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Virechana tirupati 1 dr.santosh bhattded


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Virechana tirupati 1 dr.santosh bhattded

  1. 1. Virechana KarmaDr Santoshkumar BhattedAssociate Prof, Dept of PanchakarmaNational Institute of AyurvedaJaipur5/30/2013 1Presentation by Dr Santoshkumar Bhatted
  2. 2. Approach for standardization of VirechanaProcess of Virechana Karma and its SOPTime of administration of Virechana OushadhiAssessment of Avara, Madhyam & Pravara ShuddhiVyapat of Virechana Karma and its management5/30/2013 2Presentation by Dr Santoshkumar Bhatted
  3. 3. Virechana “Virechana” is a Process by which the vitiated Pitta andother mala from the whole body are expelled outthrough gastrointestinal tract by means of purgationwith the use of specific formulations.5/30/2013 3Presentation by Dr Santoshkumar Bhatted
  4. 4. Field of Virechana Pittaja Vyadhi Shleshmasamsrushta Pittaja Vyadhi Pittasthanagata Vyadhi Raktaja Vyadhi Commonly used in Kushta, Visarpa, Vatarakta, Pandu,Kamala, Pakshaghata, shwasa, amlapitta, Amavata,Jvara, Udara, Gulma etc. In Sharad Rutu As a Poorvakarma for Rasayana and Vajikarana5/30/2013 4Presentation by Dr Santoshkumar Bhatted
  5. 5. Virechana- contraindications By nature: Pregnant, Sukumara, Rooksha, Kshudhita,Shokarta, Krisha, Bala, Vriddha, Durbala Diseased conditions like:Amavastha- Navajwara, AjeernaAdhopravritti- Atisara, Adhogat RaktapittaGudaja Roga- Kshataguda, Muktanala5/30/2013 5Presentation by Dr Santoshkumar Bhatted
  6. 6. Types of Virechana Purvakarmayukta Virechana Rutu-Anusari Virechana Sadhyo-Virechana Nitya –Virechana Punha-Punha Virechana5/30/2013 6Presentation by Dr Santoshkumar Bhatted
  7. 7. Merits of VirechanaWorks on Pitta Pradhana TridoshaEasy to perform even in Out PatientsEasy availability of drugsCost effectiveSimplicity of procedureAcceptance from the patientsLess complicationsEasy to manage complications if any5/30/2013 7Presentation by Dr Santoshkumar Bhatted
  8. 8. Why standardization of Virechana Karma To develop the uniformity of practice To overcome the difference of opinion among theAcharyas and the practitioners To overcome the complexity of decision making inselection of medicine, dose, duration, pattern at eachstep during Virechana Karma To frame certain minimum guidelines To prevent malpractice of Virechana Karma
  9. 9. Limitations in doing standardization Factors to be evaluated before planning VirechanaKarma are individual variables to a great extent Chief assessment criteria is mainly subjective Quantitative assessment of Virechana Vega ispractically difficult Number of Virechana Vega can be recorded as Vegaand Upavega
  10. 10. Factors to be evaluatedExamination of PatientKoshtaAgniPrakritiBala etcExamination of diseaseDoshaDushya etc5/30/2013 10Presentation by Dr Santoshkumar Bhatted
  11. 11. ASSESSMENT OF KOSHTHA:Understanding of Koshtha as Mrudu, Madhyama andKrura Koshtha is most important in Virechana Karma. The bowel habits were examined in following way frequency, consistency, straining or efforts, time taken forproper defecation, Krita Samdnya Previous encounters of diarrhea and constipation Previous experiences of Purgatives and Laxatives.5/30/2013 11Presentation by Dr Santoshkumar Bhatted
  12. 12. Mridu Koshtha Passes Stools daily once or twice regularly Semi formed or formed stools. Easy defecation. Less time required for defecation. Krita Samdnya after defecation. Previous encounters shows often Drava Mala Pravritti due tohot drinks, tea, milk, Mridu,Ushna, guru dravya Minor laxatives often encounter diarrhea. After the 30 ml test dose of Ghrita passes stools slightly looseand frequency may be more by 1-2 vegas5/30/2013 Presentation by Dr Santoshkumar Bhatted 12
