VAMAN CHIKITSA - THERAPEUTIC EMESIS TO ELIMIATE DOSHAS THROUGH THE ORAL ROUTE

CONTENTS:

• Introduction
• Definition
• Synonyms
• Vamanopaga Dravyas
• Vamak dravyas
• Importance of Vaman Karma
• Indications 
• Contraindications
• Vaman vidhi / Procedure
• (A) Poorva karma
• (B) Pradhaan karma
• (C) Paschaat karma
• Parihaar Vishaya
• Vaman vyapads / complications
• Vaman karma karmukata / mode of action

I. INTRODUCTION:

Vaman Karma is one the five Panchakarma therapies. This therapy basically targets the aggravated Kapha Dosha, and expels it out with the help of controlled emesis / vomiting. This treatment is especially helpful in diseases caused by excessive Kapha Dosha, like cold, cough, breathlessness, COPD, etc. Vaman has proved to be useful in various skin diseases too.

II. DEFINITION:

तत्र दोष हरणं ऊध्र्वभागं वमन संज्ञकम् ॥ (cha.ka.1/4)

Vaman is defined as a process through which the Malas or Doshas are expelled out of the body through the upper route, that is, the mouth.

Acharya Sharanghdhara has called Vaman a process of expelling out Apakva Pitta and Kapha through the mouth. 

III. SYNONYMS:

• Chardi
• Vaanti
• Vamathu
• Vamana
• Pracchardika
• Ullekhana
• Udgirana
• Vami

IV. VAMANOPAGA DRAVYAS:

• Madhu
• Madhuka
• Kovidara
• Karbudara (kanchanaar)
• Neepa (Kadamba)
• Vidhula
• Bimbi
• Shanapushpi (Arka)
• Apamarga

V. VAMAK DRAVYAS:

मदनं मधुक निम्ब जीमूतं कृतवेधनम् ।

पिप्पली कुटज इक्ष्वाकून् एलां खामार्गवाणि च।। (Cha.su. 2/7)

Acharya Charak has also mentioned 6 vamak dravyas and 355 vaman yoga in Kalpasthana.

1. Madanphala - 133 yogas
2. Jeemutaka - 39 yogas
3. Ikshvaku - 45 yogas
4. Dhamarga - 60 yogas
5. Vatsak - 18 yogas
6. Krutavedhana - 60 yogas

VI. IMPORTANCE OF VAMAN KARMA:

• Vaman is the first among Panchakarma, and is the best line of treatment for Kapha disorders.
• Vaman is always kept ahead of Virechana because, if Virechana is administered without Vaman, then all the provoked kapha moves down from the koshtha and causes heaviness and obstruction in Virechana.
• It reduces drava and sleshma
• It works in the opposite direction as that of Atisara.

VII. INDICATIONS:

• Adhogata Raktapitta
• Pulmonary tuberculosis
• Leprosy
• Diabetes
• Goitre
• Tumours
• Filariasis
• Insanity
• Cough (Kasa)
• Dsypnoea (Shwasa)
• Visarpa (Herpes)
• Breast - milk and head related diseases
• Oppression in the chest
• Pinasa (chronic rhinitis)
• Recent fever ( taruna or nava jwar)
• Poisonous bites ( visha dashta)
• Praseka (excessive salivation)
• Hrullasa (nausea)
• Arochaka (loss of taste)
• Atisaar
• Pandu
• Mukhapaka

VIII. CONTRAINDICATIONS:

• Kshata
• Ksheena
• The pregnant
• Hungry
• Grief striken
• The old
• The emaciated
• The obese
• Heart diseases
• Profusely bleeding wounds
• Blind
• Splenomegaly (pliha)
• Distended stomach
• Tumours in stomach
• Urdhwagata Raktapitta
• Persistent vomitting
• Udavarta
• Shirashoola
• Akshi shoola
• Karna shoola
• Mutraghaata
• Gulma
• Udara
• Recently given Niruha basti
• Recently given Anuvasana basti

