Vamana & Virechana

Introduction

Panchakarma- Five therapies,

shodhana in nature

Vamana & Virechana- Constitute

first two karmas: Oordhva & Adho

shodhana respectively

VAMANA

Nirukthi

• Vam- Udgare, Yak-set• Conveying the meaning, • Marddane• Charddane• Nissarane• Sarvanaga abhishyanda

• Definition

• Vamana- expulsion of doshas from the upper

route

• Virechana- expulsion of the doshas from the

lower route

As they expel malas from the body, both

are called Virechana

Contd………

• Thatra doshharanamoordhwabhagam vamanasajnjakam (Cha.sam)

• Apkwapitta sleshmanam baladoordhwam nayethu yath Vamanam thadhi vijneyam……

(Sa.Sam.Poo)

Vamana - Indications

Kapha

Pittasamsrishta kapha

Pitta or vata situated in

Kaphasthana

Commonly conducted in Kushta,

Shwasa,

Unmada etc.

Classification

1. Snehapoorvaka vamana Sadyovamana.2. Mridu vamana

Madhyama vamanaTheekshna vamana

Contd…

• In Vasanta ritu

• As a poorvakarma of rasayana

• Irrespective of the rogibala in

Visha, Gara, Ajeerna, Viruddhahara

sevana

Vamana - contraindications

• By nature: pregnant, sukumara, rooksha, kshudhita, shokarta, krisha, bala, vriddha, durbala

• Diseased conditions like:Vataprakopa- Udavarta, Gulma, VatavyadhiMarmaja vyadhi- Hridroga, Mootraghata, TimiraMaharoga- Arsha, Udara

Vamana dravya

• They can be classified as vamaka and vamanopaga

• Vamanopagas like Madhu & saindhava are used in all yogas- Kaphavilayana & Chedana

• Asatmya, Beebhatsa, Durgandha, Durdarshana

• According to dosha:Kapha- Katu, Teekshna, UshnaPittayukta- MadhuraVatayukta- Amla, Sasneha

Contd…

In Charaka Samhita, 355 vamaka yogas of 6 vamaka dravyas are explained -

Madanaphala- All rogas Jeemootaka- Jwara, Shwasa Ikshvaku- Kasa, Visha, Jwara Dhamargava- Kapha, Amashayagata

Vata Kutaja- Sukumara, Hridroga, Visarpa Kritavedhana- Kushta, Pandu, Pleeha

Vamana - Matranirnaya

• Varies according to vyadhibala, agnibala, koshta and rogibala (Sushruta)

• Madanapippali- Antarnakha Mushti or suitably (Charaka)

• Kwatha- 4 pala (1/4th pala medicine)

Choorna, Kalka-1karsha (Sharngadhara)

Vamana kala

• In Sadharana kala, preferably Vasanta

• In other seasons with artificially altering the atmosphere, if necessary

[Atyayike punah karmani kamamritum vikalpya kritrimagunopadhanena…]

(Charaka)

• In an auspicious day and time• In the morning, after proper

digestion of previous day’s food

Vamana vidhi

Divided into 3.1. Poorvakarma2. Pradhanakarma3. Pashchatkarma

Vamana - poorvakarma

Snehana- done for 3-7 days till samyak snigdhata is attained

Svedana- in 2 days gap following snehana (vagbhata)

1 day gap after snehapana (others)

Kaphotkleshakara ahara- Dadhi, Matsya, Masha - on the previous day of vamana

Vamana- pradhanakarma

•Akantapana- Usually milk, sugarcane juice etc. are given. But, can be done without it after intake of yavagoo added with ghrita

•Suitable yoga- usually a combination of vamaka and vamanopaga dravyas is taken

Madanaphala - 3-12 gmsVacha - 5-8 gmsYashtimadhu- 7.5gSaindhava - 15gMadhu - Q.S.

