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{{#seo:

|title=Vamana Virechana Vyapat Siddhi

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|keywords=Vamana (therapeutic emesis), Virechana (therapeutic purgation), Vyapad (complications), Shodhana (purification therapy), Ayurveda, charak samhita, Indian system of medicine.

|description=Siddhi Sthana Chapter 6. Management of complications of improper therapeutic emesis and purgation

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|image=http://www.carakasamhitaonline.com~~/mediawiki-1.32.1~~/resources/assets/ogimgs.jpg

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image_alt=charak samhita

|type=article

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<big>'''[[Siddhi Sthana]] Chapter 6. Management of complications of improper therapeutic emesis and purgation'''</big>

{{Infobox

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|label7 = Reviewer

|data7 = Mangalasseri P.

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|label8 = ~~Editor~~

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|label8 = Editors

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|data8 = Thakar A. B., Mangalasseri P.

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|data8 = Thakar A. B., Mangalasseri P., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

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|label9 = ~~Date~~ of publication

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|label9 = Year of publication

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|data9 = ~~December 17, 2018~~

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|data9 = 2020

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|label10 = ~~DOI~~

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|label10 = Publisher

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|data10 = [https://doi.org/10.47468/CSNE.2020.e01.s08.007 10.47468/CSNE.2020.e01.s08.007]

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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~~|header3 =~~

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s08.007 10.47468/CSNE.2020.e01.s08.007]

}}

<big>''' Abstract </big>'''

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<~~div~~ style="text-align:justify;">

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<p style="text-align:justify;">The chapter deals with complications due to improper administration of purification therapies ''[[vamana]]'' (therapeutic emesis) and ''[[virechana]]''( therapeutic purgation). Adequate dosage according to ''agni''(digestion power) and ''koshtha'' (bowel habit), proper quality of medicine, time of administration, follow up diet regimens are important to prevent complications. Observation of status of patient during purification therapy with the signs of proper, inadequate, excess elimination, causes and management of complications are described in detail in this chapter. The ten common complications like ''aadhmana'' (distension of abdomen), ''parikartika'' (fissure in ano), ''srava'' (excess discharge), ''hrid-graha'' (congestion in cardiac region), ''gatra-graha'' (body stiffness), ''jeevaadana'' (bleeding), ''vibhramsha'' (prolapse of rectum), ''stambha'' (body stiffness), ''upadrava'' (complications) and ''klama'' (fatigue without exertion) are elaborated. The causes behind this include incompetency either of the attendant, or drug, or physician or the patient.

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The chapter deals with complications due to improper administration of purification therapies ''vamana'' (therapeutic emesis) and ''virechana''( therapeutic purgation). Adequate dosage according to ''agni''(digestion power) and ''koshtha'' (bowel habit), proper quality of medicine, time of administration, follow up diet regimens are important to prevent complications. Observation of status of patient during purification therapy with the signs of proper, inadequate, excess elimination, causes and management of complications are described in detail in this chapter. The ten common complications like ''aadhmana'' (distension of abdomen), ''parikartika'' (fissure in ano), ''srava'' (excess discharge), ''hrid-graha'' (congestion in cardiac region), ''gatra-graha'' (body stiffness), ''jeevaadana'' (bleeding), ''vibhramsha'' (prolapse of rectum), ''stambha'' (body stiffness), ''upadrava'' (complications) and ''klama'' (fatigue without exertion) are elaborated. The causes behind this include incompetency either of the attendant, or drug, or physician or the patient.

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<br/>

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'''Keywords''': ''[[Vamana]]'' (therapeutic emesis), ''[[Virechana]]'' (therapeutic purgation), ''Vyapad'' (complications), ''[[Shodhana]]'' (purification therapy).

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'''Keywords''': ''Vamana'' (therapeutic emesis), ''Virechana'' (therapeutic purgation), ''Vyapad'' (complications), ''Shodhana'' (purification therapy).

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</p>

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</~~div~~>

== Introduction ==

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The chapter [[Vamana Virechana Vyapat Siddhi]] explains the complications of improper administration of ''shodhana karma'' and their effective management. Three earlier chapters dealt with complications of ''basti'' (therapeutic enema). In same sequence of describing complications of purification therapies, those of therapeutic emesis and purgation are described in this chapter.

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The chapter [[Vamana Virechana Vyapat Siddhi]] explains the complications of improper administration of ''[[shodhana]] karma'' and their effective management. Three earlier chapters dealt with complications of ''[[basti]]'' (therapeutic enema). In same sequence of describing complications of purification therapies, those of therapeutic emesis and purgation are described in this chapter.

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Earlier in [[Sutra Sthana]] 15th chapter ([[Upakalpaniya Adhyaya]]), the procedure of ''vamana'' and ''virechana'' are explained in detail. Their further specifications like signs and symptoms of proper, inadequate and excess actions are explained in first chapter ([[Kalpana Siddhi]]) of this section. The indications and and contra-indications are described in the second chapter ([[Panchakarmiya Siddhi]]). The remaining details of therapeutic emesis and purgation are explained in the present chapter.

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Earlier in [[Sutra Sthana]] 15th chapter ([[Upakalpaniya Adhyaya]]), the procedure of ''[[vamana]]'' and ''[[virechana]]'' are explained in detail. Their further specifications like signs and symptoms of proper, inadequate and excess actions are explained in first chapter ([[Kalpana Siddhi]]) of this section. The indications and and contra-indications are described in the second chapter ([[Panchakarmiya Siddhi]]). The remaining details of therapeutic emesis and purgation are explained in the present chapter.

