Chapter 6. Vamana Karma (Emesis therapy)

Vamana, also known as therapeutic emesis, stands as the most potent amongst the five Panchakarma therapies. Often dubbed the “king of purification,” it targets Kapha Dosha and accumulated Ama primarily lodged in the upper respiratory and gastrointestinal tracts. But before embarking on this powerful cleanse, understanding its essence, benefits, and considerations is crucial.

Vamana is the therapeutic procedure where forceful expulsion of vitiated doshas occurs through mouth following administration of vamanoushadha (Emetic medicines). Vamana is to be administered in diseases caused due to vitiated kapha either alone or in combination with kapha predominance.

Indications of Vamana Karma [A.H.Su. 18-2 ]

Contraindications of Vamana Karma [A.H.Su.18-4]

Infrastructure facilities

• Man power – 2 Attendants, 1 Nurse & 1 Doctor
• Space requirements Materials – 12 ft x 12 ft room attached with toilet

Materials

• Large basin – 1
• Bucket (medium) – 1
• Medium sized vessel – 2
• Steel glass (300 ml capacity) – 2
• Table spoon – 2
• Khalwa yantra – 1
• Stool – 1
• Chair with armrest (Vamana Peeth) – 1
• Cotton cloth – 2
• Hot water bath vessel – 1
• Stove – 1
• Weighing machine – 1
• Measuring glass – 1 set
• Vamanaoushadha – QS

Commonly practising Vamana yogas

Season, time of drug (vamana yoga) administration [A.H.Su. 18 -12]

Best season for Vamana is Shravana (July-August), Kartika (October – November) and Chaitra (March – April) months, Vamana is to be carried out early morning preferably at 7.00 – 8.30 AM. Basanta Ritu is good for yearly Vamana as a preventive measure.

Purva Karma (Pre-operative) of Vamana Karma

Preparation of patient for Vamana [A.H.Su.18 -13]

• Proper Snehapana with appropriate Sneha should be given before Vamana. Please follow the instructions mentioned in the SnehaPana chapter.
• After completing Snehapana, Abhyangam and Bashpasweda should be given for 1-2 days.
• Next day Kapha utklesha ahara (food items which vitiate kapha dosha) should be given in the evening.  Generally, food items prepared with masha (black gram/ lentils), tila (sesame), ksheera etc. are given to the patient on the previous day of Vamana for Kapha utklesha.
• On the day of Vamana procedure, after passing stool and urine patients should be anointed with oil and followed by local swedana.
• Examination of the patient before Vamana Dravya Administration – Physical examination and psychological counselling should be done.
• Before administering Vamana dravya, oil should be applied on the head and upper part of the body. Sudation should also be given.

Pradhan Karma (Operative) of Vamana Karma

1️⃣ On the Vamana day, after local abhyangam and swedana, the patient shall be seated on a seat with height of his knees (see below images of Vaman Peeth).

2️⃣ Prepare the Vamana medicine and keep it aside. To prepare Vamana medicine, properly mix powdered Madanphala, Vacha, Yashtimadhu, Saindhav with honey to make it like Lehyam – paste-like dosage form. Quantities mentioned in Vamana Yoga 1 heading may be followed.

3️⃣ Give 2 glasses of milk to the patient to drink, then Vamana medicines mixed in the 60 ml Yashtimadhu Kwath are given to drink. The patient is allowed to drink remaining milk.

Lukewarm milk sweetened with sugar is given to drink glass by glass. It is recommended to drink it quickly without taking time to taste it. Akantha pana (full stomach/ should be drunk till neck) is advisable. Sugarcane juice may also be used for this instead of milk as per availability.

4️⃣ When the patient refuses to drink more milk, Vamana Dravya is given to the patient. After eating this medicinal paste, Yashtimadhu Kwath should be given to drink.

5️⃣ After consuming the medicines and milk, we should wait for a muhurta (48 minutes) with keen intent, for the commencement of vomiting.

