Virechana is one of the five detoxification therapies of Panchakarma. It is an Ayurvedic detox therapy used for the purification of both body and mind and helps the body in becoming free of the exacerbated Pitta dosha and the toxic disease-causing symptoms that come with it.

Today, we are going to discuss how Virechana and Ayurvedic Herbs helped in treating a severe case of Amlapitta.

Let's have a look at how the patient improved after implementing the Ayurvedic protocols and treatments.

Supplements recommended- Dhanyaka Hima, Guduchi, Musta, Anantmul, Avipattikar, Chitrak, Vidanga, Raisins, Castor oil, Eranda thailam, Chandana. 

October 26, 2021 |  32 minutes, 26 seconds.
By Vaidya. Jay Parla. 

Namaste everyone, welcome to the Athreya Ayurveda podcast for practitioners. I welcome all our practitioner family, and we have an exciting case to discuss. The purpose of the podcast we do through Athreya herbs is to support our practitioners with different clinical case scenarios that our community brings in. I, Vaidya Jaygopal Parla, will sit in on this case and have an open discussion about how these cases can be managed effectively. Today in the podcast, I have Gemma Habibi, who is an enthusiastic Ayurvedic practitioner. She's a student at Southern California University of Health Sciences, and that's where she graduated from. She is a wonderful healer, has a great healing touch, and has been a massage therapist for a long time. She has done a lot of healing work on other people and herself by healing herself physically, mentally, and spiritually and has evolved a lot since I have known her. Welcome to the podcast. Gemma. You practice Chandra soma Ayurveda, right?

Gemma - Yes.

Vaidya - You practice in Los Angeles, and we value your time for coming on our podcast and presenting this interesting case. Before we invite you to start bringing up your case and discussing it, we will chant for Dhanwantray to guide us in this podcast.

Gemma - Amazing.

Vaidya - Om Namami Dhanwantrayam Aadi Devam, Surasura Vanditham Pada Padmam, Loke Jara Rugbhay Mrityu Nashakam, Datharam Eesham Vividhaushadhinam.Om Shanti Shanti Shanti Hari Om. May the Dhanwantray guide us in this case discussion. Thank you. Gemma, please, would you mind presenting your case to us?

Gemma - Thank you so much, Dr. Jay, for having me on. It's such an honor to be here. I will start with the case. This case is about virechana, which is part of panchakarma. The patient is a male Caucasian, 36-year-old, about 5’7”, and 165 pounds.  This patient has a very long history of smoking, tobacco, and cannabis for about 15 years. He stopped smoking cigarettes a year ago, used the nicotine vape for a year, and is working on lowering the cannabis dosage for future family planning. He suffers from severe Amla Pitta and daily headaches in the summer months. He has been diagnosed with Seborrheic dermatitis on the head, eyebrows, the beard area Eczema usually shows up around the armpits and chest. This patient is an entrepreneur, a CEO, a business owner, and an avid mountain biker. He's a lover of all things spicy and rides bikes in the mountains of Santa Monica all the time; that’s his favorite hobby. His dreams at night always have an element of chasing or being chased, being persecuted; that’s a common theme with this patient. He had a consultation in late April and was reminded to follow a Pitta pacifying diet and a more sensible routine like riding his mountain bike during the early morning hours or after sunset, where the Pitta is not too high. The client was given a little Avipattikar to purge excess Pitta dosha, a little bit of Dhanyaka Hima to help with skin issues, and also a healthy mind to help with the rajasic state of mind he tends to be in. This patient started out being very excited about the new diet and the new routine but was compliant only for a week. Previously to the consultation in late April, he was also treated for a little bit for emotional dwara. He was given Guduchi, Musta, and Anantamul. In addition to that, he also had external therapy like Abhyanga, Shirodhara, and Marma chikitsa to help with a lot of emotional issues that were coming up. He decided to do panchakarma in late fall, early November. He took Trimada three weeks before the whole process to help with Agni and the Virechana process he was going to undergo. The client took Mahathikthakam Gritham for five days. Only five days were necessary due to his super Pitta constitution, and he didn't need to take ghee for more than that. Virechana was successful. He kept a really strict diet and was dedicated to this whole process. He did the virechana successfully. He did the vilepi three days afterward and kept a strict diet for a week after the Virechana process. A day after virechana, he broke out into a massive skin rash that covered about three-quarters of his entire body. The rash was huge. There were big, itchy welts on the skin. It first appeared in the armpits and then quickly spread through the chest, insides of the body, all over the arms, and the groin area. At this point, we reached out to you for advice. Do you want to speak on that now?