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The suitable seasons for ''shodhana'', proper timing for the administration of ''snehana'' (oleation) and ''swedana'' (sudation) are required because ''~~doshas~~'' get naturally vitiated in specific seasons and are associated in case of disease. Specific pre-requisites for adequate purification are to be considered prior to the procedure. Assessment of vitiation of ''dosha, agni'' (digestive power), ''koshtha'' (bowel) and unctuousness of patient are most important factors for administration of purification therapy. Proper diet and digestion of previous day meal, stable mental state of patient is important to get benefits of purification.

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The suitable seasons for ''[[shodhana]]'', proper timing for the administration of ''[[snehana]]'' (oleation) and ''[[swedana]]'' (sudation) are required because ''[[dosha]]s'' get naturally vitiated in specific seasons and are associated in case of disease. Specific pre-requisites for adequate purification are to be considered prior to the procedure. Assessment of vitiation of ''[[dosha]], agni'' (digestive power), ''koshtha'' (bowel) and unctuousness of patient are most important factors for administration of purification therapy. Proper diet and digestion of previous day meal, stable mental state of patient is important to get benefits of purification.

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The physician should keenly observe the patient during purification therapy for assessing signs of eliminating ''~~doshas~~'' otherwise complications may arise. The physician shall be well versed with diagnosis and management of these complications.

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The physician should keenly observe the patient during purification therapy for assessing signs of eliminating ''[[dosha]]s'' otherwise complications may arise. The physician shall be well versed with diagnosis and management of these complications.

== Sanskrit text, Transliteration and English Translation ==

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Now, let me explain:

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*The procedure for proper administration of ''vamana'' and ''virechana''

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*The procedure for proper administration of ''[[vamana]]'' and ''[[virechana]]''

*The complications appearing because of inappropriate administration

*The effective treatment for the management of complications.[1-3]

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</div></div>

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The months ''Shuchi'' (''Aashadha'', Mid June to Mid July) and ''Nabha'' (''Shravana'', Mid July to Mid August) together are known as ''Pravrita ritu''. The months ''Urja'' (''Kartika'', Mid October to Mid November) and ''Saha'' (''Margashersha'' –Mid November to Mid December) are known as ''Sharada ritu''. The months ''Tapasya'' (''Phaalguna'' -Mid February to Mid March) and ''Madhu'' (''Chaitram''- mid March to mid April) are known as ''Vasanta ritu''. These seasons are specially mentioned here for the sake of administration of ''shodhana'' therapy (purificatory procedures). The physician shall select an appropriate purificatory procedure to preserve the health after determining the exact season. However, in case of disease, it has to be done with respect to the nature of the clinical condition in any of the seasons.[5-6]

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The months ''Shuchi'' (''Aashadha'', Mid June to Mid July) and ''Nabha'' (''Shravana'', Mid July to Mid August) together are known as ''Pravrita ritu''. The months ''Urja'' (''Kartika'', Mid October to Mid November) and ''Saha'' (''Margashersha'' –Mid November to Mid December) are known as ''Sharada ritu''. The months ''Tapasya'' (''Phaalguna'' -Mid February to Mid March) and ''Madhu'' (''Chaitram''- mid March to mid April) are known as ''Vasanta ritu''. These seasons are specially mentioned here for the sake of administration of ''[[shodhana]]'' therapy (purificatory procedures). The physician shall select an appropriate purificatory procedure to preserve the health after determining the exact season. However, in case of disease, it has to be done with respect to the nature of the clinical condition in any of the seasons.[5-6]

=== Importance of oleation in [[Panchakarma]] ===

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</div></div>

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In between the sequential administration of purificatory procedures like ''vamana'' (emesis) etc., ''snehana'' (oleation) and ''swedana'' (sudation) therapies need to be administered and ''snehana'' (oleation) shall be administered at the end (also). [7]

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In between the sequential administration of purificatory procedures like ''[[vamana]]'' (emesis) etc., ''[[snehana]]'' (oleation) and ''[[swedana]]'' (sudation) therapies need to be administered and ''[[snehana]]'' (oleation) shall be administered at the end (also). [7]

=== Indications of purification ===

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</div></div>

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The individual with excessively oleated body should never be given an unctuous or ''snigdha virechana''. The body with excessive oleation should be given un-unctuous or ''ruksha virechana''.[9]

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The individual with excessively oleated body should never be given an unctuous or ''snigdha [[virechana]]''. The body with excessive oleation should be given un-unctuous or ''ruksha [[virechana]]''.[9]

=== Procedure of taking purgatives for therapy ===

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</div></div>

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The person after undergoing ''snehana'' (oleation) and ''swedana'' (sudation procedures) can have the medicine for elimination with fully concentrated mind. In addition, it should be ensured that the medicine is taken only after the full digestion of previous food. Only then, the proper elimination ensues.[10]

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The person after undergoing ''[[snehana]]'' (oleation) and ''[[swedana]]'' (sudation procedures) can have the medicine for elimination with fully concentrated mind. In addition, it should be ensured that the medicine is taken only after the full digestion of previous food. Only then, the proper elimination ensues.[10]

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</div></div>

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Like how water gets out of a vessel smeared with oil, similar is the removal of ''~~doshas~~'' from a properly oleated body. Just like the fire propels the water out from the wet log wood, similarly the sudation propels out the stable ''~~doshas~~'' from the pre-oleated body. The way in which the clothes adhered with dirt is cleaned using water, which removes the dirt, similarly the stable ''~~malas~~'' that are liquefied after oleation and sudation are removed by proper purificatory therapies.[11-13]

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Like how water gets out of a vessel smeared with oil, similar is the removal of ''[[dosha]]s'' from a properly oleated body. Just like the fire propels the water out from the wet log wood, similarly the sudation propels out the stable ''[[dosha]]s'' from the pre-oleated body. The way in which the clothes adhered with dirt is cleaned using water, which removes the dirt, similarly the stable ''[[mala]]s'' that are liquefied after oleation and sudation are removed by proper purificatory therapies.[11-13]

