Changes

वमन न० वम ल्युट् । १ मर्दने २ छर्दने मेदि०) (vachaspatyam)

वमन न० वम ल्युट् । १ मर्दने २ छर्दने मेदि०) (vachaspatyam)

== Vamana Procedure ==

== Vamana Procedure ==

=== Pradhana Karma ===

=== Pradhana Karma ===

'''Dosage of Vamana medicine:''' Dosage of the medicine used for vamana varies depending on various factors related to the patient and disease. Thus even when a standard dosage for vamana drug is mentioned it is  advised to be measured by that individual patient's hand. Acharya Charaka,  advises the dose of vamaka dravya (emetic drug) should be as much as patient can hold the drug in his hand’s fist.<ref name=":0" />  The commentators of Ashtanga Hrudayam of Vagbhata have specified the parameters on the basis of which the dosage is to be decided. They have advised to decide dosage on the basis of individual’s strength, the disease severity, and more importantly with respect to koshta (digestive ability). Koshta is one another unique and wide concept, but precisely it indicate capacity of the individual to hold the waste products of digestion inside the body.<ref>Ashtanga Hrudayam (Sutrasthanam Adhyaya 18 Sutram 14)</ref> Along with the vamana dravya, a patient might be given suitable liquids like sugarcane juice or milk or some decoction in large amount to drink so as to facilitate easy induction of vomiting and removal of accumulated doshas through that.  

Vamana dravya (emetic drug) is administered which is based on the above assessment and differs with everyone. The patient is made to sit on a comfortable and relaxed chair. Just before administration of vamana dravya milk, curd, decoction of yashtimadhu (glychirhyza glabra) etc is given to elderly and very young patients, boiled pulses soup(yavagu) mixed with ghee is also given.

 

Patient must swallow vamana drug at once to avoid initial nausea.

# '''Dosage of Vamana medicine:''' Dosage of the medicine used for vamana varies depending on various factors related to the patient and disease. Thus even when a standard dosage for vamana drug is mentioned it is  advised to be measured by that individual patient's hand. Acharya Charaka,  advises the dose of vamaka dravya (emetic drug) should be as much as patient can hold the drug in his hand’s fist.<ref name=":0" />  The commentators of Ashtanga Hrudayam of Vagbhata have specified the parameters on the basis of which the dosage is to be decided. They have advised to decide dosage on the basis of individual’s strength, the disease severity, and more importantly with respect to koshta (digestive ability). Koshta is one another unique and wide concept, but precisely it indicate capacity of the individual to hold the waste products of digestion inside the body.<ref>Ashtanga Hrudayam (Sutrasthanam Adhyaya 18 Sutram 14)</ref> Along with the vamana dravya, a patient might be given suitable liquids like sugarcane juice or milk or some decoction in large amount to drink so as to facilitate easy induction of vomiting and removal of accumulated doshas through that. Vamana dravya (emetic drug) is administered which is based on the above assessment and differs with everyone.  

 

# Patient is advised to swallow vamana drug at once to avoid initial nausea.

After administration of drug, patient must be kept under constant observation.  A large vessel must be kept ready to collect the vomitus.

# After administration of drug, patient is kept under constant observation.  His vitals are checked, nadi pariksha is also done.

 

# A large vessel is kept ready to collect the vomitus.

Once the bouts of vomiting start, forehead and chest of patient must be held by nurse. Back of the patient’s is gently massaged to comfort the patient.

# Once the bouts of vomiting start, forehead and chest of patient is held by nurse and back of the patient is gently massaged to provide support as well as easy passage of vomitus.  

 

# Each Vega (bout of vomiting) is observed, counted and assessed by sound, color, taste in patients mouth, consistency, quantity, odor etc.

Each Vega (bout) should be observed, counted and assessed by sound, colour, taste, consistency, odour etc.

# A vaidya carefully monitors the entire process and decides when to give extra medicine or when to stop. There are certain parameters described in treatises on the basis of which a vaidya decides the level of cleansing of vitiated doshas and time to stop vamana. Number of bouts of vomiting, their quantity and certain signs & symptoms are criteria for assessment of grade of purification through vamana. There are certain features stated by acharyas to assess whether the procedure has been done appropriately and if the doshas have been eradicated completely indicating samyak yoga (appropriate), ayoga (insufficient elimination) and atiyoga (excess elimination)<ref>Charaka Samhita (Siddhisthanam Adhyaya 1 Sutra 15-17)</ref> <br />

 

# Individual is further observed for any kind of complications. Distension of abdomen, cutting like pain in anal region, cardiac spasms or ache, excessive discharge of any kind, blood discharge, rigidity and spasms etc. these complications can arise if the vamana karma is done inappropriately. Further treatment is given immediately in any such case.<ref>Charaka Samhita (Siddhisthanam Adhyaya 6 Sutram 29)</ref>

There are few parameters addressed by acharyas to assess the vitiation of doshas, and effects after procedure.

