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CLINICAL RESEARCH
Year : 2013  |  Volume : 34  |  Issue : 4  |  Page : 379-382  

Clinical study to evaluate the effect of Virechanakarma on serum electrolytes


1 Lecturer, Department of Panchakarma, Bharat Ayurveda Medical College, Muzaffarnagar, Uttar Pradesh, India
2 Associate Professor and Head, Department of Panchakarma, National Institute of Ayurveda, Jaipur, Rajasthan, India

Date of Web Publication21-Feb-2014

Correspondence Address:
Adil Rais
College Campus, Bharat Ayurveda Medical College, Roorkee Road, Muzaffarnagar, Uttar Pradesh - 251 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8520.127719

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   Abstract 

Panchakarma therapy aims at the elimination of excessive Doshas from the body to maintain the state of health for a longer duration, while the Shamana therapy is for suppression of vitiated Doshas within the body. Virechana is one of the Panchakarma therapies wherein purgation is induced by drugs and it specifically aims at the elimination of excessive Pitta Dosha from the body. Normally, after Virechanakarma, patient does not complain of having any untoward like those present after diarrhea due to dehydration. This study was conducted to evaluate the effect of Virechanakarma on serum electrolyte levels and to ascertain the safety of therapeutic purgation. This study involved estimation of serum electrolyte levels before and after Virechana in 15 patients and the results are suggestive of safe application of the Virechana therapy as the deviation in electrolyte levels were within the normal range.

Keywords: Electrolytes level, therapeutic purgation, Virechanakarma


How to cite this article:
Rais A, Bhatted S. Clinical study to evaluate the effect of Virechanakarma on serum electrolytes. AYU 2013;34:379-82

How to cite this URL:
Rais A, Bhatted S. Clinical study to evaluate the effect of Virechanakarma on serum electrolytes. AYU [serial online] 2013 [cited 2020 Nov 24];34:379-82. Available from: https://www.ayujournal.org/text.asp?2013/34/4/379/127719


   Introduction Top


Vitiated Dosha is the basic factor in the manifestation and progress of any disease. Panchakarma therapy, specifically the Samshodhana like Vamana and Virechana, is one of its kinds which aims at the elimination of vitiated Doshas from the body so that the disease could be prevented or if the pathology has already established, treated in the most effective manner.

Virechanakarma (Therapeutic purgation) is one among the Panchakarma therapies, which eliminates excessive vitiated Dosha in general and Pitta Dosha in particular from the body through the anal route.

Under normal circumstances, if a patient suffers from diarrhea, then certainly there is loss of electrolytes from the body resulting in weakness; development of cramps due to dehydration, and sometimes low blood pressure and renal failure.

However, if purgation is induced through Virechana therapy and if Samyakshuddhi (features of proper Virechana) occurs, no such symptoms occur. The assessment of Virechana is based on various parameters termed as Shuddhi (cleansing) criteria like Vaigiki (number of bouts of stool passed), Manaki (quantitative measurement of stools), Laingiki (symptoms based assessment), and Antyaki (assessment based on end point of purgation) Shuddhi.

The Doshas eliminated are classified on the basis of number of bouts of evacuation as low, medium, and high quantities (i.e., Hina, Madhyama, and Uttamshuddhi). These are 10, 20, and 30 times respectively.

After purgation in such high numbers, if there is an electrolyte imbalance, it needs to be evaluated and the levels are to be compared before and after Virechana therapy.

The present study was aimed at ascertain the safety of Virechanakarma on certain subjective and objective parameters and to evaluate the serum electrolyte levels before and after Virechanakarma.


   Materials and Methods Top


The study was conducted as follows:

15 cases were enrolled for Virechanakarma at the P.G. Department of Panchakarma. All the registered cases were evaluated for:

  • Serum sodium levels,
  • Serum potassium levels,
  • Serum chloride levels,
  • Serum calcium levels, before and after Virechanakarma.


The results were analyzed statistically using paired t test. P > 0.1 were considered insignificant, P values in between 0.05 and 0.001 were considered significant while P < 0.001 were taken as highly significant.

Treatment plan (Virechanakarma)

The procedure of Virechanakarma was performed in three steps.

