Psoriasis virechana, pk

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VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS, SRINIVAS RAO, PANCHAKARMA, GOVERNMENT AYURVEDIC MEDICAL COLLEGE, DHANWANTARI ROAD BANGALORE

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Psoriasis virechana, pk

  1. 1. SWARASA AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS -TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS - A COMPARATIVE STUDY By Dr. SRINIVAS RAO, B. A. M. S. A COMPARATIVE STUDY Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore for partial fulfillment of the degree AYURVEDA VACHASPATI DOCTOR OF MEDICINE (AYURVEDA) IN PANCHAKARMA. Under the guidance of Dr. SHALINI.C.ELI. M.D. (AYU),D.N.Y. Professor and H.O.D. Department of Post Graduate Studies in Panchakarma, Government Ayurvedic Medical College. Dr. SRINIVAS RAO DEPARTEMENT OF POST GRADUATE STUDIES IN 2010 - 2011 PANCHAKARMA. GOVERNMENT AYURVEDIC MEDICAL COLLEGE DHANWANTARI ROAD BANGALORE- (56009), 2010 - 2011.
  2. 2. Department of Post Graduate Studies in Pancha Karma Government Ayurvedic Medical College Bangalore. 2010-2011 CERTIFICATE BY THE GUIDE RTIFICATE This is to certify that the Dissertation entitled “TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R. TO PSORIASIS – A COMPARATIVE STUDY” is a bonafide research work done by Dr.SRINIVAS RAO in partial fulfillment for the degree of Ayurveda Vachaspathi, Doctor of Medicine (Ayurveda) in Pancha Karma of the Rajiv Gandhi University of Health Sciences, Bangalore. I recommend this dissertation for the above degree to the University for Assessment and approval. Guide: Dr.Shalini.C.Eli. M.D. (Ayu),DNY.Date: Professor and H.O.D,Place: Department of Postgraduate Studies in Panchakarma. Government Ayurvedic Medical College, Bangalore.
  3. 3. Department of Post Graduate Studies in Pancha Karma Government Ayurvedic Medical College Bangalore. ENDORSEMENT BY THE HOD & PRINCIPAL This is to certify that the Dissertation entitled “TO EVALUATE THEEFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA ANDABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS.A COMPARATIVESTUDY” is a bonafide research work done by Dr.SRINIVAS.RAO under the guidanceof Dr.SHALINI.C.ELI. Professor and H.O.D Department of Postgraduate Studies inPanchakarma, Government Ayurvedic Medical College, Bangalore.Dr Shalini C. Eli. M.D. (Ayu),D.N.Y.Professor & HOD Principal,Department of P. G Studies in Pancha Karma Govt.Ayurvedic Medical CollegeGovt.Ayurvedic Medical College, Bangalore.Bangalore.Date: Date:Place: Place:
  4. 4. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled, “TO EVALUATE THE EFFICACYOF VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADIMODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS. - A COMPARATIVE STUDY”is a bonafide and genuine research work carried out by me under the guidance ofDr. SHALINI.C.ELI. Professor and H.O.D.Department of PG studies in Pancha Karma,Govt. Ayurvedic Medical College, Bangalore.Date: Signature of the candidatePlace: Bangalore Dr. SRINIVAS RAO.
  5. 5. COPYRIGHT DECLARATION BY THE CANDIDATEI hereby declare that the Rajiv Gandhi University of health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation in print orelectronic format for academic/ research purpose.Date: Signature of the candidatePlace: Dr. SRINIVAS RAO. © Rajiv Gandhi University of Health Sciences, Karnataka
  6. 6. ACKNOWLEDGEMENT‘At times our own light goes out and is rekindled by a spark from another person.Each ofus has cause to think with deep gratitude of those who have lighted the flame withinus”.Albert Schweitzer.At this juncture of successful accomplishment of my work I bow my head to almightywith whose blessings I am able to fulfill my duties.I am short of vocabulary to express my deepest sense of gratitude towards my belovedDr.Shalini.C.Eli.for her maternal affection,timely advise,constant indefeasible guidanceand overall supervision which has moulded and enlightened my tiny work.I will always remain obliged to Dr.Shridhar B.S. for his dynamism,support,suggestionthroughout the study.I again express immense gratitude to Dr.Shalini.C.Eli, Professor & H.O.D,Departmentof P.G.Studies in Panchakarma G.A.M.C Bangalore for her encouragement and kind co-operation.I owe my sincere regards to Dr.S.G.Mangalgi,Principal,G.A.M.C,Bangalore for hisvaluable support.My heartfelt gratitude to the faculty members of the Department Dr.Shylaja kumara.R.,Dr.Janaki Y.S.,Dr.Santosh Yedahalli,Dr.V.M.Hugar,Dr.Shaila Gurappa for theirtimely guidance & support during my study.
  7. 7. I am highly indebted to all my homeland teachers for the imponderable knowledge andblessings, I received throughout my career. It needs a special mention of Dr.Nirmala.N.,Dr.Vijay Laxmi, Dr.Srinivas.J., Dr.R.Deshmukh & Dr.Veena.Mere words cannot express my feelings of gratitude towards my mom Smt.Sulochanaand my father Sri Ranappa Bannurkar,who are the motivation and inspiration for me topursue higher studies.I also thank all my sisters and my jiju for their moral support and inspiration.My heartfelt thanks to my seniors Dr.Divya Kini.,Dr.Somanath.G.,Dr.Ashwini K.,Dr.Smina, Dr.Sandeep & Dr.Rajani & all others for the support and co-operation Ireceived from them.I whole heartedly thank to my colleagues Dr.Vijaya.V, Dr.Basava jyoti, Dr.SumitPatil,Dr.Ravi Patil, and Dr.Pooja.B.A. for their support and encouragement.My heartiest gratitude’s to my junior friends Dr.Manjunath Kanthi, Dr.ShridharL,Dr.Mukund, Dr.Nandkishore, Dr.Rashmi Rao & Dr.Vanishree for their help andsupport.I take this opportunity to specially thank my senior Dr.Divya Kini for her moral support,guidance, and valuable suggestions rendered throughout my course.I extend my gratitudeness to my close friends for their constant support andencouragement in every part of my life Manjunath K., Dr.Shilpa Raga, Dr.Anand.I will be lacking in my duty without thanking the non-teaching staff of our department &hospital staffs for their help and service rendered during my study.
  8. 8. All my patients need special mention, without whose co-operation the entire study wouldbe stalemated. I express my thanks to each and everyone who helped me directly or indirectly withapologies for my inability to identify them individually. With Heartfelt Gratitude. Dr.SRINIVAS RAO.Bangalore.