With the appearance of hrillasa (nausea) and praseka (excess salivation), they should try to vomit. If the bouts are not strong enough, the patient should induce vomiting by tickling his throat with his fingers or a soft tube without injuring the throat and palate.

If the bouts are normal, the patient should allow them to continue (till elimination of doshas is complete). During the act of emesis, the patient shall be seated on a seat with height of their knees. Two flanks and forehead of the patient should be supported by another person. Their umbilical region and back should be massaged in upward direction.

After Vamana, the patient should be covered for a while and made to inhale any one of the 3 kinds of dhooma (therapeutic smoking) and follow the dietary regimen prescribed in Snehapana.

Criteria to be followed to assess Jagharya (less), Madhyama (medium), Pravara (maximum) shuddhi (purification) [A.H.Su.18 – 29]

• 4, 6 & 8 are the desirable number of bouts (vega) of vomiting for minimum, medium and maximum purification.
• In respect of quantity they are one, two and four prastha (1 Prastha = 768 grams).

Vamana should be continued till the expulsion of pitta. If the symptoms like Hrit shuddhi, Kukshi shuddhi, good appetite, Vatanulomana etc., seen, shuddhi is attained properly.

In present day practice, pittadarsana or complete expulsion of medicine is considered as samyak vamita lakshana (proper purification symptoms of Vamana).

Complications and their management [A.H.Su.18 2-4 ]

Ayoga: Non commencement of bouts, bouts coming with hindrance or expulsion of medicine alone are the features of Ayoga. Due to inadequate vomiting, excess expectoration, pruritus, urticaria, fever may occur. Symptomatic management should be given.

Atiyoga: In atiyoga, vomitus will be mixed with froth and blood. The patient will experience weakness, burning sensation, dryness in the throat, black-outs, giddiness, powerful diseases of vata origin and even death due to blood loss may be seen.

Signs & symptoms of proper Vamana [A.H.Su.18 -23 ]

Expulsion of kapha, pitta and vata in successive order without any hindrance is the feature of samyak yoga (proper therapy).

Post operative Pashchat karma after vamana [A.H.Su.18 -25]

After the vamana procedure, the patient should be consoled for a while and dhoomapana is to be administered. The oil of the Moordha (Anterior fontanelle) is to be wiped off and Rasnadi choorna is to be applied. This process is known as Talam. Patients are advised to follow the regimen mentioned in Snehapana. Those who are having a good appetite (feeling hungry) are advised to take bath in warm water and Sansarjana Karma is to follow next.

Samsarjana karma [A.H.Su.18 -27]

Persons who have had the maximum, medium and minimum purification therapies should consume Peya (thin gruel), Vilepi (thick gruel), Akrita Yushanna (rice along with unseasoned vegetable soup), Krita Yushanna (rice with seasoned vegetable soup) and Rasanna (rice along with meat soup) in successive order for time of meal respectively. It can be started on the same day if appetite appears properly. Or else, Peyadi Krama should be started from the next day morning onwards.

Samsarjana Karma Table

In present day practice, at some hospitals, 3 times Kanji is given for 7 days as Samsarjana.

Dietary and other Lifestyle guidelines/ restrictions

Dietary and other lifestyle guidelines/restrictions are to be followed as mentioned in Snehapana.

Clinical vital data

Counselling as well as Pathological and biochemical examinations are to be conducted before and after Vamana procedure. X-ray, ECG etc are also advised before the procedure. Physical examination and ashta-sthana pariksha are to be performed before and after the procedure.

Follow up therapy

Suitable shamana therapy has to be done according to disease.

Some of the Vamana Karma photographs are shown below for reference. These images are collected from various sources or AI generated.

Milk given before the administration of Vamana Dravya

Vamana Dravya administration

Supporting the patient

After Vamana, the patient should be counselled well and all safety measures should be followed.