IX. VAMAN VIDHI / PROCEDURE OF ADMINISTRATION OF VAMAN:

(A) POORVA KARMA:

1. Sambhara Sangraha:

All the equipments required for vaman, and management of any complications that may or may not arise during the procedure should be collected and kept ready before starting the procedure as it might be difficult to get the requirements immediately when there is a need. The materials that should be kept ready are as follows:

• Vaman dravya
• Vamanopaga dravya
• Apparatus:
• wash basin / sink
• tubs
• measuring flask
• measuring glass
• towel
• bowls
• rubber catheter
• spoons
• gas stove
• vessels for medicine
• weighning machine
• gloves
• spygmomanometer, sthethescope, thermometer
• Stalk of Eranda or Kamala (to induce vomiting)
• Pthya ahara for deepan pachana and samsarjana krama
• Paricharak: Atleast 3
• One to give medicine
• One to support forehead and massage Prushta is pratiloma gati
• One to check vitals like BP, pulse etc during the Vegas.

2. Selection of patient:

• Vamya / Avamya:
• Should select a patient that falls under the list of indicated.
• Dosha awastha:
• Acharya Charak advises Shodhana Chikitsa in conditions with excessively aggravated doshsa and in nirama awastha.
• Examination of other fators:
• Careful examination od dosha, bheshaja, desha, kala, bala, shareera, ahara, satmya, satva, prakruti, samawastha.
• Ashthavidha Pariksha
• Dashavidha Pariksha

3. Preparation of the patient:

(a) Pachana / Deepan:

• Achaya Vagbhata satated that if doshas are tried to remove by shodhan karma in the presence of ama, then it will destroy the body or cause vibandha and glani.
• Hence, it is important to remove ama from the body before the commencement of shodhana karma.
• Drugs like chitrakadi vati, shunthi choorna, adnitundi vati, etc are given to patient to carry out proper pachan and agni deepan, before starting snehapana.

(b) Snehan and Swedana:

• Acharya Charak explains the importance of snehana and swedan by an example of a grease coated vessel, in which if drops of water are poured, trickle to the bottom easily. 
• Similarly, Snehan acts as grease, and water droplets resemble the doshas that acquire a liquefied form due to Swedana.
• Hence, it could be understood that proper snehan and swedan helps in liquefying the doshas and bringing it to koshtha, where it becomes easy to expel them out through shodhana karma.
• Snehapana should be administered for 3-7 days or till samyak sneha lakshana are observed. Then one day gap should be given during which the patient is subjected to Abhyanga and Swedana (bashpa sweda). It can be done for 2-3 days too.

4. Ahaar Upakalpana / Dietic regimen:

(a) At the time of snehapana:

• Light liquid food that is warm and anabhishyandi.
• Small and sufficient quantity.
• Should be taken only when feeling hungry.

(b) On the night before vaman karma:

• Heavy, liquid and abhisyandi producing ahaar.
• Kaphotkleshak ahaar.
• This helps in aggravation of Kapha dosha and helps in easier expulsion of the dosha during Vaman, without causing any discomfort or pain.
• Milk and dairy products, sesame, black gram, curd, jaggery, fish, mutton soup, etc can be given to the patient.

(c) Just before vaman karma:

• Should be empty stomach or yavagu mixed with Ghrita can be given.
• The previous night's ahaar should be digested properly.

5. Management of patient on the day of Vaman Karma:

(a) Counselling before vaman:

• The patient is usually scared and has a lot of misinformation from other people and the internet.
• So, the patient should be explained about each step in the procedure and dietic regimen, and about the benefits of the procedure.
• The patient to be encouraged to follow the rules and precautions properly with discipline to get the optimum results.

(b) Preparation of patient before Vaman:

• Vaman should be carried out on auspicious constellation day, karana, and muhurta.
• The patient should be made to take a head bath and anoint himself with fragrances and wear clean and untorn clothes, and shuld be encouraged to offer prayer to God before beginning the procedure.