  9. 9. ABSTRACTPsoriasis is one of the top listed dermatological problems of present day. It is affectingthe 2% of the world’s population. Though this disorder is not a contagious but it is oftensource of social embarrassment. Patients often isolate themselves from the fear ofrejection from the society.For this agony Ayurveda has better answer. Shodhana a long recognized therapeutics ofAyurveda plays a pivotal role in the management of this condition. Virechana is one theShodhana modality which is playing very important part in treating stubborn disorderslike this.Though in Ayurveda many Virechaka drugs are mentioned but only few are in practice.There is an intense need to know the efficacy of the other drug mentioned in classics.InSushruta Samhita Karavellaka Swarasa is mentioned as best Swarasa Virechaka, but it ishardly in use as Virechaka Drug.Objectives of the study:To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa in Ekakushta.To evaluate the efficacy of Virechana with Abhayadi Modaka in Ekakushta.To compare the efficacy of Karavellaka Patra Swarasa and Abhayadi Modaka asVirechaka Yogas.Study design: Patients of Eka Kushta were randomly recruited to 2 groups. Group A: Patients of this group was treated with Abhayadi modaka for virechana.Group B: Patients of this group was treated with Karavellaka patra swarasa forvirechana.Effect of treatment is assessed using P A S I Scale. In Abhayadi group before treatmentmean P A S I Scale was 29.8 which got reduced to 7.32 after treatment. In Karavellakagroup before treatment mean P A S I Scale was 24.7 which got reduced to 5.04 aftertreatment.It was concluded that Virechana with both the drugs is highly efficient in management ofEka Kushta.Key words :Eka Kushta, Psoriasis,Virechana, Abhayadi Modaka, Karavellaka PatraSwarasa
  10. 10. ABBREVIATIONS.Aruna Datta Commentary A.CAshtanga Hrudaya A. HrAshtanga Sangraha A. SaBhaishajya Ratnavali B.RBhava Prakasha B. P.Bhela Samhita B.S.Chakra Datta Cha. DaChakrapani Commentary C.CCharaka Samhita Cha. Sa.Dalhana Commentary D.CGangadhara Commentary G.CGada Nigraha G.NHarita Samhita H.S.Kashyapa Samhita K.SMadava Nidana M. N.Sharanghadhara Samhita Sha. SaSushruta Samhita Su. SaVanga Sena V.SYoga Ratnakara Y. R.
  11. 11.                 CONTENTS    Chapters Page no 1. Introduction……………………………………. 1-2 2. Objectives of the study………………………… 03 3. Review of literature Procedure Review………………………. 5-49 Disease Review…………………………. 50-97 Drug Review…………………………….. 98-102 4. Clinical study……………………………………. 103-112 5. Observations and Results………………………... 113-132 6. Discussions……………………………………… 133-139 7. Conclusion………………………………………. 140-141 8. Scope for further study………………………….. 141 9. Summary………………………………………… 142-144
  12. 12. LIST OF TABLESTable Headings Pg. noNo.1 Chapters & contents related to Virechana in Charaka Sutra Sthana 62 Chapters & contents related to Virechana in Charaka Vimana Sthana 63 Chapters & contents related to Virechana in Charaka Kalpa Sthana 74 Chapters & contents related to Virechana in Charaka Siddhi Sthana 75 Chapters & contents related to Virechana in Sushruta Sutra Sthana 76 Chapters & contents related to Virechana in Sushruta Chikitsa Sthana 87 Chapters & contents related to Virechana in Kashyapa Siddhi Sthana 88 Chapters & contents related to Virechana in Kashyapa Khila Sthana 89 Chapters & contents related to Virechana in Ashtanga Sangraha Sutra 810 Chapters & contents related to Virechana in Ashtanga Sangraha Kalpa 911 Chapters & contents related to Virechana in Ashtanga Hrudaya Sutra 912 Chapters & contents related to Virechana in Ashtanga Hrudaya Kalpa 913 Chapters & contents related to Virechana in Bhela Siddhi Sthana 914 Chapters & contents related to Virechana in Chakra Datta 915 Chapters & contents related to Virechana in Sharanghadara Purva 10 Khanda16 Chapters & contents related to Virechana in Sharanghadara 10 UttaraKhanda17 Chapters & contents related to Virechana in Vangasena. 1018 Chapters & contents related to Virechana in Bhava Prakasha. 1019 Classification of Virechaka dravyas acc to different acharyas. 1420 Virechaka dravyas according to the parts used. 1521 Virechaka dravyas mentioned in Sushruta samhita. 1622 Virechana dravyas according to Sharangdhara. 2023 245 Virechana kalpas. 2124 Formulations of Virechana. 2225 Virechana kalpas according to sharangdhara. 22
  13. 13. 26 Virechana dravyas as per dosha. 2327 Virechana Yogya. 2428 Virechana Ayogya. 2529 Sneha matra. 2830 Sneha draya and anupana 2831 Sneha Jeeryamana and jeerna lakshanas. 2932 Samyak snigdha lakshanas. 3033 Asnigdha lakshanas. 3034 Atisnigdha lakshanas 3035 Dose of Virechana in its different forms. 3236 Criteria for Maniki,Vegiki,Antiki shuddhi of virechana. 3537 Samyak yoga lakshanas of Virechana. 3638 Ayoga lakshanas of Virechana. 3639 Atiyoga lakshanas of Virechana. 3740 Shuddhi according to Kashyapa 3841 Peyadi Samsarjana Krama 4042 Rasa Samsarjana 4143 Ayoga and Atiyoga lakshanas of Vyapat 4244 Virechana Vyapat according to acharyas. 4245 Virechana Vyapat with their treatment 4346 Layers of Twak according to different acharyas 5048 Skin layers and disease concerned to it according to Charaka 5149 Showing Sapta Twacha and Disease Relation. 5150 Classification of Maha Kushta. 6251 Kshudrakushtha according to different acharyas 6252 Kashyapokta Kushta Types. 6353 Kushtha and Dosha Relation. 6354 Difference between Mahakushtha and KshudraKushtha 6455 Doshic predominance in individual type of kushta. 6456 Showing Samanya laxana of kushta based on particular dosha. 64
  14. 14. 57 Nidanas according to different acharyas. 6658 Mithya Ahara Hetu for Kushta 6759 Mithya vihar Hetu for Kushta. 6860 Achara Hetu for Kushta. 6961 Lakshanas according to Predominance of the Doshas. 7362 Lakshanas according to Dhatu dushti 7463 Lakshanas according to Srotas 7464 Purvaroopa according to different acharyas 7765 Sadhya-Asadhyata. 8066 Pathya-Apatha. 8567 Ingredients of Chitrakadi Vati. 9868 Ingredients of Guduchi Ghrita. 9969 Ingredients of Madhuyashti taila. 9970 Showing Ingredients of Abhayadi Modaka 10171 Showing age wise distribution 11372 Showing Sex wise distribution 11473 Showing occupation wise distribution 11474 Showing Religion wise distributio 11475 Showing socio-economic status 11476 Showing diet wise distribution 11577 Showing marital status 11578 Showing Region wise distribution 11579 Showing Sleep Pattern 11581 Showing Addiction 11682 Showing Koshta of Patients 11683 Showing Prakruti of Patients 11684 Showing Satwa of the Patients 11785 Showing Satmya of the Patients 11786 Showing presence of family history of Psoriasis. 11787 Showing mental stress as triggering factor 118
