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|title=Therapeutic emesis (Vamana)
|title=Therapeutic emesis (Vamana)
|titlemode=append
|titlemode=append
|keywords=Vamana, Vamana in Ayurveda, Vamana meaning, Vamana Definition, Charak samhita, carakasamhitaonline, Indian System of medicine, emesis therapy
|keywords=Vamana, Vamana in Ayurveda, Vamana meaning, Vamana Definition, Charak samhita, carakasamhitaonline, Indian System of medicine, emesis therapy, chhardi, emetic treatment, emesis in ayurveda
|description=Therapeutic emesis intended for treatment of kapha disorders
|description=Therapeutic emesis intended for treatment of kapha disorders
|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|image_alt=carak samhita
|type=article
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}}
The word vamana means the act of vomiting.<ref>Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Vamana, Page 920</ref> It is one of the five purification therapies ([[panchakarma]]). It is the best preventive measure and treatment for disorders due to vitiation of [[kapha]] [[dosha]]. [Cha.Sa.[[Sutra Sthana]] 25/40] The [[dosha]] accumulated in the upper part of the body (trunk and supraclavicular region) is evacuated by therapeutic emesis. [Cha.Sa.[[Sutra Sthana]] 20/19][Cha.Sa.[[Kalpa Sthana]] 1/4] 'Vamana' is also a therapeutic procedure to expel vitiated [[dosha]] by administration of medicine to induce vomiting. On the other hand, 'Chhardi' is a disease with a predominant feature of vomiting due to various underlying pathologies. The present article deals with vamana, i.e., therapeutic emesis.
{{Infobox
{{Infobox
|label6 = Date of first publication:
|label6 = Date of first publication:
|data6 = November10, 2020
|data6 = November10, 2020
|label7 = DOI
|label7 = DOI
|data7 = Under process
|data7 = [https://doi.org/10.47468/CSNE.2020.e01.s09.032 10.47468/CSNE.2020.e01.s09.032]
}}
}}
==Etymology and derivation==
==Etymology and derivation==
<div style='text-align:justify;'>
The Sanskrit root 'vam' means ejection, giving out, oozing, stream, etc.The word 'vamana' is derived from the root 'vama' and adding a suffix 'lyut'. It has four meanings,
The Sanskrit root 'vam' means ejection, giving out, oozing, stream, etc.The word 'vamana' is derived from the root 'vama' and adding a suffix 'lyut'. It has four meanings,
*Destroying, crushing (mardane)
*Destroying, crushing (mardane)
#Post therapeutic measures (pashchatkarma)
#Post therapeutic measures (pashchatkarma)
===Pre therapeutic measures (purvakarma)===
===Pre therapeutic measures (purva karma)===
The pre-emesis procedure aims to prepare the body for emesis and to bring toxins to gut for expulsion.
The pre-emesis procedure aims to prepare the body for emesis and to bring toxins to gut for expulsion.
Pachana (digestive) therapies are administered to correct digestion and detach the microcellular toxins (ama).
Pachana (digestive) therapies are administered to correct digestion and detach the microcellular toxins ([[ama]]).
Unction (snehana) is prescribed in a suitable dose for a duration until proper unction features are observed. This is generally done for three to seven days.
Unction ([[snehana]]) is prescribed in a suitable dose for a duration until proper unction features are observed. This is generally done for three to seven days.
Therapeutic massage (abhyanga) and fomentation therapy (swedana) are generally advised for three sessions after completing internal unction therapy.
Therapeutic massage ([[abhyanga]]) and fomentation therapy ([[swedana]]) are generally advised for three sessions after completing internal unction therapy.
