Shodhana Procedure Note (Virechana)

Date: [Procedure date]

Start Time: [Time of Virechana agent administration]

End Time: [End of active purgation/monitoring period]

Location: [Clinic/facility and room]

Performing Clinician: [Name, credentials]

Assistants/Attendants: [Names and roles]

[One-line procedure summary] (Example: "Therapeutic purgation performed following completed Purva Karma; monitored outputs and clinical course; initiated Samsarjana Krama.")

Indication and Diagnoses

• Primary indication for Virechana: [Primary indication / Uncertain – documented after clarification]
• Ayurvedic assessment: [Dosha involvement]; [Dushya involved]; [Srotas affected]; [Agni status]; [Koshta type]
• Biomedical diagnoses relevant to indication or risk: [Diagnoses / None stated]
• Target Shuddhi intensity and planned vega range: [Avara / Madhyama / Pravara]; [Planned vega range]

Pre-Procedure Evaluation

Interval History

[Interval symptoms since Purva Karma began: hydration status, dizziness, weakness, nausea, bowel changes, sleep, appetite, intercurrent illness, new medications or substances]

Contraindication Screen

• Pregnancy status: [Negative / Positive / Not applicable]; Method: [Test type and date / Reliable exclusion method]
• Cardiac disease or red flags: [Absent / Present – details]
• Acute febrile illness: [Absent / Present – details]
• Active diarrhea: [Absent / Present – details]
• Significant weakness or frailty: [Absent / Present – details]
• Bleeding tendency: [Absent / Present – details]
• Anorectal injury or ulceration: [Absent / Present – details]
• Comorbidities increasing dehydration/electrolyte risk: [Absent / Present – details] (Include renal disease, advanced age, diuretic use, uncontrolled diabetes)

Proceeding Decision: [Proceed as planned / Modify plan / Postpone / Cancel]; Rationale: [Brief rationale if any contraindication present or risk-benefit discussion if proceeding]

Baseline Vitals and Exam

• BP: [Value and position / Not obtained – reason / Not indicated per protocol]
• HR: [Value / Not obtained – reason / Not indicated per protocol]
• RR: [Value / Not obtained – reason / Not indicated per protocol]
• Temperature: [Value and route / Not obtained – reason / Not indicated per protocol]
• SpO2: [Value on room air or supplemental O2 / Not obtained – reason / Not indicated per protocol]
• Weight: [Value / Not obtained – reason / Not indicated per protocol]
• General appearance and mental status: [Alertness, orientation, distress level]
• Mucous membranes and skin turgor: [Findings]
• Abdomen: [Inspection, bowel sounds, tenderness, guarding, distension]
• Pertinent labs: [Results with dates / None obtained]

Purva Karma Summary

• Deepana/Pachana: [Agent(s) and dose]; [Duration]; [Response and tolerability]
• Snehapana: [Substance]; [Dosing progression and dates]; Samyak Snigdha Lakshana: [Key markers observed]
• Abhyanga and Swedana: [Dates]; [Any reactions]
• Vishrama Kala: [Duration]; [Diet pattern]
• Jeernahara Lakshana on procedure day: [Present / Absent – details]

Informed Consent

Consent discussion occurred [today / prior consent reconfirmed per policy]. Topics reviewed: nature and purpose of Virechana, expected clinical course including high stool output and monitoring requirements, material risks (dehydration, syncope, electrolyte disturbance, worsening abdominal pain, rectal irritation, potential need for IV fluids or transfer), and alternatives. [Patient understanding assessment]. [Interpreter used – language / Interpreter not required].