Contd…

• After bath, patient sits on a comfortable chair

of knee-height

• Suitable dravadrayas are given for akantapana

• Vamanoushadhi is given after prayer

• Wait till 1 muhoorta, expecting vegas

Contd…

• Observe:Swedapradurbhava- liquefaction of

doshasRomaharsha- dislodging from their

seatAdhmana- reaching kukshiHridayopamarda, Hrillasa,

Asyasamsravana- upward movement

Contd…

• Gently press flanks and abdomen

• Support patient’s forehead while

vomiting

• Gently massage over his back in

pratiloma gati (upward direction)

• If vegas do not occur spontaneously,

ask the patient to stimulate vomiting

with fingers, Erandanala etc.

Contd…

• Heenavega- Pippali, Amalaki, Sarshapa, Lavanayukta Ushnodaka given repeatedly

• Assessment- 4 types1. Vaigiki- 4,6,82. Antiki- pittanta3. Maniki- 1, 1 &1/2, 2 prastha4. Laingiki- sarva, madhya, alpa

lakshana

Vamana - ayoga lakshana

• Apravritti

• Adhopravritti

• Only medicine comes out

• Vega vibandha

• Arochaka, Adhmana, Kandu, Kota, Praseka, Shopha, Sheetajwara etc.

Vamana - samyak yoga

• Kale vegapravritti• Evacuation of Sveda, Praseka,

Oushadha, Kapha, Pitta, Vata in order

• Not much discomfort• Stops automatically• Swasthata, Manah prasada,

Swarashuddhi, Laghuta

Vamana - atiyoga lakshana

• Phenila raktachandrikodgamana

• Swarakshaya, Daha, Kantashosha,

Bhrama, Moorcha, Shirahshoola,

Balahani, Agnihani

• Jeevashonita pravritti and marana

may occur

Vamana-pashchatkarma

• After samyagyoga, clean the limbs and face

• Rest for 1 muhoorta kala• Suitable dhoomapana• Tamboolasevana• Nivatagrihe shayana• Snehokta acharavidhi• Samsarjana krama (Ashtanga

Sangraha)

Vyapath

• Adhmana• Kantakarshanam• Srava• Hrithgraha• Gatragraha

• Jeevadana• Vibhramsam• Sthambha• Upadrava• Klama

Common vyapaths & Management

• Bloody streaks along with bouts – Lajatharpana with sita

• Feeble pulse, Giddiness, Collapse- Sidhamakaradhwajam with honey and betel juice

• Exhaustion- Laja ksheera, Manda, tender coconut water

Vamana kalpa in different disease

• Jwara- Thathrotklishte samuthklishte

kaphapraye chale male Sahrillasa praseka annadwesha kasa

vishoochike Sadyo bhuktasya sanjathe jware

same viseshatha Vamanam vamanarhasya

Contd…….

• Uthklishta doshas are present in amasaya

• Sneha-sweda not required or done in little intensity

• Yoga- Pippali, kalinga, Madhuka, Saindhava & Madhu

Contd…….

• Swasa- Snehasweda done until swasavega subsides

• Uthkleshahara- Dadhi etc which provokes nocturnal attacks are avoided

• Yoga- Pippali, Saindhava & Kshoudram- vata avirodhi

Kushtam

• Done in uthklishta doshavastha and in urdhwadehasritha kushta

• Yoga- Kutaja, Madana, YashtiPatola, nimba kashaya

Samsarjana krama

• Means leaving or abandoning the diet

restriction

• 2 types of samsarjana kramas- Peyadi

krama & Tarpanadi krama

• Stabilizes agni that is diminished due to

dosha shodhana, gradually

Peyadi krama

Following things are given for 3,2,1 annakalas in pravara, madhyama, avara shodhana respectively:PeyaVilepiAkrita yooshaKrita yooshaAkrita mamsarasaKrita mamsarasa

Tarpanadi krama

Indicated in alpashodhana of pitta & kapha, madyapa and in vatapitta pradhanya

Peya- svaccha tarpanaVilepi- ghana tarpana (Chakrapani)

I- annakala: lajasaktuII- annakala: jeerna shalyodanaIII- annakala: mamsarasa (Arunadatta)

Vamana in Ayurveda

Ushna, Teekshna, Sookshma, Vyavayi, Vikashi oushadhi reach Hridaya by their veerya moves through dhamanis into sarvashareera

