Changes

If there is rectal prolapse, it should be positioned by using kashaya dravya (astringent drugs) and pushed in its own location. If there is loss of consciousness, then he should be consoled and exposed to music therapy.  

If there is rectal prolapse, it should be positioned by using kashaya dravya (astringent drugs) and pushed in its own location. If there is loss of consciousness, then he should be consoled and exposed to music therapy.  

If the virechana drug stops action after the elimination of the fecal matter and the emetic recipe stops action after the elimination of medicine, the excited doshas do not get properly eliminated leading to symptoms like itching etc. This spectrum is termed as vibhramsha. These should be managed as per their individual disease protocols. (85-87)

If the virechana drug stops action after the elimination of the fecal matter and the emetic recipe stops action after the elimination of medicine, the excited doshas do not get properly eliminated leading to symptoms like itching etc. This spectrum is termed as vibhramsha. These should be managed as per their individual disease protocols. (85-87)

Complication of stambha (stiffness) and its management:

 

==== Complication of stambha (stiffness) and its management ====

 

पीतं स्निग्धेन सस्नेहं तद्दोषैर्मार्दवाद्वृतम्|  

पीतं स्निग्धेन सस्नेहं तद्दोषैर्मार्दवाद्वृतम्|  

न वाहयति दोषांस्तु स्वस्थानात् स्तम्भयेच्च्युतान्||८८||  

न वाहयति दोषांस्तु स्वस्थानात् स्तम्भयेच्च्युतान्||८८||  

Unctuous medicine for virechana when given to a person with an oleated body, because of the mild nature of doshas, they are not let out and cause occlusion in its own site. Because of the obstructed vayu, there will be obstruction and pain in the rectum and there will be frequent expulsion of doshas in little quantity.   

Unctuous medicine for virechana when given to a person with an oleated body, because of the mild nature of doshas, they are not let out and cause occlusion in its own site. Because of the obstructed vayu, there will be obstruction and pain in the rectum and there will be frequent expulsion of doshas in little quantity.   

Here highly potent basti or virechana, need to be given. First he must observe fast or take light food (langhana), then give pachana (digestive medicine ). (88-89)

Here highly potent basti or virechana, need to be given. First he must observe fast or take light food (langhana), then give pachana (digestive medicine ). (88-89)

Complications and its management:

 

==== Complications and its management ====

 

रूक्षं विरेचनं पीतं रूक्षेणाल्पबलेन वा|  

रूक्षं विरेचनं पीतं रूक्षेणाल्पबलेन वा|  

मारुतं कोपयित्वाऽऽशु कुर्याद्धोरानुपद्रवान्||९०||  

मारुतं कोपयित्वाऽऽशु कुर्याद्धोरानुपद्रवान्||९०||  

Individual with un-unctuous body and who is weak, when given an un-unctuous virechana recipe, will result in severe vitiation of vayu and cause serious complications. Vitiated vayu results in whole body stiffness and colicky pain. Here oleation and sudation therapies along with protocol for management of vata needs to be adopted. (90-91)

Individual with un-unctuous body and who is weak, when given an un-unctuous virechana recipe, will result in severe vitiation of vayu and cause serious complications. Vitiated vayu results in whole body stiffness and colicky pain. Here oleation and sudation therapies along with protocol for management of vata needs to be adopted. (90-91)

Klama (fatigue without exertion) and its management:

 

स्निग्धस्य मृदुकोष्ठस्य मृदूत्क्लिश्यौषधं कफम्|  

==== Klama (fatigue without exertion) and its management ====

 

स्निग्धस्य मृदुकोष्ठस्य मृदूत्क्लिश्यौषधं कफम्|  

पित्तं वातं च संरुध्य सतन्द्रागौरवं क्लमम्||९२||  

पित्तं वातं च संरुध्य सतन्द्रागौरवं क्लमम्||९२||  

दौर्बल्यं चाङ्गसादं च कुर्यादाशु तदुल्लिखेत्|  

दौर्बल्यं चाङ्गसादं च कुर्यादाशु तदुल्लिखेत्|  

For those with unctuous and mridu koshtha, if mild purificatory medicine is given, there is aggravation of kapha causing obstruction to pitta and vata resulting in fatigue, heaviness of body, loss of strength, excruciating pain. Here the medicine must be given to vomit immediately. Then accordingly langhana (fasting) and pachana (digestive medicine) need to be done followed by  purification with strong and  unctuous medicines. (92-93)

For those with unctuous and mridu koshtha, if mild purificatory medicine is given, there is aggravation of kapha causing obstruction to pitta and vata resulting in fatigue, heaviness of body, loss of strength, excruciating pain. Here the medicine must be given to vomit immediately. Then accordingly langhana (fasting) and pachana (digestive medicine) need to be done followed by  purification with strong and  unctuous medicines. (92-93)