  15. 15. 88 Showing seasonal factor 11889 Showing food as aggravating factor 11890 Showing Drugs as aggravating factor 11991 Showing infection as triggering factor 11992 Showing chronicity 11993 Showing Distribution of area 11994 Showing details of Itching 12095 Showing details of Erythema 12096 Showing details of area involvement - Head 12097 Showing details of area involvemet - Trunk 12098 Showing details of area involvement - Upper limb 12199 Showing details of area involvement- Lower limb 121100 Showing details of Auspitz’s Sign + 121101 Showing details of Candle Grease Sign + 122102 Showing number of days of Sneha Pana 122103 Showing Samyak Snighdha Lakshanas 122104 Showing Samyak Swinna Lakshana 123105 Showing Time required manifesting first Virechana Vega 123106 Showing Virechana Vegas 123107 Showing Time required for completion of procedure 124108 Showing Laingiki Shuddhi 124109 Showing Statistical analysis is done using Shapiro-Wilk Test 125
  16. 16. LIST OF GRAPHSGraph no. Headings 1 Showing age wise distribution 2 Showing Sex wise distribution 3 Showing Religion wise distribution 4 Showing socio-economic status 5 Showing diet wise distribution 6 Showing Marital Status 7 Showing occupation wise distribution 8 Showing region 9 Showing history of diwa swapna 10 Showing history of ratri jagarana. 11 Showing Prakruti of the patients 12 Showing Satva of the Patients 13 Showing Satmya of the Patients 14 Showing Addictions 15 Showing Koshta 16 Showing family History. 17 Stress as aggravating factor 18 Season as aggravating factor 19 Food as aggravating factor 20 Drug as aggravating factor 21 Infection as aggravating factor 22 Grading of Itching 23 Grading of Erythema 24 Area involvement in Head 25 Area involvement in Trunk 26 Area involvement in Upper Limb
  17. 17. 27 Area involvement in Lower limb29 Auspitz Sign30 Candlegreeze Sign31 Days of Snehapana32 Samyak snigdha lakshanas33 Samyak swinna lakshanas34 Time taken for initiation of Vega35 Number of Vegas36 Time taken for completion37 Laingiki shuddhi.
  18. 18. Introduction       INTRODUCTION   Ayurveda an ancient system of Health care is a result of India’s quest for disease free living. The amazing journey of Āyurveda from its divine origin to the present day gives us the hint about the enormous potential this science possessing. Its successful existence since time immemorial itself proves its scientific approach of treatment that has remained unchanged till date. One of such unique line of treatment is Shodhana Karma. Shodhana is a procedure, where if Roga janaka doshas are in prabhuta avastha they are expelled through the nearest route. Virechana karma is one of the shodhana modality which is performed to eliminate vitiated pitta dosha from the body. Though virechana is agrya shodhana for vitiated pitta dosha , we find references that it also eliminates vitiated kapha and vata doha.3 Virechana is a line of treatment in many chronic and stubborn disorders and one of such disorder is Kushta. In Ayurveda many of the skin disorders are brought under one umbrella called Kushta. Acharyas had faith in virechana to put control over disease causing morbid factors. Eka kushtha , one of the Ksudhra kushtha can be treated with Virechana karma. The signs and symptoms of Eka kushtha mentioned in ayurvedic classics resembles to that of Psoriasis. Psoriasis is a very common disease and affects one to two per cent of the population in all geographic regions Psoriasis is a chronic inflammatory and proliferative disorder of the skin clinically manifested as well-circumscribed, erythematous papules and plaques To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 1 
  19. 19. Introduction  covered with silvery scales typically located over the extensor surfaces and scalp. While specific systemic and environmental factors are known to influence the disease, it is unpredictable in its course and usually pursue spontaneously with improvement and exacerbations of lesions without discernable cause. Immune system dysfunction in the background of a genetic predisposition is believed to be at the core of the disease process. In classics we find reference about administration of virechana using different parts of the drug, among which Karavellaka patra swarasa for the virechana is the best type of aushadha kalpana. In Chakradutta and Sharangadhara samhita we get reference about Abhayadi modaka as a virechaka yoga in Kushtha. So with the motto of evaluating the efficacy of both the virechana yogas in Eka Kushtha work has been carried out under the heading, “TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRASWARASA AND ABHAYADI MODAKA IN EKA KUSHTHA W.S R. TO PSORIASIS:-ACOMPARATIVE CLINICAL STUDY. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 2 
  20. 20. Introduction  OBJECTIVES OF THE STUDY 1. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa in Ekakushta. 2. To evaluate the efficacy of Virechana with Abhayadi Modaka in Ekakushta. 3. To compare the efficacy of Karavellaka Patra Swarasa and Abhayadi Modaka as Virechaka Yogas. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 3 
  21. 21. Introduction PREVIOUS WORK DONE “Effect of Vamana and Virechana in Psoriasis” by Dr. Shankar Babu A. on 1988 at Govt. Ayurvedic college, Kerala University, Trivendrum Effect of vamana and virechana in Psoriasis by DrA.Shankar Babu,Govt Ayurvedic College,Trivendrum(1990). Concept of Kitibha (Psoriasis) in Ayurveda and Modern medicine and its treatment with Strikutaja a further study”. By Anken on 1991 at Banaras Hindu University, Varanasi “The effect of Vamana and Virechana in Psoriasis”,By Dr.Rekha, GAMC, Mysore, Mysore University.(1995) Role of Virechana with and without shamana in the management of Psoriasis ( Eka kushta )” by Dr. Ruparel.S.J on 1999 at Gujarat Ayurveda University, Jamanagar. “Comparative study of Virechana karma and Nitya rechana in the management of Ekakushta”, by Dr.Praveen B.S.,S D M College of Ayurveda, Hassan, RGUHS.(2005) Role of Virechana with and without Shamana in the management of Eka kushtha (Psoriasis) ” by Ruparel on 1999 at Gujarat Ayurveda University, Jamanagar. Role of Virechana Karma in management of Psoriasis” by Dr.Praveen V..Devarushi,Udupi(2008-09).                       To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 4 
