Vamana ppt dr .p.murali krishna

Vamana karma-
concepts, application and
current research
Dr . P. Murali Krishna,
B.A.M.S (Gold medalist), M.D., Ph.D.
Reader (PG), Dept of Pancha karma
S.V. Ayurvedic college & Hospital,
Tirupati(AP). Email: mkparasar@yahoo.co.in

Importance of Sodhana
30-May-13Dr.P.Murali krishna, Tirupati.2
-Ca.Su.16:20

Pancha karmas(Bio-purification)
1. Vamana (therapeutic emesis)
2. Virecana (therapeutic purgation)
3. Asthapana vasti (enema with primarily
medicated decoctions)
4. Anuvasana vasti (enema with medicated oils)
5. Sirovirecana (nasal instillations)

Importance of sodhana
Ca.Su.16:16-19

Purification of Body
1. Trans membrane
2. Trans dermal

Trans membrane
Sodhana

Trans Dermal Purification
 Bahya sneha
 Sweda
 Special treatments of Kerala

Introduction
Panchakarma- Five therapies, sodhana in nature
Vamana & Virecana- Constitute first two
karmas: Urdhva & Adho sodhana respectively

Vaman-Nirukthi
 Vam- Udgare, Yak-set
 Conveying the meaning,
 Marddane
 Charddane
 Nissarane
 Sarvanga abhishyanda

Definition
Sa.Pu.Kh 4/
Ch. Ka.1/

Contd………
Vamana- expulsion of doshas from the upper route
Virecana- expulsion of the doshas from the lower
route
As they expel malas from the body,
both are called Virecana

Vamana
First Panchakarma Procedure Advised
in Human being
Su.Sa.10 & Ca.Sa.8

Samyak Prayoga is the secret of
success
1. Selection of the patient
2. Examination of the patient
3. Collection of material required
3. Selection of drugs
4. Selection of Mathra(Dose)
5. Vamana vidhi (procedure)
Poorva karma (Praparatory)
Pradhana Karma(prime treatment)
Paschat karma (post treatment
measures)
6. Observation of the patient
Ch. Su-
15:4

Yogya & Ayogya vicaran
1. Vaman yogya (Inclusion criteria) patient should
be selected.
2. Vamana Ayogya (Exclusion Criteria) Patient
Should be Excluded

Vamana - Indications
 Kapha
 Pitta samsrishta kapha
 Pitta or vata situated in Kaphasthana
 Commonly conducted in Kushta, Swasa,
Unmada etc.

Vamana indications
A.Hr.Su.18/1-3

Contd…
 In Vasanta ritu
 As a purvakarma of Rasayana
 Irrespective of the rogibala in Visa, Gara, Ajirna,
Viruddhahara sevana

Common Indications
(A.H.Su. 18)
 Navajwara(Acute fever)
 Atisara(Diarrhoea)
 Adhogata
raktapitta(Anal
Urethro,vaginal
haemorrhages)
 Rajayakshma
 Kushta(skin diseases)
 Prameha
 Apachi
 Granthi
 Sleepada(filariasis)
 Unmada(insanity)
 Kasa(cough)
 Swasa(Asthma)
 Hrillasa(nausea)
 Visarpa
 Sthanya dosa(lactation
disorders)
 Urdhwajatrugata
rogas(diseases of head
& neck)

Indications of vamana karma
 Respiratory
 Digestive
 Skin
 miscellaneus

Respiratory
 Pinasa (Rhinitis)
 Rajayakshma (? Pul.koch’s)
 Kasa (Bronchitis)
 Swasa ( Bronchial Asthma)
 Puti nasa (Chronic sinusitis)
 Kantha paka (URTI)

DIGESTIVE
 Mandagni (dyspepsia)
 Vidagdajeerna (APD)
 Visucika
 Alasaka (gastro enteritis)
 Adhoga raktapitta (bleeding diathesis from lower
orifices)
 Aruci (anorexea)
 Atisara (diarrhoea)
 Hrillasa ( nausea)
 Mukha praseka ( water brash)
 Kaphaja arsas ( piles)