 

|1.1/2 prastha

 

 

 

 

There are certain features stated by acharyas to assess whether the procedure has been done appropriately and if the doshas have been eradicated completely, which are samyak yoga(appropriate), ayoga(insufficient) and atiyoga(excess) lakshanas(symptoms) which are seen in patient or an individual. Following each feature are mentioned below in the tabular form,

 

(char. siddh.1.15-17)

 

 

 

 

Individual is further observed for any kind of complications. Distension of abdomen, cutting like pain in anal region, cardiac spasms or ache, excessive discharge of any kind, blood discharge, rigidity and spasms etc. these complications can arise if the vamana karma is done inappropriately. Further treatment is given immediately in any such case. (char. sidd.6.29)

=== Pashchat Karma ===

=== Pashchat Karma ===

Once the vaidya decides to stop Vamana the post vamana procedures are considered and these are known as Pashchat karmas. Pashchata karma of vaman include Mouth cleansing, therapeutic smoking, rest, diet plan and some lifestyle related advices.  

 

# Dhumapana or inhalation of medicated smoke wherein the dravya or drugs are decided based on the condition of the patient. Dhumapana is essential procedure to eliminate the kapha doshas which are adhered to bodily channels locally. (sush. chik.33.11)

# There are certain behavioural instructions stated to avoid further complications.  Patient should avoid sitting or standing in one position for too long, long walks must be avoided, speaking loudly, anger, grief, exposure to excessive cold, sunlight, winds etc. excessive sexual intercourse, sleeping during daytime, staying awake late at night are few restrictions to be avoided after vamana karma.

# Samsarjana krama meaning diet after vamana karma (rehabilitation diet) must be given upto seven days depending on the level of shuddhi(purification) that is avara(high), madhyama(medium) or hina(low) shuddhi starting from the same day (evening) of the procedure or on the next day morning if there is any vitiation of doshas observed and remaining doshas are yet to be eradicated.

# On the first day or as a first meal, “manda” is specifically made with red variety of rice which is a gruel like food preparation which is given for three consecutive meals. This kind of preparation is liquidy in nature and helps the weak digestive ability which is present after the vamana karma.

# For the next three consecutive meals “vilepi” which is again a kind of gruel, made with red type of rice is given. This is semisolid in consistency.

# After this,” odana” which is a well cooked rice made with red rice along with mudga yusha(soup from green gram) is given for next three meals. Warm water is consumed during samsarjana krama.

# For the next three meals meat soup is given. Later, the patient is expected to have a normal diet.

 

# After appropriate vamana karma patient is made to wash mouth clean with warm water and must rest in a room where there is not direct exposure to cold air or fan or AC.  

Before advising the patient for vamana karma, physician considers whether the patient is fit or unfit for vamana procedure.

# '''Dhumapanam:''' Dhumapana (धूमपानम्) or inhalation of medicated smoke wherein the dravya or herbs to be smoked are decided based on the health of the patient. Dhumapana is essential procedure to eliminate the remnant kapha dosha which is adhered to bodily channels locally even after vamana.<ref>Sushruta Samhita (Chikitsasthanam Adhyaya 33 Sutram 11)</ref>

 

# There are certain behavioral instructions stated to avoid further complications.  Patient should avoid sitting or standing in one position for too long, long walks must be avoided, speaking loudly, anger, grief, exposure to excessive cold, sunlight, winds etc.  sexual indulgence, sleeping during daytime, staying awake late at night are few restrictions to be avoided after vamana karma.

# '''Samsarjana krama''':  (संसर्जन क्रमम्) It refers to the specific diet plan after vamana karma (rehabilitation diet) which is given from aat least 3 to 7 days depending on the grade of shuddhi (purification) happened by vamana. It is to be started from the same day (evening) of the procedure or on the next day morning if there is any vitiation of doshas observed and remaining doshas are yet to be eradicated.

Indications for vamana can be categorised according to the dominance of dosha in a particular disorder and the site at which dosha provokes.  Thus, to mention few,

# On the first day or as a first meal, “manda” (मण्डम्) is ideally made with red variety of rice which is a gruel like food preparation which is given for three consecutive meals. This kind of preparation is liquid in nature and helps the weak digestive state which is present after the vamana karma.

