 36 Business 0 2 2 6 Graph 5: Showing the occupation wise distribution of subjects OCCUPATION: 7 (24%) out of 30 were students, 11(36%) were under service, 2 (6%)belonged to business, 7(24%) belonged to occupation of labor and3(10%) out of 30 were house wives. Table No.52 Showing Economic status. Status Group A Group B Total % Poor 2 4 6 20 Middle 7 6 13 43.5 Upper middle 6 5 11 36.5 Higher 0 0 0
  • 144. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 126  Graph 6: Showing the economic status SOCIOECONOMIC STATUS: The socioeconomic status of 13(43.5%) were belonged to middle class and 6(20%) belonged to poor class, 11(36.5%) belonged to upper middle class. Table No.53: Showing Marital status Marital status Group A Group B Total % Married 2 12 14 46.67% Unmarried 13 3 16 53.33% Graph no.7: Showing Marital status MARITAL STATUS: The above table exhibits 16(53.33%) were unmarried and 14(46.67%) were married.
  • 145. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 127  Table No.:54 Showing Diet Diet Group A Group B Total % Vegetarian 7 9 16 53.33 Mixed Diet 8 6 14 46.66 Graph no.8: Showing Diet DIET: Out of 30 subjects 16(53.33%) were vegetarian and 14(46.66%) belonged to mixed diet. Table No.55: Showing Religion wise distribution. Religion Group A Group B Total % Hindu 12 13 25 83.33 Muslim 3 2 5 16.66 Christian 0 0 0 Graph no. 9: Showing Religion wise distribution.
  • 146. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 128  RELIGION: Among the 30 subjects randomly incorporated into the study 25(83.33%) belonged to Hindu community and rest 5(16.66%) were Muslim. Table No.56: Showing the incidence of Addictions. Habits Group A Group B Total % Smoking 2 1 3 10 Alcohol 1 3 4 13.33 Smoking and Alcohol 3 2 5 16.66 Tobacco 0 1 1 3 Nil 9 8 17 57 Graph no.10: Showing the incidence of Addictions. ADDICTIONS: It has been observed that 13(43%) were having addictions. And 17(57%) were not having any addictions among the 30. 4 (13.33%) out of 30 were addicted to Alcohol, 3(10%) out of 30 were smokers, 5 (16.66%)out of 30 were both alcoholic and smokers whereas 1(3%) was addicted to tobacco.
  • 147. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 129  Table No.57: Showing the Satva of the subjects. Satwa Group A Group B Total % Pravara 1 3 4 13.33 Madhyama 8 7 15 50 Avara 6 5 11 36.66
  • 148. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 130  Graph no. 11: Showing the Satva of the subject. SATVA: Maximum of 15(50%) were having madhyama satva, whereas 4(13.33%) were having Pravara and 11(36.66%) were having Avara satva. Table No.58: Showing the status of Prakruthi. Prakruthi Group A Group B Total % Vata kapha 1 4 5 16.66 Pitta vata 8 6 14 46.66 Pita kapha 6 5 11 36.66 Graph no.12: Showing the status of Prakruthi. PRAKRUTHI: Maximum 14(46.66%) belonged to Pitta vata prakruthi, 11(36.66%) belonged to Pitta kapha prakruthi and 5(16.66%) were from Vata kapha prakruthi.
  • 149. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 131 
  • 150. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 132  Table No. 59: Showing the Sara in the subjects. Sara Group A Group B Total % Pravara 3 2 5 16.66 Madhyama 8 7 15 50 Avara 4 6 10 33.33 Graph no.13: Showing the Sara in the subjects. SARA: 15(50%) were of Madhyama sara and 5(16.66%) from Pravara and 10(33.33%) were of Avara sara. Table No.60 : Showing the Satmya in the subjects. Sara Group A Group B Total % Pravara 0 0 0 Madhyama 13 12 25 83.33 Avara 2 3 5 16.66
  • 151. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 133  Graph no.14: Showing the Satmya in the subjects. Satmya: Among the 30 subjects 25(83.33%) were had madhyama satmya and 5(16.66%) were Avara satmya. Table No.61 : Showing the Samhanan in the subjects. Sara Group A Group B Total % Pravara 4 6 10 33.33 Madhyama 8 6 14 46.66 Avara 3 3 6 20 Graph no.15: Showing the Samhanan in the subjects. Samhanan:Out of 30, 14(46.66%) were had a Madhyama, 10(33.33%)were Pravara and 6(20%) were Avara samhanan
  • 152. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 134  Table No.62: Distribution of Sneha Jeeryamana Lakshanas in group A. Lakshanas Group A % Shiro Ruja 13 86.66 Bhrama 6 40 Lala Srava 5 33.33 Murcha 0 0.00 Angasada 14 93.33 Klama 3 20 Trishna 14 93.33 Daha 0 0.00 Arathi 0 0.00 In Group A, 13(86.66%) had Shiro ruja, 5(33.33%) had Lala srava, 6(40%) had Bhrama, none had Murcha, 14(93.33%) got Angasada, 3(20%) got Klama, 14(93.33%) got Trishna. Table No.63: Showing distribution of sneha Jeerna Lakshanas in group A. Lakshanas Group A % Jeeryamana lakshana prashamana 15 100.00 Shareera laghuta 13 86.66 Vatanulomana 11 73.33 Kshut pravriti 14 93.33 Trishna pravriti 10 66.66 Udgara shudhi 14 93.33 Among 15 subjects , all had Jeeryamana lakshana prashamana, Shareera laghuta was found in 13(86.66%), Vatanulomana was seen in 11(73.33%),14(93.33%) had Kshut pravrithi, 10(66.66%) had Trishna pravrithi and 14(93.33%) had Udgara shudhi.
  • 153. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 135  Table No.:64 Showing distribution of Time of initiation of Vegas in Group A Time of initiation of vegas Group A % <1/2 hr 0 0.00% ½-1hr 5 33.33% 1-1 ½ hr 9 60.00% >1 ½ hr 1 6.67% Graph no 16.: Showing distribution of Time of initiation of Vegas in Group A Time of intiation of vegas after the intake of virechana aoushada: In Group A, majority of subjects 9(60%) , the vega was started between 1-1 ½ hr,5( 33.33%) between ½ - 1hr and in 1 it was after 1 ½ hr. Table No.:65 Showing of vegas attained . Vegas Group A % 0-10 0 00 11-20 12 80 21-30 3 20
  • 154. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 136  Graph no.17: Showing of subjects by vegas attained in the groupA. In Group A, 12(80%) had madhyama vegas, and 3(20%) had pravara vegas. Table No.66: Showing Distribution of Antaki Shudhi in both the groups. Antaki Group A % Kaphantam 11 73.33 Pittantam 4 26.66 Vatantam 0 00 Graph no.18: Showing Distribution of Antaki Shudhi in the groupA. In Group A, among 15 11(73.33%)had kaphantam, 4(26.66%) had pittantam. Table No.67: Showing the Laingiki lakshanas in the Group A. Laingiki Group A % 1-2 0 0.00% 3-4 4 26.67% 5-6 5 33.33% 7-8 6 40.00%
  • 155. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 137  In Group A , among 15, 6 (40%) got complete laigiki shudhi, 5(33.33%) got 5-6 lakshanas and 4( 26.67%) got 3-4 lakshanas. Table No.68: Showing distribution of Duration of flow in both the groups. Duration Group A % Group B % 2 min 30sec -3min 3 20 0 0 3min 1sec-3min30sec 3 20 7 46.66 3min31sec-4min 5 33.33 1 7 4min1sec-4min30sec 4 26.66 7 46.66 Graph no.19: Showing distribution of Duration of flow in both the groups. Group A: Out of 15,3(20%) were had a duration in between 2min 30 sec to 3min,3(20%) were in between 3min 1 sec to 3min 30 sec, 5 (33.33%)were in between 3min 31 sec to 4 min, 4(26.66%) were in between 4 min 1 sec to 4min 30 sec. Group B: Out of 15,0(0%) were had a duration in between 2min 30 sec to 3min,7(46.66%) were in between 3min 1 sec to 3min 30 sec, 1(7%) were in between 3min 31 sec to 4 min, 7(46.66%) were in between 4 min 1 sec to 4min 30 sec. Table No.69: Showing distribution of Nature of flow in both the groups. Nature of flow Group A % Group B % Slow 5 33.33 3 20 Medium 5 33.33 6 40 Rapid 5 33.33 6 40
  • 156. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 138  Graph no.20: Showing distribution of Nature of flow in both the groups Group A: Out of 15 subjects the nature of flow was slow in 5 (33.33%), medium in 5(33.33%) and rapid in 5(33.33%). Group B: Out of 15 subjects the nature of flow was slow in 3(20%) , medium in 6(40%) and rapid in 6(40%). Table No.70: Showing distribution of Quantity of let-out blood in both the groups. Quantity Group A % Group B % 40ml-65ml 4 26.66 7 46.66 66ml-90ml 5 33.33 2 13.33 91ml-115ml 4 26.66 2 13.33 116ml-140ml 2 13.33 4 26.66 Graph no.21: Showing distribution of Quantity of let-out blood in both the groups.
  • 157. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 139  Group A: The 4(26.66%) were had a quantity in between 40ml-65ml,5(33.33%) were in between 66ml-90ml,4(26.66%) were in between 91 ml to 115ml and 2(13.33%) were 116ml-140ml. Group B: The 7(46.66%) were had a quantity in between 40ml-65ml,2(13.33%) were in between 66ml-90ml,2(13.33%) were in between 91 ml to 115ml and 4(26.66%) were 116ml-140ml. Table No.71: Showing distribution of Sira Utthapan kala after application of torniquet in both the groups. Utthapan kala Group A % Group B % 30sec-1min 3 20 1 6.66 1min1sec-1min30sec 5 33.33 7 46.66 1min31sec-2min 5 33.33 4 26.66 2min1sec-2min30sec 2 13.33 3 20 Graph no.22: Showing distribution of Sira Utthapan kala after application of torniquet in both the groups.
  • 158. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 140  Group A: Out of 15,3(20%) were had a duration in between 30 sec to 1min,5(33.33%) were in between 1min 1 sec to 1min 30 sec, 5(33.33%) were in between 1min 31 sec to 2 min, 2(13.33%) were in between 2 min 1 sec to 2min 30 sec. Group B: Out of 15, 1(6.66%) had a duration in between 30 sec to 1min,7(46.66%) were in between 1min 1 sec to 1min 30 sec, 4(26.66%) were in between 1min 31 sec to 2 min, 3 (20%)were in between 2 min 1 sec to 2min 30 sec.
