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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 12  |  Issue : 2  |  Page : 139-153

Prescribing patterns of Virechana Karma in terms of Shuddhi Lakshana


Department of Panchakarma, KLEU's Shri BMK Ayurveda Mahavidyalaya, Shahapur, Belagavi, Karnataka, India

Date of Web Publication4-Jun-2019

Correspondence Address:
Dr. Shawan Barik
Assistant Professor, Department of Panchakarma, Dayanand Ayurvedic Post Graduate Medical College and Hospital, Siwan, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_69_18

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  Abstract 


BACKGROUND: The widespread use of various drugs in a single procedure and the increasing recognition of Shuddhi achieved as per the classics to provide the best result have stimulated interest in the manner in which physicians prescribe drugs. The main sources of this information can be found at the institutional-level like hospitals. These sources reveal a varied prescribing patterns in terms of drugs used for Snehapana, drugs used for Sarvanga abhyanga, and also in terms of drug selection for Virechana karma. It also reveals the pattern in the selection of dose and the duration of the treatment vary greatly among physicians according to their place, practice, disease, and the condition of the patient.
METHODS: Therefore, a prospective study was conducted from May 2016 to December 2017 at KAHER's Shri BMK Ayurveda Hospital and Research Centre, Belagavi, Karnataka, India. A total of 1138 individuals were screened among which 319 individuals were taken as per the inclusion criteria, in which 300 participants completed the study.
RESULTS: The outcome was measured on the basis of SamyakShuddhi Lakshana (SSL) of Snehana and Virechana karma. The study revealed that 51.33% of the individuals achieved avaraShuddhi, 42.33% achieved MadhyamaShuddhi, and 6.34% achieved PravaraShuddhi. In mridu koshtha, a total of 160–200 ml of ghrita intake can attain 10–11 vegas, in Madhyama koshtha total of 295–1130 ml of ghrita intake can attain 13–18 vegas, and in krurukoshtha total of 90–520 ml of ghrita intake can attain up to 21 vegas over a period of 3 or 5 days. 92.67% times Trivritleha was observed as prescribed drug which also has 30 min onset of Virechanavega with proper snehaSamyakShuddhi.
DISCUSSION AND CONCLUSION: The study is the precursor to improve prescribing patterns and quality of care and thus provides a population based approach to advance clinical pharmacology and improved health outcomes resulting from improved prescribing choices.

Keywords: Drug utility review, prescribing patterns, prospective study, Samyak Shuddhi Lakshana, Virechana Karma


How to cite this article:
Barik S, Prasad BS. Prescribing patterns of Virechana Karma in terms of Shuddhi Lakshana. Indian J Health Sci Biomed Res 2019;12:139-53

How to cite this URL:
Barik S, Prasad BS. Prescribing patterns of Virechana Karma in terms of Shuddhi Lakshana. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2019 Aug 24];12:139-53. Available from: http://www.ijournalhs.org/text.asp?2019/12/2/139/259644




  Introduction Top


The drug utilization research (DUR) is an essential part of pharmaco-epidemiology as it describes the extent, nature, and the determinants of drug exposure which facilitate the rational use of drugs or therapy in a population. Many of the questions which arise in DUR and its answers obtained are important for initiating and modifying a rational drug or therapy policy at both local and national levels. The Virechana procedure varies in terms of individual variations, the clinical conditions, and the quantum of the Dosha. Virechana procedures are meticulously applied on the basis of different parameters and proper permutation and combination of Sneha to be selected for abhyantara (internal) Snehapana, Abhyanga during the Vishrama kala, and the dose and dosage form as per the individual requirements. The prospective DUR helps to estimate the exact exposure and usage of drug (prevalence) within the selected period (incidence); it also helps in determining the extent of the drug if it is properly used, overused or underused along with any complications or allergies, if found.[1] The DUR helps in undermining the different drugs used for a similar clinical condition and its outcome to prepare a well-recommended protocol or guidelines.

Yearly, more than 300 patients undergo classical Virechana and approximately 600 patients undergo sadyaVirechana or nityaVirechana at KAHER's Shri BMK Ayurveda Hospital for the management of various disease conditions. The application of this research principle was in need for further research into the prescribing practices of physicians and a possible approach to these studies was outlined. An improved information system for the monitoring of drug consumption is a prerequisite to more detailed investigations into physicians' prescribing patterns.

