Virechana In Management Of Abnormal Uterine Bleeding Susruta Ayurveda

Virechana Karma is the specific treatment for the regulation of Pitta and Kapha Samsargaja Pitta. Other than this as per Charaka, Asrigdara is a Rakta-Prdoshaja Vikara. in the treatment Rakta-Prodoshaja Vikara a Virechana is superior among all. Kashyapa had described that Virechana therapy, mitigates vitiated Pitta and Rakta Doshas and maintains the healthy state of Aamashaya, Pakwashaya, and Garbhashaya. It is a bio cleansing method meant to clean the obstruction of Srotas. Virechana normalises Pitta Dosha condition.

Virechana Karma:

Etymology: The word Virechana components

  विरेचन: वि उपसर्ग + रिच (धातु) + (ल्युट प्रत्यय) मलादे: निसरण ||

i.e., By applying „Lyuta‟ Pratyaya to „Rechana-rich‟ Dhatu word “Rechana” is formed that means „Mala Bhedana‟ (expelling out the Malas).

  विरेचन:वि +रिच + णिच- ल्युट | विशेषेण रेचयतिती ||

The word ‘Rechana’ commonly stands for evacuation

Definition:

तत्र दोषहरणमूर्ध्वभागं वमनसञ्ज्ञकम्, अधोभागं विरेचनसञ्ज्ञकम्;
उभयं वा शरीरमलविरेचनाद्विचनसञ्ज्ञां लभते||
(Ch.Ka.1/4)

Elimination of Dosha through the Adhobhaga (Guda) considered as Virechana Karma.

Benefits of Virechana:

विरेचनं पित्तहराणां || (Cha. Su.25/40)
विरेचनं तु सर्वोपक्रमेभ्यः पित्ते प्रधानतमं मन्यन्ते भिषजः|| (Cha. Su.20/16)

Virechana is among the main procedures out of all Panchkarma, especially for the elimination of Pitta dosha. In Ashtanga Samgraha, commentator Indu said that Virechana indicated for Shleshma Sanshrusta Pitta dosha and Pittasthanagata Prakupita Shleshma or Shleshmasthanagata Prakupita Pitta, too.

Samshodhana:

संशोधनमिह वमनं न विरेकः” इत्यपरे, कुतः? विरेचनेन हि पित्तक्षयादार्तवस्य क्षय एव स्यादिति, वमनेन तु सौम्यधातौ निर्हृते आग्नेयधातौ वृद्धे आर्तवमाप्याय्यते|  (Su. Su 15/12) Dalhana

Shamshodhan stands for the elimination of toxins from tissues. The prime Shodhana protocol indicated in this condition is „Vamana‟; if the predominant Dosha is Kapha, and „Basti‟; if the same is Vata for its Anulomana. Though „Virechana‟ is effective for Kapha Dushti to a certain extent and Vatanulomana. Virechana has a direct effect on Agnisthana and it pacifies the vitiated Kapha and Vata Dosha and has the quality of Srotovishodhana and helps to normalize the Pratiloma Gati of Vata, which produces symptoms like Vibandha, Kukshikathinya, Kukshi Shoola, etc. It has got much wide scope to be effective in many diseases with a varied involvement of Dosha and Dushyant.

The scope of Virechana is as follows.

Dosha: Pitta, Pitta Sthanagata Alpa Kapha, Kapha Sthanagata Bahu Pitta, Pittavrita Vata, Sannipata (Bhela).

Dushya: Rasa, Rakta, Mamsa, Asthi, Majja, Shukra Dushtiiii

Srotas: Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Majjavaha, Artava Vaha Srotas.

In the treatment of Apana AavritVata, Acharya Charaka mentioned Vatanulomana and Pakvashaya–Vishodhana. Therefore, Virechana is the best line of treatment for Pittavrita Apana i.e., Asrigdara.

Line of treatment of Asrigdara (Abnormal Uterine bleeding)–

अपानेनावृते सर्वं दीपनं ग्राहि भेषजम्|
वातानुलोमनं यच्च पक्वाशयविशोधनम् || (Ch. Chi 28/43)

मपानं चानुलोमयेत् || (Ch. Chi 28/43)

Shodhana therapy is the most important measure for Bahudoshaja Vyadhi. If Doshas are depleted with Shamana therapy, there is a chance to provoke that Doshas again, but if they are removed by Shodhana therapy, there is no chance to provoke again. (Apunarbhava) (Ch. Su. 16/20).

