Changes

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

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

==== Verse 7 ====

==== Importance of oleation and sudation therapies before purification ====

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).

Chakrapani 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''. Chakrapani says, it is to control the fatigue caused by the ''samshodhana karma'' that the use of ''samshamana sneha'' is told here.

Chakrapani 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''. Chakrapani says, it is to control the fatigue caused by the ''samshodhana karma'' that the use of ''samshamana sneha'' is told here.(Verse 7)

==== 8th verse ====

==== Indications of ''Virechana'' ====

   

   

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.(Verse 8)

==== 9th Verse ====

==== Indications of ''Sneha Virechana and Ruksha Virechana'' ====

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. (Verse 9)

==== 10th Verse ====

==== Procedure of ''virechana'' ====

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. Chakrapaani 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.(Verse 10)

==== Verses 11,12,13 ====

==== Similes for action of ''virechana'' ====

We can see the use of similes at various contexts in Ayurvedic classics. It not only gives the reader a clear idea behind the concept, but it also reveal observational talent of Ayurvedic seers to relate external world (macrocosm) with the internal world (microcosm), principles acting inside the body are similar to that act outside and vice versa. The simile of pot smeared with oil to oleated body and water that can be taken out linked to shodhana therapy explain the action to its fullest. Similarly, the malaas removed from the body by shodhana similar to the dirt adhered to the cloth by rinsing in water also explains the mechanism of action in the most understandable way.

We can see the use of similes at various contexts in Ayurvedic classics. It not only gives the reader a clear idea behind the concept, but it also reveal observational talent of Ayurvedic seers to relate external world (macrocosm) with the internal world (microcosm), principles acting inside the body are similar to that act outside and vice versa. The simile of pot smeared with oil to oleated body and water that can be taken out linked to shodhana therapy explain the action to its fullest. Similarly, the malaas removed from the body by shodhana similar to the dirt adhered to the cloth by rinsing in water also explains the mechanism of action in the most understandable way. (Verses 11-13)

==== 14th verse ====

==== Contraindication in state of indigestion ====

The importance of understanding the physiological state of the human body during the shodhana therapy is revealed here. We can see the lakshana indicating srotorodha and aama-avastha like glaani and vibandha on administering medicine to patient in ajeerna avastha. Here this ajeerna will definitely lead to aama, which will again aggravate the condition.

The importance of understanding the physiological state of the human body during the shodhana therapy is revealed here. We can see the lakshana indicating srotorodha and aama-avastha like glaani and vibandha on administering medicine to patient in ajeerna avastha. Here this ajeerna will definitely lead to aama, which will again aggravate the condition.

For the practical assessment of the jeerna-aahaara in the patient to be administered with the shodhana therapy, the following signs and symptoms can be assessed like the elimination of the faeces and urine unobstructed, when the mind is clear, belching are pure, hunger is well manifest, flatus moving downward, digestive activity is clean, sense organs are clear, body is light as mentioned in A.H.Suu. Maatrasheetiyam Adhyayam (A.H.Su.8/55) can be taken into account.

For the practical assessment of the jeerna-aahaara in the patient to be administered with the shodhana therapy, the following signs and symptoms can be assessed like the elimination of the faeces and urine unobstructed, when the mind is clear, belching are pure, hunger is well manifest, flatus moving downward, digestive activity is clean, sense organs are clear, body is light as mentioned in A.H.Suu. Maatrasheetiyam Adhyayam (A.H.Su.8/55) can be taken into account. (Verses 14)

==== Verse 15,16 ====

==== Characteristics of proper dosage ====

The lakshana of maatravad oushadham touches all aspects of an ideal drug. We can see the pharmacoleptic, pharmacologicaland pharmacokinetic aspects being mentioned here for selecting the right drug in the appropriate dosage.

The lakshana of maatravad oushadham touches all aspects of an ideal drug. We can see the pharmacoleptic, pharmacologicaland pharmacokinetic aspects being mentioned here for selecting the right drug in the appropriate dosage.

Each formulation has its own guna with respect to its contents. Even though the drug has its guna, the outcome of the kriyakrama in the patient will also depend on the physiological and the environmental factors too. However, an ideal drug and its ideal dosage in a particular clinical condition, in a particular patient can only be assessed only after the continuous practice and experience of the physician. The same medicine may have different outcome in different patients. Hence, an ideal drug even though is important, more important is fixing the dosage appropriately considering all other factors.

