Virechana
Virechana is a procedure in which the prakupita doshas are expelled through gudamarga by the administration of medicines through oral route. Medicines are used in different forms like choorna, kwatha, sneha, lehya etc, depending on the condition of the patient.
Materials required
• Virechana oushadha
Common Drugs and dosage
1. Avipatti Choorna with honey – 20-40 gm
2. Bahushala guda
3. Trivrut lehya 20-40 gm
4. Manibadra guda
5. Patolamooladi kwatha – up to 90-180ml
6. Eranda taila preparations – 25-50 ml
• Luke warm water
Pre operative procedures
• Samyak bahya & abyantara snehana and swedana should be ensured.
• Swedana is done generally in the form of abhyanga and ooshma sveda for three days.
• Food regimen of drava ushna dhanwokta rasa should be followed
• Asta mahavarjya bhavas should be avoided.
• On the day of Virechana, the following things should be ensured before administering the medicine
1. Proper sleep in the previous night
2. Proper digestion of previous day’s food
3. Proper elimination of natural urges
Time of administration
After sleshma kala, i.e. three and half hours after sun rise.
Procedure
• Virechana oushadha is administered in empty stomach. if needed virechana drugs can be given in divided doses which should be completely administered in 15 mts.
• Proper anupanas like ushnodaka, madhu, milk, triphala kashaya, patoladi kashaya, draksha rasa, ikshu rasa etc. are used.
• Patient is advised to wash face with cold water and mouth with luke warm water and is advised to smell substances like lemon, cardamom etc to prevent vomiting .
• Patient is advised to take rest in the bed and wait till the urge for defecation occurs.
• The patient should not force or hold the urge and should use warm water for all purposes.
• Whenever he feels thirsty, he should drink little quantity of warm water sip by sip till vegas appear.
• Each vega should be observed keenly and should be informed to the doctor.
• He can take rest, but shouldn’t sleep in between the Vegas.
• Physician should record the vital data of the patient at regular intervals.
• Patient is observed for the samyak Virechana lakshana like
1. Initial expulsion of stools followed by Pitta (observed as golden yellow colored viscous fluid with a characteristic bilious odour)and at last Kapha (mucous)
2. Lightness of the body
3. Subsiding of Vega by itself without causing excessive weakness( even if kaphanta is not seen)
• If the patient doesn’t get any urge for defecation, after the previous Vega for a long time, hot water drink and mild local abdominal fomentation is advised.
• After ensuring jeernoushadhalakshanas, subsiding of Vegas, the patient is advised to take bath in lukewarm water followed by samsarjanakrama.
• Enough quantity of water is to be administered to avoid dehydration
Post- operative procedure
After getting proper appetite, samsarjana krama should be done according to satmya & vyadhi ranging from laghu drava aharas to guru ahara, as per suddhi and digestive power. Kanji with more water –kanji with less water – rice with mudga yusha –if non veg rice with meat soup is advised for 3/2/1 annakala depending on shuddhi. Three annakalas are practiced per day if agnibala is good.
Complication and management:
1. Nausea and vomiting
It may occur at the time of intake of medicine and during the procedure. To avoid the feeling of nausea, the patient is advised to smell lemon.
2. Feeble pulse, Giddiness, Collapse.
Sidhamakaradhwajam with honey and betel juice, Drakshadi kashaya, Dhanwantharam gulika can be given in this condition.
3. Adhmanam
Swedana should be done locally at abdominal region.
4. Apravrithi of Vega
Ushnajalapana, Swedana.
5. Kandu
Thrikatu with sitha is given
6. Udarasoola
Ushnajalapana, Swedana. Hinguvachadi Choorna can be given
if necessary.
7. Dehydration: tender coconut water.
8. Electrolyte imbalance: tender coconut water, chincha pani, lime juice with sugar & salt. Avoid coloured ORS solution since it cause gastritis.
Precautions:
• The selected medicine should be made palatable by adding proper adjuvant.
• Intake of kaphothklesakara ahara should be avoided on the previous day
• Virechanoushadha can be administered in divided dose within very short duration to avoid immediate vomiting if necessary.
• Time of administration should be immediately after kaphakala
• Indulgence in any other activity should be strictly avoided like watching TV, excessive talking etc.
• Intake of excess water should be avoided
• Ensure proper subsidence of vega before administering paschath karma.
