Changes

{{#seo:

{{#seo:

|title=Virechana

|title=Virechana

|titlemode=append

|titlemode=append

|keywords=Virechana,Virechana in ayurveda,Virechana meaning,Virechana Definition,Charak samhita,carakasamhitaonline, Indian System of Medicine

|keywords=Virechana, Virechana in ayurveda, Virechana meaning, purging therapy, Charak samhita, carakasamhitaonline, Indian System of Medicine, therapeutic purgation, purgation therapy in ayurveda, detoxification therapy, bio purification, panchakarma, treatment of excess heat, skin diseases, constipation, bowel cleansing therapy   

|description=Therapeutic purgation is one of the five Panchakarma procedures mainly indicated in disorders due to excess vitiation of Pitta dosha and rakta

|description=Therapeutic purgation is one of the five Panchakarma procedures mainly indicated in disorders due to excess vitiation of Pitta dosha and rakta

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

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

|image_alt=carak samhita

|image_alt=carak samhita

|type=article

|type=article

}}

}}

 

{{Infobox

{{Infobox

|data5 = carakasamhita@gmail.com

|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:

|label6 = Publisher

|data6 = December 01, 2020

|label7 = DOI

 

|data7 = Under process

|label7 = Date of first publication:

|data7 = December 01, 2020

 

|label8 = DOI

|data8 = [https://doi.org/10.47468/CSNE.2020.e01.s09.033 10.47468/CSNE.2020.e01.s09.033]

 

}}

}}

==Etymology and derivation==

==Etymology and derivation==

 

The word virechana is derived by adding ‘vi’ prefix and ‘lyut’ suffix to the Sanskrit root ‘rich’ [vacaspatyam]. It means evacuation of waste materials (mala nissaranam).<ref name=VCP>Patil V C. Chap.12 Virechanakarma (Purgation therapy), In: Principles and practice of Pancakarma. Reprint ed. New Delhi: Chaukamba publications;2016</ref>

The word virechana is derived by adding ‘vi’ prefix and ‘lyut’ suffix to the Sanskrit root ‘rich’ [vacaspatyam]. It means evacuation of waste materials (mala nissaranam).<ref name=VCP>Patil V C. Chap.12 Virechanakarma (Purgation therapy), In: Principles and practice of Pancakarma. Reprint ed. New Delhi: Chaukamba publications;2016</ref>

==Indications==

==Indications==

   

   

Purificatory procedures like therapeutic purgation is advocated only in case of excessive aggravation of [[pitta dosha]].[Cha.Sa.[[Sutra Sthana]] 16/16] It is an important treatment for vitiation of [[rakta dhatu]], [[mamsa dhatu]], [[meda dhatu]] and [[shukra dhatu]]. [Cha.Vi.5 ref] It is also indicated in conditions caused due to [[pitta dosha]] associated with [[kapha]] [[dosha]], encroachment of [[kapha]] in site of [[pitta]] and vice versa.[A.S.Sutra Sthana.27/4]<ref name=Sangraha>Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.</ref>

Purificatory procedures like therapeutic purgation is advocated only in case of excessive aggravation of [[pitta dosha]].[Cha.Sa.[[Sutra Sthana]] 16/16] It is an important treatment for vitiation of [[rakta dhatu]], [[mamsa dhatu]], [[meda dhatu]] and [[shukra dhatu]]. It is also indicated in conditions caused due to [[pitta dosha]] associated with [[kapha]] [[dosha]], encroachment of [[kapha]] in site of [[pitta]] and vice versa.[A.S.Sutra Sthana.27/4]<ref name=Sangraha>Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.</ref>

==Contraindications==

==Contraindications==

|-

|-

|}

|}

  *Dosage as per Sharangadhara if the medicine used is in the form of paste or tablet or powder form.[Sha.Sa.Uttara Khanda 4]<ref name=Shargadara>Sharangadhara. Sharangadhara Samhita. Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Chaukhambha orientalia;2016.</ref>

[Dalhana on Su.Sa.Chikitsa Sthana 33/20] *Dosage as per Sharangadhara if the medicine used is in the form of paste or tablet or powder form.[Sha.Sa.Uttara Khanda 4]<ref name=Shargadara>Sharangadhara. Sharangadhara Samhita. Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Chaukhambha orientalia;2016.</ref>