Vaidya - Yes. You said the patient originally had been complaining of Amlapitta. For as long as you remember, the patient had been suffering. The first manifestation is Amlapitta, would you say? 

Gemma - Yes, that was always there. Always a headache.

Vaidya - The second thing was the headache. Amlapitta has a headache, Seborrheic dermatitis in the scalp, and certain areas of the body. In some areas, there was a bit of eczema, Correct?

Gemma - Yes, correct.

Vaidya - You said that he loved everything spicy under the sun. There was an increase or push towards Pitta; that is why you chose Virechana.  First, I liked that you tried to do a little bit of sramsana. Sramsana means, tiny amount of mild virechanas on a daily basis with Avipattikar churna. The dosha aggravation was far higher than the small amount of Avipattikar purging. Interestingly, cases like that will puzzle you at times.  I like your brave decision, and you said I don't want to just play with this higher dosha aggravation of Pitta, not only in the kostha but also in twak. It is the Pitta aggravated in the kostha causing Amlapitta, and it is also moving towards the head and neck region. Most of the lesions, to begin with, were in the scalp, and you said around the eyebrows. Correct?

Gemma - Yes.

Vaidya - The Pitta was moving because of its Laghu Guna (light quality) as he's always active and mountain biking. Laghu moved towards the upper part of the body to the head and neck region, causing headaches and dermatitis. To pull the Pitta from the head and neck region to the kostha and eliminate it, Avipattikar may work, but your decision on the Virechana was the right decision. The patient was put on the Pitta pacifying diet, which is Shamana. I heard from your history narration that there was one week of Pitta intensity, and it seemed like Pitta rejected the diet.

Gemma - Yes. Very little compliance.

Vaidya - That's an issue with Pitta patients. If they are compliant, they're 100% compliant, and then suddenly, if they feel averse towards one of these protocols, they will reject all the things that you have suggested. That's a common thing that I see in my practice too. The only thing that you need to do for Pitta people is to keep challenging yourself. If you will challenge them to drink this, or challenge them to drink soup as a dinner. They will do; they will push themselves. This is the trick you can use in the future when Pitta patients come. Then you gave a combination of Pitta pacifying Herbs, which were like Guduchi and what else, Gemma?

Gemma - I gave Guduchi, Anantmul, and Musta, but this was in late April. I knew this patient wanted to do panchakarma in a few months, and I thought we should start little by little on the way out for Pitta.

Vaidya - You chose the month also. Here in Southern California, October/ November is when the summer season (Grisham Ritu) ends, and that's the time when virechana should be given. The timing was also perfect that you chose virechana as a treatment for this Pitta aggravated patient. Now, the shamana you made with the Guduchi, Guduchi is Katuka, which means it is pungent, tikta- bitter. Swadupaka means it undergoes sweet transformation and is a Rasayana for Dhatus. It has action not only on the Kostha but also on the Rasa and Rakta; these are the two dhatus on which it acts. It also acts on the Meda Dhatu and Asthi Dhatu, but most action will be seen on Rasa and Rakta. The patient had a fever?

Gemma - It was an emotional fever and also a little correlated to sangrahani aspects.

Vaidya - Emotional fever in the sense of being agitated, angry?

Gemma - Yes, different emotions for a very long time, such as upset or anger.

Vaidya - His body would feel hot too?

Gemma - He was like a human furnace. I forgot to go over the eight-fold part.

Vaidya - I said that because sometimes those types of patients are very difficult to manage. If anything changes a little bit, they may feel uncomfortable, then get rajasic and move away from the protocols. I heard that you kept him on a good change of programs from time to time so that the patient doesn't get discouraged. The combination of Anantamul and Musta to calm down the Pitta and Guduchi to take away the Rasa and Rakta based Ama and Pitta is good. I like the combination.  So, two or three months went by, from July, you started preparing him for the virechana. When did you start virechana?

Gemma - Virechana started in early November, but three weeks before that, we incorporated Trimada to prepare his Agni.

Vaidya - Good. All of our listeners should know the Trimada is Musta, Chitrak, and Vidanga combined, one for Ama pachana and one for Agni increasing. Chitrak is good for increasing the Agni. It is best among the Agni, instigating Deepana herbs, whereas Musta takes away the Ama and is also good for the preparation of the gut in Kostha, and Vidanga, which is Ruksha and aam pachak is a good combination. The patient was given about three weeks of this aam pachnah and Agni Deepana. Then we took Guggulutiktakam Gritham or Mahathikthaka Gritham?

