Module on “Introduction to Vamana” Talk By- Dr. Rajkala P. Patil

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Introduction to Vamana

Dr. Rajkala P. Patil
Head & Associate Professor,
Department of Panchakarma,
Faculty of Ayurveda, IMS, BHU, Varanasi

Vamana:

Vamana, derived from the Sanskrit word “वमन” (vamana), is a therapeutic procedure in the field of Ayurveda, an ancient system of natural healing. This procedure plays a pivotal role in expelling vitiated doshas from the human body through the upper route, primarily via the mouth.

तत्र दोषहरणं उर्ध्वभागं वमनसंज्ञकम्|

 Vamana is a well-established and integral aspect of Ayurvedic treatments, with a dual-purpose encompassing preventive and curative applications.

The Scope of Vamana:

  1. Preventive Aspect: Vamana therapy is employed in the prevention of diseases, particularly those caused by an excess of Kapha dosha. This can be utilized in the context of seasonal cleansing, known as Vasant (spring detoxification), and as a preparatory measure before embarking on rejuvenation therapies like Rasayana and Vajeekarana.
  2. Curative Aspect: Vamana therapy is also a valuable tool for the treatment of specific ailments. It is particularly effective in addressing disorders that can be attributed to imbalances in Kapha dosha, such as skin diseases and respiratory conditions like asthma.

Acharya Sushruta, one of the eminent figures in Ayurvedic medicine, beautifully illustrates the significance of Vamana therapy with a poignant analogy. He likens the expulsion of excessive Kapha dosha through Vamana to cutting the root of a tree. Just as the removal of the root leads to the withering of flowers, fruits, and branches, the elimination of excessive Kapha can pave the way for the pacification and resolution of ailments originating from this dosha.

छिन्ने तरौ पुष्पफलप्ररोहा यथा विनाशं सहसा व्रजन्ति |
तथा हृते श्लेष्मणि शोधनेन तज्जा विकाराः प्रशमं प्रयान्ति ||१३
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Su.Chi.33/12

Classification of Vamana Therapy:

Vamana, an Ayurvedic therapeutic procedure aimed at expelling vitiated doshas from the body through the upper route, is classified into various types to cater to the specific needs and conditions of the individual undergoing the treatment. 

  1. Sadyo Vamana: This is the most immediate or sudden form of Vamana. In Sadyo Vamana, the patient is made to vomit forcefully by administering emetic substances. This type of Vamana is usually reserved for situations where there is an urgent need to expel vitiated doshas from the body. It’s often employed in cases of severe toxicity or acute conditions, such as poisoning.
  2. Sneha Purvak Vamana: Sneha purvak Vamana involves the use of medicated ghee as a preparatory step before inducing vomiting. The patient is given a specific amount of medicated ghee over a few days to prepare the body for Vamana. This helps in softening and mobilizing the doshas, making their elimination through Vamana more effective. Sneha purvak Vamana is typically used for individuals with an aggravated Vata dosha.
  3. Mridu, Madhyama, Tikshna Vamana: These classifications pertain to the intensity or strength of the Vamana therapy. They are used to tailor the treatment to the patient’s constitution and the nature of the disease.
  4. Mridu Vamana: In this approach, a mild Vamana is performed. It is suitable for patients with a delicate constitution or those who may not tolerate a more intense Vamana procedure. Mridu Vamana is generally employed when the dosha imbalance is not too severe.
  5. Madhyama Vamana: Madhyama Vamana is a moderate or medium-strength Vamana procedure. It is commonly used in cases where the dosha imbalance is moderate, and the patient’s constitution can handle a moderate cleansing process. This form of Vamana is versatile and often chosen for various ailments.
  6. Tikshna Vamana: Tikshna Vamana is the most intense and forceful form of Vamana. It is typically used when the dosha imbalance is severe, and a powerful cleansing is required. Patients who are physically strong and able to endure this intense procedure may opt for Tikshna Vamana. It is essential for diseases with deep-seated imbalances.