===Therapeutic purgation (pradhanakarma)===

===Therapeutic purgation (pradhanakarma)===

Therapeutic purgation is always performed late morning during the time of the natural decrease of [[kapha]] [[dosha]] and increase of [[pitta dosha]]. [A.H.Sutra Sthana.18/33] <ref name=Hridaya>Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref> Practically the purgative medicines are administered between 9 AM to 11 AM <ref name=VCP/> on empty stomach. The person is advised to pass stool whenever the urge is felt and to take rest in between the urges. He should not indulge in other activities and should concentrate in the procedure itself. [Su.Sa. Chikitsa Sthana 33/21]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005</ref> Drinking a little amount of warm water and mild sudation with warm palms over abdomen region to trigger the urge is advised.[A.H.Sutra Sthana.18/36]<ref name=Hridaya/> The person should never withhold the urge for defecation and should not strain while passing the stool [Su.Sa. ChikitsaSthana 33/22]<ref name=Susruta/> as these may aggravate the [[vata dosha]]. After intake of purgative medicine, the person should only use warm water for drinking and cleaning purpose. Cold water may obstruct the movement of [[dosha]] and thereby prevents evacuation due to its styptic action.

Therapeutic purgation is always performed late morning during the time of the natural decrease of [[kapha]] [[dosha]] and increase of [[pitta dosha]]. [A.Hr.Sutra Sthana.18/33] <ref name=Hridaya>Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref> Practically the purgative medicines are administered between 9 AM to 11 AM <ref name=VCP/> on empty stomach. The person is advised to pass stool whenever the urge is felt and to take rest in between the urges. He should not indulge in other activities and should concentrate in the procedure itself. [Su.Sa. Chikitsa Sthana 33/21]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005</ref> Drinking a little amount of warm water and mild sudation with warm palms over abdomen region to trigger the urge is advised.[A.Hr.Sutra Sthana.18/36]<ref name=Hridaya/> The person should never withhold the urge for defecation and should not strain while passing the stool [Su.Sa. Chikitsa Sthana 33/22]<ref name=Susruta/> as these may aggravate the [[vata dosha]]. After intake of purgative medicine, the person should only use warm water for drinking and cleaning purpose. Cold water may obstruct the movement of [[dosha]] and thereby prevents evacuation due to its styptic action.

   

   

Purgative medicine shows effect only after its digestion. [Su.Sa.Chikitsa Sthana 33/34]<ref name=Susruta/> Depending upon the time required for digestion of medicine, the first urge to defecate varied from one hour to three hours after administration of medicine.<ref name=GuptaSK>Gupta SK, Thakar AB, Dudhamal TS, Nema A. Management of Amavata (rheumatoid arthritis) with diet and Virechanakarma. Ayu 2015;36:413-5.</ref>

Purgative medicine shows effect only after its digestion. [Su.Sa.Chikitsa Sthana 33/34]<ref name=Susruta/> Depending upon the time required for digestion of medicine, the first urge to defecate varied from one hour to three hours after administration of medicine.<ref name=GuptaSK>Gupta SK, Thakar AB, Dudhamal TS, Nema A. Management of Amavata (rheumatoid arthritis) with diet and Virechanakarma. Ayu 2015;36:413-5.</ref>

===Anulomana===

===Anulomana===

This includes expulsion of waste products/feces (mala) after its complete digestion (paka) of ama (incompletely digested wastes and toxins) and detachment from their abodes. [Sha. Purva khanda.4/4]<ref name=Shargadara/> The medicine kindles the digestion and metabolic process (agni) first and further increases the liquidity (drava[[guna]]) and mobility (sara[[guna]]) of waste products for smooth passage through rectum. [Adhamalla on Sha.Purvakhanda 4/4]<ref name=Shargadara/> Anulomana medicines are predominant of [[aap]] and [[prithvi]] [[mahabhuta]]<ref name=KulkarniM>Kulkarni M, Sherekar D. Understanding the applied aspects of Sharandharokta virechan karma- A review. PIJAR. 2017 [cited 2020 Sep 06] . Available from: http://pijar.org/archives.html</ref>  which results in unobstructed downward movement of the waste materials. Along with the digestion of waste products, it also improves the digestion process by [[dosha]].<ref name=KulkarniM/>Anulomana can have an effect on samanavata (type of vata responsible for digestion) and its site of action may be the gastro intestinal tract.<ref name=KulkarniM/>