  13. 13. Madhyama KoshthaPasses stools daily once Formed stools Requires minimum stress. Little long time (in comparison to mridu). Krita Samdnya after defecation. Doesnt often encounter diarrhoea or constipation. Requires medium dose of Purgatives and laxatives. Doesntpurgates by milk or by minor laxatives. After the intake of test dose of Ghrita, passes semi formed orformed stools once or twice.5/30/2013 Presentation by Dr Santoshkumar Bhatted 13
  14. 14. Krura Koshtha Doesnt pass stool regularly Kathina or Shushka Mala Pravritti. Requires straining. Requires long time for defecation. Krite Api Akrita Samdnya (unsatisfactory bowelclearance). Seldom encounters diarrhea and more frequentlyexperiences constipation. Requires drastic purgatives, No change in the bowels by test dose of Sneha.5/30/2013 Presentation by Dr Santoshkumar Bhatted 14
  15. 15. Assessment of AgniAfter the Koshtha, assessment of Agni is prior requisite inVirechana Karma Ruchi Aahara kale Abhyavaharana Shakti Jarana Shakti Time required for digestion of routine /moderate quantityof food Time required for digestion of light/ less food Time required for digestion of heavy/excess food5/30/2013 15Presentation by Dr Santoshkumar Bhatted
  16. 16. Important issues in Virechana Karma Standard operative procedure Snehapana and its assessment Selection of Virechana Dravya and Yoga Assessment of Virechana karma Planning of Samsarjana Krama5/30/2013 16Presentation by Dr Santoshkumar Bhatted
  17. 17. SOP of Virechana Karma Purva karma: (pre-operative procedure) Pachana and Deepana Abhyantara Snehapana Bahya Snehana Svedana Ahara Vishesh Upayoga Pradhana karma: (operative procedure) Virechana Yoga administration Pashchata karma: (post-operative procedure) Assessment of Virechana Sansarjana Krama5/30/2013 17Presentation by Dr Santoshkumar Bhatted
  18. 18. Pachana and Deepana Tab Amapachana vati: 1 gram three times/day Tab Chitrakadi vati: 1 gram three times/day Panchakola Churna 2 grams three times a day For 3 to 7 days or till Niraama Lakshana andAgnideepti is achieved5/30/2013 18Presentation by Dr Santoshkumar Bhatted
  19. 19. Abhyantara Snehapana (internal oleation) Shodhananga Snehapana: Selection ofSneha, Dose, Duration, Dose Pattern Sneha: Select preferably Murchita Shuddha Sneha (plainghee or oil)or medicated Sneha as per the patient anddisease Dose, Duration, Dose Pattern: For 3 to 7 days inincreasing dose early in the morning in empty stomachas per Agnibala and Koshtha or till Samyaka SnigdhaLakshana achieved Start with test dose (Hrasiyasi Matra)5/30/2013 19Presentation by Dr Santoshkumar Bhatted
  20. 20. Bahya Snehana and Svedana Vishrama Kala: 03 days Sarvanga Taila Abhyanga(Whole body oil Massage): for30 minutes Sarvanga Bashpa/Nadi Svedana: whole body steam bath10 -15 minutes Two times a day for three days after internal oleation5/30/2013 20Presentation by Dr Santoshkumar Bhatted
  21. 21. Food regimenOdana, Mudga Yusha, Jangala Mamsa Rasawith little amount of fat, spices and salt(Riceand meat soup/green gram soup )in moderatequantitySour fruits like grapesfrequent drinking of warm waterNo complex food is permitted5/30/2013 21Presentation by Dr Santoshkumar Bhatted
  22. 22. Ensure on the day of Virechana Assess for Jirna Ahara Lakshana Proper digestion of food taken on previous day Proper clearance of natural urges Patient had proper sleep in the night No Kaphavruddhi Lakshana developed in patient Administer Sarvanga Abhyanga and Svedana Time of administration: After passing Kaphakala(about 10.00 AM)5/30/2013 22Presentation by Dr Santoshkumar Bhatted
