जघन्यमध्यप्रवरे तु वेगाश्चत्वार इष्टा वमने षडष्टौ||
दशैव ते द्वित्रिगुणा विरेके प्रस्थस्तथा द्वित्रिचतुर्गुणश्च|
पित्तान्तमिष्टं वमनं विरेकादर्धं कफान्तं च विरेकमाहुः||
द्वित्रान् सविट्कानपनीय वेगान्मेयं विरेके वमने तु पीतम्|               (Cha. Si. 1/13-14)

For understanding the pravara, madhyama and avaraśuddhi, four criterias mainly vegikī, mānikī, āntikīand laiṅgikīhas been explained. The desirable number of vega (bouts) in vamana karma are 8, 6 and 4 in pravaraśuddhi, madhyamaśuddhi and avaraśuddhi respectively, and they are 30, 20 and 10 in case of virecana.

In terms of quantity, it is 2 prastha, 1 ½ prastha and 1 prastha in case of vamana and 4 prastha, 3 prastha and 2 prastha in virecana.

Vamana should be conducted till the appearance of pitta as well as getting proper signs and symptoms of emesis. Similarlyvirecana should be conducted till the appearance of kapha as well as getting proper signs and symptoms of purgation.

While counting the number of bouts in case of virecana, one has to start counting by leaving the first 2-3 bouts. In case of vamana the counting of bouts should be started after the expulsion of the emetic drug.

While planning the saṃsarjana krama, one has to fix accordingly to which śuddhi the person has attained after the virecana karma. Mainly there are three types of saṃsarjana: they are peyādisaṃsarjana, tarpanādisaṃsarjana and rasa saṃsarjana. Based on the annakālas the physician has to fix the number of times the patient should undergo the diet. If the person has attained the pravaraśuddhi , he has to undergo seven days of saṃsarjana krama. For madhyamaśuddhi  five days and for avaraśuddhi  three days.

Peyādi Saṃsarjana Krama

पेयांविलेपीमकृतंकृतंचयूषंरसंत्रीनुभयंतथैकम्|
क्रमेणसेवेतनरोऽन्नकालान्प्रधानमध्यावरशुद्धिशुद्धः||                                                                                                                             (A. H. Su. 18/29)

Peyā (thin gruel), vilepī (thick gruel), akṛta or kṛtayūṣa (soup) and akṛta or kṛtamāṃsarasa (mutton soup) can be given to the persons who had pravaraśuddhi for 3 anna kālas. For the persons who had mādhyāmaśuddhi for 2 anna kālas while it should be given for 1 anna kāla in avaraśuddhi.

Indication of PeyādiSaṃsarjana Krama

संशोधनास्रविस्रावस्नेहयोजनलङ्घनैः||
यात्यग्निर्मन्दतांतस्मात्क्रमंपेयादिमाचरेत्|                               (A. H. Su. 18/46)

Soon after the elimination therapy, bloodletting, oleation, laṅghana etc. the digestive power gets impaired. Hence ‘peyādisaṃsarjanakrama ‘is to be followed.

Tarpanādi Saṃsarjana Krama

कफपित्ते विशुद्धेऽल्पं मद्यपे वातपैत्तिके|
तर्पणादिक्रमं कुर्यात् पेयाऽभिष्यन्दयेद्धि तान्||                      (Cha .Si. 6/25)

When there is little elimination of kapha and pitta through purification therapy, in alcoholics and in persons with predominance of vāta and pitta doṣā, the dietary regimen called tarpaṇādi krama need to be started instead of peyādi krama, as peyādi may increase kapha causing abhiṣyanda (clogging of the channels of circulation).

Rasa Saṃsarjana Krama

संसर्गेणविवृद्धेऽग्नौदोषकोपभयाद्भजेत् |           (Su. Chi. 39/19)

Agni will increase after saṃsarjana krama. To avoid doṣakopa due to increased agni, rasa saṃsarjana krama is to be followed.

अग्निसन्धुक्षणार्थंतुपूर्वंपेयादिनाभिषक्|
रसोत्तरेणोपचरेत्क्रमेणक्रमकोविदः||
स्निग्धाम्लस्वादुहृद्यानिततोऽम्ललवणौरसौ|
स्वादुतिक्तौततोभूयःकषायकटुकौततः||
अन्योऽन्यप्रत्यनीकानांरसानांस्निग्धरूक्षयोः|
व्यत्यासादुपयोगेनप्रकृतिंगमयेद्भिषक्||                                 (Cha. Si. 12/6-8)

After vamanādisamśodhana karma, the jaṭharāgni should be made strong by giving peyā first and māṃsarasa at last. The patient should be given a sequence of rasa with snigdha (unctuous), amla (sour), svādu (sweet) and hṛdya (pleasing) food, with sour and salty taste should be given, then the food having svādu and tikta  taste and lastly the food articles having astringent and pungent tastes should be given.

