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VAMANA KARMA – EMESIS

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VAMANA KARMA – EMESIS

Post by Admin on Mon 25 Oct 2010, 12:04 am

VAMANA – EMESIS
In this procedure, excess and vitiated doshas are removed from the upper part of the body by way of vomiting. It is normally the first main purificatory therapy which follows preparatory procedures. Vomiting is induced with herbal emetic substances for the purpose of eliminating vitiated Kapha and Pitta.

Indications of Medicated Emesis:

It is the supreme method of eradicating aggravated Kapha dosha and to some extent for removal of Pitta. Hence, it is useful for patients having disorders of Kapha and Pitta predominance like asthma, bronchitis, sinusitis, cervical lymph adenitis, indigestion, skin diseases, obesity, stomatitis, laryngitis & Pharyngitis, mental disorders, epilepsy, excessive salivation, loss of taste of the food.


Similarly, medicated emesis is useful in diseases of fatty tissue and muscular tissue also e.g. haemorrhoids, tumors of fat and muscle etc.

It is also useful in diseases like visarpa – erysipelas, eczema and diabetes.


Contra indications of medicated emesis:
Patients who are very weak and old and those who have lost their body strength due to chronic long standing diseases, small children, pregnant women should not be given medicated emesis.

Similarly in diseases where there is bleeding through upper respiratory passage, oesophageal varices, heart disease, spleenomegaly and ascites it is contra indicated.

Method of Administration of Medicated emesis
After completing the preliminary procedures of oleation and fomentation the patient must be given food preparation containing Tila, or other oils to aggravate Kapha or he should be given rice with yoghurt. The patient thus suitably prepared is asked to drink 500 cc. or 4 to 8 cups of warm milk, sugarcane juice or buttermilk. This should be given till the stomach is full. Herb induced emesis should NOT be given in empty stomach. Many herbs having emetic action are mentioned by Charaka and Vagbhata. The best combinations are as follows:

1. Madana Phala (Randia dumetorium) – 3 Parts.
Vacha (Acorus calamus) – 2 Parts
Yashtimadhu (Glycerrhiza glabra) - 1 Part with honey or water.

2. Randia dumetorium – 3 Parts + Liquourice – 2 Parts + Rock salt – 1 Part
mixed with honey or water.

If the patient is Kapha Prakriti or with Kapha Rogam 1 part of Piper longum should be added to the above recipe. If it is Pitta Prakriti or with Pitta Rogam 1 part of Neem or Vasa should be added. If the individual is Vata Prakriti or with Vata Rogam the above recipe should be taken with cow’s milk.

Charaka has stated that patient should be observed for a muhoorta (48 minutes) after the administration of vamana-dravyas. According to him, the onset of perspiration is indicative of the liquification of doshas (malas), lomaharsa or horripilation signifies that the dosha (mala) has been dislodged from the places where it has been embedded, the distension of the stomach is being caused by the dosha which has reached this place. Hrillasa or nausea and asyasravana or salivation are indicative of its upward movement for being expelled.

The patient is then instructed to vomit without straining himself unduly and must be discouraged from inhibiting the urge. In the case of sluggish response, the patient’s tongue should be tickled to encourage the emptying of the stomach. His head should be supported while he is actually vomiting.

Minute observation of patient to judge whether the purification done has shown optimum signs or it is in excess or inadequate should be made.

The physician should watch the pulse and respiration of the patient from time to time. Pulse should always remain below 150 per minute.

Measure the quantity of intake and output. Total output should be always more than the total intake.

Examine the vomited matter in each bout for Kapha, pitta or blood
To know whether proper signs of purification has developed or not, the physician is asked to conduct 4 types of examinations. 1. He should observe the substances coming out in vomitus. 2. He should measure the substance that is vomited out. 3. He should measure the number of vomits and 4. He should also observe the symptoms of optimum purification.

From these signs, one can decide whether the purification done is optimum, medium or minimum.