(c) Management during vaman:

• The patient is advised to concentrate solely on the procedure and keep kama, krodha, lobha, irshya, etc factors aside.
• Vaman has a lot of complications with it, and therefore proper concentration is important.

6. Fixation of dose:

Koshta Sthithi	Dose
Mrudu	Kaniyasi matra (1994 ml / 3 Prastha)
Madhyam	Madhyam matra (2592 ml / 4 Prastha)
Krura	Jyesta matra (5832 ml / 9 Prastha)

(B) PRADHANA KARMA:

1. Kaal:

• Vaman is always administered at Purvahna, that is in the morning, when the Kapha is in the most aggravated state naturally.
• The best time to conduct is Vaman is between 6:00 am - 8:00 am.

2. Administration of Vamak Drugs:

• Vaman room:
• Well built.
• Air should be allowed only through one passage.
• Spacious.
• Protected from dust, pollution, light, and noise pollution.
• Should not be situated on high altitudes.
• Position of patient:
• Should be draped in clean towel or cloth upto the neck to prevent soiling of clothes by vomitus.
• Then should be seated on vaman chair or vaman peetha that comes high upto knee joint.
• Examination of vitals:
• Pulse, blood pressure, respiration is recorded prior the procedure.
• Pulse and BP recorded at regular intervals during the procedure.
• Administration:
• Acharya Charaka advised administrating vamak drugs with vamanopaga drugs kwath.
• Acharya Arundatta advised administrating milk, sugarcane juice, mamsarasa, etc after giving them bhavana of vamak drugs.
• Acharya Sushruta advised using ksheera, ikshurasa, etc before the administration of Vamaka drugs, for the weak and old patients.

3. Administration of Vamanopaga Dravyas:

• Yashthimadhu Phant is more commonly used and vamanopaga dravya.
• Acharya Charak mentioned that a handful or a fistful of Madanphala should be soaked in a kwath of vamanopaga dravyas like Yasthimadhu, Karbudara, etc.

4. Observation after drug administration:

• After the administration of drugs, the patient is allowed to sit on the chair and is continuously observed carefully, waiting for the vaman vega to start.
• Vaman vega usually start in one muhurta kala if it doesn't, then the base of the tongue should tickled or agitated lightly with index finger or nala of kamala, eranda, etc.
• Stages or symptoms of vaman vega are as follows;
• Appearance of sweat that indicate liquifaction of doshas.
• Horripilation, that indicate doshas moving towards amashaya.
• Discomfort in abdomen, that indicate doshas have entered the amashaya
• Nausea and salivation, that indicate doshas moving upwards towards the mouth.

5. Care of patient after the onset of Vaman Vega:

• Lalaat Pratigrahe:
• Holding the forehead when the patient bends down to vomit, helps ease the pressure on the neck muscles and prevents the entry of vomitus into the nose.
• Parshvopagrahane:
• The back should be supported so as to support the muscles of chest and the sides of chest in order to prevent spasms due to the force of vomit.
• Prushta Unmardana:
• Gentle massage in the opposite direction over the spine helps in easing the muscles around the spine.
• After each vega, time, pulse and blood pressure needs to be recorded.
• During the procedure, vamanopaga kashaya should be given to patient at regular intervals for continuation of vomiting, until pitta comes out.
• After the appearance of pitta in the vomitus, the kashaya dravyas should be stopped and assessment of the procedure needs to be done. 

6. Observation of samyak lakshana:

Kale Pravrutti	Onset of vegas on precise time
Yatha krama dosha harana	Orderly elimination of kapha, pitta and vata dosha
Svayam avasthana	stops on itself
Hridaya shuddhi	lightness in chest
Parshva shuddhi	lightness in the sides of chest
Murdha Shudhhi	lightness in head
Kapha samsrave cha stithe	excessive salivation stops
Strotas shuddhi	cleaning and clearing of all the channels
Indriya shuddhi	cleansed sense organs
Daourbalya	slight exhaustion or weakness
Laghuta	lightness all over the body
Karshya	weight loss
Kantha shuddhi	clear throat
Anati mahati vyatha	no discomfort of any sort

