Ayurveda is science of life and longevity. It isn’t just highlighting on prevention of diseases but in addition also encourages the maintenance of wellbeing through close consideration of balance in one’s life by right thinking, diet and way of living. It empowers one to see how to create this balance of body, mind and consciousness according to one’s own constitution. The dependable factor behind any action, procedure or execution is called as Karma (Charaka Samhita, Sutra sthan, 1/54).

Charaka has considered Vamana (emesis) and Virechana (purgation) also as Karma. According to Chakrapani, Brimhana (nourishment) etc. should also be considered as Karma. Dosha (fundamental factors), Dhatu (fundamental elements), Malas (waste product of body) and Srotas (minute channels) and etc. are helpful in the assessment of Aushadha Karma (action of drug) on the basis of their effects on Sharira (body) (Charaka Samhita, Sutra sthan, 1/49). The aim of Ayurveda is to maintain health of a healthy person and treat the diseased one. The first aim can be fulfilled by the diet and life style such as Ritucharya (seasonal regimen), Dincharya (daily regimen), Abhayanga (massage), Dhupana (fumigation), Nasya (Erhines), etc. Above all comes under the category of Karma. The second aim can be fulfilled by diet, many drugs and procedures which are described by ancient Ayurvedic sages like Vamana, Virechan, Basti, Nasya, Snehana, Swedana, etc. All these are part of Chikitsa (treatment) and goes under the heading of Karma (Charaka Samhita, Sutra sthan, 30/26).

Panchakarma (bio-purificatory methods) is a science for purification of the body. Since the vitiation of Doshas beyond a particular level produces Doshavaishamya (defect in fundamental factor) which will in general accumulate in the Srotasa (minute channels) of the body which are to be evacuated for maintaining equilibrium either at the state of health or disease. Panchakarma treats the sickness as well as keeps up all strength of the body in great and excellent way. Capacity of clearing, predominance and adequacy of the procedures focus on of Dosha eradication and large number of activities are characteristics of Panchakarma procedures. Panchakarma therapy is a systematize Samshodhana Therapy under which all methodology of purification incorporated. The Panchakarma therapy is classified as following:

■ Purva Karma (pre-procedure) - It includes the following:

1. Deepana (augments metabolism)

■ Pradhana Karma (Main therapy) - The Pradhana Karmas are as give below:

1. Vamana Karma (Therapeutic emesis )

■ Pashchat Karma (post therapy) - It includes the procedures like Samsarjana Krama (specific diet post bowel cleansing), specially planned.

Virechana Karma is a process in which waste products i.e. vitiated Doshas are eliminated through the lower channels i.e. through the anus. According to Ashtanga Sangrah, Virechana Karma is not merely a therapy for Pittaja disorders but for the Kapha, too (Ashtanga Sangrah, Sutra sthan, 27/4). The natural external route to expel out such Doshas is anal route, so in such conditions Virechana is indicated. According to Acharya Charaka, Karma is action in the form of curative efforts. It is the combination and separation which takes place at a time or simultaneously (Charaka Samhita, Sutra sthan, 1/52). Hence, present study was undertaken. Prior approval of Institutional human Ethical Committee (No. ECR/BHU/693/Inst/UP/2013/Re-registration 2017 Dt. 31.1.2017) of Banaras Hindu University was obtained before commencing clinical study.

Selection of Patients: Total no. of 40 cases have been selected from OPD and IPD of Panchakarma department, S.S.H., I.M.S., B.H.U., Varanasi through proper history taking and clinical examination prior to Virechana Karma. Only Virechana Karma Yogya subjects were selected for the Virechana Karma.

Inclusion criteria:

• Virechana Yogya individuals, as per Ayurvedic literatures. (Pitta Pradhan Vyadhi, Raktaj Roga, Shodhan Yogya Avasthaa and etc.) (Charaka Samhita, Sidhi sthan, 2/13)

Exclusion criteria:

• Virechana Ayogya individual, as per Ayurvedic literatures. (Sama Avastha (severe phase), Aashukari Roga (fast acting), Adhamarga Vegit Roga (anal urge), etc.) (Charaka Samhita, Sidhi sthan, 2/11)

Follow up study: Single follow up was taken in 15 to 21 days.

Grouping: Single group study.

Chi square test has been calculated to test the significance of difference between two categorical variables. Whereas the expected frequency will come less than five, the chi square test has been calculated by pooling the rows or columns.

Chi-square (χ2) test calculations is done on SPSS Tool developed by IBM (Version – 26 released on 09 April 2019).

▪ p<0.05 is considered statistically significant.

Clinical profile of patient

▶ Statistically highly significant difference (P<0.000) was obtained on Vaigiki Shuddhi because Maximum no. of patients i.e. 24(60%) patients showed Madhyama Shuddhi.

▶ Statistically highly significant difference (P<0.007) was obtained on Antiki Shuddhi since Maximum patients showed Kaphanta Virechana i.e. 26 (65%) patients which is the essential criteria for Samayaka Virechana.

▶ Statistically highly significant difference (P<0.000) was obtained on Laingiki Shuddhi as maximum patients showed Samyaka Lakshana i.e. 36 (90%) patients.

▶ Statistically highly significant difference (P<0.000) was obtained on Samsarjana Krama because maximum no. of patients i.e. 28 (70%) patients showed Madhyama Samsarjana Krama.