Summary:

 

==== Summary ====

 

तत्र श्लोकौ-  

तत्र श्लोकौ-  

इत्येता व्यापदः प्रोक्ताः सरूपाः सचिकित्सिताः|  

इत्येता व्यापदः प्रोक्ताः सरूपाः सचिकित्सिताः|  

dadyAt  saMshodhanaM samyagArogyArthI  nRuNAM sadA||95||  

dadyAt  saMshodhanaM samyagArogyArthI  nRuNAM sadA||95||  

Thus the features of complications that may arise due to vamana and virechana by un-skilled physician and their management are described. Intelligent ones must always properly understand these states and administer proper purification therapy in the persons desiring health. (94-95)

Thus the features of complications that may arise due to vamana and virechana by un-skilled physician and their management are described. Intelligent ones must always properly understand these states and administer proper purification therapy in the persons desiring health. (94-95)

 

• The purification treatments shall be done in specific seasons in which the doshas are in vitiated state naturally. In case of disease, it can be followed anytime.  

• The purification treatments shall be done in specific seasons in which the doshas are in vitiated state naturally. In case of disease, it can be followed anytime.  

• Vamana (therapeutic emesis) for kapha dosha shall be followed in vasanta (spring season from mid February to mid April in India); virechana (therapeutic purgation) for pitta dosha shall be followed in sharada (Autumn season from mid October to mid December in India); basti (therapeutic enema) for vata dosha shall be followed in pravrit (early rains season from mid June to mid August in India).  

• Vamana (therapeutic emesis) for kapha dosha shall be followed in vasanta (spring season from mid February to mid April in India); virechana (therapeutic purgation) for pitta dosha shall be followed in sharada (Autumn season from mid October to mid December in India); basti (therapeutic enema) for vata dosha shall be followed in pravrit (early rains season from mid June to mid August in India).  

• The physician should keenly observe the patient during purification therapy for assessing signs of eliminating doshas. The conditions and complications shall be treated based on dosha dominance and disease protocols.

• The physician should keenly observe the patient during purification therapy for assessing signs of eliminating doshas. The conditions and complications shall be treated based on dosha dominance and disease protocols.

• Assessment of vitiation of dosha, agni (digestive power), koshtha (bowel) and unctuousness of patient are most important factors for administration of purification therapy. Otherwise complications may arise due to improper dosage, potency of medicines.  

• Assessment of vitiation of dosha, agni (digestive power), koshtha (bowel) and unctuousness of patient are most important factors for administration of purification therapy. Otherwise complications may arise due to improper dosage, potency of medicines.  

Vidhi Vimarsha:

 

=== ''Vidhi Vimarsha'' ===

 

Verse 7 :  

Verse 7 :  

The shloka highlights the importance of the spacing of sneha-sweda in between the therapies. Shodhanaanga snehapaana and swedana before vamana or virechana  brings in the utklishta doshas (after snehapaana), to the koshtha (after swedana) and eliminates it (A.H.Su.17/29)

The shloka highlights the importance of the spacing of sneha-sweda in between the therapies. Shodhanaanga snehapaana and swedana before vamana or virechana  brings in the utklishta doshas (after snehapaana), to the koshtha (after swedana) and eliminates it (A.H.Su.17/29)

Cakrapaani while commenting here says, one should not misunderstand the context as sneha sweda is required only once before all shodhana. The mentioning of sneham ca ante prayojayet, is important in clinical practice. Once the patient gets discharged from the hospital after shodhana, the physician must use a sneha internally after peyadikramam. Cakrapaani says, it is to control the fatigue caused by the samshodhana karma that the use of samshamana sneha is told here.

Cakrapaani while commenting here says, one should not misunderstand the context as sneha sweda is required only once before all shodhana. The mentioning of sneham ca ante prayojayet, is important in clinical practice. Once the patient gets discharged from the hospital after shodhana, the physician must use a sneha internally after peyadikramam. Cakrapaani says, it is to control the fatigue caused by the samshodhana karma that the use of samshamana sneha is told here.

8th verse:  

 

8th verse:  

On analyzing the samprapti of the conditions (visarpa, pidaka etc.) mentioned here, it is well evident that the common thread in them is kapha-pitta dushti. Shopha is also a clinical condition where there is prohibition to use oleating substances like guda, aanuupa-amisha etc. (A.H.Su.16/43) . Here abhighaata and visha which is always an acute emergency presenting kapha-pitta dushti also requires immediate shodhana without much swedana. Paandu roga is a condition which is entitled for the use of sneha prayoga like kalyaanakaghrta. Here, Aacharya cautions not to reach ati-snigdhatwam. Visarpa is also a condition where in snehana is prohibited.