Virechana is the most important appraise for Pitta. It is a specific modality for the elimination of Pitta Dosha but it is also effective upon Vata & Kapha Dosha as well as Rakta.

Poorva Karma:

Deepana-Pachana: Sunthi, Guduchi, Haritaki (1:2:2=5gm BD) before food with luck warm water.
Snehapana: Go-Ghrita 30ml/day increasing dose for 5 to 7 days with luck warm water (As per Koshtha & Agni)
Abhyanga: With BalaTaila for 3 days
Swedana: Bashpa Sweda for 20 minute per day for 3 days.

Importance of Deepana -Pachana:

The purpose of Shodhana is to eliminate out morbid Doshas from the body. These Doshas remain adherent with Dhatus in their Sama condition. To detach them from tissues, they should be free of Ama’s condition. So, Before Snehapana, mild medicines which stimulate the digestive fire and cause lightness of Koshtha are used. Deepana isolates Doshas from tissues, which can then be moved to Koshtha for their expulsion.

Snehpana Karma:

विरेचनमपि स्निग्धस्विन्नाय|| (Su.Chi.33/19)

Snehapana plays a vital role in any type of Shodhana Karma. Snehana has properties like Vishyandana, Kledana, etc., which help in dissolving the vitiated Dosha.

The time limit for Snehapana as per Koshtha:

Koshtha is the deciding factor for the time limit of Snehapana in a patient. To get a proper idea of the Koshtha of a person, firstly, Hrasiyasi Matra (Small test dose) of Sneha is administered. After ascertaining the Koshtha in this way, further doses of Sneha are prescribed accordingly. Generally, it takes three, five, and seven days respectively for the oleation of persons having Mridu, Madhyama, and Krura Koshtha. After this duration, Sneha becomes accustomed to the body and does not excite Doshas anymore.

Regimen in Snehapana:

Warm water used for all purposes
Celibacy – observed
Day sleep and awakening at night -avoided.
Natural urges should not be with holed.
Exercise, Anger, exposure to wind – avoided.
Anabhishyandi, liquid, hot diet mixed with slight unctuous substances – taken.

Observations during Snehapana:

During the period of Snehapana, the Patient observed for the appearance of Samyak Snigdha Lakshana like Vatanulomana, Diptagni, Snigdha, and Asamhat Varcha, Snigdhangata, etc.

Abhyanga – Swedana:

After Samyak Snigdha Lakshana , Sarvanga Abhyanga Swedana (whole-body massage and fomentation) – for 3 days during Vishrama Kala (Intermediate days between completion of Snehapana and Virechana).

Need of Snehana and Swedana:

Emphasizing the role of Snehana and Swedana as preparative procedures, Charaka quoted that as in a vessel smeared with oil, water slips down without efforts; similarly, Kapha and other Doshas slip out easily in the body that has undergone Snehana therapy. as the fire makes the water in moist wood trickle out from every pore, similarly Swedana (Sudation) causes the adhered toxic matter to melt and flow out in a person who has been previously oleate.

Action of Abhyanga and Swedana

Snehana moistens and liquefies the Doshas and Swedana disintegrates them responsible for Vilayana of Doshas. According to Vagbhata, by the action of Snehana and Swedana, the morbid Doshas are liquefied and dissolved in Sneha and brought to Koshtha.

Charaka quoted that by Vriddhi (increase), Vishyandana (dissolving), Paka (digesting) Strotomukhavishodhana (Clearing the orifice of channels), and Vata Nigraha (regulating the movement of Vata); the morbid Doshas brought back from Shakha to Koshtha. Here, Snehana and Swedana act on every aspect of the above processes.

Pradhana Karma:

Pradhana karma includes the following steps:

Administration of Virechanaushadha (Trivrita Avaleha 80 to 100 gms)along with Draksha Jala.
Observation and management during Virechana Vega

Administration of Virechanaushadha:

After Samyak Snehana Swedana
When the patient is cheerful, slept well and has completely digested previous meal, and empty stomach
After Swastivachana
Assessment of vitals prior to drug administration
Virechanaushadha is administered when natural time of Kapha aggravation has passed.
On the day of Virechana, nothing should be eaten as medicine may be covered with food. In this condition, vomiting may occur and medicine will induce Virechana late in the day.