The prevalence and rate of Virechana procedure is high in India, as it has been seen that till now approximately 134 postgraduate thesis and 9 postdoctoral thesis were completed on the same subject in various universities and the publications were approximately 1010 articles on Google Scholar Database, among which 25 can be found in SCOPUS database and 129 articles are in PUBMED database. It can easily be deducted that on a daily basis the prevalence rate is higher, next to that of basti procedure. In KAHER's Shri BMK Ayurveda Hospital, it has been noted that approximately 600 Virechana procedures are done each year, Depending on these, a retrospective analysis of the Panchakarma procedure on different prescription patterns was previously done, providing about 70.17% of madhyamaShuddhi, 15.78% of avaraShuddhi, and 14.03% of UttamaShuddhilakshanas, which provided a good database to study different prescription patterns.[2]

Objective

To analyze and evaluate Shuddhi Lakshana s in various patterns of Virechana karma prescriptions.


  Materials and Methods Top


The study had obtained ethical clearance as per the International Guidelines of Good Clinical Practice from the Institutional Ethics committee and the protocol number is BMK/15/PG/PK/10. It is also enrolled with Clinical Trials Registry, India (CTRI), with the number CTRI/2018/01/011391.

Design

This was a prospective observational study from May 2016 to December 2017.

Settings

Institutional care at KAHER's Shri BMK Ayurveda Hospital and Research Centre, Belagavi, Karnataka, India.

Subjects

A total of 1138 individuals were screened among which 319 individuals were taken as per the inclusion criteria, in which 300 individuals completed the study.

Intervention

Evaluation of the individuals on the basis of agni, kostha, strength of the patient, Deepana-Pachana drugs prescribed, Sneha prescribed and its SSL, the drugs used during Vishramakala, patterns in prescribing Virechana drug and its outcome has been measured on a day-to-day basis.

Methodology

The study methodology was carried out in the following phases:

  • Screening and assessment of the individuals
  • Data collection and analysis.


Screening and assessment of the patients

The study was carried out in the following ways:

Patients were thoroughly screened for clinical evaluation of agni, koshtha, and diseased condition along with evaluation of the individuals done on a day-to-day basis in terms of:

  1. Agni assessment (by taking the signs of agnivriddhi)
  2. Snehapana assessment (through Samyaksnigdhalakshanas for a maximum period of 7 days)
  3. During Vishramkala (in accordance to the pro forma)


    • Snehana assessment
    • Swedana assessment
    • Pathya assessment
    • Vishramakala


  4. During Virechanakarma:


    • The onset, number of vegas, and complications were observed, followed by assessment of Shuddhi.


Complete clinical assessment of the patients was done after Samsarjana krama for clinical evaluation of the diseased condition.

Data collection and analysis

The prescription of the patients was analyzed by the following parameters:

  1. Demographic data of the patients: The personal details of the patients such as age, sex, and prakriti were included in the study to generalize the occurrence of the diagnosed case, patients undergoing Virechana procedure, gender prevalence, and prakriti prevalence
  2. Agni and Koshtha of the patients: The agni and koshtha of the patients were assessed for further dose fixation of Snehapana and Virechana drug dose to justify the rationality of the drug used
  3. Category of Sneha used for internal Snehapana: The Snehapana drug was segregated and analyzed for SnehaSamyaksuddhilakshana for further outcome of the study
  4. Classification of Vishramakala and its outcome: data were generated on the basis of bahyaSnehana drug, type of Swedana, pathyaahara, and duration to correlate with the Shuddhi achievement
  5. Classification of Virechana drug, dose, and outcome: The data were classified on the basis of Virechana drug, dose, duration of the total treatment, onset of vegas, and their respective analysis was done
  6. Classification of complication and their correlation with drugs and prakriti: A reverse analysis of the data was carried out by the classification of complication and the respective drugs and prakriti
  7. Classification of Shuddhi achieved with Snehapana: Reverse analysis was done on the basis of Shuddhi achieved to gain insight about the drug dose given with the number of days
  8. Duration: Analysis was done on the basis of entire duration starting from the day of Deepana-pachaan to completion of Samsarjanakrama, to analyze the entire duration of the treatment in correlation to disease or healthy condition.


Inclusion criteria

  1. Patients undergoing Virechana Karma were enrolled
  2. Patients of age between 18 and 60 years irrespective of sex, caste, religion, and disease condition were included.


Exclusion criteria

  1. Patients not consenting for being included in the study
  2. Patients undergoing sadyo Virechana and nityaVirechana were excluded.



  Observation and Results Top


The study is further divided into three groups namely Group 1 as Pravara Shuddhi, Group 2 as Madhyama Shuddhi, and Group 3 as avara Shuddhi. It is further explained in tables and figures.