=== Consequences if medicines taken during indigestion ===

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</div></div>

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If the medicine for purification is administered before the digestion of the previous meal, it will lead to ''glani'' (tiredness), ''vibandha'' (obstruction of feces and urine), and an action that is opposite to that intended by elimination therapy. (''virechana oushadha'' will lead to ''vamana'' and vice versa.)[14]

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If the medicine for purification is administered before the digestion of the previous meal, it will lead to ''glani'' (tiredness), ''vibandha'' (obstruction of feces and urine), and an action that is opposite to that intended by elimination therapy. (''[[virechana]] oushadha'' will lead to ''[[vamana]]'' and vice versa.)[14]

=== Characteristics of appropriate dosage of medicine ===

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*It should work optimally in small dosage

*It must have quick action

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*It must eliminate large amounts of ''dosha''

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*It must eliminate large amounts of ''[[dosha]]''

*It should bring in comfort

*It should be easily digestible

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</div></div>

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The individual scheduled to undergo ''vamana'' on the next day should have foods which are easily digestible, rich in fluids and will increase the ''kapha dosha''. Similarly, the individual scheduled to undergo ''virechana'' should have foods which are light and hot. Since the first diet leads to vitiation and second diet leads to reduction of ''kapha'', the ''~~doshas~~'' are removed quickly and completely. [18-18½]

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The individual scheduled to undergo ''[[vamana]]'' on the next day should have foods which are easily digestible, rich in fluids and will increase the ''[[kapha dosha]]''. Similarly, the individual scheduled to undergo ''[[virechana]]'' should have foods which are light and hot. Since the first diet leads to vitiation and second diet leads to reduction of ''[[kapha]]'', the ''[[dosha]]s'' are removed quickly and completely. [18-18½]

=== Signs of proper elimination ===

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The physician who had administered medicines for purification must be in observation for the following symptoms:

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*For ''vamana'', the ''pitta'' is expelled out after the elimination of ''kapha''

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*For ''[[vamana]]'', the ''[[pitta]]'' is expelled out after the elimination of ''[[kapha]]''

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*For ''virechana'', the elimination of fecal matter will be followed by ''pitta'' and thereafter by ''kapha''

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*For ''[[virechana]]'', the elimination of fecal matter will be followed by ''[[pitta]]'' and thereafter by ''[[kapha]]''

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When ''~~doshas~~'' are eliminated, the patient will experience emaciation, weakness and lightness of body.[19-20]

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When ''[[dosha]]s'' are eliminated, the patient will experience emaciation, weakness and lightness of body.[19-20]

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</div></div>

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If after the completion of the purificatory procedures, there is presence of residual medicines, ''vamana'' must be administered. If there is no feeling of lightness, then also ''vamana'' should be performed. ''Vamana'' must be specifically performed, when there is ''staimitya'' (a feeling of wet covering), obstruction of ''vayu'' and absence of belching. ''Vamana'' should be continued till there is lightness of the body and reduction of ''kapha''. If continued, it can result in serious consequences. [21-21½]

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If after the completion of the purificatory procedures, there is presence of residual medicines, ''[[vamana]]'' must be administered. If there is no feeling of lightness, then also ''[[vamana]]'' should be performed. ''[[Vamana]]'' must be specifically performed, when there is ''staimitya'' (a feeling of wet covering), obstruction of ''vayu'' and absence of belching. ''[[Vamana]]'' should be continued till there is lightness of the body and reduction of ''[[kapha]]''. If continued, it can result in serious consequences. [21-21½]

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</div></div>

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The one who has been purified by ''vamana'' will have augmented ''agni'', leading to the alleviation of ''dosha''. He need to undergo fasting till the signs of proper digestion of drugs for ''vamana'' is seen. For one having those signs, ''peyadi kramam'' (regulatory diet regimen) has to be initiated. He should not undergo further ''langhana'' (fasting). [22-23]

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The one who has been purified by ''[[vamana]]'' will have augmented ''agni'', leading to the alleviation of ''[[dosha]]''. He need to undergo fasting till the signs of proper digestion of drugs for ''[[vamana]]'' is seen. For one having those signs, ''peyadi kramam'' (regulatory diet regimen) has to be initiated. He should not undergo further ''[[langhana]]'' (fasting). [22-23]

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</div></div>

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The individual who is purified after elimination therapy and removal of ''dosha'' from the body, has his ''agni'' diminished. Hence it is highly pertinent to institute dietary regimen termed ''peyaadi kramam''. [24]

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The individual who is purified after elimination therapy and removal of ''[[dosha]]'' from the body, has his ''agni'' diminished. Hence it is highly pertinent to institute dietary regimen termed ''peyaadi kramam''. [24]

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</div></div>

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When there is little elimination of ''kapha'' and ''pitta'' through purification therapy, in alcoholics and in persons with predominance of ''vata'' and ''pitta dosha'', the dietary regimen called ''tarpanaadi kramam'' need to be started instead of ''peyaadi kramam'', as ''peyadi'' may increase ''kapha'' causing ''abhishyandam'' (clogging of the channels of circulation).[25]

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When there is little elimination of ''[[kapha]]'' and ''[[pitta]]'' through purification therapy, in alcoholics and in persons with predominance of ''[[vata]]'' and ''[[pitta dosha]]'', the dietary regimen called ''tarpanaadi kramam'' need to be started instead of ''peyaadi kramam'', as ''peyadi'' may increase ''[[kapha]]'' causing ''abhishyandam'' (clogging of the channels of circulation).[25]

=== Signs of digested and undigested medicine ===

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</div></div>

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The three types of outcome for ''Vamana'' and ''Virechana'' are:

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The three types of outcome for ''[[Vamana]]'' and ''[[Virechana]]'' are:

