A case report on Acute cardiac syndrome following Virechana karma in Avascular necrosis of femoral head

The safety of Panchakarma (~five internal bio-cleansing therapies) protocol, including Purvakarma (~preparatory procedures) such as Snehapana (~internal oleation) and Swedana (~therapeutic sudation), varies significantly depending on the quality of drugs used and the patient’s comorbidities. Snehapana , the oleation therapy, indeed has a significant impact on lipid metabolism. Research suggests that derangements in the complicated dynamics of lipid metabolism have a significant impact on cardiovascular well-being. This is a case report of a 45-year-old male diagnosed with avascular necrosis (Stage III) of bilateral femoral head with a previous history of coronary artery disease, who developed an episode of acute cardiac syndrome after undergoing Snehapana , Swedana, and Virechana (~therapeutic purgation). Subsequently, he was referred to a higher center and was managed successfully. The case report highlights the importance of determining the Paka (~transformation) of Taila (~oil) for Snehapana , particularly in high-risk groups, investigating potential interactions with concomitant allopathic medications, and establishing safe dosage ranges while practicing Shodhananga snehapana (~internal oleation for purification). Proper surveillance of the source of formulations used and their quality assurance is indispensable to minimize safety concerns in vulnerable groups undergoing Panchakarma procedures.