“EFFICICACY OF SIRAVYADHA WITH AND
WITHOUT VIRECHANA IN SHARAD RUTU-
A COMPARATIVE STUDY.”
BY
Dr. RAVIKUMAR B. PATIL., B.A...
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “Efficacy of
Siravyadha with and without Vir...
Department of Post Graduate Studies in Panchakarma
Government Ayurvedic Medical College
Bangalore - 560009
CERTIFICATE BY ...
ENDORSEMENT BY HOD & PRINCIPAL
This is to certify that the dissertation entitled “Efficacy of Siravyadha with
and without ...
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of Health Sciences,
Karnataka, Ba...
ACKNOWLEDGEMENT
It gives me immense pleasure to offer my sincere thanks to all those
who have rendered their wholehearted ...
I am especially thankful to Dr. Somnath Gore, Dr.Pooja B.A. and
Dr. Manjunath Kanti for their support and cooperation.
I a...
LIST OF ABBREVIATIONS
A.H. – Ashtanga Hridaya.
A.S. – Ashtanga Sangraha.
A.V. _ Atharvana veda
Aru. – Arunadatta.
B.P. – B...
Pur. - Purvakhanda.
Si. – SiddhiSthana
Sha.S – Sharangadhara Samhita
Su. S. – SushrutaSamhita
Su. – SutraSthana
Van.Sam. –...
ABSTRACT
“EFFICACY OF SIRAVYADHA WITH AND WITHOUT VIRECHANANA
IN SHARAD RUTU –A COMPARATIVE STUDY”
Preserving the Health i...
before raktamokshana with the objective of keeping diseases of modernity in
check.
Methods:A total of 30 subjects having t...
CONTENTS
1. Introduction 1-3
2. Objectives 4
3. Review of Literature: 5- 109
• Procedure Review
• Rutu Review
• Drug Revie...
List of Tables
Sl.No. Headings PageNo.
1 Chapters and contents related to Virechana in Charaka
samhita
5
2 Chapters and co...
40 Table showing the rutus with respective months 87-88
41 Table showing the contents and properties of Jeerakadi
churna.
...
75 Table Showing distribution of Subjects by pittaprakopak and
raktaprakopa nidan in both the groups.
140
76 Table Showing...
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 i...
24 Graph no.24: Showing distribution of Clotting time in both the
groups.
139
25 Graph no.25: Showing the Samyaka Viddha l...
Introduction
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 1 
 
INTRODUCTION
Ayurveda an ancient India...
Introduction
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 2 
 
Maintaining the health in healthy is o...
Introduction
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 3 
 
Virechana is one of the prime purifica...
Objectives of study. 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 4 
 
OBJECTIVES OF STUDY:
1) To st...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 5 
PROCEDURE REVIEW
VIRECHANA KARMA:
...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 6 
yogya-ayogya
6 Vamanavirechan
vyap...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 7 
karma , samyak,
ayoga, atiyoga,
vy...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 8 
SHAREERA –
Anatomy and Physiology ...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 9 
• Grahani
• Kshudrantra
• Sthulant...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 10 
The consumed food is brought into...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 11 
According to Vagbhata, the separa...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 12 
Sub mucous Nerve Plexus
Extrinsic...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 13 
sphincter.
Muscularis Mixing wave...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 14 
(Duodenum 12
times per min,
Ileum...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 15 
4. The last stages of chemical di...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 16 
By the time chyme has remained in...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 17 
Richir – Rich Dhatu (Root) – samp...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 18 
Virechana Karma is considered as ...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 19 
Pandu + + - - - + +
Kamala + - - ...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 20 
4. Tridoshaja Vyadhi
Kushta + + -...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 21 
Galaganda + - - - - - -
Bradhna +...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 22 
Vibandha - + + + - - -
Anaha - + ...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 23 
Durbala + - - - + - -
Durbalendri...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 24 
Ratri Jagarita - - + - - - -
Anup...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 25 
Urusthambha - - - - + - -
Ardita ...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 26 
Sl.No Parts used Charaka 61
Sushr...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 27 
B. Virechana drugs according to t...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 28 
In the context of Jwara Chikitsa ...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 29 
known as Mridu Virechana. Those d...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 30 
According to Charaka, the drug wh...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 31 
The preparations, which do not co...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 32 
Shweta
Chandana
Trivrit Hemakshi
...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 33 
Kalpana Trivrth Argvada Tilvaka S...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 34 
Taila - - - - 6 2
Chatusneha - - ...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 35 
dose and for Krura Kostha persons...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 36 
2) Snehapana :
Snehapana procedur...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 37 
habituated of doing exercise dail...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 38 
it is more than Aturabala then it...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 39 
The Vaidya or physician must obse...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 40 
c) Shuddhi Lakshana113-117
:
Four...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 41 
Shareera Laghuta + + -
Agnivriddh...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 42 
Kandu - + +
Vit Sanga + + +
Mutra...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 43 
Mamsa Dhavana vat udaka srava - -...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 44 
Acharya Charaka gives beautiful e...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 45 
that incase of Ksheena Kapha, Pey...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 46 
dosha,thereafter kashaya katu ras...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 47 
Table No. 24 Showing the Virechan...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 48 
Table No.25 showing the vyapath a...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 49 
with ushna
lavana guna
3 Srava In...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 50 
sha vibramsha,kand
u
ahara,udumba...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 51 
12 Jirna
aousha
di
vyapat
h
Virec...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 52 
MODE OF ACTION OF VIRECHANA:
ÌuÉU...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 53 
g) Mainly due to Prabhava, Prithw...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 54 
Laxative-Lax (laks), [Lat-laxus,s...
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 55 
Segmental movement – due to contr...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 79 
 
RUTU
Vedic Period:
Yajurveda...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 80 
 
The rutus are classified as,...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 81 
 
Table No.34:Table Showing Ch...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 82 
 
from late winter to summer.T...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 83 
 
During the varsha, sharad, a...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 84 
 
Six rutus are divided on the...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 85 
 
Ayana 3 rutu
Varsha 2 ayana
...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 86 
 
MEASURES TO BE ADOPTED AS PE...
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...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 88 
 
The accumulated pitta underg...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 89 
 
regimen so far described for...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 90 
 
Sharangdhara: Doshas which a...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 91 
 
In sharad rutu one should un...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 92 
 
and clean dress, garlands, a...
Review of literature 
 
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore.   Page 93 
 
YOGARATNAKAR: Substances hav...
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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 DHANWANTARI ROAD, BANGALORE

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Virechana in sharad rutu pk

  1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.

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