  • 159. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 141  Table No.72: Showing distribution of Bleeding time in both the groups. Bleeding time Group A % Group B % 30sec-1min 0 00 0 00 1min1sec-1min30sec 2 13.33 8 53.33 1min31sec-2min 7 46.66 3 20 2min1sec-2min30sec 6 40 4 26.66 Graph no.23: Showing distribution of Bleeding time in both the groups. Group A: Among the 15,2 (13.33%)were in between 1min 1 sec to 1min 30 sec, 7(46.66%) were in between 1min 31 sec to 2 min, 6(40%) were in between 2 min 1 sec to 2min 30 sec. Group B: Among the 15, 8(53.33%) were in between 1min 1 sec to 1min 30 sec, 3(20%) were in between 1min 31 sec to 2 min, 4(26.66%) were in between 2 min 1 sec to 2min 30 sec. Table No.73: Showing distribution of Clotting time in both the groups. Clotting time Group A % Group B % Up to 1 min 0 00 0 00 1min 1sec-2min 0 00 0 00 2min1sec-3min 0 00 0 00 3min1sec-4min 9 60 10 66.66 4min1sec-5min 6 40 5 33.33
  • 160. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 142  Graph no.24: Showing distribution of Clotting time in both the groups Group A:In this group 9(60%) were had a clotting time in between 3 min 1 sec to 4min and 6 (40%)were had in between 4min 1 sec to 5min. Group B:In this group 10(66.66%) were had a clotting time in between 3 min 1 sec to 4min and 5(33.33%) were had in between 4min 1 sec to 5min. Table No.74: Showing distribution of Subjects by pittaprakopak and raktaprakopa Symptomology in both the groups. Symptoms No of subjects % Dah 30 100 Vidah 30 100 Kandu 30 100 Pitika 30 100 Mukhapak 30 100 Dhumodgar 6 20 Kanthashosha 13 43.33 Amlavaktrata 14 46.66 Mukhashosha 5 16.66 Swedasrava 2 6.66 Kotha 16 53.33 Ushnagata 3 10 Tiktasyata 18 60 Raktamandala 7 23.33 Annaavipak 13 43.33 Lavanasyata 3 10 Tiktamlodgirana 19 63.33 SYMPTOMS: 100% of the subjects had Dah, Vidah, Kandu, Pitika, Mukhapak. associatedwithDhumodgar20%,Kanthashosha43.33%,Amlavaktrata46.66%,Mukhash
  • 161. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 143  osha16.66%,Swedasrav6.66%,Kotha53.33%,Ushnagata10%,Tiktasyata60%,Raktama ndala23.33%,Annaavipak43.33%,Lavanasyata10%,Tiktamlodgirana63.33% Table No.75: Showing distribution of Subjects by pittaprakopak and raktaprakopa Nidan in both the groups. Symptoms No of subjects % Lavana 13 43.33 Katu 18 60 Amla 26 86.66 Kulattha 9 30 Shigru 4 13.33 Mulaka 9 30 Mamsa 14 46.66 Madya 9 30 Masha 27 90 Dadhi 28 93.33 Lashuna 3 10 Suryoptap 30 100 Diwaswapna 4 13.33 Nidan : 100% were afflicted by suryoptap, 43.33% lavan rasa, 60% amla rasa%,kulattha 30%,shigru 13.33%, mulaka 30%,mamsa 46.66%,madya 30%,masha90%,dadhi 93.33%,lashuna10%,diwaswapna 13.33% Table No.76: Showing the Samyaka Viddha lakshanas in both the Groups. Lakshanas Group A % Group B % 1 0 00 0 00 2 3 20 2 13.33 3 8 53.33 6 40 4 4 26.66 7 46.66
  • 162. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 144  Graph no.25: Showing the Samyaka Viddha lakshanas in both the Groups. Group A: Among the 15 ,3(20%)were had 2 lakshanas,8(53.33%) had 3 lakshanas,4(26.66%)had 4 lakshanas Group B: Among the 15 ,2(13.33%)were had 2 lakshanas,6(40%) had 3 lakshanas,7(46.66%)had 4 lakshanas Hematological: Here the hematological values were observed, viz., Heamoglobin, total WBC count, Differential count, ESR. Here values were observed at three stages Before shodhana Assessment of let-out blood. On 7th day (after). Table No. 77: Showing the hematological analysis. Heamoglobin(in gm %): Group A: Before(B) During(D) After(A) D-B A-B 1 13.9 13.9 13.9 0 0 2 13.5 13.6 13.4 0.1 -0.1 3 13.9 13.8 13.9 -0.1 0 4 14.3 14.2 14.1 -0.1 -0.2 5 12.5 12.2 12.9 -0.3 0.4 6 12.7 12.5 12.8 -0.2 0.1 7 13.1 12.8 13.2 -0.3 0.1 8 14.5 14.2 14.4 -0.3 -0.1 9 13 12.5 13.2 -0.5 0.2 10 13.5 13 13.6 -0.5 0.1 11 13.8 13.7 13.9 -0.1 0.1 12 13.6 13.7 13.5 0.1 -0.1 13 13.2 13 13.1 -0.2 -0.1 14 12.8 12.3 12.7 -0.5 -0.1
  • 163. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 145  15 13.6 13.4 13.7 -0.2 0.1 Difference between during (let-out): Among the 15 subjects, 12 had shown the decreasement in let-out blood in comparison with before, 2 shown the slight increment, one remained unchanged. Difference between After (on 7th day) and before: Among the 15, 6 shown the decresement, 2 unchanged, 7 shown slight incensement. Group B: Before During After D-B A-B 1 12.9 13.1 13.2 0.2 0.3 2 13.8 13.7 13.9 -0.1 0.1 3 12.8 12.9 12.9 0.1 0.1 4 12.5 12.8 12.9 0.3 0.4 5 12.5 12.3 12.8 -0.2 0.3 6 13.5 13.1 13.4 -0.4 -0.1 7 13.5 13.2 13.4 -0.3 -0.1 8 12.9 12.8 12.9 -0.1 0 9 13.2 13 12.9 -0.2 -0.1 10 13.8 13.7 13.6 -0.1 -0.2 11 13.6 13.4 13.5 -0.2 -0.1 12 12.8 12 12.5 -0.8 -0.3 13 12.9 12.7 13 -0.2 0.1 14 13.5 13.2 13.7 -0.3 0.2 15 13.2 12.9 13.5 -0.3 0.3 Difference between During (let-out): Among the 15 samples, 12 had shown the decreasement in let-out blood in comparison with before, 3 shown the slight increment . Difference between After( on 7th day) and before: Among the 15 ,6 shown the decresement, 1 unchanged, 8 shown slight incresement. ESR: Group A: Before During After D-B A-B 1 7 9 8 2 1 2 8 9 6 1 -2 3 8 10 7 2 -1 4 5 8 4 3 -1 5 7 8 5 1 -2 6 6 8 4 2 -2 7 6 9 5 3 -1 8 9 10 7 1 -2 9 8 9 7 1 -1 10 5 8 6 3 -1
  • 164. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 146  11 8 10 6 2 -2 12 8 9 5 1 -3 13 9 10 7 1 -2 14 6 7 7 1 1 15 7 9 5 2 -2 Difference between during (let-out): All the 15 samples had shown the increasement in let-out blood in comparison with before. Difference between After( on 7th day) and before: Among the 15 ,13 shown the decresement, 2 shown slight incresement. Group B: Before During After D-B A-B 1 8 10 7 2 -1 2 7 10 6 3 -1 3 9 10 7 1 -2 4 4 9 3 5 -1 5 10 20 8 10 -2 6 4 9 5 5 1 7 2 3 2 1 0 8 8 10 7 2 -1 9 5 8 4 3 -1 10 5 8 4 3 -1 11 6 9 7 3 1 12 9 10 10 1 1 13 5 8 4 3 -1 14 2 3 2 1 0 15 3 8 4 5 1 Difference between during (let-out): All the 15 samples had shown the increasement in let-out blood in comparison with before. Difference between After (on 7th day) and before: Among the 15 ,9 shown the decresement, 4 shown slight incresement, 2 were unchanged. Total Count (W.B.C.): Group A: Before During After D-B A-B 1 9600 9900 9700 300 100 2 8300 8500 8200 200 -100
  • 165. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 147  3 8400 8500 8600 100 200 4 9800 9900 9700 100 -100 5 8800 8600 9100 -200 300 6 8900 9100 8800 200 -100 7 8600 8400 8700 -200 100 8 9600 9800 9700 200 100 9 7400 7800 7600 400 200 10 8700 8900 8800 200 100 11 9300 9500 9600 200 300 12 8200 8800 8100 600 -100 13 8400 8700 8300 300 -100 14 7600 7800 8100 200 500 15 7800 8000 7900 200 100 Difference between During(let-out): Among the 15 samples,13 had shown the increasement in let-out blood in comparison with before and 2 had shown decreasement. Difference between After( on 7th day) and before: Among the 15 ,5 shown the decresement, 10 shown slight incresement. Group B: Before During After D-B A-B 1 8600 8500 8400 -100 -200 2 8200 8500 8100 300 -100 3 6900 7000 7000 100 100 4 7600 7800 7900 200 300 5 8200 8500 8400 300 200 6 8900 9100 8900 200 000 7 7800 7700 7900 -100 100 8 7500 7900 7600 400 100 9 7900 9000 8800 1100 900 10 7900 8200 8100 300 200 11 7900 8100 8200 200 300 12 6900 6800 7000 -100 100 13 7500 7900 7800 400 300 14 7800 7700 7900 -100 100 15 8400 8900 8500 500 100 Difference between During(let-out): Among the 15 samples, 4 had shown the decreasement in let-out blood in comparison with before and 12 shown increasement.
  • 166. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 148  Difference between After( on 7th day) and before: Among the 15 ,2 shown the decresement, 12 shown slight incresement and 1 was unchanged. Polymorph(%) Group A Before During After D-B A-B 1 68 67 68 -1 0 2 63 66 64 3 1 3 69 68 69 -1 0 4 63 64 65 1 2 5 67 68 65 1 -2 6 63 67 64 4 1 7 67 65 69 -2 2 8 65 67 67 2 2 9 65 68 66 3 1 10 65 68 67 3 2 11 68 70 68 2 0 12 69 69 68 0 -1 13 67 69 68 2 1 14 64 65 67 1 3 15 68 69 67 1 -2 Difference between During (let-out): Among the 15 samples, 12 had shown the decreasement in let-out blood in comparison with before, 2 shown the slight increment , one remained unchanged. Difference between After( on 7th day) and before: Among the 15 ,6 shown the decresement, 2 unchanged, 7 shown slight incresement. Group B: Before During After D-B A-B 1 68 66 65 -2 -3 2 61 65 63 4 2 3 62 65 64 3 2 4 60 67 65 7 5 5 62 67 65 5 3 6 67 70 68 3 1 7 61 64 63 3 2 8 66 70 65 4 -1 9 65 67 64 2 -1 10 64 68 65 4 1 11 63 65 65 2 2 12 61 58 62 -3 1 13 64 65 65 1 1 14 61 64 64 3 3 15 66 68 67 2 1
  • 167. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 149  Difference between During(let-out): Among the 15 samples, 2 had shown the decreasement in let-out blood in comparison with before, 13 shown the slight increment , one remained unchanged. Difference between After( on 7th day) and before: Among the 15 ,3 shown the decresement, 12 shown slight incresement. Lymphocyte (%): Group A: Before During After D-B A-B 1 31 32 30 1 -1 2 37 34 35 -3 -2 3 30 32 31 2 1 4 35 35 34 0 -1 5 33 32 33 -1 0 6 34 30 35 -4 1 7 31 31 30 0 -1 8 34 32 33 -2 -1 9 34 28 33 -6 -1 10 30 28 32 -2 2 11 31 30 30 -1 0 12 30 31 30 1 0 13 32 30 32 -2 0 14 35 33 32 -2 -3 15 32 33 32 1 0 Difference between During(let-out): Among the 15 samples, 9 had shown the decreasement in let-out blood in comparison with before, 4 shown the slight increment , 2 remained unchanged. Difference between After( on 7th day) and before: Among the 15 ,6 shown the decresement, 2 unchanged, 7 shown slight incresement. Group B: Before During After D-B A-B 1 30 33 34 3 4 2 34 32 35 -2 1 3 35 34 35 -1 0 4 35 32 34 -3 -1 5 33 31 33 -2 0 6 32 30 32 -2 0 7 34 34 35 0 1 8 31 30 33 -1 -2 9 32 30 32 -2 0 10 34 32 35 -2 1
  • 168. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 150  11 35 33 35 -2 0 12 34 37 35 3 1 13 34 32 33 -2 -1 14 34 34 34 0 0 15 31 30 33 -1 2 Difference between During(let-out): Among the 15 samples, 11 had shown the decreasement in let-out blood in comparison with before, 2 shown the slight increment , 2 remained unchanged. Difference between after (on 7th day) and before: Among the 15, 3 shown the decresement, 6 unchanged, 6 shown slight incresement. Esonophil(%): Group A: Before During After D-B A-B 1 1 1 2 0 1 2 - - 1 - 1 3 1 - - -1 -1 4 1 1 1 0 0 5 - - 2 - 2 6 2 3 1 1 -1 7 1 2 1 1 0 8 1 1 - 0 -1 9 1 1 1 0 0 10 2 2 1 0 -1 11 1 - 2 -1 1 12 1 - 2 -1 1 13 1 1 0 -1 14 1 2 1 1 -1 15 - - 1 - 1 Difference between During(let-out): Among the 15 samples, 3 had shown the decreasement in let-out blood in comparison with before, 3 shown the slight increment , 9 remained unchanged. Difference between After( on 7th day) and before: Among the 15 ,6 shown the decresement, 3 unchanged, 6 shown slight incresement.