Each formulation has its own guna with respect to its contents. Even though the drug has its guna, the outcome of the kriyakrama in the patient will also depend on the physiological and the environmental factors too. However, an ideal drug and its ideal dosage in a particular clinical condition, in a particular patient can only be assessed only after the continuous practice and experience of the physician. The same medicine may have different outcome in different patients. Hence, an ideal drug even though is important, more important is fixing the dosage appropriately considering all other factors.(Verses 15-16)

==== 17th verse ====

==== Importance of concentration while taking purification treatment ====

The shloka explains the context of ekagra manah, as mentioned earlier. It reinforces the idea that negative emotions of mind like kaamaadi would hinder the effective outcome of shodhana for which the mind must be free and fully concentrating only on shodhana therapy.

The shloka 17 explains the context of ekagra manah, as mentioned earlier. It reinforces the idea that negative emotions of mind like kaamaadi would hinder the effective outcome of shodhana for which the mind must be free and fully concentrating only on shodhana therapy.(Verse 17 )

==== 18th verse ====

==== Diet before purification treatment ====

After warning about ajeerna ahaara, the present context explain the guna of ahaara. For vamana, all kind of kapha-aggravating ahaara that is easily digestible and liquid in nature is advised on the previous day which is to facilitate the intending karma. The increased kapha state as specified in the kalpana sidhi as well as the decreased kapha state are important for vamana and virechana  respectievely. Kapha is the dosha that basically decides the action (C.S.Si.1/9)

After warning about ajeerna ahaara, the present context explain the guna of ahaara. For vamana, all kind of kapha-aggravating ahaara that is easily digestible and liquid in nature is advised on the previous day which is to facilitate the intending karma. The increased kapha state as specified in the kalpana sidhi as well as the decreased kapha state are important for vamana and virechana  respectievely. Kapha is the dosha that basically decides the action (C.S.Si.1/9)  

For virechana, the ahaara on the previous day is mentioned to be laghu and asheeta, that is, easily digestible and hot. Hence, the action of vamana happens with utklishta kapha and for virechana  with alpa kapha. In similar context, Susruta Samhita Cikitsa sthaana, he speaks of pitta-utklehsa before virechana, with amla dravya like beeja-puurka rasa. This will also ultimately result in alpa-kaphatvam.

For virechana, the ahaara on the previous day is mentioned to be laghu and asheeta, that is, easily digestible and hot. Hence, the action of vamana happens with utklishta kapha and for virechana  with alpa kapha. In similar context, Susruta Samhita Cikitsa sthaana, he speaks of pitta-utklehsa before virechana, with amla dravya like beeja-puurka rasa. This will also ultimately result in alpa-kaphatvam.

In practice, we give porridge made of maasha (black gram) with sugar, yoghurt, boiled fish with no spices, preparation of masha like iddli (south Indian dish), rice and milk porridge, milk peda, jilebi (north indian sweet) as kaphakara aahaara before vamana. On previous day of virechana  like hot rasam (A south Indian dish mainly of tamarind juice, lime juice etc. with meal.)

In practice, we give porridge made of maasha (black gram) with sugar, yoghurt, boiled fish with no spices, preparation of masha like iddli (south Indian dish), rice and milk porridge, milk peda, jilebi (north indian sweet) as kaphakara aahaara before vamana. On previous day of virechana  like hot rasam (A south Indian dish mainly of tamarind juice, lime juice etc. with meal.) (Verse 18)

==== Verse 19-20 ====

==== Signs of proper purification ====

The sloka explains specific objective signs to assess optimum activity of the shodhana karma. Like in vamana, the output of kapha is succeeded by bile and in virechana, first faeces must come out followed by pitta and then kapha. However, after both the procedure, if done properly, will make the patient feel light, fatigued and emaciated which indicates the expulsion or mitigation of kapha and pitta and increase of vata as expected after any shodhana therapy.

The sloka explains specific objective signs to assess optimum activity of the shodhana karma. Like in vamana, the output of kapha is succeeded by bile and in virechana, first faeces must come out followed by pitta and then kapha. However, after both the procedure, if done properly, will make the patient feel light, fatigued and emaciated which indicates the expulsion or mitigation of kapha and pitta and increase of vata as expected after any shodhana therapy. (Verse 19-20)

==== Verse 21 ====

Even though aacharya gives us practical tips to understand the presence of residual drug and emesis to be done to remove the residue, in our limited experience, we have not come across such practice. The practice of vamana as a correction therapy other than main procedure is seldom done. (Verse 21)

Even though aacharya gives us practical tips to understand the presence of residual drug and emesis to be done to remove the residue, in our limited experience, we have not come across such practice. The practice of vamana as a correction therapy other than main procedure is seldom done.

