Virechana is the procedure in which doshas are expelled through anal route.

• Knee high chair – 1
• BP apparatus – 1
• Stethoscope – 1
• Glass – 2
• Virechanoushadi – Q. S.
• Hot water – Q. S.

Manpower

• Physician – 1
• Attendant – 1

Preparation of tray

• Take a clean tray.
• Put virechana oushadhi, hot water in a glass

Preparation of patient

• Check vitals.
• Jeernahara lakshana assessed.
• Vegotsarga

• Shodananga snehana is done till samyak snigdha lakshana is attained. (Ref video and SOP of snehapana)
• After samyak snigdha lakshana is attained, during vishrama kala (2 days) pittavridhikara ahara is given.
• Sarvanga abhyanga and bashpa sveda is done during visrama kala and on the morning day of virechana. (Ref video and SOP of sarvanga abhyanga and bashpa sveda)

Virechana drug is administered in empty stomach after sleshma kala at 8 am.

• Pulse and blood pressure is recorded.
• Patient is asked to sit comfortably on a knee highchair.
• The virechana oushadi is given to the patient and allowed to drink.
• Once the purgative medicine has been consumed, the patient is asked to sip hot water.
• Cold water is given for drinking when the preparation of jayapala like abhayadi modaka etc. is used as a purgative medicine.
• Patient is advised to follow snehacharika vidhi. (Ref SOP of snehapana).
• Patient should be attentive to expecting purgation.
• Purgation is expected to occur after two – three hours of drug administration or till jeernoushadha lakshanas like downward movement of vayu in the intestine, a sense of well-being, proper hunger, and thirst, feeling of energy and self-confidence, lightness of the body, clarity of senses, and purity of eructation occurs.
• If the vega (bout) doesn’t commends, despite of these symptoms then hot water bag is applied on the abdominal region.
• If the purgative medicine does not get digested in time and the patient responds poorly, he should be allowed to take his food and another dose of medicine is administered on the next day.
• When the vega starts, patient is asked to sip hot water frequently.
• Also, patient is asked to note the time and number of vegas, colour and consistency of the stool.
• Number of vegas are calculated after rejecting two or three vegas.
• Purgation is continued till kapha appears (kaphanta) in the stool.

• Pulse and blood pressure is recorded.
• The level of shudhi is assessed based on vaigiki, maniki, antiki and laingiki shudhi.

• Keep the patient under observation.
• Samsarjana krama is to be followed.

• 1 hour

• Skin diseases like psoriasis, eczema, Allergic dermatitis etc
• Hemiplegia
• Bronchial Asthma
• Ascites
• Constipation
• Worm infestation
• Jaundice
• Chronic fever
• Diabetes
• Tumours
• Poisoning

• Pregnancy
• Cardiac disorders
• Acute fever
• Weak person
• Bleeding disorders
• Indigestion
• Diarrhoea
• Injury or ulceration in anal region
• Incontinence

• Should closely observe the general condition of the patient during the procedure.
• If virechana doesn’t occurs properly, then another dose of purgative should not be given on the same day. It should be given only on next day.
• Patient should not do suppression or forcible initiation of natural urges after the intake of medicine.
• Virechana oushadha should be given only after sleshma kala.

• Abdominal pain: fomentation with hot water bag.
• Dehydration: can give ORS, tender coconut water, laja tarpana, manda.
• Fainting: Splash cold water on to face, keep legs in a higher level than head, oral rehydration.
• Distension of abdomen: fomentation with hot water bag, can give dhanwantharam gulika.
• Proctitis: can apply Satadhoutha ghritha or Murivenna lepam, Avagaha swedam with triphala Kashaya.