Symptoms of proper emesis
Usually the vomited matter comes in the following serial first the food, followed by mucous-Kapha, then yellowish or greenish secretions of Pitta and lastly Vata will come out.

The amount vomited is evaluated to know whether the purification done is maximum, medium or minimum. These are judged from the number of vomiting and the total quantity of vomit expelled during the therapy.

Number of vomiting Quantity expelled
4 minimum 325 c.c.
6 moderate 650 c.c.
8 maximum 1,300 c.c.

However the symptoms of proper elimination are more important than the quantity expelled or the number of vomiting. The symptoms of proper elimination are a feeling of lightness in the body, increased digestive power, decrease in the symptoms of the disease for which the emesis was prescribed, and the automatic stopping of vomiting after the expulsion of the doshas.

Symptoms of inadequate emesis
The process does not start or even if it starts in between two bouts there is large gap. Only the material given to start the process comes out. This means that the expected vitiated doshas do not come out. Also symptoms like rashes on the skin, heaviness in the abdomen and heart and lethargy develop.

Treatment
In such condition, try to induce emesis with mechanical aids. The patient is instructed to stimulate the gag reflex by gently tickling the base of the tongue (or back of the throat) with one or two fingers, or give warm decoction of licorice again. If there is no response and the patient becomes restless, put Ryle’s tube into the stomach to take out the ingested material. When the whole material comes out, give Tab. Shankha vati and Tab. Sutashekhar 2 tablets with honey.

Symptoms of excessive emesis:
After proper purification, the vomiting should stop automatically, instead if it continues and sometimes if there is blood in the vomiting, it is excessive emesis and is associated with excessive thirst, giddiness, weakness and burning in the stomach and chest region. Due to dehydration he may faint and there are symptoms of Pitta aggravation.

Treatment
First apply little oil on the body and give cold water bath to the patient. Also give sip by sip fruit juice of apple or grapes in small quantity, but repeatedly. It is also beneficial to give puffed rice water along with rock candy. If there is too much irritation of stomach, give mixture of shatavari, rock candy, oxide of praval with cool water. Use Pitta alleviating minerals and herbs like sandalwood, vetivera or give Suvarna sutshekhara 125 mg. with honey three times a day, or mauktik kamadugha three to four times a day.

After 6 to 8 hours of vomiting, give salt water for last bout of vomiting. In the end, ask the patient to do gargling of salt water followed by ordinary warm water gargling, and then ask him to take complete bed rest.

Post Emesis Regimen
1. Medicated smoking
To remove the mucous in the region of pharynx, ask the patient to smoke medicated cigarette which contains mixture of various herbs like agaru, jyotishmati etc. (This special cigarette does not contain any tobacco). Do not give any food or drinks for next two hours. After that, herbal tea can be given. In the evening the patient should not take any food but should be given hot liquids like soup or herbal tea.



2. Behaviours to be avoided
Overeating, loud speech, excessive sitting or walking, anger, anxiety, excessive use of vehicle, sex, excessive heat or cold, wind, inhibition of natural urges etc.,

3. Dietary regimen (Samsarjana Krama)
Day Time Diet
Day 1 Morning --
Day 1 Evening Peya
Day 2 Morning Vilepy
Day 2 Evening Akrita Yusha
Day 3 Morning Akrita or Krita Yusha
Day 3 Evening Normal Diet
Peya: Cook 1/3rd cup of basmati rice in 4 cups of water for 25 minutes. Strain. The liquid which remains is Peya.

Vilepy: Cook 1/3rd cup of basmati rice in 2 or 3 cups of water for 25 minutes or until rice is soft. The rice plus the water is Vilepy.

Yusha: Cook 1/3rd pre-soaked (2 hours) split moong dal in 2 cups of water until the dal is soft; Eat this semi-solid soup, this is Yusha.

Krita Yusha: Yusha added with salt, black pepper, asafoetida, pippali and other spices.

Akrita Yusha: is without spices
Beginning with the normal diet on 3rd day evening, patients should gradually begin to take foods which are appropriate for their constitution and/or season.