7. Observation of Atiyoga Lakshana:

Phelina vamana	Frothy vomit
Pakta chnadrikayukta	Expulsion of blood in vomitus
Trishna	Excessive thirst
Moha and Murcha	Confusion and loss of consciousness
Vata prakopa	Vata provocation
Daha	Burning sensation
Nidrahani	Loss of sleep
Bala hani	Loss of strength
Hrid peeda	Pain in chest region
Kantha peeda	Pain in throat
Tamah pravesha	Darkness in front of eyes
Bhrama	Dizziness
Pittadi yoga	Excessive loss of pitta
Mrityu	Death

8. Observayion of Ayoga Lakshana:

Apravritti	Insufficient bouts of vomit or vega
Hridaya Avishuddhi	Insufficient cleansing of chest
Strotas Avishuddhi	Insufficient cleansing of channels
Guru Gatrata	Heaviness in body
Sphota	Eruptions on skin
Kotha	Different types of eruptions on skin
Pratiloma Pravrutti	expulsion out through anal route
Kevala Aushadha Pravrutti	Expulsion out of only medicine
Vega Vibandha	Obstruction in vomit
Kandu	Itching
Kapha Praseka	Excessive salivation
Jwara	Fever

9. Oservation of Shuddhi Lakshana:

Vamana	Avara shuddhi	Madhyanma Shuddhi	Pravara Shuddhi
Vaigiki	4 Vega	6 Vega	8 Vega
Maniki	1 Prastha (648 ml)	1 1/2 Prastha (972 ml)	2 Prastha (1296 ml)
Antiki	Pitta	Pitta	Pitta
Laingiki	Samyak vaman lakshana	Samyak vamana lakshana	Samyak vaman lakshana

(C) PASCHAAT KARMA:

1. Dhumapana:

• After completion of vamana, hands, feet, and face of the patient should be washed properly with warm water, and should be made ready fr Dhumapana.
• Dhumapana removes any excessive Kapha in the body.
• Snaihika Dhumapana - Vata Prakriti.
• Virechanika Dhumapa - Pitta and Kapha Prakriti
• Shamaniya / Prayogika Dhumapan - Sama dosha Prakriti or healthy person.

2. Peyadi Samsarjan Krama:

Days	Annakala Shuddhi	Pravara Shuddhi	Madhyama Shuddhi	Avara Shuddhi
I	Morning	-	-	-
	Evening	Peya	Peya	Peya
II	Morning	Peya	Vilepi
	Evening	Peya	Vilepi	Krita/Akrita Yusha
III	Morning	Vilepi	Vilepi	Krita/Akrita Mamsarasa
	Evening	Vilepi	Akrita Yusha	Normal Diet
IV	Morning	Vilepi	Krita Yusha	-
	Evening	Akrita Yusha	Akrita Mamsarasa	-
V	Morning	Krita Yusha	Krita Mamsarasa	-
	Evening	Krita Yusha	Normal Diet	-
VI	Morning	Akrita Mamsarasa	-	-
	Evening	Krita Mamsarasa	-	-
VII	Morning	Krita Mamsarasa	-	-
	Evening	Normal Diet	-	-

3. Tarpanadi Samsarjan Krama:

• Should be followed under the following conditions:
• Kapha and Pitta expelled in smaller quantities.
• Alcoholics.
• Vata and Pitta prakriti.
• Swaccha tarpana given instead of Peya.
• Ghana tarpana given instead of Vilepi.

X. PARIHAAR VISHAYA:

After dhumapana, the patient should avoid the following factors:

1. Speaking loudly.
2. Over eating.
3. Standing for too long.
4. Walking for too long.
5. Anger and grief.
6. Exposure to sun and strong wind.
7. Travelling by vehicles.
8. Indulging is sexual intercourse.
9. Vigil during night.
10. Sleeping during daytime.
11. Taking viruddha, asatmya, guru type of food.
12. Vegasandharan.