This includes expulsion of waste products/feces (mala) after its complete digestion (paka) of ama (incompletely digested wastes and toxins) and detachment from their abodes. [Sha.Sa.Purva khanda.4/4]<ref name=Shargadara/> The medicine kindles the digestion and metabolic process (agni) first and further increases the liquidity (drava[[guna]]) and mobility (sara[[guna]]) of waste products for smooth passage through rectum. [Adhamalla on Sha.Sa.Purva khanda 4/4]<ref name=Shargadara/> Anulomana medicines are predominant of [[aap]] and [[prithvi]] [[mahabhuta]]<ref name=KulkarniM>Kulkarni M, Sherekar D. Understanding the applied aspects of Sharandharokta virechan karma- A review. PIJAR. 2017 [cited 2020 Sep 06] . Available from: http://pijar.org/archives.html</ref>  which results in unobstructed downward movement of the waste materials. Along with the digestion of waste products, it also improves the digestion process by [[dosha]].<ref name=KulkarniM/>Anulomana can have an effect on samanavata (type of [[vata]] responsible for digestion) and its site of action may be the gastro intestinal tract.<ref name=KulkarniM/>

This can be compared to carminative laxatives. Carminative laxatives due to the presence of volatile oils stimulate the digestive system and regulates gut contractions. It may also increase the water retention in intestinal lumen.<ref name=NimmyVS>Nimmy V S, Praveen Kumar K S. A Conceptual Appraisal of Virechana Karma. AYUSHDHARA, 2018;5(2):1664-1668.</ref> In a study conducted on 15 participants, anulomana procedure took approximately 258 minutes to complete. Most number of participants did not pass [[kapha]] in their final bout of purgation. In 73.46% of participants the consistency of stool as per bristol stool scale lies in category 7  (watery, no solid pieces, entirely liquid).<ref name=NithinPS/>

This can be compared to carminative laxatives. Carminative laxatives due to the presence of volatile oils stimulate the digestive system and regulates gut contractions. It may also increase the water retention in intestinal lumen.<ref name=NimmyVS>Nimmy V S, Praveen Kumar K S. A Conceptual Appraisal of Virechana Karma. AYUSHDHARA, 2018;5(2):1664-1668.</ref> In a study conducted on 15 participants, anulomana procedure took approximately 258 minutes to complete. Most number of participants did not pass [[kapha]] in their final bout of purgation. In 73.46% of participants the consistency of stool as per bristol stool scale lies in category 7  (watery, no solid pieces, entirely liquid).<ref name=NithinPS/>

===Sramsana===

===Sramsana===

   

   

This includes expulsion of waste products/feces (mala) with or without its digestion and stools may be sticky. [Sha.Purvakhanda.4/5]<ref name=Shargadara/>

This includes expulsion of waste products/feces (mala) with or without its digestion and stools may be sticky. [Sha.Sa.Purva khanda.4/5]<ref name=Shargadara/>

The waste materials (mala) adhered to the gut (koshtha) are removed through the anal route in digested or undigested form. It may act on apanavata (type of [[vata]] responsible for excretion). Sramsana medicines might be acting over the last part of small intestine and on large intestine motility.<ref name=KulkarniM/>

The waste materials (mala) adhered to the gut (koshtha) are removed through the anal route in digested or undigested form. It may act on apanavata (type of [[vata]] responsible for excretion). Sramsana medicines might be acting over the last part of small intestine and on large intestine motility.<ref name=KulkarniM/>

===Bhedana===

===Bhedana===

   

   

This includes evacuation of waste products/feces after disintegrating the formed/solidified or unformed state. [Sha.Purvakhanda.4/6]<ref name=Shargadara/>

This includes evacuation of waste products/feces after disintegrating the formed/solidified or unformed state. [Sha.Sa.Purva khanda.4/6]<ref name=Shargadara/>

The liquefied (abaddha) or solidified (baddha/pindita) fecal matter gets forcefully excreted out through this type of purgation. The action is more intense. The drug might be sharply acting (tikshna), hot (ushna) and light (laghu) in nature. Bhedana medicines might be acting over large intestine and increases intestinal motility.<ref name=KulkarniM/>

The liquefied (abaddha) or solidified (baddha/pindita) fecal matter gets forcefully excreted out through this type of purgation. The action is more intense. The drug might be sharply acting (tikshna), hot (ushna) and light (laghu) in nature. Bhedana medicines might be acting over large intestine and increases intestinal motility.<ref name=KulkarniM/>