These classifications enable physician to adapt Vamana therapy to meet the unique requirements of each patient. The choice of which type of Vamana to administer depends on factors such as the patient’s constitution, the severity of the disease, and the therapeutic goals, ensuring that the treatment is as effective and safe as possible.

Vamana Medicines or Emetic Drugs:

In Ayurvedic Vamana therapy, emetic drugs are used to induce therapeutic vomiting, thereby eliminating vitiated doshas from the body. The choice of emetic drugs depends on the individual’s constitution, the nature of the ailment, and the specific requirements of the treatment

  1. Madanphala (Emetic Nut): Madanphala, also known as Randia dumetorum, is a traditional emetic drug. It contains alkaloids that stimulate the vomiting reflex, leading to the expulsion of vitiated doshas. It is often used in moderate to severe Vamana therapies, especially when Kapha dosha needs to be eliminated. Madanphala is considered potent and is typically used in stronger Vamana procedures. It is called as Anapaayitvaat- it doesn’t produce much complications. 
  2. Dhamargava: Dhamargava, scientifically known as Fagonia cretica, is another emetic herb employed in Vamana therapy. It is particularly useful in cases where there is an excess of Kapha dosha or when treating respiratory conditions like bronchial asthma, Depression. Dhamargava is known for its strong emetic properties and is chosen when a forceful Vamana is required.
  3. Kutaja: Kutaja, or Holarrhena antidysenterica, is a well-known herb, often used as an emetic. It is commonly used in Vamana therapy to eliminate aggravated Pitta dosha and is considered safer for individuals with a Pitta constitution. Kutaja has moderate emetic properties, making it suitable for medium-strength Vamana procedures. 
  4. Vacha (Acorus calamus): Vacha, also known as Sweet Flag or Acorus calamus, is a traditional Ayurvedic emetic herb with a range of therapeutic properties. It is often used in Vamana therapy to target conditions associated with an imbalance of Kapha dosha. Vacha is valued for its ability to stimulate the vomiting reflex and eliminate excess doshas, especially when Kapha-related disorders need to be addressed. It is considered to have moderate emetic properties, making it suitable for medium-strength Vamana procedures. Vacha is also known for its potential to enhance mental clarity and cognitive function, and it is used in Ayurveda for various neurological and psychological conditions.

The action of emetic drugs, which induce vomiting, can be categorized into two main types: centrally acting and locally acting. These categories are further divided into direct and indirect acting drugs for centrally acting emetics, and CTZ stimulation and saponin-based emetics for locally acting emetics.

Centrally Acting Emetic Drugs:

  1. Direct Acting Centrally Acting Emetics: These drugs act directly on the emetic center in the brain to induce vomiting. They include substances that stimulate the vomiting reflex in the central nervous system.
  2. Indirect Acting Centrally Acting Emetics: These drugs work indirectly by irritating or stimulating other parts of the body, such as the gastrointestinal tract, which, in turn, send signals to the brain to initiate the vomiting reflex.

Locally Acting Emetic Drugs:

  1. CTZ Stimulation (Chemoreceptor Trigger Zone): The CTZ, located in the brain, is sensitive to toxins and emetic substances in the blood. Emetics that act on the CTZ stimulate this region, leading to the initiation of the vomiting reflex. This is the central area where emetic signals are integrated.
  2. Saponin-Based Emetics: Saponins are natural chemical compounds found in various plant species. They can irritate the gastrointestinal tract’s mucous membranes, leading to nausea and vomiting. These substances can cause a localized reaction in the gut that eventually triggers the vomiting reflex.

The overall mechanism of emetic drug action involves one or more of the following:

Stimulation of Vomiting Center: Centrally acting emetics, both direct and indirect, stimulate the vomiting center in the brain. This can be achieved by directly affecting the brain or through the signaling of other areas of the body.