  23. 23. Intake of Virechana Yoga Selection of Virechana Yoga as per the Prakriti, Koshta, Bala, Dosha etc Give it in empty stomach with suitable Anupana like TriphalaKvath, Draksharasa, Ushnodaka/Shitodaka, Madhu etc Patient is to be advised to clean his mouth with warm water, sprinkle coldwater on face and smell something like lemon etc Take rest waiting for the urges of defecation without going into sleep Warm water should be used frequently for drinking in little quantity Examination of vitals like BP, Pulse before in between and aftercompletion of Virechana Vegas5/30/2013 23Presentation by Dr Santoshkumar Bhatted
  24. 24. Recording of Virechana Vega Number of Vega after excluding initial 2-3 Vegas of fecalmatter Time of Vega Approximate quantity Color Consistency Any complications5/30/2013 24Presentation by Dr Santoshkumar Bhatted
  25. 25. Pashchata Karma- Do’s & Don’ts After the subsiding of Vegas and ensuring Jeerna OushadhaLakshana, Patient is to be advised to take warm water bath inthe evening Dietetic schedule should be advised as per the Shuddhiachieved once the patient feels hunger. Regimen – avoid exposure to Pravatha, drinking coldwater, Guru Ahara, Vyayama, Maithuna5/30/2013 25Presentation by Dr Santoshkumar Bhatted
  26. 26. Assessment of Virechana KarmaSHUDDHI VAIGIKI MANIKI ANTIKI LAINGIKI LAKSHANAHina 10Vega2PrasthaKaphantaSroto VishuddhiIndriya Prasada,LaghutaAgnivriddhiAnamayatvaKramatVata Pitta KaphaNirgamanaMadhyam 20Vega3PrasthaKaphantaPravara 30Vega4PrasthaKaphanta5/30/2013 26Presentation by Dr Santoshkumar Bhatted
  27. 27. Vyapat5/30/2013 27Presentation by Dr Santoshkumar Bhatted
  28. 28. VyapatAdhmanaParikartikaSravaHridgrahaGatragrahaJeevadanaVibhramshaStambhaUpadravaKlama.5/30/2013 28Presentation by Dr Santoshkumar Bhatted
  29. 29. Vyapat1) Savasesha aushadhatva2) Jeerna aushadhatva3) Hina doshapahritatva4) Adhika- doshaapahritatva5) Vata shoola5/30/2013 29Presentation by Dr Santoshkumar Bhatted
  30. 30. Virechana Ayoga- Causes5/30/2013 Presentation by Dr Santoshkumar Bhatted 30
  31. 31. Virechana Ayoga LakshanaApravrittiOordhvapravrittiVata, Mootra, Pureesha sangaUtklesha of Kapha & PittaVatha pratilomathaAvishuddhi in Kukshi & Hridaya•Adhmana•Praseka• Bhrama• Kandu, Vivarnata• Vidaha• Staimitya•Agnimandya• Gaurava•Prathishyaya• Tandra• Chchardi• Aruchi5/30/2013 31Presentation by Dr Santoshkumar Bhatted
  32. 32. Management in case of Apravrita Vega If Virechana Vegas are not started than the patientshould be given hot water for drinking and fomentationshould be done on the abdomen. Assess for Aushadhi Jeerna and Ajirna Lakshanas If Jeerna Lakshanas are found than another VirechanaYoga can be given Still if Vega has not started, than Niruha Basti withGomutra is to be given followed by Anuvasana Basti Again proper Snehapana is to be given followed byTikshna Virechana If Ajirna Lakshanas are found than wait for the Vegashe/she should be allowed to take food in the evening onthat day and should be subjected to Virechana on thenext day.5/30/2013 32Presentation by Dr Santoshkumar Bhatted
  33. 33. Management of Ayoga Vyapat5/30/2013 Presentation by Dr Santoshkumar Bhatted 33
  34. 34. Features of Jeerna & Ajeerna Oushadhi5/30/2013 34Presentation by Dr Santoshkumar Bhatted
  35. 35. Features of Jeerna & Ajeerna OushadhiJeerna Oushadhi Ajeerna Oushadhi Vatanulomana Svasthata Kshudha Trushna Manasvita Indriya Shuddhi Udgara Shuddhi Klama Daha Angasada Bhrama Murcha Shiroruja Arati Balahani5/30/2013 Presentation by Dr Santoshkumar Bhatted 35
  36. 36. Virechana Atiyoga- Causes5/30/2013 Presentation by Dr Santoshkumar Bhatted 36