*''Samyaka yoga'' indicates optimum action of elimination therapy

*''Ati-yoga'' indicates excess elimination

*''Ayoga'' indicates insufficient or no elimination

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The medicines administered for ''virechana'', in a patient with aggravated and excited status of ''kapha'', will act as ''vamaka'' under the following conditions:

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The medicines administered for ''[[virechana]]'', in a patient with aggravated and excited status of ''[[kapha]]'', will act as ''vamaka'' under the following conditions:

*If the medicine is having bad smell

*The drug not being wholesome

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*Intake of medicine before the previous meal is digested

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The medicines administered for ''vamana'' will cause ''virechana'' under the following conditions:

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The medicines administered for ''[[vamana]]'' will cause ''[[virechana]]'' under the following conditions:

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*''Vamana'' is performed on an individual who is hungry,

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*''[[Vamana]]'' is performed on an individual who is hungry,

*An individual with ''mridu –koshtha'',

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*An individual with little increase of ''kapha'',

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*An individual with little increase of ''[[kapha]]'',

*If the medicine is ''tikshna'' (penetrating / potent),

*If the medicine is reminent and agitating

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Whether in ''vamana'' or ''virechana'', if the medicines work in opposite, it is termed ''ayoga'' or inadequate action. It is also called the same, if ''~~doshas~~'' are not eliminated or eliminated with difficulty. [31-34]

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Whether in ''[[vamana]]'' or ''[[virechana]]'', if the medicines work in opposite, it is termed ''ayoga'' or inadequate action. It is also called the same, if ''[[dosha]]s'' are not eliminated or eliminated with difficulty. [31-34]

=== Various conditions and management ===

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</div></div>

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Never give emetic drug to people who are unsuitable for ''vamana; virechana'' to those with unsuitable ''koshtha'', if medicine intake happens in such conditions it may even lead to death.[37]

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Never give emetic drug to people who are unsuitable for ''[[vamana]]; [[virechana]]'' to those with unsuitable ''koshtha'', if medicine intake happens in such conditions it may even lead to death.[37]

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</div></div>

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''Ayoga'' happens when ''asnigdha'' (under-oleated) and ''asvinna'' (under-sudated) person with ''ruksha'' nature of the body, is administered a recipe, which is stored for long duration. Here, the drug is unable to remove ''~~doshas~~'' from the body by creating ''dosha-utklesha''. Such a condition will lead to symptoms like ''vibhramsha'' (''virechana oushadha'' will lead to ''vamana'' and vice versa), swelling, hiccups, black-out, cramps in calf muscle, itching, fainting and discoloration.[38-39]

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''Ayoga'' happens when ''asnigdha'' (under-oleated) and ''asvinna'' (under-sudated) person with ''ruksha'' nature of the body, is administered a recipe, which is stored for long duration. Here, the drug is unable to remove ''[[dosha]]s'' from the body by creating ''[[dosha]]-utklesha''. Such a condition will lead to symptoms like ''vibhramsha'' (''[[virechana]] oushadha'' will lead to ''[[vamana]]'' and vice versa), swelling, hiccups, black-out, cramps in calf muscle, itching, fainting and discoloration.[38-39]

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*Due to increased ''agni'' (digestive capacity), quick digestion of medicine happens

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If there is ''ama dosha'', the medicine for ''vamana'' will not work in the desired manner. The case is similar also with ''virechana'' drugs.

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If there is ''ama dosha'', the medicine for ''[[vamana]]'' will not work in the desired manner. The case is similar also with ''[[virechana]]'' drugs.

Because of the above mentioned causes, the earlier mentioned conditions like ''vibhramsha'' will happen. These come under ''ayoga''. The intelligent physician must understand the same and treat accordingly.

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Here the ''taila'' (oil) processed with ''lavana'' (salt) has to be applied and made to undergo ''prastara'' and ''sankara'' kind of sudation. Once the medicine for ''vamana'' or ''virechana'' must be administered again or else ''kashaya basti'' (decoction enema) with cow’s urine has to be done. After the administration of ''kashaya basti'', food with meats of animals of arid regions (''jangala mamsa rasa'') should be taken and should be followed by administration of ''sneha basti'' (oil enema).

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Here the ''taila'' (oil) processed with ''lavana'' (salt) has to be applied and made to undergo ''prastara'' and ''sankara'' kind of sudation. Once the medicine for ''[[vamana]]'' or ''[[virechana]]'' must be administered again or else ''kashaya [[basti]]'' (decoction enema) with cow’s urine has to be done. After the administration of ''kashaya [[basti]]'', food with meats of animals of arid regions (''jangala mamsa rasa'') should be taken and should be followed by administration of ''sneha [[basti]]'' (oil enema).

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''Sneha basti'' can be done by oil processed with ''madana'' (Randia dumetorum), ''pippali'' (Piper longum), ''devadaru'' (Cedrus deodara), in proper dose. Once adequate oleation happens, elimination must be done with a recipe containing ''teekshna'' drugs.

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''Sneha [[basti]]'' can be done by oil processed with ''madana'' (Randia dumetorum), ''pippali'' (Piper longum), ''devadaru'' (Cedrus deodara), in proper dose. Once adequate oleation happens, elimination must be done with a recipe containing ''teekshna'' drugs.

However, the medicines that are ''ati-teekshna'' should not be given, as it may result in ''atiyoga''.[40-44]

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</div></div>

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When a patient who is with ''mridukoshtha'', who is affected with hunger, is provided with an exceedingly strong ''vamana'' or ''virechana'', it results in the quick elimination of not only the faecal matter, ''pitta'' and ''kapha'', but also the ''drava-dhatu'' (liquid content of the body). Consequently, there will be sudden depression of strength and voice, dryness of throat, giddiness and thirst. In such a condition, it is preferable to eliminate the residual drug in the ''koshtha'' using the drugs of ''madhura gana'' (mentioned in sweet category).