Gemma - Guggulutiktakam Gritham.

Vaidya - I am surprised that this patient was able to take Guggulu tiktaka Gritham because sometimes it is intense. I have taken Guggulu tiktaka Gritham for Virechana, and it is a challenge. The first day it's okay; the third day, it is already getting to your nerves, and on the fourth day, you just can't drink it, burp, and smell the Guggulutiktakam Gritham coming up right through your mouth. It's difficult, but I'm surprised and proud that you kept this patient on Guggulu tiktaka Gritham for about five days. You saw the Samyak Snigdha Lakshana, that is, the skin being oily and moist, stools being very soft and light-colored. Did you see those symptoms?

Gemma - Yes, we kept a very close eye on the skin and the malas.

Vaidya - Our listeners will have to make a point here because if the Samyak Snigdha Lakshana is not achieved, then Virechana will not be successful. It is compared in the classical textbook. Charaka himself says while comparing the body to a ripe or unripe mango, "If you squeeze an unripe mango, no juice will come out of it. You have to allow the mango to be completely ripe." Mango here is your digestive system; when it is ripe, it will easily squeeze out all the doshas, the malas, and Amas present in it, so you did the right thing. What was used for Virechana?  That class I missed.

Gemma - In that part, we used a combination of raisins, Avipattikar, and a little bit of castor oil.

Vaidya - That was made into a blend because the raisins or draksha in Ayurveda is seen as Virechanopaga, the substance that facilitates the main herb to purge. The main herb is Avipattikar and Eranda thailam?

Gemma - Yes.

Vaidya - Avipattikar, the main ingredient. All our listeners may already be enthusiastically saying, it is trivrit. Yes, trivrit is the main ingredient. Charaka says Virechana Tivrit Moolam, among the Virechana herbs, trivrit root, is the best because it is an annapakari. That means apaya (complication) will not be seen. Then, on top of it, Snigdha dravya, a Snigdha virechana, is a good choice because when the Pitta is in the head and neck region, Vata will be associated. There is the involvement of Prana Vata and Vyana Vata. For the taila virechana using, Eranda thailam is a good choice too. It is easy to drink because it’s a great combination when you blend it with the raisins. I love that combination, and all my patients receive it well. Some people hate the taste and smell of castor oil, but if you blend it with the cooked raisins, it's wonderful. It works well and is easy to drink. How many urges did the patient have?

Gemma - He had about 9 to 11; it’s a successful purge.

Vaidya - 9 to 11 urges Madhyama Vega. The classical textbooks classify the virechana into a mild virechana, a moderate virechana, and an intense virechana. This falls under moderate virechana and is good for the complaints that he's having. If you do tikshna virechana, then sometimes the patient may feel irritated, so the madhyam virechana is good. After that, you started the vilepi, which the classical textbooks have said to replenish the nutritional needs and rekindle the Agni. The day after virechana, you started noticing the rash, correct?

Gemma - Yes, that's right. He noticed that it started under the armpits and then quickly spread.

Vaidya - It started under the armpits. When we discussed and sent me a picture, it looked furious in the chest and the flank area. So what happened is that when you did the virechana dosha vilayana, i.e., the doshas in the periphery. Bhrajaka Pitta and the Vyana Vata that were aggravated came to the kostha. From the kostha, they are flushed out by the combination of virechana dravyas. A little bit of Pitta that was lurking in the skin or the rakta. Do you remember that explanation that we had for some discussion?

Gemma - Yes, I do remember.

Vaidya - I said that Pitta might have taken the rakta (blood) as its boat, and the blood would have favored the Pitta staying in the blood. After the virechana was complete, this Pitta that was residual or settling into the rakta started becoming aggravated. The first thing that you see is the armpits because the temperature is maintained in the groin or the armpits. In India, the kid cannot keep the thermometer in the mouth, and the doctor used to keep the thermometer in the armpit. Have you ever come across something like this?

Gemma - Yes, I have.

Vaidya - That's because the temperature there is maintained, and the Pitta finds it to be the most conducive area to bring in imbalance. That is why it started from there and then took hold of the entire abdominal and the flanks on the side of the body. It first spread in the kostha, the gut area, and then started spreading to the limps, is that right?

Gemma - Yes.