Skin diseases
 Kitibha (psoriasis)
 Ekakushta
 Vicaricika ( Ch.Dermatitis)
 Kandu (pruritus)
 Vidradhi (abscess)
 Apachi (Cold abscess)

miscellaneus
 Nava jwara (acute fever)
 Gala graha (pharyngitis)
 Sleepada (filarial lymphedema)
 Galaganda(Goitre)
 Unmada ( psychosis)
 Apasmara ( Seizure disorders)
 Chitta vibhrama (delusions)
 Granthi ( cystic lesions)
 Arbuda ( Neoplasms)

Vamana-Contraindications
 By nature:
pregnant, sukumara, rooksha, kshudhita, shokart
a, krisha, bala, vriddha, durbala
 Diseased conditions like:
Vataprakopa- Udavarta, Gulma, Vatavyadhi
Marmaja vyadhi- Hridroga, Mutragata, Timira
Maharoga- Arsas, Udara

EXCLUDING CONDITIONS
 Cardiac problems like CAD, CHF & congenital
heart diseases
 Ascitis & Cirrhosis of liver
 Pleurisy
 Spleenomegaly
 Chronic diabetic with complications
 Hypertension
 very weak patients
 Cancer

Contra indications of Vaman
A.Hr.Su.18:3-5

Vaman Ayogya
Ca.Si.8:
8

Contra indications of vamana
 Children & Old aged
 Pregnant women
 Emaciated
 Durbala (weak)
 Asthapita/ Anuvasita
(after vasti)
 Pipasita/kshudita/upa
vasita
 Bhara hata
 Vyayama prasakta
 chinta prasakta
 Parsva soola
 Krimi koshta
 Udavarta
 Asthila
 Pleeha dosa
 Mutraghat
 Gulma
 Udara
 Vata vyadhi
 Bhrama
 Karnasula
 Akshisula
 Bhrama
 Vata rogi

Discriminatory use
Ca.Si.2:2
7

Views of classics on use of Vaman in
Hridroga
 Caraka contra indicated vaman but left to
the discretion of physician(Ca.Si.2:24-27)
 Susruta & Vagbhata advocates vaman
karma in all three hridrogas

Classification
 Sadyovamana.
 Snehapurvaka vamana
Mridu vamana
Madhyama vamana
Tiksna vamana

Examination of the patient
 Patient should be examined completely.
(Vital datas like BP. Pulse, Temp. etc)
 Investigations.
a) Blood sugar, b) Lipid profile
c) SGPT, SGOT d) Blood urea &
creatinine
d) CT, BT f) Haemogram
g) Urine exam h) Stool exam
i) ECG j) X-Ray chest.

Materials required:-
 Large Basin ------------------------- 1
 Medium sized vessel ------------- 2
 Steel tumblers (capacity-250ml) 2
 Table spoon ----------------------- 2
 Khalwa yanthra --------------------- 1
 Stool ---------------------------------- 1
 Chair with arm rest ----------------- 1
 Cotton cloth--------------------------- 2
 Hot water bath vessel ---------------1
 Stove------------------------------------ 1

Selection of drugs

Vamana dravya
They can be classified as vamaka and vamanopaga
Vamanopaga
 Madhuka
 Ikshurasa
 Kovidara
 Sadapushpi
 Pratyak pushpi
 Madhu
 Ksheera
 Lavana

 Vamanopagas like Madhu & Saindhava are
used in all yogas- Kaphavilayana & Chedana
 According to dosa
Kapha- Katu, Tiksna, Usna
Pittayukta- Madhura
Vatayukta- Amla, Sasneha

Quality of Vamana Dravyas
Su.Ci.33:
7
Asatmya (unsuitable)
Beebhatsa (aversive)
Durgandha (unpleasant
smell) smelling)
Durdarsana (Ugly looking)

Qualities of Vamana dravya
 Usna
 Tiksna
 Suksma
 Vyavayi
 Vikasi
 Sthula, Anu, sroto gatatwa
 Vishyandana, Vicchindana
Ca.Ka.1 : 5

