Clinical and Biochemical Efficacy of Virechana Karma in the Management of Kamala (Jaundice)

Abstract

In Ayurveda, Kamala (jaundice) is classified as a Pittaja Nanatmaja Vyadhi and Raktapradoshaja Vikara characterized by hepatobiliary dysfunction. Virechana Karma (therapeutic purgation) is classically heralded as the premier bio-purification (Shodhana) therapy for this condition as emphasized by the dictum "Kamale Tu Virechanam". Case Description- A 35-year-old male presented with progressive icterus, reddish urine, generalized weakness, fatigue, and severe anorexia (Aruchi). Baseline liver function tests confirmed hyperbilirubinemia with a total bilirubin of 2.9mg/dL and elevated transaminases, including an SGOT of 97.4 U/L and an SGPT of 92.5 U/L, which correlated with Kamala. Methods- The Purva Karma phase involved Deepana-Pachana with Chitrakadi Vati to digest endotoxins (Ama), followed by graduated internal oleation (Abhyantara Snehapana) with Triphala Ghrita and subsequent sudation (Swedana). During the Pradhana Karma phase, a Mridu-Tikta Virechana formulation was administered, safely yielding a Madhyama Shodhana of 16 purgation bouts (Vegas). Finally, the Paschat Karma phase comprised a strict, graduated dietary regimen known as Samsarjana Krama. Results: Post-treatment evaluation revealed a 70.83% mean relief in subjective symptoms, including complete 100% resolution of yellowish skin and sclera discoloration, dark urine, fever, and pruritus. Objective biochemical parameters showed a 59.71% mean improvement. Total bilirubin completely normalized to 0.9mg/dL representing a 68.97% reduction, SGPT completely normalized to 39.9 U/L showing a 56.86% reduction, and SGOT dropped to 40.7 U/L reflecting a 58.21% reduction. Conclusion- The structured Virechana Karma protocol demonstrated profound efficacy in breaking the pathogenesis of kamala. By clearing metabolic channels and eliminating vitiated Pitta, it successfully restored hepatobiliary function and normalized liver enzymes. These findings validate the classical therapeutic mandate of "Kamale Tu Virechanam", though large-scale controlled clinical trials are warranted to further investigate the underlying molecular mechanisms.