This document discusses Virechana Karma, an Ayurvedic procedure to purge the body of toxins and waste through induced purgation. It covers the appropriate patients and conditions for Virechana, contraindications, types of Virechana, benefits, and potential complications. It also provides standard operating procedures for Virechana Karma, including preparation techniques like internal and external oleation as well as post-procedure care like diet and monitoring for side effects.

1. Virechana Karma
Dr Santoshkumar Bhatted
Associate Prof, Dept of Panchakarma
National Institute of Ayurveda
Jaipur
5/30/2013 1Presentation by Dr Santoshkumar Bhatted

2. Approach for standardization of Virechana
Process of Virechana Karma and its SOP
Time of administration of Virechana Oushadhi
Assessment of Avara, Madhyam & Pravara Shuddhi
Vyapat of Virechana Karma and its management
5/30/2013 2Presentation by Dr Santoshkumar Bhatted

3. Virechana
 “Virechana” is a Process by which the vitiated Pitta and
other mala from the whole body are expelled out
through gastrointestinal tract by means of purgation
with the use of specific formulations.
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4. Field of Virechana
 Pittaja Vyadhi
 Shleshmasamsrushta Pittaja Vyadhi
 Pittasthanagata Vyadhi
 Raktaja Vyadhi
 Commonly used in Kushta, Visarpa, Vatarakta, Pandu,
Kamala, Pakshaghata, shwasa, amlapitta, Amavata,
Jvara, Udara, Gulma etc.
 In Sharad Rutu
 As a Poorvakarma for Rasayana and Vajikarana
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5. Virechana- contraindications
 By nature: Pregnant, Sukumara, Rooksha, Kshudhita,
Shokarta, Krisha, Bala, Vriddha, Durbala
 Diseased conditions like:
Amavastha- Navajwara, Ajeerna
Adhopravritti- Atisara, Adhogat Raktapitta
Gudaja Roga- Kshataguda, Muktanala
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6. Types of Virechana
 Purvakarmayukta Virechana
 Rutu-Anusari Virechana
 Sadhyo-Virechana
 Nitya –Virechana
 Punha-Punha Virechana
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7. Merits of Virechana
Works on Pitta Pradhana Tridosha
Easy to perform even in Out Patients
Easy availability of drugs
Cost effective
Simplicity of procedure
Acceptance from the patients
Less complications
Easy to manage complications if any
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8. Why standardization of Virechana Karma
 To develop the uniformity of practice
 To overcome the difference of opinion among the
Acharyas and the practitioners
 To overcome the complexity of decision making in
selection of medicine, dose, duration, pattern at each
step during Virechana Karma
 To frame certain minimum guidelines
 To prevent malpractice of Virechana Karma

9. Limitations in doing standardization
 Factors to be evaluated before planning Virechana
Karma are individual variables to a great extent
 Chief assessment criteria is mainly subjective
 Quantitative assessment of Virechana Vega is
practically difficult
 Number of Virechana Vega can be recorded as Vega
and Upavega