  Discussion Top


Disease-wise distribution of the cases shows the highest in twakvikara, Sthoulya, Vandhyatwa and amlapitta [Table 1]. In the present study, 300 patients completed the study, among which 51.33% achieved AvaraShuddhi, 42.33% attained MadhyamaShuddhi, and 6.34% achieved PravaraShuddhi [Figure 1]. The 19 patients who had not completed the study were due to pain abdomen, family crisis, commencement of menstruation cycle, or due to intake of alcohol. The following parameters were taken for analysis and discussion depending on both the observation and result.
Table 1: Disease-wise distribution of cases

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Figure 1: Age-wise distribution of subjects

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Age

The age class of 30–40 years was in the maximum range [Figure 2], as it is VataPittajakala which may lead to Pittapradhanavikara.
Figure 2: Prakriti-wise distribution of the subjects

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Prakriti

Prakriti wise it was observed that, Pitta-Pradhanprakriti is more incline to undergo Virechana[3] [Figure 3], due to their natural tendency to develop PittaPradhanvyadhi. The subjects with Kapha-Pitta prakriti having Mridu or Madhyama koshtha with Madhyama agni leads to Pravara Shuddhi with 6.16%. Vata-Pitta prakruti patients achieved the highest Madhyama Shuddhi (51.13%) which might be due to madhyama koshtha and madhyama agni, typical of these prakriti individuals. Similarly, Vata-Kapha prakruti with madhyama and kruru koshtha achieved avara Shuddhi (62.12%).
Figure 3: Koshtha-wise distribution

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Koshtha

It was observed that the individuals with madhyam koshtha is highest [Figure 4], it may be due to more number of pitta prakruti individuals.
Figure 4: Sneha as DOC for Snehapana

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Agni

All the diseases arise due to impaired agni; therefore, Agni is an essential factor for the fixation of dose of Snehapana and Virechana aushadi which is to be preceded by Deepana-pachana.[4] Agni should be same throughout the procedure as in atimandagni and atitikshnagni, Virechana medicine cannot work properly and hence the desired Shuddhi cannot be achieved.[4] In patients with 50% agni, outcome was 13.33% PravaraShuddhi, 50% madhyamaShuddhi, and 11% avaraShuddhi. With 75% agni, 3.26% attained Pravara, 43.13% madhyama, and 59.59% avaraShuddhi. With 100% agni, 5.12% attained Pravara, 42.73% attained madhyama, and 52.13% attained avarasuddhi. It all might be due to misinterpreted Deepana-pachana which were responsible for the increase of agni. Along with these, ruksha, bahuanila, krurukoshtha, and person accustomed to heavy exercise cause the drug to digest fast and produce less vega and as a result lead to falls in avara Shuddhi.[5]

Deepana-Paachana medication

It was observed that 49% of the individuals were administered chitrakadi v ati, followed by 21% with Shunthi, Jeeraka, and Ajamoda Jala and 12.33% were administered agnitundi v ati [Table 2].
Table 2: Deepana-Paachana distribution with medicine used

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Disease and Abhyanga oil

The most prevalent diseases undergoing Virechana in the tenure of the study were observed to be twakvikara, sthoulya, Vandhyatwa, and AmlaPitta; accordingly, it was observed that the drug of choice (DOC) in twak vikara was eladi taila with 52.94% followed by nalpamradi taila at 16.67%. In Sthoulya, the DOC was murchita tila taila and Mahanarayana taila at 44.73% and 25%, respectively. The DOC in vandhyatwa was observed to be murchitatilataila, Ksheerabalataila, and Mahanarayantaila at 29.54%, 27.27%, and 20.45%, respectively. Mahanarayantaila has been observed to be the highest DOC in AmlaPitta with 32% [Table 3].
Table 3: Distribution of Abhyanga oil with diagnosed diseases

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Duration of the entire treatment

The duration of the treatment, starting from the day of Deepan-pachana till the completion of samsarjanakrama in swasthapurusha (7%), has been observed as 10–11 days. In diseased condition, an average of 11 ± 5 days was observed to complete the total duration of the treatment [Figure 5].
Figure 5: Administration of Virechana Drug

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Snehapana

Snehas which are most commonly used are PanchaTiktakaGuggulu Ghrita[6],[7] [Figure 6], Tiktaka Ghrita,[8],[9] Mah ati ktaka Ghrita,[10],[11] Varunadi Ghrita,[12],[13],[14] Kalyanak Ghrita,[15] etc., which may be due to predominance of TwakVikara, Sthoulya, Vandhyatwa, etc., of the diseases. 100% achievement of sneha SSL is essential to excite the vitiated Dosha s and to move from shakha to koshtha[16] [Table 4].
Figure 6: Virechana drug as 1st dose DOC

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Table 4: Doshic predominance chief complaints with Snehapana medicine used

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Quantum of Sneha

The individuals who were in the range of 50% SSL had an total intake of 150 ml, 75% SSL individuals had an total intake of 150–300 ml, and 58.36% of the individuals having 100% SSL had an total intake of 150–300 ml [Table 5]. The level of snehana showing 100% achievement has the most variation in the total sneha intake range [Table 6]. The sneha intake range of 150-200 ml who were given virechana drug avipattikar churna (dose 20-30 g) attained vegas in the range of 10-17, while those were given trivrit leha (30-50 g) attained approximately 28 vegas [Table 7]. The subjects having attained 100% snehana for a period of 7 days attained smooth vegas with pravara shuddhi [Table 8].
Table 5: Koshtha with Virechana Vega and quantum of Snehapana

