A Critical Analysis and the Clinical Importance of Parameters of

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IJA A M
INTERNATIONAL JOURNAL
OF AYURVEDA & ALTERNATIVE MEDICINE
Bi-Monthly Peer Reviewed International Journal
VOL 2
ISSUE 6 (2014)
INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE
eISSN
2348-0173
eISSN 2348- 0173
REVIEW ARTICLE
Global Impact Factor (GIF) – 0.187 (2013)
A CRITICAL ANALYSIS AND THE CLINICAL IMPORTANCE OF
PARAMETERS OF ASSESSMENT OF VAMANA AND VIRECHANA KARMA
Vijay Kumar Rai1*, Radhey Shyam Sharma2
1. Lecturer, Dept. of Swasthavritta, Government Ayurvedic College and Hospital, Varanasi.
Contact No. +91 9532340500, E-mail – [email protected]
2. Prof. Radhey Shyam Sharma, Honourable V. C., Dr. S.R. Rajasthan Ayurveda University,
Jodhpur.
Article Received on - 26th Dec 2014
- 20th Jan 2015
Article Revised on
Article Accepted on - 4th Feb 2015
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distributed freely for non commercial purpose (see copyright notice below).
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Vijay Kumar Rai et. al., A Critical Analysis and the Clinical Importance of Parameters of Assessment of Vamana and Virechana Karma, Int.
J. Ayu. Alt. Med., 2014;2(6):16-20
VOL 2
ISSUE 6 (2014)
eISSN
2348-0173
eISSN 2348- 0173
REVIEW ARTICLE
A CRITICAL ANALYSIS AND THE CLINICAL IMPORTANCE OF
PARAMETERS OF ASSESSMENT OF VAMANA AND VIRECHANA KARMA
*Corresponding Author
Vijay Kumar Rai
Lecturer, Dept. of Swasthavritta,
Government Ayurvedic College and
Hospital, Varanasi.
Contact No. +91 9532340500,
E-mail – [email protected]
QR Code IJAAM
ABSTRACT:
Vamana and Virechana Karma are the two internal purification practices
described in Ayurveda which help to cleanse the body of the excess amount
of the vitiated Kapha and Pitta Doshas respectively and consecutively help in
maintaining the Doshika homeostasis in the body. It is very important for a
physician to be vigilant during these procedures and supervise and assess
carefully the status of cleansing (Shuddhi) achieved in the patient and
accordingly plan the further diet and treatment schedule for the individual
(Sansarjana Krama). Four types of criteria’s (Vaigiki, Maniki, Aantiki, and
Laingiki) are described in the texts for judging the status of cleansing
(Shuddhi) achieved in the patient by these procedures. In this paper an
attempt has been made to analyze those criteria’s and determine their utility
and clinical importance for the purpose of assessing the degree and the
success of Vamana and Virechana procedures.
The Brihattrayi Granthas of Ayurveda were
searched for references regarding the assessment
of Shuddhi [3] of the Vamana and Virechana
procedures and an attempt was made to interpret
them in the light of scientific view so that a
genuine interpretation could be done.
Criteria for Assessment of Vamana and
Virechana Karma described in the texts Charaka has coined some definite parameters
regarding the characteristics of proper or
successful procedures (Sanshodhana Karma) [4] in
terms of Shuddhi (cleansing). He has divided all the
characteristics into three types i.e. Jaghanya or
Avara shuddhi, Madhya Shuddhi and Pravara
Shuddhi which respectively mean the minimum
type of cleansing procedure, moderate type and
maximum type of cleansing procedure. Susruta has
also mentioned some characteristics for the
assessment of performance of Sanshodhana
(internal cleansing practices) Karma in terms of
Heena Yoga (less than desired Sanshodhana),
Atiyoga (more than desired Sanshodhana) and
Samyak Yoga [5] (proper or desired/ successful
Sanshodhana) and in terms of volume [6] of morbid
Doshas which come out after the procedures in
short. Vagbhatta has also mentioned the
characteristics of Sanshodhana Karma and
followed the pattern of Charaka Samhita with
more explanations.
First of all, Acharya Chakrapani has categorized [7]
all the above stated criteria’s of Sanshodhana
Karma (procedure) into four independent
parameters by naming them as Aantiki, Vaigiki,
Maniki and Laingiki criteria in order to make the
parameters for the assessment of a successful
procedure in a convenient manner.