  1. Poorvakarma, i.e., the preparatory procedures; is to be performed before the main therapy, which includes Deepana and Pachana (use of appetizers and digestives drugs) followed by Snehapana (oral administration of medicated ghee) for 3-7 days as per the Koshtha (nature of bowel) of the patient until achieving features of adequate oleation. This is followed by Abhyanga (external application of oil) and Swedana (sudation) for next 3 days
  2. Pradhanakarma (main procedure), which means administration of Virechana drug as per the disease, Bala (strength), and Koshtha of the patient. The drugs commonly used for inducing Virechana in the patients are:

    • Triphala decoction prepared from Haritaki (Terminalia chebula), Vibhitaki (Terminalia bellirica), and Amalaki (Emblica officinalis) [1] between 80 and 160 ml
    • Katuki (Picrorhiza kurroa) [1] 15-25 g
    • Trivrit (Operculina turpethum) [1] 15-30 g
    • Castor oil 30-50 ml and
    • Ichchabhedirasa [2] 125-250 mg (1-2 tablets) as per the requirement after assessing the Koshta and Vegas.


The patients are observed for Samyakshuddhi Lakshana (symptoms of appropriate Virechanakarma). [3],[4]

The classical features observed after Virechana are:

  1. Daurbalyam (weakness)
  2. Laghavam (feeling of lightness)
  3. Glani (fatigue)
  4. Vyadhi nam anuta or Anaamayatvam (subsidence of disease)
  5. Hrid shuddhi (clarity in thoracic region)
  6. Varna shuddhi (improved complexion)
  7. Buddhi indriya manah shuddhi (clarity of thoughts, sensoria, and intellect with a feeling of wellbeing)
  8. Marutasya anulomata (downward movement of vata)
  9. Kayagneshcha anuvartanam (improved digestive capacity)
  10. Srotovishuddhi (clarity of channels)
  11. Indriya samprasado (improved sensory and motor functions).


(3) Pashchatakarma (postoperative procedures) also known as Samsarjanakrama, in which the patient is advised for specific code of conduct and dietary regimens for 3-7 days depending upon the number of bouts of bowel evacuated after administering Virechana drug.

Inclusion criteria

  • Patients fit for Virechanakarma and presenting with Samyakshuddhi lakshana.
  • Patients within the age group of 20-60 years, irrespective of gender and religion.
  • Patients not suffering from any serious disease.
  • The patients in this study were selected irrespective of the disease for which they were advised Virechanakarma.


Exclusion criteria

  • Patients presenting with any serious disease having gross electrolyte imbalance.



   Observations and Results Top


Following the classical guidelines for Virechana, starting from Purvakarma, patients were administered Snehapana for an average of 5.13 days in 15 patients. Snehapana was stopped when Samyakashuddhi features were present in the patients.

Out of 15 patients, two had Krurakoshtha, four patients had Mridukoshtha, and the remaining nine had Madhyamakoshtha.

After a period of 3 days, wherein patients were advised external oleation (Abhyanga) and sudation (Swedana), Virechana drug was administered as per the need of the patient.

The average number of bouts of bowel evacuation (Vegas) in the 15 patients was 17.

Analysis of serum electrolyte levels

The assessment of serum sodium level before and after the Virechana was within the normal range with an average reduction of 1.80 mmol/L, which was statistically highly significant [Table 1].
Table 1: Statistical analysis of serum electrolyte levels before and after therapy

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Serum chloride level was within the normal range before and after Virechana karma with an average reduction of 0.60 mmol/L and this result was statistically significant [Table 1].

The results obtained for serum potassium levels were well within the normal range before and after Virechana. The average reduction after Virechana in serum potassium value was 0.043 mmol/L, which was significant statistically [Table 1].

The data obtained for serum calcium levels reveal that the average before and after values lie in normal range. However, there is an average increase of 0.0934 mmol/L after Virechana [Table 1].

The average systolic pressure before Virechana was 123.32 mm of Hg while it was 114.93 mm of Hg after Virechana [Table 2].
Table 2: Analysis of vital parameters of the patients

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The average diastolic pressure before Virechana was 78.266 mm of Hg while it was 74.66 mm of Hg after Virechana [Table 2].

The average pulse before Virechana was 76.8 per minute while that afterwards was 74 per minute [Table 2].

