Impact factor: 3.958/ICV: 4.10 ISSN:

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1 Impact factor: 3.958/ICV: 4.10 ISSN: Pharma Science Monitor 8(2), Apr-Jun 2017 PHARMA SCIENCE MONITOR AN INTERNATIONAL JOURNAL OF PHARMACEUTICAL SCIENCES Journal home page: A REVIEW ARTICLE ON ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF AMAVATA Amrit Godbole 1, Sweta 2, Abhinav 3, O.P. Singh 4 1 Junior resident-iii, Dept. of Kayachikitsa, Faculty of Ayurveda, IMS-BHU, Varanasi, India. 2 Junior resident-iii, Dept. of Rachana sharir, Faculty of Ayurveda, IMS-BHU, Varanasi, India. 3 Assistant professor (Panchakarma), Dept. of Kayachikitsa, Faculty of Ayurveda, IMS-BHU, Varanasi, India. 4 Professor, Dept. of Kayachikitsa, Faculty of Ayurveda, IMS-BHU, Varanasi, India. ABSTRACT As the name suggests Amavata is made up of two terms, Ama & Vata. When Ama and Vata gets vitiated simultaneously and gets deposited in the Koshtha (gut), Trik (sacral region) and Sandhi (joints) where it produced Shotha (edema), Shoola (pain) and Stabdhata (stiffness) then the manifestation is known as Amavata. Due to impaired Jatharagni the Aahar rasa formed is Apakva, this Apakva Aahar rasa thus formed is in AMA stage which causes Sarvadoshaprakopa. Virechana is the biopurification procedure of Ayurveda. When doshas are expelled out from the body through anal route then it is called Virechana. AMA which is formed as a result of Manadagni being macromolecular in nature gets accumulated in the Sukshma srotas and there this Ama causes Srotavarodha (Channels obstruction). Thus Virechana karma is one of the important bio-purificative methods which is indicated for complete elimination of Doshas and thus results in eradication of diseases. KEYWORDS: Ama, Amavata, Jatharagni, Mandagni, Virechana. INTRODUCTION In Ayurveda, all the diseases get manifested as a result of Mandagni 1. Agni has been the basis of Ayu (longevity), Varna (complexion), Bala (power), Swasthya(health) etc 2. Thus due to impaired Agni the Aahar rasa formed is in Apakva stage and is known as Ama. Which causes Sarva dosh prakopa (vitiation of doshas) 3. Another definition of Ama given in Classical text is as The Anna rasa produced as a result of Ajirna awastha (Indigestion) gets accumulated in the gut known as Ama and causes Ruja (pain) in head and all over the body 4. This gets engaged with vitiated Vata and enters sacral joints and makes the body stiff. This condition is called as Amavata 5. Pathogenesis: In Ayurvedic texts, the etiology of Ama Vata are very well described, Viruddha Aahar/cheshta (incompatible diet and habits) Mandagni (impaired Agni), Nischalata (sedentary lifestyle) and heavy exercise after taking fatty meals. All this leads to formation of Ama dosha. This Ama dosha under influence of vitiated Vata gets manifested at the Shleshma sthana 6.

2 Impact factor: 3.958/ICV: 4.10 ISSN: Viruddha Ahara/Chesta/Mandagni/Nisschalta + Heavy Exercise after meal Ama Vitiation Vata Vitiation AMA+ VATA Ama associated with vitiated Vata, moves quickly to the different seats of kapha in the body, filling them and also to the Dhamani with waxy material. Thus the bad end products of digestion associated with Vata, Pitta and Kapha attaining different colours, block the path with thick Picchila material i.e. Ama. It produces weakness and heaviness in the body and Heart, which becomes the seat of the disease. It simultaneously also affects the joints of the body such as Janu, Gulpha, Kati, Ansa, Manya etc. This dreadful disease is known as Amavata which produces stiffness in the body 7. Clinical symptoms in which mainly joints are involved along with the chronicity of diseases give a close relation of Amavata with Rheumatoid Arthritis. Rheumatoid Arthritis (RA) is a chronic inflammatory disease of unknown aetiology marked by a symmetric, peripheral polyarthritis. Often results in joint damage and physical disability 8. Prevalence: The incidence of RA between years of age is common, after which it plateaus until the age of 75 and then decreases. RA affects approximately 0.5% to 1% of the adult population worldwide. RA occurs more commonly in females than in males with a 2-3:1 ratio 9. Clinical features vaxenksz v:fpklr`".kk vkyl; xksjoa Toj%A vikdks ÓwUkrk kukkekeokrl; Yk{k.kaAA ¼ek0fUk0½ Body ache, lack of taste, thirst, general weakness, feeling of heaviness, fever, morning stiffness of the joints pain and swelling in the affected part, shifting of pains in joints. Role of Virechana karma: One of the fundamental concepts of Ayurvedic management of disease is to eliminate toxic materials (Vitiated Doshas) from the body in order to cure a disease. Panchakarma therapy is designed to eliminate the toxins. It is an important component of Ayurvedic management of disease. It is the comprehensive method of internal purification of the body through emesis