Vaidya - The Pitta is feeding the rakta, and the rakta is feeding the Pitta. It turned into a little bit of the rakta-Pitta phenomenon. Even though there was no bleeding, you can see that it is a type of dosha imbalance. That’s why when we discussed, and I said, let us do something to cool the Pitta. What did we do?

Gemma - We gave Dhanyaka Hima, Chandana and Anantmul.

Vaidya - The first Guna that we saw for Pitta is the Ushna Guna. I saw the Ushna Guna and the Tikshna Guna. The redness and then the angry looks of it showed it was Tikshna. Lastly, there was also Sara quality. Sara means to spread. Pitta was spreading because of its Sara quality. When we looked at these three, the first thing that we discussed and chose was Dhanyaka, which means the coriander Hima (cold-infusion). We used to soak and allow it to settle down for about six hours, then strain and drink it. We did that almost every six hours. Is that right?

Gemma - Yes, He drinks this throughout the day.

Vaidya - We kept drinking the Dhanyaka Hima, and the aggravated Pitta in the Rakta moved into the Ambu. Ambu means water-carrying channels. Through the water-carrying channels, we were trying to use urine as a method instead of sweat. This Pitta was aggravated in the blood and was trying to come through the sweat. We redirected it and sent it towards the mutravaha srotas. Dhanyaka, even though it is slightly warm when you infuse it with cold water, becomes cooler daily, and it is kashaya rasa, astringent taste. This kashaya rasa is very important for Sara Guna, it constricts and takes away the Sara Guna of the Pitta, and that's what we advised him to drink all day long, if not every six hours. Then we chose the two cooling herbs that are Chandana, which is red sandalwood if combined with the Anantamul. Anantamul is cool in property, and it is Snigdha, Madura, and also has the Soumya quality. Tikshna is balanced by Soumya quality, Chandana is also excellent for  bhrajaka Pitta, especially for bhrajaka Pitta skin conditions Chandana is the best. Both of these were used internally like a shot, we mixed it in water, and he would drink it, is that right?

Gemma - Yes, that's correct. 

Vaidya - That they gave two or three times a day. What happened after that, Gemma?

Gemma - The rash was completely gone in two days, but he continued taking the Dhanyaka Hima for a whole seven days just to ensure that all the residual Pitta was gone.

Vaidya - The Dhanyaka Hima for Mutravaha action, and for Pitta and Rakta calming, we have Chandana and Anantmul. That was the trick to remove the Pitta from the Rakta and redirect it towards the Mutravaha srota. In cases like this, after virechana, something that you cannot expect would happen. My question to Gemma is, after the virechana, how is the skin where the lesions were, the scalp, the forehead, and the eyebrows?

Gemma - It is perfect. Now that it's getting a little colder, there's a tiny bit of dryness, but this patient has never seen his skin be so clear and eczema-free. He is an entirely different person. He can't tolerate anything spicy anymore.

Vaidya - You did the magic of your wand of virechana to allow or express his body. The body is saying no more of these irritating things into my system. The body is now reminding the mind not to do what it was constantly doing without mindfulness. It is a very important lesson that Virechana or Panchakarma teaches our patients. There is a subtle shift which the patient will notice after the virechana, or maybe a week later, they will see a sudden change. That is the ability of these panchakarma treatments. Don't be fearful at all; when you're doing panchakarma, be bold; small complications can easily be handled, but prepare the patient well, as Gemma did. There is Deepana pachana, snehana, abhyanga swedana, and then the virechana given in a very specific order. Then based on the dosha dushya sammurchana, which is very important for all the Panchakarma, we can administer. It can be Nasya or virechana, and it can be as simple as Shirodhara. Anything you want to do needs to be thought of with the Dosha Dushya and the Vikruti. You will see great benefits after the cleansing, or the panchakarma is done. I am very thankful that you got this case to look at how things can go wrong, and we can still fix it.

Gemma - Yes. It's just a minor complication, as you said.

Vaidya - I hope our listeners will take a lot from this case. Thank you, Gemma, for coming up on our podcast for all the practitioners and presenting this case. We look forward to inviting you again, for some other interesting cases. I know that you're busy in practice, if you have time, you can come back. We would love to have you back here on our podcast and discuss your cases. Thank you so much.

Gemma - Thank you so much, Dr. Jay. It's always such a joy to speak with you, and I would love to come back.

Vaidya - Thank you, Namaste

Gemma - Namaste.