The day of therapeutic emesis is decided only after observing proper unction and fomentation features in an individual. [A.Hr. Sutra Sthana 16/36]<ref name=Hridaya>Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref> This can be continued for two or three days. [Cha.Sa.[[Kalpa Sthana]] 1/14]
The day of therapeutic emesis is decided only after observing proper unction and fomentation features in an individual. [A.Hr. Sutra Sthana 16/36]<ref name=Hridaya>Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref> This can be continued for two or three days. [Cha.Sa.[[Kalpa Sthana]] 1/14]
![[Dosha]] involved in pathogenesis !! Selective properties of medicine
![[Dosha]] involved in pathogenesis !! Selective properties of medicine
|-
|-
| |Kapha ||Sharp (tikshna), hot (ushna), spicy (katu)
| |[[Kapha]] ||Sharp (tikshna), hot (ushna), spicy (katu)
|-
|-
| |Kapha + Pitta||Cold (hima), Sweet (swadu)
| |[[Kapha]] + [[Pitta]]||Cold (hima), Sweet (swadu)
|-
|-
| |Kapha + Vata||Unctuous (snigdha), sour (amla), salty (lavana)
| |[[Kapha]] + [[Vata]]||Unctuous (snigdha), sour (amla), salty (lavana)
|-
|-
|}
|}
The following table shows various dose patterns advised in patients.[table 2]
The following table shows various dose patterns advised in patients.[table 2]
{| class="wikitable"
{| class="wikitable"
|+ Table 2: Dose patterns for therapeutic emesis
|+ Table 2: Dose patterns for therapeutic emesis
|-
|-
|}
|}
*[Dalhana on Su.Sa.Chikitsa Sthana 33/7]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>, **[Sha.Sa. Uttara khanda 3/15]<ref name=Shargadara/>, #[Ka. Khilasthana 7/44]<ref name=Kashyapa>Vrddhajivaka, Kasyapa Samhita. Edited by Tewari P V, Reprint edition. Varanasi: Chaukhambha visvabharati; 2008</ref>
===Therapeutic emesis (pradhanakarma)===
===Therapeutic emesis (pradhana karma)===
Therapeutic emesis is always performed early morning during the time of the natural increase of [[kapha]] [[dosha]]. After completing proper sleep and passage of natural urges in the morning, the individual follows whole-body therapeutic massage and fomentation.The patient should be seated comfortably in a chair of a suitable height.
Therapeutic emesis is always performed early morning during the time of the natural increase of [[kapha]] [[dosha]]. After completing proper sleep and passage of natural urges in the morning, the individual follows whole-body therapeutic massage and fomentation.The patient should be seated comfortably in a chair of a suitable height.
====Endpoints====
====Endpoints====
The procedure is continued till the appearance of signs of adequate emesis or bile ([[pitta]]) in the vomitus.
The procedure is continued till the appearance of signs of adequate emesis or bile ([[pitta]]) in the vomitus.
===Post therapeutic measures (pashchatkarma)===
===Post therapeutic measures (pashchat karma)===
After completion of procedure and bouts of emesis end,the patient is then advised medicated smoke inhalation (dhumapana) which helps to remove the remaining [[kapha]] adhered to the body channels. [A.S.Sutra Sthana 27/21]<ref name=Sangraha/> [Su.Sa.Chikitsa Sthana 33/10]<ref name=Susruta/> The patient is advised to take complete rest in a room and avoid direct exposure to wind. The patient is advised to take hot water bath and follow specific dietary pattern (samsarjana krama), when he feels hungry.
After completion of procedure and bouts of emesis end,the patient is then advised medicated smoke inhalation (dhumapana) which helps to remove the remaining [[kapha]] adhered to the body channels. [A.S.Sutra Sthana 27/21]<ref name=Sangraha/> [Su.Sa.Chikitsa Sthana 33/10]<ref name=Susruta/> The patient is advised to take complete rest in a room and avoid direct exposure to wind. The patient is advised to take hot water bath and follow specific dietary pattern (samsarjana krama), when he feels hungry.
===Quantity of vomitus (maniki)===
===Quantity of vomitus (maniki)===
The quantitative output of vomitus is measured. If approximately 1280ml(2 prastha) of vomitus is expelled out, it is considered a maximum purification level. The 960ml(1.5 prastha) and 640ml (1 prastha) are considered moderate and minimum purification levels respectively. [Cha.Sa.[[Siddhi Sthana]] 1/14] Vagbhata differs in opinion by considering 640ml (1 prastha) and 320ml (1/2 prastha) as moderate and minimum levels of purification. [A.Hr.Sutra Sthana 18/31]
The quantitative output of vomitus is measured. If approximately 1280ml(2 prastha) of vomitus is expelled out, it is considered a maximum purification level. The 960ml(1.5 prastha) and 640ml (1 prastha) are considered moderate and minimum purification levels respectively. [Cha.Sa.[[Siddhi Sthana]] 1/14] Vagbhata differs in opinion by considering 640ml (1 prastha) and 320ml (1/2 prastha) as moderate and minimum levels of purification. [A.Hr.Sutra Sthana 18/31]<ref name=Hridaya/>
The quantity of [[dosha]] expelled (maniki) should be calculated by excluding the intake of all medicines given to the patient.[Cha.Sa.[[Siddhi Sthana]] 1/14] Practically it is observed that the amount of vomitus is always less when compared to the intake consumed by patient. In other words, some amount of total intake remains inside the patient's body.<ref name=GuptaB6/> <ref name=Sachin9/> So, more practically, the intake-output ratio should be measured to better understand the amount of [[dosha]] expelled. For this purpose, the Maniki Shuddhi Index (MSI) is introduced.