10. Factors to be evaluated
Examination of Patient
Koshta
Agni
Prakriti
Bala etc
Examination of disease
Dosha
Dushya etc
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11. ASSESSMENT OF KOSHTHA:
Understanding of Koshtha as Mrudu, Madhyama and
Krura Koshtha is most important in Virechana Karma.
 The bowel habits were examined in following way
 frequency, consistency, straining or efforts, time taken for
proper defecation, Krita Samdnya
 Previous encounters of diarrhea and constipation
 Previous experiences of Purgatives and Laxatives.
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12. Mridu Koshtha
 Passes Stools daily once or twice regularly
 Semi formed or formed stools.
 Easy defecation.
 Less time required for defecation.
 Krita Samdnya after defecation.
 Previous encounters shows often Drava Mala Pravritti due to
hot drinks, tea, milk, Mridu,Ushna, guru dravya
 Minor laxatives often encounter diarrhea.
 After the 30 ml test dose of Ghrita passes stools slightly loose
and frequency may be more by 1-2 vegas
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13. Madhyama Koshtha
Passes stools daily once
 Formed stools
 Requires minimum stress.
 Little long time (in comparison to mridu).
 Krita Samdnya after defecation.
 Doesn't often encounter diarrhoea or constipation.
 Requires medium dose of Purgatives and laxatives. Doesn't
purgates by milk or by minor laxatives.
 After the intake of test dose of Ghrita, passes semi formed or
formed stools once or twice.
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14. Krura Koshtha
 Doesn't pass stool regularly
 Kathina or Shushka Mala Pravritti.
 Requires straining.
 Requires long time for defecation.
 Krite Api Akrita Samdnya (unsatisfactory bowel
clearance).
 Seldom encounters diarrhea and more frequently
experiences constipation.
 Requires drastic purgatives,
 No change in the bowels by test dose of Sneha.
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15. Assessment of Agni
After the Koshtha, assessment of Agni is prior requisite in
Virechana Karma
 Ruchi Aahara kale
 Abhyavaharana Shakti
 Jarana Shakti
 Time required for digestion of routine /moderate quantity
of food
 Time required for digestion of light/ less food
 Time required for digestion of heavy/excess food
5/30/2013 15Presentation by Dr Santoshkumar Bhatted

16. Important issues in Virechana Karma
 Standard operative procedure
 Snehapana and its assessment
 Selection of Virechana Dravya and Yoga
 Assessment of Virechana karma
 Planning of Samsarjana Krama
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17. SOP of Virechana Karma
 Purva karma: (pre-operative procedure)
 Pachana and Deepana
 Abhyantara Snehapana
 Bahya Snehana
 Svedana
 Ahara Vishesh Upayoga
 Pradhana karma: (operative procedure)
 Virechana Yoga administration
 Pashchata karma: (post-operative procedure)
 Assessment of Virechana
 Sansarjana Krama
5/30/2013 17Presentation by Dr Santoshkumar Bhatted

18. Pachana and Deepana
 Tab Amapachana vati: 1 gram three times/day
 Tab Chitrakadi vati: 1 gram three times/day
 Panchakola Churna 2 grams three times a day
 For 3 to 7 days or till Niraama Lakshana and
Agnideepti is achieved
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19. Abhyantara Snehapana (internal oleation)
 Shodhananga Snehapana: Selection of
Sneha, Dose, Duration, Dose Pattern
 Sneha: Select preferably Murchita Shuddha Sneha (plain
ghee or oil)or medicated Sneha as per the patient and
disease
 Dose, Duration, Dose Pattern: For 3 to 7 days in
increasing dose early in the morning in empty stomach
as per Agnibala and Koshtha or till Samyaka Snigdha
Lakshana achieved
 Start with test dose (Hrasiyasi Matra)
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20. Bahya Snehana and Svedana
 Vishrama Kala: 03 days
 Sarvanga Taila Abhyanga(Whole body oil Massage): for
30 minutes
 Sarvanga Bashpa/Nadi Svedana: whole body steam bath
10 -15 minutes
 Two times a day for three days after internal oleation
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21. Food regimen
Odana, Mudga Yusha, Jangala Mamsa Rasa
with little amount of fat, spices and salt(Rice
and meat soup/green gram soup )in moderate
quantity
Sour fruits like grapes
frequent drinking of warm water
No complex food is permitted
5/30/2013 21Presentation by Dr Santoshkumar Bhatted

22. Ensure on the day of Virechana
 Assess for Jirna Ahara Lakshana
 Proper digestion of food taken on previous day
 Proper clearance of natural urges
 Patient had proper sleep in the night
 No Kaphavruddhi Lakshana developed in patient
 Administer Sarvanga Abhyanga and Svedana
 Time of administration: After passing Kaphakala
(about 10.00 AM)
5/30/2013 22Presentation by Dr Santoshkumar Bhatted