Contd…
In Caraka Samhita, 355 vamaka yogas and 6
vamaka dravyas are explained -
 Madanaphala- All rogas
 Jimutaka- Jwara, Swasa
 Ikshvaku- Kasa, Visha, Jwara
 Dhamargava- Kapha, Amasayagata Vata
 Kutaja- Sukumara, Hridroga, Visarpa
 Kritavedana- Kusta, Pandu, Pliha

Processing of Madanaphala
Fruits of Randia dumetorum

Madana phala(Randia dumetorum
•Administered in antarnakha musti
pramana
•It contains oleanolic acid3-/3-
glucoside
•It acts on GIT and CTZ
•It is the drug of choice for
asthapana vasti also

Ca.Ka.1:13

Vamana - Matranirnaya
 Varies according to vyadhibala, agnibala, kosta and
rogibala (Susruta)
 Madana pippali- Antarnakha Mushti or suitably
(Caraka)

Dose of vamana dravya
Uttama Madhyama & Kaneeyasi Matra for
Kwata-9, 6 & 3prastha
Churna, Kalka-3,2 & 1 pala
Sa . U. 3 : 14

Vamana kala
 In Sadharana kala, preferably Vasanta
 In other seasons with artificially altering the
atmosphere, if necessary
[Atyayike punah karmani kamamritum vikalpya
kritrimagunopadhanena…]
(Caraka)
 In an auspicious day and time
 In the morning, after proper digestion of previous
day’s food

Procedure of Vamana Karma
1. Purva karma
2. Pradhana karma
3. Pascat karma

Vamana - purvakarma
 Snehan- done for 3-7 days till samyak
snigdata is attained
 Swedan- in 2 days gap following snehan
(Vagbhata)
1 day gap after snehapana (others)
 Kaphotklesa kara ahara-
Dadhi, Matsya, Masa - on the previous
day of vamana

A.H.Su.16:36-37

Vamana- pradhanakarma
 Akantapana- Usually milk, sugarcane juice
etc. are given. But, can be done without it after
intake of yavagu added with ghrita
 Suitable yoga- usually a combination of
vamaka and vamanopaga dravyas is taken
Madanaphala - 3-12 g
Vaca - 5-8 g
Yashtimadhu - 7.5 g
Saindhava - 15 g
Madhu - Q.S.

Contd…
 After bath, patient sits on a comfortable
chair of knee-height
 Suitable dravadrayas are given for
akantapana
 Vamanousadhi is given after prayer
 Wait till 1 muhurta, expecting vegas

A. H. Su.18

Contd…..
A.H.Su.18:12-15

Arundatta Kosta classification
 Arundatta - three special type of Kostha in
relation of Vamana.
 Dominance of Kapha -Mrudu Kostha for Vamana.
 Madhya Kapha - Madhya Kostha
 Slight Kapha in Kostha - Krura Kostha for Vamana.

Contd…
 Observe:
Swedapradurbhava- liquefaction of dosas
Romaharsa- dislodging from their seat
Adhmana- reaching kuksi
Hridayopamarda, hrillasa, asyasamsravana -
upward movement

Ca.Su.15:11

Contd…
 Gently press flanks and abdomen
 Support patient’s forehead while vomiting
 Gently massage over his back in pratiloma
gati (upward direction)
 If vegas do not occur spontaneously, ask the
patient to stimulate vomiting with
fingers, Erandanala etc.

A.H.Su.18:19-20

Vamana

vamana

Causes of Ayoga and Atiyoga
 Improper snehana i.e. internal oelation as
well as external application of snehana.
 Improper swedana.
 Insufficient kaphotklesana
 Selection of improper drug and dose , old
and less potency drug .
 Krura or Mridu Kostha.
 Tikshna or Mandagni.
 Strong body or weak body.
 Predominance of Ama.

Vamana - ayoga laksana

Contd....
 Apravritti
 Adhopravritti
 Only medicine comes out
 Vega vibandha
 Arocaka, Adhmana, Kandu, Kota, Praseka, Sopha, Se
etajwara etc.