 

# For the next 1 or 2 consecutive meals “vilepi” (विलेपी) which is again a kind of gruel, made with red type of rice is given. This is semisolid in consistency.

Acute fever, diarrhoea, bleeding disorders, tuberculosis, different types of skin disorders, diabetes, tumours, cough, asthma, obesity, heart diseases, epilepsy, piles, anaemia etc. (asht. sutr.27) (char. sidd.2.10) (sush.chik. 33.18)  

# After this,” odana” (ओदनम्) which is a well cooked rice made with red rice along with mudga yusha (मुद्ग यूषम्  soup from green gram) is given for next one or three meals. Warm water is consumed during samsarjana krama.

 

# For the next one or three meals meat soup is given or for vegetarians simple regular diet is started. Later, the patient is expected to have a normal diet.

== Contraindications for Vamana Karma ==

In this way gradual shift in diet from rice water to normal diet helps one to regain his digestive strength which is significantly hampered in the process of vamana. Thus if one follows all the diet and other guidelines carefully can recover from illness and also prevent adverse effects of the therapy.  

Vamana is mainly not considered in vata predominant diseases, where body is highly emaciated, in very weak and very old individuals. Thus, to mention few,

 

In infant, very old, weak, tired, hungry, excessive thirst, exhausted from lifting weights, pregnancy, suffering from anxiety, worm infestations, bleeding disorders having pathology in upper half of body etc.

== Mode of action of vamana karma ==

== Mode of action of vamana karma ==

Vamana karma is not just a gastric lavage, or a pathological vomiting, it is a complete systemic cleansing of morbid Kapha dosha having widespread advantages. When vamana drug is given orally, the active principal present in the drug reaches the cell where it forces the cell to release the toxins back in the stomach. From there on the vomiting occurs. This process occurs due to the irritant action of the drugs, which leads to mild inflammation at the site of action. This in turn leads to increased permeability in the capillaries which will allow the absorption as well as excretion of the substances. The vamana drug are given in full stomach when the pyloric end of stomach is closed allowing all the activities of the vamana dravya to remain in stomach itself. At the end of process bile is seen in vomitus due to flux of antiperistalsis set during the process, which means that the pyloric valve is open, and the procedure is completed or the morbid kapha dosha has been completely expelled out.

Vamana karma is not just a gastric lavage, or a pathological vomiting, it is a complete systemic cleansing of morbid Kapha dosha having widespread advantages. When vamana drug is given orally, the active principle present in the drug reaches the cell where it forces the cell to release the toxins back in the stomach. (NeedsCitation) From there on the vomiting occurs. This process occurs due to the irritant action of the drugs, which leads to mild inflammation at the site of action. This in turn leads to increased permeability in the capillaries which will allow the absorption as well as excretion of the substances. The vamana drug are given in full stomach when the pyloric end of stomach is closed allowing all the activities of the vamana dravya to remain in stomach itself. At the end of process bile is seen in vomitus due to flux of antiperistalsis set during the process, which means that the pyloric valve is open, and the procedure is completed or the morbid kapha dosha has been completely expelled out.

In a nut shell, vomiting in modern view is a cascade of events which leads to expulsion of upper gastrointestinal contents.

In a nut shell, vomiting in modern view is a cascade of events which leads to expulsion of upper gastrointestinal contents.

== Therapeutic considerations ==

== Therapeutic considerations ==

Vamana is advised even prophylactically in Vasant rutu where kapha dosha is seen in prakopa awastha (exaggerated). Mainly in chaitra month of hindu calendar which is mid-March to mid-April.   (char. Sutr.10.46)

Vamana is advised even prophylactically in Vasant [[Rutucharya (ऋतुचर्या)|rutucharya]] where kapha dosha is seen in prakopa awastha (exaggerated). Mainly in chaitra month of hindu calendar which is mid-March to mid-April.   (char. Sutr.10.46)

Dashavidha(10 fold examination parameters) and astha vidha pareeksha (8 fold examination parameters)  alongside modern clinical parameters, like respiratory system examination, Gastrointestinal Tract examination, Cardiovascular examination etc. also B.P, temperature, pulse etc before and during vamana karma.

Dashavidha(10 fold examination parameters) and astha vidha pareeksha (8 fold examination parameters)  alongside modern clinical parameters, like respiratory system examination, Gastrointestinal Tract examination, Cardiovascular examination etc. also B.P, temperature, pulse etc before and during vamana karma.

Vamana is contraindicated in vata dosha related diseases but there can be certain exceptions also, in such cases mild vamana is indicated.

Vamana is contraindicated in vata dosha related diseases but there can be certain exceptions also, in such cases mild vamana is indicated.