3 Impact factor: 3.958/ICV: 4.10 ISSN: (Vamana karma), purgation (Virechana karma), enema (Basti), er rhines (Nasya) and Bloodletting (Raktamokshana) 10. The Vamaka and Virechaka Dravya induce emesis and purgation respectively due to their specific Prabhava 11. In relation to Amavata, Virechana karma has been clearly mentioned in the classical texts as 1. yaäuka LosnUka frkdrka nhiukuh dvwuh pafoj pue~...ç kl rs [12][13][14] 2. YkaÄUk Lo nuka frdra nhiukaj PkUka dvqa [15] Ama is a product of disturbed Digestion/ Metabolism, which is carried by Vayu, It obstructs the channels at different sites and causes inflammation of joints 16. In Ayurvedic texts Virechana is described as the treatment procedure w.s.r to Kostha shuddhi in Pittaja vikara, Amajanya roga, Udara roga and Aadhmaan 17. As Agnimaandya is the reason for Amottpatti, the treatment of Agnimandya as per Ayurveda includes Langhan, langhan- Paachana and Doshavashechan 18. Yogaratnakara, in reference to treatment of Agnimaandya describes a preparation that not only vitiates Agni but also is Pachaka and Rechaka in nature 19. Thus we can understand the role of Virechana in Agnimandya and Agnimandya janya vikara. Virechana has been described to be the best remedy for Pitta dosha, yet it is effective in the vitiated Kapha and Vata dosha also to some extent. So in this way it appears to be the most appropriate therapeutic measure in this condition. After Langhana, Swedana and Tikta, Katu, Deepana dravyas, doshas attain Niramaavastha and may require elimination from the body by Shodhana. 20 Generally Vamana precedes Virechana but in Amavata, the patients should be subjected to Virechana therapy because of the following possible reasons. Symptoms of Amavata like Aanaha, Vibandha, Antrakujana, Kukshishula etc. are indicative of Pratiloma gati of Vata. This is best conquered by Virechana, while Vamana is likely to aggravate these features. It removes the Avarana produced by Kledaka kapha. 21 Pharmacological Properties of Virechana Dravya: These are Vyavayi 22 Vikasi 23 Ushna Tikshna Sukshma 24. Virechana drug possessing the above properties reaches the Hridaya by virtue of its Virya and then following the Dhamani it pervades the whole body through large and small Srotas. On virtue of its Agneya properties, it causes Vishyandana i.e. melting of the Doshas and by its Tikshana Guna, it is able to disintegrate the accumulated Dosha. Due to Snehana, Dosha smear easily without any hurdle and easily come to Amashaya from where Virechana evacuates them 25.

4 Impact factor: 3.958/ICV: 4.10 ISSN: Mode of Action of Virechana Dravya: Virechana is a medicated purgation therapy which removes Pitta toxins from the body that are accumulated in the liver and gallbladder 26. The Virechana Dravya spreads throughout the body of cellular level due to its pharmacological properties. Now, the mode of action of Virechana dravya on the basis of its pharmacological properties has been described 27. Step 1: Due to Vyavayi Guna, quick absorption of virechana dravya occur Step 2: Now, Vikasi Guna causes softening and loosening of the bond by Dhatu Saithilya Karma. Step 3:Ushna Guna of virechana dravya creates the liquification (Vishyandana) 28 of Dosha Sanghata (compactness) Step 4: Tikshna Guna causes Chedana of the Doshas or able to disintegrate the Sanghata of the Doshas. According to Dalhana this action is due to quick excretion (Dosha Sravana- Karatvam) Thus, liquefied Doshas are dragged towards the Koshtha. Step 5: Due to Sukshma Guna, virechana dravya reached into micro channels & then disintegrates the endogenic toxins, which are then excreted through micro channels. Step 6 Due to dominance of Prithivi and Jala Mahabhutas in the Virechana drugs and their potent Adhobhaga Hara Prabhava, the vitiated Doshas are made to pass through anal route and are expelled out of the body. 29 CONCLUSION Since RA is auto-immune in nature therefore its management in modern parameters includes immuno-suppressants and symptomatic cure through corticosteroids and NSAIDs. Thereby management of RA ( Amavata) is not that trustworthy and safe in modern medical science and the provided management of Rheumatoid arthritis is having some dangerous side effects, therefore we can rely upon Ayurvedic management incorporating Virechana as a bio-purificatory process followed by Samshaman chikitsa which is comparatively much safer and promising therapeutic module. REFERENCES 1. Astanga Hridaya(Hindi) by Kaviraja Atrideva Gupta, Edited by Vaidaya Yadunandana Upadhyaya,Publisher- Chaukhambha Sanskrit Sansthan 3rd Edition ibid.,charaka Samhita (Hindi) by Dr. Gorakha Natha Chaturvedi, vol -2, Edited by- Rajeswaradatta sastri, chaukhambha Bharti Academy, 2004.