  22. 22.  Procedure Review Of Literature  PROCEDURE REVIEW HISTORICAL REVIEW Historical review of virechana karma: Vedas are the oldest source of information regarding the disease and its treatment A close review of the history of various systems of medicinal science reveals the fact that the treatments was prevalent from time immemorial, but only very few references are available about Virechana in Vedic times. PURANA KALA Agnipurana1: . Agni purana has stated virechana as best treatment for the diseases caused due to Pitta.Trivrth as best virechaka dravya. It is indicated in urdhwaga rakta pitta, jwara, hridroga.But detail description of Virechana was not found. In Manu smrithi, it is told that snana is done after the completion of vamana and virechana2. Vinayapitaka(Buddha literature):3 In the text Vinaya pittaka, Buddha period, virechana was given to Bhagwan Buddha by inhaling some powder spread over uthplapatra. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 5
  23. 23.  Procedure Review Of Literature  Kasika4 It was explained that Panchakarma was common method of treatment which prescribed Poorvakarma such as Snehana, Swedana and Panchakarma, Annasamsarjana etc. SAMHITA KALA: 1.CHARAKA SAMHITASutra Sthana: Table No.1 Ch.no Name of the Chapter Content 1 Deerghanjeeviteeya Adhyaya Moolinis and Phalinis used for Virechana 2 Apamaargatanduleeya Adhayaya Important purgative drugs 4 Shat virechana Shatashrateeya Virechanopaga drugs Adhyaya 15 Upakalpaneeya Adhayaya Sambhara Sangraha, Dose of Virechana , Yogya,Ayoga, Atiyoga laxanas, virechana vidhi and its benefits. 16 Chikitsaprabrutiya adhyaya Complications & its management. 20 Maharoga Adhayaya Utility of Virechana karma in Nanatmaja pittajaVikaras.Vimana Sthana: Table No.2 Ch. no Name of the Chapter Content 08 Rogabhishagjiteeya Vimana Virechana dravya Kalpa adhyaya. Sangraha. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 6
  24. 24.  Procedure Review Of Literature Kalpa sthana: Table No.3 Ch. no Name of the Chapter Content 07. Shyama trivrit Kalpa Adhyaya Different formulations of shyamatrivrit. 08. Chaturangula Kalpa Adhyaya Different formulations of chaturangula. 03. Tilwaka Kalpa Adhyaya Different formulations of tilwaka. 09. Sudha Kalpa Adhyaya Formulations of Sudha. 10. Saptala shankini Kalpa Adhyaya Different formulations of saptalashankini 11. Danti dravanti Kalpa Adhyaya Different formulations of dantidravanti.Siddhi Sthana: Table No.4 Ch. no Name of the Chapter Content 01. Kalpana Siddhi Virechana purva ahara,samyog,heena & atiyoga laxanas,Samsarjana krama, Shuddhi are described. 02. Panchakarmeeya Siddhi Virechya and Avirechya are described. 06. Vamana Virechana Vyapad Complication manifested due to Siddhi. Ayoga and Atiyoga and its Management. 2. SUSHRUTA SAMHITASutra Sthana: Table No.5 Ch. no Name of the Chapter Content 38. Dravyasangrhaniya adhyaya Description of Virechana dravyas. 39. Samshodhana samshamaniya. Adho bhaga dosha hara dravyas are mentioned. 41. Dravya Vishesha Vignaneeya Described the Adhobhaga Prabhava Adhyaya of Virechaka drugs. 44. Virechana Dravya Vikalpaneeya Different formulations for the Adhyaya Virechana karma. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 7
  25. 25.  Procedure Review Of Literature  Chikitsa Sthana:- Table No.6Ch.no Name of the Chapter Content 33. Vamana Virechana Sadhya Virechana process, Phamacodynamics of Upadrava Chikitsitam Adhyaya virechana, , Ayoga, Atiyoga and Samyak yoga of Virechana,Virechya –Avirechya, importance of dosha nirhana. 34. Vamana Virechana Vyapat Complication of Virechana karma. Chikitsitam 39. Aturopadrava Chikitsitam Samsarjana Krama is described. Adhyaya 3.KASHYAPA SAMHITA:Siddhi Sthana: Table No.7 Ch no Name of the Chapter Content 03. Vamana Virecahna Adhyaya Detailed discription of Virechana Karma Heena, Madhyama, Uttama Shuddhis, Regimen to be followed after Virechana, utility of Virechana Karma in Bala roga, Vyapat of Virechana. 07. Pancha Karmeeya Siddhi Yogya Ayogya for Virechana.Khila sthana: Table No.8 Ch.no Name of the Chapter Content 07. Samshuddhi Visheshaneeya Virechana Karma and Samsarjana Adhyaya Krama. 4. ASTHANGA SANGRAHA:Sutra sthana: Table No.9 Ch. no Name of the Chapter Content To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 8
  26. 26.  Procedure Review Of Literature  27. Vamana Virechana Vidhi Detailed description of Virechana Adhyaya Karma, Pharmacological actions of Virechana dravyas,Virechya, Avirecya are mentioned.Kalpa sthana:- Table No.10Ch no Name of the Chapter Content 02. Virechana kalpa Adhyaya. Different formulations of Virechana Karma. 03. VamanaVirechana Vyapat Vyapat and its Management. Siddhi. 5. ASHTANGA HRIDAYA:Sutra sthana: Table No.11 Ch.no Name of the Chapter Content 18. Vamana Virechana Vidhi Detailed description of Virechana Adhyaya KarmaKalpa sthana: Table No.12 Ch. no Name of the Chapter Content 02. Virechanaa Kalpa Adhyaya. Detailed description of Virechana process. 03. Vamana Virechana Vyapat Virechana Vyapat with its Adhyaya. treatment. 7. BHELA SAMHITA: Kalpa sthana: Chapters deal with preparations of Chaturangula. Dantiphala. Shankini. Shyamatrivrit.Siddhi Sthana: Table No.13 Ch. no Name of the Chapter Content 01. Vamana virechana siddhi It deals with samyak,ayog & atiyoga laxanas of virechana. 04. Vamana Virechana Detailed description of Virechana Siddhi Adhyaya. Karma is available.8. CHAKRADATTA: Table No.14 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 9
  27. 27.  Procedure Review Of Literature  Ch.no Name of the Chapter Content 71. Virechana adhikara. Detailed description of Virechana Karma. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 10
  28. 28.  Procedure Review Of Literature   9. SHARANGADHARA SAMHITA: Poorva kanda: Table No.15 Chapter Name of the Chapter Content 04. Deepana Pachana Adhyaya. Description of four types of virechana dravya laxanas. Uttara kanda:- Table No.16 Chapter Name of the Chapter Content 04. Virechana Vidhi Adhyaya Virechana karma described in detail 10. VANGASENA: Table No.17 Chapter Name of the chapter Content 89. Virechana adhikara Adhyaya. Detailed description of Virechana karma and virechana yogas. 11. BHAVA PRAKASHA Table No.18Chapter Name of the Chapter Content 06. Mishra Prakarana Adhyaya Details regarding virechana and Pathya and Apathya during Virechana karma. Virechana in western medicine.5 In Mesopotamian Civilization Physicians of Mesopotamia were using Virechana to treat pain abdomen. In seventeen century Handersn has written in his book that it was customary to use Purgatives. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 11