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When a patient who is with ''mridukoshtha'', who is affected with hunger, is provided with an exceedingly strong ''[[vamana]]'' or ''[[virechana]]'', it results in the quick elimination of not only the faecal matter, ''[[pitta]]'' and ''[[kapha]]'', but also the ''drava-dhatu'' (liquid content of the body). Consequently, there will be sudden depression of strength and voice, dryness of throat, giddiness and thirst. In such a condition, it is preferable to eliminate the residual drug in the ''koshtha'' using the drugs of ''madhura gana'' (mentioned in sweet category).

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If ''ati-yoga'' happens like this during attempting ''vamana'', the residual ''~~doshas~~'' are eliminated by initiating a ''virechana'' and vice-versa.

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If ''ati-yoga'' happens like this during attempting ''[[vamana]]'', the residual ''[[dosha]]s'' are eliminated by initiating a ''[[virechana]]'' and vice-versa.

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The following remedies need to be instituted fast for ''stambhana'' (To check the supra-optimal purificatory effect of therapy).

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The following remedies need to be instituted fast for ''[[stambhana]]'' (To check the supra-optimal purificatory effect of therapy).

By providing cold irrigation (''parishekam'') and tub bath (''avagaaham'')

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By providing foods, drinks and medicine which are ''sheeta'' (cold), ''kashaya'' (astrigent) and ''madhura'' (sweet).

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By following appropriate regimens prescribed for ''rakta-pitta, atisaara, daaha'' and ''jwara''.

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By following appropriate regimens prescribed for ''rakta-pitta, atisaara, daaha'' and ''[[jwara]]''.

−

For ''ati-yoga'' of ''virechana, sharkarodakam'' (sugar syrup) added with ''rasaanjana'' (Berberis aristata), ''chandana'' (Santalum album), ''usheera'' (Vetivera zizanoides), blood of goat, cornflake powder etc. can be taken to stop excessive loss of fluid. Then ''peya'' made from ''vata shunga'' (leaf buds of banyan tree) added with honey, milk or porridge processed with samgraahi substances (that which pacifies excess bowel movements) like the priyangvaadi gana, food added with jaangala maamsa rasam (meat soup of animals from arid region), picchha basti mentioned in rakta-arshas, sneha basti using ghee made out of milk processed with madhura aushadha (sweet drugs).[46-51]

+

For ''ati-yoga'' of ''[[virechana]], sharkarodakam'' (sugar syrup) added with ''rasaanjana'' (Berberis aristata), ''chandana'' (Santalum album), ''usheera'' (Vetivera zizanoides), blood of goat, cornflake powder etc. can be taken to stop excessive loss of fluid. Then ''peya'' made from ''vata shunga'' (leaf buds of banyan tree) added with honey, milk or porridge processed with samgraahi substances (that which pacifies excess bowel movements) like the priyangvaadi gana, food added with jaangala maamsa rasam (meat soup of animals from arid region), picchha [[basti]] mentioned in rakta-arshas, sneha [[basti]] using ghee made out of milk processed with madhura aushadha (sweet drugs).[46-51]

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</div></div>

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In ''atiyoga'' of ''vamana'', the whole body irrigation must be done with cold water. ''Mantha'' must be prepared with ghee, honey and sugar.

+

In ''atiyoga'' of ''[[vamana]]'', the whole body irrigation must be done with cold water. ''Mantha'' must be prepared with ghee, honey and sugar.

If ''atiyoga'' happens with belching and fainting, powdered ''dhanyaka'' (Coriandum sativum), ''musta'' (Cyonodon dactylon), ''rasanjana'' (Berberis aristata) etc. added with honey can be licked.

−

If due to excessive ''vamana'', his tongue goes inside, a vegetable soup milk or meat soup which are prepared by incorporating unctuous, salty, sour and pleasant ingredients can be used for gargling. Eating sour fruits in front of him by others will also be helpful.

+

If due to excessive ''[[vamana]]'', his tongue goes inside, a vegetable soup milk or meat soup which are prepared by incorporating unctuous, salty, sour and pleasant ingredients can be used for gargling. Eating sour fruits in front of him by others will also be helpful.

If the tongue comes out, a paste of ''tila''(sesame) and ''draksha'' (grapes) can be applied over it and can be made to move out.

−

If there is problem in speech or other disorders of ''vata'', he can be given a porridge made of ghee and meat juice. The intelligent physician then must do ''snehana'' (oleation) and ''swedana'' (sudation).[52-56]

+

If there is problem in speech or other disorders of ''[[vata]]'', he can be given a porridge made of ghee and meat juice. The intelligent physician then must do ''[[snehana]]'' (oleation) and ''[[swedana]]'' (sudation).[52-56]

=== Importance of diet after purification ===

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</div></div>

−

''Peyadi krama'' (''peyadi'' diet regimen) must be followed by those who undergo ''Vamana'' and ''Virechana'', who have diminished ''agni'' and who is under fasting for improving the ''jatharaagni'' ( digestion and metabolism) and ''prana shakti''(vitality)

+

''Peyadi krama'' (''peyadi'' diet regimen) must be followed by those who undergo ''[[Vamana]]'' and ''[[Virechana]]'', who have diminished ''agni'' and who is under fasting for improving the ''jatharaagni'' ( digestion and metabolism) and ''prana shakti''(vitality)

=== Complication of ''adhmana'' (abdominal distension) and its management ===

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</div></div>

−

If medicine with low potency and in small quantity is given in patients with excessively vitiated ''dosha'', excess dryness in body, low digestive power and ''udavarta'' then it leads to further aggravation of ''dosha'' resulting in obstruction in channels, severe abdominal distension in umbilical region, pain in the back, flanks and head, severe dyspnea, retention of urine, feces and flatus. This condition shall be treated with ''abhyanga'' (oil massage), ''swedana'' (sudation), ''varti'' (use of suppositories), ''niruha'' along with ''anuvasana'' (decoction and oil enema) and all the treatment that cure ''udavarta''. [58-60]