  • 169. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 151  Group B: Before During After D-B A-D 1 2 1 1 -1 -1 2 4 3 2 -1 -2 3 3 1 1 -2 -2 4 4 1 1 -3 -3 5 3 2 2 -1 -1 6 1 - - -1 -1 7 4 2 2 -2 -2 8 2 - 2 -2 0 9 3 3 4 0 1 10 2 - - -2 -2 11 2 2 - 0 -2 12 3 4 3 -1 0 13 2 3 2 1 0 14 4 2 2 -2 -2 15 2 2 - 0 -2 Difference between During(let-out): Among the 15 samples, 11 had shown the decreasement in let-out blood in comparison with before, 1 shown the slight increment , 3 remained unchanged. Difference between After( on 7th day) and before: Among the 15 ,11 shown the decresement, 3 unchanged, 1 shown slight incresement. Monocyte (%): Group A: Before During After D-B A-B 1 - - - - - 2 - - - - - 3 - - - - - 4 1 - - -1 -1 5 - - - - - 6 1 - - -1 -1 7 1 2 - 1 - 8 - - - - - 9 - - - - - 10 1 2 - 1 -1 11 - - - - - 12 - - - - - 13 - - - - - 14 - - - - -
  • 170. Observations Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 152  15 - - - - - Difference between During (let-out): Among the 15 samples, 2 had shown the decreasement in let-out blood in comparison with before, 2 shown the slight increment , 11 remained unchanged. Difference between After( on 7th day) and before: Among the 15 ,3 shown the decresement, 12 unchanged. Group B: Before During After D-B A-B 1 - - - - - 2 1 - - -1 -1 3 - - - - - 4 1 - - -1 -1 5 2 - - -2 -2 6 - - - - - 7 1 - - -1 -1 8 1 - - -1 -1 9 - - - - - 10 - - - - - 11 - - - - - 12 2 1 - -1 -2 13 - - - - - 14 - - - - - 15 1 - - -1 -1 Difference between During(let-out): Among the 15 samples, 7 had shown the decreasement in let-out blood in comparison with before, 8 remained unchanged. Difference between After( on 7th day) and before: Among the 15 ,7 shown the decresement, 8 unchanged. Basophil(%): Among the 30 subjects basophil was found in one subject in before analysis.
  • 171. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 150    RESULT The effect of therapy on various parameter studied under two headings. A) Within the groups B) In between Groups A) Within the Group Statistical analysis within group was done by using Wilcoxons sign rank test Daha In Group A Z Asymp. Sig.(2-tailed) Result -3.442a .001 H S a-Based on positive ranks. p=0.001 indicates there is highly significant result i.e. decrease in dah after the treatment. In Group B Z Asymp. Sig.(2-tailed) Result -3.542a <0.001 H S P<0.001 indicates there is highly significant decrease in dah after the treatment. a-Based on positive ranks. Vidah In Group A Z Asymp. Sig.(2-tailed) Result -3.402a .001 H S
  • 172. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 151    a-Based on positive ranks. p=0.001 indicates there is highly significant decrease in vidah after the treatment. In Group B Z Asymp. Sig.(2-tailed) Result -3.557a <0.001 H S a-Based on positive ranks. p<0.001 indicates there is highly significant decrease in vidah after the treatment. Kandu In Group A Z Asymp. Sig.(2-tailed) Result -3.494a <0.001 H S a-Based on positive ranks. p<0.001 indicates there is highly significant decrease in kandu after the treatment. In Group B Z Asymp. Sig.(2-tailed) Result -3.626a <0.001 H S a-Based on positive ranks. p<0.001 indicates there is highly significant decrease in kandu after the treatment. Mukhapak In Group A Z Asymp. Sig.(2-tailed) Result -3.360a .001 H S a-Based on positive ranks.
  • 173. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 152    p=0.001 indicates there is highly significant decrease in mukhapak after the treatment. In Group B Z Asymp. Sig.(2-tailed) Result -3.638a <0.001 H S a-Based on positive ranks. p<0.001 indicates there is highly significant decrease in mukhapak after the treatment. Pitika In Group A Z Asymp. Sig.(2-tailed) Result -3.384a .001 H S a-Based on positive ranks. p=0.001 indicates there is highly significant decrease in pitika after the treatment. In Group B Z Asymp. Sig.(2-tailed) Result -3.606a <0.001 H S a-Based on positive ranks. p<0.001 indicates there is highly significant decrease in Pitika after the treatment.
  • 174. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 153    B) In Between Groups The data were analysed for normality of distribution and were found to deviate significantly from a normal distribution using Shapiro Wilks test and hence a non parametric wilcoxons test within groups and independent samples Mann Whitney test between groups were done. Table No.78 : Showing the test for normality. Group Shaprio-Wilk Statistic Df Sig. Dah B.T. Group A .771 15 .002 Group B .630 15 .000 Dah A.T. Group A .516 15 .000 Group B .817 15 .006 Vidah B.T. Group A .771 15 .002 Group B .603 15 .000 Vidah A.T. Group A .639 15 .000 Group B .758 15 .001 Kandu B.T. Group A .769 15 .002 Group B .603 15 .000 Kandu A.T. Group A .646 15 .000 Group B .774 15 .001 Mukhapak B.T. Group A .816 15 .008 Group B .790 15 .003
  • 175. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 154    Mukhapak A.T. Group A .297 15 .000 Group B .790 15 .003 Pitika B.T. Group A .801 15 .005 Group B .779 15 .004 Pitika A.T. Group A .428 15 .000 Group B .790 15 .003 • Comparison of mean score of the parameter Dah in Group A and Group B using Mann Whitney test. Table No.79: Showing the Mann whitney for the parameter dah. Group Dah B.T. Dah A.T. Dah Change Group A Mean±SD N=15 2.36±0.63 .21±0.43*** 2.14±0.53+++ Group B Mean±SD N=15 2.4±0.51 1.07±0.8*** 1.3±0.5+++ *** p value for Wilcoxons,+++ p value for Mann Whitney test Graph No.26.: Showing the Mann whitney for the parameter dah.
  • 176. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 155    There was a significant decrease in Dah after Shodhana in both groups using Wilcoxons test. However there was a significant decrease in Dah in Group A as compared to Group B on Mann Whitney test. Test statistics Between Groups Dah change Mann-Whitney U 35.000 Wilcoxon W 155.000 Z -3.401 Asymp. Sig. (2-tailed) .001 Statistical analysis shown that the parameter Dah showed highly significant result as p=0.001 in between the groups. • Comparison of mean score of the parameter Vidah in Group A and Group B using Mann Whitney test. Table No.80: Showing the Mann whitney for the parameter vidah. Group Vidah B.T. Vidah A.T. Vidah Change Group A Mean±SD N=15 2.36±0.633 .43±0.514*** 1.93±0.615+++ Group B Mean±SD N=15 2.33±0.49 1.27±0.594*** 1.067±0.458+++
  • 177. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 156    *** p value for Wilcoxons,+++ p value for Mann Whitney test Graph No27: Showing the Mann whitney for the parameter vidah. There was a significant decrease in Vidahah after Shodhana in both groups using Wilcoxons test. However there was a significant decrease in Vidah in Group A as compared to Group B on Mann Whitney test. Test statistics Between Groups Vidah change Mann-Whitney U 33.000 Wilcoxon W 153.000 Z -3.497 Asymp. Sig. (2-tailed) <0.001 Statistical analysis shown that the parameter Vidah showed highly significant result as p<0.001 in between the groups. • Comparison of mean score of the parameter Kandu in Group A and Group B using Mann Whitney test.