  29. 29.  Procedure Review Of Literature  VIRECHANAThe process by which the vitiated doshas are eliminated through the adhobhaga ieguda marga, is called ‘Virechana.This is widely used shodana therapy, is less stressfulwith least complication.Virechana in broader term denotes both vamana andvirechana.6 Etymology:-(1) Virechana7 :V+Rich+ Nich , lytu-malade: nissernam ......(Vachaspathyam).(2)Virechanaha8 :V+Rich+Nich, lytu-Visheshena rechathete ...... (Shabdakalpadruma)The Vircehana word is derived from the ‘Rich’ dhatu ,‘Nich’ &’Lyut’ pratyaya &with ‘Vi’ upasarga. It also means Maladehe nissaranam i.e. expelling out the malas. "Ricir" - evacuation. "Ric" - Viyojana (separation).Virechana word is derived from the ‘Rich’ dhatu, ‘Rich’ meaning – To empty ,evacuate, leave, give up.9The root ‘Rich’ is also very important to understand the systemic action of Virechana.According to Charaka, the Virechana drugs first get digested in Amashaya, thenreaches to Hridaya, Dhamani, macro and micro channels (srotases) of the body andreach the site where Doshas are accumulated.10Virechana drugs soften the compactness (Sanghata) of the Doshas and break thebigger molecules to smaller ones. This process occurs in a proper way by separation(Viyojana) and combination (Samparchana) of doshas. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 12
  30. 30.  Procedure Review Of Literature Up to this stage the action of Virechana is known as its systemic effect and it isobviously governed by Viyojana and Samparchana components of Virechana dravya.Definition: iÉ§É SÉåwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉxÉÇ¥ÉMüqÉ,AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç .....|11    The act of expelling Doshas through Adhobhaga is known as Virechana. Here themeaning of Adhobhaga is ‘Guda’ as commented by Chakrapani. ÌuÉUåMüÉå qÉÑZÉmÉÏiÉÇ aÉÑSqÉaÉåïhÉÉliÉ:ÎxjÉiÉxrÉ SÉåwÉxrÉÌlÉ:xÉÉUhÉÇ ...|12 The procedure in which the drug is administered orally, acts on morbid Doshas,specifically on Pitta and expels them out through anal route.ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç |UåcÉirÉÌmÉiÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||13The procedure where the morbid Dosha is expelled out in the form of Drava eitherpakva or apkva state.ÌmɨÉå iÉÑ ÌuÉUåMÇü zsÉåwqÉxÉÇxÉ×¹å uÉÉ iÉixjÉÉlÉaÉiÉå uÉÉzsÉåwqÉhÉÏÌiÉ |14  urÉMÑüsÉÉlÉç xÉͳÉmÉÉiÉÉåijÉÉlÉç mÉæ̨ÉMüÉlÉç MüTüümÉæ̨ÉMüÉlÉç | xÉÇxÉ×¹ÉlÉç MüTüqÉÔsÉÉÇ¶É xÉëÇxÉlÉëålÉÉprÉÑmÉ¢üqÉåiÉç||15Even though Virechana is best line of treatment modality for pittadosha16it can act onkaphasamsrusta pitta or pittasthanagat kapha. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 13
  31. 31.  Procedure Review Of Literature And moreover in case of vatasyopakrama mridu shodhana indicated which refers tomridu Virechana karma17.So Virechana is major line of treatment for morbid pittadosha & also it act on morbidkapha and vata dosha. Thus action of Virechana is seen on all tridosha. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 14
  32. 32.  Procedure Review Of Literature Paryaya:Instead of word Virechana the following terms were used in different context, theseall can be consider as synonyms for virechana, Vireka, Rechana, Adhobhagahara. Anulomana 18 Praskandana.According to the Sanskrit – English dictionary the different meanings are- Purgative,Cathartic, Evacuant and Aperient.IMPORTANCE OF VIRECHANA:-Virechana is a sovereign procedure for elimination of Pitta Dosha19,20 Indu explainsthat in the vitiation of Kevala Pitta, Pitta associated with Kapha and in PittasthanaGata Kapha Virechana is the obvious treatment procedure to be followed21.Charaka explains that Virechana drug after entering Amashaya dislodges the vitiatedPitta Dosha and henceforth pacifies all Pitta Vikara of the body22. Virechana also cleanses sense organs i.e. improves their function. Just as removal ofwater from its reservoir destroys various organisms and plants residing in it, in thesimilar manner removal of excessive Pitta destroys the various symptoms caused dueto it23Virechana is mentioned as Shodhana procedure in Dusthi of Rasa,Rakta, Mamsa,Asthi, Majja & Shukra Dhatus. Hence in majority of the Dhatupradoshaja VikarasVirechana is the better option . To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 15
  33. 33.  Procedure Review Of Literature  Virechana dravya guna karma:The guna of virechana dravya are ushna, tikshna, sukshma, vyavayi, vikashi, thesequalities are common in vamana aoushadam, but virechana dravya has adhobagaharaprabhavam.Virechana dravya has jala and prithwi mahabootha predominance.24CLASSIFICATION OF VIRECHANA DRUGS:--The drugs which produce Virechana are known as Virechaka dravyas. According toreferences available Virechana drugs may be classified in following 6 groups, Table.no.19 I) Virechana Dravyas According to their a) Animal origin DRAVYAS origin & parts used b) Plants origin c) Miscellaneous II) According to the mode of action a) Anulomana b) Samsrana c) Bhedana d) Rechana VIRECHANA III) According to the intensity of action a) Mrudu b) Madhyama c) Tikshna IV) According to the Rukshata & Snigdhata view. V) Virechana drugs according to the seasons VI) Virechana drugs according to kalpanas A.Virechana drugs according to their origin and parts used:  a) Animal origin: ∗ Urine.25,26 ∗ Milk 27 ∗ Takra 28 b) Plant Origin: c) Miscellaneous: To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 16
  34. 34.  Procedure Review Of Literature  To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 17
  35. 35.  Procedure Review Of Literature Classification of virechana dravyas based on parts used. Table no:20. Part of the Sl.no. plant used for Charaka 29 Sushruta 30 Vagbhata 31 virechana. 1. Mulini Hastidanti Trivrit,Shyama virechana Shyama Danti Danti,Kumbha dravya. Trivrit Dravanti (Trivrit) Adhoguda Saptala Gavakshi Saptala Shankhini Shankhini Danti Gavakshi Vishanika Vishanika Gavakshi Ajagandha Chitraka Dravanti Kush, Kasha Avartaki Kinahi 2. Phalini Shankhini Kampillaka Neelini virechana Vidanga Puga Triphala dravya Anupa Eranda,Haritaki Kampillak Sthalaja Bibhitaki, Prakeerya Amalaki Udakeerya Neelini Abhaya Aragwada Anthakotrapuspi Kampillaka Aragwada 3. Ksheera Snuhi ksheera Mahavriksh Snuhi virechana Arka Saptachala Swarna ksheeri dravya. Swarna ksheeri Godugdha 4. Twak Tilwaka Tilwaka Tilwaka virechana Patala Ramyaka dravya Ramyaka 5. Patra virechana Swarna patri Putika Aragwada dravya Aragwada Aragwada KaravellakaD) Based on Parts of the Dravya used: Sushruta describes the following drugs with priority for Virechana Karma32. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 18