Reason of Samayaka Virechana Karma:

Samyaka Virechana Karma depends on Chikitsa Chatushpada. These Chatushpada includes Bhishag, Rogi, Dravya and Upasthata (Charaka Samhita, Sutrasthan, 9/33).

➢ Bhishag (physician) – The physician should choose the Yogya patient and explain the full procedure of Virechana Karma, assessment of Purva, Pradhahan and Pashchat Karma should be done. In case of adverse effect of the therapy, the management should be done properly. The physician should be Yuktigya/knower of the Yukti.

These four components of treatment, when they are having requisite and specific qualities helps in proper Virechana Karma in particular but if in any condition these components are not having appropriate qualities, then it will cause improper Virechana Karma which may cause complication too.

Effect of therapy:

The results obtained in above group of patients of Virechana, on each parameter are being discussed here as under;

Samyaka Suddhi Lakshana

Vata–Pitta-Kapha Nihasarana, Vatanulomana and Laghuta was observed in 36 patients (90%). Agnivriddhi was observed in 32 patients (80%). Indriya Prasadana was reported by 21 patients (52.5%). Srotoshuddhi was observed in 19 patients (47.5%). Urjas was observed in 14 patients (35%). Rugprasadan was observed in 11 patients (27.5%).

i. Srotoshuddhi (cleansing of minute channels) – When Vikrita Pitta, Kapha, Mala, etc. which are causing Marga Avarodha are expelled out through Virechana hence, Vyadhi Shamana occurs.

Reason of Ayoga Lakshana - 2 patients showed Ayoga Lakshana because one of them had taken more quantity of water with Virechana Aushadi despite of explaining the quantity to the patient which leads to vomiting of entire Virechana medicine and causes no Virechana. And for in the other patient the Koshtha analysis was not done properly and the patient had taken small quantity of Virechana Aushadi which causes less Vega Pravruti during Virechana.

Reason of Atiyoga Lakshana - Only one patient showed Atiyoga Lakshana because the patient had taken more quantity of Virechana Aushadhi even though the dose was told properly and explain by the physician himself which leads to more Vega Pravruti during Virechana. To stop the Vegas Sthambhan Aushadi (Kutajghan Vati) had given to the patient, and for electrolytes balance lukewarm water with electrode powder is given from time to time. Intake of meal was stopped for a while and patient was under proper supervision for 2 days.

Reason of Dropout - Only one patient had not completed the therapy because during Snehapana the patient was not tolerating the Abhyantara Snehana (Ghrita Pana) and left the therapy.

Probable mode of action of Virechana therapy (Charaka. Kalpasthan 1/5 – Chakrapani)

The properties of Virechana Dravyas are Ushna, Tikshna, Sukshma, Vyavayi, Vikasi etc. are mentioned in Ayurvedic classics which play a vital role in the mode of action of Virechana Karma.

1) Ushna - Ushna Guna has Agneya property and hence “Vishyandana” occurs i.e. ‘Vilininam Kurvanti’ (Chakrapani). Hence it facilitates movement of morbid Doshas towards Kostha. It also assists to Tikshana property to perform its action.

Now on the basis of above description of Virechana Dravya’s properties it can be conclude that due to their Vyavayi, Vikasi, Sukshma Guna, Virechana drugs reaches to the micro channels and by virtue of its Ushna, Tikshna Guna it scrapes out and liquefies morbid Mala and compact Doshas. In this way, Virechana Drugs brings Shakhagat Mala (impurities in limbs) to Koshtha (GIT) and consequently expels out form the body.

Virechaka drugs carry out the Virechana due to the Prabhava or Achintya Virya of drug rather than its above properties. No doubt these properties help to do so but drug should have that Prabhava. The drugs which are having Jala (water) and Pruthvi (earth) Mahabhutas dominancy have a natural tendency to go downwards and thus they can assist in induction of Virechana. If drugs are having all above said properties but if it is not having Virechaka Prabhava then it will not induce the Virechana Karma. Hence we can say, that drugs act by its active principle can be said as Virya (potency) or Prabhava not by Guna (property), but properties assist in carrying the function of drug.

Previous Researches done on Virechana karma are

1. Paradkar Hemant et al. has done observational study on 48 years old male patient to show effect of Virechana in Psoriasis (Paradkar Hemant et al., 2014).

40 patients for Virechana were registered in this out of which total 39 patients completed therapy. In this study during assessment of Virechana Karma maximum no. of patients lying under following criteria. In Vegiki, Madhyama Shuddhi was observed mainly in 24 patients. In Antiki, Kaphanta was observed mostly in 26 patients and lastly in Laingiki, Samyaka Lakshana was observed in 36 patients. In this study a highly significant relief was found in patients i.e. p<0.001.Due to Virechana mainly Vitiated Pitta Dosha and secondary Kapha dosha and Vata Dosha are being expelled out which might have accounted for better relief in Virechan Yogya individuals (Pitta Pradhan Vyadhi, Raktaj Roga, Shodhan Yogya Avastha, etc.) in the above group of patients. Panchakarma is the ultimate tool for better maintenance of health, prevention and curing of diseases. Judicious and appropriate application of Panchakarma could be the right way for our practitioners. It is upto the practitioner to choose the right method of Shodhana after assessing the disease as well as the patient. Virechana in particular can be used as a regular treatment modality for OPD and IPD patients. Many of the acute conditions can be treated by using virechana karma as a therapeutic procedure.