+

If medicine with low potency and in small quantity is given in patients with excessively vitiated ''[[dosha]]'', excess dryness in body, low digestive power and ''udavarta'' then it leads to further aggravation of ''[[dosha]]'' resulting in obstruction in channels, severe abdominal distension in umbilical region, pain in the back, flanks and head, severe dyspnea, retention of urine, feces and flatus. This condition shall be treated with ''abhyanga'' (oil massage), ''[[swedana]]'' (sudation), ''varti'' (use of suppositories), ''niruha'' along with ''anuvasana'' (decoction and oil enema) and all the treatment that cure ''udavarta''. [58-60]

=== Complication of ''parikartika'' (fissure in ano) and its management ===

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</div></div>

−

If potent (purification) medicine is given in properly oleated patients, with ''guru koshtha''(heavy bowel), in cases of ''ama dosha'', body being lean with ''mridu koshtha'' (soft bowel), fatigued and less strength, then ''~~doshas~~'' reach ''guda'' (rectum) in ''sama'' condition and get expelled out immediately. It results in ''parikartika'' (fissure in ano) with severe pain, mucous and bloody secretions. In ''amadosha'' or ''sama'' conditions, fasting (''langhana''), digestive (''pachana''), drying (''rukshana''), should be done and easily digestible (light) and hot food must be taken. For those whose body is emaciated, every ''brimhana'' (nourishing) measure like food with ''madhura rasa'' (sweet taste) dominance must be taken. [61-63]

+

If potent (purification) medicine is given in properly oleated patients, with ''guru koshtha''(heavy bowel), in cases of ''ama dosha'', body being lean with ''mridu koshtha'' (soft bowel), fatigued and less strength, then ''[[dosha]]s'' reach ''guda'' (rectum) in ''sama'' condition and get expelled out immediately. It results in ''parikartika'' (fissure in ano) with severe pain, mucous and bloody secretions. In ''amadosha'' or ''sama'' conditions, fasting (''[[langhana]]''), digestive (''[[pachana]]''), drying (''[[rukshana]]''), should be done and easily digestible (light) and hot food must be taken. For those whose body is emaciated, every ''[[brimhana]]'' (nourishing) measure like food with ''madhura rasa'' (sweet taste) dominance must be taken. [61-63]

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</div></div>

−

If ''parikartika'' continues even if the ''ama'' got digested, light food added with ''kshara'' (alkalizing) and ''amla'' (sour) is good. For aggravated ''vayu'', ghee medicated with pomegranate juice, ''puspa-kaaseesa'' (green vitriol- Ferrous sulphate), ''kshara'' (alkalies), ''lavana''(salts) and ''dadima'' (Punica granatum) can be used. The powder of skin of ''dadima'' along with sour curd can be taken or with other food. The paste made of ''devadaru'' (Cedrus deodara) and ''tila'' (sesame) can be taken in hot water. Milk processed with the skin of ''ashwatha'' (Ficus bengalensis), ''udumbara'' (Ficus glomerata), ''plaksha'' (Ficus lacor) and ''kadamba'' (Anthocephalus kadamba) can be taken. ''Pichchha basti'' can be done using ''madhura rasa'' (drugs with sweet taste) and cooling ingredients and ''sneha basti'' with oil processed with ''yashti madhu'' (Glycerrhiza glabra) can be done.[64-67]

+

If ''parikartika'' continues even if the ''ama'' got digested, light food added with ''kshara'' (alkalizing) and ''amla'' (sour) is good. For aggravated ''vayu'', ghee medicated with pomegranate juice, ''puspa-kaaseesa'' (green vitriol- Ferrous sulphate), ''kshara'' (alkalies), ''lavana''(salts) and ''dadima'' (Punica granatum) can be used. The powder of skin of ''dadima'' along with sour curd can be taken or with other food. The paste made of ''devadaru'' (Cedrus deodara) and ''tila'' (sesame) can be taken in hot water. Milk processed with the skin of ''ashwatha'' (Ficus bengalensis), ''udumbara'' (Ficus glomerata), ''plaksha'' (Ficus lacor) and ''kadamba'' (Anthocephalus kadamba) can be taken. ''Pichchha [[basti]]'' can be done using ''madhura rasa'' (drugs with sweet taste) and cooling ingredients and ''sneha [[basti]]'' with oil processed with ''yashti madhu'' (Glycerrhiza glabra) can be done.[64-67]

=== Complication of ''paristrava'' (discharge) and its management ===

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</div></div>

−

In the patients with excessively vitiated ''~~doshas~~'', when only a small dose of medicine is given, the ''dosha'' get aggravated and discharged out in little quantity frequently. This result in ''alpa shopha'' (swelling), ''kandu'' (itching), ''kushtam'' (skin diseases), ''gauravam'' (heaviness), ''agni naasham'' (destruction of digestive power), ''utklesham'' (nausea), ''staimityam'' ( feeling of body covered with wet cloths), ''aruchi'' (ageusia) and ''pandu'' (anemia). The entire spectrum is called ''parisravam''. In this condition, the aggravated ''dosha'' must either be alleviated or removed out by emesis. Otherwise after oleation, potent ''virechana'' medicine can be given again for purification after which ''arishta'' (alcoholic medicated preparations) processed with drugs that enhance ''agni'' (digestive power) can be used. [68-70]

