Changes

In practice, usually in all these conditions ''[[virechana]]'' is done with ''ruuksha prayoga'' like ''churna, kashaya'' etc. ''Avipathi churna'',''Vidangatandulaadi churna'',<ref> Vagbhata. Kalpa Sthana. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4 </ref>,  ''Trivrita kashaya, Maanibhadra churna'' (''churna'' form of ''Maanibhadra gudam''-)<ref>Vagbhata. Chikitsa Sthana,  In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4. </ref>, ''Patolaadi shodhana kashayam'' (''sahasrayoga'') are used.(Verse 8)

In practice, usually in all these conditions ''[[virechana]]'' is done with ''ruuksha prayoga'' like ''churna, kashaya'' etc. ''Avipathi churna'',''Vidangatandulaadi churna'',<ref> Vagbhata. Kalpa Sthana. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4 </ref>,  ''Trivrita kashaya, Maanibhadra churna'' (''churna'' form of ''Maanibhadra gudam''-)<ref>Vagbhata. Chikitsa Sthana,  In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4. </ref>, ''Patolaadi shodhana kashayam'' (''sahasrayoga'') are used.(Verse 8)

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

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

Following the principle, ''vridhisamane sarvesham vipareetai viparyata'' <ref>Vagbhata. Sutra Sthana, Cha.1 Ayushkamiya Adhyaya verse 14. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref> 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. Chakrapani 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 ''doshas'' 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/ruksha'' kind of ''shodhana'' need to be performed. (Verse 9)

Following the principle, ''vridhisamane sarvesham vipareetai viparyata'' <ref>Vagbhata. Sutra Sthana, Cha.1 Ayushkamiya Adhyaya verse 14. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref> 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. Chakrapani 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 ''[[dosha]]s'' already in a the morbid state cannot be removed. These vitiated ''[[dosha]]s'' that has already moved from their site will clog the ''srotas''. Hence to remove this vitiated ''dosha ununctuous/ruksha'' kind of ''[[shodhana]]'' need to be performed. (Verse 9)

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

=== 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 ''ahaara,'' 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 [[Trividhakukshiya Vimana]]. There, the Acharya lays importance to the appropriate ''maatra'' of ''ahaara''. Here Acharya, gives importance to the appropriate ''maatra'' of ''aushadha''. Only the desired dosage is acted upon by ''agni'' to create the optimum response in the body.  

''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 ''ahaara,'' 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 [[Trividhakukshiya Vimana]]. There, the Acharya lays importance to the appropriate ''maatra'' of ''ahaara''. Here Acharya, gives importance to the appropriate ''maatra'' of ''aushadha''. 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. Chakrapani 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)

Fourthly, the relevance of focused mind is explained. Chakrapani 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)

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

=== 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 ''malas'' 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)

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 ''[[mala]]s'' 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)

=== Contraindication in state of indigestion ===

=== 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 ''ama-avastha'' like ''glaani'' and ''vibandha'' on administering medicine to patient in ''ajeerna avastha''. Here this ''ajeerna'' will definitely lead to ''ama'', 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 ''ama-avastha'' like ''glaani'' and ''vibandha'' on administering medicine to patient in ''ajeerna avastha''. Here this ''ajeerna'' will definitely lead to ''ama'', which will again aggravate the condition.

For the practical assessment of the ''jeerna-ahaara'' in the patient to be administered with the ''shodhana'' therapy, the following signs and symptoms can be assessed like the elimination of the feces 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 by Vagbhata<ref>Vagbhata. Sutra Sthana, Cha.8 Matrasheetiyam Adhyaya verse 55. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4. Maatrasheetiyam Adhyayam </ref> can be taken into account. (Verses 14)

For the practical assessment of the ''jeerna-ahaara'' in the patient to be administered with the ''[[shodhana]]'' therapy, the following signs and symptoms can be assessed like the elimination of the feces 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 by Vagbhata<ref>Vagbhata. Sutra Sthana, Cha.8 Matrasheetiyam Adhyaya verse 55. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4. Maatrasheetiyam Adhyayam </ref> can be taken into account. (Verses 14)

=== Characteristics of proper dosage ===

=== Characteristics of proper dosage ===

The ''lakshana'' of ''maatravada aushadham'' touches all aspects of an ideal drug. We can see the pharmacoleptic, pharmacological and pharmacokinetic aspects being mentioned here for selecting the right drug in the appropriate dosage.

The ''lakshana'' of ''maatravada aushadham'' touches all aspects of an ideal drug. We can see the pharmacoleptic, pharmacological and 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.(Verses 15-16)

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)

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

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

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 )

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 )

=== Diet before purification treatment ===

=== 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 [[Kalpana Siddhi]] as well as the decreased ''kapha'' state are important for ''vamana'' and ''virechana'' respectively. ''Kapha'' is the ''dosha'' that basically decides the action [Cha.Sa.[[Siddhi Sthana]] 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 [[Kalpana Siddhi]] as well as the decreased ''[[kapha]]'' state are important for ''[[vamana]]'' and ''[[virechana]]'' respectively. ''[[Kapha]]'' is the ''[[dosha]]'' that basically decides the action [Cha.Sa.[[Siddhi Sthana]] 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 Chikitsa Sthana, he speaks of ''pitta-utklehsa'' before ''virechana'', with ''amla dravya'' like ''beeja-purka 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 Chikitsa Sthana, he speaks of ''[[pitta]]-utklehsa'' before ''[[virechana]]'', with ''amla dravya'' like ''beeja-purka rasa''. This will also ultimately result in ''alpa-kaphatvam''.