Consent Obtained: [Yes / No]

Witness: [Name]

Form Location: [EHR reference]

Time-Out

• Patient identity verified: [Method]
• Procedure confirmed: Virechana (therapeutic purgation)
• Allergies reviewed: [Allergy list / No known allergies]
• Key risk flags announced: [Fall risk / Hypotension risk / Diabetes management plan / Other / None]
• Team members present: [Names and roles]
• Time-Out Completed: [Time]

Procedure Details

Procedure Narrative

[Patient position]; [Environment setup]; [Empty stomach confirmation and timing since last intake]; [Agent verification and administration]; [Initial response]; [Any immediate adjustments]. (4–8 sentences, factual)

Virechana Agent(s) Administered

• [Agent name – classical and common]; [Formulation]; [Dose]; [Route]; [Time administered]; [Anupana/adjuvant]; [Instructions given]
• (Additional agents if applicable)

Supportive Measures

• Oral fluid strategy: [Type, volume, timing]
• Nonpharmacologic measures: [Fomentation, positioning, other]
• Patient instructions: [Avoid suppression/forced initiation of urges; call staff if dizzy; use assist for ambulation; other]

Monitoring and Output Log

Monitoring Performed

Monitoring cadence: [Frequency]. Parameters monitored: [Vitals, mental status, symptoms, hydration indicators]. Protocol deviations: [None / Description with reason and mitigation].

Output Log

Vega counting convention: [Definition used for counting bouts]

• Time: [Timestamp or range]; Vega count: [Number]; Stool: [Volume estimate, consistency, color, notable components, blood Y/N]; Symptoms: [Cramping severity, nausea, dizziness – note if patient-reported]; Oral intake: [Type and volume]
• (Repeat for each bout or time block; note if data partial or patient-reported)

Shuddhi Determination

• Desired endpoint achieved: [Yes – specify endpoint / No]
• Assigned Shuddhi level: [Avara / Madhyama / Pravara]
• Basis for determination: [Criteria used]
• If response inadequate: [Observe only / Feed and plan re-dose / Alternate plan]; Rationale: [Brief reasoning]

Complications

[None observed during monitored period]

(If complications occurred, document each:)

• Event: [Abdominal pain / Dehydration / Syncope / Distension / Vomiting / Rectal irritation / Suspected GI bleed / Other]
• Onset: [Time]; Precipitating factors: [If known]
• Objective findings: [Vitals, exam changes, mental status]
• Interventions: [Details]
• Response: [Improved / No change / Worsened – details]
• Escalation: [Consultation / Transfer / Extended observation / None]

Post-Procedure Status

[End-of-procedure vitals]; [Clinical condition]; [Hydration status]; [Ambulation safety]; [Abdominal exam if symptoms occurred].

Samsarjana Krama (Post-Procedure Diet)

Start Time: [Explicit start date and time]

• Diet phase and duration tied to Shuddhi intensity: [Phase progression with durations]
• Meal-by-meal progression: [Allowed foods and preparation for each step]
• Hydration plan: [Fluids, volumes, frequency]
• Adaptations: [Dietary restrictions or comorbidity-specific adjustments / None]

Activity and Regimen

• Rest and activity: [Recommendations and gradual resumption plan]
• Temperature exposure: [Avoid chill/overheating; bathing guidance]
• Medication plan: [Supportive medications, holds, restart dates, glucose management if diabetic]
• Expected bowel pattern next 24–72 hours: [Normal expectations vs concerning signs]

Return Precautions

• Persistent vomiting or inability to keep fluids down
• Syncope, severe dizziness, or confusion
• Markedly decreased urination
• Severe or progressive abdominal pain or distension
• Fever or signs of infection
• Blood in stool or black/tarry stool
• Chest pain, shortness of breath, or palpitations
• [Patient-specific red flags based on comorbidities]

Planned Follow-Up: [Timeframe and modality]

Clinic Contact: [Phone number]

Disposition

Disposition: [Home / Observation / Inpatient Admission / Transfer]

Condition at Disposition: [Stable / Guarded]; [Mobility status]

Handoff To: [Name and role / Not applicable]

Outstanding Tasks: [Pending labs, continued monitoring, diet start time, next evaluation time]

[Closing summary of procedure course and immediate plan]

Signature

Author: [Name, credentials]

Date/Time Signed: [Date and time]

(If applicable: Vitals and I/O imported from nursing flowsheet and reviewed by author.)