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Table 6: Quantum of Sneha

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Table 7: Quantum of Sneha with Virechana medicine and Virechana Vega

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Table 8: Distribution on the basis of Snehana 100% assessment and its outcome

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Vishramakala

It was observed that 24.9% of the individuals had a Vishramakala of 3 days, while 69.75% of the individuals had a Vishramakala of 4 days. By 4th day of Vishramakala, the Doshavileyana occurs, which gives avaraShuddhi; for PravaraShuddhi, little amount of sneha should be kept to avoid any future complication.

Vishrama Kala food regimen

21.67% of the individuals took Pittavardhak ahara,[17] which is one of the factors to be taken so that the mandaKaphaawastha[4] can be attained and less complication can be seen [Figure 7].
Figure 7: Virechana Drug as 2nd dose DOC

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Virechana 1st dose drug

Virechana dose and drug depends on the agnibala, koshtha, desha, kala, etc., The Virechana drugs which are used are Mriduvirechak dravya such as Nimbamruta Erandadi Taila and Triphala kasaya and of Madhyama virechak dravya such as trivrutlehya and in kruru koshtha, the use of tikshna virechak dravya has been used [Figure 8]. Nimba amruta erandadi taila which is tikta rasa pradhan might have been used because of increased Kapha in the body [Figure 9]. Both Haritaki churna and avipattikar churna are ruksha virechak [Table 9]; it might be in accordance to the Dosha pratyanika chikitsa. Gandharavahastadi castor oil is snigdha virechak, which is mainly used to counteract the rukshasarira and also acts in amaja conditions. Majority of the individuals (92.67%) were given Trivritleha, it might be because of its easy palatability, Snigdha, and sukha virechak, and hence less complication, and also in accordance to the desha (belgaum is an anupa desha),[18] making it a drug of choice for all seasons and it can also be used in Vata ja, Pitta ja, and Kapha ja condition with change of anupana.
Figure 8: Vaigiki-wise Distribution

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Figure 9: Samsarjana Krama-wise distribution

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Table 9: Distribution as per vegas

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Virechana 2nd drug dose

The 2nd dosage [Figure 10] has been given after the assessment of the previous Virechana dravya, when digested, but suitable result has not been achieved.[19] Nearly 18% of the subjects received 2nd dose of Virechana drug, it was further observed that among them around 40.74% received minimal 1st dose (15 g approx) and the remaining 59.25% individuals although received (35 g to 60 gm), they did not display the desired result, as the majority of the individuals, in the latter group, were predominant of sthoulya, which may lead to inadequate medicine dose as per their body weight. In some of the individuals, a repetition of 2nd dose was done with avipattikar churna as it is indicated in Pitta ja vikara and also having 16 parts of trivrut churna. The 2nd dose is advised after 1 h or 1½ hour if the Virechana vega has not started, it might be as the digestion starts and moves to small intestine after 1–2 h and it has been said Virechana should start as in “pachyamane Virechanam.”[20]
Figure 10: Antaki-wise distribution

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On the onset of VirechanaVega

In PravaraShuddhi (6.34%) (20–30 vegas), it was observed, the individuals had undergone more number of days of arohana krama of Snehapana and the Virechana started in less than 30 min [Table 10], which might be due to increased koshtha snigdhata which helps in easy evacuation. In Madhyama Shuddhi (42.33%) (10–20 vegas), it was observed the onset of vega was more than 1 h, it might be due to delayed digestion of the medicine and poor evacuation of the Dosha s [Table 11],[21] It may be kruru koshtha subjects received Mridu Virechana dravya. In avara Shuddhi (51.33%) (1–10 vega), It was observed that, the onset of vega was >1 hour it might be because of Mridu virechak drug (GHC) and less dose given.[22] Another factor was observed that around 50% of the subject belong to the age group of >50 years [Table 12]. The overall onset of virechana vega has been given in [Table 13].
Table 10: Onset of Virechana Vega with respect to Pravara Shuddhi

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Table 11: Onset of Virechana Vega on the basis of Virechana medicine and Snehapana duration in Madhyama Shuddhi

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Table 12: Onset of Virechana Vega on the basis of Virechana medicine and Snehapana duration in Avara Shuddhi

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Table 13: Prakriti wise distribution on the basis of onset of duration of Virechana Vegas