Oushnya- vishyandana of doshasanghata

Taikshnya- vicchindana of doshasanghata

Reach amashaya & propelled out by Udana vayu due to Agni, Vayubhoota &

oordhvabhaga prabhava

Mechanism of Action- Vamana

• Central emesis- By stimulating the vomiting centre situated in Medulla

• Reflex emesis- irritation of the gastric mucosa stimulates the Vomiting centre through Vagus and sympathetic pathways

Probably both actions can be seen with the vamanoushadhi

Contd…• Vomiting is coordinated by the brain stem –

effected by neuromuscular responses in the gut, pharynx and thoraco abdominal wall

• Somatic and visceral muscles – stereotypic responses

• Inspiratory thoracic and abdominal wall muscles contract – raised intra thoracic intra abdominal pressure

• Larynx moves up, reduced gastric tone and peristalsis along with increased tone of duodenum – conditions that inhibit gastric emptying, promote vomiting

MECHANISM

• Vagal and sympathetic afferents –bilateral vomiting centre (tractus solitarius near vagus nucleus)

• Automatic motor impulses – Transmitted by 5,7,9,10,12th cranial nerves to upper GIT and through spinal nerves to diaphragm and abdominal muscles

SEQUENTIAL ANALYSIS

• OUSHADA• VEERYA ( SENSORY STIMULI- neuron or vascular

path)• HRIDAYA ( SHIRAS - ? VOMITING CENTER)• SHAREERA DOSHA

VISHYANDANA ,SVEDA,LOMAHARSHA,KUKSHISAMADMAPANA

(PARASYMPATHETIC ACTION)• HRILLASA, ASYA SRAVANA ( NAUSEA)• UDANA ACTION • VAMANA ( VOMITING )

Vamana phala

• Efficacy is compared to the destruction

of the leaves, fruit, flowers by severing

the root of a tree

• Also to the destruction of the budding

paddy by drying the water

VIRECHANA

Nirukthi

• Derived from the root “rich”.• Means causing viyoga of samparka.• Maladeradhonissaranam-virekah:• Maladernissarane thad vidhi:-virechana. (Vachaspathya)• Thathra doshaharanamadhobhagam

virechana sajnakam.

Definition

• Thathra doshaharanamadho bhagam virechanasajnakam

(Cha)• Vipakwam yadapakwam va

maladi dravatham nayeth Rechayathyapi thajneyam rechanam………..(Sa Sam Poo)

Types

Virechana - indications

PittaKaphayukta pittaPittasthanagata kaphaRaktaja vyadhiCommonly used in kusta,

vatarakta, kamala, pakshaghata, shwasa etc.

In sharadrituAs a poorvakarma for rasayana

Virechana- contraindications

• By nature: pregnant, sukumara, rooksha, kshudhita, shokarta, krisha, bala, vriddha, durbala

• Diseased conditions like:amavastha- navajwara, ajeernaadhopravritti- atisara, adhoga raktapittagudaja roga- kshataguda, muktanala

Virechana dravya

• Can be classified as Virechaka and Virechanopaga

• satmya, abeebhatsa, sugandhi, sudarshana

• Pitta- Kashaya, Madhurakapha- Mootra, Katu, Ushnavata- Snigdha, Ushna, Lavana

Contd…

• Charaka has mentioned 245 virechana yogas of 6 oushadhis:

Shyama trivrit – All rogasAragvadha – Bala, Vriddha, Ksheena,

Jwara, HridrogaTilvaka – VatavyadhiSnuhi – Pandu, DusheevishaSaptala-sankhini – Gulma, GaraDanti-dravanti – Krimi, Bhagandara

Contd…

• Moola - Shyama• Twak - Tilvaka• Phala - Hareetaki• Thaila - Eranda• Swarasa - Karavella• Ksheera - Snuhi (Sushruta)

Virechana- matranirnaya

• Kwatha – Uthama – 2 pala– Madhyama – 1 pala– Heena – ½ pala

• Choornam- Uthama – 1 pala- Madhyama – ½ pala- Heena – ¼ pala (Sharngadhara)

Virechana bheda

• Anulomana – Hareetaki

• Sramsana – Aragvadha

• Bhedana – Katuki

• Rechana – Trivrit

Virechanadravyas according to doshabheda.

