Vamana Therapy – Right Method, Side Effects, Management

If you are prescribed Vamana therapy by your doctor, it means that they are planning to induce a controlled vomiting in you. Controlled vomiting means – it is planned, it is induced and vomiting is expected to run for a definite amount of time and then it is planned to stop. 

Purpose of Vamana

Vamana treatment is targeted to expel increased Kapha Dosha out of the body. When Kapha dosha gets increased, 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 induced.

Advantages of Vaman

Vitiated and aggressive Kapha dosha is expelled out of the body, leading to cure of disease.
The digestion and metabolism power gets enhanced,
Normal health is restored;
The sense organs, mind, intelligence, and complexion become clear and gain strength;
The person gains strength, nourishment and immunity,
It improves the chances of fertility, virility and sexual power.
It helps to slow down aging process.
One can live healthily for long time.

Indications

Indications for Vaman Panchakarma treatment –
Vomiting therapy should be administered in two Kapha conditions –
When Kapha Dosha is increased aggressively causing a disease.
Kapha is associated with Pitta dosha and they together cause disease, but Kapha (aka Shleshma) is the dominant Dosha. 

Persons suitable for Vamana

Persons suitable for Vamana procedure – Vamana Arha
People suffering with-
fever of recent origin,
diarrhea, dysentery
Pitta imbalance in lower part of abdomen
Bleeding disorder due to Pitta imbalance
cough, cold, Asthma, chronic Respiratory disorder,
skin diseases, with itching and burning sensation such as herpes
diabetes, urinary tract disorders
Goiter, tumour, fibroid, thyroid disorders
Elephantiasis, Filariasis
Schizophrenia
Shwasa – Chronic Respiratory tract disease,
indigestion, continuous nausea, Anorexia, lack of taste,
Vitiated breast milk
Kapha disorders affecting neck, ear, nose eyes, and throat
obesity
Anemia
heaviness of the body
eruption of pimples, urticaria, itching
lethargy, laziness, lack of inclination for work, lack of co-ordination in sense organs,
Fatigue, Weakness, tiredness without any reason.
Foul smell of the body,
sleeplessness or excessive sleep,
drowsiness, weak sense organs,
impotency,
loss of strength and complexion in spite of the intake of nutritious diet.

Persons unsuitable for Vamana

Persons not suitable for Vamana Panchakarma – 
Basically, person who has Kapha deficiency – like dryness, lightness etc symptoms is not suitable for Vamana.
Pregnant woman – she already will be having
Rooskha – persons who are dry
Person who has not undergone oleation therapy – because, without oleation treatment (procedure of consuming ghee / oil, ahead of Vamana, explained in detail below), Kapha does not get extracted into the gut.
who have strong digestive activity, person who is hungry – here, usually Pitta is dominant. If a person is really hungry, then chances are there that he will digest the medicine that is being given to induce vomiting and hence, vomiting might never happen.
Constantly grief-stricken,
children, old persons, the emaciated, highly obese
patient with heart disease, the wounded, weak, debilitated,
who are having bouts of vomiting,
enlargement of spleen, blindness,
intestinal parasites
upward movement of vata, bloating,
hematemesis (blood vomiting), nasal bleeding
Soon after administration of Vamana,
who have loss of speech, dysuria,
ascites, intestinal obstruction,
tumor of the abdomen,
who faced difficulties during Vamana therapy in earlier attempts,
hemorrhoids
upward movement of air – reverse peristalsis,
Giddiness / Dizziness – enlargement of the prostate,
pain in the flanks and diseases caused by vata;

Before Vamana therapy

Before Vamana therapy, you may be given a digestive medicine such as Trikatu churna, Chitrakadi Vati, Hingwashtaka Churna etc. for up to three days.
Then you may be asked to drink a specific type of ghee or oil for 3 – 7 days. It is usually gradually increased day by day. In emergency conditions,  the ghee or oil consumption may be advised for 1 day only, in which case, it is usually mixed with rock salt. This process of drinking ghee is called as Snehakarma or oleation therapy – click to read more.  

After 3 – 7 days of oil / ghee consumption, you will be advised to undergo oil massage with sweating treatment. At that day, night, you will be given with Kapha increasing diet such as sweet curds, black gram ,Vada etc.

On the day before Vamana

Kapha Dosha is excited in the patient by administering drink / thin gruel prepared from fish, black gram, Sesame etc. added with little quantity of fats, in morning.

