त्रिवृत्कल्कमक्षमात्रं यथार्हालोडनप्रतिविनीतं पाययेत् प्रसमीक्ष्य दोषभेषजदेशकालबलशरीराहारसात्म्यसत्त्वप्रकृतिवयसामवस्थान्तराणि विकारांश्च, |                                                                                                                           (Cha. Su. 15/17)

The patient should be administered one akṣamātrā of trivṛtkalka. The dose is decided, after noticing the rogabala, rogibala, agnibala, koṣṭha, auṣadhavīrya, deśa, kāla, satva, sātmya, prakṛti, vaya and sāmavasthā.

MĀTRĀ VINIŚCAYA

According to Bhāvaprakāśa and Śāraṅgadhara (Sha. Sam. U. 4/16-17)

According to Su.Chi.33

Mṛdukoṣṭha – 1 tola

Madhyamakoṣṭha – 2 tola

Krūrakoṣṭha – 3 tola

Some of the anupāna’s administered for virecana – uṣṇodaka, drākṣā rasa, triphalā kaṣāya, guḍa, harītakī kaṣāya, kaṭukikaṣāya, ikṣu rasa, gomūtra, kṣīra etc.

According to A. H. Su. 18/34

For vāta predominant diseases – virecana with dravyas having the properties of snigdha, uṣṇa and lavaṇa are administered.

For pitta predominant – kaṣāya, madhuradravyas are administered

For kapha predominant – kaṭudravyas are administered.

मात्राप्रमाणं तु खलु सर्वसंशोधनमात्राप्रमाणानि च प्रतिपुरुषमपेक्षितव्यानि भवन्ति; यावद्धि यस्य संशोधनं पीतं वैकारिकदोषहरणायोपपद्यते न चातियोगायोगाय, तावदस्य मात्राप्रमाणं वेदितव्यं भवति||                                         (Cha. Su. 15/10)

Mātrā should be in such a quantity that it should get rid of the vaikārikadoṣas and the desired effect of śodhana must be achieved without causing ayoga or atiyogalakṣanas.

TIME OF ADMINISTRATION

अथापरेऽहनि विगतश्लेष्मधातुमातुरोपक्रमणीयादवेक्ष्यातुरमथास्मै औषधमात्रां पातुं प्रयच्छेत् ||

(Su. Chi. 33/20)

According to Suśruta, in the morning after vigataśleṣmadhātu, when the person is devoid of praseka, virecanaauṣadha should be administered.

श्लेष्म–कालेगतेज्ञात्वाकोष्ठंसम्यग्विरेचयेत्॥                (A. H. Su. 18/33)

Whereas ĀcāryaVāgbhaṭa explains; virecanaauṣadha should be administered after the śleṣmakāla.

METHOD OF PERFORMING VIRECANA KARMA

Vihārās to be followed after the intake of virecanaauṣadha:

विरेचनं पीतवांस्तु न वेगान् धारयेद्बुधः |
निवातशायी शीताम्बु न स्पृशेन्न प्रवाहयेत् ||                (Su. Chi. 33/22)

After the intake of virecanaauṣadha, the person should not undergo dhāraṇa, he should reside in a room which is devoid of the direct entry of wind, he should not use śītambu, and should not pressurise himself during defecation.

OBSERVATIONS DURING VIRECANA

After the administration of virecanaauṣadha, the physician should observe for the jīrṇa, ajīrṇaauṣadhalakṣanas, hrītadoṣā and vyāpats.

Jīrṇaauṣadhalakṣanas:

अनुलोमोऽनिलः स्वास्थ्यं क्षुत्तृष्णोर्जो मनस्विता|
लघुत्वमिन्द्रियोद्गारशुद्धिर्जीर्णौषधाकृतिः||                   (Cha. Si. 6/26)

Vātanulomana, svāsthya, kṣut, pipāsā, mana prasannatā, laghutva, indriyaśuddhi, and udgāraśuddhi are the jīrṇaauṣadhalakṣanas

Ajīrṇaauṣadhalakṣanas:

क्लमो दाहोऽङ्गसदनं भ्रमो मूर्च्छा शिरोरुजा|
अरतिर्बलहानिश्च सावशेषौषधाकृतिः||                        (Cha. Si. 6/27)

Klāma, udgāra, aṅgasadana, bhrāma, mūrchā, śirorujā, arati, balahāni are the sāvaśeṣaauṣadhalakṣanas. In these lakṣanas, virecanadravyas should not be administered again as it may cause atiyoga.