===Rechana===

===Rechana===

   

   

This includes elimination of waste products/feces with or without its digestion, in watery form. [Sha.Purvakhanda.4/7]<ref name=Shargadara/>

This includes elimination of waste products/feces with or without its digestion, in watery form. [Sha.Sa.Purva khanda.4/7]<ref name=Shargadara/>

The digested or undigested fecal matter gets evacuated in watery form. It affects mainly on large intestine and increases secretions of intestine and its motility.<ref name=KulkarniM/>

The digested or undigested fecal matter gets evacuated in watery form. It affects mainly on large intestine and increases secretions of intestine and its motility.<ref name=KulkarniM/>

==Importance in preservation of health and prevention==

==Importance in preservation of health and prevention==

In healthy individuals, therapeutic purgation is advised in autumn season (sharad) during natural aggravation of [[pitta dosha]]. [Sha.Uttrakhanda.4/4]<ref name=Shargadara/> It helps to prevent many diseases caused due to [[pitta]] aggravation and [[rakta]] vitiation.

In healthy individuals, therapeutic purgation is advised in autumn season (sharad) during natural aggravation of [[pitta dosha]]. [Sha.Sa.Uttrakhanda.4/4]<ref name=Shargadara/> It helps to prevent many diseases caused due to [[pitta]] aggravation and [[rakta]] vitiation.

==Importance in management of disease==

==Importance in management of disease==

Virechana is effective in eliminating excessive aggravated [[pitta dosha]] and balancing it. [Cha.Sa.[[Sutra Sthana]] 20/16] Therefore it is the principle treatment for [[pitta]] predominant diseases like chronic fever (jwara), anaemia (pandu), jaundice (kamala) etc.[Cha.Sa.[[Siddhi Sthana]] 2/13], hemiplegia(pakshaghata)[Cha.Sa.[[Chikitsa Sthana]] 28/100) and bronchial asthma (shwasa).[Cha.Sa.[[Chikitsa Sthana]] 17/121]

Virechana is effective in eliminating excessive aggravated [[pitta dosha]] and balancing it. [Cha.Sa.[[Sutra Sthana]] 20/16] Therefore it is the principle treatment for [[pitta]] predominant diseases like chronic fever (jwara), anaemia (pandu), jaundice (kamala) etc.[Cha.Sa.[[Siddhi Sthana]] 2/13], hemiplegia (pakshaghata) [Cha.Sa.[[Chikitsa Sthana]] 28/100) and bronchial asthma (shwasa).[Cha.Sa.[[Chikitsa Sthana]] 17/121]

==Physiology of purgation==

==Physiology of purgation==

In a case report on rheumatoid arthritis, virechana showed significant reduction in RA factor to 50 IU/ml  from earlier level of 94 IU/ml. Virechana followed by avoidance of allergens reduced the CRP level from 22.7mg/l to 1.8 mh/l. After 3 months of follow up the IgE levels reduced from 680kU/l to 53.7 kU/l. The 40% relief in pain and stiffness of joints were reported soon after the virechana.<ref name=GuptaSK/>

In a case report on rheumatoid arthritis, virechana showed significant reduction in RA factor to 50 IU/ml  from earlier level of 94 IU/ml. Virechana followed by avoidance of allergens reduced the CRP level from 22.7mg/l to 1.8 mh/l. After 3 months of follow up the IgE levels reduced from 680kU/l to 53.7 kU/l. The 40% relief in pain and stiffness of joints were reported soon after the virechana.<ref name=GuptaSK/>

A study conducted on 20 non-insulin dependent diabetes patients showed a better reduction in fasting blood sugar (FBS) and post prandial blood sugar (PPBS) levels through virechana, when compared with therapeutic emesis (vamana). The 51.5% reduction is observed in FBS levels after virechana, at the same time PPBS values shows 81.6% reduction. It is assumed that virechana acts on liver and pancreas as they are the sites of [[pitta dosha]]. It may reduce the hepatic glucose production or may increase the insulin secretion.<ref>Jindal N, Joshi NP. Comparative study of Vamana and Virechanakarma in controlling blood sugar levels in diabetes mellitus. Ayu. 2013 Jul;34(3):263-9. doi: 10.4103/0974-8520.123115. PMID: 24501520; PMCID: PMC3902591.</ref>  

