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CLINICAL RESEARCH
Year : 2011  |  Volume : 32  |  Issue : 2  |  Page : 181-186  

A study on Vasantika Vamana (therapeutic emesis in spring season) - A preventive measure for diseases of Kapha origin


1 Associate Professor, Department of Panchakarma, National Institute of Ayurveda, Jaipur, India
2 Ex.Head, Department of Panchakarma, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
3 Associate Professor & I/c Head, Department of Panchakarma, Institute for Post Graduate Teaching and Research in Ayurveda,Gujarat Ayurved University, Jamnagar, Gujarat, India
4 Panchakarma Physician, Department of Panchakarma, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India

Date of Web Publication2-Feb-2012

Correspondence Address:
Santoshkumar Bhatted
Associate Professor, Department of Panchakarma, National Institute of Ayurveda, Jaipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8520.92562

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   Abstract 

Panchakarma is the most essential part of Ayurveda treatments. It is preventive, preservative, promotive, curative and rehabilitative therapy. Ayurveda believes in strong relationship between macrocosm and microcosm and states that the seasonal changes will influence the biological systems resulting into the accumulation and aggravation of particular Dosha in a particular season like accumulation and aggravation of Kapha in Hemant Rutu (winter season) and Vasant Rutu (spring season) respectively, accumulation and aggravation of Pitta in Varsha Rutu (rainy season) and Sharad Rutu (autumn season) respectively. Vasantika Vamana is done in spring season approximately in the month of March and April for the elimination of vitiated Kapha Dosha which in turn helps to prevent the forth coming Kapha disorders and associated Pitta disorders or diseases originating or settled in the place of Kapha like bronchial asthma, allergic bronchitis, rhinitis, sinusitis, migraine, hyperacidity, indigestion, anorexia, obesity, overweight, dyslipidemia, diabetes mellitus, acne vulgaris, psoriasis, eczema, urticaria etc. In this study, a total of 89 persons were registered and 69 volnteers/patients undergone classical Vamana Karma without any major complications. Average minimum, maximum, total dose and total days of Snehapana were 36.40 ml, 187.21 ml, 578.59 ml and 5.01 days respectively. Average quantity of Madanaphala, Ksheera, Yashtimadhu Phanta and Lavanodaka was 5.81 g, 1130.29 ml, 3202.9 and 2489.13 ml respectively. The results were encouraging; hence, further studies may be conducted including large population in this direction.

Keywords: Antiki , Dosha, Kapha, Laingiki, Madanaphala, Maniki, Pitta, Samsarjana Krama, Snehapana, Vasantika Vamana, Vegiki


How to cite this article:
Bhatted S, Shukla V D, Thakar A, Bhatt N N. A study on Vasantika Vamana (therapeutic emesis in spring season) - A preventive measure for diseases of Kapha origin. AYU 2011;32:181-6

How to cite this URL:
Bhatted S, Shukla V D, Thakar A, Bhatt N N. A study on Vasantika Vamana (therapeutic emesis in spring season) - A preventive measure for diseases of Kapha origin. AYU [serial online] 2011 [cited 2019 Jul 18];32:181-6. Available from: http://www.ayujournal.org/text.asp?2011/32/2/181/92562


   Introduction Top


Panchakarma is the most essential part of Ayurveda treatments. It is preventive, preservative, promotive, curative and rehabilitative therapy. The umbrella of Panchakarma includes five major therapeutic procedures Vamana (therapeutic emesis), Virechana (therapeutic purgation), Niruha Basti (therapeutic decoction enema), Anuvasan Basti (therapeutic oily enema) and Nasya (therapeutic errhine) and many allied therapies. Ayurveda practices Tridosha (Vata, Pitta and Kapha) theory. For the correction of abnormalities of Tridosha and related body constituents, specific therapy among the Panchakarma is practiced like Vamana for Kapha Dosha, Virechana for Pitta Dosha, and Basti for Vata Dosha predominantly. Ayurveda believes in the strong relationship between macrocosm and microcosm and states that the seasonal changes will influence the biological systems resulting into the accumulation and aggravation of particular Dosha in a particular season like accumulation and aggravation of Kapha in Hemant Rutu (winter season) and Vasant Rutu (spring season) respectively, accumulation and aggravation of Pitta in Varsha Rutu (rainy season) and Sharad Rutu (autumn season) respectively. Ayurveda emphasized to practice these therapies to eliminate the vitiated Dosha in accordance to the seasonal variation like Vamana in Vasant Rutu, Virechana in Sharad Rutu, Basti in Varsha Rutu etc for preservation and promotion of health and prevention of disease; hence, Vasantika Vamana, Sharadika Virechana and Varshika Basti are the preventive practices of Panchakarma.