The quantity of [[dosha]] expelled (maniki) should be calculated by excluding the intake of all medicines given to the patient.[Cha.Sa.[[Siddhi Sthana]] 1/14] Practically it is observed that the amount of vomitus is always less when compared to the intake consumed by patient. In other words, some amount of total intake remains inside the patient's body.<ref name=GuptaB6/> <ref name=Sachin9/> So, more practically, the intake-output ratio should be measured to better understand the amount of [[dosha]] expelled. For this purpose, the Maniki Shuddhi Index (MSI) is introduced.
Maniki Shuddhi Index = (Volume inside divided by Volume input) x 100
Maniki Shuddhi Index = (Volume inside ÷ Volume input) × 100
A lesser MSI indicates a greater evacuation.If MSI is more, it suggests more residual fluids in the body.<ref name=Sachin9/>
A lesser MSI indicates a greater evacuation. If MSI is more, it suggests more residual fluids in the body.<ref name=Sachin9/>
===Number of bouts of vomitus (vaigiki)===
===Number of bouts of vomitus (vaigiki)===
==Importance in preservation of health and prevention==
==Importance in preservation of health and prevention==
Therapeutic emesis is the best measure for prevention and management of disorders due to [[kapha]] [[dosha]]. Healthy individual is advised to follow therapeutic emesis in spring season (vasanta ritu) as a part of seasonal regimen. [Cha.Sa.[[Sutra Sthana]] 6/ ] It can also be taken during autumn or just prior to rainy season [Sha.Sa.Uttarakhanda 3/1] or when the weather is neither too hot nor too cold.[A.Hr.Sutra Sthana 18/12] Vamana conducted in spring season among 69 participants was found to be safe, and the participants' overall well-being was also improved. <ref name=Bhatted7/>
Therapeutic emesis is the best measure for prevention and management of disorders due to [[kapha]] [[dosha]]. Healthy individual is advised to follow therapeutic emesis in spring season (vasanta ritu) as a part of seasonal regimen. [Cha.Sa.[[Sutra Sthana]] 6/23] It can also be taken during autumn or just prior to rainy season [Sha.Sa.Uttarakhanda 3/1]<ref name=Shargadara/> or when the weather is neither too hot nor too cold.[A.Hr.Sutra Sthana 18/12]<ref name=Hridaya/> Vamana conducted in spring season among 69 participants was found to be safe, and the participants' overall well-being was also improved. <ref name=Bhatted7/>
==Importance in management of disease==
==Importance in management of disease==
===Effect on biochemical parameters===
===Effect on biochemical parameters===
Various physiological and biochemical changes occur after therapeutic emesis. In a study conducted on 30 healthy volunteers, Erythrocyte sedimentation rate (ESR), LDL and blood urea decreased significantly immediately after emesis. Slight reduction in serum sodium, potassium, creatinine and protein levels was reported. Plasma histamine and plasma adrenaline also reduced insignificantly. Total leukocyte count, HDL, SGOT and SGPT were increased significantly immediately after vamana. Plasma dopamine, nor adrenaline and IgEwere insignificantly increased. A reduction in ESR and AEC is reported in a study among 15 participants with seed powder of Lagenaria siceraria (ikshvaku).<ref name=Shweta12>Shweta GP, AB Thakar. Efficacy of Vamana Karma with Ikshvaku Ksheera Yoga in the management of Tamaka Shvasa (bronchial asthma) Ayu. 2017 Jan-Jun; 38(1-2): 10–14.doi: 10.4103/ayu.AYU_95_13</ref>
Various physiological and biochemical changes occur after therapeutic emesis. In a study conducted on 30 healthy volunteers, Erythrocyte sedimentation rate (ESR), LDL and blood urea decreased significantly immediately after emesis. Slight reduction in serum sodium, potassium, creatinine and protein levels was reported. Plasma histamine and plasma adrenaline also reduced insignificantly. Total leukocyte count, HDL, SGOT and SGPT were increased significantly immediately after vamana. Plasma dopamine, nor adrenaline and IgE were insignificantly increased. A reduction in ESR and AEC is reported in a study among 15 participants with seed powder of Lagenaria siceraria (ikshvaku).<ref name=Shweta12>Shweta GP, AB Thakar. Efficacy of Vamana Karma with Ikshvaku Ksheera Yoga in the management of Tamaka Shvasa (bronchial asthma) Ayu. 2017 Jan-Jun; 38(1-2): 10–14.doi: 10.4103/ayu.AYU_95_13</ref>
