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Vamana & Virechana
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Introduction
Panchakarma- Five therapies,
shodhana in nature
Vamana & Virechana- Constitute
first two karmas: Oordhva & Adho
shodhana respectively
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VAMANA
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Nirukthi
• Vam- Udgare, Yak-set• Conveying the meaning, • Marddane• Charddane• Nissarane• Sarvanaga abhishyanda
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• 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
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Contd………
• Thatra doshharanamoordhwabhagam vamanasajnjakam (Cha.sam)
• Apkwapitta sleshmanam baladoordhwam nayethu yath Vamanam thadhi vijneyam……
(Sa.Sam.Poo)
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Vamana - Indications
Kapha
Pittasamsrishta kapha
Pitta or vata situated in
Kaphasthana
Commonly conducted in Kushta,
Shwasa,
Unmada etc.
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Classification
1. Snehapoorvaka vamana Sadyovamana.2. Mridu vamana
Madhyama vamanaTheekshna vamana
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Contd…
• In Vasanta ritu
• As a poorvakarma of rasayana
• Irrespective of the rogibala in
Visha, Gara, Ajeerna, Viruddhahara
sevana
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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
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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
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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
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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)
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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
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Vamana vidhi
Divided into 3.1. Poorvakarma2. Pradhanakarma3. Pashchatkarma
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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
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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.
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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
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Contd…
• Observe:Swedapradurbhava- liquefaction of
doshasRomaharsha- dislodging from their
seatAdhmana- reaching kukshiHridayopamarda, Hrillasa,
Asyasamsravana- upward movement
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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.
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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
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Vamana - ayoga lakshana
• Apravritti
• Adhopravritti
• Only medicine comes out
• Vega vibandha
• Arochaka, Adhmana, Kandu, Kota, Praseka, Shopha, Sheetajwara etc.
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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
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Vamana - atiyoga lakshana
• Phenila raktachandrikodgamana
• Swarakshaya, Daha, Kantashosha,
Bhrama, Moorcha, Shirahshoola,
Balahani, Agnihani
• Jeevashonita pravritti and marana
may occur
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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)
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Vyapath
• Adhmana• Kantakarshanam• Srava• Hrithgraha• Gatragraha
• Jeevadana• Vibhramsam• Sthambha• Upadrava• Klama
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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
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Vamana kalpa in different disease
• Jwara- Thathrotklishte samuthklishte
kaphapraye chale male Sahrillasa praseka annadwesha kasa
vishoochike Sadyo bhuktasya sanjathe jware
same viseshatha Vamanam vamanarhasya
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Contd…….
• Uthklishta doshas are present in amasaya
• Sneha-sweda not required or done in little intensity
• Yoga- Pippali, kalinga, Madhuka, Saindhava & Madhu
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Contd…….
• Swasa- Snehasweda done until swasavega subsides
• Uthkleshahara- Dadhi etc which provokes nocturnal attacks are avoided
• Yoga- Pippali, Saindhava & Kshoudram- vata avirodhi
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Kushtam
• Done in uthklishta doshavastha and in urdhwadehasritha kushta
• Yoga- Kutaja, Madana, YashtiPatola, nimba kashaya
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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
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Peyadi krama
Following things are given for 3,2,1 annakalas in pravara, madhyama, avara shodhana respectively:PeyaVilepiAkrita yooshaKrita yooshaAkrita mamsarasaKrita mamsarasa
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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)
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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
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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
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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
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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
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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 )
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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
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VIRECHANA
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Nirukthi
• Derived from the root “rich”.• Means causing viyoga of samparka.• Maladeradhonissaranam-virekah:• Maladernissarane thad vidhi:-virechana. (Vachaspathya)• Thathra doshaharanamadhobhagam
virechana sajnakam.
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Definition
• Thathra doshaharanamadho bhagam virechanasajnakam
(Cha)• Vipakwam yadapakwam va
maladi dravatham nayeth Rechayathyapi thajneyam rechanam………..(Sa Sam Poo)
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Types
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Virechana - indications
PittaKaphayukta pittaPittasthanagata kaphaRaktaja vyadhiCommonly used in kusta,
vatarakta, kamala, pakshaghata, shwasa etc.
In sharadrituAs a poorvakarma for rasayana
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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
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Virechana dravya
• Can be classified as Virechaka and Virechanopaga
• satmya, abeebhatsa, sugandhi, sudarshana
• Pitta- Kashaya, Madhurakapha- Mootra, Katu, Ushnavata- Snigdha, Ushna, Lavana
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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
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Contd…
• Moola - Shyama• Twak - Tilvaka• Phala - Hareetaki• Thaila - Eranda• Swarasa - Karavella• Ksheera - Snuhi (Sushruta)
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Virechana- matranirnaya
• Kwatha – Uthama – 2 pala– Madhyama – 1 pala– Heena – ½ pala
• Choornam- Uthama – 1 pala- Madhyama – ½ pala- Heena – ¼ pala (Sharngadhara)
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Virechana bheda
• Anulomana – Hareetaki
• Sramsana – Aragvadha
• Bhedana – Katuki
• Rechana – Trivrit
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Virechanadravyas according to doshabheda.
• Vatha-snigdhoshnalavana-Eranda.• Pitha-Kashaya madhura-Aragwadha.• Kapha-Katu-Danti,Snuhi. Nathisnigdhasareeraya
snehavirechanam Snehothklishta sareerasya dadyath
rookshavirechanam
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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
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Factors leading to Madhyam/Avara sudhi
• Above said mathra• Proper snehasweda• Kinchith gunaheena drugs Madhyathwa• Mandaveerya of drugs• Rooksha person• Heenamathra• Athulyaveeryayuktham
Mandavega
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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)
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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
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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
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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
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Contd…
• Frequently sip little quantities of
warm water
• Luke warm water is to be used for
cleansing
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Contd…
• Assessment- 4 types1. Vaigiki- 30,20,102. Antiki- kaphanta3. Maniki- 1,2,4 prastha4. Laingiki- sarva, madhya, alpa
lakshana
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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.
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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
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Virechana- atiyoga lakshana
• Kevala, dosharahita jala, rakta,
krishna, medomamsa dhavanodaka
like srava
• Parikartika, Hridayodveshtana,
Gudanissarana, nayana pravesha
etc.
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Virechana- pashchatkarma
• Same as that of Vamana, but
devoid of Dhoomapana
• Samsarjana krama- similar to
Vamana vidhi
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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
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Classification of purgatives.
• Based on intensity of action: Mild. Moderate. Drastic.
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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).
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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General rules
Vamana- after digestion of annaVirechana- after digestion of KaphaNo need of oushadha paka to
produce vamanaVirechana occurs during the
digestion of oushadha
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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
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Vyapath of Vamana & Virechana
Adhmana
Parikartika
Srava
Hridgraha
Gatragraha
Jeevadana
Vibhramsha
Stambha
Upadrava
Klama
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Commonly faced problems
• Vamana:
bleeding
adhopravritti
• Virechana:
apravritti
atipravritti
pratiloma pravritti
udarashoola
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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
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