1. Virechana Karma
Dr Santoshkumar Bhatted
Associate Prof, Dept of Panchakarma
National Institute of Ayurveda
5/30/2013 Presentation by Dr Santoshkumar Bhatted 1
2. Effective Virechana Oushadhi
Standardization of Virechana Oushadhi on the
basis of Classification
Standardization of dose of Virechana Oushadhi
Assessment of mode of action of Virechana drugs
Assessment of Mridu, Madhyam & Tikshna
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3. Virechana dravya- as per potency
Can be classified as
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9. Best Virechana dravyas as per the
Swarasa - Karavellaka
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11. Preference and safety of use of
Use of Mild & less quantity of Aushadha- in
durbala, shodhita, alpadosha, krisha and
Better to give repeated shodhana in
bahudoshayukta durbala rogi with alpoushadhi
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13. Doses of Virechana drugs according to
Aushadhi Kalpana and Koshta
Hina Matra Madhyama Matra Uttama Matra
Kvatha ½ Pala (2
1 Pala ( 4 tola) 2 Pala (8 tola)
Churna Kalka etc. 1 tola 2 tola 4 tola
(2 tola )
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14. Dose of Virechana drug as per
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15. Qualities of Virechana dravya as
Vata – Snighdha, Ushna, Amla and Lavana
Eg Eranda Taila
Pitta – Kashaya, Madhura,
Eg Draksha Kashaya, Avipathikar Choorna
Kapha – Katu Ushna and Tikshna
Eg Trivrut, Triphala, Gomutra
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16. Selection of Virechana Yoga as per
severity of disease and strength of
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17. Examples of Mridu, Madhyama and Tikshna
Virechana Dravya as per Koshtha
Mridu Koshtha- Draksha Kashaya, Kshira, Aragvadha
Madhyama Koshtha- Trivruta
Krura Koshtha- Snuhi Kshira, Svarnakshiri, Danti
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18. Classification of Virechana dravyas
as per their action on Mala
Anulomana – Hareetaki
Sramsana – Aragvadha
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23. Trivrut Kalpa as per Dosha
Vata- Trivruta Churna with saindhava, Shunti, with the
anupana of amla dravya or Jangala Mamsarasa
Pitta- Trivruta Churna with Ghrita, Madhu, Sharkara
anupana with Draksha Kashaya
Kapha- Trivruta Churna with Trikatu, Panchakola and
Gomutra with the Anupana of Triphala Kvatha, Pilu Rasa
31. Virechana drugs -Mechanism of Action
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
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32. Classification of Laxatives
Promote and facilitate bowel evacuation;
By acting locally to stimulate intestinal peristalsis
To soften bowel contents, or both.
Types of Laxatives
A. Bulk laxatives
B. Osmotically Active Laxatives
C. Irritant laxatives—purgatives, cathartics.
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33. Classification of Laxatives
Acc. to laxative effect
1. Slow onset- those which produce softening of stool after
1-3 days of daily use- bulk laxatives, mineral oil,
lactulose, dioctyl sodium succinate.
2. 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
3. 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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34. Bulk laxatives:
Bulk-producing laxatives are not digested by
the body and therefore add bulk and water to the contents
of the intestines. The added bulk in the intestines
stimulates peristalsis, moves the products of digestion
through the intestine, and encourages evacuation of the
Distention of the intestinal wall by
bowel contents stimulates propulsive movements of the
gut musculature (peristalsis). Activation of intramural
mechanoreceptors induces a neurally mediated ascending
reflex contraction (red ) and descending relaxation (blue)
whereby the intraluminal bolus is moved in the anal
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36. Osmotically Active Laxatives:
They are soluble but nonabsorbable particles that retain
water in the bowel by virtue of their osmotic action.
The osmotic pressure (particle
concentration) of bowel contents always corresponds to that of
the extracellular space. The intestinal mucosa is unable to
maintain a higher or lower osmotic pressure of the luminal
Therefore, absorption of molecules (e.g.,
glucose, NaCl) occurs isoosmotically, i.e., solute molecules are
followed by a corresponding amount of water.
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37. Conversely, water remains in the bowel when molecules cannot be
With Epsom and Glauber’s salts (MgSO4 and Na2SO4, respectively),
-2 anion is nonabsorbable and retains cations to maintain
Mg2+ ions are also believed to promote release from the duodenal
mucosa of cholecystokinin/pancreozymin, a polypeptide that also
These so-called saline cathartics elicit a watery bowel discharge
1–3 h after administration (preferably in isotonic solution).