J. Ayu. Alt. Med., 2014;2(6):16-20
Page
INTRODUCTION Assessment of the Sanshodhana Karma (the
Ayurvedic internal cleansing practices) has great
importance. If a Vaidya (physician) is not expert in
the assessment of characteristics of a successful
procedure of Sanshodhana Karma, he can’t
perform the Vamana (medicated vomiting
procedure) or Virechana Karma (medicated
purgation procedure) successfully [1] because there
are some indicators for knowing the status of
procedure and assessing the degree of completion
of the procedure. Vamana and Virechana [2] are the
Sanshodhana processes which are carried out to
remove the morbid Kapha and Pitta Doshas from
the body by means of the two main openings of the
gastrointestinal tract. So it is very necessary to
know in detail the characteristics of proper
Sanshodhana Karma otherwise procedure can’t
achieve the desired clinical benefits. So, in this
paper an attempt has been made to review and
analyze the literature available in Ayurvedic texts
related with the characteristics of proper
performance of Vamana and Virechana Karma and
make an attempt to find out the best and
convenient way to assess the success of
Sanshodhana Karma procedure.
17
Key Words: - Vamana , Virechana, Vaigiki, Maniki, Laingiki, Antiki.
Acharya Charaka [8] and Vagbhatta [9] have
emphasized on the observations based on Vega,
but Acharya Sushruta has ignored the Vaigiki
Pariksha completely. Acharya Charaka and
Vagbhatta have described three types of Shuddhi
naming them as Jaghanya or Avara Shuddhi,
Madhya Shuddhi and Pravara Shuddhi when four,
six and eight Vegas come out respectively in
Vamana and 10, 20 and 30 Vegas in Virechana
respectively.
Maniki Criteria
This criterion assesses the vomitus for its amount,
colour, consistency etc. to judge for the amount of
Dosha expelled. The reason for stating the Maniki
criteria by the Acharyas might have been the fact
that Sanshodhana Karma was indicated for ‘Bahu
Doshavastha’. The word Bahu denotes that the
Doshas are vitiated and increased in all respects i.e.
– Dravyatah (quantitatively in amount), Gunatah
(qualitatively in properties) and Karmatah
(functionally in its actions). Thus, Maniki criteria
have been stated to assess the expelled vomited
material for its amount, colour, consisitency etc. to
judge for the amount of Dosha i.e. Kapha and Pitta
which is expelled out.
While narrating the Shuddhi, Acharya Charaka [10]
and Vagbhatta [11] have mentioned the quantities of
the morbid material (Dosha) coming out of the
Sanshodhana procedures as two, three and four
prastha in Virechana Karma and one, one and half
& two Prastha in Vamana Karma respectively for
Jaghanya or Avara suddhi, Madhya Suddhi and
Pravara Suddhi . Chakrapani has considered them
under the term ‘Maniki Pariksha’.
Antiki Criteria
The features reflecting that therapy or procedure
has passed in the end phase can be assessed using
the features towards the end of Vamana and
Virechana Karma which have been called as "Antiki
Criteria."
Charaka has advised to continue procedure till
bouts of Pitta or Kapha stop appearing. [12] Later on
[13] he has given a clue that Vamana should be
Pittanta (Pitta should come out at last) and
Virechana should be Kaphanta (Kapha should
come out at last) to assess the “Samyaka Vamana
and Virechana symptoms”. He has stated that in
"Samyaka Vamana”, Kapha should be succeeded by
Pitta and in "Samyaka Virechan” Pitta should be
succeeded by Kapha. Sushruta [14] has also included
the symptom of “Kapha followed by Pitta" in the
"common symptoms of Samyaka Vamana” which
may be considered as Aantiki Criteria for Vamana.
Acharya Vagabhatta has described the Antiki
Criteria as- Pittantam Vamanam and Kaphanta Cha
Virekamahu. [15] So, it can be concluded that the
Antiki Criteria shows that Vamana having Pitta and
Virechana having Kapha should be taken as
endpoint for the procedure.