  • 178. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 157    Table No.81: Showing the Mann whitney for the parameter kandu Group Kandu B.T. Kandu A.T. Kandu Change Group A Mean±SD N=15 2.29±0.611 .50±0.519*** 1.79±0.42582+++ Group B Mean±SD N=15 2.67±0.49 1.47±0.640*** 1.2±0.41404+++ *** p value for Wilcoxons,+++ p value for Mann Whitney test Graph No.28.: Showing the Mann whitney for the parameter kandu There was a significant decrease in Kandu after Shodhana in both groups using Wilcoxons test. However there was a significant decrease in Kandu in Group A as compared to Group B on Mann Whitney test. Test statistics Between Groups Kandu change
  • 179. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 158    Mann-Whitney U 43.500 Wilcoxon W 163.500 Z -3.009 Asymp. Sig. (2-tailed) .002 Statistical analysis shown that the parameter Kandu showed highly significant result as p<0.005 in between the groups. • Comparison of mean score of the parameter Mukhapak in Group A and Group B using Mann Whitney test. Table No.82: Showing the Mann whitney for the parameter mukhapak Group Mukhapak B.T. Mukhapak A.T. Mukhapak Change Group A Mean±SD N=15 1.86±0.770 .07±0.267*** 1.79±0.7+++ Group B Mean±SD N=15 1.87±0.640 .87±.640*** 1.00±0.38+++ *** p value for Wilcoxons,+++ p value for Mann Whitney test
  • 180. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 159    Graph No.29: Showing the Mann whitney for the parameter mukhapak. There was a significant decrease in Mukhapak after Shodhana in both groups using Wilcoxons test. However there was a significant decrease in Mukhapak in Group A as compared to Group B on Mann Whitney test. Test statistics Between Groups Mukhapak change Mann-Whitney U 41.000 Wilcoxon W 161.000 Z -3.246 Asymp. Sig. (2-tailed) .001 Statistical analysis shown that the parameter Mukhapak showed highly significant result as p=0.001in between the groups • Comparison of mean score of the parameter Pitika in Group A and Group B using Mann Whitney test. Table No.83: Showing the Mann whitney for the parameter pitika Group Pitika B.T. Pitika A.T. Pitika Change Group A Mean±SD N=15 1.86±0.663 .14±0.363*** 1.7143±0.61125+++ Group B Mean±SD N=15 2.00±0.655 1.13±0.640*** .8667±0.35187+++
  • 181. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 160    *** p value for Wilcoxons,+++ p value for Mann Whitney test Graph No.30: Showing the Mann whitney for the parameter pitika. There was a significant decrease in Pitika after Shodhana in both groups using Wilcoxons test. However there was a significant decrease pitika in Group A as compared to Group B on Mann Whitney test. Test statistics Between Groups Pitika change Mann-Whitney U 32.500 Wilcoxon W 152.500 Z -3.677 Asymp. Sig. (2-tailed) <0.001 Statistical analysis shown that the parameter Pitika showed highly significant result as p<0.001 in between the groups. Statistical Analysis of Procedure Assessment:
  • 182. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 161    Comparison of mean scores for duration of flow, nature of flow and quantity of flow of blood ,in Siravyadha followed by Virechana and Siravyadha alone. Table No.84: Showing the statistical analysis of duration of flow,nature of flow, and quantity. Group Duration of Flow in min Nature of Flow Quantity in ml Group A Mean±SD N=15 3.57±0.56 1.93±0.83 85±25.3 Group B Mean±SD N=15 3.71±0.51 2.2±0.78 87±36.3 Graph No31 .: Showing the statistical analysis of duration of flow,nature of flow, and quantity. Independent samples Mann Whitney tests between groups for duration of flow . 0 20 40 60 80 100 Dur.of  flow Nat. of  flow Quantity Group A Group B
  • 183. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 162   
  • 184. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 163    Test Statisticsb Duration of flow in min Mann-Whitney U 87.500 Wilcoxon W 192.500 Z -.769 Asymp. Sig. (2-tailed) .442 b:Grouping Variable:Group Though there was a slight increase in duration of flow in Group B as compared to Group A the result was not statistically significant (p> 0.05). Independent samples Mann Whitney tests between groups for Nature of flow . Test Statisticsb Nature of flow Mann-Whitney U 85.500 Wilcoxon W 190.500 Z -.905 Asymp. Sig. (2-tailed) .366 b:Grouping Variable:Group Statistical analysis shown that the parameter, nature of flow, showed non- significant result as (p>0.05) i.e. the mean effect is same in both the groups.
  • 185. Results    Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 164    Independent samples Mann Whitney tests between groups for Quantity in ml . Test Statisticsb Quantity in ml Mann-Whitney U 102.000 Wilcoxon W 222.000 Z -132 Asymp. Sig. (2-tailed) .895 b:Grouping Variable:Group Statistical analysis shown that the parameter, quantity in ml, showed non significant result as (p>0.05) i.e. the mean effect is same in both the groups.
  • 186. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 164  Discussion Conceptual Part: Discussion on Virechana: iÉ§É SÉåwÉWûUhÉÇ AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç | The act of expelling vitiated doshas (malas) through Adhobhaga is known as Virechana.Virechana is the purificatory measure especially used for the elimination of vitiated pitta dosha. All the Acharyas underlined its importance in the management of pitta dosha. In Charaka samhita, while explaining Agryaoushada stated as, ÌuÉUåcÉlÉqÉç ÌmɨÉWûUÉhÉÉÇ ´Éå¹qÉç”||. The guna of virechana dravya are ushna, teekshna, sukshma, vyavayi, vikashi, these qualities are common in vamana aoushadam, but virechana dravya has adhobagahara prabhavam.Virechana dravya has jala and prithwi mahabootha predominance. It is also useful in the conditions such as pitta associated,with kapha, Kapha displaced to vatasthana ‘ÌmɨÉå iÉÑ ÌuÉUåMüqÉç,zsÉåwqÉ xÉÇxÉë×¹å uÉÉiÉxjÉÉlÉ aÉiÉå uÉÉ zsÉåwqÉÍhÉ CÌiÉ|| Pitta is mala of rakta –“ÌmÉ¨É iÉÑ xuÉåS U£ürÉÉå:” So it can be indicated in raktavaha srotho vikara and virechana is also indicated for raktapradoshaja vikaras. Acharya Charaka, while explaining about treatment of Pitta vikara stated as-ÌuÉUåcÉlÉqÉç iÉÑ xÉuÉÉåïmÉ¢üqÉåpÄrÉ: ÌmÉiÉå mÉëkÉÉlÉiÉqÉèû qÉlrÉliÉå ÍpÉwÉeÉÈ”||. Classification of Virechana dravyas: The drugs which produce virechana are classified into many types based on their origin, mode of action, parts used, according to seasons and kalpana. Acharya
  • 187. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 165  Sharangadhara has given a unique classification as Anulomana, Bhedana, Sramsana, Rechana. According to seasons, different virechaka drugs are used in different season. Among all the drugs, Trivrutta is safe and can be used in all seasons. These virechaka yogas can be prepared in many forms like Gritha, Taila, and Avalehya etc. This is according to convenience and for easy palatability. Depending on the Koshta of the patient dosage can be fixed. Acharya Sharangadhara has given dosage of Kwatha, Kalka and Choorna. Procedure Review: Virechana karma has been studied under 3 headings, Poorva Karma, Pradhana karma and Paschat karma. Poorva Karma:- In Purvakarma Pachana-Deepana, Snehana, Swedana are to be done. Aampachana and agnideepti are the two essential aspects before the administration of sneha. Here in snehapana, ghrita or taila reaches the cellular level and does the shithilata of vitiated doshas.Swedana helps to bring them into koshtha for elimination. Pachana -Deepana This preparatory procedure aims at Niramikarana.For the administration of snehapan Niramikaran is essential, as snehapana in amavastha leads to many complications. Snehapana: This is one of the very important stage in shodhana procedure. Administration of sneha does the dosha vilayana and moistens the strotas. Swedana:The doshas which are present all over body brought to koshtha by swedana. Hence swedana helps for elimination of vitiated doshas through shodhana procedure by bringing them to koshtha.
  • 188. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 166  Pradhana karma: This is the most important aspect of shodhana by Virechana. This includes the administration of Virechana drug to the person. The care should be taken to avoid any vyapat, and if occurs that must be treated carefully. In the Pradhana karma, virechaka yoga is given, it gets digested and enters the systemic circulation, which increases the peristalsis and eliminates the vitiated doshas (malas). For assessment of virechana, vaigiki, manaki, antaki, and laingiki lakshanas are taken, where laigiki is given more importance. Assessment of Virechana Vaigiki Shudhi:- helps to decide whether Shudhi is Pravara , Madhyama , Avara and plan the Samsarjana Krama accordingly. Maniki Shudhi:- helps to decide whether Shudhi is Pravara , Madhyama , Avara and gives idea about the Quantity of Doshas expelled and Quantity of the remnant if any. Antiki Shudhi: - valuable criteria to make decision about end point of Virechana. It gives idea to physician from proceeding further and leading to Ati yoga or Vyapath. Laingiki Shudhi:This is important among the all. It shows the effect of procedure over human body and calamities. Paschat Karma: It includes samsarjana karma, after Shodana, the Agni becomes diminished, hence it is brought to normal by samsarjana karma. This depends on the type of shuddhi achieved. Depending upon the pravara,madhyama and avara shudhi samsarjana karma has to be planned. Discussion on Raktamokshana:Raktamokshana is one among the shodhanakarma according to Acharya Sushruta and Vagbhata. Charaka has also mentioned the procedure Raktamokshana but not considered it under Panchakarma.
  • 189. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 167  Raktamokshana can be achieved mainly by 2 ways.Shastravisravana and Ashastravisravana.Shastravisravana is done by either of the ways. Pracchanna and Siravyadha iÉ§É vÉx§ÉÌuÉxÉëÉuÉhÉÇ Ì²ÌuÉkÉÇ mÉëcNû³ÉÇ ÍxÉUÉurÉkÉlÉqÉç cÉ || Ashastra visravana can be carried out by the way of Shringa, Jalauka Alabu and Ghatiyantra Efficacy of each method: Application of Shringa can bring out blood from an area of Ten angulis around, Jalauka can suck from an area of one hasta, Alabu from an area of twelve anguli, Pracchanna from an area of one anguli, while Siravyadha can purify entire body. SIRAVYADHA It is a type of Shastrakruta Raktamokshana, in which Shastra is being used to do Vyadhana of the Sira (the vessel) to let out the blood. Sira sankhya and Prakara: There are Seven hundred Siras in the entire body. These 700 siras originate from 40 principle siras. These 40 siras are divided into 4 types as, Vatavaha Siras:10, Pittavaha Siras:10 Kaphavaha Siras:10 Raktavaha Siras:10 Siras in Extremeties:These are twenty five Vatavaha Siras in one extremity and same count applies to other three extremities, thus making the total of 100. The same is with Pitta, Kapha and Raktavaha Siras. Siras in Koshta: Guda, Medra, Shroni:8 Parshwa:4 Prushta:6 Udara:6 Vaksha:10 Siras in Urdhwajatru:Greeva:14, Karna:4, Jihwa:9, Nasika:6, Netra:8 Thus total numbers of Vatavaha Siras are 175, similarly with Pittavaha, Kaphavaha and Raktavaha Siras, with an exception where the Pittavaha in Netra are 10 each and in karna 2 each.
