Vamana vyapath

Anand P.K.V.

Vaidyaratnam Ayurveda College

Ollur – Thaikkattussery

Thrissur

Vamana has become a common practice nowadays than earlier decades, reflecting the constructive outlook in the practitioner’s mindset. A regularity of practice can obviously offer a higher occurrence of complications also, unless we learn from them seriously. Poor reporting reduced updating of current events and absence of addition of current practices in syllabus keeps the Ayurvedic community away from the ground realities.

Skin diseases, psychiatry, acid peptic  disorders and asthmatic complaints are the major areas where Vamana is performed these days. Some rare practices include Vamana for cases such as low back ache, preparatory procedure for rasayanas or rasoushadhas etc. The practice of organizing Vasanthic Vaman camp, along with massive campaign on Ayurvedic lifestyle by organizations in Maharashtra etc., deserves applous for its optimism.  They have become successful to some extent to convince the public about seasonal purificatory procedures.  Organisers of such camps say that, they have observed Ayoga lakshnas in some but no Athiyoga or Vyapath with such a practice.  Vamana is performed so casually and routinely since generations in a temple near Alappuzha as a remedial mesure for Garavisha. Oil from a tarnished bronze lamp is given internally in a religious environment to initiate vomiting.

Therapeutic Vamana is rarely done in very young age. Vd.Gourisankar narrates his experience of Vamana performed the procedure in baby of 6 months age, who had delayed milestone manifested as inability to raise head or hold the neck. Vacha choornam, 3 grams was administered as Vamanadravya, mixed with breast milk for the baby, who eventually vomited 3-4 times effortlessly. In an informal discussion regarding this, a pediatrician has cautioned about aspiration of vomitus into trachea or petechial heamarrage in brain by increased capillary pressure as happening in the case of whooping cough. However, in this case, there was no complications and in addition, he claimed a higher response to the subsequent treatments.

Purificatory therapy through the opposite direction is the treatment in the disease Rakthpitha.  A case of undue and prolonged menstrual bleeding, which often caused the heamoglobin fall upto 5mg%, prompting for blood transfusion, was treated in the above line with above principle by Vd.Bharat Lunavat of Pune.  Vamana, being koshtasodhana and prathilomasodhana,  was performed during the menstural period itself, for which he claimed an immediate and sustained  relief.  He has also reported a case of Indralupta, which did not respond well to Lepana or Lekhana procedures showing higher respose with the same treatments after performing a Vamana in the same patient.

Dr.Mohankumar, Retd.Professor Vaidyaratnam Ayurveda college, has made Vaman a routine preliminary procedure in cases of low back ache and other vertebral diseases.  Even when Vamana in fixed intervals are advocated in Kushta, Apasmara etc., it is not practiced as such by majority.

Previous incidental vomiting and the effortless expulsion during the same should be taken into account to consider one as Duccharditha says Dr.Manoj Kaloor of Calicut.  When he has attempted vamana on a person who had never vomited by any cause, it went futile, making the patient to suffer the intense discomfort generated by the Vamnoushadha. Dr.Sundaran of Govt.Mental hospital, Kottackal, had narrated an incidence of Dhoomapana helping to stop the Vamana vegas which was continuing till late evening.

A pandurogi with heamoglobin as low as 6mg%, who also had excertional dispnoea, when underwent Vamana, developed a transient ischemic attack manifesting as pakshaghata. This was explained by the teachers as an example of marmaghatha, when purificatory procedures performed in a weak patient with swasaroga. 

Identifying oesophagal varices in advance, which threatens to bleed during Vamanakarma is a rewarding safety measure.  Performing such an investigation in each case is awkward, expensive and not so essential. However, this may lead to accidental profuce bleeding during Vamana. Vd.Bharath Lunavat of Pune claims that admininstering Katuki as Kwatha immediately for virechana following the principle of prathilomasodhana of Rakthapitha has been helpful in such a case he treated, which eventually purged with coffee brown stools without making the complication worse.

Capillary bleeding from throat, which stains the mucus during Vamana is a frequent feature in patients who strains much for spitting.  This is usually self limiting except for a few incidents which went for throat infection.

Boerhauves or spontaneous oesophageal rupture is reported more in europian countries than in our country.  It happens during a violent vomiting after full stomach food.  It usually happens as a result of defect in coordination of upper and lower sphycters of oesophagus leading to higher pressure development in the tract, which eventually ruptures, pushing its contents out to the mediastinum. This has neither has a relation with the oesophageal varices existing,  nor is predisposed by alcoholism or active peptic ulcer. As the immediate manifestation might be a chest pain, these patients often reach first to a cardiac physician. If diagnosed in time, the mortality chances even in the first day is 20%  which increases to 60% in the seconed day. Awareness of such a possibility to diagnose it early and allowing surgeons to intervene are very important in its management. There was one such incident reported during therapeutic emesis, at Thrissur in 2002.  Since vomiting on a full stomach  predisposes the incident, it will be ideal to follow the textual instructions and select those who need Aakandhapaana of milk, etc., such as baala, Durbala etc., and for others avoid filling stomach fully prior to vomiting.  It will be ideal to replace Aakandhapana in those who are strong enough. Instead, make them drink the specified liquid, as and when necessory after Praseka and hrillasa have been set in.  Having a fluid rich diet in place of fluid alone during the preparatory days, ensures smooth utklesa and prevents dehydration resulting from the procedure.   

Although not so common, another similar occation, the presence of Mallary weiss syndrome, can result in the presence of fresh blood in the sputum, or vomittus.  Here, small cracks appearing in the mucus layer of oesophageal wall,  in the areas near to the stomach bleeds in any activity involving Vulsalva’s Manoveour.  Attempting forced expiration against the closure of airway outlets in the Vulsalva’s manoveour makes the pressure in the chest increase, leading to such bleeds.  Unlike borehauves, the presence of oesophageal varices, can worsen the bleeding in such cases.  The diagnosis often follows the accidental presence of fresh blood in the vomitus  followed by direct visualization of bleeding cracks near to stomach. As the bleeding remits spontaneously in them, intervening for treatment might not be necessary, but they should treated to prevent such incidents in the future. 

There are occational incidences of immediate exacerbation of skin lesions in psoriatic patients, which might be due to Ayoga or Apathya.  If vomiting has not happent sufficiently, the emetic drug consumed will make a purgation, which is a very common incident. Some teaching institutions in Mumbai, prefers a simple, Niruhavasthy administered with enema apparatus on the same day prior to Vamana, assuming to ensure Vathanulomya and reduce Vyapath.

The most important sign of Athiyoga is the presence of frothy and rainbow tinted blood in the vomitus.  All other descriptions are associated or sequential to this one.  Even if the Athiyoga manifestation might be isolated incidents and with high individual variation, we have to anticipate, think of possibilities, identify cases with special precaution, and attend complications using the common measures.  Reporting and analyzing the accidental complications which is inherent risk of any procedure should help to prevent and treat them in future. 

Case to case planning to ensure samyak yoga is essential in any procedure. The positive and negetive responses also has an individualistic character.  As the popularity of Panchakarma increases the inherent risks of each of them also gets a seat. Recommenting a oparable and sufficient preparatory steps will reduce such incidences.