Administration of Vamana medicines

Administering medicine for Vamana – emesis therapy –
The patient is made sure that he has slept well the previous night.
Patient is made sure that his previous food is well digested
The patient is made to take hot water bath.
He is either maintained on empty stomach or a little quantity of ghee is given.
The aged, children, the debilitated, VIPs and cowards, should be made to drink wine, milk, sugarcane juice or meat juice added with honey and Saindhava salt, appropriate to the disease, to their maximum capacity.
Determining the nature the nature of his bowels (Intestines – Koshta), the emetic drug is administered.
The physician should administer a dose of the decoction  (Kashaya) of the fruit of Madanaphala (Randia dumetorum Lam). Along with Honey, Rock salt, Phanita ( a preparation of Sugar cane juice) and the  powder of Madhuka– (Licorice – Glycyrrhiza glabra)

Dose of emetics

Dose of emetics (Vamana Dravya) –
The Dosage of the Kashayam of the fruit of Madana (Randia Dumetorum Lam) and of all the other drugs used in elimination therapy should be determined according to the individual needs. The quantity, which when taken brings about the desired effect in the form of elimination of the vitiated Doshas which does not cause over- elimination or inadequate elimination, is to be regarded as the proper dose for the patient.

Adjuvants for Vamana drug

In case of increase of Kapha, vomiting should be induced with drugs having properties like penetrating, hot and Pungent
In case of Pitta with drugs of sweet and cold properties and
In case of association of Vata with Kapha, with drugs of Unctuous, sour and salt properties.

Examples

Examples of combination of herbs for inducing Vamana:
The decoction of Madanaphala – Randia dumetorum mixed with Pippali – long pepper- piper longum and Sarshapa is used for emetic therapy. – Charaka Chikitsa Sthana 15th chapter.

Vamana procedure

Vamana Vidhi – Procedure of Vamana therapy-
After consuming the medicine, he should await for one Muhurta – 48 minutes for the commencement of vomiting, with keen intent.
With the appearance of oppression in the chest and salivation he should try to vomit.
Patient is instructed not to exert too much, but allow the vomiting urge to be fully manifested.
If the bouts are not coming up easily, he should tickle his throat either with his fingers or a soft tube without injuring the throat,
Sitting on a seat of the height of one knee, the bouts of vomiting should be held supported by another person.
His umbilical region and back should be massaged in upward direction.

The physician should  very carefully observe the vomit in the spittoon, ascertain the number of urges and should conclude therapy as to whether the therapy has been well administered, inadequately administered or administered in excess. It is from this observation that the physician can determine the further line of action. So he should very carefully observe the vomiting urges.
If bouts are insufficient, they should be induced again and again by drinking water boiled with long pepper,Amla, mustard and rock salt.

Signs and symptoms

Signs and symptoms indicating the proper action of the drug:  
The first effect of the administration of decoction would be perspiration which indicates that the Dosha has started melting.
After that, the patient would have horripilation which shows that the Dosha has started moving from its own position.
In the third stage patient will have distension of the abdomen indicative of the Doshas having shifted to  the intestine.
Nausea and salivation which occur in the fourth stage are indicate that the Dosha has started moving upwards.

Position of patient

Position of patient during vomiting:
It is at this stage that the patient should be asked to sit on a bed of knee height comfortably, well covered and equipped with bed-sheet, towel, pillow and cushion. A  spittoon should be kept nearby. The caretaker of the patient should support his head, sides, press the navel and massage the back of the patient.

Number of bouts

How many bouts of vomiting?
Heenayoga – Minimum bouts – 4 bouts
Madhyama vega – Moderate – 6 bouts
Atiyoga – Maximum bouts – 8 bouts
Vomiting should be allowed till the appearance- coming out of Pitta. This is appreciated by expulsion of bile or yellow sticky material, at the end. Coming out of Pitta indicates complete expulsion of Kapha Dosha.

Ayoga – inadequate bouts – Non – commencement of bouts, bouts coming on with hindrance or elimination of the medicine only- are the features of inadequate bouts; from it arise, excess of expectoration, itching, appearance of skin rashes, fever etc.

Signs of proper Vamana

Signs of proper administration of Vamana therapy:
Manifestation of the vomiting urges in time
Absence of too much pain
Elimination of Doshas in proper order. Kapha, Pitta and vata coming out in successive order, without any hindrance,
The urge for vomiting will recede on its own, after the Doshas are properly eliminated.
Calmness of the mind and cessation of vomit bouts on its own,
Absence of features of inadequate bouts and
Feeling of not too much of discomfort are the features of samyakyoga- proper bout.

 In Atiyoga- excess bouts the vomited materials will be frothy,  with glistering particles and blood;
The patient will experience weakness, burning sensation, dryness of the throat, giddiness, powerful disease of vata origin and even death due to discharge of life supporting blood.