On analyzing the samprapti of the conditions (visarpa, pidaka etc.) mentioned here, it is well evident that the common thread in them is kapha-pitta dushti. Shopha is also a clinical condition where there is prohibition to use oleating substances like guda, aanuupa-amisha etc. (A.H.Su.16/43) . Here abhighaata and visha which is always an acute emergency presenting kapha-pitta dushti also requires immediate shodhana without much swedana. Paandu roga is a condition which is entitled for the use of sneha prayoga like kalyaanakaghrta. Here, Aacharya cautions not to reach ati-snigdhatwam. Visarpa is also a condition where in snehana is prohibited.

In practice, usually in all these conditions virechana  is done with ruuksha prayoga like cuurna, kashaya etc. Avipathi chuurna (A.H.Ka), Vidangatandulaadi chuurna (A.H.Ka), Trvrt kashaaya, Maanibhadra chuurna (chuurna form of Maanibhadra gudam- A.H.Ci), Patolaadi shodhana kashayam (sahasrayoga) are used.

In practice, usually in all these conditions virechana  is done with ruuksha prayoga like cuurna, kashaya etc. Avipathi chuurna (A.H.Ka), Vidangatandulaadi chuurna (A.H.Ka), Trvrt kashaaya, Maanibhadra chuurna (chuurna form of Maanibhadra gudam- A.H.Ci), Patolaadi shodhana kashayam (sahasrayoga) are used.

9th Verse:  

9th Verse:  

Following the principle, ‘vrdhisamane sarvesham vipareetai viparyata’ (A.H.Su.1/14) if an excessively oleated person is administered a drug which is unctuous in nature, it will not work, rather when medicine of opposite guna like ruksha is used for shodhana, the appropriate action will happen. Cakrapaani says sneha virechana  means snigdha virechana, that is virechana  with snigdha (unctuous) dravya. If sneha virechana  is given to an atisnigdha shareera, because of sneha prakarsha (excess sneha) the vitiated doshaas already in a the morbid state cannot be removed. These vitiated doshas that has already moved from their site will clog the srotas. Hence to remove this vitiated dosha ununctuous/ ruuksha kind of shodhana need to be performed.

Following the principle, ‘vrdhisamane sarvesham vipareetai viparyata’ (A.H.Su.1/14) if an excessively oleated person is administered a drug which is unctuous in nature, it will not work, rather when medicine of opposite guna like ruksha is used for shodhana, the appropriate action will happen. Cakrapaani says sneha virechana  means snigdha virechana, that is virechana  with snigdha (unctuous) dravya. If sneha virechana  is given to an atisnigdha shareera, because of sneha prakarsha (excess sneha) the vitiated doshaas already in a the morbid state cannot be removed. These vitiated doshas that has already moved from their site will clog the srotas. Hence to remove this vitiated dosha ununctuous/ ruuksha kind of shodhana need to be performed.

10th Verse:  

10th Verse:  

Samyak is the word used to indicate appropriate/ optimum action in many contexts. Any kriyakrama is performed for its appropriate outcome as desired by the physician. The shloka here reveals the four important limbs of it, which are equally important. The first being the proper preparation of the patient in the form of sneha sweda, the second being the physiological status of the patient with respect to aahraa, only then can the agni do its duty. So the medicine has to be given after the ahaara is digested. The third being the importance of maatra which is previously well explained in Charaka vimaanasthaana trividhakuksheeyam adhyaayam. There Acharya lays importance to the appropriate maatra of aahaara. Here Acharya, gives importance to the appropriate maatra of oushadha. Only the desired dosage is acted upon by agni to create the optimum response in the body. Fourthly, the relevance of focused mind is explained. Cakrapaani says the patient must concentrate only on the action of shodhana, the presence of negative emotions like lust, anger, jealousy will only have negative effect on the outcome.  

Samyak is the word used to indicate appropriate/ optimum action in many contexts. Any kriyakrama is performed for its appropriate outcome as desired by the physician. The shloka here reveals the four important limbs of it, which are equally important. The first being the proper preparation of the patient in the form of sneha sweda, the second being the physiological status of the patient with respect to aahraa, only then can the agni do its duty. So the medicine has to be given after the ahaara is digested. The third being the importance of maatra which is previously well explained in Charaka vimaanasthaana trividhakuksheeyam adhyaayam. There Acharya lays importance to the appropriate maatra of aahaara. Here Acharya, gives importance to the appropriate maatra of oushadha. Only the desired dosage is acted upon by agni to create the optimum response in the body. Fourthly, the relevance of focused mind is explained. Cakrapaani says the patient must concentrate only on the action of shodhana, the presence of negative emotions like lust, anger, jealousy will only have negative effect on the outcome.