5 Impact factor: 3.958/ICV: 4.10 ISSN: ibid.,madhava Nidana I & II nd Madhukosa Sanskrit and Vidyotini Hindicommentary by Yadunandana Upadhyaya, Edi.21st V.S. 2050, Chaukhambha Samskrita Sansthana, Varanasi. 4. Yogaratnakara edited with Vidyotini, Comm. By Shri Laksmipati Sastri, Edi. 6th1997, Chaukhambha Sanskrit Bhavan. 5. ibid., Yogaratnakara edited with Vidyotini, Comm. By Shri Laksmipati Sastri, Edi. 6th1997, Chaukhambha Sanskrit Bhavan. 6. Madhavakara, Madhava Nidana, uttaradha with madhukokosha vyakya by vijay rakshita and srikantadutta, vidyotini tika by Ayurvedacharya sri sudarshana shastri 27 th edition 1998,chaukhambha Sanskrit sanathana, Varanasi, uttar Pradesh. 7. Vangasena; (Hindi Tika) by Kaviraj shri Shaleegramli Vvasiasaya, Edition Dec 2003, published by -khemraj shrikrishna Das prakashan Bombay. 8. Principles of Internal medicine by Harrison, 15th edition, Mac-graw hill Publication. 9. Principles of Internal medicine by Harrison, 15th edition, Mac-graw hill Publication dicines-book.pdf 11. Mridul et al. / Pharma Science Monitor 5(3) Supl-1, Jul-Sep 2014, Impact factor: /ICV: Vrindamadhav chapter Cakradatta edit with Vaidyaprabha by Dr.Indradeva Tripathi, Edi. 3rd 1997, Pub.Chaukhambha Sanskrit Sansthana, Varanasi. pøåvke-fp Bhaisajya Ratnavali 29/1- Shri Govindadas Vicharita, by Pandit Shri.Lalchandra Vaidya, 8th edi., Delhi Chikitsa adarsh rajeshwar dutta shastri 16. Singhal G. D. et.al, Ayurvedic Clinical Diagnosis, Mādhavakara,Volume 5 of Chaukhamba ayurvijnan studies Singhal Publications, 1985, Digitized(4 Aug 2009). 17. Tripathi Bhramanand,Sharangadhar Samhita, virechana vidhi, chapter 4, Varanasi, Chaukhambha Subharti Prakashan ; 2008, Chakrapani, Charaka Samhita (Ayurveda Deepika Commentary of Chakrapani datta). 19. ibid., Yogaratnakara edited with Vidyotini, Comm. By Shri Laksmipati Sastri, Edi. 6th 1997, Chaukhambha Sanskrit Bhavan. 20. ibid Cakradatta edit with Vaidyaprabha by Dr.Indradeva Tripathi, Edi. 3rd 1997, Pub.Chaukhambha Sanskrit Sansthana, Varanasi.

6 Impact factor: 3.958/ICV: 4.10 ISSN: Comparative Clinical Evaluation Of Vaitarana Vasti And Rasona Pinda In The Management Of Amavata Vis-À -Vis Rheumatoid Arthritis ". Post Graduate. Banaras Hindu University, Print. 22. Acharya Sharngadhara, Sharngadhara Samhita, Chaukhmba Ayurvijnana Granthmala, Varanasi,reprinted-2011, pg.50, S. Pu.4/ Acharya Sharngadhara, Sharngadhara Samhita, Chaukhmba Ayurvijnana Granthmala, Varanasi,reprinted-2011, pg.34, S. Pu.4/ Cakradatta edit with Vaidyaprabha by Dr.Indradeva Tripathi, Edi. 3rd 1997, Pub.Chaukhambha Sanskrit Sansthana, Varanasi. 25. Chakrapani, Charaka Samhita (Ayurveda Deepika Commentary of Chakrapani datta). Yadavakji Trikamji, editor. Chaukambha Sanskrit Samsthana, Varanasi, pg , Chakrapani on K.1/5 26. Panchakarma, Panchakarma Therapy, Panchakarma Ayurveda Treatment, Panchakarma Detoxification Process, What is Panchakarma, Ayurveda, 6/24/ Shri Dalhanacharya, Shushrut Samhita, with Nibandhasangraha commentary, Edited by Yadavji Trikamji Acharya, Chowkhamba Krishnadas Academy, Varanasi, reprinted,2004, pg. 519, Dalhana on Ch. 33/ Chakrapani, Charaka Samhita (Ayurveda Deepika Commentary of Chakrapani datta). Yadavakji Trikamji, editor. Chaukambha Sanskrit Samsthana, Varanasi, pg , Chakrapani on K.1/5 29. ibid.,charaka Samhita (Hindi) by Dr. Gorakha Natha Chaturvedi, vol -2, Edited by- Rajeswaradatta sastri, chaukhambha Bharti Academy, 2004.kalpa 1/5.