==== After measures of vamana ====

==== Verse 22,23 ====

The after-measure of vamana is specifically told here. It probably highlights the seriousness of the procedure, which is the only one done in the pratiloma direction among the pancakarma. Hence, the removal of residual dosha becomes even more pertinent. (Verse 22-23)

The after-measure of vamana is specifically told here. It probably highlights the seriousness of the procedure, which is the only one done in the pratiloma direction among the pancakarma. Hence, the removal of residual dosha becomes even more pertinent.

==== Importance of specific diet after purification treatment ====

==== Verse 24,25 ====

As explained already in the first chapter of Siddhi sthana, the mentioning of peyaadikrama here again, is only to reinforce its importance in the practice of shodhana karma. However, Cakrapaani, in his commentary reminds the fact that, after vasti, peyadi is not mentioned because the status of agni after vasti is not hampered as much as in virechana  and vamana. Cakrapani intelligently compare the context wherein it is mentioned that shodhanakriya improves / kindles agni. He says it is as mentioned in Sidhi 1/17,22. He says the agni is kindled when compared to the earlier status of agni before shodhana. (Verse 24-25)

As explained already in the first chapter of Siddhi sthana, the mentioning of peyaadikrama here again, is only to reinforce its importance in the practice of shodhana karma. However, Cakrapaani, in his commentary reminds the fact that, after vasti, peyadi is not mentioned because the status of agni after vasti is not hampered as much as in virechana  and vamana. Cakrapani intelligently compare the context wherein it is mentioned that shodhanakriya improves / kindles agni. He says it is as mentioned in Sidhi 1/17,22. He says the agni is kindled when compared to the earlier status of agni before shodhana.

==== Signs of digestion of purification medicine ====

==== Verse 26,27,28 ====

We can see jeerna-oushadha lakshana exhibits all types of jeerna-aaharaa lakshana too. Signs of residual drug indicate lakshana of aama. In the next sloka, he warns of inappropriate medicine, which is unseasonal, untimely collected, stored for long period, improperly processed etc. This sloka sequentially expresses the idea that if there are signs of residual drug, the factors considered here may be reasoned upon. (Verse 26-28)

We can see jeerna-oushadha lakshana exhibits all types of jeerna-aaharaa lakshana too. Signs of residual drug indicate lakshana of aama. In the next sloka, he warns of inappropriate medicine, which is unseasonal, untimely collected, stored for long period, improperly processed etc. This sloka sequentially expresses the idea that if there are signs of residual drug, the factors considered here may be reasoned upon.

==== Complications of purification treatment ====

==== Verse 29,30 ====

The 10 sets of vyaapath are explained either as ayoga or atiyoga, because ultimately drug can act broadly only in these contexts. Very intelligently aachaarya says, this can happen because of defect in preshya (attendent), bhaishajya (drug), vaidya (physician) and atura (patient). These are also the chatushpaada mentioned in Ayurveda. (A.H.Su.1/27). In the above context, we can see the change in the order. The attendant comes in first, then drug, then the physician and then only the patient. Probably the clinical observation of aacharya might have lead him to this conclusion, but most of the time, it is the attendant who becomes responsible, because of ill-equipped expertise, then comes the drug. However, the position of rogi is the last one, because the vaidya must have the capability to correct even the rogi. (Verse 29-30)

The 10 sets of vyaapath are explained either as ayoga or atiyoga, because ultimately drug can act broadly only in these contexts. Very intelligently aachaarya says, this can happen because of defect in preshya (attendent), bhaishajya (drug), vaidya (physician) and atura (patient). These are also the chatushpaada mentioned in Ayurveda. (A.H.Su.1/27). In the above context, we can see the change in the order. The attendant comes in first, then drug, then the physician and then only the patient. Probably the clinical observation of aacharya might have lead him to this conclusion, but most of the time, it is the attendant who becomes responsible, because of ill-equipped expertise, then comes the drug. However, the position of rogi is the last one, because the vaidya must have the capability to correct even the rogi.

Any procedure can have the outcome only in three ways, which is explained here. Hence, the procedure has to be analysed within the frame of these three outcomes. (Verse 31)

==== Verse 31 ====

==== Signs of improper purification and its consequences ====

Any procedure can have the outcome only in three ways, which is explained here. Hence, the procedure has to be analysed within the frame of these three outcomes.  