• Vatha-snigdhoshnalavana-Eranda.• Pitha-Kashaya madhura-Aragwadha.• Kapha-Katu-Danti,Snuhi. Nathisnigdhasareeraya

snehavirechanam Snehothklishta sareerasya dadyath

rookshavirechanam

Factors influencing sodhanaprakara

• Alpasyapi maharthathwam prabhoothsya alpakarmatha

Kuryath samyoga vislesha kala samskara yukthibhi:

• Jalagnikeetairasprishtam…………..• Desakala…………• Eeshadadhikamathra.• Bhavana by thulyaveerya drugs.• Proper snehasweda. Theekshnathwa of bheshaja

ch ka12

Factors leading to Madhyam/Avara sudhi

• Above said mathra• Proper snehasweda• Kinchith gunaheena drugs Madhyathwa• Mandaveerya of drugs• Rooksha person• Heenamathra• Athulyaveeryayuktham

Mandavega

Factors favouring virechana.

• Virichyathe mandakaphasthu samyak.• Kaphe jeerne virechanam.• Sleshmakale gathe……….• Vigathasleshmadhathum athuram• Snehath praskandanam…Thrirathroparathah…

pibeth• Uthklishtalpa kaphathwena kshipram dosha:

sravanthi hi (su.chi33)

Virechana kala

• In Sadharana kala, preferably Sharat

• In other seasons with artificially altering the atmosphere, if necessary

• In an auspicious day and time• In post-vamana period• In empty stomach, after Shleshma

kala

Virechana- poorvakarma

• Snehana- done for 3-7 days till samyak snigdhata is attained

• Svedana- done in the gap of 3 days following snehana

• Ahara- snigdha, kapha avriddhikara like jangala mamsarasa, phalamla, yoosha etc. with ushnodaka anupana

Virechana- pradhanakarma

After snanadi karmas, give oushadha in empty stomach

Sprinkle cold water over the face to prevent vomiting

Gargle with warm water and smell fragrant substances like lemon etc.

Lie down on a comfortable bed without exposing to breeze

Contd…

• Frequently sip little quantities of

warm water

• Luke warm water is to be used for

cleansing

Contd…

• Assessment- 4 types1. Vaigiki- 30,20,102. Antiki- kaphanta3. Maniki- 1,2,4 prastha4. Laingiki- sarva, madhya, alpa

lakshana

Virechana- ayoga lakshana

• Apravritti• Oordhvapravritti• Vata, Mootra, Pureesha sanga• Utklesha of Kapha & Pitta • Avishuddhi in Kukshi & Hridaya, Chardi,

Adhmana, Aruchi, Praseka, Bhrama, Kandu, Vidaha, Agnisada, Staimitya, Pratishyaya etc.

Virechana- samyak yoga

• Kale vegapravritti• Evacuation of Vata, Mootra,

Pureesha, Pitta & Vata in order• Not much discomfort• Stops automatically• Swasthata, Manah prasada,

Swarashuddhi, Laghuta, agnivriddhi

Virechana- atiyoga lakshana

• Kevala, dosharahita jala, rakta,

krishna, medomamsa dhavanodaka

like srava

• Parikartika, Hridayodveshtana,

Gudanissarana, nayana pravesha

etc.

Virechana- pashchatkarma

• Same as that of Vamana, but

devoid of Dhoomapana

• Samsarjana krama- similar to

Vamana vidhi

Virechana in Ayurveda

Ushna, Teekshna, Sookshma, Vyavayi,

Vikashi oushadhi reach Hridaya by their

veerya moves through dhamanis into

sarvashareera

Oushnya- vishyandana of

doshasanghata

Taikshnya- vicchindana of

doshasanghata

Reach amashaya & propelled out

because of prithvi, jala mahabhootas

and adhobhaga prabhava

Classification of purgatives.

• Based on intensity of action: Mild. Moderate. Drastic.

Classification of Purgatives.• Acc. to laxative effect:• Slow onset- those which produce softening of

stool after 1-3 days of daily use- bulk laxatives, mineral oil, lactulose, dioctyl sodium succinate.