A study conducted on 20 non-insulin dependent diabetes patients showed a better reduction in fasting blood sugar (FBS) and post prandial blood sugar (PPBS) levels through virechana, when compared with therapeutic emesis (vamana). The 51.5% reduction is observed in FBS levels after virechana, at the same time PPBS values shows 81.6% reduction. It is assumed that virechana acts on liver and pancreas as they are the sites of [[pitta dosha]]. It may reduce the hepatic glucose production or may increase the insulin secretion.<ref>Jindal N, Joshi NP. Comparative study of Vamana and Virechana karma in controlling blood sugar levels in diabetes mellitus. Ayu. 2013 Jul;34(3):263-9. doi: 10.4103/0974-8520.123115. PMID: 24501520; PMCID: PMC3902591.</ref>  

In another study conducted on 30 dyslipidemic persons, a significant reduction is reported in serum cholesterol, triglyceride and VLDL levels after virechana. LDL also shows reduction. Serum HDL increased significantly. Evacuation of [[pitta]] is the prime phenomenon achieved through virechana. Large amount of bile is excreted through virechana which results in reduction of cholesterol levels.<ref>Pooja BA, Bhatted SK. A standard controlled clinical study on Virechana Karma and Lekhana Basti in the management of dyslipidemia (Medoroga). AYU 2016;37:32-7.</ref>

In another study conducted on 30 dyslipidemia persons, a significant reduction is reported in serum cholesterol, triglyceride and VLDL levels after virechana. LDL also shows reduction. Serum HDL increased significantly. Evacuation of [[pitta]] is the prime phenomenon achieved through virechana. Large amount of bile is excreted through virechana which results in reduction of cholesterol levels.<ref>Pooja BA, Bhatted SK. A standard controlled clinical study on Virechana Karma and Lekhana Basti in the management of dyslipidemia (Medoroga). AYU 2016;37:32-7.</ref>  

In a study conducted on 30 patients,virechana is reported to be more effective in reducing the signs and symptoms of psoriasis than therapeutic emesis ([[vamana]]). <ref>A. N. Parida, N.N Bhatt et al. A comparative study of vamana and virechana karma in ekakushta w.s.r to psoriasis. Ayu. 2009 Jul-Sep; VOL. 30, NO. 3: 255 - 259</ref>

In a study conducted on 30 patients, virechana is reported to be more effective in reducing the signs and symptoms of psoriasis than therapeutic emesis ([[vamana]]). <ref>A. N. Parida, N.N Bhatt et al. A comparative study of vamana and virechana karma in ekakushta w.s.r to psoriasis. Ayu. 2009 Jul-Sep; VOL. 30, NO. 3: 255 - 259</ref>

==List of theses done==

==List of theses done==

#Shiho Oikawa (2018): Virechana karma along with vaitaranabasti followed by mahabhallataka avaleha in the management of amavata wsr to rheumatoid arthritis-A comparative randomized controlled study . Department of Panchakarma, IPGT&RA  Jamnagar

#Shiho Oikawa (2018): Virechana karma along with vaitaranabasti followed by mahabhallataka avaleha in the management of amavata wsr to rheumatoid arthritis-A comparative randomized controlled study . Department of Panchakarma, IPGT&RA  Jamnagar

==More information==

==Related chapters==

[[Upakalpaniya Adhyaya]], [[Chikitsaprabhritiya Adhyaya]], [[Kalpana Siddhi]], [[Shyamatrivrita Kalpa Adhyaya]], [[Chaturangula Kalpa Adhyaya]], [[Tilvaka Kalpa Adhyaya]], [[Sudha Kalpa Adhyaya]], [[Saptalashankhini Kalpa Adhyaya]], [[Dantidravanti Kalpa Adhyaya]]

[[Upakalpaniya Adhyaya]], [[Chikitsaprabhritiya Adhyaya]], [[Kalpana Siddhi]], [[Shyamatrivrita Kalpa Adhyaya]], [[Chaturangula Kalpa Adhyaya]], [[Tilvaka Kalpa Adhyaya]], [[Sudha Kalpa Adhyaya]], [[Saptalashankhini Kalpa Adhyaya]], [[Dantidravanti Kalpa Adhyaya]]

==List of References==

==List of References==

The list of references for Virechana in Charak Samhita can be seen

The list of references for Virechana in Charak Samhita can be seen [[Media:List_of_references_of_word_virechana_in_charaka-converted.pdf|here]]

 

==Reference==

==Reference==

</div>

</div>