VAMANA KARMA – EMESIS

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 1/3^rd cup of basmati rice in 4 cups of water for 25 minutes. Strain. The liquid which remains is Peya.

Vilepy: Cook 1/3^rd 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 1/3^rd 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 3^rd 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 1^st 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.