Irritation of Gastrointestinal Tract: Locally acting emetics, such as saponins, irritate the mucous membranes of the gastrointestinal tract, leading to nausea and, eventually, vomiting.

Activation of Chemoreceptors: The chemoreceptors in the CTZ are sensitive to emetic substances and toxins in the bloodstream. Emetics that act on the CTZ can trigger the vomiting reflex by affecting these receptors.

Various medicines used in Vamana Procedure: 

  • Vamaka yoga, 
  • Vamanopaga drugs 
  • Mulini, Phalini etc.
  • Madanphala Pippali Choorna with Honey
  • Dadhi
  • Kshirapaka 
  • Kashaya 
  • Ghreya yoga

Indications of Vamana:

विशेषेण तु वामयेत्||१||
नवज्वरातिसाराधःपित्तासृग्राजयक्ष्मिणः|

कुष्ठमेहापचीग्रन्थिश्लीपदोन्मादकासिनः||२||

श्वासहृल्लासवीसर्पस्तन्यदोषोर्ध्वरोगिणः|३| 

Clinical indication

  • In conditions with excited (utklishta kapha)
  • The first stage of Jwara.
  • Rajayakshma which involves a complex pathology resulting in a multitude of symptoms.
  • Skin diseases like Psoriasis
  • Respiratory diseases including Asthma.
  • Certain psychological disorders- Depression, Schizophrenia 
  • Prameha etc.
  • PCOD

Contra-indications

अवाम्या गर्भिणी रूक्षः क्षुधितो नित्यदुःखितः||||
बालवृद्धकृशस्थूलहृद्रोगिक्षतदुर्बलाः|
प्रसक्तवमथुप्लीहतिमिरक्रिमिकोष्ठिनः||४||

ऊर्ध्वप्रवृत्तवाय्वस्रदत्तबस्तिहतस्वराः|
मूत्राघात्युदरी गुल्मी दुर्वमोऽत्यग्निरर्शसः||५||

उदावर्तभ्रमाष्ठीलापार्श्वरुग्वातरोगिणः|
ऋते विषगराजीर्णविरुद्धाभ्यवहारतः||६
||
A.H.Su.18/3-6

Clinical contra-indications

  • Strictly contra indicated in pregnancy.
  • In children below 12 years
  • Old age
  • In emaciated patients
  • In those suffering from cardiac problems etc
  • Gastroparesis 

Procedure in detail 

In Panchakarma, Vamana therapy is a structured and well-detailed procedure, encompassing several stages:

  1. Sambhara Sangraha (Collection of Materials): This initial stage involves gathering all the necessary materials and resources for the Vamana therapy. This includes emetic drugs, Vamana-specific herbs, oils, and equipment required for the procedure. It is essential to ensure that everything is prepared and organized before the therapy begins.
  1. Atura Pariksha (Examination of the Patient): Before starting Vamana therapy, a thorough examination of the patient is conducted. This involves assessing the individual’s constitution (Prakriti), the nature of the ailment, and any specific doshic imbalances. This examination helps determine the suitability of Vamana therapy for the patient and the specific requirements of the treatment.
  2. Matra Nirnaya (Deciding the Dose of Vamaka Drugs): The dosage of emetic drugs (Vamaka) is calculated based on the patient’s constitution, the severity of the ailment, and the dosha imbalance being targeted. The correct dose of emetic substances is crucial to achieve effective therapeutic vomiting while avoiding complications.
  3. Atura Siddhata (Preparation of the Patient): This stage involves preparing the patient both physically and mentally for the Vamana therapy. It includes the following components:

   