Management of Hinayoga
Heenavega- Pippali, Amalaki, Sarsapa,
Lavanayukta Usnodaka given repeatedly

Vamana - samyak yoga

Contd….
 Kale vegapravritti
 Evacuation of Sveda, Praseka, Oushadha, Kapha,
Pitta, Vata in order
 Not much discomfort
 Stops automatically
 Swasthata, Manah prasada, Swarasuddhi, Laghuta

Types of Suddhi
Assessment- 4 types
Vaigiki- 4,6,8
Antiki- pittanta
Maniki- 1, 1 &1/2, 2 prastha
Laingiki- sarva, madhya, alpa laksana

Laingiki Suddhi
Elimination of Kapha, Pitta & Vata
respectively
Hridaya Shuddhi
Parsva Shuddhi
Murdha Shuddhi
Srotas Shuddhi

Contd..
 Laghuta
 Daurbalya
 Kantha Shuddhi
 Kapha Samsrava
 Yatha kala Ksudha & Pipasa
 Roga Samana

Ca.Si.1:16
Ca.Si.1:17

Vamana - atiyoga lakshana
A.H.Su.18:26
Ca.Si.1:17

Atiyoga lakshana
 Phenila raktachandrikodgamana
 Swarakshaya, Daha, Kantasosha, Bhrama, Murcha, Si
rahsula, Balahani, Agnihani
 Jeevashonita pravritti and marana may occur

Vamana-pascat karma
30-May-13Dr.P.Murali krishna, Tirupati. 79
A.H.Su.18:27-28
Ca.Su.15:14

Pascat karma
 After samyak yoga, clean the limbs and face
 Rest for 1 muhurta kala
 Suitable dhumapana
 Tambula sevana
 Nivatagrihe sayana
 Snehokta acharavidhi
 Samsarjana krama (Ashtanga Sangraha)

Samsarjana krama

samsarjana
 Means leaving or abandoning the diet restriction
 2 types of samsarjana kramas- Peyadi krama &
Tarpanadi krama
 Stabilizes agni that is diminished due to dosa
sodhana, gradually

Ca.Su.15:16

Peyadi krama
Following things are given for 3,2,1 annakalas in
pravara, madhyama, avara sodhana respectively:
Peya
Vilepi
Akrita yusa
Krita yusa
Akrita mamsarasa
Krita mamsarasa

Samsarjana kram
diet Pravara madhyama avara
peya 3 2 1
vilepi 3 2 1
Akrita yusha 1 1 1
Krita yusha 2 1
Akrita mamsa rasa 1 1 1
4
Krita mansa ras 1
12
1
8

Samsarjana krama
•Peya:-easily digestible carbohydrate in liquid form
•Vilepi:- easily digestible carbohydrate in semisolid
form
•Akritha Yusha:- easily digestible plant protein in
semisolid form
•Kritha yusha :- easily digestible plant protein with
saturated fat in semisolid form
•Akritha mamsa rasa:- animal protein
•Kritha mamsa rasa:- animal protein with saturated
fatty acids

Effects of Samsarjana krama
•Restores the physiology of digestion
•Restores mucosal barrier
•Habituates the three important nutrients
viz.carbohydrates, proteins and fats in an
order

Tarpanadi krama
A. H.18

Tarpana indications
 Indicated in alpa sodhana of pitta & kapha,
madyapa and in vatapitta pradhanya
 Peya- svaccha tarpana
Vilepi- ghana tarpana (Chakrapani)
1. annakala: lajasaktu
2. annakala: jeerna salyodana
3. annakala: mamsarasa (Arunadatta)

Things to do After the samyak
Vamana
Ca.Su.15:15

Observation of the patient

Vaman vyapath
Ca.Si.6:29-30

Vyapath –Susruta quotes
Su.Ci.34:3

Vyapath
 Adhmana(Bloating)
 Kanta karsanam
 Srava
 Hrithgraha
 Gatragraha
 Jeevadana
 Vibhramsam
 Sthambha
 Upadrava
 Klama

Common vyapaths & Management
 Bloody streaks along with bouts – Lajatarpana
with sita
 Feeble pulse, giddiness, collapse-
Sidhamakaradhwajam with honey and betel juice
 Exhaustion- Laja, ksheera, Manda, tender
coconut water.