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Antaki Shuddhi

In avaraShuddhi, 40% achieved Kaphanta [Figure 11] and [Table 3], while in both madhyama and PravaraShuddhi, 100% Kaphanta was observed. As observed, a mean of 9th vega onwards, the subjects were seen with Kaphanta, it may be due to the natural barrier of the large intestine with mucous along with the Kapha which are accumulated in the koshtha from the sakha. The main function of the mucosal layer of the Large Intestine is the protectiveness from external factors which is an indicator for Samyak virchak.[23],[24] Kaphanta should not be the only criteria for the stoppage of Virechana and in the assessment of SSL, it was said by the acharya that even if the subject achieved early Kaphanta, the physician must continue the vega till the achievement of other SSL like karsya, dourbalya, laghuta.[25]
Figure 11: Total days for the entire plan of care

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Prakriti of an individual and onset of Virechanavega

It was observed that in Kapha-Pittaprakriti (48.67%) the onset duration is between 30 min and 1 h [Figure 12], which may be due the koshtha of that prakriti individuals, which are Mridu or madhyamatara and also the agni of those individual are in madhyama avastha. In individuals with Kapha-Vata (20.67%) and Pitta-Vata (30.67%), it was observed to be more than 1 h, some the Virechana may start in the evening, and it may be due their koshtha, which are madhyama or madhyamatama [Figure 13]. In some cases (~1%), it was observed that the onset starts after evening, it is due to the lodging of Kapha in the urahpradesh, which is dislodged in the evening or night due to liquification and then the vega starts [Figure 14] and [Table 14].[26]
Figure 12: Prakriti-wise distribution on the basis of onset duration of Virechana Vega

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Figure 13: Complication with special reference to Prakriti

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Figure 14: Distribution on the basis of Snehana 100% assessment and its outcome

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Table 14: Vaigiki Shuddhi assessment with special reference to Prakriti

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Koshtha with Virechanavega and quantum of Sneha

Individuals with Mridukoshtha were observed to have 3 days of Snehapana with quantum of 160–200 ml and attaining 10–11 vegas. In Madhyamakoshtha, no such specificity was observed. In krurutarakoshtha, 5 days of Snehapana with the range 295 –1130 ml had achieved [Table 5] 13–18 vegas, while in krurutamakoshtha, 3 days of Snehapana, with 90–520 ml of Sneha intake had achieved up to 21 vegas.

Snehana drug and its complication

It was observed that KalyanakaGhrita (31.57%) had the highest complication, in this study, with the individuals of madhyamatarakoshtha and 75% of agni, with complication of chardi, angamarda, shiroshula, it may be due to excessive kaphotklesha, leading to diminished state of agni in the latter stage of the procedure.[27] It was also observed that sukumarghrita (10.52%) and VarunadiGhrita (5.2%) cause the complication of loose stool, which is taken as varchasnigdhata, an early Samyaksnigdhalakshana of Snehana giving a 100% achievement of Snehana SSL. Sukumarghrita shows early signs of loose stool, as one of its ingredients is castor oil, which acts anulomana, hence the early sign of varchasnigdhata. Individuals who were subjected to dadimadiGhrita (5.26%) had chardi and shiroshula, which may be in accordance to their diseased condition, krurukoshtha, with age more than 50 years and 50% of agni leading to the condition of increased Vatapradhanatwa in the body, ahridya, and BahuDoshaawastha.[27] It may be also due to the complication of drug manufacturing defect, as the SSL also depends on the nature of the recipe, virya of the drug along with both the strength of the patient and disease [Table 15].
Table 15: Drug wise distribution of complication with respect to Agni and Koshtha

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Prakriti and nature of complication

It was observed that Kapha-Pittaprakriti (52.63%) individuals are comparatively more prone to lalapraseka, or excessive salivation of the mouth, which is mistaken with complication such as vomiting and also generalized weakness and sometimes pain in the calf muscles, but all these factors were observed to be self-limiting, and without any intervention, the said complaints were diminished in the next two vegas [Figure 12]. In the Pitta-Vata (31.57%) and Kapha-Vata (15.78%) prakriti, it was observed that the individuals suffered from headache, vomiting, and pain abdomen, which may be due to diminished agni and inappropriate kala in giving the Virechana medication, Like in Pitta-Vataprakriti and Vata-Kaphaprakriti, it is advised to give the medication before sunrise or after sunset, so the body can tolerate it,[28] though appropriate time for giving Virechanakala is sleshmakalagate [Table 16].
Table 16: Complication with special reference to Prakriti

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100% Snehana SamyakShuddhi Lakshana and its outcome