The most important rule to follow is to simply not overeat. Also it is wise not to combine too many different foods at any cost during 1st week. Complications of Herb induced emesis are excessive purification or negligible purification.

Complications of medicated emesis
Various complications can occur due to improper assessment by the physician or if the patient has not followed the instructions given by the physician or the emetic substances are not potent.

These include abdominal distension, blood in the vomiting, dehydration, heaviness in the heart, heaviness in the limbs or the whole body.

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vamana karma -full details

Post by Admin on Sat 06 Nov 2010, 8:17 pm

Vaman Karma

It is expulsion of aggravated doshas from the mouth region or the oral canal is called Vaman karma. It should not be compared with vomiting. Vomiting is the forceful expulsion of content of stomach. Where as Vaman karma is performed after sequence of procedures under the supervision of panchkarma expert and is done according to the patients requirements from treating him from the disease.

Definition. - Vaman or administration of emetics is one of the series of panchkarma procedures. This is a Shodhana karma (cleansing procedure) or purifying operation with regards to kapha dosha. The aim and administration of Vaman karma are different from and more comprehensive than those of administration of emetics in modern sciencesDifference between administration of emetics and Vaman karma

• Benefits of Vaman karma
• Properties of herbs that are used in Vaman karma
• Unfit for Vaman karma
• Uses of Vaman in dieses mentioned by various rishis.
• Avamya roga (contra indication of Vaman karma)
• Necessity of performing purva karma before performing Vaman Procedure
• Selection of emetic
• Herbs used for Vaman karma.
• Herbs mentioned by various rishis for Vaman purpose
• Various kalpnaye (various recipes) for preparation of vamaka dravya.
• Purva karmas of Vaman karma
• Administration of the vamaka dravya
• How does an emetic work


Panchakarma: Difference between administration of emetics and Vaman Karma

Vaman karma is not done merely with the object of relieving stomach with its contents, especially poisonous contents and to clear out passage of children as stated above. Vaman karma in ayurvedic system of medicine is performed when there is presentation of kapha doshas, which has symptoms such as heaviness in body etc. The doshas predominantly affects amashya (compared to stomach), then the Vaman karma is advised after performing the purva karma i.e., Snehan and swedan in a proper procedure mentioned according to ayurvedic text. These injunctions will be set below and if carried out, no untoward symptoms such as depression and gastrointestinal irritation should result. More over, in ayurveda, the herbs used such as madanphala, pipilli, nimb, and kutaja seed, etc. are of vegetable origin and are not minerals such as tartar emetic etc, are therefore not poisonous and depressant and therefore are not involved in degrading and deteriorating bodies’ mechanism. Their selection again depends upon the condition of doshas presented by the patient.


Benefits of Vaman Karma

• Vaman karma is effective in Shodhana of amashya i.e. cleaning stomach
• Vaman karma is highly recommended on countering the kapha dosha which is in aggravated state
• Vaman karma is very effective and acts as a life saver in situations like ajirn (indigestion), vish peet (consumption of poisonous substance), visuchika (cholera) and virudh aahar (food poisoning).
• Vaman not only cleanses the doshas present in stomach but also helps in purification of the whole body as the purvakarmas i.e. Snehan and swedan helps in bringing kleda (aggravated kapha) to the amashya (stomach) which is been removed from the body by practicing Vaman karma


Herbs used for Vaman karma.

The herbs mentioned below are used in performing Vaman karma in general use.
• Madan phala
• Yastimadhu
• bitter gourd
• neem
• kaakanaasa
• indravaruni
• bitter cucumber
• kutaja
• morrvamool
• devadaali
• vidanga
• jalavetasa
• chitraka
• mooshikaparnee
• kosavatee
• karanja
• pipilli
• saindhav lavan
• vacha
• ela
• mustard
• kritavedhana
• kaanchanaara
• ashwagandha
• bandhujeeva
• satapushpa


Unfit for Vaman Karma

Vaman is not permissible in patients who are sufferingfrom aneurism, hernia, prolepses of uterus or rectum, peritonitis or tendency of hemorrhages, because of straining induced by vomiting, which should make us a cautious in giving it to those who have disease ofvessels or high tension in them, for the straining may lead to hemorrhage

Uses of Vaman in diseases mentioned by various rishis.