Definition of Vamana

Vamana is a procedure in which Doshas (waste products or toxins) are eliminated through upper channels i.e. mouth. [1] Specially the Kapha and Pitta Dosha brought to Amashaya (stomach and duodenum) from all over the body by the specific preoperative procedures and then eliminated out by inducing the emesis.

Importance

  1. Kapha disorders and associated Pitta disorders or diseases originating or settled in the place of Kapha will be relieved either permanently or for a longer period of time.
  2. It helps to prevent the forth coming diseases due to Kapha and Pitta.
  3. Most of Ayurvedic drugs are administered by oral root. First it goes to the Amashaya (stomach), which is the main seat of Kapha. Digestion of food also starts from Amashaya. If there is accumulation or aggravation of Kapha in Amashaya, the digestion of food or drug cannot takes place properly. With the help of Vamana Karma, Amashaya Shuddhi (cleansing) occurs, so the digestion of drug and food takes place properly.
Vasantika Vamana (emesis in spring season)

In Ayurvedic texts, Vamana procedure is indicated for the expulsion of Kapha Dosha. Kapha Dosha is aggravated in Vasant Rutu; hence, Vamana is indicated in spring season approximately in the month of March and April.


   Vasantika Vamana-Contra-Indications/Indications Top


Almost everybody can undergo Vasantika Vamana except those suffering from the diseases contraindicated for Vamana like bleeding from the upper channels like mouth, upper GIT, bronchial tree, emaciated, very old, pregnant woman, persons with hypertension and heart diseases, exclusively Vata constitution and Vata disorders.

Especially it is highly beneficial for volnteers of Kapha and Kapha-Pitta constitution and patients suffering with Kapha disorders and associated Pitta disorders or diseases originating or settled in the place of Kapha like bronchial asthma, allergic bronchitis, rhinitis, sinusitis, COPD, productive cough, migraine, hyperacidity, indigestion, anorexia, obesity, overweight, dyslipidemia, diabetes mellitus, skin diseases like acne vulgaris, psoriasis, eczema, dermatitis, Lichen Plannus, vitiligo, urticaria, falling and graying of hairs, inflammatory and swollen joint disorders of early stage, depression, drowsiness, excessive sleep, epilepsy, certain auto immune diseases etc.

Diagnostic procedures


The persons were examined on the basis of Dosha, Dushya, (tissues and excreta), Desha (habitat), Prakriti (constitution), Bala (strength), Kala (season), Agni (digestion and metabolism), Vaya (age), Satva (psychological make up), Satmya (adaptability), Ahara (diet) etc and fit persons for Vamana were only selected after having a written consent.

Vamana protocol: It can be divided into three steps

  1. Purva Karma (preoperative preparation)
  2. Pradhana Karma (operative procedure/induction of Vamana)
  3. Pashchat Karma (post operative care)
Purva Karma ( Pre-operative preparation) Pachana and Deepana (digestives and appetizers)

Trikatu Churna 2 g, Chitrakadi Vati/Amapachana Vati 2 tab TID with warm water for three days.

Abhyantara Snehana (internal oleation)

Shuddha Ghrita/Siddha Ghrita or Tail (plain/medicated ghee/oil) was given in increasing dose for three to seven days as per the requirement till achieving the signs and symptoms of proper Snehana.

Abhyanga (massage) and Swedana (fomentation)

After proper Snehana on next day, Abhyanga was done with Bala Taila followed by Sarvanga Swedana two times a day for one day and next day morning before administering Vamana again. Abhyanga with Bala Taila followed by Sarvang Swedana was done.

Dietetic guidelines during Purva Karma

Diet during the days of Snehapana


  1. Patients were advised to take moderate quantity of liquid and warm food, easy to digest mixed with little fat, which is neither sticky nor complex and to drink lukewarm water.
Diet on previous day of Vamana

Patients were advised to have plenty of milk, curd, sweets like sesame and Jaggary Laddu, Jalebi, Khicadi made from black gram, sesame, jaggary and rice or Dahi Wada.

