Vamana Karma — Complete Procedure and Indications

Indications and Contraindications

Indications (rogi pariksha) - **Chronic asthma + bronchitis** (tamak shwasa, kasa) with kapha dominance - **Skin disorders** with kapha-dominance: eczema (vicharchika), urticaria (kotha), psoriasis (mandala kushtha) - **Sinusitis + chronic rhinitis** (kapha-vata) - **Diabetes + obesity** (sthaulya, kaphaja prameha) - **Hyperacidity with kapha symptoms** (uncommon) - **Chronic depression + lethargy** (tamasika manas dushti)

Contraindications (rogi-asyaata) **Absolute**: - Pregnancy - Bleeding disorders (hemophilia, thrombocytopenia) - Recent myocardial infarction - Severe debility, malnutrition - Active peptic ulcer - Pulmonary hemorrhage - Children under 12 (some texts) and elderly over 75 - Vata-pradhana constitution

**Relative**: - Recent surgery (<3 months) - Active TB - Hypertension uncontrolled - Severe anxiety/depression — need psychiatric assessment first

Patient Preparation — Poorva Karma (3-7 days)

Day 1-3: Deepana-Pachana - Trikatu churnam 1g before meals - Light diet — kichadi, vegetable soup - Goal: improve agni, digest existing ama

Day 4-8: Snehapana (oleation) - **Day 1**: 30 ml ghrita (cow ghee or medicated like Mahatikta ghrita) on empty stomach early morning - **Day 2**: 50 ml - **Day 3**: 75 ml - **Day 4**: 100 ml - **Day 5**: 125 ml — if tolerated, this is samyak snigdha - Increase further only if needed

**Signs of samyak snigdha** (proper oleation): - Vatanulomana (regular bowel) - Klama-mardava-saukumarya (softness, lightness) - Mridu-koshtha (soft stool) - Snigdha-twak (skin shows oil) - Ojas-vardhana (mild glow)

**Signs of atisnigdha** (over-oleation): nausea, anorexia, lethargy, indigestion. Stop snehapana, pause 1-2 days.

Day after snehapana completion: Abhyanga + Swedana

Whole body warm sesame oil massage (1 hour) followed by steam bath (10-15 min). Done daily until day of vamana. Goal: bring kapha + ama into rasa-vaha srotas (loose, ready to expel).

Pradhana Karma — Vamana Day

Pre-procedure - Day before: light dinner. Only liquid kashaya. - Morning of vamana: empty stomach. Patient in seated position, head support. - Vital signs noted. IV access if hospital setting.

Vamana proper 1. **Akantha pana** — drink to throat: 1-2 litres of milk + sugarcane juice or yashtimadhu kashaya. Belly distended. 2. Wait 5-10 minutes for the drink to absorb. 3. **Vamana yoga**: Madanaphala churnam 4-8g + honey + saindhava + vamana kashaya. Patient swallows. 4. Position patient for vomiting (forward lean). 5. If vomiting doesn't start in 10 min, **tickle pharynx** with clean finger or feather. 6. Vegas (episodes of vomiting) start. Each vega = expelling rasa + kapha (some bile + ama).

Vega Assessment

Count and classify each vega: - Initial vegas: clear water + food remains - Middle vegas: yellowish bile + kapha-laden - Later vegas: more bile-tinged, less volume

Samyak Vamana Signs - Clear endpoint: last 2 vegas are just bile, no kapha - Patient feels light, calm - Heart rate steady, BP stable - No dehydration signs - Throat clear of mucus - Cough productive but easy

Stopping Vamana - After 6-8 vegas if criteria met - If patient becomes weak, hypotensive, faint — stop immediately, IV fluids, monitor

Paschat Karma — Recovery (3-7 days)

Sansarjana Karma — graduated diet

Day 1 post-vamana: **Peya** (rice gruel, very thin) Day 2: **Vilepi** (thicker rice porridge) Day 3: **Akrita yusha** (vegetable soup) Day 4: **Krita yusha** (with seasoning) Day 5: **Akrita mansa rasa** (meat soup or vegetable equivalent) Day 6: **Krita mansa rasa** (seasoned) Day 7: Normal diet resumed

This 7-day protocol gives agni time to recover and prevents acidity/rebound disease.

Restrictions during sansarjana - No cold water, ice - No physical exertion - No sexual activity - No mental stress - No fasting or overeating - Total rest, light reading, calm environment

Complications

Atiyoga (excess vamana) - Severe dehydration, hypotension - Severe weakness, syncope - Excessive bleeding - Cardiovascular collapse (rare)

**Treatment**: Stop. IV fluids. Sugar + salt water. Madhu + ghrita. Bed rest 24-48 hours.

Ayoga (incomplete) - Symptoms not resolved - Patient feels heavy - Kapha not expelled

**Treatment**: Repeat snehapana cycle, retry vamana with stronger emetic.

Other complications - **Aspiration** — rare but serious; ensure patient is upright - **Throat irritation** — gargle with warm saline - **Hypoglycemia** — patient was fasting; give light food - **Anxiety** — explain, reassure, monitor

Modern Adaptation

Many modern centres modify the classical protocol: - Shorter snehapana (3 days instead of 5-7) - Pre-screened patients with bloods + ECG - IV line access during pradhana karma - Hospital setting for complex patients - Avoidance of vamana in unsafe patient profiles

This adaptation increases safety without losing core therapeutic effect.

Self-test

• List indications and absolute contraindications for vamana.
• Describe the 5-day snehapana protocol with dose escalation.
• What is samyak vamana? How many vegas constitute it?
• Outline the 7-day sansarjana karma diet progression.
• A patient develops severe weakness after 11 vegas — what is your management?