Vamana (वमनम्)

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Vamana karma is one of the panchakarma procedure wherein there is controlled therapeutic emesis or vomiting. Vamana translates to act of vomiting, ejecting or emesis. Thus, it is a type of shodhana karma (detoxification process) in Chikitsa or treatment aspect where the doshas which are morbid are eliminated from stomach through vomiting. vamana karma is a frontline treatment protocol in the treatment of various kapha dosha related disorders. Vamana karma along with other panchakarma therapies are amongst the most known and widely used procedures not just for treatment purposes but for prevention of diseases as well and are considered as rejuvenating therapies commonly.

DEFINITION

तत्र दोषहरणमूर्ध्वभागं वमनसञ्ज्ञकम् (char. kalp.1.4)

When the morbid doshas in the body are eliminated through oral route in a controlled manner by vomiting, the procedure is known as vamana karma.

(shar. purv.4.8)

The procedure wherein undigested pitta dosha and kapha dosha are forcibly made to travel towards oral route and by there are expelled by the action of vomiting is vamana karma.

DERIVATION

(vachaspatyam)

The word “vamana” in Sanskrit is made from root word “vam” which means to eject. Suffix “lyut” is added.

Vama and lyut pratyaya together makes word vamana.

Meaning, to vomit, to expel,to move or movement.

VAMANA VIDHI (PROCEDURE)

The whole vamana therapy is divided in 3 sections,

PURVA KARMA (pre procedure/before procedure)

PRADHANA KARMA (main procedure)

PASCHAT KARMA (after procedure)

PURVA KARMA (before procedure)                                                

It mainly includes the procedure which is supposed to done before vamana karma.

1.   Collection of materials- though a very basic karma or part of process it is essential to keep the ingredients and materials required for the therapy ready beforehand.

Materials like weighing scale, measuring flask, medicines for management of any complications, dravya or drugs to be used for vamana karma etc.

2.   Assessment of patient – there is consideration of few aspects in patient or individual before vamana karma. Whether the individual is vamya(indicated for vamana) or avamya(contraindicated for vamana). Ashta vidha pariksha or 8 factors of examination (bowel,bladder etc). dosha and bala(strength) of patient.

3.   Dosage – according to acharya charaka the dose of vamaka dravya (emetic drug) should be as much as patient can hold the drug in one hand’s fist. (char. kalp.1.14). there is also one another pramana or measurement mentioned by commentators of ashtanga hrudaya, that the dosage should be considered according to individual’s strength and the disease affected, and more importantly with respect to koshta (digestive ability). Koshta is one another unique and wide concept, but precisely if koshta or digestive ability of individual is mrudu(weak) then the matra(dose) of drug or dravya is alpa(small) if koshta is madhyama(medium) then matra(dose) is also madhyama(medium) if koshta is krura(strong) then matra(dose) will be uttama(high). (asht. hrud. sutr.18.14)

4.   Diet before vamana karma- diet starts from the day of snehapana (oral administration of ghee or oil). Individual is advised to take food which are liquid in consistency, ushna (hot) in potency and which is abhishyandi (heavy and slimy, eg;curd), should not be unctuous and should be clean.(asht.sutr.16.25).

Patients who are old, very young, have low strength or are weak, and are afraid of vamana karma, to them Yusha(water in which various pulses have been boiled), sugarcane juice, milk, meat soup  etc should be given.

Pachana karma (improving digestion) is an essential purva karma to avoid complications.

5.   Snehana and swedana(fomentation) - oral administration of Sneha (ghee or oil) is given for a period of 3-7 days according to the condition, disease of the individual in increasing order according to the digestive ability of the individual.

Later, on the day of completion of snehapana, abhyanga (oil massage) is done for 2-3 days followed by swedana(fomentation) until the day of vamana karma. (char. kalp.1.14)

Every pre procedure plays an important role in the whole vamana karma, thus, in a nutshell with snehapana, there is aggravation of the doshas in the body and when abhyanga and swedana is done these doshas are moved from the affecting area to stomach, then with the help of vamana dravya these doshas are expelled out from the body through controlled vomiting.

6.   Manasaupchara(counselling) – individual or patient must be well acknowledged about the procedure beforehand. To keep the patient in good mental health, patient is required to have a good sleep, overhead bath, worn clean clothes, worshiping god, brahmin, Vaidya(physician). Thus, a happy and calm atmosphere must be created.

PRADHAN KARMA

1.   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.

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

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

4.   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.

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

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

SHUDDHI(PURIFICATION)	PRAVARA (high)	MADHYAMA (medium)	AVARA (low)
VAIGIKI (number)	8 vega(bout)	6 vega(bout)	4 vega(bout)
MANIKI (measurement)	2 prastha	1.1/2 prastha	1 prastha
ANTIKI (end effect/product)	Pitta(bile)	pitta	pitta

1 prastha = 640 gm(approx.)

7.   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)

SAMYAK YOGA(APPROPRIATE)	AYOGA(INSUFFICIENT)	ATIYOGA(EXCESS)
On time vega(bout) initiation	No initiation of vega (bout)	Excessive thirst
Kapha dosha, pitta dosha, vata dosha elimination sequence	Skin eruptions	Delusions
Vega’s(bout) stop by itself	Excess salivation	Giddiness
purification of bodily channels	Itching all over body	Vitiation of vata dosha and its related disorders
Feeling of lightness	Heaviness of body	Excessive Weakness
Cleanliness of the sensory organs	Improper cleansing of channels	Loss of sleep or insomnia
	rashes

8.   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)

PASCHAT KARMA

It includes few dietic and behavioural restrictions and advises after the vamana karma.

1.   After appropriate vamana karma patient is made to wash mouth clean with warm water and must rest in a room which is not very well ventilated or where there is not direct air

2.   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)

3.   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.

4.   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.

5.   On the first day or as a first meal, “manda” is specifically made with red variety of rice which is 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.

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

7.   After this,” odana” which is a well cooked rice made with red rice along with mudga yusha(soup from green gram)

8.    

FIT AND UNFIT/ VAMANA ARHA AND ANARHA

MODERN VIEW

IMPORTANCE

ELIGIBILITY CRITERIA