Counselling before Vamana

  1. Patients were informed about different steps involved in this procedure.
  2. A well-informed written consent was obtained.
  3. Patients were advised to relax and remove the negative thoughts.
Pradhana Karma (induction of Vamana): It includes

  1. Administration of Vamana Yoga [Table 1]
  2. Observations during Vamana Karma
  3. Observations regarding four criteria
Table 1: Average quantity of drugs used for Vamana Karma

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(I) Administration of Vamana yoga: This was done in the following way.

  1. Position of patients:

    Patients were asked to sit on a comfortable Vamana chair of the height of knee joint.
  2. Examination of vital data:

    Pulse and blood pressure were recorded before, during and after completion of Vamana Karma.
  3. Administration of food articles and drugs:Vamana was induced in the early morning between 6 am and 9 am.
    1. Patients were asked to drink milk stomach full (Aakantha pana) approx. 2 l, Peya (thin rice gruel) mixed with ghee was also given for some patients.
    2. Then patients are given Vamana Yoga 0- medicinal formulation (Madanaphala Pippali (powder of seeds of Randia dumetorum) 4 parts, Vacha (Acorus calamus) 2 parts, Saindhava Lavana (rock salt) 1 part and Honey Q.S.) to induce emesis. [2]

      For collecting vomitus, a wide mouth vessel was kept ready. Now the patient is instructed to vomit without much straining. The urge may be excited by opening wide the lips, the palate, the throat and by slightly bowing the upper part of the body. The dormant urge may be excited by tickling the throat with two well manicured fingers. [3] During the act of emesis when actual bout is being thrown out, forehead and chest of the patient was held, umbilical region of the patient was pressed and back of the patient was gently massaged in upward direction. [4]
    3. During the procedure, Vamanopaga Kashaya (supportive decoction to continue vomiting) like decoction/hot infusion of Yashtimadhu (glycyrriza glabra) after each Vega was administered repeatedly to support the act of vomiting till the appearance of Pitta (bile) in vomitus. [5]


(II) Observations during Vamana Karma: Record of input, output and other observations were maintained.

(III) Assessment of Vamana: It was assessed as Pravara (highest), Madhyama (moderate) and Hina (lowest) Shuddhi (cleansing) on the basis of four criteria as per the classical texts. [6]

  1. Vegiki criteria: It is on the basis of number of bouts like 4, 6 and 8 Vega (projectile vomiting bouts) for Hina, Madhyama and Pravara Shuddhi respectively. In addition to projectile bouts, smaller bouts in every aspect than Vega (Upavega) were also recorded.
  2. Maniki criteria: It is on the basis of the quantity of elimination of Dosha, like 1, 1½ and 2 Prastha for Hina, Madhyama, Pravara Shuddhi, respectively (Prastha = 540 ml).

    This is calculated from the total quantity of output minus the total quantity of input.
  3. Antiki criteria: It is on the basis of endpoint, it is advised to continue Vamana till the appearance of Pitta in the vomitus which marks the end of Vamana.
  4. Laingiki criteria: It is on the basis of positive signs and symptoms produced after Vamana.
Pashchata Karma (Post operative care)

When Vamana Karma was completed, patients were kept on close observation and on special dietetic and behavioral restrictions which are considered as "Pashchata Karma" for some days till achieving Agnideepti and Bala. This may be classified as follows.

Dhumapana and Gandusha (medicated smoke and gargling)

After Samyaka Vamana, patients are advised to inhale the medicated smoke, gargle and wash mouth, hands and feet, then to rest for about an hour. [7]

Behavioral and dietetic restrictions

Patients were advised to avoid loud speeches, sitting or standing in one position for long duration, excessive walk, excessive rage or excessive depression, exposure to excessive cold, heat, dew, to flowing winds, long journey, night waking, day sleep, to retain or provoke urges. Frequently, untimely, excessive, less, contradictory and heavy diet were also avoided. [8]

Samsarjana Krama: (special dietetic schedule)

It has to be planned on the basis of type of purification achieved by Vamana i.e. for Hina, Madhyama and Pravara Shuddhi, three, five and seven days respectively. [9] Generally, in all the patients after Vamana Karma, the Peyadi Samsarjana Krama is advised as dietary regimen as follows with little modification:

On the day of Vamana, thin rice gruel without spices and fat once a day; on second day thick rice gruel without spices and fat twice a day; on third day rice and liquid soup of green gram and rice without spices and fat twice a day in moderate quantity; on forth day liquid soup of green gram and rice with spices and fat twice a day in moderate quantity and on fifth day onwards normal diet was given.