  36. 36.  Procedure Review Of Literature Classification of virechana dravyas based on parts used and agraoushdaTable no.21 Mula Virechana Shyama Trivrith Phala Virechana Haritaki Twak Virechana Tilwaka Swarasa Virechana Karvellaka Dugdha Virechana Snuhi Taila Erandamd) Miscellaneous: As Madya, Dhanyamla33,Guda, Ikshu Rasa, Payas, Krishara, Ushna Jala, some minerals - Swarna, Kamsya, Manahsila, Gandhaka, Ratna, Uparatna, Samudraphena also have Sara properties.B. Virechana drugs according to their mode of action by Sharangadhara Acharya Sharangdhara has classified according to the action of the Virechanadravyas.a) Anulomana 34 :M×üiuÉÉ mÉÉMÇü qÉsÉÉlÉÉÇ rÉiÉç ÎpÉiuÉÉ oÉlkÉqÉkÉÉå lÉrÉåiÉç|iÉŠÉlÉÑsÉÉåqÉlÉÇ ¥ÉårÉÇÇ mÉëÉå£üÉ WûUÏiÉMüÐ ||These drugs will digest the Apakwa (undigested material) malas and bring them toadhomarga for defecation process. That is these drugs will facilitate the defecationprocess.eg: Hareetaki (Terminalia Chebula). Sushruta considers Sara as the synonym of Anulomana. According to DalhanaAnulomana causes expulsion of Vata and Kapha35. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 19
  37. 37.  Procedure Review Of Literature According to Raja Nighantu, Bhoutika composition of Anulomana drugs is similar tothat of Virechana drugs i.e. Prithvi and Aap Mahabhuthas.b) Sramsana 36 :mÉ£üurÉÇ rÉSmÉ£üurÉÇ ÎvsÉ¹Ç MüÉã¹ã qÉsÉÉÌSMüqÉç |lÉrÉirÉkÉ:xÉëÇxÉlÉÇ iÉSè rÉjÉÉ xrÉÉiÉç ¢üiÉqÉÉsÉMüqÉç|The drugs which expel the malas adhered to the lumen of intestines in to the rectumwithout digesting (Paka) them. eg: Aragwada (Casia Fistula).In the context of Jwara Chikitsa it has been mentioned that Sramsana eliminates thePitta and Kapha situated in Pakwashaya 37.c) Bhedana 38:   qÉsÉÉÌSMüÇqÉoÉ®Ç cÉ oÉ®Ç uÉÉ ÌmÉÎhQûiÉÇ qÉsÉæ:| ÍpÉiuÉÉÅkÉ: mÉÉiÉrÉÌiÉ, iÉSè pÉãSlÉÇ MüOÒûÌMü rÉjÉÉThe drug which disintegrates the ‘Abaddha’ (unformed) or ‘Baddha’ (formed) or‘Pindita’ (dried fecal mass) forms of Malas by facilitating penetration into it and thenevacuating through the lower gut, is known as Bhedana. eg. Katuki. Bhedana is a process in which Shareera Mala Nirharana is brought about. 39.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.40d) Rechana 41: ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç | UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ || To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 20
  38. 38.  Procedure Review Of Literature  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. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 21
  39. 39.  Procedure Review Of Literature  Virechanopagas: 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 Pilu42 C) Virechana drugs according to intensity of action: According to the degree of potency of the drugs, the Virechana may be classified into the following categories. A) Mridu Virechana:43 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 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 disease44 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 45 Sharangdhara recommends the use of Mridu Virechana drugs in Mridu Koshta (eg. Draksha, Milk, Caster oil, Warm water etc.). 46Drugs effective in Mridu Koshta To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 22
  40. 40.  Procedure Review Of Literature   are Guda, Ikshu Rasa, Mastu, Ullodita Dadhi, Payas, Kshira, Sarpi, Kashamari, Triphala, Pilu and Taruna Madya47.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 Balavan rogi is useless because, they are unable to eliminate Dosha completely48.Sharangdhara recommends the use of Madhyama Virechana in Madhyama Koshta. eg. Trivrit, Katuki and Aragvadha49.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. 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 Virechana50.Sharangdhara recommends use of Teekshna Virechana drugs in Krura Koshta persons. Charaka recommends the use of these drugs in the strong (Balavan) patients all the symptoms of the diseases i.e. Teekshna Vyadhi51.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 properly52,Snuhi Kshira is considered as the best amongst these drugs53.More over To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 23
  41. 41.  Procedure Review Of Literature   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 54. 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 Srotas55. Sneha Virechana should be administered in Sama-Shitoshma Kala 56. 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 57. E. Virechana drugs according to seasons 58 Table no:22 Showing Virechana drugs according to seasons.  Shishira   Varsha Sharad /Vasanta Greeshma Hemanta All seasonsPreparation Beeja Shyama Shyama Shyama Trivrit Trivrit Trivrit Trivrit Trivrit Trivrit Chitraka Danti Kutaja Duralabha Pippali Patha Hapusha Pippali Musta Nagara Ajaji Saptala Shunthi Sharkara Sindhu Sarala Katuki Udichya Aruna Vacha Swarnaksiri Shweta Trivrit Hemakshiri Chandana churna To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 24
  42. 42.  Procedure Review Of Literature  Anupana Draksha Yasti Honey Sugar Warm Bhavana with Rasa and madhu in Water cow ‘s urine madhu Draksha Swarasa or Draksha Swarasa only 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. F.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:23. Showing 245 Virechana kalpas according to Charaka.59 Kalpana Trivrth Argvada Tilvaka Sudha Saptala Danti Shankini 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 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 25
  43. 43.  Procedure Review Of Literature   Gritha 4 2 4 4 8 6 Taila - - - - 6 2Chatusneha - - - - - 1Asavarishta - 1 1 - - 5 Greya - - - 1 - - Yavagu - - - - - 1 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 26
  44. 44.  Procedure Review Of Literature   G.Specific formulations for Virechana6 Tabe no:24. Showing Formulations for virechana based on dosha involvement.Vata Pradhana Trivrit + Saindhava + Shunthi + Kanji or MamsasaraPitta Pradhana Trivrit Choorna + Draksha KvathaKapha Pradhana Triphala Kvatha, Gomutra, TrikatuChildren between the Age group of 4-12 years61 Draksha rasa+ Aragvadha phala majja 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 62. Table no.25: Virechana kalpas according to Sharangadhara. 63 Heena for Mridu Madhyama for Uttama for Kalpana Koshta Madhyama Koshta Krura Koshta Kwatha 8 tolas 4 tolas 2 tolas Kalka, Choorna Modaka 4 tolas 2 tolas 1 tola According to Sushruta64: 1, 2 and 3 Tolas Matra is mentioned for Mridu, Madhyama and Krura Koshta respectively. I. Nature of Koshta and Virechana65: 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 dose and for Krura Kostha persons, the Virechana drugs should be Tikshna and its dose is minimum. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 27
