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. 1/14-15)

For understanding the pravara, madhyama and avara śuddhi , four criterias mainly vegikī, mānikī, āntikī and laiṅgikī has been explained. The desirable number of vega (bouts) in vamana karma are 8, 6 and 4 in pravara śuddhi, madhyama śuddhi and avara śuddhi 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. Similarly virecana 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 peyādi saṃsarjana, tarpanādi saṃsarjana 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 pravara śuddhi , he has to undergo seven days of saṃsarjana krama. For madhyama śuddhi  five days and for avara śuddhi  three days.

Peyādi Anna Saṃsarjana Krama

पेयां विलेपीमकृतं कृतं च  यूषं रसं त्रीनुभयं तथैकम्|
क्रमेण सेवेत नरोऽन्नकालान्  प्रधानमध्यावरशुद्धिशुद्धः|| (A. H. Su. 18/29)

Peyā (thin gruel), vilepī (thick gruel), akṛta or kṛta yūṣa (soup) and akṛta or kṛta māṃsarasa (mutton soup) can be given to the persons who had pravara śuddhi for 3 anna kālas. For the persons who had mādhyāma śuddhi for 2 anna kālas while it should be given for 1 anna kāla in avara śuddhi.

Indication of peyādi Saṃsarjana Krama

संशोधनास्रविस्रावस्नेहयोजनलङ्घनैः||
यात्यग्निर्मन्दतां तस्मात् क्रमं पेयादिमाचरेत्| (A. H. Su. 18/46)

Soon after the elimination therapy, bloodletting, oleation, laṅghana etc. the digestive power gets impaired. Hence ‘peyādi saṃsarjanakrāma ‘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

संसर्गेण विवृद्धेऽग्नौ दोषकोपभयाद्भजेत् | (Su. Chi. 39/19)

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

अग्निसन्धुक्षणार्थं तु पूर्वं पेयादिना भिषक्|
रसोत्तरेणोपचरेत् क्रमेण क्रमकोविदः||
स्निग्धाम्लस्वादुहृद्यानि ततोऽम्ललवणौ रसौ|
स्वादुतिक्तौ ततो भूयः कषायकटुकौ ततः||
अन्योऽन्यप्रत्यनीकानां रसानां स्निग्धरूक्षयोः|
व्यत्यासादुपयोगेन प्रकृतिं गमयेद्भिषक्|| (Cha. Si. 12/6-8)

After vamanādi samśodhana 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

यथाऽणुरग्निस्तृणगोमयाद्यैः सन्धुक्ष्यमाणो भवति क्रमेण|
महान् स्थिरः सर्वपचस्तथैव शुद्धस्य पेयादिभिरन्तराग्निः|| (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 saṃsarjana krāma. Agni of a person after saṃsarjana karāma become strong and stable, can digest any kind of food.

PARIHĀRA VISHAYA

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

For attaining a samyak śuddhi, laghu bhojana, amla phala rasa, snigdha, drava, uṣṇa āhāra, jaṅgala māṃsarasa is advised to be taken as pathya. Laghu bhojana, amla phala rasa, uṣṇodaka will helps to alleviate pitta doṣa and kapha avjayārtha.

Further in viśrāma kāla: Bāhya sneha 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. 12/12)

The aṣṭa mahā doṣakara bhāvas are the eight factors which are apathya during śodhana procedures. They are uccairbhāṣya, raktakṣobha, aticaṅkramaṇa, atyāsana, ajīrṇa, ahita bhojana, divāsvapna and maithuna. As uccairbhāṣya leads to ūrdhvabhāga deha rogas. Ratakṣobha leads to sarva deha rogas. Ati caṅkrāmaṇa leads to adho deha rogas, atyāsana leads to Madhya deha rogas. ajīrṇa and ahitaśana leads to āma doṣā. Divāsvapna leads to kaphaja rogas and maithuna leads to kṣayaja rogas.

भोज्योऽन्नं मात्रया पास्यन् श्वः पिबन् पीतवानपि|
द्रवोष्णमनभिष्यन्दि नातिस्निग्धमसङ्करम्||

उष्णोदकोपचारी स्याद्ब्रह्मचारी क्षपाशयः|
न वेगरोधी व्यायामक्रोधशोकहिमातपान्||
प्रवातयानयानाध्वभाष्यात्यासन संस्थितीः|
नीचात्युच्चोपधानाहः स्वप्नधूमरजांसि च||
यान्यहानि पिबेत्तानि तावन्त्यन्यान्यपि त्यजेत्|
सर्वकर्मस्वयं प्रायो व्याधिक्षीणेषु च क्रमः|| (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 anila vega), 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 pathya āhāra and viharas has to be observed. This period is equal to the number of days required for śodhana therapy except for basti karma. The parihara kāla 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. Śamana auṣadhas should be given after Saṃsarjanakrāma.