===Examination of vomitus===
===Examination of vomitus===
Vamana performed in 15 bronchial asthma patients showed a significant reduction in symptoms like breathlessness, cough, wheezing and expectoration. There was a significant improvement in lung function tests parameters like peak expiratory flow and forced expiratory volume.<ref name=Shweta12/>
Vamana performed in 15 bronchial asthma patients showed a significant reduction in symptoms like breathlessness, cough, wheezing and expectoration. There was a significant improvement in lung function tests parameters like peak expiratory flow and forced expiratory volume.<ref name=Shweta12/>
Vamana with Lagenaria siceraria (ikshvaku) followed by pacifying therapy showed significant changes in the signs and symptoms of Poly Cystic Ovarian Syndrome (PCOS).Good improvements were observed in delayed menses (55.68%) and prolonged interval of menses (42.91%). Significant changes were observed in the mean non dominant follicles and ovarian volume. Vamana with ikshwaku has testosterone lowering effect. Follicle-stimulating hormone gets stimulated by the lesser level of Luteinizing hormone. It helps in the maturation of follicles.<ref name=Bhingardive10/>
Vamana with Lagenaria siceraria (ikshvaku) followed by pacifying therapy showed significant changes in the signs and symptoms of Poly Cystic Ovarian Syndrome (PCOS). Good improvements were observed in delayed menses (55.68%) and prolonged interval of menses (42.91%). Significant changes were observed in the mean non dominant follicles and ovarian volume. Vamana with ikshwaku has testosterone lowering effect. Follicle-stimulating hormone gets stimulated by the lesser level of Luteinizing hormone. It helps in the maturation of follicles.<ref name=Bhingardive10/>
==List of theses done==
==List of theses done==
#Lineswala Gaurang (2002) : Clinical study on the role of Vamana and shamana in the management of kaphaja galaganda w.s.r to hypothyroidism. Department of Kayachikitsa, IPGT&RA Jamnagar
#Lineswala Gaurang (2002) : Clinical study on the role of Vamana and shamana in the management of kaphaja galaganda w.s.r to hypothyroidism. Department of Kayachikitsa, IPGT&RA Jamnagar
#Chandaliya Sachin S (2003): A clinical study on standardization of Vamana Karma w.s.r to antiki, vaigiki, maniki and laingiki criteria. Department of Kayachikitsa, IPGT&RA, Jamnagar
#Chandaliya Sachin S (2003): A clinical study on standardization of Vamana Karma w.s.r to antiki, vaigiki, maniki and laingiki criteria. Department of Kayachikitsa, IPGT&RA, Jamnagar
#Chandrakar Jayaprakash (2005): Cilinical study on the role of Vamana Karma in the management of YuvanaPidika. Department of Kayachikitsa, IPGT&RA Jamnagar
#Chandrakar Jayaprakash (2005): Cilinical study on the role of Vamana Karma in the management of Yuvana Pidika. Department of Kayachikitsa, IPGT&RA Jamnagar
#Ranjip Dass (2006): A clinical study on the standardization of Vamana vidhi w.s.r to classical and traditional methods. Department of Kayachikitsa, IPGT&RA Jamnagar
#Ranjip Dass (2006): A clinical study on the standardization of Vamana vidhi w.s.r to classical and traditional methods. Department of Kayachikitsa, IPGT&RA Jamnagar
#Kapil A Pandya (2007): A comparative clinical study of Vamana Karma and Jalaukavacharana in the management of Vicharchika. Department of Panchakarma, IPGT&RA Jamnagar
#Kapil A Pandya (2007): A comparative clinical study of Vamana Karma and Jalaukavacharana in the management of Vicharchika. Department of Panchakarma, IPGT&RA Jamnagar
#Akhil Nath Parida (2008): Comparitive study of Vamana and Virechana karma in Ekakushtha w.s.r to Psoriasis. Department of Panchakarma, IPGT&RA Jamnagar
#Akhil Nath Parida (2008): Comparative study of Vamana and Virechana karma in Ekakushtha w.s.r to Psoriasis. Department of Panchakarma, IPGT&RA Jamnagar
#Padhsala Satish V (2009): A comparative study on Vamana karma by using shuddhaghrita and samskritaghrita as abhyantarasnehpana in Ekakushtha w.s.r to Psoriasis. Department of Panchakarma, IPGT&RA Jamnagar