23. Intake of Virechana Yoga
 Selection of Virechana Yoga as per the Prakriti, Koshta, Bala, Dosha etc
 Give it in empty stomach with suitable Anupana like Triphala
Kvath, Draksharasa, Ushnodaka/Shitodaka, Madhu etc
 Patient is to be advised to clean his mouth with warm water, sprinkle cold
water on face and smell something like lemon etc
 Take rest waiting for the urges of defecation without going into sleep
 Warm water should be used frequently for drinking in little quantity
 Examination of vitals like BP, Pulse before in between and after
completion of Virechana Vegas
5/30/2013 23Presentation by Dr Santoshkumar Bhatted

24. Recording of Virechana Vega
 Number of Vega after excluding initial 2-3 Vegas of fecal
matter
 Time of Vega
 Approximate quantity
 Color
 Consistency
 Any complications
5/30/2013 24Presentation by Dr Santoshkumar Bhatted

25. Pashchata Karma- Do’s & Don’ts
 After the subsiding of Vegas and ensuring Jeerna Oushadha
Lakshana, Patient is to be advised to take warm water bath in
the evening
 Dietetic schedule should be advised as per the Shuddhi
achieved once the patient feels hunger.
 Regimen – avoid exposure to Pravatha, drinking cold
water, Guru Ahara, Vyayama, Maithuna
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26. Assessment of Virechana Karma
SHUDDHI VAIGIKI MANIKI ANTIKI LAINGIKI LAKSHANA
Hina 10
Vega
2
Prastha
Kaphanta
Sroto Vishuddhi
Indriya Prasada,
Laghuta
Agnivriddhi
Anamayatva
Kramat
Vata Pitta Kapha
Nirgamana
Madhyam 20
Vega
3
Prastha
Kaphanta
Pravara 30
Vega
4
Prastha
Kaphanta
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27. Vyapat
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28. Vyapat
Adhmana
Parikartika
Srava
Hridgraha
Gatragraha
Jeevadana
Vibhramsha
Stambha
Upadrava
Klama.
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29. Vyapat
1) Savasesha aushadhatva
2) Jeerna aushadhatva
3) Hina doshapahritatva
4) Adhika- doshaapahritatva
5) Vata shoola
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30. Virechana Ayoga- Causes
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31. Virechana Ayoga Lakshana
Apravritti
Oordhvapravritti
Vata, Mootra, Pureesha sanga
Utklesha of Kapha & Pitta
Vatha pratilomatha
Avishuddhi in Kukshi & Hridaya
•Adhmana
•Praseka
• Bhrama
• Kandu, Vivarnata
• Vidaha
• Staimitya
•Agnimandya
• Gaurava
•Prathishyaya
• Tandra
• Chchardi
• Aruchi
5/30/2013 31Presentation by Dr Santoshkumar Bhatted

32. Management in case of Apravrita Vega
 If Virechana Vegas are not started than the patient
should be given hot water for drinking and fomentation
should be done on the abdomen.
 Assess for Aushadhi Jeerna and Ajirna Lakshanas
 If Jeerna Lakshanas are found than another Virechana
Yoga can be given
 Still if Vega has not started, than Niruha Basti with
Gomutra is to be given followed by Anuvasana Basti
 Again proper Snehapana is to be given followed by
Tikshna Virechana
 If Ajirna Lakshanas are found than wait for the Vegas
he/she should be allowed to take food in the evening on
that day and should be subjected to Virechana on the
next day.
5/30/2013 32Presentation by Dr Santoshkumar Bhatted

33. Management of Ayoga Vyapat
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34. Features of Jeerna & Ajeerna Oushadhi
5/30/2013 34Presentation by Dr Santoshkumar Bhatted