+

In the patients with excessively vitiated ''[[dosha]]s'', when only a small dose of medicine is given, the ''[[dosha]]'' get aggravated and discharged out in little quantity frequently. This result in ''alpa shopha'' (swelling), ''kandu'' (itching), ''kushtam'' (skin diseases), ''gauravam'' (heaviness), ''agni naasham'' (destruction of digestive power), ''utklesham'' (nausea), ''staimityam'' ( feeling of body covered with wet cloths), ''aruchi'' (ageusia) and ''pandu'' (anemia). The entire spectrum is called ''parisravam''. In this condition, the aggravated ''[[dosha]]'' must either be alleviated or removed out by emesis. Otherwise after oleation, potent ''[[virechana]]'' medicine can be given again for purification after which ''arishta'' (alcoholic medicated preparations) processed with drugs that enhance ''agni'' (digestive power) can be used. [68-70]

=== Complication of ''hridgraha'' (chest congestion) and its management ===

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</div></div>

−

After taking (emetic) medicine, if one restricts the urges (of vomiting bouts), ''vata'' etc. ''dosha'' get aggravated and located in precordium, resulting in severe chest congestion. This leads to hiccups, pain in flanks, cough, fatigue, salivation, perplexion of eyes/rolling of eyes, fainting with tongue bite and severe grinding of teeth. In this case, without getting confused, the physician must immediately make the patient to vomit. For ''pitta murchita'' (fainting due to aggravation of ''pitta''), ''madhura rasa'' (sweet taste) medicines need to be used and for ''kapha murchita'' (fainting due to aggravation of ''kapha''), ''katu rasa'' (pungent taste) need to be used.

+

After taking (emetic) medicine, if one restricts the urges (of vomiting bouts), ''[[vata]]'' etc. ''[[dosha]]'' get aggravated and located in precordium, resulting in severe chest congestion. This leads to hiccups, pain in flanks, cough, fatigue, salivation, perplexion of eyes/rolling of eyes, fainting with tongue bite and severe grinding of teeth. In this case, without getting confused, the physician must immediately make the patient to vomit. For ''pitta murchita'' (fainting due to aggravation of ''[[pitta]]''), ''madhura rasa'' (sweet taste) medicines need to be used and for ''kapha murchita'' (fainting due to aggravation of ''[[kapha]]''), ''katu rasa'' (pungent taste) need to be used.

−

Digestive medicines shall be given to digest remaining ''dosha'' and sequential rehabilitation to re-instate ''agni'' (digestive power) and strength of the body shall be done. If there is excessive vomiting because of vitiation of ''vayu'' leading to chest congestion, then it shall be treated with unctuous, sour and salty medicines. If there is increase in ''kapha'' and ''pitta'', those opposite to unctuous, sour and salty properties that is un-unctuous, bitter and pungent tastes need to be taken.[71-75]

+

Digestive medicines shall be given to digest remaining ''[[dosha]]'' and sequential rehabilitation to re-instate ''agni'' (digestive power) and strength of the body shall be done. If there is excessive vomiting because of vitiation of ''vayu'' leading to chest congestion, then it shall be treated with unctuous, sour and salty medicines. If there is increase in ''[[kapha]]'' and ''[[pitta]]'', those opposite to unctuous, sour and salty properties that is un-unctuous, bitter and pungent tastes need to be taken.[71-75]

=== Complication of ''gatra-graha'' (body stiffness) and its management ===

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</div></div>

−

After taking (emetic) medicines, if one restricts the urges (vomiting bouts) or get obstructed because of vitiated ''kapha'', then the excessively vitiated ''vata'' causes body stiffness. This results in stiffness, tremor, pricking pain, fainting, cramps and fatigue. This condition shall be managed with all ''vata'' alleviating treatments like oleation, sudation etc. [76-77]

+

After taking (emetic) medicines, if one restricts the urges (vomiting bouts) or get obstructed because of vitiated ''[[kapha]]'', then the excessively vitiated ''[[vata]]'' causes body stiffness. This results in stiffness, tremor, pricking pain, fainting, cramps and fatigue. This condition shall be managed with all ''[[vata]]'' alleviating treatments like oleation, sudation etc. [76-77]

=== Complication of ''jeevadana'' (bleeding) and its management ===

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</div></div>

−

If in the individual with ''mridu koshtha'' (soft bowel), and less aggravated ''dosha'', highly potent (''virechana'') medicine is administered, that will result in the removal of ''dosha'' after which bleeding ensues and then finally lead to evacuation of ''jeeva rakta'' (pure, functioning blood).

+

If in the individual with ''mridu koshtha'' (soft bowel), and less aggravated ''[[dosha]]'', highly potent (''[[virechana]]'') medicine is administered, that will result in the removal of ''[[dosha]]'' after which bleeding ensues and then finally lead to evacuation of ''jeeva rakta'' (pure, functioning blood).

−

If the evacuated material is mixed with food and given to crow or dog, if they eat it, it can be confirmed that it is ''jeeva-rakta''. If, they do not eat, then the blood is mixed with ''pitta'' (as seen in ''rakta-pitta'').

+

If the evacuated material is mixed with food and given to crow or dog, if they eat it, it can be confirmed that it is ''jeeva-rakta''. If, they do not eat, then the blood is mixed with ''[[pitta]]'' (as seen in ''rakta-pitta'').

If the evacuated blood is applied over a cloth and the cloth is washed with hot water, if the blood remains, it is bile and if the cloth clears off, it is ''jeeva-rakta''.

−

When ''jeeva-rakta'' gets evacuated, it results in burning sensation, fainting and intoxication. Here all treatments for impending death, all kinds of ''pitta nashaka'' treatments and treatments told in ''atiyoga'' must be done. For those whose ''jeeva-rakta'' is getting evacuated immediately, the blood of deer, cow, buffalo, goat etc. need to be given orally. That will sustain life because blood of animals gets immediately transformed to the human. The same blood can be used for ''basti'' by adding ''churna'' of ''darbha'' (Desmostachya bipinnata).