When virechana  dravya with the said qualities causes vamana, two conditions mentioned here are shleshmotklishta avastha and ajeerna avastha. In both cases, there is always a tendency for vamana which is of course not the classical shodhana but just to let out the things because the body could not assimiliate the virechana  aushadha intended to cause virechana. Now similarly, when the patient who is hungry with less kapha and has the potent drug for vamana will lead to virechana . The reason being the digestion of oushadha by the agni. It is very well told that the virechana  oushadha can act only in paripakwa avastha and vamana in avipaakwa avastha. (Verse 32-34)

==== Verse 32,33,34 ====

Finally the status of koshtha and strength of the patient decides which kind of medicine has to be given in case of ayoga. The mentioning of avoiding repeated dose if the patient is not suitable also gains clinical relevance. Aacharya warns in the context that such usage inappropriately can even lead to death. (Verse 35-37)

==== ''Ayoga'' (less purification) ====

 

==== Verse 35,36,37 ====

 

 

==== Verse 38,39 ====

Before going for specific vyaapath, the general presentation of ayoga is explained. Here also, the aspect touching the preparation of the individual, quality of medicine is touched upon. The medicine that is stored for a long time is used in an improperly oleated and sudated individual will not be able to move out the morbid doshaas properly. Here we can see mostly the vaata kopa lakshanaas, like the pindikodweshtana, tamaso darshanam etc. Kapha-pitta dushti lakshana like kandu is also seen.

Before going for specific vyaapath, the general presentation of ayoga is explained. Here also, the aspect touching the preparation of the individual, quality of medicine is touched upon. The medicine that is stored for a long time is used in an improperly oleated and sudated individual will not be able to move out the morbid doshaas properly. Here we can see mostly the vaata kopa lakshanaas, like the pindikodweshtana, tamaso darshanam etc. Kapha-pitta dushti lakshana like kandu is also seen.

Usually in clinical practice, this is encountered commonly, when the snehapaana is compromised for various reasons without attaining proper samyak lakshana, medicines with low quality or long stored ones is also seen to play its role.  

Usually in clinical practice, this is encountered commonly, when the snehapaana is compromised for various reasons without attaining proper samyak lakshana, medicines with low quality or long stored ones is also seen to play its role. (Verse 38-39)

 

==== Verse 40,41 ====

 

 

The treatment mentioned here is again reversing the dosha dushti using various kriya krama. The role of niruuha basti here relates to the context where in durvirechyaa, due to ruuksha bahvaanila krrura koshta are advised to undergo niruuha first.

These verses explain the possibility of ayoga even after proper sneha sweda. The relevance of agni and quality of medicine are reinforced here. (Verse 40-41)

==== Verse 44-48 ====

The treatment mentioned here is again reversing the dosha dushti using various kriya krama. The role of niruuha basti here relates to the context where in durvirechyaa, due to ruuksha bahvaanila krrura koshta are advised to undergo niruuha first. (Verse 42-44)

Cakrapaani in the context comments that this indicates atiyoga of virechana  only since seeing of vata, pitta, kapha is mentioned and on administering medicine in patient who is hungry and with mrdu koshtha is mentioned. He also adds that the context can also be interpreted as atiyoga of vamana by using the ati-teekshna dravya and ati-yoga of virechana  if medicine is used in a hungry patient with mrdu koshta. He says, the order of vata, pitta and kapha should be changed and applied to the context logically.

==== Hazards of excess purification and its management ====

The signs and symptoms presented here points to many emergency contexts. The practice of going for vamana in case of ati-yoga of virechana  and vice-versa is not done widely. However, the use of parisheka, avagaaha and managing with internal medicines are done more. Vilwadi gutika, sidhamakara dhwaja, dhanwantaram gutika, kalashakadi kashaya etc are the commonly used ones.

==== Verse 49-51 ====

The signs and symptoms presented here points to many emergency contexts. The practice of going for vamana in case of ati-yoga of virechana  and vice-versa is not done widely. However, the use of parisheka, avagaaha and managing with internal medicines are done more. Vilwadi gutika, sidhamakara dhwaja, dhanwantaram gutika, kalashakadi kashaya etc are the commonly used ones. (Verse 45-48)

The treatment for atiyoga of vamana and virechana  is mentioned separately. For virechana, the effect of internal medicines is told. The use of milk which itself is rechana in nature is used while processing with drugs of opposite guna. Picha basti and anuvasana basti with madhura gana dravya will definitely be sthambhana in action.