It was observed that 85.67% of the total individuals attained 100% of Shuddhi SSL [Figure 15], still 51.36% had attained avaraShuddhi, 43.57% attained MadhyamaShuddhi, and 5.05% in PravaraShuddhi [Table 14]. It was also observed that the more number of days of arohanakramaShuddhi can lead to PravaraShuddhi outcome, keeping in mind the achievement of Sneha SSL. In snigdhasarira, instead of arohana kramashodhanartha Sneha of high dose, small dose with more number of Snehapana days had provided with PravaraShuddhi. The above-said Shuddhi has been achieved with low dose of madhyamVirechanadravya such as trivritleha and Virechanopagadravya like drakshajala as anupana.[29],[30] Although 100% of sneha SSL was achieved, still 51.36% of the individuals attained avaraShuddhi, which may be due to factors such as Rogabala, Rogibala, agnibala, koshtha, aushadivirya, and Dosha.[31] In the incidence of avaraShuddhi outcome, it was also observed due to disease such as Vatavyadhi (8.33%), in which Mridu Virechana is advised and in AmlaPitta (8.67%) where there is diminished agni and excessive aggravated Pitta, and it is advised to use mandaviryavirechak drug.[32]
Figure 15: Vaigiki Shuddhi assessment with special reference to prakriti

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Duration of Virechanavega

It was observed that in majority of the individuals, the Virechanavega was completed in the Pittakala of the day. In Vata-Pitta and Vata-Kaphaprakriti, which are 29% and 22%, respectively, the Virechana vegas complete to the maximum within 5–8 h, which is the Pittakala of the day [Table 17]. In Vata-Pittaprakriti individuals, 44.31% completed within 8 h and Vata-Kaphaprakriti individuals (43.93%) completed in 5 h. In Kapha-Pittaprakriti (49%), the range of Virechanavega duration varies from < 2 h to more than 14 h, where the majority of the individualsfall in the Pittakala [Figure 16]. The exception of 50% having extended duration in between the vegas throughout the day, which increases in frequency after 8 h of onset, may be due to the excessive Kapha or the lodging of Kapha in the chest, which liquefies in the evening or night and the vegas start increasing in frequency.[33]
Table 17: Prakriti wise entire duration of Virechana

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Figure 16: Prakriti-wise entire Duration of Virechana Vega

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Overall efficacy of the disease

In the overall efficacy of the disease, it was observed that immediately after Virechana, the disease like twakvikara has an efficacy of 70% which is reduced to 60% after samsarjana, may be due to the accountability of the subject in not following the proper regime [Table 18]. In sthoulya, the weight has been maintained in both after Virechana and after samsarjana with the overall efficacy of 50%, while in vandyatwa, shodhana procedure is the paschatkarma of the vajikarana treatment; therefore, the efficacy was observed to increase from 50% to 60% after samsarjanakrama. In Vatavyadhi, there is indication of MriduVirechana, still the patients achieve 60% efficacy after the treatment, which reduces to 50% after samsarjanakrama, which may be due to the RogaDosha, bala of vyadhi, and bala of Rogi. In AmlaPitta, the efficacy immediately is 40% which increases to 50% after samsarjanakrama, which may be due to correction of Pitta and agni, afterward. It was also observed in the scenario of swasthapurusha, that after the sodhana, its efficacy is 50%, which increases to 65% after samsarjanakrama along with a heightened immunity is observed in the individuals, it establishes the advised notion of our body to undergo ritushodhana [Figure 17].
Table 18: Overall efficacy of the disease (as per the prescriptions) - After Virechana and after Samsarjana

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Figure 17: Overall efficacy of the diseases (as per the prescriptions) - After Virechana & After Samsarjana

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Effect of Virechana on erythrocyte sedimentation rate

No significant changes were observed in the erythrocyte sedimentation rate, irrespective of Shuddhi [Table 19] and [Figure 18].
Table 19: Comparisons of three study Groups (1, 2, 3) with respect to erythrocyte sedimentation rate scores at before and after treatment by Kruskal-Wallis ANOVA

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Figure 18: Erythrocyte sedimentation rate comparison in three groups

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Effect of Virechana on lipid profile and serum electrolytes

Virechana procedure is bringing the dhatusamyata or homeostasis in the body [Table 20], [Table 21], [Table 22], [Table 23], [Table 24], [Table 25], [Table 26]. The abnormal values were corrected to normal range, whereas the normal values were maintained within the normal range. In the incidence of complication, it was observed that the electrolytes were undisturbed and maintained as per the Shuddhi.
Table 20: Effect on lipid profile mean within normal limit

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Table 21: Effect on lipid profile mean in abnormal values

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Table 22: Effect on serum electrolyte mean within normal limit

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Table 23: Effect on serum electrolytes mean in abnormal values

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Table 24: Aspect of lipid profile in subjects with complication having mean values within normal limit

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Table 25: Aspect of serum electrolyte in subjects with complication having mean values within normal limit

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Table 26: Normality before and after treatments scores of all parameters in three study Groups (1, 2, 3) by Kolmogorov-Smirnov test