Vamana kalpa in different disease
 Jwara-
Thathrotklishte samuthklishte kaphapraye
chale male
Sahrillasa praseka annadwesha kasa
vishucike
Sadyo bhuktasya sanjathe jware same
viseshatha
Vamanam vamanarhasya

Contd…….
 Uthklishta doshas are present in amasaya
 Sneha-sweda not required or done in little
intensity
 Yoga- Pippali, kalinga, Madhuka, Saindhava &
Madhu

Contd…….
 Swasa-
Snehasweda done until swasavega subsides
 Uthkleshahara- Dadhi etc which provokes
nocturnal attacks are avoided
 Yoga- Pippali, Saindhava & Kshoudram- vata
avirodhi

Kushtam
 Done in uthklishta doshavastha and in
urdhwadehasrita kushta
 Yoga- Kutaja, Madana, Yashti
Patola, nimba kasaya

Vaman in Ayurveda
Usna, Tiksna, Suksma, Vyavayi, Vikasi
oushadhi reach Hridaya by their veerya
moves through dhamanis into sarvashareera
Oushnya- vishyandana of doshasanghata
Taikshnya- vicchindana of doshasanghata
Reach amashaya & propelled out by Udana vayu
due to Agni, Vayubhoota & oordhvabhaga
prabhava

Ca.Ka. 1:5

Physiology of vomiting
Vomiting is produced by a series of co-ordinate
changes in GI activity and respiratory movements.
Salivation-sharp and deep inspiration-increase
in intra-abdominal pressure-contraction of
abdominal muscles-closure of epiglottis and
soft palate-forcible contraction of stomach
pylorus-relaxation of fundus,cardiac
sphincter and esophagus.

VOMITING
PATHWAYS
Ipecac syrup 30-May-13Dr.P.Murali krishna, Tirupati.104

The Physiology of Vomiting
 The Chemoreceptor Trigger Zone (CTZ) and Vomiting Center
(VC) are regions within the brain
 When stimulated these regions initiate the vomiting reflex
 Different causes of nausea and vomiting stimulate these
regions in different ways

Causes of Nausea and Vomiting: Motion
Sickness
The visual and vestibular systems send mixed messages to
the VC, inducing the vomiting reflex
VC
Vomiting Reflex
visual
input
vestibular
input
(balance)

Mechanisms of Chemotherapy-induced
nausea and vomiting (CINV)
 Central mechanism
 Chemotherapeutic agent activates the
chemoreceptor trigger zone (CTZ)
 Activated CTZ invokes release of various
neurotransmitters, which stimulate vomiting center
 Peripheral mechanism
 Chemotherapeutic agent causes irritation and
damage to gastrointestinal (GI) mucosa, resulting in
the release of neurotransmitters
 Activated receptors send signals to vomiting center
via vagal afferents
Berger AM et al. In: Cancer: Principles and Practice of Oncology. 6th ed.
Lippincott Williams & Wilkins; 2001:2869–2880.

Vamana karma
 Drugs act on
* vomiting centre of medulla
* CTZ ( Chemo-receptor Trigger Zone)
* gastric mucosa
* gag reflex

Vomiting center
 It is located in the dorso-lateral border of the reticular
formation of the medulla.
 It consists of
1. N .tractus solitarius
2. Parvicellular reticular formation
3. Visceral & motor nuclei

Vomiting center
Excitatory inputs from
1. Nerve endings of vagal sensory fibers in
the GI tract
2.Labyrinths via vestibular nuclei
3.Higher centers in the cortex
4.CTZ
5.Intra cranial pressure receptors

Chemo-receptor Trigger Zone
1. It is located in the area postrema on the iv
ventricle
2. Blood brain barrier is poorly developed in CTZ
hence it is readily accessible to emetic
substances in the general circulation

Drugs acting on GIT
Activate entero chromaffin cells in the mucosa of
the GIT causing the cells to secrete serotonin
which acts on the 5 HT3 receptors at the nerve
endings of the vagal sensory fibers.
The afferent fibers transmit the excitation to the N.
Tractus solitarius , which in turn activates the
vomiting center