   Clinical Study Top


Aims and objectives

  1. To assess the role of season in the induction of Vamana Karma.
  2. To evaluate the effect Vasantika Vamana in healthy volunteers and patients.

   Materials and Methods Top


Healthy volunteers and certain patients who are indicated for Vamana Karma were selected from the OPD and IPD of IPGT and RA, Jamanagar. 89 persons were registered out of which 20 persons left the treatment in between and 69 persons completed the whole treatment. Details of the registered patients have been placed at [Table 2], [Table 3], [Table 4], [Table 5] and [Table 6].
Table 2: Age-wise distribution of the persons

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Table 3: Sex-wise distribution of the persons

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Table 4: Agni (digestive power)-wise distribution of the persons

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Table 5: Koshtha (bowel)-wise distribution of the persons

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Table 6: Prakriti (constitution)-wise distribution of the persons

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Inclusion criteria

  • Age between 16 and 60 years.
  • Patients suffering from Kapha or Kapha associated with Pitta disorders
Exclusion criteria

  • Age below 16 years and above 60 years.
  • Patients suffering from tuberculosis, ischemic heart disease, hypertension, carcinoma and other life threatening and complicated diseases.
Hematological investigations

Blood for HB, TC, DC, and ESR. Hemoglobin, total leucocyte Count, differential count, erythrocyte sedimentation rate were done.

Biochemical investigations

Lipid profile, FBS, blood urea, serum creatinine, A/G ratio, total protein, SGPT, and SGOT.

Criteria for assessment

  1. On the basis of various aspects of Vamana Karma.
  2. On the basis of overall improvement in his/her wellbeing.



   Observations and Results Top


The hematological and biochemical tests were done before and after the Vamana Karma. Minor changes were found. The observations of the procedure in volunteers are shown in [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14] and [Table 15].
Table 7: Assessment of dose and duration of Snehapana

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Table 8: Assessment of Samyak Snigdha Lakshana (features of proper oleation)

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Table 9: Vyapada (complications) of Snehapana

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Table 10: Average increase in vital parameters before and after Vamana Karma

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Table 11: Assessment of Vamana Karma - Vegiki (bouts) and Maniki (quantity) criteria

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Table 12: Assessment of Vamana Karma - Antiki (end point) criteria

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Table 13: Assessment of Vamana Karma-Laingiki (signs and symptoms) criteria

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Table 14: Time relation in Vamana Karma

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Table 15: Vyapada (complications) of Vamana Karma

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   Discussion Top


Pachana and Deepana help to digest the Ama, makes the Dosha Nirama and increases the Agni, Abhyantara Snehana helps to dissolve the Dosha and to increase the volume and makes the Dosha free from their adherence and Abhyanga and Swedana help the Dosha to liquefy and disintegrate. All these preparatory measures help to mobilize the Dosha from Shakha to Koshta.

Vamana was induced in the early morning between 6 am to 9 am as this is Kapha Kala. Ksheera belongs to Kapha Varga and palatable to most of the persons and hence selected for Akanthapana which facilitates the Vamana process and prevents the complications. Madanaphala pippali 4 parts, Vacha 2 parts, Saindhava Lavana 1 part and Honey quantity sufficient was used safely in our routine practice and generally devoid of complications and hence it was used for inducing vamana. Peyadi sansarjana karma is advised to improve the Agni gradually, to support the Prana (vitality) and nourish the body gradually with carbohydrates, proteins and fats one by one to avoid the Agnimandhya.

Average minimum, maximum and total quantity of Snehapana was 36.40 ml, 187.21 ml and 578.59 ml [Table 7] respectively because the maximum number of persons were having Mandagni followed by Samagni and average days of Snehapana was 5.06 days as the maximum number of persons were having Madhyama Koshtha.

Varcha Snigdhata and Asamhatata, Diptagni, Vatanulomana, was found in 86.76, 76.47, 67.65% of persons respectively because the changes in the stool and increase in the appetite are commonly noted as the days of Snehapana advances in majority of the persons whereas Mardavata and Snigdhatangata is generally a late feature to be noted and observed when higher dose of Snehapana is given and hence found in only 52.94% of persons [Table 8]. Few complication were also observed with Sneha Pana [Table 9].