• Intermediate onset- those which lead to a soft /semisolid stool in 6-12 hrs of a single dose- saline laxatives (low dose), phenolphthalein, bisacodyl (oral), anthraquinone group.

• Rapid onset- those which lead to a watery evacuation in 2-6 hrs of a single dose. - Saline laxatives (high dose), castor oil, bisacodys (rectal).

Contd….

• Based on mechanism of action:1.Bulk forming agents-By increasing

volume of non-absorbable solid residue.2.Fecal softeners-By altering consistency

of feces.3.Osmotic laxatives-By increasing water

content.4.Stimulant laxatives-By increasing

motility and secretion.

Bulk forming agents:

• Natural or semisynthetic polysacharides.• Not absorbed when given orally.• Produce mechanical distension by absorbing

water.• Can be taken regularly for maintaining bowel

movements.• Site of action S.I& L.I.• Onset of action: 12-72hrs.• Eg: Bran,Isabgol husk,Methyl cellulose.

Fecal softeners (Surfactants).

• Cause water and fat to penetrate stool making it easier to move along.

• Produce tolerance and is ineffective with prolonged use.

• Again divided as: Lubricants. Surface wetting agents.• Site of action-S.I& L.I• Onset of action-12-72hrs.• Eg:sodium docusate,Liquid paraffin.

Osmotic laxatives. (Hydrating agents)

• They cause intestines to concentrate more water within softening the stool.

• Types-Saline. Hyperosmotic.1. Saline: Site of action-S.I&L.I. Onset of action-1/2-6 hrs in cathartic

doses.(empty stomach) -6-8hrs in lower

laxative doses.Eg:Milk of magnesia.

Contd……..

• Hyper-osmotic agents: Site of action-Colon. Onset of action-1/2-3hrs.• Eg:Glycerin suppositories &

Lactulose.• They show primary osmotic effect

in distal ileum & colon after bacterial fermentation.

Stimulant or Irritant laxatives.

• They act mainly by increasing water& electrolyte secretion by mucosa.

• They also increase peristalsis by stimulating the E.N.S.

Bisacodyl,senna.etc.• Site of action-Colon.• Onset of action-6-12hrs.

Contd…..

• Castor oil: Usual cathartic dose-15-60ml(empty

stomach) Site of action- Small Intestine. Onset of action-1-6hrs.(night use not

recommended) Ricinoleic acid reduces net absorption of fluid

and electrolytes and promotes peristalsis. Since action is on S.I evacuation is almost

complete.

Mechanism of Action- Virechana

1. Hydrophilic or osmotic action, retaining water and electrolytes in the intestinal lumen- increase volume of colonic content and make it easily expelled.

2. Acting on intestinal mucosa to reduce net absorption of water and electrolytes, intestinal transit is enhanced indirectly by the fluid bulk.

3. Increasing propulsive activity as primary action allowing less time for absorption of salt and water as a secondary effect.

Virechana phala

Efficacy is compared to the

destruction of aquatic life by

emptying the reservoir

Also to reduction of temperature in

the heat chamber by reducing fire

General rules

Vamana- after digestion of annaVirechana- after digestion of KaphaNo need of oushadha paka to

produce vamanaVirechana occurs during the

digestion of oushadha

Contd…

Mild & less quantity of oushadha- durbala, shodhita, alpadosha, krisha and ajnatakoshta

Better to give repeated shodhana in bahudoshayukta durbala rogi with alpoushadhi

Mandagni & kroorakoshta- ghrita with kshara & lavana before shodhana to control kapha & vata

Vyapath of Vamana & Virechana

Adhmana

Parikartika

Srava

Hridgraha

Gatragraha

Jeevadana

Vibhramsha

Stambha

Upadrava

Klama

Commonly faced problems

• Vamana:

bleeding

adhopravritti

• Virechana:

apravritti

atipravritti

pratiloma pravritti

udarashoola

Conclusion

Major modalities of shareera shodhana

Can be used in swastha as well as rogi as per condition

Different dravyas used, serve multiple purposes

Judicious and careful approach will fulfill the aim of Ayurveda