They are used to purge the bowel (e.g., before bowel surgery) or
to hasten the elimination of ingested poisons.
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Osmotic laxative effects are also produced by the polyhydric
alcohols, mannitol and sorbitol, which unlike glucose cannot
be transported through the intestinal mucosa, as well as by the
nonhydrolyzable disaccharide, lactulose.
Lactulose is used in hepatic failure in order to prevent bacterial
production of ammonia and its subsequent absorption
(absorbable NH3 ! Nonabsorbable NH4 +), so as to forestall
Glauber’s salt (high Na+ content) is contraindicated in
hypertension, congestive heart failure, and edema.
Epsom salt is contraindicated in renal failure (risk of Mg2+
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40. Irritant laxatives—purgatives, cathartics.
Laxatives in this group exert an irritant action
on the enteric mucosa. Consequently, less fluid is absorbed
than is secreted. The increased filling of the bowel promotes
Excitation of sensory nerve endings elicits
According to the site of irritation, one
distinguishes the small bowel irritant castor oil from the
large bowel irritants anthraquinone and diphenolmethane
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41. Small Bowel Irritant Purgative
e.g. Ricinoleic Acid (Castor oil )
Ricinoleic acid, but not the oil itself, is active. It arises as
a result of the regular processes involved in fat digestion.
Oral administration of 10–30 mL of castor oil is followed
within 0.5 to 3 h by discharge of a watery stool.
Because of its massive effect, castor oil is hardly suitable
for the treatment of ordinary constipation.
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42. It can be employed after oral ingestion of a toxin in order to hasten elimination and
to reduce absorption of toxin from the gut.
Castor oil is not indicated after the ingestion of lipophilic toxins likely to depend on
bile acids for their absorption.
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It can be employed after oral ingestion of a toxin in order to hasten elimination
and to reduce absorption of toxin from the gut.
Castor oil is not indicated after the ingestion of lipophilic toxins likely to depend
on bile acids for their absorption.
44. Large Bowel Irritant Purgatives:
They occur in the leaves (folia sennae) or fruits (fructus sennae)
of the senna plant, the bark of Rhamnus frangulae and Rh.
purshiana, (cortex frangulae, cascara sagrada), the roots of rhubarb
(rhizoma rhei), or the leaf extract from Aloe species .
Among other substituents, the anthraquinone nucleus contains
hydroxyl groups, one of which is bound to a sugar(glucose,
Following ingestion of galenical preparations or of the
anthraquinone glycosides, discharge of soft stool occurs after a
latency of 6 to 8h.
The anthraquinone glycosides themselves are inactive but are
converted by colon bacteria to the active free aglycones.
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46. Emollient laxatives:
They lubricate the intestinal walls and soften the
stool, there by enhancing passage of fecal material. Mineral oil
is an emollient laxative.
Fecal softeners promote water retention in the fecal mass and
soften the stool.
One difference between emollient laxatives and
fecal softeners is that the emollient laxatives do not promote
the retention of water in the stool.
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47. Examples of fecal softeners include docusate sodium
(Colace) and docusate calcium (Surfak).
attract or pull water into the
intestine, thereby increasing pressure in the intestine,
followed by an increase in peristalsis.
Magnesium hydroxide (Milk of Magnesia) is a saline
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48. Virechana Dravya Karmukata
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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49. PROBABLE MODE OF ACTION
The Ayurvedic Sodhana Karmas are "Physician induced mild
Mainly Virechana drugs are quite irritant to the intestinal mucosa , to cause
Due to this, the permeability of the membrane changes and those substances
come out due to the changed permeability which can not come out in
The gross signs of inflammation are redness, heat, swelling, pain and loss of
These signs occur due to three following changes at microscopic level.
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50. Hyperemia - It occurs due to capillary dilatation and arteriolar
Exudation - Exudation is the increased passage of protein rich fluid
through the vessel wall, in the intestinal tissue. The advantageous
result of fluid increases is dilution of toxins.
Increase Permeability: Some chemical factors are also responsible
which increase the permeability in response to acute inflammation.
b.Vaso active polypeptides: These causes
c.Miscellaneous agents: like Prostaglandins
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