In practice, we give porridge made of ''maasha'' (black gram) with sugar, yogurt, boiled fish with no spices, preparation of ''masha'' like ''idli'' (south Indian dish), rice and milk porridge, milk ''peda, jalebi'' (north indian sweet) as ''kaphakara ahaara'' 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)

In practice, we give porridge made of ''maasha'' (black gram) with sugar, yogurt, boiled fish with no spices, preparation of ''masha'' like ''idli'' (south Indian dish), rice and milk porridge, milk ''peda, jalebi'' (north indian sweet) as ''[[kapha]]kara ahaara'' 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)

=== Signs of proper purification ===

=== 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 feces 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)

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 feces 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)

Even though ''acharya'' 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 ''acharya'' 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)

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

=== After measures of ''[[vamana]]'' ===

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 [[Panchakarma]]. 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 [[Panchakarma]]. Hence, the removal of residual ''[[dosha]]'' becomes even more pertinent. (Verse 22-23)

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

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

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, Chakrapani, 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''.  

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, Chakrapani, in his commentary reminds the fact that, after ''[[basti]]'', ''peyadi'' is not mentioned because the status of ''agni'' after ''[[basti]]'' is not hampered as much as in ''[[virechana]]'' and ''[[vamana]]''.  

Chakrapani intelligently compare the context wherein it is mentioned that ''shodhanakriya'' improves / kindles ''agni''. He says it is as mentioned in [ Cha. Sa. [[Siddhi Stahan]] 1/17,22]. He says the ''agni'' is kindled when compared to the earlier status of ''agni'' before ''shodhana''. (Verse 24-25)

Chakrapani intelligently compare the context wherein it is mentioned that ''shodhanakriya'' improves / kindles ''agni''. He says it is as mentioned in [ Cha. Sa. [[Siddhi Stahan]] 1/17,22]. He says the ''agni'' is kindled when compared to the earlier status of ''agni'' before ''[[shodhana]]''. (Verse 24-25)

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

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

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

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

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 assimilate 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 ''aushadha'' by the ''agni''. It is very well told that the ''virechana aushadha'' can act only in ''paripakwa avastha'' and ''vamana'' in ''avipaakwa avastha''. (Verse 32-34)

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 assimilate 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 ''aushadha'' by the ''agni''. It is very well told that the ''[[virechana]] aushadha'' can act only in ''paripakwa avastha'' and ''[[vamana]]'' in ''avipaakwa avastha''. (Verse 32-34)

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. ''Acharya'' warns in the context that such usage inappropriately can even lead to death. (Verse 35-37)

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. ''Acharya'' warns in the context that such usage inappropriately can even lead to death. (Verse 35-37)

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

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

Before going for specific ''vyapat'', 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 ''doshas'' properly. Here we can see mostly the ''vata kopa lakshanas'', like the ''pindikodweshtana, tamaso darshanam'' etc. ''Kapha-pitta dushti lakshana'' like ''kandu'' is also seen.

Before going for specific ''vyapat'', 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 ''[[dosha]]s'' properly. Here we can see mostly the ''[[vata]] kopa lakshanas'', 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 ''snehapana'' 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)

Usually in clinical practice, this is encountered commonly, when the ''snehapana'' 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)

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)

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)

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

The treatment mentioned here is again reversing the ''[[dosha]] dushti'' using various ''kriya krama''. The role of ''niruha [[basti]]'' here relates to the context where in ''durvirechya'', due to ''ruksha bahvaanila krura koshta'' are advised to undergo ''niruha'' first. (Verse 42-44)

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

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

Chakrapani 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 ''mridu koshtha'' is mentioned. He also adds that the context can also be interpreted as ''atiyoga'' of ''vamana'' by using the ''ati-teekshna dravya'' and ''atiyoga'' of ''virechana'' if medicine is used in a hungry patient with ''mridu koshta''. He says, the order of ''vata, pitta'' and ''kapha'' should be changed and applied to the context logically.

Chakrapani 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 ''mridu koshtha'' is mentioned. He also adds that the context can also be interpreted as ''atiyoga'' of ''[[vamana]]'' by using the ''ati-teekshna dravya'' and ''atiyoga'' of ''[[virechana]]'' if medicine is used in a hungry patient with ''mridu koshta''. He says, the order of ''[[vata]], [[pitta]]'' and ''[[kapha]]'' should be changed and applied to the context logically.

The signs and symptoms presented here points to many emergency contexts. The practice of going for ''vamana'' in case of ''atiyoga'' 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 signs and symptoms presented here points to many emergency contexts. The practice of going for ''[[vamana]]'' in case of ''atiyoga'' 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. (Verse 49-51)

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)

=== Management of excess emesis===

=== 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.  (Verse 52-56)

For ''vamanatiyoga, [[kapha]]hara 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)

=== Diet after procedure ===

=== Diet after procedure ===

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

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

=== Important concepts in the chapter ===

=== Important 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 Charak 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 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 Charak 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.

==References==

==References==