XI. VAMAN VYAPAD / COMPLICATIONS OF VAMAN KARMA:

1. Adhmana:

Nidaan: Alpa matra aushada in pt. with bahudosha, atirukshata, madagni, and udvarta.

Lakshana: Pain in back, sides, and head, dsypnoea, and obstruction of flatus, feces and                     urine.

Chikitsa:

• Abhyanga
• Sweda
• Varti
• Niruha and Anuvasana basti
• All udavartahara karma.

2. Parikartika:

Nidaan: Balavat aushada in pt. with atisnigdhata, gurukoshta, mrudukoshtha, alpabala.

Lakshana: Severe pain with slimy and bloody discharge during defecation.

Chikitsa:

• In amavastha:
• langhana, pachana, rukshana, ushna and laghu bhojana.
• If kshaama:
• Amapachana bruhana vidhi.

3. Parisrava:

Nidaan: Alpa matra or alpa virya aushadha in pt. with bahudoshaavastha.

Lakshana: Agninasha, feels cold, aruchi, pandu.

Chikitsa:

• Alpa dosha - shaman chikitsa
• Bahu dosha - 
• Induced vomiting
• snehana followed by teekshna virechana
• asava arishtha post shodhana

4. Hrudroga:

Nidaan: Vega nirgraha after taking aushadha.

Lakshana: Hiccups, cough, pain in sides, excessive salivation, biting of tongue,                                 unconsciousness, brixism biting of teeth, darkness in front of eyes.

Chikitsa: 

• Emesis should be administered immediately
• Pittaja murcha - madhura aushadha
• Kaphaj murcha - katu aushadha
• Pachana post samshodhana

5. Angagraha:

Nidaan: 

• Suppressing urges after taking medicines
• Obstruction of channels by kapha
• Excessive purification

Lakshana: Stiffness, pricking pain, tiredness, twitching pain, chruning pain.

Chikitsa: Snehana, swedana, vatopakrama.

6. Jeevadana:

Nidaan: Atiteekshna aushadha in pt. with mrudu koshtha and laghu dosha.

Lakshana: Presence of vital blood in vomitus.

Chikitsa: 

• Rakta basti
• Sheeta basti
• Piccha basti
• Anuvasana with ghrita manda

7. Vibhramsha:

Nidaan: Atiyoga of vaman.

Lakshana: Prolapse of rectum.

Chikitsa: 

• Rectum should be put back by stiffening it with kashaya rasa dravyas.
• Further treatment should be done according to the vyadhi awastha.

8. Stambha:

Nidaan: Uncted pt. takes snigdha aushadha.

Lakshana: Guda stambha, guda shoola.

Chikitsa:

• Langhana
• Teekshna basti
• Virechana

9. Upadrava: 

Nidaan: Ruksha aushadha to pt. with rukshata and alpa bala.

Lakshana: Stambha, murcha, savagatra shula.

Chikitsa:

• Snehana
• Swedan
• Vatahara vidhi

10. Klama:

Nidaan: Mrudu aushadha in pt. with snigdha and mrudu koshtha.

Lakshana: Angasaad, daurbalya.

Chikitsa:

• Ashu ullekhana
• langhana - pachana
• Snigdha and teekshna virechana

XII. VAMAN KARMUKATA / MODE OF ACTION:

• Vamaka drugs posses properties like ushna, teekshna, sookshma, vyavayi and vikasi.
• Due to their swavirya, they move to hrudaya and then to dhamniyas and finally reach the micro amd macro channels of the body, and act on the vitiated doshas in various sites.
• Due to agneya property, they liquefy doshas.
• And due to teekshna properties, they break them down into smaller form.
• This liquefied and smaller matter glides down through different uncted channels in to the Koshtha.
• After entering in to Amashaya, these vitiated doshas are stimulated by Udana vayu, and are expelled out through the mukha marga due to dominance of Agni and Vayu.
• This expulsion out of doshas through mukha marga is known as Vaman.
• This is the mode of action of Vamam.