Laingiki Criteria
This criterion describes for the assessment of the
features shown in the patient’s body. Laingiki
Criteria depends upon the sign and symptoms
which appear after the proper procedures of
Sanshodhana Karma (Samyaka Vamana and
Virechana) and this criterion is always
accompanied by Antiki Criteria, which is explained
immediately after the same. Chakrapani [16] has
stated that there is little existence of other Shuddhi
except ‘Laingiki’ one. Pittanta and Kaphanta
criteria have been included in the Laingiki criteria
by Chakrapani and Dalhana both.
Laingiki criteria have two aspects i.e. features
appearing immediately after the procedure and
symptoms arising after some time (after the
completion of Sansarjana krama). As, the goal
behind the conduction of Sanshodhana Karma
/procedure is to check the disease or to minimize
the symptoms present in it; hence, Laingiki criteria
are much more emphasized by all the
commentators.
Method of estimation –
Vaigiki Criteria
In this criteria estimation of the number of vegas
(bouts) expelled by the patient is done and each
vega is also observed carefully. Four, six and eight
Vegas in Vamana and 10, 20 and 30 Vegas in
Virechana constitute Jaghanya or Avara Shuddhi,
Madhya Shuddhi and Pravara Shuddhi respectively.
Maniki Criteria
The measurement of the total vomited and voided
material is described in the unit quantity of
Prastha. As we know that Kapha and Pitta are
Dravyabhuta Doshas and have some forms in the
body and like all material substances have specific
properties, volume and weight which can be
measured.
So, Maniki criteria can be dealt by considering both
the meanings i.e. weight and volume. According to
Chakrapani [17] one Prastha = 13 ½ Pala = 54 Tola =
540 ml. So, the described literature for the three
J. Ayu. Alt. Med., 2014;2(6):16-20
18
Vaigiki Criteria
Vaigiki criterias include parameters about the
bouts (Vegas) for its nature like speed, force and
strength etc. The analysis of bouts regarding its
several factors constitutes 'Vaigiki criteria'.
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kinds of Shuddhis can be interpreted in terms of
grams and milliliters as
Table No.1- Showing the volume of the vomitus and
voided materials for each Shuddhi
Jaghanya or Avara
Shuddhi,
Madhya Shuddhi
Pravara Shuddhi
Vamana - 540ml
Virechana - 1080ml
Vamana - 810 ml
Virechana - 1620ml
Vamana - 1080 ml
Virechana - 2160ml
Antiki Criteria
Panchakarma Vaidya has to be very careful in
watching the changes in colour (and smell) of
vomitus and expulsion also, because these are the
criteria which indicate about the arrival of Pitta
and Kapha in vomitus expulsion respectively. To
decide for the “Pittanta Lakshana” Vaidya has to
ask the patient about symptoms like pungent or
bitter taste in mouth (Katukasyata or Tiktasyata),
Netradaha (burning sensation in the eyes),
Kanthadaha (burning sensation of throat) &
Urodaha (heartburn) etc. for determining whether
Pitta is coming out or not. Similarly, to decide
“Kaphanta Lakshana” Vaidya has to observe the
series of expulsion of faeces, Pitta, Kapha and Vayu
in succession in the procedure of Virechana. At the
end phase of Virechana procedure, only white,
Pichhilla (slimy) and watery material comes out,
indicating the Kaphanta criteria.
Laingiki Criteria
The criteria’s for the assessment of Samyaka
Vamana and Virechana in terms of features
evolving in the body can be evaluated in two
categories (A)
The symptoms appearing immediately
after Sanshodhana procedure as Kale Pravritti
(movement of the Doshas at the desired time),
Yathakrama Kapha Pitta Vata Dosha Harana (the
expulsion of the Doshas in the proper order of
Kapha, followed by Pitta and lastly Vata Dosha),
Swayam Cha Avasthanam (self stoppage of the
bouts) and Hridaya Parshwa Shuddhi (feeling of
lightness in the heart and sides of the chest) etc.
(B)
The Symptoms occurring after a span of
time (after Sansarjana Krama) as Swasthata
(health), Swara Vishuddhi (feeling of clarity in the
voice), Ruchi, (desire for food) Laghava (lightness
in the body) and Koshtha Tanutva (lean stomach).
DISCUSSION The analysis of all these above stated criterias for
the purpose of determination of the type of
Shuddhi in the patient reveals the following
aspects.