Hrītadoṣā lakṣanas:

ऊर्ध्वं कफानुगे पित्ते विट्पित्तेऽनुकफे त्वधः|
हृतदोषं वदेत् कार्श्यदौर्बल्ये चेत् सलाघवे||                  (Cha. Si. 6/20)

Passing of viṭ, pitta and kapha in chronological order, achieving kārśya, daurbalya and laghutā. These are also taken as the lakṣanas of complete virecana.

———————–अप्रवृत्तौतुपाययेत्॥

उष्णाम्बुस्वेदयेद्अस्यपाणितापेनचोदरम्।
उत्थानेऽल्पेदिनेतस्मिन्भुक्त्वान्ये–द्युःपुनःपिबेत्॥

अदृढस्नेहकोष्ठस्तुपिबेद्ऊर्ध्वंदशाहतः।
भूयोऽप्य्उपस्कृस्तनुःस्नेहस्वेदैर्विरेचनम्॥                             (A. H. Su. 18/35-37)

If the vegas are not expelled properly, he should drink uṣṇambu and his udarapradeśa should be fomented with palms and made warm. If only little quantity is expelled, he should take food on that day and again virecanahas to be administered on the next day.

If the koṣṭha is not properly undergone snehana, he should be administered with snehana and svedana procedures for ten days. Then appropriate virecanaauṣadhahas to be given, after considering all aspects and memorizing the earlier effect.

पीते प्रस्रंसने दोषान्न निर्हत्य जरां गते|
वमिते चौषधे धीरः पाययेदौषधं पुनः||                         (Cha. Ka. 12/63)

If the virecanaauṣadha itself gets digested, or gets expelled by vomiting, then the physician should administer the second dose on that day itself.

यस्योर्ध्वं कफसंसृष्टं पीतं यात्यानुलोमिकम्|
वमितं कवलैः शुद्धं लङ्घितं पाययेत्तु तम्||           (Cha. Ka. 12/70)

A virecakaauṣadha may get mixed up with kapha and move upwards. This may cause vomiting. To such patients vamana and kavala should be administered for the elimination. He should be made to fast and thereafter the virecanaauṣadhahas to be administered.

Some observations during virecanakarma

During virecana karma, the consistency of the stool such as: it is hard and dry, semisolid and watery; and also, the colour of the stool should be observed thoroughly. Whether it is black, brown, green and colourless.

The patient should be observed for the symptoms like abdominal pain, burning sensation in the gudapradeśa, pain in the gudapradeśa, thirst, hunger, tiredness, giddiness, and also any mucous feeling is felt while washing after passing the vega etc.

The counting of the vegas should be done after avoiding the first two to three vegas.

SAMYAK LAKṢANAS

स्रोतोविशुद्धीन्द्रियसम्प्रसादौ लघुत्वमूर्जोऽग्निरनामयत्वम्||
प्राप्तिश्च विट्पित्तकफानिलानां सम्यग्विरिक्तस्य भवेत् क्रमेण|

(Cha. Si. 1/17-18)

According to ĀcāryaCaraka, samyaklakṣanas of virecana are clarity of body channels, clarity of sense organs, lightness of the body, patient become energetic, increase of agni (digestive power), free from disease and expulsion of faeces, pitta (bile), kapha (phlegm), and vāyu (flatus) in succession.

गतेषु दोषेषु कफान्वितेषु नाभ्या लघुत्वे मनसश्च तुष्टौ |
गतेऽनिले चाप्यनुलोमभावं सम्यग्विरिक्तं मनुजं व्यवस्येत् ||  (Su. Chi. 33/26)

According to ĀcāryaSuśruta, the person is said to be properly purged, when all the doṣas along with kapha are expelled out, when he feels light in the region of the umbilicus, gets satisfaction in the mind and downward movement of flatus is felt.

ĀcāryaVāgbhaṭasaid that samyakvirecanalakṣanas are exactly opposite of the ayogalakṣanas of virecana.

AYOGA LAKṢANAS

स्याच्छ्लेष्मपित्तानिलसम्प्रकोपः सादस्तथाऽग्नेर्गुरुता  प्रतिश्या||
तन्द्रा तथा च्छर्दिररोचकश्च वातानुलोम्यं न च दुर्विरिक्ते|                                                                                                                          (Cha. Si. 1/18-19)

According to ĀcāryaCaraka, the ayogalakṣanas of virecana are excessive aggravation of kapha, pitta and vāyu, agnisāda (suppression of agni), gaurava (heaviness of the body), pratiśyāya (rhinitis), tandrā (drowsiness), chardi (vomiting), arocaka (anorexia), absence of downward movement of flatus.