Benefits of Saṃsarjana Krama

यथाऽणुरग्निस्तृणगोमयाद्यैःसन्धुक्ष्यमाणोभवतिक्रमेण|
महान्स्थिरःसर्वपचस्तथैवशुद्धस्यपेयादिभिरन्तराग्निः|| (A. H. Su. 18/30)

Just as small flame of fire gets ignited by addition of tṛṇa (dry grass), gomaya (dry cow dung), etc , in the same way the agni which has become manda due to śodhana will get increased by saṃsarjanakrāma. Agni of a person after saṃsarjanakarāma become strong and stable, can digest any kind of food.

बलं यत्त्रिविधं प्रोक्तमतस्तत्र क्रमस्त्रिधा |
तत्रानुक्रममेकं तु बलस्थः सकृदाचरेत् ||
द्विराचरेन्मध्यबलस्त्रीन् वारान् दुर्बलस्तथा |
केचिदेवं क्रमं प्राहुर्मन्दमध्योत्तमाग्निषु ||             (Su. Chi. 39/17-18)

ĀcāryaSuśruta has mentioned three types of bala. Hence saṃsarjana krama can be done by considering the strength of the patient. Therefore, the annakālas are advised accordingly. For individuals having pravarabala, three annakālas are advised, two annakāla for individuals having madhyamabala and one annakāla, for avarabala is advised.

Parihāryaviṣayas means dietic and behavioral restrictions, observed before, during and after the śodhana therapy.

For attaining a samyakśuddhi, laghubhojana, amla phala rasa, snigdha, drava, uṣṇaāhāra, jaṅgalamāṃsarasa is advised to be taken as pathya. Laghubhojana, amla phala rasa, uṣṇodaka will helps to alleviate pitta doṣa and kaphaavjayārtha.

Further in viśrāmakāla: Bāhyasneha and svedana should be done for the proper movement of the doṣas from śākhā to koṣṭha. And after virecana, depending on the śuddhi attained, saṃsarjana krama is advised as pathya.

एतां प्रकृतिमप्राप्तः सर्ववर्ज्यानि वर्जयेत्|
महादोषकराण्यष्टाविमानि तु विशेषतः||
उच्चैर्भाष्यं रथक्षोभमविचङ्क्रमणासने|
अजीर्णाहितभोज्ये च दिवास्वप्नं समैथुनम्||
तज्जा देहोर्ध्वसर्वाधोमध्यपीडामदोषजाः|
श्लेष्मजाः क्षयजाश्चैव व्याध्यः स्युर्यथाक्रमम्||               (Cha. Si. 12/10-12)

The aṣṭamahā doṣakarabhāvas are the eight factors which are apathya during śodhana procedures. They are uccairbhāṣya, raktakṣobha, aticaṅkramaṇa, atyāsana, ajīrṇa, ahitabhojana, divāsvapna and maithuna. As uccairbhāṣya leads to ūrdhvabhāgadeharogas. Ratakṣobha leads to sarvadeharogas. Aticaṅkrāmaṇa leads to adhodeharogas, atyāsana leads to Madhya deharogas. ajīrṇa and ahitaśana leads to āmadoṣā. Divāsvapna leads to kaphajarogas and maithuna leads to kṣayajarogas.

भोज्योऽन्नंमात्रयापास्यन्श्वःपिबन्पीतवानपि|
द्रवोष्णमनभिष्यन्दिनातिस्निग्धमसङ्करम्||

उष्णोदकोपचारीस्याद्ब्रह्मचारीक्षपाशयः|
नवेगरोधीव्यायामक्रोधशोकहिमातपान्||
प्रवातयानयानाध्वभाष्यात्यासनसंस्थितीः|
नीचात्युच्चोपधानाहःस्वप्नधूमरजांसिच||
यान्यहानिपिबेत्तानितावन्त्यन्यान्यपित्यजेत्|
सर्वकर्मस्वयंप्रायोव्याधिक्षीणेषुचक्रमः||                       (A. H. Su. 16/25-28)                                   

Take proper quantity of food which is simple, hot and liquid in nature, containing only little fat  and not obstructing the channels, Should take hot water for all purposes, Should maintain celibacy, Should sleep during night time only, Should not do suppression or induce natural urges (mala, mūtra and anilavega), Should not do exercise, loud speech, Avoid anger, depression and Avoid exposure to mist, sunlight, breeze.

PARIHĀRA KĀLA

This is the period of days where the proper pathyaāhāra and viharas has to be observed. This period is equal to the number of days required for śodhana therapy except for basti karma. The pariharakāla for basti karma is double the days required for the basti therapy. If basti is to administered, after virecana, then it should be given on the 9^th day after virecana. Śamanaauṣadhas should be given after Saṃsarjanakrama