As majority of the persons were healthy volunteers and even the selected patients were not suffering from hypertension or heart disease, no much increase was found in the vital parameters like blood pressure and pulse [Table 10].

Average difference of quantity between output and input was 272.15 ml [Table 11], which indicate toward the Avara Shuddhi whereas the average number of Vega and Upavega was 6.68 and 6.3 respectively [Table 11], showing Madhyama Shuddhi. 56.52% of persons had Pittant [Table 12] and aassessment of Vamana Karma by Laingiki criteria showed that majority of the persons had Indriyaprasada, Laghuta, Hridaya Parshva Murdha and Kantha Shuddhi, Vatanulomana, Kramat Doshanirharana [Table 13] which clearly indicates that proper Vamana Karma occurred in most of the persons. This indicates that Vasant Rutu supports for proper conduction of Vamana Karma as majority had Madhyama Shuddhi without any complications. The average days of Sansarjana Krama were 5.06 days [Table 14], because majority of the persons had Madhyama Shuddhi.

Only two persons each had complications like Adhmana, Udarashoola and Rakta darshana and only one person each had complications like Shirahsoola and Kasa which was not statistically significant [Table 15] and it may be because of their Vata-Pittaja Prakruti.

As the change in the hematological biochemical and vital parameters were within normal range and they were not statistically significant and no major complications were found, the drugs and the total procedure may be considered as safe.

The main aim of the study was to see the safety of Vamana Karma particularly conducted in Vasant Rutu and it was found to be safe. Simultaneously, it was observed that overall wellbeing of the volunteers and patients was improved. As the patients were suffering from different diseases and the number of patients suffering from the same disease was very less, statistical significance in the relief of their signs and symptoms could not be drawn. Long-term follow up is required for observing the prevention of Kapha diseases.


   Conclusion Top


  1. Panchakarma is the most essential part of Ayurveda treatments, which can be practiced as preventive, preservative, promotive, curative and rehabilitative therapy as per the need.
  2. Ayurveda emphasized to practice Vamana in Vasant Rutu, Virechana in Sharad Rutu, Basti in Varsha Rutu for preservation and promotion of health and prevention of disease.
  3. Vasantika Vamana is highly beneficial for volunteers of Kapha and Kapha-Pitta constitution and patients suffering from Kapha disorders and associated Pitta disorders or diseases originating or settled in the place of Kapha.
  4. Vamana should be practiced as per the classical guidelines to avoid complications.
  5. Average minimum, maximum, total dose and total days of Snehapana were 36.40 ml, 187.21 ml, 578.59 ml, and 5.01 days respectively.
  6. Average quantity of Madanaphala, Ksheera, Yastimadhu Phanta and Lavanodaka was 5.81 g, 1130.29 ml, 3202.9 and 2489.13 ml respectively.
  7. The average days of Sansarjana Krama were 5.06 days.
  8. Laingiki and Antiki criteria seem to be the better criteria for the assessment of Vamana.

   Acknowledgment Top


Prof M. S. Baghel: Director, IPGT and RA, GAU, Jamnagar, Prof. R R Dwivedi, Dean, IPGT and RA, GAU, Jamnagar, MD and PhD scholars of the Dept of Panchakarma, Students of Panchakarma technician course and masseurs of the department. Volunteers of the study.

 
   References Top

1.Charaka samhita with Ayurveda Dipika Comm. of Chakrapani, Edited. by Yadavaji Trikamji Acharya. Kalpasthana 1/4, Varanasi: Chaukhamba Sanskrit series; 1992.  Back to cited text no. 1
    
2.Kasture HS, Ayurvediya Panchakarma Vigyana. by editor. 1978.  Back to cited text no. 2
    
3.Ibid, Charaka samhita, Sutrasthana 15/12.  Back to cited text no. 3
    
4.Charaka samhita, Sutrasthana 15/11.  Back to cited text no. 4
    
5.Ibid, Charaka samhita, Kalpasthana 1/14.  Back to cited text no. 5
    
6.Ibid, Charaka samhita, Siddhisthana 1/14-16.  Back to cited text no. 6
    
7.Ibid, Charaka samhita, Sutrasthana 15/14.  Back to cited text no. 7
    
8.Ibid, Charaka samhita, Sutrasthana 15/15.  Back to cited text no. 8
    
9.Ibid, Charaka samhita, Siddhisthana 1/11-12.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15]


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