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  Conclusion Top


To attain PravaraShuddhi, low dose of Madhyama Virechana dravya and Virechanopaga is ideal, when the body has attained snigdhata by medium dose of arohana Snehapana for 6–7 days. Trivritleha was observed to have 30-min onset of Virechanavega with proper Sneha Samyak Shuddhi. The individuals were in the range of 50% SSL had an total intake of 150 ml, in the range of 75% SSL individuals had an total intake of 150–300 ml, and 58.36% of the individuals having 100% SSL had an total intake of 150–300 ml. Mridukoshtha with 160–200 ml of Sneha intake for 3 days can attain 10–11 vegas. In krurutarakoshtha, with a range of 295 ml–1130 ml for 5 days of Sneha intake can achieve 13–18 vegas. In krurutamakoshtha, 3 days of Snehapana with 90–520 ml of Sneha intake can be achieved up to 21 vegas. The early Kaphanta can cause bias and is not the only criteria for stoppage of vega; therefore, other Samyak Shuddhi Lakshana should be taken into consideration such as laghuta and dourbalya for the stoppage of vega. In the overall efficacy of the disease, the highest immediate effect was drawn in twak vikara (skin disorders) with 70%, while highest effect retain after Samsarjana krama was in swastha purusha with 65%. Virechana procedure maintains the dhatu samyata or homeostasis in the body; this can be observed with the lipid profile and serum electrolyte values.

Acknowledgment

KAHER'S Shri BMK Ayurveda Mahavidyalaya PG Studies & Research Centre And KLE Ayurveda Hospital, Belagavi, Karnataka.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Introduction To Drug Utilization Research, Sources Of Data On Drug Utilization, Printed in Oslo, Norway: World Health Organization; 2003. p. 13-9.  Back to cited text no. 1
    
2.
Chaudhary A. Dissertation, Submitted to KAHER's Deemed-To-Be University, Study on Various Patterns of Panchakarma Practice and Their Outcome: A Retrospective Data Analysis; 2016.  Back to cited text no. 2
    
3.
Shastri Paradakara Vaidya BH, editor. Sutrasthana: Vagbhata, Ashtangahrdayam Sarvanga Sundari Commentary of Arunadatta and Ayurveda Rasayana Commentary of Hemadri. 9th ed., Ch. 1, Ver. 25. Varanasi: Choukhambha Orientalia; 2005. p. 20.  Back to cited text no. 3
    
4.
Sharma RK, Dash B. Siddhisthana. Agnivesha Charak Samhita. 1st ed., Vol. 6, Ch. 1, Ver. 9. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 142-3.  Back to cited text no. 4
    
5.
Sharma RK, Dash B. Kalpasthana. Agnivesha Bharak Samhita. 1st ed., Vol. 6, Ch. 12, Ver. 79-80. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 127.  Back to cited text no. 5
    
6.
Tripathi B. Chikitsasthana. Vagbhata's Astanga Hrdayam. 1st ed., Ch. 21, Ver. 57-60. New Delhi: Chaukhambha Sanskrit Pratisthana; 2007. p. 811.  Back to cited text no. 6
    
7.
Nishteshwar, Vidyanath R. Sahasrayoga Textbook. 4th ed., Ch. 2, Ver. 3. Varanasi: Chaukhamba Sanskrit Series Office, 2014. p. 60.  Back to cited text no. 7
    
8.
Bhisagratna GD. Commenter Vaidya Shri Ambika Datta Shastri, Translator by Lochan K, Ratnavali B. 1st ed., Vol. 3, Ch. 54, Ver. 239-242. New Delhi: Chaukhambha Publication; 2009. p. 79.  Back to cited text no. 8
    
9.
Nishteshwar, Vidyanath R. Sahasrayoga Textbook. 4th ed., Ch. 2, Ver. 1. Varanasi: Chaukhamba Sanskrit Series Office; 2014. p. 58.  Back to cited text no. 9
    
10.
Bhisagratna GD. Commenter Vaidya Shri Ambika Datta Shastri. Translator by Lochan K, Ratnavali B. 1st ed., Vol. 3, Ch. 54, Ver. 243-249. New Delhi: Chaukhambha Publication; 2009. p. 80.  Back to cited text no. 10
    
11.
Nishteshwar, Vidyanath R. Sahasrayoga Textbook. 4th ed., Ch. 2, Ver. 2. Varanasi: Chaukhamba Sanskrit Series Office; 2014. p. 59.  Back to cited text no. 11
    
12.
Bhisagratna GD. Commenter Vaidya Shri Ambika Datta Shastri. Translator by Lochan K, Ratnavali B. 1st ed., Vol. 2, Ch. 36, Ver. 65-67. New Delhi: Chaukhambha Publication; 2009. p. 497.  Back to cited text no. 12
    
13.
Bhisagratna GD. Commenter Vaidya Shri Ambika Datta Shastri. Translator by Lochan K, Ratnavali B. 1st ed., Vol. 2, Ch. 46, Ver. 21-22. New Delhi: Chaukhambha Publication; 2009. p. 743.  Back to cited text no. 13
    