#Padhsala Satish V (2009): A comparative study on Vamana karma by using shuddhaghrita and samskritaghrita as abhyantarasnehpana in Ekakushtha w.s.r to Psoriasis. Department of Panchakarma, IPGT&RA Jamnagar
#Jaimin R Patel (2010): A Comparative Study on Vamana Karma with Madanaphala and Krutavedhana W.S.R. to Ekakushtha (Psoriasis). Department of Panchakarma, IPGT&RA Jamnagar
#Jaimin R Patel (2010): A Comparative Study on Vamana Karma with Madanaphala and Krutavedhana W.S.R. to Ekakushtha (Psoriasis). Department of Panchakarma, IPGT&RA Jamnagar
#Kundan Gadhvi (2011): A Comparative Study between the Efficacy of Vamana and Virechana Karma in the Management of Tamaka Shvasa (Bronchial Asthma). Department of Panchakarma, IPGT&RA Jamnagar
#Kundan Gadhvi (2011): A Comparative Study between the Efficacy of Vamana and Virechana Karma in the Management of Tamaka Shvasa (Bronchial Asthma). Department of Panchakarma, IPGT&RA Jamnagar
#Neetu jain (2012): A forwarding clinical study on standardization of vamana karma w.s.r to antiki, vaigiki, maniki and laingiki criteria. Department of Panchakarma, IPGT&RA Jamnagar
#Neetu jain (2012): A forwarding clinical study on standardization of vamana karma w.s.r to antiki, vaigiki, maniki and laingiki criteria. Department of Panchakarma, IPGT&RA Jamnagar
#Shaizi Layeeq (2013): A clinical study on the effect of Vamana karma and amalaki rasayana in the management of Pandu w.s.r to iron deficiency anaemia. Department of Panchakarma, IPGT&RA Jamnagar
#Shaizi Layeeq (2013): A clinical study on the effect of Vamana karma and Amalaki rasayana in the management of Pandu w.s.r to iron deficiency anaemia. Department of Panchakarma, IPGT&RA Jamnagar
#Shweta Patil (2013): A comparative study on the effect of vamana and virechana karma followed by brumhana snehapana (kantakari ghrita) in the management of tamaka shvasa w.s.r to Bronchial asthma. Department of Panchakarma, IPGT&RA Jamnagar
#Shweta Patil (2013): A comparative study on the effect of vamana and virechana karma followed by brumhana snehapana (kantakari ghrita) in the management of tamaka shvasa w.s.r to Bronchial asthma. Department of Panchakarma, IPGT&RA Jamnagar
#Sunita Sheike (2013): A comparative study between vamana and virechana karma in the management of sthula pramehi w.s.r to type-ll diabetes mellitus. Department of Panchakarma, IPGT&RA Jamnagar
#Sunita Sheike (2013): A comparative study between vamana and virechana karma in the management of sthula pramehi w.s.r to type-ll diabetes mellitus. Department of Panchakarma, IPGT&RA Jamnagar
#Patairya Pratiksha Prakash (2014): A clinical study on the role of vamana and virechana in the management of hypothyroidism with punarnava-aruta-guggulu. Department of Panchakarma, IPGT&RA Jamnagar
#Patairya Pratiksha Prakash (2014): A clinical study on the role of vamana and virechana in the management of hypothyroidism with punarnava-aruta-guggulu. Department of Panchakarma, IPGT&RA Jamnagar
#Ritika Mishra (2018): A clinical study to evaluate and compare the efficacy of vamana, virechana and shamana in the management of ekakushtha w.s.r to psoriasis. Department of Panchakarma, IPGT&RA Jamnagar
#Ritika Mishra (2018): A clinical study to evaluate and compare the efficacy of vamana, virechana and shamana in the management of ekakushtha w.s.r to psoriasis. Department of Panchakarma, IPGT&RA Jamnagar
#Laveena Kumari(2018): A comparative clinical study to evaluate the effect of virechana, vamana and shwasahara yoga in the management of tamaka shwasa w.s.r to bronchial asthma. Department of Panchakarma, IPGT&RA Jamnagar
#Laveena Kumari(2018): A comparative clinical study to evaluate the effect of virechana, vamana and shwasahara yoga in the management of tamaka shwasa w.s.r to bronchial asthma. Department of Panchakarma, IPGT&RA Jamnagar
==More information==
==More information==
The list of references for Vamana in Charak Samhita can be seen [[Media:Reference_of_word_Vamana_in_Charaka-converted.pdf|here]]
The list of references for Vamana in Charak Samhita can be seen [[Media:Reference_of_word_Vamana_in_Charaka-converted.pdf|here]]
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==References==
==References==
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