The treatment for atiyoga of vamana and virechana  is mentioned separately. For virechana, the effect of internal medicines is told. The use of milk which itself is rechana in nature is used while processing with drugs of opposite guna. Picha basti and anuvasana basti with madhura gana dravya will definitely be sthambhana in action. (Verse 49-51)

==== Verse 52-56 ====

==== Management of excess emesis====

For vamanatiyoga, kaphahara dravya has to be considered. Here we can see many emergency situations like fainting, protrusion of tongue inside and outside, vakgraha etc. the management has also to be fixed by using simple techniques like eating tamarind in front of the patient which will stimulate the physiology to correct itself. Techniques like pushing back of the tongue to normal after applying the paste of tila and draaksha demand the skill of the physician.  

For vamanatiyoga, kaphahara dravya has to be considered. Here we can see many emergency situations like fainting, protrusion of tongue inside and outside, vakgraha etc. the management has also to be fixed by using simple techniques like eating tamarind in front of the patient which will stimulate the physiology to correct itself. Techniques like pushing back of the tongue to normal after applying the paste of tila and draaksha demand the skill of the physician. (Verse 52-56)

==== Verse 57 ====

==== Diet after procedure ====

The ''shloka'' lays importance to the use of ''peyadi'' after ''atiyoga'' of ''vamana'' and ''virechana'' considering the excessively hampered ''agni''.

The ''shloka'' lays importance to the use of ''peyadi'' after ''atiyoga'' of ''vamana'' and ''virechana'' considering the excessively hampered ''agni''. (Verse 57)

==== Verse 58-90 ====

==== Significant concepts in the chapter ====

The ten ''vyapat adhmana, parikatika, parisraava, hrdayopasarana, anga graham, jeevaadaana, vibhramsha, sthambha, upadrava'' and ''klama'' are explained in a systematic manner. Each ''vyapat'' represent a cluster of signs and symptoms. However, every context begins with explaining the possible causative factors for the happening. On analyzing the various causes told for ''vyapat'', we can see the ''doshic'' status, the general quality of the ''sharira'' and the ''koshtha'', the status of ''agni'', the physiological state of the individual-all plays an important role. The treatments mentioned are also grouped. The physician may not see all the signs and symptoms for each as told in the text, but can infer from some of the presentation. It becomes the responsibility of the intelligent physician to select the appropriate ''karma'' for the treatment of the complication presented. The presentation of ''vyapat'' itself reveals the clinical skill of Charaka to observe the minute presentation in the body. Each complication is self-explanatory as mentioned in the text. However, in the present day practice, how much a modern day Ayurveda physician encounters these complications is an issue to be discussed about. Whether the lack of quality of the ''shodhana'' performed, change in practical standards, problem at all four levels of the ''chatushpada'' could be the cause.

The ten ''vyapat adhmana, parikatika, parisraava, hrdayopasarana, anga graham, jeevaadaana, vibhramsha, sthambha, upadrava'' and ''klama'' are explained in a systematic manner. Each ''vyapat'' represent a cluster of signs and symptoms. However, every context begins with explaining the possible causative factors for the happening. On analyzing the various causes told for ''vyapat'', we can see the ''doshic'' status, the general quality of the ''sharira'' and the ''koshtha'', the status of ''agni'', the physiological state of the individual-all plays an important role. The treatments mentioned are also grouped. The physician may not see all the signs and symptoms for each as told in the text, but can infer from some of the presentation. It becomes the responsibility of the intelligent physician to select the appropriate ''karma'' for the treatment of the complication presented. The presentation of ''vyapat'' itself reveals the clinical skill of Charaka to observe the minute presentation in the body. Each complication is self-explanatory as mentioned in the text. However, in the present day practice, how much a modern day Ayurveda physician encounters these complications is an issue to be discussed about. Whether the lack of quality of the ''shodhana'' performed, change in practical standards, problem at all four levels of the ''chatushpada'' could be the cause.(Verse 58-90)

The chapter ends by reinforcing the idea of a knowledgeable physician who knows, where, when, how to apply ''shodhana'' therapy accurately and thus avoid complications.

The chapter ends by reinforcing the idea of a knowledgeable physician who knows, where, when, how to apply ''shodhana'' therapy accurately and thus avoid complications.