  1. a) Vamana Purva Bhojana Vyavastha (Dietetic Regimen): The patient is placed on a specific diet regimen before the actual Vamana procedure. This diet is light and easily digestible, ensuring there is no undigested food in the stomach before Vamana.
  2. b) Snehana and Swedana (Oleation & Sudation Therapy): This involves applying specific oils to the body (Snehana) and inducing sweating (Swedana). These therapies help in softening and mobilizing doshas, making them more amenable to elimination during Vamana.
  3. c) Manasopachara (Counselling): Preparing the patient’s mind is equally important. Counseling helps in reducing anxiety and ensuring the patient is mentally ready for the emesis therapy.
  4. Purvakarma: This phase involves preparatory measures immediately before Vamana, which may include procedures like Dipana (stimulating digestion) and Pachana (digestive treatment).
  5. Snehapana (Specific, Proper Snehana): Snehapana is the administration of medicated ghee or oils to the patient. It continues the process of oleation and prepares the body for Vamana.
  6. Gap Day (Abhyanga Swedana): The gap day typically separates the administration of Snehapana and the actual Vamana procedure. On this day, the patient may receive oil massages (Abhyanga) and sweating therapies (Swedana).
  7. Utkleshakara Diet: Before the actual Vamana, on the previous day, the patient is given a specific diet to further prepare the body. This diet helps in inducing a sense of heaviness or increases Kapha, which contributes to successful emesis during Vamana.

Signs and Symptoms of proper Pachana (Digestion)

  • Laghuta (feeling of lightness in the body)
  • Kshudha-pravritti (improved appetite)
  • Pipasa (Feeling of thirst)
  • Nirama Mala (well-formed stools Without mucous)

Materials required-

  • Large Basin – 1
  • Medium sized vessel – 2
  • Steel glass (capacity-250ml)- 2
  • Table spoon      – 2
  • Khalwa yantra – 1
  • Stool                – 1
  • Chair with arm rest – 1
  • Cotton cloth-           – 2
  • Hot water bath vessel – 1
  • Stove – 1

Medicines on the day of Vamana: Approximate combination of Vamana Aoushdha 

  • Madanaphalachoorna- 10 to 15 gm
  • Vachachoorna-5 gm
  • Yashtimadhuchoornam- 5- 10 gm
  • Honey       – Q S
  • Saindhava- 15 gm

Classical Vamana Procedure: 

अथ साधारणे काले स्निग्धस्विन्नं यथाविधि|
श्वोवम्यमुत्क्लिष्टकफं मत्स्यमाषतिलादिभिः||१२||

निशां सुप्तं सुजीर्णान्नं पूर्वाह्णे कृतमङ्गलम्|
निरन्नमीषत्स्निग्धं वा पेयया पीतसर्पिषम्||१३||

वृद्धबालाबलक्लीबभीरून् रोगानुरोधतः|
आकण्ठं पायितान्मद्यं क्षीरमिक्षुरसं रसम्||१४||

यथाविकारविहितां मधुसैन्धवसंयुताम्|
कोष्ठं विभज्य भैषज्यमात्रां मन्त्राभिमन्त्रिताम्||१५||
A.H.Su.19/12-14

On the day of Vamana: Sequence of things administered in Patient: 

  • Akanthapana/ Yavagu pana 
  • Aushadhi sevana –  पीतो मुहूर्तमनुपालयेत्| तन्मनाः
  • Vamanopaga 
  • Lavan jala 

Assessment of Samyak Vaman

निर्विबन्धं प्रवर्तन्ते कफपित्तानिलाः क्रमात्|
मनःप्रसादः स्वास्थ्यं चावस्थानं च स्वयं भवेत्

Features of Samyak vamana-

  • Adequate expulsion of Kapha dosha followed by Pitta
  • Sense of comfort and well being
  • Remission of symptoms of the disease
  • Feeling of lightness of the body
  • Improved body and sensory functions and natural urges

Post emesis management

  1. Peyadi sansarjana krama (dietary regimen)
  2. Shaman Upachara (medicine for pacification of diseases)
  3. Rasayana therapy (rejuvenation drugs)

Rationality of Samsarjana

The initial dietary intake consists of Peya and Vilepi, both composed of rice and water. These choices are rich in carbohydrates and are readily digestible. 