  45. 45.  Procedure Review Of Literature J. Virechana Drugs According to Dosha 66: Table no:26 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 PradhanaVIRECHANA VIDHI:-- Virechana Vidhi can be studied under 3 main headings: Purva Karma (Pre Therapeutic Procedure) Pradhana Karma (Therapeutic Procedure) Paschat Karma(Post Therapeutic Procedure) A) PURVAKARMA: 1) Sambhara Samgraha 2) Aatura Pariksha 3) Aatura Siddhata 4) Matra Vinishchaya Sambhara Samgraha:-67 Ahara: Shali.Mudga,Maasha,Yava,Tila,Dugdha,GrithaUshana jala, Mamsa etc. Aushadha: Deepananeeya,Paachaneeya,Upashamaneeya,Vatahara, Sneha,Swedana ,Virechana drugs like Draksha, Triphala, Suoveerak etc. Equipments: Achamani,Udaka koshta , Sharava,Darvi, Tula, Manabhanda,Dhumanetra,Sutra,Karpasa etc.ghata,etc. Atura Pariksha:68 Before performing Virechana karma it is necessary to know patient fitness in terms of his/her Dosha, Dushya, Atura Bala kala, Desha, Agni, koshta, Sharir & Ahara Satma, Satva etc. for proper adminstration of Verchana karma.. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 28
  46. 46.  Procedure Review Of Literature  Virechana Yogya and Ayogya. Table no:27: Showing Virechana YogyaVirechana Yogya Ch.Si69 Sus.Chi70 A.S.71 A.Hr.72 K.Si.73 Sha.S.U74 Pranavaha srotoduhti vikaraShwasa + - - - - -Kasa + - - - - -Parshvaruja + - - - - - Annavaha srotoduhti vikaraAruchi + + + - - +Avipaka + - + - - -Visuchika + + + - - +Alasaka + + + - - -Chardi + + + + - + Udakavaha srotoduhti vikaraUdara + + + + - + Rasa pradoshaja vikaraPandu + + - - + +Jwara + + + + - +Aruchi + + - - - +Avipaka + - + - - -Hridroga + + - - + + Rakta pradoshaja vikaraKamala + - - + + -Vidradhi - + + + - +Netradaha + + - - - +Aasyadaha + + - - - +Vatarakta + + + + - +Kustha + + - + + +Paittika vyadhi + + + - - -Visarpa + + - - + -Pliha + + + + - +Vyanga + - + + - -Nilika + - - + - -Urdva Raktapitta + + + + + - Mamsa pradoshaja vikaraArbuda + + - - - -Galaganda + - - - - - Meda pradoshaja vikaraPrameha + + - + + +Yoni Dosha + + + + - +Retodosha + - + + - - Mootravaha srotoduhti vikaraMutraghata + + + + - + Purishavaha srotoduhti vikaraArsha + + + + + +Bhagandara + + + - - +Udavarta + - + + +Vibhandha - + + + + -Pakvashaya shoola + + + + - - OtherVisphota - - - - + +Vatavyadhi - - - - + +Garavisha - + + + + + To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 29
  47. 47.  Procedure Review Of Literature   Some other indications for Virechana are: a)In Swastha.75,76 b)Utkleshita Pitta. Pitta Sthanagata Alpa Kapha Kapha Sthanagata Bahu Pitta77 Pakwashayagata Pitta or Kapha Pitta78 Pittavrita Vata Kaphavrita Vata79 Shonita Roga80 a) As Purvakarma in Rasayana and Vajikarana81,82 TABLE NO:28 Showing Virechana AyogyaVirechana Ayogya Ch.Si83 Sus.Chi84 A.S.85 A.Hr.86 K.Si. 87 Sha.S.U88 Physiological condition Langitha + - + - - - Upavasita + - - - - - Durbalendriya + - - - - - Durbala + - - - + - Alpagni + + + + - + Shranta + + - - - + Pipasita + + - - - +Karmabharadhvahata + + - - - - Daruna koshtha + - + + - - Kshama + - - - - - Kamadivyagra + + - - - - Bhakta + + - - - - Sukumara - - - - + - Navaprasuta - + - - - + Rathri Jagarana - - + - - - Atiruksha + - + - - + Bhayoptapta - + - - - + Chinta prasaktha + - - - - -Maithuna prasaktha + - - - - -Adhyayana prasaktha + - - - - - vyayama prasaktha + + - + - - Garbhini + + - - - - Age related condition Vriddha + + - - + Bala + + - - + To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 30
  48. 48.  Procedure Review Of Literature   Pathological condition Kshatkshina + + - - - + Atikrisha + - - - + - Atisthula + + - - + + Muktanala + - + - - - Atisara - - + + - -Adhoga Raktapitta + + + + - - Shosha - - - - - - Rajayakshma - - + - - - Urustambha - - - - + - Madatyaya + + + - - + Talushosha - - - - + - Hridroga - - - - + - Traumatic condition Abhighata + - - - - - Subhaga + - - - - - Kshataguda + + + - - - Shalyardita + + + + - + Saama condition Nava Jwara + + + + - +Nava Pratishyaya - + - - - - Some vataroga conditionKevala Vataroga - - - - + - Hanugraha - - - - + - Ardita - - - - + - Purvakarma related conditions. Nirudha + - + - - - Atisnigdha + + + + - + Anupasnigdha - - - - + - Pakshahata - - - - + - Atura Sidhata:- Pachana and deepana:- Ama is considered as one among the etiological factor in most of disease, & Shodhana in ama state is said to be contraindication. If Samshodhana medicine is taken in the condition of Ajirna, it will lead to Vibandha and Glani. If the Doshas are in Ama conditions and anybody tries to remove these Dosha forcefully then it will destroy the body. If the condition of patient is associated with Ama then Shodhana can only be done after the Pachana of Ama by Deepana, Pachana So it is necessary to administer deepan & pachana drugs before the virechana to attain nirama state.89 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 31
  49. 49.  Procedure Review Of Literature Snehana & Swedana:Snehana includes both Abhyantara (oral ingestion of unctuous material) and BahyaSnehana (external application of unctuous material) .Abhyantara Snehapana followedby Sarvanga Abhyanga along with Sarvanga Sweda (Whole body sudation) areperformed prior to Virechana.Snehapana procedure is to be followed after observing Nirama Lakshanas. Therequired Sneha should be administered early in the morning at Suryodayakala afterobserving Jeerna Ahara Lakshanas of the previous meal and when the patient is emptystomach. The duration of Sneha Pana should be 3 to 7 days90,91.Importance: -Action of Snehana and Swedana prior to shodhana explained by Charaka in followingway.Due to Snehana there will be further vriddhi of doshas, and increase influidity(Vishyandana) and due to Swedana dosha paka along with removal ofobstruction at the enterance of the channels.Because of this the doshas leave theShakha and comes to the Koshta.92Sushrutha says Samshodana given without oleation and fomentation will destroy thebody like the dry wood.93Abhyantara Snehapana:Shodhananga Snehapana is done untill the attainment of ‘Samyak SnigdhaLakshanas’ which can be achieved in 3, 5 and 7 days in Mrudu, Madhyama, andKrura Koshta respectively.Thus, Shodhananga Snehapana can be carried out for a maximum period of 7 daysotherwise it will create Sneha Satmyata94, 95. However, if Samyak snigdha lakshanas To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 32