Serial no. Disease Maharishi charak Maharishi
sushurut Maharishi Vagabhatta

1 Peenus (sinusitis and influenza) + + +
2 Kushth (skin disease) + - +
3 Nav jwar (acute fever) + + +
4 Rajyakshma (tuberculosis) + + +
5 Kaas (cough) + + +
6 Shwas (asthma) + + +
7 Malgrah (constipation) + - -
8 Shlipada (elephantiasis) + + +
9 Galgand (goiter) + + +
10 Prahmeh (urine related diseases) + - +
11 Mandagni (loss of appetite) + + +
12 Virudh aahar (food poisoning) + + +
13 Ajirn (indigestion) + - +
14 Visuchika (cholera) + - +
15 Alsak () + + +
16 Vish peet () + + +
17 Dasht, digdhviddh + - +
18 Adhog rakt pitta (bleeding per rectum) + - +
19 Mutraprasek () + + +
20 Arsh (hemorrhoids) + - -
21 Hallaas + + +
22 Aruchi (tastelessness) + + +
23 Avipaak + - +
24 Apchi + - +
25 Granthi - - +
26 Apasmar (epilepsy) + + +
27 Unnmad (hysteria) + + +
28 Atisaar (diarrhoea) + + +
29 Shauf (oedema) + - -
30 Pandu (anemia) + - -
31 Mukh paak (stomastis) + + -
32 Stanay dushti () + + +
33 Arburd (tumor) - - +
34 Vidarika (skin disease) - + +
35 Medo roga (obesity) - + +
36 Hridya roga (heart disease) - + -
37 Chitt vibrham (depression) - + -
38 Visarp (ery) - + +
39 Vidradhi (abscess) - + -
40 Pootinash - + -
41 Kanth paak (pharyngitis) - + -
42 Karn srav(otoria) - + -
43 Adhijivika (uvilitis) - + -
44 Gal shundika (adenoids) - + -
45 kapha roga + + +


Avamya roga

Serial no.
Disease Maharishi charak Maharishi
sushurut Maharishi Vagabhatta

1 Shat shirn (weakened due disease) + + +
2 Atisthool (obese) + - +
3 Atikrish (weak + + +
4 Baal (child) + + +
5 Vridh (old) + + +
6 Durbal (weak) + + +
7 Shrant + + +
8 Pipasit (thirsty) + + +
9 Shudhit (hungry) + + +
10 Karmhatt + - -
11 Nhar hatt + - -
12 Adharv hatt + - -
13 Upvasit (fasting) + - -
14 Maityhun prast + - -
15 Adhyan prast + - -
16 Vyayam prast + - -
17 Chinta prast (tensed) + - -
18 Ksham + - -
19 Garbhini (pregnant) + + +
20 Sukumar (new born) + - -
21 Sanvritam koshth + + -
22 Krimi koshth - + +
23 Dushchardan + + +
24 Udharv rakt pitta (epistasis) + + +
25 Prasakt chardi + + +
26 Asthapitt + + +
27 Udhrava vata + + +
28 Anuvasit+ + + +
29 Hridya roga (heart disease) + - +
30 Udavaata + +

Selection of emetic

There have been some principles laid down for selection of vamaka dravya (emetic). It is judged according to the prakruti (nature and body constitution of the individual) and the status of all the three doshas of the body. When a person has the predominance of kapha dosha then the herb which is to be selected must be of katu rasa and dominant. It should also be tikshan in guna and ushan in virya (hot potency).When the patient is of pitta dominance then madhur rasa dominant herbs should be preferred in treating the pitta dosha. Sheet virya (cold potent) herb is to be administered in the cases of pitta dominance that will help in subduing the pitta aggravation in the body, especially in amashya (stomach).If there is vata predominance with the association of aggravated kapha then the herbs that are madhur (sweet), amal (sour) and lavan (salty). Herbs which are ushan in virya i.e. hot in potency are to be used to counter the vata dosha.