Signs of inadequate Vamana

Inadequate administration of Vamana therapy: 
Absence of vomiting or occasional vomiting
Vomiting of the drug material only, without the vitiated Kapha Dosha
Excretion of the drug material through purgation
Obstruction to the vomiting urges.
Management: While the therapy is going on, if inadequate symptoms are observed, then patient can be given with repeated dose of Madana phala Kashaya or Yashtimadhu phanta (licorice infusion), so as to induce vomiting. If that also fails, then the patient is made to follow Samsarjana krama (see below), and again within a few days, a quick Vamana therapy is planned.

Over administration of Vamana

Over-emesis may cause the diseases of the head and neck due to the vitiation of Vata and disturbance of speech.
Appearance of foam in the vomit
Appearance of blood streaks in vomit.

Complications of Vamana

The following complications arise out of over administration or inadequate administration of the therapy;
Distension of abdomen,
sawing type of pain,
salivation,
palpitation,
rigidity, and
blood vomiting,
displacement of viscera of the body,
stiffness,
and exhaustion.

Post emesis management

Post emesis management – Care after vomiting therapy
After the therapy has been well-administered, the hands, feet and face of the patient should be washed with warm water
The patient should be consoled.
Made to undergo herbal smoking 
He should then enter into a room which is not exposed to the wind and should lie down there.

Activities to avoid

The patient should abstain from the following for the whole day –
Speaking aloud,
Excess eating,
Sitting at one place for long time,
Walking long distances,
Anger and grief,
Exposure to sun, dew and stormy wind,
Travelling,
Indulging in sexual  intercourse,
Waking up at night, avoiding sleep
sleeping during day time,
foods with opposite qualities, wrong food combinations and
Foods that may cause indigestion,
Intake of diet exclusively having one taste, intake of diet deficient in nutritive value, or heavy or irregularly mixed up
Suppression or forcible initiation of natural urges.

Diet regimen after Vamana

Diet regimen after Vamana treatment
It is also called as Samsarjana Krama. Soon after emesis, the digestive capacity of the patient is very low. Hence, all of a sudden regular diet cannot be introduced. In stead, liquid diet should be started and gradually turning to solids. 
In the same evening or the next day after Vamana, patient should take bath in lukewarm water.

He should be given like- warm gruel (Manda) prepared with well cooked old rice. The gruel should be very thin. This is to be given with due regard to the power of digestion, for three meal-times.
For the fourth meal- time, gruel prepared with rice (Vilepi), well-cooked, warm and devoid of oil / ghee and salt altogether or with oil / ghee and salt in small  quantity is to be given. Warm water is to be taken after the  intake of gruel.

The same type of diet is to be continued for the fifth and sixth meal-times.
For the seventh meal-time again, well-cooked porridge (odana) prepared with the same type of rice of two Prasruta along with a very thin green gram soup (Mudga yusha),  added with oil / ghee and salt in small quantity is to be given.

Warm water should be taken after the intake of the porridge. The same diet is to be repeated for the eight and ninth meal-times. For the tenth meal-time, thin meat-soup  (Mamsarasa) prepared with water and salt should be given. Warm water is to be taken after this.
This is again to be repeated for the eleventh and twelfth meal times. Thereafter, the patient should take food having different tastes  and he should start taking his normal diet from the seventh night.

Another method of Samsarjana

Persons who have had the maximum, medium and minimum purificatory therapies, should consume
Peya- thin Gruel,
Vilepi- thick Gruel,
Akruta Yusa- soup not processed with fat, salt, sours etc.
Krutayusa- Soup processed with fat, salt and Sours and
Rasa- meat juice- in Successive order, for three, two and one Annakala- time of meal respectively.

Note:
Eating periods = Anna Kala.
Each day has two anna kala. – morning and evening.
If the maximum vomiting bouts were observed (Ati Yoga), Then, the patient should take Peya, Vilepi, Akruta Yusha, Kruta Yusha and Mamsarasa – three eating periods (Annakala) each. The patient will not have any food except these. Likewise, for the medium vomiting bouts, the number of eating periods Is two each and for lesser bouts (Heena Yoga), the number of eating periods (Anna kala) is one each.

Benefits of Samsarjana Karma

Just as a spark of fire after being fed by grass, powder of dry cow dung etc, gets augmented gradually and becomes great, steady, and capable of burning everything, similarly, the internal digestion fire, by the Samsarjana regimen, in the patient who has undergone Vamana karma, gains strength.
So, this is how Vamana treatment is administered in patients.

Vamana therapy for a normal person:
It is a must for people with Kapha body type, to undergo Vamana treatment occasionally. Even for other people, Kapha Dosha gets naturally aggravated during spring season. At that time, Vamana is recommended as part of spring cleansing to all.

References:
Charaka Samhita Sutrasthana 15th chapter
Ashtanga Hrudaya Sutrasthana 18th chapter 

Pittanta Vamana

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Therapeutic emesis is a part of Panchakarma purification therapies. It is meant to expel morbid kapha or kapha predominant doshas from the body. But it is said that emesis therapy should be given until the pitta is eliminated in the vomit material. If emesis is the best remedy for kapha and if we are administering it to expel excess kapha in the body or to treat kapha predominant diseases, why should we look for pitta to be expelled?