There has been a transient fall in vital parameters like blood pressure and pulse immediately after Virechana. However, these values returned to the normal limits on the next day of Virechana.


   Discussion Top


The modern day literature suggests that purgation leads to dehydration, electrolyte imbalance and loss of electrolytes, hypotension, and shock. [5],[6] Certain Vyapada's (complications) of Virechana karma and signs and symptoms of excessive Virechana are described in Ayurveda which are similar to the features of dehydration and associated complications. Hence Virechana being therapeutically induced purgation needs to be evaluated for its safety. Thus, the present study was conducted to establish the safety profile of Virechanakarma if conducted as per the classical guidelines starting with Poorvakarma, followed by Pradhanakarma, and finally completing with Samsarjanakrama.

To support this hypothesis, the electrolyte study was undertaken before and after the treatment [Table 1], it is clear that the deviation is within normal range. [5],[6]

In addition to this, the vital parameters like pulse and blood pressure were within the normal limits as [Table 2].

The clinical features of hyponatremia [7] hypokalemia [8] hypocalcemia [9] were not reported in any of the 15 patients after Virechanakarma.

Subjectively, in one of the patients, giddiness was reported due to hypovolemia after Virechana, as the number of bouts of evacuations was 32. The condition of the patient was managed by oral rehydration.

Along with this, two patients also complained of cramping of abdominal which subsided by evening in both of them.

Statistically, the results showed significant decrease in levels of serum sodium, potassium and chloride levels and significant increase in level of serum calcium [Table 1]. But all, the changes were within normal limit.

Though the change in electrolyte levels was statistically significant, they were within the normal range.


   Conclusion Top


The present work was a pilot study aimed to ascertain the safety of Virechanakarma, which was performed keeping in mind that the Panchakarma procedure though efficacious and safe needed an assessment of its safe application in this modern era. Serum electrolytes values were well within the normal ranges in all the 15 patients after the therapeutic purgation. The study was helpful in establishing the safety of therapeutic purgation, i.e. Virechanakarma subjectively and statistically as well without causing any adverse effects.However in this study, the sample size was small, so a similar study in a larger sample needs to be conducted to further strengthen the findings of this study. Studies aiming at safe application of other Panchakarma therapies can also be conducted using various parameters.

 
   References Top

1.Sharma P. Katuki, Dravyaguna Vijnana. Vol. 2. Varanasi: Choukhambha Bharati Publications; 2005. p. 442.  Back to cited text no. 1
    
2.Sen GD. Udavarta Aanaha Rogadhikara, SiddhiPrada on Bhaishajya Ratnaavali. In: Siddhi NM, editor. Varanasi: Chowkhambha Surbharati Publication; 2009. p. 646.  Back to cited text no. 2
    
3.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutra Sthana, Chikitsaprabhritiya Adhyaya, 16/5-6, edited by Vaidya Yadav ji Vikram ji Acharya, reprint edition, Chowkhambha Surbharati Publication, Varanasi, 2011;93.  Back to cited text no. 3
    
4.Ibidem, Charaka Samhita, Siddhi Sthana, Kalpasiddhi Adhyaya, 1/17;680.  Back to cited text no. 4
    
5.Harrison′s Principles of Internal Medicine. In: Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, et al. editors. 17 th ed., Vol. 2., Appendix-4, Appendix-7. USA: McGraw Hill Publication; 2008.  Back to cited text no. 5
    
6.Murray R, Kennelly P, Bender D, Rodwell V, Anthony PW, Kathleen MB. Harper′s Illustrated Biochemistry. 28 th ed., Appendi×1. USA: McGraw Hill Publication; 2009. p. 647.  Back to cited text no. 6
    
7.Harrison′s Principles of Internal Medicine. Fluid and electrolyte disturbances. Principles of Internal Medicine. In: Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, et al., editors. 17 th ed. Vol. 1. USA: McGraw Hill Publication; 2008. p. 278.  Back to cited text no. 7
    
8.Ibidem, Harrison′s Principles of Internal Medicine, Fluid and electrolyte disturbances. Vol. 1. pp. 282.  Back to cited text no. 8
    
9.Ibidem, Harrison′s Principles of Internal Medicine, Fluid and electrolyte disturbances. Vol. 1. pp. 287.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2]


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