According to sharanghdhar samhita in kapha dominant disease pipilli (piper longum), madan phala and saindhav lavan are to administered by hot waterIf pitta dosha is of dominance then the cool decoction of patol patra, vasa and neem are to be taken. In vata dominance diseases associated with kapha dosha present in urah pradesh (chest region) or amashya (stomach), madan phala is to be given with cows’ milk. In indigestion, saindhav lavan is to be taken with hot water to produce Vaman.

Various Recipes for Preparation of Vamaka Dravya


churan (powder)
kalk
kashaya (decoction)
sneh
varti
avleh
kshir
dahi (curd)
dadhisaar
ghrit (ghee)
takr
mastu
yvagu
krishra
yuush (soup)
utkarika
shaskuli
apuup
shadav
kambalik
faint
modak (ladoo like sweet)
manth
navneet
matrayen
madira (alcohol)
suramand
aasut
palal
mansras
dhreyeyog
ikshuras (juice of sugarcane)
salil


Administration of the Vamaka Dravya

If the patient is a delicate one or weak or very much afraid of the emetic or a boy or an old man, he should be give yavagu (conjee) or milk or butter milk or curds to the fullest and then the emetic dose is to be given to vomit it out along with the dosha. After taking the dose of the emetic, the patient has to rest for a muhurat. To have his body fomented with heated hands all the while. If sweat appears, it should be known that dosha is being melting and liquefying, if horripilation occurs, it should be known that the dosha has begun to move from its location, if the distension of the abdomen appears, it should be known that the dosha has come to kukshi (koshtha). When nausea (hrillaasa) and the watering of the mouth (aasyasravanam) occur, it should be known that the dosha is coming out. The patient should sit on a cushioned chair about eighteen inches in height, so as to enable him to stoop forward and vomit easily and to rest in the interval. He should be held by the attendants. These parts should be also massaged by them. If the patient does not feel sufficiently nauseous, he should tickle his face with finger or with his fingers or with the stem of errand nalaa (stem of castor plant), or with the stalk of the water lily flower, so that he may easily vomit out the contents.The patient is thus induced to vomit when he gets the nauseous sensation; he should not be made to vomit when he gets the nauseous sensation, he should not be made to vomit sufficient nausea. In this way, he may vomit four to six times or eight times according to his strength. Four vomits are considered to be due to an inferior action of medicine. Six vomits are considered to be due to medium action of the medicine and eight vomits are due to drastic action of the medicine. There are four ways of knowing that the dose of the emetics has produced its results in a satisfactory manner. The four ways of such knowledge are named by the commentators.laingikee: the patient should experience a feeling of relief as he vomits out the dosha, and he feels lightness of heart region, sides, heads, senses and upper koshta and a feeling of relief their in . This sort of feeling demotes the laingikee way of knowing that the emetic has acted in the desirable manner.

Maanikee: the total volume of the vomited matter is measured and one prastha (2 seers= about 48 fluid ozs.) of the matter is considered as madhayama (medium) suddhi (purification) and four prastha are considered as uttam (best) suddhi (purification). This consideration of suddhi is according to manna or measurement and hence it is called maanikee

Vaigikee: the number of vegaas or urges to vomit is another consideration. It is noted already that four vegaas or urges or vomits are considered as madhayama suddhi and eight vegaas are considered uttam suddhi (pradhaana suddhi). As the consideration of suddhi rests on the number of vegaas of the patient, it is called vaigikee.