14.
Nishteshwar, Vidyanath R. Sahasrayoga Textbook. 4th ed., Ch. 2, Ver. 27. Varanasi: Chaukhamba Sanskrit Series Office; 2014. p. 65.  Back to cited text no. 14
    
15.
Nishteshwar, Vidyanath R. Sahasrayoga Textbook. 4th ed., Ch. 2, Ver. 28. Varanasi: Chaukhamba Sanskrit Series Office; 2014. p. 81.  Back to cited text no. 15
    
16.
Sharma RK, Dash B. Siddhisthan. Agnivesha Charak Samhita. 1st ed., Vol. 1, Ch. 13, Ver. 58. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 258-9.  Back to cited text no. 16
    
17.
Sharma PV. Chikitshasthana. Samhita Sushruta. 1st ed., Vol. 2, Ch. 31, Ver. 20. Varanasi: Choukhambha Visvabharati; 1999. p. 509.  Back to cited text no. 17
    
18.
Sharma RK, Dash B. Kalpasthana. Agnivesha Charak Samhita. 1st ed., Vol. 6, Ch. 7, Ver. 5-6. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 59.  Back to cited text no. 18
    
19.
Sharma RK, Dash B. Kalpasthana. Agnivesha Charak Samhita. 1st ed., Vol. 6, Ch. 12, Ver. 55. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 119.  Back to cited text no. 19
    
20.
Sharma RK, Dash B. Kalpasthana. Agnivesha Charak Samhita. 1st ed., Vol. 1, Ch. 12, Ver. 62. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 122.  Back to cited text no. 20
    
21.
Sharangadharacharya. Translator by Shrivastava S, Samhita S. 1st ed., Ch. 14, Ver. 13-14. Varanasi, Uttarakhand: Chaukhambha Orientalia; 2014. p. 342.  Back to cited text no. 21
    
22.
Sharma RK, Dash B. Kalpasthana. Agnivesha Charak Samhita. 1st ed., Vol. 6, Ch. 12, Ver. 56. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 119-20.  Back to cited text no. 22
    
23.
Patil VC. Principles & Practice of Panchakarma. 5th ed. Pune: Chaukhamba Sanskrit Sansthan; 2015. p. 396.  Back to cited text no. 23
    
24.
Sharma RK, Dash B. Siddhisthana. Agnivesha Charak Samhita. 1st ed., Vol. 6, Ch. 1, Ver. 14-15. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 146.  Back to cited text no. 24
    
25.
Sharma RK, Dash B. Siddhisthana. Agnivesha Charak Samhita. 1st ed., Vol. 6, Ch. 6, Ver. 19-20. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 266-7.  Back to cited text no. 25
    
26.
Sharma RK, Dash B. Kalpasthana, Agnivesha Charak Samhita. 1st ed., Vol. 6, Ch. 12, Ver. 74. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 126.  Back to cited text no. 26
    
27.
Sharma RK, Dash B. Siddhisthana. Agnivesha Charak Samhita. 1st ed., Vol. 6, Ch. 6, Ver. 32-34. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 272.  Back to cited text no. 27
    
28.
Shrikant Murthy KR. Chikitshasthana. Samhita Sushruta. 1st ed., Vol. 2, Ch. 31, Ver. 22-23. Varanasi: Choukhambha Orientalia; 2008. p. 294.  Back to cited text no. 28
    
29.
Sharma RK, Dash B. Sutrasthana. Agnivesha Charak Samhita. 1st ed., Vol. 1, Ch. 13, Ver. 69. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 260.  Back to cited text no. 29
    
30.
Sharma RK, Dash B. Kalpasthana. Agnivesha Charak Samhita. 1st ed., Vol. 6, Ch. 12, Ver. 47-48. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 117.  Back to cited text no. 30
    
31.
Sharma RK, Dash B. Sutrasthana. Agnivesha Charak Samhita. 1st ed., Vol. 1, Ch. 15, Ver. 10. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 292.  Back to cited text no. 31
    
32.
Shrikant Murthy KR. Chikitshasthana. Samhita Sushruta. 1st ed., Vol. 2, Ch. 33, Ver. 32. Varanasi: Choukhambha Orientalia, 2008. p. 314.  Back to cited text no. 32
    
33.
Sharma RK, Dash B. Kalpasthana. Agnivesha Charak Samhita. 1st ed., Vol. 6, Ch. 12, Ver. 74. Varanasi: Chowkhamba Sanskrit Series Office; 2008. p. 126.  Back to cited text no. 33
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17], [Table 18], [Table 19], [Table 20], [Table 21], [Table 22], [Table 23], [Table 24], [Table 25], [Table 26]



 

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