  50. 50.  Procedure Review Of Literature are not achieved with in 7 days then it can be continued after one day interval96. Doseof Sneha for shodhana mentioned in various classics is as follows.97-99. Table No.29 Showing Sneha matra. Madhyama Matra Charaka Samhita , Ashtanga Sangraha (Dose which digests in 12 hours) Uttama Matra (Dose which digests Ashtanga Hrudaya. in 24 hours) Uttama & Madhyama Matra ChakarapaniShodhananga Snehapana can be administered in 2 methods: a) Arohana Snehapana b) Sadyo Snehapanaa) Arohana Snehapana:Kalyanakaraka first mentioned about increasing dose schedule. He clearly mentionedthat Shodhanartha Abhyantara Sneha pana has to be taken in increasing order(“Krama Vardhitam Pibet”). Vangasena also followed Kalyanakaraka’sVardhamana dose schedule.b) Sadyo Snehapana: Sadyo Snehapana involves administration of large quantity ofSneha to achieve Snigdha Lakshana immediately or within short duration. It isgenerally indicated in Bala, Vriddha, Balaheena, Mrudu koshta, Alpa dosha, Raja,Raja samipya, Sneha parihara asahishnushu.100Table No.30 . Showing Sneha Dravya and Anupana: 101 Sneha Anupana Ghrta Ushnodaka Taila Yusha Vasa & Majja Manda To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 33
  51. 51.  Procedure Review Of Literature  Bhallataka & Tuvaraka Taila Shita Jala In general Ushnodaka can be administered as Anupana for all Sneha. Sneha dravya can be administered in 2 ways, (!)Accha Peya102 – denotes consumption of Sneha without mixing with other foodarticles. 103 (2) Pravicharana – denotes administering Sneha by mixing with food articleseither in the form of Odanadi (24 in number) or Rasa Pravicharana (64 in number). Among them, Accha Peya is considered as superior for the purpose of ShodanangaSnehapana. Administration of Sneha for Shodhana: 104On the day of Snehapana, when the raising sun has attained golden yellow colour,individual exhibiting Jeerna ahara lakshana (symptoms of digested food of theprevious night) except kshudha (hunger), after performing auspicious rituals,Snehapana is done.After snehapan individual should be observed for Sneha Jeeryamana (symptoms ofSneha undergoing digestion) and Sneha Jeerna (symptoms of digested Sneha)Lakshanas. Table No.31 Showing Sneha Jeeryamana and Jeerna Lakshana: 105 Sneha Jeeryaman Lakshana Sneha Jeerna Lakshana Shiroruja Shirorujadi Jeeryamana Lakshana prashamana Bhrama Vatanulomana Nisthiva Swasthyata Murcha Kshut Sada Trishna Arati Udgara shuddhi Klama, Trishna, Daha Laghuta To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 34
  52. 52.  Procedure Review Of Literature  Table no:32 Showing Samyak Snigdha Lakshana: 106-109 Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.S Vatanulomana + - + + Deepta agni + - + + Snigdha varcha + - + + Asamhatha Varcha + - + + Angha Mardava + - + + Snigdha anga + - + + Snigdha twak - + - - Vit Shaithilya - + - - Glani - + - + Angha laghava - + - + Adhastat sneha darshana - + - - Snehodwega - + - + Vimalendriya - - - + Table No:33 . Showing Asnigdha Lakshana. 110-113Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.SGrathitha purisha + + - -Ruksha purisha + + - -Agnimandya + + - -Vayu pratiloma + + - -Khara Gatra + _ - -Ruksha Gatra + - - -Uro vidaha _ + - -Daurbalya _ + - -Dur varna - + - -Krichrat anna Pachana _ + - -Susnigdha Lakshana Viparyaya _ _ + +Table No.34 . Showing Atisnigdha Lakshana.. 114-117 Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.S Pandutha + - - - Gaurava + - - - Jadya + - - - Avipakwa Purisha + + - - Tandra + - - - Aruchi + + - - Utklesha + - - - To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 35
  53. 53.  Procedure Review Of Literature  Mukha srava + + + + Guda srava - + + - Ghrana srava - + - Guda daha + + - + Bhakta dwesha - + - + Pravahika - + - + Purishaati pravritti - + - -Bahya Snehana & Swedana: 118After attainment of Samyak Snigdha Lakshanas, Abhyanga and Swedana should beadvised for either once or twice on the rest day(vishrama kala) and just prior toPradhana karma on the day of Virechana.SWEDANA:- Dosha Vilayana’ takes place through the Swedana. According to Vagbhata, by the action of Snehana and Swedana, the morbid Doshas are liquefied, dissolved and are brought to koshta119. 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 water120.Bhojana Vyavastha:During the procedure of Abhyanga and Swedana, Snigdha, Drava,Ushna bhojana,Mamsarasa,Pramanayukta,Anabhishandhi,NatiSnighdha,Asankeerna,Odana, Amlarasa Phala is recommended.121.Before pradhana karma the diet should be such that, it does not increase ‘Kapha’otherwise Vamana may occur122.‘Manda Kapha’ term is used for the state of Kapha, which is desired for the properVirechana. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 36
  54. 54.  Procedure Review Of Literature MATRA VINISCHIYA:1. The dose of Virechana Yoga should be decided according to Vyadhibala, Aturabala and Agnibala123. If the dose given more than Vyadhibala, may cause another Vyadhi. If it is more than Agnibala it may cause Ajeerna, Vishtambha, and if it is more than Aturabala then it may cause Atipravrtti or Apravrtti. So, the dose should be in Sama Pramana only and also the dose of Virechana drug of an individual is, one which expels only morbid Dosha out of the body without manifesting any complication.124Table.no.35 . DOSE OF VIRECHANA DRUG IN ITS DIFFERENT FORM125-128. Form Of Medicine Koshta Dose Sus125,126 Sha127 Van128 Krura Uttama Tikshana Tikshana 1 pala Madhyam Madhyam Madhya Madhya ½ pala 1 Any form Mrudu Heena Mrudu Mrudu 1 Karsha Krura Uttama 8 Karsha Madhyam Madhyam 1 Anjali 4 Karsha 2 pala 2 Kwatha Mrudu Heena (4 pala) 2 Karsha Krura Uttama - 2 Karsha Madhyam Madhya 1 Karsha 1 Karsha 1 Karsha 3 Churna Mrudu Heena - ½Karsha Krura Uttama - 8 Karsha Madhyam Madhyam - 4 Karsha 1 pala 4 Svarasa Mrudu Heena - 2 Karsha Krura Uttama - - 5 Kalka Madhyam Madhyam 1 Karsha 1 Karsha Mrudu Heena - - Krura Uttama - - - 6 Modaka Madhyam Madhyam - 1 Karsha - Mrudu Kaneeya - - - 7 Hima& Krura Uttama 8 Karsha - phanta Madhyam Madhyam 1 Anjali 4 Karsha - Mrudu Heena (4 pala) 2 Karsha - - - - - 2 Karsha 8 Sneha - - - - or1 pala - - - - Ushna Mrudu - - - 2 pala 9 jala as Anoopan Madhyam - - - 4 pala To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 37

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