  • 190. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 168  Avedhya Sira: A total of 16 Sira out of 400 in the extremities, 32 Sira out of 136 in the Koshta and 50 out of 164 Siras in the Urdhwajatrugata region should not be taken for Siravyadha purpose. Vedhya Sira: A total 602 sira out of 700 are vedhya in which Shakhagata are 384, Koshtagata are 104, Urdhwajatrugata are 114. Siravyadha Procedure: iÉ§É ÎxlÉakÉÎxuɳÉqÉÉiÉÑUÇ rÉjÉÉSÉåwÉmÉëirÉlÉÏMüÇ SìuÉmÉëÉrÉqÉç A³ÉqÉç pÉÑ£üuÉliÉÇ rÉuÉÉaÉÔÇ mÉÏiÉuÉliÉÇ uÉÉ The patient, after snehana, swedana should be given ahara or Yavagu, at appropriate time, and should be asked to sit or stand comfortably. Selecting the area, the Sira are made prominent with the help of either vastra, patta, charma, antharvalkala, latha tied neither too hard nor too loose. Such uttita Sira are taken for vyadhana karma with the shastras mentioned. Samyak Viddha Lakshana: Following features are indicative of properly performed Siravyadha During Raktamokshana, when the blood which is flowing freely stops on its own, it has to be known that shodhana has taken place and is indicative of Samyak visravana. A well and successfully viddha sira, bleeds in stream and spontaneously stops after a muhurta.The vitiated blood is seen first to flow out of an opened sira, like the drop of yellow pigment first coming out of a Kusumbha flower.Lightness, cessation of pain, decrease in the intensity of vyadhi and cheerfulness of mind are symptoms of proper blood letting. There are 4 methods of preventing excess bleeding: Sandhana, Skandana, Pachana, Dahana. Discussion on Rutu: In Yajurveda we come across the description of six rutus and their respective months. Madhu Madhav –Vasant rutu,Shukra Shuchi-Greeshma rutu,
  • 191. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 169  Nabha nabhasya- Varsha, Isha Urja –Sharad, Saha Sahasya-Hemant, Tapa Tapasya- Shishira. The same description has been followed by all the Ayurvedic classics. But while explaining the rutus for application of shodhana procedure they are classified as Vasant, Greeshma, Pravrut, Varsha, Sharad, Hemant.While Chakrapani commented as this classification varies according to southern and northen area of river Ganga. In Shathapatha Brahman rutus are classified as Deva rutu and Pitru rutu. ME ASURES TO BE ADOPTED AS PER RUTUS: Gopatha Brahman:The diseases are going to manifest during rutusandhi,hence yagnya has to be perform during this period. Jaiminiya Brahman:During sandhikala there is elaboration of ashwini ukth. shathapatha Brahman:the Brahman has to perform yagnya during vasant rutu,kshatriya during greeshma,and vaishya during varsha rutu. Aapastambha kshoutrasutra. The yagnya has been told as per the rutus, Vasant-vaishwadevyagnya,Pravrut-arunpraghasyagnya,Sharadshakmedhayagnya.Here also we come to know about the consideration of sadharan rutu to perform yagnya, similar to that of Ayurveda which narrate the elimination of doshas as per sadharan rutu,viz.,Sharad-Pitta,Vasant-Kapha,Pravrut-Vata. In Charaka Samhita stated that having the administration of purification therapies in view ,seasons are thus divided into six.There are three rutus pravrut sharad and vasant which are of moderate nature Purificatory therapies viz., vaman etc., should be administered only in seasons of moderate nature. In other seasons having extreme cold ,heat, or rain such therapies should not be administered .If needed administered with utmost care. The reason behind this is, the time of other seasons are unsuitable because of the risk of
  • 192. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 170  inadequate or excessive bouts. Ordinary seasons are ideal because of mild degrees of cold heat and rain during these seasons and so are easy and harmless. Doshas accumulated in hemant be eliminated in vasant, those accumulated in greeshma be eliminated in abhrakal and those accumulated in varsha be eliminated in sharad. And the same principle is elaborated in all the other Ayurvedic classics. In Astang samgraha stated that Just as slit develops surely, in course of time, even in pure water kept undisturbed in a earthen pot, so also dirt accumulates inside the body hence it should be removed from the body at appropriate times.32 In Astang hradaya told that, all our efforts should be made to clear out the malas(doshas and waste products) at appropriate time ,their accumulation may become life threatening. Hence the doshas should be removed out of the body as per their shodhana kala. Charaka underlined the importance of shodhana as, In case of a poor man in the event of the administration of the purification therapy should take the prescribed drugs available without caring for collecting all the rare medicaments in advance. All the prescribed medicaments are not available to all human beings. At the same time diseases can attack even poor. So in these circumstances whatever drugs, cloths, diets are easily available should be used by patients according to their capacity. SHARAD RUTU CHARYA: Dos: In this season sweet, light, cold and bitter foods and drinks which have potentialities to alleviate pitta are to be taken in proper quantity when there is good appetite. The meat of common quail,grey partridge, antelope, sheep, wapiti, rabbit, rice, barley, and wheat are prescribed during this season. Use of garlands made of autumnal flowers and clean apparel and also the rays of the moon are exceedingly beneficial in
  • 193. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 171  this season. He should drink laja saktu along with water containing sugar or honey. Person should eat old rice specially the one that matures in sixty days along with a soup of mudga. Person should consume sweet taste and the juice of vidari, ikshu, and draksha. Person should drink ghee. Day time should be spent in sailing in lakes which are full of swans, rows of humming bees, and blossomed lotus flowers, wearing light and clean dress, garlands, anointing the body with the paste of ushira,Chandan which is coolant, nights should be spent on a terrace having good moonlight. Donts: One should avoid taking sun bath ,vasa(fat), oil and meat of aquatic and marshy animals, alkaline salt preparations and curd in food. One should not sleep during day time and should not expose himself to frost and facing wind. One should avoid irritant, sour, hot, alkaline items in food, day sleep, sun rays, night awaking. These all measures are told by Aacharyas to counteract the vitiation of pitta dosha. But in present era, it is difficult to follow these measures. SHODHANA IN SHARADA RUTU: • ÌiÉ£üxrÉ xÉÌmÉïwÉÉmÉÉlÉÇ ÌuÉUåMüÉå U£üqÉÉåYzÉlÉqÉ|| cÉUMü Pitta which has been accumulated in varsha rutu gets aggravated in sharad rutu.In order to check the pitta prakopa one should undergo virechana and raktamokshana-charak • ÌiÉ£üxrÉ xÉÌmÉïwÉ: mÉÉlÉæUxÉëÑYxÉëÉuÉæ¶É rÉÑÌ£üiÉ:|| uÉwÉÉïxÉÑmÉÍcÉiÉÇ ÌmɨÉÇ WûUåŠÌmÉ ÌuÉUåcÉlÉæ:|| xÉÑ´ÉÑiÉ Pitta accumulated in rainy season should be eliminated properly with blood letting and purgation.-sushruta .
  • 194. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 172  • zÉxiÉÇ ÌiÉ£üWûÌuÉ:mÉÉlÉÇ ÌuÉUåMüÉå xÉëxÉëÑÌiÉ: xÉSÉ| A¹ÉÇaÉ xÉaÉëÇWû • iÉ‹rÉÉrÉ bÉëÑiÉÇ ÌiÉ£Çü ÌuÉUåMüÉå U£üqÉÉåYzÉlÉqÉ| A¹ÉÇaÉ ¾ûSrÉ46 • zÉUiMüÉsÉå xuÉpÉÉuÉålÉ MÑürÉÉïS U£üxÉëÑÌiÉÇ lÉU:| zÉÉUÇaÉkÉU47 In sharad rutu rakta gets aggravated naturally hence one should undergo raktamokshana.sharangadhara • ÌmɨÉÉlÉÉÇcÉ ÌuÉUåcÉlÉÇ oÉsÉuÉiÉÉårÉÑ£Çü ÍxÉUÉqÉÉåYzÉlÉqÉ| pÉÉuÉÍqÉ´É 48 • ÌmɨÉÉlÉÉÇcÉ ÌuÉUåcÉlÉÇ oÉsÉuÉiÉÉårÉÑ£Çü ÍxÉUÉqÉÉåYzÉlÉqÉ| rÉÉåaÉU¦ÉÉMüU49 In sharad rutu one should undergo siravyadha. . DISCUSSION ON MATERIAL AND METHODS This is a comparative clinical study conducted to assess the efficacy of Siravyadha with and without Virechana in Sharad rutu. As per the inclusion and exclusion criterias, the subjects who fulfill the criteria were selected and randomly divided into two groups. After the Shodhana effects were analysed on 7th day in both the groups. Inclusion criteria: The age limit for Siravyadha is 16 to 70 years therefore the 16yr. to 70yr. age group criteria was taken. As per the classics the rutushodhana has to be conducted on healthy person. But without any parameters it is difficult to assess its efficacy, So the pittaprakopak and raktaprakopaka laxanas appeared in that particular season without any variation in their routine lifestyle, aahar and vihar was considered for inclusion criteria.
  • 195. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 173  The subjects were scrutinized for normal clotting time, bleeding time, Virechana yogyata and Raktamokshana yogyata to avoid any complication. Hematological investigation such as Hb, TC, DC, ESR were carried out to observe the variations. Group A: Jeerakadi Churna was administered till Niramavastha followed by arohana krama snehapan with Murchit goghrut until getting samyaka snigdha laxanas.Abhyanga with tila taila followed by parisheka sweda(Ushnodak) carried out for three days. On third day virechana yoga was administered. Depending upon the shuddhi the samsarjana karma was planned. After two days of completion of samsarjana karma snehapan with murchit goghrit was done for two days. On the day of siravyadha abhyanga and parisheka sweda was done. Group B: Jeerakadi Churna was administered till Niramavastha followed by snehapan with murchit goghrit for two days. On the day of siravyadha abhyanga and parisheka sweda was done. Site of Siravyadha: The site selected for siravyadha was Dakshina Bahu kurpara sandhigata sira. The siravyadha does the sarvang rakta shuddhi and this site is also indicated for Yakruta vikara.The yakruta is a raktavahastrotomula .Hence the site was selected. Samsarjana Karma: In olden days there were two Aaharkala and in samsarjana karma also included two aaharkala.However now a days it changes to three therefore while planning to samsarjana karma three aaharkala were considered. Snehapan after two days:Followed by virechana and samsarjana karma snehapan has to be done on 9th dat i.e. seven day of samsarjana karma and gap of two days xÉÇxÉÚ¹pÉ£Çü lÉuÉqÉå ÎlWû xÉÌmÉïxiÉÇ mÉÉrÉrÉåiÉ|
  • 196. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 174  No Pachana and Deepan: In group A after virechana and samsarjana karma there will be nil formation of aama .therefore before snehapan for siravyadha pachana-deepan was not done Snehapan before Siravyadha: iÉ§É ÎxlÉakÉÎxuɳÉqÉÉiÉÑUÇ Here stated that snehana and swedan should be done before siravyadha.The snehapan is done for doshavilayana and to bring them to koshtha. In aarohana karma snehapan, doshavilayana and their movement towards koshtha occur as dose and duration increases. Here the removal of doshas takes place from shakha(Rakta) only therefore to achieve the doshavilayan in shakha and prevent their movement towards koshtha two day of snehapana was done.And on the day of siravyadha swedana was carried out. Parisheka sweda: The parisheka sweda is indicated for pitta dosha therefore selected. Discussion on the Medicines used: Jeerakadi Churna: Usually the drugs which does aampachana are ushna, tikshna. In the present study pitta dosha is having prime imporatance so such kinds of drugs may not suits directly. In Jeerakadi churna 9 drugs are having laghu ruksha guna,4 are having laghu tikshna , and rest are having laghu ruksha tikshna, snigdha, ushna guru snigdha, laghu snigdha, tikshna laghu pichhila, guru ruksha tikshna gunas. In case of veeryata 15 drugs are having ushna veerya and 9 drugs are having sheet veerya. Because of such excellent combination our aim to do aampachana without disturbing pitta gets fulfilled.
  • 197. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 175  Murchita Goghrit: In case of pitta samanya chikitsa told that xÉÌmÉïwÉÉ xlÉåWûlÉÇ AkÉÉåSÉåwÉWûUhÉqÉç || To eliminate the Aamdosha of ghrit the murchana samskar is essential.Therefore for snehan purpose murchit ghrit was selected. Trivrutta Leha: Trivrutta is the best drug among all the purgatives. It has less complication. ̧ÉuÉÚixÉÑZÉÌuÉUåcÉlÉÉlÉÉÇ| In this yoga trivrutta is the only drug of virechana remaining are sita, madhu, twak, ela, patra.This yoga is hradya having least complication. As there is no addition of any drastic purgative, this is not going to hamper the strength of person considerably . Apart from this, In this group siravyadha has to be conduct after virechana so special consideration was given to bala of person. Hence this yoga was selected to achieve desired effect i.e. Virechana should happen with least complication and should not hamper the bala of person. DISCUSSION ON OBSERVATION: SEX: It has been observed that among 30 patients, 23(77%) were males and 7(33%) were females. AGE: Maximum of patients belonged to middle aged people.1(3%)out of 30 patients were in 16-19, 17(57%) in 20-29. 7(24%) out of 30 patients belonged to 30-39, 3(10%) in 40-49 ,1(3%) in 50-59and1(3%) in 60-70 age group. Here maximum number of patient belongs to20-39yr which is the pittapradhan kala.