Aantikee: the patient who has taken an emetic should first vomit the medicine and gradually kapha in the succeeding vomits and pitta in the last vomit. Thus pitta is the last to be vomited and hence it is said “pittaanam isstam vamanam” i.e. pitta should be the last to be vomited. The appearance of pitta (bile) in the concluding vomit is desired and this kind of suddhi is called aantikee (pertaining to conclusion). Or Vayu is also, however, said to be the last or concluding dosha.

But the discharge of the Vayu is only inferred by the empty urges (to vomit) in the end and it is not attended with any matter. If there is matter, however little, it should be pitta. Hence pitta is practically the last dosha to appear concretely. This consideration of suddhi
is called aantikee. The commentators (Chakarpani and Dalhan etc) say that there may be fallacies in concluding that the doshas have been expelled by any one or two of these consideration and hence all these points should be considered in deciding weather the patient had a thorough suddhi or not.

Panchakarma: Herbs Used in Vaman Karma

Ushan (heat): due to this ushan gunn (hot property) vamaka dravya (emetic herbs) makes doshas vishyand i.e. it melts the doshas and then makes it to reach amashya (stomach) and mahastrota (gastro intestinal tract)thus doshas enters in kushth, which are easier to eliminate from the body.

Tikshan (sharpness): it is an agneye (fire) in dominance thus helps in melting the doshas which get stick to the body parts due to this property it easily penetrate

Suksham (fineness): due to Aakash mahabhoot, vyavyahi and tejas gunna it gets the property of penetrating power which helps it to penetrating into the small strotas (channels)

Vyavyahi: it is property in which the herb enters body and digested in the whole body. It has dominance of Aakash and Vayu mahabhoot.

Vikashi; herb that gets spreads in whole body and then decreases oja ands creates shathiliye in dhatus and sandhis. It has been predominantly Vayu mahabhoot rich.

Udhrapravati: in literal meaning it means the tendency to move upwards. These vamaka herbs help in upward movements the doshas thus helping in emesis.

Procedure


In the morning, the panchkarma is to be performed; proper dose of the vamaka dravya (emetic) is to be administered to the patient. The decoction of madanphala is advocated as the best. Honey, decoction of Yastimadhu, saindhav lavan (rock salt) and some quantity of phaanita (syrup of jaggery) are added to the medicine prepared. Not only madan phala but the herbs mentioned in the kalp sthana (chapter based on the vamaka dravya and virechak dravya) i.e. jeemutak, ishwaaku, dhaamaargrava, vatsaka, kritavedhana, etc are advocated in charak samhita. According to Maharishi Charak there are 355 recipes of vamaka dravya preparation. According to him these herbs can be administered in the form of powders, confections, lehyams (jam form), inhalations, etc. however he consider madan phalka the best out of all the emetics mentioned. The various recipes mentioned in kalp sthana of Charak samhita are composed according to different constitutions, temperatures, diseases, tastes, habits etc.

Purva karmas of Vaman karma


Following points have to be kept in mind before the Vaman karma is to be administered
Atmanirikshan (self analysis) First of all the physician performing panchkarma procedure has to have that confident that, he is capable in performing the procedure efficiently and with ease. He should be having expertise in handling all the complications or situations that might arise during the procedure.

Atur pariksha (patients condition)


It is very important to examine the patient thoroughly and then the procedure should be preceded. Check the strength of the patient, his physical fitness, environmental conditions, his condition of doshas. His diet, things that would be suitable to him while
performing the procedure and most importantly his age.

Vaman samagri (things required in performing Vaman karma)


It is necessary to have the proper availability of substances needed in performing the Vaman karma like a well shielded room in which patient do not gets exposed to the out side environment. Room should be cozy and should able to capacitate small family. It should be well supplied with water. it should have a proper kitchen, washroom and bathroom. The utensils which are to be used or are used in performing Vaman karma are to be well equipped in that place.

Paricharak (assistance)


A trained assistant must be present who will help in performing the procedure and also to nurse the patient. He should help patient in performing his day to day activity like bathing etc. He should be expert in helping the physician in carrying out the procedure and should follow instruction given by the doctor carefully. And most importantly should be very enthusiastic in performing his duties. He should also have feeling of kindness towards the patients.