हृत्कुक्ष्यशुद्धिररुचिरुत्क्लेशःश्लेष्मपित्तयोः||
कण्डूविदाहःपिटिकाःपीनसोवातविङ्ग्रहः|
अयोगलक्षणम्———————————–||             (A. H. Su. 18/38)

According to ĀcāryaVāgbhaṭa, the ayogalakṣanas of virecana are hṛt, kukṣiaśuddhi (improper cleaning of the heart and abdomen), aruci (anorexia), kapha pitta utkleśa (salivation associated with kapha and pitta), kaṇḍū (itching), vidāha (burning sensation in the abdomen), piḍaka (eruptions on the skin), pīnasa (rhinitis), vātaviṭgraha (obstruction of flatus and faeces).

हृत्कुक्ष्यशुद्धिः परिदाहकण्डूविण्मूत्रसङ्गाश्च न सद्विरिक्ते |     (Su. Chi. 33/24)

According to ĀcāryaSuśruta, if purgationis not proper, there will be impurity in the chest and abdomen, feeling of burning sensation all over the body, irritation and obstruction of faeces and urine.

ATIYOGA LAKṢANAS

कफास्रपित्तक्षयजानिलोत्थाः सुप्त्यङ्गमर्दक्लमवेपनाद्याः||
निद्राबलाभावतमःप्रवेशाः सोन्मादहिक्काश्च विरेचितेऽति|     (Cha. Si. 1/19-20)

According to ĀcāryaCaraka, virecanaatiyogalakṣanas are diseases caused by aggravated vātaas a result of diminution of kapha, rakta and pitta, supti (numbness), aṅgamarda (body pain), klama (fatigue), vepana (tremor), nidrā abhāva (insomnia), balaabhāva (debility), tāmapraveśa (fainting), unmāda (insanity) and hikkā (hiccup).

विट्पित्तकफवातेषुनिःसृतेषुक्रमात्स्रवेत्|
निःश्लेष्मपित्तमुदकंश्वेतंकृष्णंसलोहितम्||
मांसधावनतुल्यंवामेदःखण्डाभमेववा|
गुदनिःसरणंतृष्णाभ्रमोनेत्रप्रवेशनम्||
भवन्त्यतिविरिक्तस्यतथाऽतिवमनामयाः|                   (A.Hr.Su.18/40-41)

According to ĀcāryaVāgbhaṭa, the virecanaatiyogalakṣanas are liquid material without associating any doṣas will be eliminated from the body after the elimination of faeces, pitta, kapha and vāta in the succeeding order. Such liquid material may be whitish or blackish in colour or associated with blood or the colour resembling red blood or māṃsadhāvanatulya (resembling the water in which meat has been washed) or medokhaṇḍābhameva (looks like a piece of fatty tissue) will be discharged. Other symptoms includesgudanissaraṇa (prolapsed rectum), tṛṣṇā (thirst), bhrama (giddiness), netrapraveśana (sunken eyes) and also the symptoms of excessive emesis.

मूर्च्छागुदभ्रंशकफातियोगाः शूलोद्गमश्चातिविरिक्तलिङ्गम् ||  (Su. Chi. 33/24)

According to ĀcāryaSuśruta, virecanaatiyogalakṣanas are fainting, prolapse of the rectum, excess elimination of kapha and svere pain.

सम्यक् विरिक्तं चैनं वमनोक्तेन धूमवर्जेन विधिनोपपादयेदाबलवर्णप्रकृतिलाभात्,

(Cha. Su. 15/17)

After virecana karma, all the diet and regimen mentioned for vamana karma should be followed except dhūmapāna. Soon after the karma according to the śuddhi attained for virecana the saṃsarjanakrāmahas to be followed, in order to bring back the strength and the normal state of the agni.

संशोधनाभ्यां शुद्धस्य हृतदोषस्य देहिनः|
यात्यग्निर्मन्दतां तस्मात् क्रमं पेयादिमाचरेत्||२४||(cha.si.6/24)

Soon after the karma according to the śuddhi attained for virecana the saṃsarjanakramahas to be followed, in order to bring back the strength and the normal state of the agni.

सम्यग्विरिक्तमेनंचवमनोक्तेनयोजयेत्||
धूमवर्ज्येनविधिनाततोवमितवानिव|
क्रमेणान्नानिभुञ्जानोभजेत्प्रकृतिभोजनम्||                   (A. H. Su. 18/ 42-43)

After obtaining proper signs and symptoms of purgation follow the post-operative regimen similar to emesis except dhūmapāna. Afterwards follow saṃsarjanakrāma.