  • 198. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 176  EDUCATION: Among the 30 subjects 7(24%) had primary education,11(36.5%) had higher secondary,11(36.5%) had graduation and 1(3%) was illiterate. OCCUPATION: 7 (24%)out of 30 were students, 11(36%) were under service, 2 (6%)belonged to business, 7(24%) belonged to occupation of labour and3(10%) out of 30 were house wives. This shows that almost all groups of people get influenced by the effect of season. SOCIOECONOMIC STATUS: The socioeconomic status of 13(43.5%) were belonged to middle class and 6(20%) belonged to poor class, 11(36.5%) belonged to upper middle class. MARITAL STATUS: Out of 30 subjects, 16(53.33%) were unmarried and 14(46.67%) were married. Here the both married and unmarried get affected almost equally, shows that marital status has no significant role. DIET: Out of 30 subjects 16(53.33%) were vegetarian and 14(46.66%) belonged to mixed diet. RELIGION: Among the 30 subjects randomly incorporated into the study 25(83.33%) belonged to Hindu community and rest 5(16.66%) were Muslim. This may be because of dominance of Hindu community in the area where the work had been carried out. ADDICTIONS: It has been observed that 13(43%) were having addictions. And 17(57%) were not having any addictions among the 30. 4 (13.33%)out of 30 were addicted to Alcohol, 3(10%) out of 30 were smokers, 5 (16.66%)out of 30 were both alcoholic and smokers whereas 1(3%) was addicted to tobacco. SATVA: Maximum of 15(50%) were having madhyama satva, whereas 4(13.33%) were having Pravara and 11(36.66%) were having Avara satva. It shows that there
  • 199. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 177  were less person who had a pravara satva.Avara satva person were needed more councelling whereas Madhyama satva person were needed less councelling. PRAKRUTHI: Maximum 14(46.66%) belonged to Pitta vata prakruthi, 11(36.66%) belonged to Pitta kapha prakruthi and 5(16.66%) were from Vata kapha prakruthi. Here the maximum person shown the dominance of involvement of pittaprakrutti as 14 of pittavata and 11 of pittakapha.The less number of person were belonged to vatakapha prakrutti. SARA: 15(50%) were of Madhyama sara and 5(16.66%) from Pravara and 10(33.33%) were of Avara sara. Time of intiation of vegas after the intake of virechana aoushada: In Group A, majority of patients 9(60%), the vega was started between 1-1 ½ hr,5( 33.33%) between ½ - 1hr and in 1 it was after 1 ½ hr. No. of Vegas in Group A, 12(80%) had madhyama vegas, and 3(20%) had pravara vegas. Antiki Shuddhi in Group A, among 15 11(73.33%)had kaphantam, 4(26.66%) had pittantam. Laingiki Shuddhi in Group A: Among 15, 6 (40%) got complete laigiki shudhi, 5(33.33%) got 5-6 lakshanas and 4( 26.67%) got 3-4 lakshanas. Bleeding Time: Group A: Among the 15,2 (13.33%)were in between 1min 1 sec to 1min 30 sec, 7(46.66%) were in between 1min 31 sec to 2 min, 6(40%) were in between 2 min 1 sec to 2min 30 sec. Group B: Among the 15, 8(53.33%) were in between 1min 1 sec to 1min 30 sec, 3(20%) were in between 1min 31 sec to 2 min, 4(26.66%) were in between 2 min 1 sec to 2min 30 sec.
  • 200. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 178  Clotting Time: Group A:In this group 9(60%) were had a clotting time in between 3 min 1 sec to 4min and 6 (40%)were had in between 4min 1 sec to 5min. Group B:In this group 10(66.66%) were had a clotting time in between 3 min 1 sec to 4min and 5(33.33%) were had in between 4min 1 sec to 5min. Duration of Flow: Group A: Out of 15,3(20%) were had a duration in between 2min 30 sec to 3min,3(20%) were in between 3min 1 sec to 3min 30 sec, 5 (33.33%)were in between 3min 31 sec to 4 min, 4(26.66%) were in between 4 min 1 sec to 4min 30 sec. Group B: Out of 15,0(0%) were had a duration in between 2min 30 sec to 3min,7(46.66%) were in between 3min 1 sec to 3min 30 sec, 1(7%) were in between 3min 31 sec to 4 min, 7(46.66%) were in between 4 min 1 sec to 4min 30 sec. Among the both groups on average the group A was having more bleeding time than group B whereas the clotting time was almost same, But the duration of flow was marginally more in group B than group A. As group A received virechana before siravyadha the vitiation of pitta get decreased. As there is less dushit rakta it flows for less duration. On contrary the group B had more dushit rakta it flows for more duration. Nature of Flow: Group A: Out of 15 subjects the nature of flow was slow in 5 (33.33%), medium in 5(33.33%) and rapid in 5(33.33%). Group B: Out of 15 subjects the nature of flow was slow in 3(20%) , medium in 6(40%) and rapid in 6(40%). In group A the nature of flow was equally distributed. In group B in majority the nature of flow was medium and rapid. This shows that after vene-section dushit rakta flows rapidally.
  • 201. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 179  Quantity of let out blood: Group A: The 4(26.66%) were had a quantity in between 40ml-65ml,5(33.33%) were in between 66ml-90ml,4(26.66%) were in between 91 ml to 115ml and 2(13.33%) were 116ml-140ml. Group B: The 7(46.66%) were had a quantity in between 40ml-65ml,2(13.33%) were in between 66ml-90ml,2(13.33%) were in between 91 ml to 115ml and 4(26.66%) were 116ml-140ml. Here on average the quantity was more in group B than Group A even though the group B was having less bleeding time..It shows that after vene section the dushita rakta flows out. Colour of Rakta:After doing vene section the shyava varna blood flown out initially, later on the progressively the colour was changing to bright red and cease the flow. The shyavata was less in rakta let out after virechana .It underline the raktaprasadan and pitta shodhana action of virechana. Sira Utthapan Kala: Group A: Out of 15,3(20%) were had a duration in between 30 sec to 1min,5(33.33%) were in between 1min 1 sec to 1min 30 sec, 5(33.33%) were in between 1min 31 sec to 2 min, 2(13.33%) were in between 2 min 1 sec to 2min 30 sec. Group B: Out of 15, 1(6.66%) had a duration in between 30 sec to 1min,7(46.66%) were in between 1min 1 sec to 1min 30 sec, 4(26.66%) were in between 1min 31 sec to 2 min, 3 (20%)were in between 2 min 1 sec to 2min 30 sec. SYMPTOMS: 100% of the patients had Dah, Vidah, Kandu, Pitika, Mukhapak. Associated with Dhumodgar20%, Kanthashosha43.33%, Amlavaktrata46.66%, Mukhashosha16.66%, Swedasrav6.66%, Kotha53.33%, Ushnagata10%, Tiktasyata60%, Raktamandala23.33%, Annaavipak43.33%, Lavanasyata10%, Tiktamlodgirana63.33%.
  • 202. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 180  Nidan : 100% were afflicted by suryoptap, 43.33% lavan rasa, 60% amla rasa%,kulattha 30%,shigru 13.33%, mulaka 30%,mamsa 46.66%,madya 30%,masha90%,dadhi 93.33%,lashuna10%,diwaswapna 13.33%. Samyaka Viddha Laxanas: Group A: Among the 15, 3(20%)were had 2 lakshanas, 8(53.33%) had 3 lakshanas, 4(26.66%)had 4 lakshanas Group B: Among the 15, 2(13.33%) were had 2 lakshanas, 6(40%) had 3 lakshanas, 7(46.66%)had 4 lakshanas. Hematological: In Hematological analysis Hb., total count, differential count there was no significant variations. In case of ESR it was significantly increased in letout blood DISCUSSION ON RESULTS: In the present study both group has shown significant result both clinically and statistically. Assessment Dah: Significant improvement was seen in both the groups, In group A the mean dah was 2.36 before shodhana which reduced to 0.21 after shodhana. In group B the mean dah was 2.4 before shodhana which reduced to 1.07. Vidah: Significant improvement was seen in both the groups, In group A the mean vidah was 2.36 before shodhana which reduced to 0.43 after shodhana. In group B the mean vidah was 2.33 before shodhana which reduced to 1.27.
  • 203. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 181  Kandu: Significant improvement was seen in both the groups, In group A the mean kandu was 2.29 before shodhana which reduced to 0.50 after shodhana. In group B the mean kandu was 2.67 before shodhana which reduced to 1.47. Mukhapak: Significant improvement was seen in both the groups, In group A the mean mukhapak was 1.86 before shodhana which reduced to 0.07 after shodhana. In group B the mean mukhapak was 1.87 before shodhana which reduced to 0.87. Pitika: Significant improvement was seen in both the groups, In group A the mean pitika was 1.86 before shodhana which reduced to 0.14 after shodhana. In group B the mean pitika was 2.0 before shodhana which reduced to 1.13. There was a significant decrease in all the parameters in both groups. However there was a significant decrease in Group A as compared to Group B on Mann Whitney test, Procedure Assessment: Duration of flow: The mean duration was 3.57 min in group A,and 3.71 min in group B. Among the both groups on average the group A was having more bleeding time than group B whereas the clotting time was almost same, But the duration of flow was marginally more in group B than group A . As group A received virechana before siravyadha the vitiation of pitta get decreased. As there is less dushit rakta it flows for less duration. On contrary the group B had more dushit rakta it flows for more duration.
  • 204. Discussion  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 182  Nature of Flow: The mean nature of flow was 1.93 i.e. slow to medium, in Group A.whereas it was 2.2 i.e. medium to rapid Group B. In group A the nature of flow was equally distributed. In group B in majority the nature of flow was medium and rapid. This shows that after vene-section dushit rakta flows rapidally. Quantity: The mean quantity of let-out blood was 85 ml. in group A and it was 87ml. in group B. Here on average the quantity was more in group B than Group A even though the group B was having less bleeding time.It shows that after vene section the dushita rakta flows out.
