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A Beginner’s Guide to Virechana Treatment in Ayurveda: Purify Your Body and Mind

Virechana karma is the purificatory therapy and one among Panchakarma (five therapies of purification). It is the expulsion of vitiated dosha through the downward route. Virechana karma is mainly indicated in Pitta dosha and diseases of Pitta dosha are associated with Vata and Kapha dosha. Rechana and Praskandanam are synonyms of Virechana.

Classification of Virechana

Virechana can be classified based on the following factors:

  1. Mode of action
  2. Intensity of action
  3. Based on drug properties
  4. Based on the source of drugs

Mode of action – Based on the mode of action Virechana is classified as

  • Anulomana – Anulomana karma acts on partially formed Mala and assists in the proper formation of Mala for its easy expulsion. The formed mala or waste undergoes digestion and then causes downward movement of Vata dosha, expelling the mala from the body through a downward route. Example: Haritaki (Terminalia chebula).
  • Sramsana – The partially formed mala that is adhered to the channels is detached and expelled from the body through the downward route without undergoing digestion. Example: Aragwadha (Cassia angustifolia).
  • Bhedana – Bhedana karma is the one that breaks, loosens, or separates. The drugs expel abaddha mala (a liquid form of Mala) and baddha mala (a solid form of mala) through the downward route. Examples: Trivrut (Operculina turpethum), Chitraka (Plumbago zeylanica), Katuki (Picrorrhiza kurroa), etc.
  • Rechana – Rechana karma liquifies both pakwa mala (formed mala) and apakwa mala (improperly formed mala) and then expels from the body. Example: Trivrut (Operculina turpethum).

Intensity of action – Based on the intensity of action, Virechana is classified into:

  1. Mrudu Virechana – The drugs of Mrudu Virechana are mild, given in low dosage, and cause less or mild purgation. It is indicated in patients who have mild vitiation of dosha, weakness, who have undergone purification therapies, etc. Examples: jaggery, sugarcane juice, etc.
  2. Madhyama Virechana – The drugs of Madhyama Virechana are moderate in strength and cause moderate levels of purgation. It is administered in patients who have good strength and are tolerant. Example: Aragwadha (Cassia angustifolia), Trivrut (Operculina turpethum).
  3. Teekshana VirechanaTeekshana Virechana, the purgation that occurs in numerous episodes with the elimination of large amounts of dosha quickly but without causing any discomfort to the patient. This is indicated in patients who have good strength to tolerate the therapy and vitiation of dosha is of high intensity. Examples: Snuhiksheera (latex of Euphorbia neriifolia), Jayapala (Croton tiglium), etc.

Based on drug properties

  1. Sneha Virechana – The drugs possess Snigdha guna (unctuous property) and are given to patients who have Rukshata (dryness) and contra-indicated to those who have undergone Snehana (internal oleation) of high dose. Example: Eranda (Ricinus communis).
  2. Ruksha Virechana – The drugs possess rukshata property and are administered to people who have Atisnigdhata (excess oily skin and unctuousness in the body). Example: Katuki (Picrorrhiza kurroa).

Based on the source of drugs

  1. Animal-origin drugs like Mutra (urine), Ksheera (milk), etc.
  2. Plant-origin drugs like Phala (ex: Triphala), Ksheera (ex: latex of Snuhi), Moola (ex: root of Danti), etc.

Indications and Contra-indications Virechana Treatment

Indications of Virechana Treatment

  • In Pittaja disorders, where Pitta dosha vitiation is in high intensity.
  • Pitta Prakriti
  • Pandu (anemia)
  • Jwara (fever)
  • Netra daha (burning sensation of the eyes)
  • Aasya daha (burning sensation of the mouth)
  • Kamala (jaundice)
  • Parshwashoola (pain in the flanks)
  • Shirashoola (headache)
  • Vatarakta (gouty arthritis)
  • Kushtha (skin disorders)
  • Prameha (diabetes mellitus)
  • Shwaasa (dyspnea)
  • Kasa (cough)
  • Visarpa (erysipelas)
  • Hridroga (cardiac diseases)

Contra-indications of Virechana Treatment

  • Adhogaraktapitta (a bleeding disorder in the lower gastrointestinal tract)
  • Weak
  • Old aged people
  • Children
  • Pregnancy
  • Post-partum stage
  • Navajwara (fever of recent origin)

Time of administration of Virechana Treatment

  • Sharad rutu or the autumn season is the ideal period to administer Virechana Treatment (purgation therapy). During the autumn season, Pitta dosha is aggravated, and thus, Virechana eliminates the vitiated Pitta dosha and the associated diseases.
  • Virechana Treatment can also be administered to healthy individuals during Sharad rutu. It keeps the person healthy by cleansing and activating all the upper body systems and the channels in a normal state.
  • Apart from this, Virechana Treatment can be given based on the condition of the patient and the intensity of the dosha which is to be decided by the physician.

Virechana Treatment

The administration of virechana treatment is divided into three stages: Purva karma, Pradhana karma, and Paschat karma.

Purva karma: The pre-requisites and the pre-arrangements before carrying out virechana treatment.

  • The screening of the patients is done based on indications and contra-indications for virechana treatment.
  • The Agni (digestion strength), Prakriti (constitution of the individual), psychological state of the person, external environmental factors, etc. are assessed and then decide the therapy.
  • Deepana-Pachana (appetizers and digestives) are given to the patient to stimulate digestion and digest any undigested food in the gastrointestinal tract. This will prepare the person for the digestion of drugs for purgation and achieve the benefits of Virechana.
  • Snehana – This is oleation therapy. Intake of medicated ghee and oil massage. Medicated ghee is advised on an empty stomach for 3, 5, or 7 days. The dosage of the ghee should start with a minimum dose and then gradually increase such that it gets digested within 24 hours. The ghee is advised with hot water. Snehapana is administered till the desired symptoms are achieved by 7 days. During this course, a warm, liquid, light diet in a suitable quantity is given to the patient.
  • After the course of Snehapana, a rest period of three days is advised during which Abhyanga (oil massage) followed by Bashpa Swedana (fomentation in a steam chamber) is administered.
  • A day before Virechana karma, the food items that can cause Pitta aggravation sour taste foods, etc. are advised to the patient.

