Vaman is one of the five therapies of panchakarma in Ayurveda. Vaman means therapeutic vomiting which is a medicated emesis. This treatment is done for the aggravated kapha dosha, which removes the toxins mainly from the respiratory and gastrointestinal tract. This therapy is done for preventive & curative purposes. Ayurveda believes that different seasons have a great influence in the aggravation of doshas, ex: Kapha in Hemant Rutu (Winter Season) and Vasant Rutu(spring season) respectivaly, accumulation and aggravation Pitta in Varsha Rutu(Rainy Season) and Sharada (autumn Season) and Vata in Greeshma (summers) season. Hence one can adopt Vaman therapy in spring i.e. Vasant season as a preventive therapy in order to prevent disorders related to kapha.
Purpose of Vamana Treatment:
Vamana treatment is targeted to expel increased Kapha Dosha out of the body. When Kapha dosha increases, it causes certain types of diseases – such as cold, cough etc. If the extent of Kapha increase is less, then some oral medicines can be given to suppress it. But if it has increased to a large extent and if it has moved from its natural place to other places, then it needs to be expelled out of the body. By expelling it out, the disease gets cured, often completely. Since Kapha is situated in the chest region, expelling it from the oral route is very easy. Hence, Vamana treatment is designed. To expel it out, first the Kapha Dosha needs to be forcefully brought from the extremities and different organs into the stomach, and then vomiting is induce
Vamana is a procedure in which Doshas (waste products or toxins) are eliminated through upper channels i.e. mouth. 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.
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.
It helps to prevent the forth coming diseases due to Kapha and Pitta.
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.
Vasantik 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.
Almost everybody can undergo Vasantik 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 volunteers 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.
The persons were examined on the basis of Dosha (vata, pitta,kapha), 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
Purva Karma (preoperative preparation)
Pradhana Karma (operative procedure/induction of Vamana)
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
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
(i) Patients were informed about different steps involved in this procedure.
(ii) A well-informed written consent was obtained.
(iii) Patients were advised to relax and remove the negative thoughts.
Pradhana Karma (induction of Vamana):
It includes Vamana Karma
(III) Observations regarding four criteria
(I)Administration of Vamana yoga: This was done in the following way.
Position of patients:
Patients were asked to sit on a comfortable Vamana chair of the height of knee joint.
Examination of vital data:
Pulse and blood pressure were recorded before, during and after completion of Vamana Karma.
Administration of food articles and drugs:
Vamana was induced in the early morning between 6 am and 9 am.
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.
Then patients are given Vamana Yoga - 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.
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. 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.
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.
(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.
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.
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.
This is calculated from the total quantity of output minus the total quantity of input.
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.
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.
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.
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. 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.