35. Features of Jeerna & Ajeerna Oushadhi
Jeerna Oushadhi Ajeerna Oushadhi
 Vatanulomana
 Svasthata
 Kshudha
 Trushna
 Manasvita
 Indriya Shuddhi
 Udgara Shuddhi
 Klama
 Daha
 Angasada
 Bhrama
 Murcha
 Shiroruja
 Arati
 Balahani
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36. Virechana Atiyoga- Causes
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37. Virechana Atiyoga Lakshana
Kapha kshayaja vikaras
Pitha kshayaja vikaras
Vata Prakopaja vikaras
Kevala Dosharahita Jala, Rakta,
Medo-Mamsa Dhavanodaka like
Krishna Varna Srava
• Supti
•Angamarda
• Klama
•Vepathu
• Nidra
• Bala Abhava
• Tama Pravesha
•Nayana Anta Pravesha
• Hikka
•Unmada
•Hridayodveshtana
• Parikartika
• Gudanissarana
5/30/2013 37Presentation by Dr Santoshkumar Bhatted

38. Management of Atiyoga Vyapat
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39. Management of Atipravruti
 Maintenance of Hydration by fluid replacement
 Electrolytes supplement
 Maintenance of BP, Pulse
 Use of
 Mantha, Sharkara Udaka
 Panchavalkala Siddha Peya
 Purisha Sanghahaniya Kshirapaka
 Tandulodaka
 PicchaBasti, Ghrita Manda Basti, Madhura Oushadhi
Basti
 Raktapittahara Daha and Atisara hara Chikitsa
 Shita Kashaya and Madhura Dravya and Ahara Prayoga
5/30/2013 39Presentation by Dr Santoshkumar Bhatted

40. Management of Udara Shula &Adhmana
 Use of Warm water
 Udara Svedana
 Phala Varti Prayoga
 Niruha and Anuvasana Basti
 Use of Vatanulomana drugs
 Shankha Vati, Hinguashtaka Churna, Shankha
Bhasma etc
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41. Factors to be considered to
prevent Vyapat
 Proper preparation of the patient by Purvakarma
 Use of Proper Virechana drug and formulation in
appropriate dose in accordance to patient status like
 Koshtha
 Dosha and its pramana
 Agni Sthithi
 Bala
 Ruksha or Snigdha Purusha
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42. Meticulous care during Samshodhana
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43. Sansarjana Krama (dietetic schedule)
 Special dietetic schedule
 To improve the Agni
 To maintain the strength (Prana)
 To provide basic nourishment and positive energy balance
 To supplement the body gradually one by one from
carbohydrates to proteins to fat along with fluid and
electrolytes replacement
 3 types of Samsarjana Kramas- Peyadi krama &
Tarpanadi Krama and Rasa Sansarjana
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44. Why Sansarjana Krama
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45. Diet during Peyadi Sansarjana Krama
 Peya (Thin rice gruel)
 Vilepi (Thick rice gruel)
 Mudga Yusha (Green gram soup)
 Krita
 Akrita
 Mamsa Rasa (Meat soup)
 Krita
 Akrita
 For three, two, one Annakala for Pravara Madhyama
and Avara Shuddhi respectively.

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46. Peyadi Samsarjana krama- Contd
In Pradhana Shuddhi
Day morning evening
1st - peya
2nd peya peya
3rd vilepi vilepi
4th vilepi akrithayusha
5th krithayusha krithayusha
6th akrithamamsarasa krithamamsarasa
7th krithamamsarasa normal diet
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47. Peyadi Samsarjana krama- Contd
Madhyama Shuddhi
Day morning evening
1st - peya
2nd peya vilepi
3rd vilepi akrithayusha
4th kritha yusha akrithamamsarasa
5th krithamamsarasa normal diet
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48. Avara Shuddhi
Day morning evening
1st - peya
2nd vilepi krithakritha yusha
3rd krithakritha rasa normal diet
Peyadi Samsarjana krama- Contd
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49. Why Peyadi /Tarpanadi Krama
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50. Tarpanadi krama
Indicated in Alpashodhana of Pitta &
Kapha, Madhyapa and in Vatapitta Pradhanya
Peya- svaccha tarpana
 Vilepi- ghana tarpana (Chakrapani)
I- annakala: lajasaktu
II- annakala: jeerna shalyodana
III- annakala: mamsarasa (Arunadatta)
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51. Supplement by food not by
medicine
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52. Rasa Sansarjana Krama
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53. Use with caution
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54. Thank You
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