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In Vaigiki criteria each Vega is assessed carefully
because they intimate about Jaghanya or Avara
suddhi, Madhya Suddhi and Pravara Suddhi through
the analysis of bouts, which helps them in planning
‘the Sansarjana Krama’ (The schedule for planning
of diet and some restrictions which are to be
followed after these procedures) and achieving the
benefits of procedures. Gangadhara has explained
that a Vaidya can take prompt decision after
sensing any fore coming complication by keeping
his mind alert and assessing each Vega carefully.
The quantity wise analysis [18] of the vomitus
voided after each bout gives a clear idea about the
drug which is remaining inside and the analysis of
the Vegas also gives an idea about the changes in
colour, pH and consistency of the vomitus
occurring after each bout. Maniki criteria guides us
in differentiating the three types of cleansing types
(Shuddhi) i.e. Avara, Madhyama and Pravara
Shuddhi on the basis of the overall amount of
material expelled out in Vamana and Virechana. It
guides us in deciding the quantity of morbid
Doshas i.e. Kapha and Pitta, expelled out and also
to analyze the quantity of the same within the
body, which is to be pacified afterwards with the
Shamana treatment. It also helps us to judge the
characteristics of Doshas like colour, odour, and
properties like Guruta (heavy), Dravata (liquidity),
etc. which will further help us to judge the vitiated
properties in the Doshas accordingly. When factors
like Prakriti, Doshavastha etc. are taken in account,
a lot of variations are observed in the consistency
of the expelled material. This criteria helps us
know the amount of each Vega separately and the
total volume of all Vegas. It can also help us in
knowing the differences in the vomitus obtained
after the usage of various types of Vamanopaga
and Virechanopaga drugs. Antiki Criteria is the
most valuable criteria assisting Vaidya in making
the decision of whether to carry on or to cease the
process of Sanshodhana therapy as it indicates
about the complete expulsion of morbid Kapha and
Pitta Dosha in Vamana and Virechana procedures.
It limits the procedure and warns the Vaidya from
proceeding further and creating ‘Atiyoga’ of
therapy [19] Laingiki criteria also helps a physician
to decide about the time for the stoppage of
Vamana or Virechana Karma and plan the
Sansarjan karma (diet regimen) accordingly just
like the Antiki criteria (end point criteria). The
specialty of this criterion is that it is the only
criterion which considers the features being
produced in the patient as a result of these
procedures besides considering the parameter of
bouts. These features in the patient are to be
judged twice - once immediately after the
Sanshodhana procedures and secondly after the
completion of the prescribed dietary schedule [20]
J. Ayu. Alt. Med., 2014;2(6):16-20
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(Sansarjana Krama) [21] The immediate assessment
of the patient after these procedures helps a
physician to know about the physiological status of
the patient and the assessment after the
Sansarjana Krama helps him determine the overall
effect of therapy and decide his further course of
action for the remaining Doshas, either by
Shamana or further Shodhana whichever is
suitable for the patient.
CONCLUSION –
The above discussion regarding the four criteria of
assessing the Samyaka Vamana and Virechana
Yoga in the patient reveals that though all the
criteria’s have their own importance, still Laingiki
criteria can be considered as the best for
assessment of Samyaka Vamana and Virechana
Yoga in the patient because this criteria also takes
into account the various features developing in the
patient also; unlike the other criterias which take
into account only the characteristics of the vomitus
and voided matterials. Still, the other criterias can’t
be denied as they also have their own importance
for determining the kind of Shuddhi achieved in the
patient. A principle in Ayurveda states for the
examination of the same patient by various
methods and techniques so that no minor detail
about him may be missed or overlooked. It is in
compliance with this principle only that so many
methods of estimation of type of Shuddhi (of
Vamana and Virechana) might have been
advocated, so all these criteria’s should be used
together for determining the type of Shuddhi
achieved in the patient after Vamana and
Virechana procedures and accordingly plan his
further regime of treatment.
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Chikitsasthan 33/8-25, 16th ed. Varanasi: Chaukhamba
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.CITE THIS ARTICLE AS –
Vijay Kumar Rai et. al., A Critical Analysis and the Clinical Importance of Parameters of Assessment of Vamana
and Virechana Karma, Int. J. Ayu. Alt. Med., 2014;2(6):16-20
Source of Support – Nil
Conflict of Interest – None Declared
J. Ayu. Alt. Med., 2014;2(6):16-20
20
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ISSUE 6 (2014)
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A Critical Analysis and the Clinical Importance of Parameters of

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