+

When ''jeeva-rakta'' gets evacuated, it results in burning sensation, fainting and intoxication. Here all treatments for impending death, all kinds of ''[[pitta]] nashaka'' treatments and treatments told in ''atiyoga'' must be done. For those whose ''jeeva-rakta'' is getting evacuated immediately, the blood of deer, cow, buffalo, goat etc. need to be given orally. That will sustain life because blood of animals gets immediately transformed to the human. The same blood can be used for ''[[basti]]'' by adding ''churna'' of ''darbha'' (Desmostachya bipinnata).

−

''Basti'', coolant in nature, using milk processed with drugs like ''shyama'' (Cassia fistula), ''kashmari'' (Gmelina arborea), ''badara'' (Zizyphus mauritiana), ''durva'' (Cyonodon dactylon), ''usheera'' (Vetiveria zizanoides) need to be done. Or coolant ''pichchha basti'' or ''sneha basti'' with ''ghrita manda'' is effective. [78-84]

+

''[[Basti]]'', coolant in nature, using milk processed with drugs like ''shyama'' (Cassia fistula), ''kashmari'' (Gmelina arborea), ''badara'' (Zizyphus mauritiana), ''durva'' (Cyonodon dactylon), ''usheera'' (Vetiveria zizanoides) need to be done. Or coolant ''pichchha [[basti]]'' or ''sneha [[basti]]'' with ''ghrita manda'' is effective. [78-84]

=== Complication of ''gudavibhramsha'' (rectum prolapse) and its management ===

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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 ''[[dosha]]s'' 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 ===

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</div></div>

−

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 ''[[dosha]]s'', 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 ''[[dosha]]s'' 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 ===

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</div></div>

−

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 ===

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</div></div>

−

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 ===

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</div></div>

−

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]

== Tattva Vimarsha (Fundamental Principles) ==

−

*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 ''[[dosha]]s'' 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 ''pravrita'' (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 ''pravrita'' (early rains season from mid June to mid August in India).

−

*''Snehana'' (oleation) therapy shall be done in between two purification therapies and at the end of purification. This is to prevent vitiation of ''vata dosha'' after purification.

+

*''[[Snehana]]'' (oleation) therapy shall be done in between two purification therapies and at the end of purification. This is to prevent vitiation of ''[[vata dosha]]'' after purification.

*Oleation shall neither be excess nor be less for proper purification.

*Purification therapy shall always be taken after proper digestion of previous day meal and in appropriate dosage.

*The stable mental state of patient is important to get benefits of purification.

−

*Diet before and after purification is important for maximum sustaining effects. The previous day meal before ''vamana'' shall be easily digestible, rich in fluids and increasing ''kapha''. The previous day meal before ''virechana'' shall be light to digest and hot.

+

*Diet before and after purification is important for maximum sustaining effects. The previous day meal before ''[[vamana]]'' shall be easily digestible, rich in fluids and increasing ''[[kapha]]''. The previous day meal before ''[[virechana]]'' shall be light to digest and hot.

−

*In proper ''vamana'', the ''pitta'' is expelled out at the end. In proper ''virechana, kapha'' is expelled out at the end. Emaciation, weakness and lightness of body are other signs of proper purification.

+

*In proper ''[[vamana]]'', the ''[[pitta]]'' is expelled out at the end. In proper ''[[virechana]], [[kapha]]'' is expelled out at the end. Emaciation, weakness and lightness of body are other signs of proper purification.

−

*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 ''[[dosha]]s''. 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 (Applied Inferences ) ==

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=== 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 <ref> Vagbhata. Sutra Sthana, Cha.17 Swedavidhi Adhyaya verse 29. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>

+

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 [[dosha]]s'' (after ''snehapaana''), to the ''koshtha'' (after [[swedana]]) and eliminates it <ref> Vagbhata. Sutra Sthana, Cha.17 Swedavidhi Adhyaya verse 29. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>

−

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)

+

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)

−

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

+

=== 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, aanoopa-amisha'' etc.<ref> Vagbhata. Sutra Sthana, Cha.16 Snehavidhi Adhyaya verse 43. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>. Here ''abhighaata'' and ''visha'' which is always an acute emergency presenting ''kapha-pitta dushti'' also requires immediate ''shodhana'' without much ''swedana''. ''Pandu roga'' is a condition which is entitled for the use of ''sneha prayoga'' like ''kalyanakaghrita''. Here, Acharya 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, aanoopa-amisha'' etc.<ref> Vagbhata. Sutra Sthana, Cha.16 Snehavidhi Adhyaya verse 43. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>. Here ''abhighaata'' and ''visha'' which is always an acute emergency presenting ''[[kapha]]-[[pitta]] dushti'' also requires immediate ''[[shodhana]]'' without much ''[[swedana]]''. ''Pandu roga'' is a condition which is entitled for the use of ''sneha prayoga'' like ''kalyanakaghrita''. Here, Acharya 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 ''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)

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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)

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

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

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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)

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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)

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

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=== 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.

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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)

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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)

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

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=== Similes for action of ''[[virechana]]'' ===

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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)

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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 ===

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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.

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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.

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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)

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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 ===

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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.

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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)

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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 ===

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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 )

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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 ===

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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]

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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]

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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''.

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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''.

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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)

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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 ===

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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)

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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)

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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)

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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)

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

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

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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)

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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 ===

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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''.

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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]]''.

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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)

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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 ===

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

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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)

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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)

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

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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.

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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)

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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)

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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)

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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 ===

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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.

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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.

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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)

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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)

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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)

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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===

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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)

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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 ===

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

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

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=== Important concepts in the chapter ===

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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)

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

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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.

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~~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)~~

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~~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==

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Agnivesha

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