Pittanta means ending with pitta. Pittanta vamana means emesis administered until pitta is seen in the vomitus. When pitta is seen in the vomited material emesis therapy should be stopped immediately. Therefore the sight of pitta is a sign of completion of emesis therapy successfully. It is also an indication to the physician that no more emesis should be given.

Does absence of Pita (bile) coming out necessarily means improper completion of Vamana?
Not seeing Pitta at the end of Vamana procedure, need not mean the completion of Vamana. Other signs such as number of bouts of vomiting, quantity of vomitus etc. should also be considered.

Regional anatomy of the doshas

Kapha is located in the upper portion of the body, above the navel. Pitta is located below kapha region, around the navel region. Vata is located at the bottom tier, below pitta zone and below the navel. We need to remember that these doshas are located everywhere in the body and the mentioned anatomical regions are their regions of predominance.

Amashaya is said to be the seat of both kapha and pitta. Amashaya means stomach. If we do not take this in literary meaning we can consider kapha to be predominantly present in the stomach and pitta in the lower portion of stomach i.e. the upper part of the intestines.

When emesis is administered the exited kapha predominant doshas are thrown upwards due to the effect of the medicine and is expelled through the mouth. Once the kapha has been totally expelled, the pitta located in the intestine below is pulled upwards due to the suction effect of emetic medicine. When pitta is seen the emesis is said to be completed and kapha is said to be expelled in totality. The physician should observe carefully for the sight of pitta towards the end of emesis.
Read – Vamana Virechana – Emesis and Purgation – Ashtanga Hridayam Sutrasthana 18

How to know that pitta is coming upwards at the end of emesis?

In therapeutic emesis kapha, pitta and vata are eliminated in that order. Only when they are eliminated in this order it will be considered as signs of properly done emesis therapy. Only sight of pitta is desired in emesis but not complete expulsion of pitta. Similarly the appearance of vata at the end of emesis is just explained for purpose of understanding the chronology of expulsion of doshas but is not desired as an event. If pitta is expelled in excess or vata appears at the end of emesis or when emesis is not stopped at the sight of pitta complications of the therapy will arise.

Pitta will be seen as greenish bilious material in the emesis. The patient would experience bitterness, the taste of pitta in his mouth. A sort of burning discomfort may be felt in the chest, throat and mouth due to the pitta moving upwards.

Is expulsion of pitta the ultimate sign of comprehensive emesis?

Emesis is said to be comprehensive and fruitful if pitta is seen at the end of the emesis. Along with this the number of bouts and quantity of emesis should be in accordance to the type of emesis administered i.e. major cleansing, moderate cleansing or minor cleansing. Also signs of proper emesis should be present.
Read – Pitta Increase Symptoms – Pitta Vriddhi Lakshana

Click to Consult Dr Raghuram Y.S. MD (Ayu) – Skype

Vamana Vs Kunjala kriya

Concerning vamana, after proper internal and external oleation, can Kunjal kryia be substituted for herbal emetics to remove the doshas? Is the regular practice of kunjal kriya a way to control kapha and pitta doshas?
Answer by Dr JV Hebbar: 
Context: There is a vomit inducing detoxification procedure in Ayurveda, called Vamana. This is done for Kapha disorders such as obesity, chronic respiratory disorders, etc. 
Procedure is – high dose fat intake for few days (internal oleation) 
Oil massage – for a day 
Sweating treatment 
Then medicine is given to induce vomiting with licorice, sweet flag, Randia spinosa etc.  

There is a Yogic practice called Kunjala Kriya, where salt water is consumed in huge quantities and vomiting is induced. 
The questioner is asking, in the traditional Vamana procedure, can the vomiting medicines be replaced with Kunjala kriya after internal and external oleation therapy? 

Simple answer is no. Here are the following reasons – 
a. If it was allowed, Charaka, Sushruta etc. masters would have mentioned about this, as they were knowing about Ayurvedic procedures. 
b. It is not a good idea to mix Ayurvedic therapies with Yoga ones and vice versa. The purpose of therapy, mechanism of action of medicine used, etc. completely differ in these two great sciences of heatlhcare. 
c. In the Vamana procedure, the vomiting medicines are given specifically to liquefy the toxins from the sites of pathology and to expel them through oral route. Just saline water might not do this laborious work efficiently. 
Read related: Dhauti Karma – Method, Benefits

I am not saying that Kunjala Kriya is inferior. I am just saying that the purpose of these two therapies are different. 
Read related: Hatha Yoga and Shat Karma