Shuddhi Lakshana (Level of Purification):

According to Chakrapani, four types of Shuddhi viz. Laingiki, Antiki, Vaigiki, and Maniki – monitored. Special attention to Laingiki Shuddhi.

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

Table no: 4.1 Criteria for Vaigiki, Maniki, Antiki, and Laingiki Shuddhi of Virechana Karma-

Type	P	M	A
Vaigiki (Total bouts of Mal a Pravritti)	30 Vega	20 Vega	10 Vega
Maniki (Quantity of voided material)	4 Prastha	3 Prastha	2 Prastha
Aantiki	Kaphanta	Kaphanta	Kaphanta
Laingiki	To get the Samyaka Lakshana of Virechana Karma as described below.

Vaigiki, Maniki, Antiki, and Laingiki Shuddhi of Virechana Karma

These sorts of Shuddhi Lakshana are dependent on the number of Doshas present in the body and are offered as a general rule. Because the same standards cannot be applied in all instances, Laingiki Shuddhi is regarded as the best of the Shuddhi categories discussed. Samyaka Virechana is projected to eliminate Mala, Pitta, and finally Kapha in that order.

Samyak (Proper) Lakshana (Improper Evacuation) of Virechana

Strotovishuddhi (Feeling of clarity in channels), Indriya Prasad (Sensorial pleasure), Laghuta (lightness), Utsaha (Energy), Agnivriddhi (Improved Agni), Anamayatva (Relief in symptoms of ailment), Kramat Vata Pitta Kapha Nirharana, Vatanulomana (Downward movement of Vata).

Pashchata Karma:

After the successful completion of Virechana, the patients need to have complete physical and mental rest and to follow all the precautions related to Virechana.

Sansarjana Krama: (Cha.Si.9/12, Cha.Su.15/16, As.Hr.18/30)

                  पेयां विलेपीमकृतं कृतं च यूषं रसं त्रिर्द्विरथैकशश्च|
                  क्रमेण सेवेत विशुद्धकायः प्रधानमध्यावरशुद्धिशुद्धः|| (Ch.Si.1/11)
                 यथाऽणुरग्निस्तृणगोमयाद्यैः सन्धुक्ष्यमाणो भवति क्रमेण|
                   महान् स्थिरः सर्वपचस्तथैव  शुद्धस्य पेयादिभिरन्तरग्निः|| (Ch.Si.1/12)

Then Samsarjana Karma was decided based on Shuddhi grade and it was started from the same evening. After Samshodhana Karma, Agnimandhya occurs because the Doshas come to Amashaya (Jejata). So, Peyadi Krama is recommended to gradually increase the Agni to the normal level and make Tivra digest Guru Anna. In the Peyadi Krama, Peya, Vilepi, Akruta Yusha, Kruta Yusha, Akruta Mamsarasa, and Kruta Mamsarasa should be given for 3, 2, and 1 Anna Kala for Pravara, Madhyama, and Avara Shuddhi patients respectively. (Cha.Si.1/11).

Acharya Sushruta mentions Kulattha, Adhaki and Jangala Mamsarasa inspite of Peyadi Krama (Su.Chi.33). Dalhana comments that in Kshina Kapha Peya is given. Mamsarasa should be given to Vatapradhana patients, having Diptagni and if Kapha dominance is there according to Dosha and Prakruti, then Kulathi Yusha should be given. In the Pradhana Shuddhi, the Peyadi are complete on the seventh day.

Mode of action of Virechana:

Mode of action of Virechna Karma- according to Ayurveda – तत्रोष्णतीक्ष्णसूक्ष्मव्यवायिविकाशीन्यौषधानि स्ववीर्येण हृदयमुपेत्य धमनीरनुसृत्य स्थूलाणुस्रोतोभ्यःकेवलं शरीरगतं दोषसङ्घातमाग्नेयत्वाद् विष्यन्दयन्ति, तैक्ष्ण्याद् विच्छिन्दन्ति, स विच्छिन्नः परिप्लवन् स्नेहभाविते काये स्नेहाक्तभाजनस्थमिव क्षौद्रमसज्जन्नणुप्रवणभावादामाशयमागम्योदानप्रणुन्नोऽग्निवाय्वात्मकत्वादूर्ध्वभागप्रभावादौषधस्योर्ध्वमुत्क्षिप्यते, सलिलपृथिव्यात्मकत्वादधोभागप्रभावाच्चौषधस्याधः प्रवर्तते|| (Ch.Ka.1/5)

Mode of action of Virechana