Vamana karma - research
 Vomitus contains abundant muco poly
saccharides
 Small quantities of sterco bilinogen
 Histamine also seen

mucins
Mucins are very high molecular weight glyco
proteins secreted by mucosae or some exo crine
glands in to the lumen of the respiratory
tract, gastro intestinal & reproductive tracts.
Intestinal mucins are produced by Goblet cells &
entero cytes

VAMANA
MECHANISM OF ACTION
Vamana karma occurs at three different levels
in this mechanism.
A- Activation of emesis.
B- Stimulation of vomiting centre.
C- Actual motor response through motor
nerves.

Activation of emesis.
 Vomiting starts in the stomach or upper GIT when it is full
of contents (Akanthapana during Vamana. It becomes over
distended and over excitable)
 Reflex from gastric mucosa. This excited stage stimulates
both Sympathetics & Vagal afferents

Stimulation of vomiting centre
 Central emesis- By stimulating the vomiting centre
situated in Medulla
 Reflex emesis- irritation of the gastric mucosa
stimulates the Vomiting centre through Vagus and
sympathetic pathways
Probably both actions can be seen with the
vamanoushadhi

Contd…
 Vomiting is coordinated by the brain stem –
effected by neuromuscular responses in the
gut, pharynx and thoraco abdominal wall
 Somatic and visceral muscles – stereotypic
responses
 Inspiratory thoracic and abdominal wall
muscles contract – raised intra thoracic &
intra abdominal pressure
 Larynx moves up, reduced gastric tone and
peristalsis along with increased tone of
duodenum – conditions that inhibit gastric
emptying, promote vomiting

 Administration of certain drugs (which have
vamaka prabhava) may stimulate chemoreceptor
trigger zone - bilateral vomiting centre in the
medulla.
 Emesis is provoked by several psychic stimuli or
by noxious thoughts

Actual motor response through motor
nerves
 Vagal and sympathetic afferents –bilateral
vomiting centre (tractus solitarius near vagus
nucleus)
 Automatic motor impulses – Transmitted by
5,7,9,10,12th cranial nerves to upper GIT and
through spinal nerves to diaphragm and
abdominal muscles

SEQUENTIAL ANALYSIS
 OUSHADA
 VEERYA ( SENSORY STIMULI- neuron or vascular
path)
 HRIDAYA ( SHIRAS - ? VOMITING CENTER)
 SAREERA DOSA VISYANDANA
,SVEDA,LOMAHARSA,KUKSHISAMADMAPANA
(PARASYMPATHETIC ACTION)
 HRILLASA, ASYA SRAVANA ( NAUSEA)
 UDANA ACTION
 VAMANA ( VOMITING )

Pharmaco dynamics of
Vaman
Liquifidies the
doshas or
toxins
Doshas or toxins detached
from dhatus
(Chedan Bhedan
Doshas or toxic
microfined (Anupravana
bhavat)
Asajjannamiti –
Nakwachidapi
Sanghagachhati
Agni,Vayu
Roma
harshaAdhmana
Hrillasa
A o rti c a rte ry
P u lm o n ary ve in s
L eft atriu m
L eft co ro n a ry arte ry
A n te rio r
in te rve n tri cu la r a rte ry
Gre a t c a rd ia c
vei n
De sc e n di ng a o rta
A n te rio r
c ard ia c ve in s
In fe rio r
ven a c a va
Rig h t ve ntri cl e
Rig h t c o ro n ary
a rte ry
Rig h t a triu m
P u lm o n ary ve in s
S u pe ri o r
ven a c a va
P u lm o n ary arte ry
Fat
HEART
Vyavahi vikasiAdministration of drug

Benefit of Vamana
 Efficacy is compared to the destruction of the
leaves, fruit, flowers by severing the root of a
tree
 Also to the destruction of the budding paddy
by drying the water

Vamana ppt dr .p.murali krishna

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Vamana ppt dr .p.murali krishna