  • 205. CONCLUSION CONCLUSION 1) The description of seasons told in Ayurvedic classics is true till to the date. 2) Pitta gets aggravated by the effect of season in sharad rutu. 3) It is difficult to follow the seasonal regimen in present era because of strain and stressful lifestyle. Hence the vitiation of doshas occur tremendously. Therefore to preserve the health and counteract doshic vitiation one should undergo rutushodhana. 4) Siravyadha followed by virechana and siravyadha alone are beneficial to eradicate the vitiated pitta dosha . But the siravyadha followed by virechana is better than siravyadha alone. 5) Clinically and statistically this study was shown good results in subjective and objective parameters in both the groups. 6) Siravyadha followed by virechana required more duration in comparison with siravyadha alone. 7) In present busy life style if it is difficult to spare time for virechana and siravyadha, person can undergo siravyadha alone to counteract vitiation of pitta. 8) Siravyadha let-out the vitiated blood. 9) Virechana does the raktaprasadan karma. Suggestions for further study: • The use of virechana yoga told in sharad rutu. • Assess the effects of rutushodhana in sharad rutu with including follow-up till next sharad rutu. Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 183 
  • 206. CONCLUSION • Assess the effects of shodhana indicated in three shodhana kala viz. pravrut, vasant,sharad. • Assess the effect of shodhana over human by conducting trials for longer duration and over large sample. • May be included under National Health Programme as a preventive measure. Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 184 
  • 207. Summary  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 185  SUMMARY The Thesis title ‘Efficacy of Siravyadha with and without Virechana in sharad rutu –A comparative study”. Consists of – 1) Introductory part regarding the present work and the objective. 2) Review of procedure- It includes the review of virechana, Nirukthi, Paribasha, classifications, Indication, Contraindications, Procedure, Management of Complication, if any vyapaths occur. It includes the review of raktamokshana, Nirukthi, Paribasha, classifications, Indication, Contraindications, Procedure, Management of Complication, if any vyapaths occur. 3)Review of rutu includes description of rutus in vedic period, in Ayurvedic literature and in present era. Detailed description about the measures adopted as per the rutus, importance of rutushodhana, rutushodhana in sharad rutu and sharad rutucharya. 4) Review of drugs used in Amapachana, snehapana, virechana and siravyadha. 5) Description regarding the materials and methods used in present study. 6) Observation and result of the present study, discussion, summary, conclusion and bibliography. • The study was conducted on 30 volunteers having pittaprakopaka laxanas, 15 subjects in each group. • The drugs selected for the study was Jeerakadi Churna for pachana and deepan, snehapan with Murchit goghrut, Abhyanga with tila taila, parisheka sweda with ushnodak, this was common in both the groups. Apart from this
  • 208. Summary  Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 186  trivrutta leha was used for virechana in group A. All the drugs used for this procedure have been explained under the heading of drug review in the first part of the thesis. • The clinical study in the beginning describes about the inclusion, exclusion criteria, study design of both the groups Subjective and objective parameters on each group were statistically analyzed and systematically presented in tables. • The observation and results are discussed. • The points observed in this study were- By clinically and statistically both groups were shown good results. But the siravyadha followed by virechana is having better result than siravyadha alone
  • 209. REFERENCES Virechana: 1. Manu smruti 2. Agni purana 3. Ch. Su. Ch. 2/9,10 4. Ch. Su Ch.4/4 5. Ch. Su Ch. 15/17 6. Ch. Kal. Ch.7/12 7. Ch. Si. Ch.1/ 17,18,19 8. Ch. Si. Ch.1/11 9. Ch. Si. Ch.6 10. Su. Su.Ch. 39/4 11. Su. Su.Ch.44/1-91 12. Su. Chi. Ch.33 13. Su. Chi.Ch.34 14. A.S. Su.Ch. 27 15. A.H.Su.Ch. 18 16. A.H. Ka.Ch.2 17. A.H.Ka.Ch.3 18. C.D.Ch.71 19. Sha.Ut.Ch.4/1-48 20. Pharmacology and Pharmacotherapeutics. Ch. 33 21. C. Dwaraknath , Digestion and metabolism in Ayurveda, Ch. 33. 22. C. Dwaraknath , Digestion and metabolism in Ayurveda, p.32 23. Toratora, Principles of anatomy and physiology. 24. Martini, Fundamentals of anatomy and physiology p.1008-20 25. Ch. Kal. Ch.1/4 26. Ch.Kal. Ch.1/5 27. Ch.Kal. Ch.1/4 28. Commentary on Ch. Kal.1/4 by Chakrapani. 29. A.S. Su.Ch.1/39 30. Ch. Kal. Ch.1/5 31. Ch.Su. Ch.13/80 32. Ch. Si.Ch. 2/13 33. Su. Chi.Ch.33/25-32 34. A.S.Su.Ch.27/4 35. A.H.Su.Ch.18/8,9,10 36. B.S. 37. Sh.Ut.Ch.4/8-11 38. B.P. Pu.virechanarogadhikara. 39. Y.R.virechana rogadikara 40. Ch.Su.Ch.6/44 41. A.H.Su.Ch.4/35 42. A.S.Su.Ch.27/4 43. A.H.Chi.Ch.1 44. Ch.Chi.Ch.28/188-190 45. Ch. Su.Ch.24/18 46. Ch.Chi.Ch.1/24 47. A.H. Ut.Ch.39/11 48. Ch.Si. Ch.2/11 49. Su.Chi.Ch.33/29,30 50. A.S.Su.Ch.27/5 51. A.H.Su.Ch.18/7 52. B.S 53. Sh.Ut.Ch.4/6,7 54. B.P.Pu.virechana adhikara 55. Y.R. Virechanadhikara 6,7. 56. A.S.Su Ch.14/4 57. Ch.Su.Ch.1/94-97 58. Ch.Su.Ch.1/107-114 59. A.S.Su. Ch.14/4
  • 210. 60. A.S.Su.Ch.14/4 61. Ch.su.Ch.1/77-85 62. Su. Su.Ch. 39/4 63. A. S. Su. Ch.14 64. Sh. P. kh.Ch.4/3 65. Dal.commentary on Su.Su.Ch.46/259 66. Sh.P.kh.Ch.4/4 67. Ch.Chi.Ch.3/171 68. Sh.P.kh.Ch.4/5 69. Ch.Su.Ch.4/9 70. Ch.Su.Ch.4/9 71. Sh.P.kh.Ch.4/6 72. Ch.Su.Ch.4/13 73. Ch.Kal.Ch.12/56 74. Ch.Kal.Ch.12/56-58, 67-69 75. Su.S.Ch.33/44 76. Sh.U.Ch.4/13 77. Ch.Su.Ch.13/66-67 78. Ch.K.Ch.12/55. 79. Sh.PU.Ch.4/6 80. Ch.Kal.Ch.12/54 81. Ch.Kal.Ch.12/58 82. Su.Su.ch.33/35 83. Ch.Su.Ch.25/40. 84. A.H.SU.Ch.18/53 85. S.Ch.33/41.,C.si.6/9 86. Bhe.Su25/8 87. Ch.Si.Ch.6/9 88. Su.Su.Ch.44/1,2 89. Sh.U.Ch.4/21 90. Ch.Kal. Ch.7.Trivrth kalpa 91. Ch.Su.Ch.15/17 92. Sh. Ut.Ch.4/16 93. Su.Su.Ch.33/21 94. Sh.U.Ch.4/13 95. A.H.Su.Ch.18/33 96. Sh.U.Ch.4/18 97. Ch.Kal.Ch.8/8 98. Ch.Si.Ch.1/6. 99. Ch.Su.Ch.13/51 100. Ch.Su Ch..13/60,61 102 Ch.Su Ch..28/33 103. Chakradatta.virechana26 104 A.H.Su Ch..2/8 105. A.S.Su.Ch.26/18 106. A.H.Su.Ch.18/58 107. Ch.Si.Ch.1/8 108.Ch.Si.Ch.1/8 109. Su.Su.Ch.39/10 110.A.S.Su.Ch.27 111. Ch.Si.Ch.6/26 112.Ch.Si.Ch.6/21 113.A.H.Su.Ch.18/36-38 114.Ch.Su.Ch.16/5-10 115.Ch.Si.Ch.1/17-19 116.Su.Chi.Ch.33/24-27 117.Su.Chi.Ch.33/24-27 118.A.S. Kal.Ch.3/6 119.Ch.Si.Ch.1/12,13 120.Ch.Su.Ch.15/16 121.Chakrapani commentary on Ch.Su.Ch.16/2 122.A.H.Su.Ch.18/29 123. Ch.Si.Ch.6/57 124. Ch.Si.Ch.1/2 125. A.H.Su.Ch.18/30 126. Ch.Si.Ch.1/3-5
  • 211. 127.Su.Chi.Ch.33 128. Su.Chi.Ch.39/17,18 129. Chakrapani commentary on Ch.Si.Ch.6/25 130. Su.Chi.Ch.39/19-20 131. Chakrapani commentary on Ch.Si.Ch.12/6-8 132. Su.Chi.Ch.39/18-19 133. Ch.Si.Ch.12 134. Ch.Si.Ch.6/58-93 135. Su.Chi.34/13,14 136.Ch.Su.Ch.20/16 137.Pharmacology and Pharmacotherapeutics chapter 33. 138. The pharmacological basis of therapeutics. RAKTAMOKSHANA: 1)Shabdakalpadruma P-69 2)Shabdakalpadruma P-69 3)Su. Su. Ch.14/4-5 4)Su.Su. Ch.14/9 5)Su.Su.Ch.14/64 6)Su.Su.Ch.14/22 7)Ch.Su.Ch.24/22 8)Su.Su.Ch.21/16 9)Su.Su.Ch.21/17 10)Su.Su.Ch.15/5 11)Su.Su.Ch.21/25 12)Su.Su.Ch.14/21 13)Shabdakalpadruma P-786 14)Aayurvedasya Bruhat Itihas P-96 15)Sha. Utt. 16)Ay.Vai.Itihas 17)Ay.Vai.Itihas 18)Ay.Vai.Itihas 19)William Boyd’s Textbook of pathology P-1097 20)Sevils system of clinical medicine 21)Boyds Textbook of pathology http:www.iron.panel.org.au/ais/aisdocs/ad mit dols/A.overload.html. 22)Su.Su.Ch.14/24 23)Su.Su.Ch.13/4 24)Sha.Utt.Ch.12/26 25)Su.Sha.Ch.9/3 26)Su.Sha.Ch.4/29 27)Su.Sha.Ch.7/3 28)Su.Sha.Ch.7/2 29)Su.Sha.Ch.7/19 30)Su.Su.Ch.14/24 31)Su.Sha.Ch.8/2 32)Su.Su.Ch.25/12-15 33)Su.Sha.Ch.8/6 34)Su.Sha.Ch.8/9 35)Su.Sha.Ch.8/7 36)Su.Sha.Ch.8/10 37)Su.Su.Ch.27/17 38)Su.Sha.8/16 39)Su.Su.Ch.14/32 40)Su.Sha.Ch.8/11 41)Su.Sha.Ch.8/12 42)Su.Su.Ch.14/32 43)Su.Su.Ch.14/27-28 44)Su.Su.Ch.14/29 45)Su.Su.Ch.14/30 46)Su.Sha.Ch.8/18