Pradhana karma

  • The patient is asked to come on an empty stomach.
  • On the day of the Virechana administration, Abhyanga and fomentation are given.
  • Virechana karma should be given after the early morning phase has passed (approximately 9-10 am).
  • The patient is made to sit in a comfortable position in a chair.
  • Virechana medicine is administered to the patient.
  • Following the administration of medicine, the patient is asked to sprinkle hot water on the face and gargle with hot water, and a lemon is given to take the smell to avoid nausea.
  • The patient is advised to take complete rest and avoid talking, laughing, etc.
  • The patient is asked to drink hot water sip by sip repeatedly.
  • Wait for the episodes of purgation to begin, if not, give mild fomentation over the abdomen.

Virechana karma is assessed in four stages of clinical manifestation:

  1. Aantiki Kaphanta Virechana, the episodes of purgation that end with the elimination of Kapha dosha.
  2. Vaigiki – The episodes of Virechana karma are graded as 10, 20, and 30 episodes as minimum, moderate, and maximum episodes respectively.
  3. Maniki – The amount of purgation that is measured in terms of the minimum level of purification, moderate level of purification, and maximum level of purification and that is 2 prastha, 3 prastha, and 4 prastha respectively.
  4. Laingiki – The proper purification is assessed by the symptoms like cleansing of channels, increased appetite, feeling of lightness in the body increased functioning of Indriya (sense organs).

Dosage of Virechana medicine

Depending on the koshtha, the medicine is divided into three types: Krura koshta, Madhyama koshtha and Mrudu koshtha. The medicine used is in the form of Kwatha (decoction), kalka and choorna (paste and powder), swarasa (juice of the medicines).

  • Kwatha – 8 tola (Krura koshtha), 4 tola (Madhyama koshtha), and 2 tola (Mrudu koshtha).
  • Kalka and choorna – 4 tola (Krura koshtha), 2 tola (Madhyama koshtha), and 1 tola (Mrudu koshtha).
  • Swarasa – 4 tola (Krura koshtha), 2 tola (Madhyama koshtha), and 1 tola (Mrudu koshtha).

Paschat karma

The dietary regimen to be followed by the patient after the administration is the intake of Peya, Vilepi, Akrita yoosha, Krita yoosha, Akrita Mamsa rasa, Krita Mamsa rasa, and then the normal diet. Avoiding excess talk, excess laugh, riding vehicles, exposure to dust, wind, and heat, day sleep, and controlling natural urges are some of the instructions to be followed after Virechana karma.

Symptoms of Ayoga, Samyak yoga, and Atiyoga of Virechana karma

Symptoms of inadequate administration of Virechana treatment

Gauravata (heaviness in the body), Kandu (itching), Pidika (formation of blisters), Daha (burning sensation), Chardi (vomiting), Adhmana (distension of abdomen), Mutrasanga (difficulty in micturition), Vitsanga (constipation), Agnimandya (loss of appetite), etc. are some of the symptoms of inadequately administered Virechana therapy.

Symptoms of adequate administration of Virechana treatment

Srotoshuddhi (cleansing of channels), Indriyaprsadanam (increased functioning of sense organs), Agnivruddhi (increased appetite), Laghuta (feeling lightness in the body), Kramat Vit-Pitta-Kapha-Anila Shuddhi (passing of stools, Pitta doshaKapha dosha and flatus in chronolgy), Vatanulomana (downward movement of Vata), etc. are some of the symptoms of properly administered Virechana therapy.

Symptoms of excess dosage administration of Virechana treatment

Increased Vata dosha, bleeding through the anus, Hikka (hiccoughs), etc. are the symptoms if the dosage of medicine is given in excess.

Conclusion

Virechana karma is the elimination of dosha through a downward route. The procedure is mainly indicated in Pitta dosha. Sharad rutu is the ideal season for Virechana karma. Virechana is classified into various types like mode of action, intensity of action, properties of drugs, and source of drugs. Kaphanta is the sign of proper administration of Virechana karma.

References
  1. REVIEW ON VIRECHANA KARMA (THERAPEUTIC PURGATION), World Journal of Pharmaceutical and Medical Research, 20121, Volume 8, Issue 6, p. 214-218.
  2. REVIEW OF VIRECHANA KARMA IN CLASSICAL TEXTS OF AYURVEDA, Journal of Ayurveda and Integrated Medical Sciences, 2016 (Nov-Dec), Volume 1, Issue 4, p.105-117.
  3. Chaturvedi A, Nath G, Yadav VB, Antiwal M, Shakya N, Swathi C, Singh JP. A clinical study on Virechana Karma (therapeutic purgation) over the gut flora with special reference to obesity. Ayu. 2019 Jul-Sep;40(3):179-184. doi: 10.4103/ayu.AYU_302_19. Epub 2020 Aug 8. PMID: 33281395; PMCID: PMC7685265.
  4. Rais A, Bhatted S. Clinical study to evaluate the effect of Virechanakarma on serum electrolytes. Ayu. 2013 Oct;34(4):379-82. doi: 10.4103/0974-8520.127719. PMID: 24696575; PMCID: PMC3968700.

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