The subsequent dietary option, Yusha, is crafted from legumes (Daal), imparting a protein-rich quality.

Lastly, the third recommended diet is Mamsarasa (meat juice), which is abundant in fats. This represents a progressive transition in dietary administration, starting with lighter options and progressing towards more substantial and calorically dense choices.

10 multiple-choice questions with answers related to the introduction to Vamana therapy 

1. What is the primary purpose of Vamana therapy in Ayurveda?
a. To induce sleep
b. To promote weight gain
c. To expel vitiated doshas
d. To enhance memory
Answer: c. To expel vitiated doshas

2. Which dosha is primarily targeted in Vamana therapy?
a. Vata
b. Pitta
c. Kapha
d. None of the above
Answer: c. Kapha

3. What is the significance of Sadyo Vamana in Ayurveda?
a. It is used for long-term preventive care.
b. It is the most immediate form of Vamana for urgent cases.
c. It targets Vata dosha imbalances.
d. It is only employed for children.
Answer: b. It is the most immediate form of Vamana for urgent cases.

4. Which classification of Vamana is suitable for patients with a delicate constitution?
a. Mridu Vamana
b. Madhyama Vamana
c. Tikshna Vamana
d. Sadyo Vamana
Answer: a. Mridu Vamana

5. What type of emetic drug is Kutaja commonly used for in Vamana therapy?
a. To target Kapha dosha
b. To stimulate Pitta dosha
c. To alleviate Vata dosha imbalances
d. To promote mental clarity
Answer: a. To target Kapha dosha

6. What is the main action of centrally acting emetic drugs in Vamana therapy?
a. They directly irritate the gastrointestinal tract.
b. They stimulate the vomiting center in the brain.
c. They work through saponins.
d. They have no role in the process.
Answer: b. They stimulate the vomiting center in the brain.

7. Which category of emetic drugs works by irritating the gastrointestinal tract’s mucous membranes in Vamana therapy?
a. Direct acting drugs
b. CTZ stimulation
c. Saponin-based drugs
d. Indirect acting drugs
Answer: c. Saponin-based drugs

8. What is the main purpose of Vamanopaga drugs in the Vamana procedure?
a. To stimulate digestion
b. To induce vomiting
c. To facilitate the Vamana process
d. To promote deep sleep
Answer: c. To facilitate the Vamana process

9. What are some clinical indications for Vamana therapy in Ayurveda?
a. Pregnancy and emaciated patients
b. Skin diseases and asthma
c. Ulcers in stomach
d. All of the above
Answer: b. Skin diseases and asthma

10. What dietary regimen is recommended during the preparatory phase of Vamana?
a. Heavy and complex foods
b. Meat-based diet
c. Light and easily digestible foods
d. Spicy and oily foods
Answer: c. Light and easily digestible foods

References: 

  1. Agnivesha; Charaka Samhita; redacted by Charaka and Dridabala with Ayurveda Dipika Commentary by Chakrapanidutta; English translation edition 1997; by Ram Karan Sharma and Vaidya Bhagwan Dash; Chaukhambha Sanskrit Series Office, Varanasi, Uttar Pradesh. Pp 738 pg 699-700
  2. Vagbhatacharya; Ashtanga Hridaya with commentaries Sarvangasundara of Arunadutta and Ayurveda Rasayana of Hemadri, ed. by Pandit Bhishak Acharya, Hari Shastri Paradkar Akola; 8th edition, 2000; Chaukhambha Orientalia, Varanasi, Uttar Pradesh. Pp 956 pg 769
  3. Sushruta, Sushruta Samhita with commentary of Sri Dalhanacharya edited by Aryan Ram Acharya “Kavyatirtha”, published by Chaukhamba Orientalia, Varanasi, Reprint 2009
  4. Dravyaguna Vijnana by Dr. J. L. N Shastri, Vol. 2, 3rd Edition, Chaukhamba Orientalia, Varanasi, 2008

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