  • 212. 47)Su.Su.Ch.14/35 48)Su.Su.Ch.14/39-40 49)Su.Sha.8/22 50)Su.Su.Ch.14/34 RUTU: 1)Yajurveda 2)Ay.vai.Itihas 3)Ay.vai.Itihas 4)Ay.vai.Itihas 5)Ay.vai.Itihas 6)Ay.in Sanskrit sahitya 7)Ay.in Sanskrit sahitya 8)Ch.Su.Ch.6/4 9)Ch.Su.Ch.6/5 10)Ch.Su.Ch.6/6 11)Ch.Su.Ch.6/7 12)Ch.Su.Ch.6/8 13)Su.Su.Ch.6/6 14)Su.Su.Ch.6/7 15)Su.Su.Ch.6/14 16)A.Sa.Su. Ch.4/4 17)A.Hr.Su.Ch. 18)Sha.Pr.Kh.2/24-26 19)Yogratnakar-rutucharya. 20)Ay.vai.Itihas 21)Ay.vai.Itihas 22)Ay.vai.Itihas 23)Ay.vai.Itihas 24)Ch.Vi.Ch.8/125 25)Ch.Vi.Ch.8/126 26)Ch.Su.Ch.11/58 27)Ch.Su.Ch.15/19-21 28)Ch.Sha.Ch.2/45 29)Su.Su.Ch.6/10 30)Su.Su.Ch.6/11 31)Su.Su.Ch.6/12 32)A.S.Su.Ch.5/26 33)A.S.Su.Ch.5/32-33 34)A.S.Su.Ch.21/10 35)A.S.Su.Ch.23/8 36)A.S.Su.Ch.4/62 37)A.H.Su.Ch.4/25 38)A.H.Su.Ch.3/49 39)A.H.Su.Ch.4/35 40)A.H.Su.Ch.13/33 41)Bhel 42)Sharangdhar 43)Ch.Su.Ch.6/44 44)Su.Ut.Ch. 45)A.S.Su.Ch.4/54 46)A.H.Su. 47)Sha. 48)B.P. 49)Y.R. 50)Ch.Su.Ch. 51)Su.Ut.Ch. 52)A.S.Su.Ch. 53)A.H.Su.Ch. 54)Bhel 55)Harit 56)Y.R. 57)G.N. 58)A.H.Su.Ch. 59)www.seasonwikipaedia.com DRUG REVIEW: 1. Ch.Su.25 2. Ch.Kal.7/3 3. Ch. Kal.7/4
  • 213. 4. Ch.Kal.7/7 5. Ch.Kal.7/5,6 6. Ch.Kal.7/6 7. A.H.Ka.2/9 8. Sh.Pu.4/6 9. Bhavaprakasha 10. Kaiyadeva Nighnatu 11. Bha.Rat. 12. R.R.S. 13. Aa.pra. 14. Aa.Rasashatra 15. J.L.N.Shastry-DravyaGunavignana 16. Gyanendra pandey- Dravya Guna vijnana    
  • 214. BIBLIOGRAPHY 1. Raja Radhakanta Dev. Shabdakalpadruma. 3rd ed. Varanasi: Chaukambha Orientallia; 1967 2. Shree Taranatha Tarka Vachaspati Bhattacharya. Vachaspatyam – reprint 2003, Varanasi: Chowkhamba Sanskrit Series Office; 2003. 3. Sir Monier Monier Williams. A Dictionary of English and Sanskrit - 4th ed. Varanasi: Motilal Banarasidass 4. Vaman Shivram Apte: The Students Sanskrit English Dictionary: Motilal Banarasi Publications Private Limited, Delhi. 5. Amarkosha Amarasimha, Manushyavarga Pandit Vishwanath Jha, editor. Delhi Motilal Banarasi Das; 1976 6. Ayurvediya Mahakosha or Ayurvediya Shabdadosha. Edited by Ayurvedacharya Venimadhava Shastri Joshi and Ayurveda visharada Narayanahari Joshi. Maharastra Rajya Sahitya Ani Samkruta Mandal, Mumbai; 7. Agni Purana, Of Maharshi Veda Vyasa Edited by Acharya Baladeva Upadhyaya, Chowkhamba publishers, Varanasi. Pp: 566 pg: 412 8. Manu Smriti edited with the Maniprabha hindi commentary by Pandit Haragovind Sastri,Chowkamba Sanskrit Series,Varanasi.PP 716 , pg 283 9. Agnivesha, Charaka Samhita, Revised by Charaka and Dridhabala with Ayurveda Deepika commentary of Chakrapani Datta, 3rd ed.Bombay: Nirnaya Sagar Press; reprint2009.
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  • 219.               YAVAGU                                                                            TRIVRUT  LEHA            MATERIALS REQUIRED FOR SIRAVYADHA             MURCHITH GOGHRITH 
  • 220. PROCEDURE :- SIRAVYADHA                                                                                                                               GROUP A                                                                                                                            
  • 221.   GROUP B                                                                                                                                                                                   
  • 222. DEPARTMENT OF PG STUDIES IN PANCHAKARMA GOVT. AYURVEDA MEDICAL COLLEGE BANGALORE Case Performa for “ Efficacy of siravyadha with and without virechana in sharad rutu.” Guide : Dr Shylaja Kumari R. PG Scholar: Dr. Ravikumar Patil M.D.(Ayu.) Asst. professor Dept of PG Studies in Panchakarma GAMC Bangalore 09 --------------------------------------------------------------------------------------------------- Name of patient: Sl .no O.P.D.no Group Fathers / Husbands Name: Age :……Yrs Sex : M/F Education: Marital Status: Married /Unmarried Religion: Hindu /Muslim /Christian /Others Occupation: Adress: Desha : Janmatah:jangal/sadharan/aanup Sammrudhita: jangal/sadharan/aanup
  • 223. PITTA PRAKOPAKA LAXANAS: Dhoomodgar Vidah Ushnagatva Kantha shosha Mookha shosha Tiktaasyata Amla vaktratva Swedasrav Dourgandhya Haridra netra mutra shakrut Kopa Angapak Mookha pak Dah Rakta mandal Alpanidrata Kotha Mandal RAKTA PRAKOPAKA LAXANAS: Rakta netrata Rakta pidaka Mookhapak Dah Angapak Pitika Vat rakta Kushtha Pipasa Shiroruk Anna avipak Puti Ghran Asya Gandhita Lavanasyata Tiktamlodgiran Kandu Krodha Agnisad
  • 224. Personal History: Aahar: Shakahar Mishrahar Nidra : Duration Disturbed/undisturbed Day sleep Yes/No (Duration if Yes: ) Vyasan: Duration Occasional Regular Stopped Reduced Quantity Smoking Tobbaco Alcohol Snuff Any Other Nature of work: Day/Night Manual/Sedentary/Labour Travelling/Walking/Standing/Sitting Gynaecological History: Menarche: Menstrual Cycle: days/regular/irregul Any other specific:
  • 225. Family History: Any hereditary disorders Paternal Maternal Health Status of family member Any other specific General Examination: Built: well/moderate/ poor Nourishment: well/moderate/poor Pallor :present/absent Icterus: present/absent Cynosis: present/absent Clubbing : present/absent Lymphadenopathy;present/absent Oedema: present/absent Gait:normal/abnormal Ht: cms Wt: Kgs Pulse: /min B.P : mm of Hg
  • 226. Systemic examination: Cardiovascular system: Respiratory system: Per abdomen : CNS: Ashta Vidha Pariksha Nadi : /min Mala: Baddha/Abaddha Sadaha/Adah Malapravrutti …… /day Mutra: Prakrut/Vaikrut Sadah/Adah Mutra pravrutti ……. /Day ……/Night Jivha: Lipta/Alpa lipta/ Alipta Shabda: Prakruta/Vaikruta Sparsha: Mrudu/Khara Ushna/Anushna sheet/Sheet Druka: Prakruta/Vaikruta Sadaha/Adah Ragata Pitata Aakruti : Sthula/Madhyama/Hina
  • 227. Dasha Vidha Pariksha:Prakruti: Kaphaja: Snigdhanga Shlkshnanga Samhat sthira sharira Manda chesta aahar vihar Alpa kshuta trushna Sushlishta sandhibandhana Upachit paripurna sarvanga Avadat Gatra Prabhut shukra vyavaya apatya Ashighra aarambha kshobha vikar Prasanna snigdha varna swara Pittaja: Ushna asaha Avadat gatra Prabhut viplu vyanga til pidika Kshut pipasavanta Kshipra vali palitya khalitya dosha Mrudu alpa kapil shmashru lom kesha Klesha asahishnuta Shithila mrudu sandhi mamsa Prabhoot putikaksha aasya shira sharira gandha Prabhuta ashana pan
  • 228. Vataja: Alpa sharira Ruksha kshama sanna sakta jarjar swara Jagruka Chapal gati aaha chesta vihar Anavsthita sharira avayava Bahu pralapa Kandara sira pratana Shighra aarambha Alpa smruti shruti grahi Parusha kesha shmashru rom nakha dashana vadana panipada Sphutita anga avayava. Sarata: Twaka Rakta Mamsa Meda Asthi Majja Shukra Satva Pravara/Madhyama/Avara Samhanan: Pravara/Madhyama/Avara
  • 229. Satmya:Madhur/Aamla/Lavan/Katu/Tikta/Kashaya Pravara/Madhyama/Avara Satva: Pravara/Madhyama/Avara Aahar:Abhyavaharn shakti: Pravara/Madhyama/Avara Jaran shakti: Pravara/Madhyama/Avara Vyayama Shakti: Pravara/Madhyama/Avara Vaya: Yrs Pramana: Ht Wt B.M.I. Lab Investigation: BT CT RBS ValuesTEST Before During After Hb% ESR Total count Differential count P% L% E% M% B%
  • 230. Pitta prakopak and Rakta prakopak Nidan Aahar: Ati lavan Kshara Katu Amla Kulattha Masha Aadhaki Nishpava Shigru Sarshapa Mulaka Dadhi Mamsa Dadhimanda Madya Lashuna Katvar kanji Harit varga seven Vihara: Suryoptap Diwaswapna Abhigata krodha Santap Shrama
  • 231. SHODHANA VIDHI: Group A: Siravyadha followed by Virechana Poorva karma : Dipan pachana Till Niramavstha No of days Snehan with Goghrut Days Quantity . Abhyanga and Parishek sweda Sl.no. Jeeryamana lakshanas Sneha Jeerna Lakshanas Shiroruja Jeeryamana Lakshanas Prashama Bhrama Shareera Laghuta Lalasrava Vatanulomana Murcha Shkutpravrithi Klama Trishna Pravritti Trishna Udgara Shuddhi Daha Anya Arati Virechana: Once Laingiki
  • 232. Srotoshuddhi Indriya Prasadana Shareera Laghuta Agnideepti Anamayatwa Kramatvitpittakapha Vatanulomana Absence of ayoga No. Of vegas Initiation of Vega Samsarjan Karma: Depending upon shuddhi Annakal: Snehana: With Goghrut Days Quantity Abhyanga and Parishek sweda: For one day Pradhana Karma: Siravyadha Once: Duration of Flow Nature of Flow Quantity
  • 233. Samyaka Viddha laxan: #Sraved Dhara #Svyayam Avtishthate #Laghuta #Manaprasad #Vedana shanti Complication Observed: Treatment: Paschat Karma: Plota Bandhana Allowed to take rest for some time. Adviced to take laghu and dipaniya aahar. Observation: Group B: Siravyadha without Virechana. Poorva karma : Dipan pachana Till Niramavstha No of days
  • 234. Snehana: With Goghrut Days Quantity Abhyanga and Parishek sweda: For one day Pradhana Karma: Siravyadha Once: Duration of Flow Nature of Flow Quantity Samyaka Viddha laxan: #Sraved Dhara #Svyayam Avtishthate #Laghuta #Manaprasad #Vedana shanty Complication Observed: Treatment: Paschat Karma: Plota Bandhana Allowed to take rest for some time. Adviced to take laghu and dipaniya aahar. Observation:
  • 235. . Assessment : Parameters Before Shodhana After Shodhana Follow up 7th day Daha Vidaha Kandu Mookha pak Pitika