  37. 37. Virechana Atiyoga LakshanaKapha kshayaja vikarasPitha kshayaja vikarasVata Prakopaja vikarasKevala Dosharahita Jala, Rakta,Medo-Mamsa Dhavanodaka likeKrishna Varna Srava• Supti•Angamarda• Klama•Vepathu• Nidra• Bala Abhava• Tama Pravesha•Nayana Anta Pravesha• Hikka•Unmada•Hridayodveshtana• Parikartika• Gudanissarana5/30/2013 37Presentation by Dr Santoshkumar Bhatted
  38. 38. Management of Atiyoga Vyapat5/30/2013 38Presentation by Dr Santoshkumar Bhatted
  39. 39. Management of Atipravruti Maintenance of Hydration by fluid replacement Electrolytes supplement Maintenance of BP, Pulse Use of Mantha, Sharkara Udaka Panchavalkala Siddha Peya Purisha Sanghahaniya Kshirapaka Tandulodaka PicchaBasti, Ghrita Manda Basti, Madhura OushadhiBasti Raktapittahara Daha and Atisara hara Chikitsa Shita Kashaya and Madhura Dravya and Ahara Prayoga5/30/2013 39Presentation by Dr Santoshkumar Bhatted
  40. 40. Management of Udara Shula &Adhmana Use of Warm water Udara Svedana Phala Varti Prayoga Niruha and Anuvasana Basti Use of Vatanulomana drugs Shankha Vati, Hinguashtaka Churna, ShankhaBhasma etc5/30/2013 40Presentation by Dr Santoshkumar Bhatted
  41. 41. Factors to be considered toprevent Vyapat Proper preparation of the patient by Purvakarma Use of Proper Virechana drug and formulation inappropriate dose in accordance to patient status like Koshtha Dosha and its pramana Agni Sthithi Bala Ruksha or Snigdha Purusha5/30/2013 Presentation by Dr Santoshkumar Bhatted 41
  42. 42. Meticulous care during Samshodhana5/30/2013 42Presentation by Dr Santoshkumar Bhatted
  43. 43. Sansarjana Krama (dietetic schedule) Special dietetic schedule To improve the Agni To maintain the strength (Prana) To provide basic nourishment and positive energy balance To supplement the body gradually one by one fromcarbohydrates to proteins to fat along with fluid andelectrolytes replacement 3 types of Samsarjana Kramas- Peyadi krama &Tarpanadi Krama and Rasa Sansarjana5/30/2013 Presentation by Dr Santoshkumar Bhatted 43
  44. 44. Why Sansarjana Krama5/30/2013 Presentation by Dr Santoshkumar Bhatted 44
  45. 45. Diet during Peyadi Sansarjana Krama Peya (Thin rice gruel) Vilepi (Thick rice gruel) Mudga Yusha (Green gram soup) Krita Akrita Mamsa Rasa (Meat soup) Krita Akrita For three, two, one Annakala for Pravara Madhyamaand Avara Shuddhi respectively.5/30/2013 Presentation by Dr Santoshkumar Bhatted 45
  46. 46. Peyadi Samsarjana krama- ContdIn Pradhana ShuddhiDay morning evening1st - peya2nd peya peya3rd vilepi vilepi4th vilepi akrithayusha5th krithayusha krithayusha6th akrithamamsarasa krithamamsarasa7th krithamamsarasa normal diet5/30/2013 Presentation by Dr Santoshkumar Bhatted 46
  47. 47. Peyadi Samsarjana krama- ContdMadhyama ShuddhiDay morning evening1st - peya2nd peya vilepi3rd vilepi akrithayusha4th kritha yusha akrithamamsarasa5th krithamamsarasa normal diet5/30/2013 Presentation by Dr Santoshkumar Bhatted 47
  48. 48. Avara ShuddhiDay morning evening1st - peya2nd vilepi krithakritha yusha3rd krithakritha rasa normal dietPeyadi Samsarjana krama- Contd5/30/2013 Presentation by Dr Santoshkumar Bhatted 48
  49. 49. Why Peyadi /Tarpanadi Krama5/30/2013 Presentation by Dr Santoshkumar Bhatted 49
  50. 50. Tarpanadi kramaIndicated in Alpashodhana of Pitta &Kapha, Madhyapa and in Vatapitta PradhanyaPeya- svaccha tarpana Vilepi- ghana tarpana (Chakrapani)I- annakala: lajasaktuII- annakala: jeerna shalyodanaIII- annakala: mamsarasa (Arunadatta)5/30/2013 Presentation by Dr Santoshkumar Bhatted 50
  51. 51. Supplement by food not bymedicine5/30/2013 Presentation by Dr Santoshkumar Bhatted 51
  52. 52. Rasa Sansarjana Krama5/30/2013 Presentation by Dr Santoshkumar Bhatted 52
  53. 53. Use with caution5/30/2013 53Presentation by Dr Santoshkumar Bhatted
  54. 54. Thank You5/30/2013 54Presentation by Dr Santoshkumar Bhatted