Aushadh (herb that is vamaka in nature)


The herb which has been decided after the proper examination of the patient should be in adequate amount and its availability should always be there. In case of any emergency antidotes should be available. Certain drugs and herbs should be available to counter any kind of situations and complications

Rogi ka utklesh (preparing patient for the operation)


After performing the Snehan and swedan of the body patient should be advice a diet which is rich in food of kapha origin especially a night before the procedure has top be performed. For example milk, curd, till and meat of fish and animals who live in water etc. It helps in increasing the kapha content in the body therefore which is essential for expulsion of kapha dosha the next day when the procedure has to be performed the next day.

Snehan swedan (lubrication and sweating)


According to the category of the disease patient should be lubricated with the oils internally and externally. When the symptom of proper swedan appears then the swedan should be stopped. After the appearance of these symptoms swedan should be performed. Swedan should be of stream which is helpful in whole body sweating.

Vamankalika achar (phsycological therapy)


Patient should be given proper sympathy and should be taken in confidence, that the physian is expert in performing the Vaman procedure and has all the qualification and confidence in treating the patient and curing him off, of his ailments. Patient should also be informed about the steps involved in the procedure and all the steps to be followed while performing the procedure. Patient should be given full guaranteed that he will not face any trouble and he would definitely will get well from the suffering he is suffering from. Accompanied of the patient should also be given assurance that the procedure is for benefit of the patient and it would help him getting free from his troubles. They should also be informed that procedure is safe and has very little chances of that the procedure has complications.

Necessity of performing Purva Karma before performing Vaman


Purva karma is very essential before performing the Vaman karma. Other wise many complications can arise. Snehan (lubrication) and swedan (sweating) are very important procedures are very critical before the Vaman karma is initiated. Snehan (lubrication) checks the Vayu, softens the tissues (deham) and separates the debris (mala) from the healthy tissue. Sweating, if it is conducted after proper lubrication, liquefies the debris which is entangled in the tiny channels. In order to enhance the effect of Snehan and swedan, kapha or moisture should be increased by the previous administration of milk or other kapha increasing foods.

In a chronic disease, such as prameha (urine disorder), kushth (skin disease), apasmaara (epilepsy), etc which is caused principally by kapha dosha or by any other dosha located in amashya (stomach) along with kapha, the preliminary process of Snehan karma and swedan karma has to be sufficiently executed before Vaman karma is administered, carefully regulating the diet and other habits all the while. Such processes were described by charaka and sushurut in the following manner. The patient is to undergo snehakarma along with proper diet. Usually three to six days relapse in such a course. Swedan karma suited to constitution and the dosha vitiation of the patient in the next administered. If the patient is in the habit of taking snigdh foods, he may have swedan karma administers on the next day following Snehan karma. He has to take abhishyandi or kapha producing food such as anoop maasam or milk or black gram etc, on the night of the next day. This act of eating such food increases kapha and this increased kapha makes the old stationary kapha somewhat mobile. If the static dosha is thus made mobile; it may easily be removed by administration of proper emetic.

How does an Emetic Work


According Maharishi Charak the emetic substance which is empowered with be ushan, tikshan, suksham, vyavyahi and vikashi qualities, reaches the hridya by its own penetrating power (swa veeryena) and from there, it gets into the dhamanees (channels) and entering the big and minute strotas (sthoola anu srotrebhyah) throughout the body (kevelam sareeragatam), liquefies the doshas lodge there, by its agneye (biochemical) quantities and breaks (vicchindati) the dosha by its tikshan qualities. The dosha thus liberated, enters the circulation broken and when the patient’s body had been sufficiently lubricated by the previous Snehan, the dosha cannot stick up anywhere, just as honey cannot stick up in a vessel, which is anointed with oil and therefore the dosha naturally comes to the koshth. From the alimentary canal the dosha is finally vomited out by the action of udan Vayu. The emetic which starts its action in the alimentary canal enters the circulation and brings the dosha along with it, into the alimentary canal for elimination from there.

Excessive use of the emetics


If the dose of the emetic is excessive, there would be atiyoga, i.e. excessive action of the emetic which is not desirable. Such a dose produces excessive evacuation of pitta, unconsciousness and pain in the heart region and throat. Moreover thirst, coma, , vitiation of Vayu, sleepiness, excessive weakness also may be caused. Streaks of blood, foam etc, and may be seen in the vomited matter. There may be tympanitis, hemorrhages etc as a result of an excessive dose of an emetic herb.

Ayoga- insufficient dose of emetics


There, in the Ayoga or improper evacuation of the dosha the emetic , the symptoms caused by such an improper dose are dribbling of saliva, sensation as if there is no purification in the heart region and itching, skin eruption (kotha and sphotaka) and heaviness of the body.

Dhumapanam after emetics


The patients who has had a desirable evacuation (samyoga) of the dosha by the emetic (Vaman karma) should have a Dhumapanam (medicated smoking). There are three kinds of medicated smokes, Snehan, virechan, and samana. The proper one should be selected. If there is still some little dosha, a little virechan or samana Dhumapanam should be given: if there is excessive evacuation and consequently a little increase of vata is suspected, a Snehan Dhumapanam is given.

Diet to administered after Vaman karma


The patient should not take food immediately; he should at least fast until afternoon. When according to his jatharagni, he should be allowed to take a light meal with kulutha yoosha or mugadha yoosha or aadhaka yoosha or jaangalamaamsarasa, having taken a refreshing hot water bath.

Maharishi charak says that the patient should fast for that day or may take a thin manda and yavagu of old red saali rice on that day in the evening if he is so allowed by the physician after judging his digestive capacity. He should repeat the same at the time of the two meals on the next day also; on the third day, he should take the vilepi or thick kanjee of the same rice preferably without salt or with very little salt (if it is so desired by the (patient). The same is too repeated on the third day evening and fourth day forenoon (only two meals are to allowed). On the evening of the fourth day, he may take same old rice well boiled with the mudga yoosha. The same is to be repeated on the fifth day both forenoon and evening. On the sixth day, in the morning, he may take the same food with jaangalamaamsarasa added to it (according top satmyam of the body) the same food is to be repeated in the evening and on the seventh day both in the morning and evening. On the eight day onwards, the patient may gradually indulge in his usual food but with good care. The principal to be noted here is that the consideration of jatharagni (digestive fire)is most important. The Shodhana karma (Vaman) makes the jatharagni weak by its nature and any food hastily given after such Shodhana Kama only weakens the jatharagni further which means further vitiation of the tridoshas eventfully. Hence, if his jatharagni is alright the patient may be allowed to take light meals: otherwise manda, peya etc should be given prior to the administration of the usual food for some days till his jatharagni becomes proper. In this connection, Maharishi Charak has mentioned that just as the fire in the outside world is kindled by the bits of dry straw, hay, dry cow dung cakes, small dry twigs, etc. and gradually develops into a large fire, when it will be able to consume powerful by graded and planned diet, hence it should be kindled by peya etc, and made firm before normal indulgence in ordinary foods. It is very important to mention here that during the whole course of treatment of Vaman karma, a person should follow all the rules and regulation of brahmacharya (non indulgence in sexual affair) as mentioned by Maharishi sushurut.

Things to be avoided


In chronic diseases where systematic Vaman karma is done after sneak and swedan, the patient, in addition to the regulation of diet mentioned already, should rest in the room free from draughts and should not indulge in overwork, fasting, excessive walking, walking in night, sexual intercourse, sleep, heavy and in compatible food etc.

Vaman in rasayan treatment


Person who desires to take rasayan treatment (though they do not suffer from any disease) should first undergo panchkarma, Vaman being the first karma in the sequence of five methods of treatment. Patient should carefully and patiently undergo all the procedures for the duration each and every process requites.

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